Commonly prescribed IV antimicrobial medications:

Question 1

IV antibiotic groups:

Answer 1

• Penicillin
• Cephalosporins
• Monobactams and Carbopenems
• Aminoglycosides
• Glycopeptides
• Quinolones

Question 2

Penicillin:

Answer 2

• Bactericidal
• inhibits cell wall synthesis
• used for a wide range of infectious conditions for organs including respiratory; heart; kidneys; skin and tissues; gut; specific conditions such as STDs; meningitis
• Adverse effects:
• hypersensitivity, blood disorder, GI upset
• super infection, localised IV reaction - phlebitis
• Incompatibilities/precautions for penicillins:
• Aminoglycosides, Anticoagulants, antiplatelets
• Allopurinol, Methotrexate, Probenecid
• Precautions:
• treatment should not exceed 14 days
• FBE, U&Es should be monitored in high dose/prolonged treatment
• administer slowly over 3-5 minutes to avoid convulsions
• Examples of common IV Penicillins:
• Ampicillin, Benzylpenicillin, Flucloxacillin, etc.

Question 3

Carbapenems:

Answer 3

• used to treat moderate to serious infection of the lower respiratory tract, intra-abdominal infections, GUT, skin, bone and joint infections etc.
• Adverse effects:
• GIT - nausea, vomiting, altered taste, dizziness, abdominal pain/cramps, mouth ulcers etc.
• Immune - hypersensitivity, anaphylaxis, superinfection etc.
• CVS - haematological disorders
• NEURO - convulsions (rare)
• Peripheral symptoms - rash, fever, flushing, sweating etc.
• Localised IV site - phlebitis, thrombophlebitis, pain/discomfort etc.

Question 3

Cephalosporins:

Answer 3

• bactericidal, interfere with cell wall synthesis
• used to treat infections of skin; skeletal; gut; GIT; ENT; and respiratory symptoms for meningitis etc.
• contraindicated in patients allergic to penicillin
• Adverse effects:
• Hypersensitivity, GIT upset, dizziness, headache
• insomnia, tiredness, reduced WBC
• phlebitis and thrombophlebitis
  Examples of common IV Cephalosporins:
• Cefepime, Cefotaxime, Ceftriaxone, Cephazolin

Question 4

Glycopeptides:

Answer 4

• bactericidal or bacteriostatic depending on microorganism, interferes with cell wall synthesis
• only used for life threatening conditions resistant to other less toxic antibiotics
• incompatible with penicillins and cephalosporins * Adverse effects:
• hearing loss, vertigo, tinnitus, not recommended for people with hearing loss
• GIT upsets, hypersensitivity, renal and hepatic impairment
• phlebitis and thrombophlebitis

Question 4

Aminoglycosides:

Answer 4

• bactericidal antibiotics used to treat infections cause by aerobic gram-negative organisms
• classified as high-risk medication and protocols for monitoring apply
• only used for life threatening conditions resistant to other less toxic antibiotics
• adverse effects include otoxicity, neurotoxicity etc.
• Examples of common IV Aminoglycosides:
• Gentamicin, Amikacin, tobramycin
• Gentamicin is the most commonly prescribed

Question 5

Monitoring and precautions for toxicity:

Answer 5

• renal function tests
• monitor hydration and fluid balance
• gentamicin blood levels are- required for treatment longer than 48 hours
• serum levels should be checked every 72 hours

Question 6

Quinolones:

Answer 6

• bactericidal, inhibit DNA synthesis in bacteria
• used to treat respiratory tract infections; severe skin; bone or joint infections; complicated UTIS; GIT infections
• interact with NSAIDS
• Adverse effects:
• GIT upsets, rash, palpitations, thrombophlebitis and pain
• neurological effects such as agitation, headaches, dizziness, insomnia and abnormal dreams
• Monitoring and precautions:
• monitor hydration to avoid crystalluria
• monitor for neurological impairment
• monitor for tendon pain and inflammation
• Example of common IV Quinolones:
• Ciprofloxacin - administered by readymade infusion

Question 6

Metronidazole:

Answer 6

• has anaerobic bactercidal effects as well as anti-protozoal
• treatment of severe infections caused by anