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Penicillins (examples)
Penicillin G (Bicillin)
Amoxil (amoxicillin)
Omnipen (ampicilin)
Ticar (ticarcillin)
Zosyn (piperacillin-
tazobactam)
Penicillins
(side effects/contradictions)
Side/Adverse Effects:
Hypersensitivity,
nausea/vomiting, diarrhea/GI
disturbances, renal impairment
Drug Interactions: Oral
contraceptives,
Aminoglycosides
Penicillins
(Nursing considerations)
Take with full glass of water 1
hour before or 2 hours
after meals except for
Amoxicillin, bacampicillin,
pencillin V and Augmentin
which may be taken with food
Monitor for superinfections
(mouth ulcers, vaginitis)
Monitor for bleeding (high
doses can decrease platelet
aggregation)
Contraindicated in clients
with allergies to
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cephalosporins
Instruct to take on time and
to finish full course of
medication
Report signs of allergic
reaction such as hives, rash,
itching, wheezing
Macrolides - Bacteriostatic
Inhibitors
(Examples)
Erythromycin (E-mycin)
Clarithromycin (Biaxin)
Azithromycin (Zithromax)
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Macrolides - Bacteriostatic
Inhibitors
(Side effects and
contradictions)
Side/Adverse Effects: GI
discomfort (nausea, vomiting,
epigastric pain),
thrombophlebitis
Drug Interactions:
Antihistamines, theophylline,
carbamezepine, warfarin
Macrolides - Bacteriostatic
Inhibitors
(Nursing Considerations)
*Contraindicated in liver
disease
Infusion of erythromycin
must be slow and in a dilute
solution to prevent
thrombophlebitis
Instruct client to complete
entire course of therapy
Notify health care provider
of GI upset or allergic
reactions
Aminoglycosides
(Examples)
Gentamicin (Garamycin)
Tobramycin (Nebcin)
Streptomycin (Neomycin)
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Aminoglycosides
(Side effects and
contradictions)
nephrotoxicity, neurotoxicity,
ototoxicity, hypersensitivity,
nausea, vomiting, cramps,
diarrhea, rash, tinnitus, pruritis
Drug Interactions: Coumadin,
penicillin (will inactivate
aminoglycosides when mixed
in samesolution)
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Aminoglycosides
(Nursing Considerations)
*Monitor peak and trough
levels
Monitor for s/s of
superinfection
Contraindicated with
myasthenia gravis, renal
disease, hearing loss
Take on an empty stomach
Notify health care provider
of hearing loss, tinnitus,
vertigo
Peak and Trough Levels for
Antibiotic Therapy
Samples for peak levels should
be collected 30 minutes after
administration of medication.
Samples for trough levels
should be collected prior to
the next dose.
Tetracyclines
(Examples)
Tetracycline (Achromycin)
Doxycycline (Vibramycin)
nausea, vomiting, diarrhea,
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Tetracyclines
(Side effects and
contraindications)
photosensitivity, stomatitis,
nephrotoxicity, hepatotoxicity,
superinfection, yellow-brown
tooth discoloration
Medication Interactions: milk
products, calcium
supplements, iron
supplements, magnesium
containing laxatives and most
antacids (these will decrease
effectiveness of tetracycline)
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Tetracyclines
(Nursing Considerations)
Take on an empty stomach
with a full glass of water,
except doxycycline and
minocycline which may be
taken with food.
Administer at least 1 hour
before and 2 hours after any
food or supplements
containing calcium and/or
magnesium
Use of tetracycline during
pregnancy can cause staining
of the deciduous teeth avoid
administration to children
under 8 years of age
Cephalosporins
(examples)
cephalexin (Keflex)
cefaclor (Ceclor)
ceftriaxone (Rocephin)
cefepime (Maxipime)
Cephlosporins
Allergic/hypersensitivity,
bleeding tendencies,
thrombophlebitis, pain with
IM injection, cross allergy to
penicillins, antibiotic
associated pseudomembranous
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(SE and Contraindications) colitis
Medication Interactions:
Intolerance to alcohol
(Disulfiram reaction) and
Probenecid (gout med)
Cephlosporins
(Nursing considerations)
Should not be given to clients
who have a severe allergic
reaction to penicillins
Use cautiously with renal
impairment
Monitor for bleeding if used
with medications that promote
bleeding (anticoagulants,
NSAIDs)
Should be taken with food
Oral suspensions should be
stored in refrigerator
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Monobactams
(examples)
vancomycin (Vancocin)
azetreonam (Azactam)
Monobactams
(SE and contraindications)
Ototoxicity, infusion reaction
(rash, flushing, tachycardia,
hypotension),
thrombophlebitis
Monobactams
(Nursing considerations)
Use cautiously with renal
impairment
Assess for hearing loss
Administer slowly over at
least 60 minutes
Peak blood levels should be
collected 1-2 hours after
completion of IV infusion.
Therapeutic peak level 30 to
40 micrograms/ml.
Sulfonamides
trimethoprim-
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(examples) sulfamethoxazole
(TMP-SMZ, Bactrim)
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Sulfonamides
(SE and contraindications)
Hypersensitivity, blood
dyscrasias, crystalluria,
kernicterus, photosensitivity
Medication Interactions:
Coumadin, Dilantin,
sulfonylurea oral
hypoglycemics
Sulfonamides
(Nursing considerations)
Contraindicated in clients
with folate deficiency
Avoid use in pregnancy and
lactation
Use cautiously if renal
dysfunction
Take on an empty stomach
with a full glass of water
Stop medication at first
indication of hypersensitivity
such as rash
Observe for bleeding, sore
throat or pallor (signs of blood
dyscrasia)
Increase fluid intake to
prevent crystalluria
Avoid prolonged exposure to
sunlight
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Fluoroquinolones
(Examples)
ciprofloxacin (Cipro)
Fluoroquinolones
(SE and contraindications)
GI discomfort, Achilles tendon
rupture, suprainfection
Medication/food interactions:
aluminummagnesium antacids,
iron salts, sucralfate, milk and
diary products (decrease
absorption of Cipro);
Theophylline (can lead to
theophylline toxicity);
Warfarin (can lead to warfarin
toxicity)
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Fluoroquinolones
(Nursing considerations)
Do not administer to children
<18 years of age due to
increased risk of Achilles
tendon rupture
Dosage is decreased for renal
dysfunction
Administer cationic
compounds 1 hr before or 2
hrs after Cipro
Instruct to complete entire
course of therapy
Antiprotozoals
(examples)
metronidazole (Flagyl)
Antiprotozoals
(SE and contraindications)
GI discomfort, darkening of
urine, CNS symptoms such as
numbness of extremities,
ataxia, seizures
Alcohol ingestion may cause a
Disulfiram-like reaction,
warfarin
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Antiprotozoals
(nursing considerations)
Use cautiously in clients with
renal dysfunction
Avoid use in first trimester of
pregnancy and use cautiously
thereafter as it can pass
through the placenta
Advise clients to avoid
alcohol consumption during
therapy
If taking warfarin, monitor
PT/INR closely
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Antifungals
(examples)
amphotericin B (Fungizone)
Antifungals
(SE and contraindications)
Infusion reactions,
thrombophlebitis,
nephrotoxicity, hypokalemia,
bone marrow suppression
Medication Interactions:
Aminoglycosides (additive
nephrotoxic risk), Flucytosine
(potentiates effect)
Antifungals
Commonly pretreated with
Benadryl and Demerol as
ordered to diminish infusion
reactions
Monitor for thrombophlebitis
Obtain baseline renal
function tests, notify health
care provider if urine output
decreases
Administer additional IV
saline as ordered
Monitor potassium levels
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Antimycobacterials -
Antituberculosis
(examples)
Isoniazid (INH)
streptomycin
ethambutol
pyrazinamide
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Antimycobacterials -
Antituberculosis
(SE and contraindications)
Peripheral neuropathy,
hepatoxicity
Medication Interactions:
Phenytoin (can cause
toxicity); alcohol, rifampin
and pyrazinamide (increases
risk for hepatotoxicity)
Antimycobacterials -
Antituberculosis
(Nursing considerations)
INH is contraindicated in
liver disease
For active TB, direct
observation therapy (DOT) is
done to ensure compliance
Take INH on empty stomach
(1 hr before meals or 2 hrs
after)
Monitor for tingling,
numbness, burning pain
related to pyridoxine (vitamin
B6) deficiency treatment is
50-200 mg of B6 daily
Monitor liver function tests
and instruct client to avoid
alcohol
Antivirals
Acyclovir (Zovirax)
ganciclovir (Cytovene)
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(examples) lamivudine (Epivir)
amantadine (Symmetrel)
Antivirals
(SE and contraindications)
phlebitis/inflammation at
infusion site, nephrotoxicity,
nausea, headache, diarrhea
(with oral therapy),
granulocytopenia,
thrombocytopenia,
reproductive toxicity
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Antivirals
(Nursing considerations)
Administer acyclovir slowly
over 1 hr
Ensure adequate hydration to
minimize nephrotoxicity
Obtain baseline CBC and
platelet count
Ganciclovir is teratogenic
avoid pregnancy and teach
risk of sterility
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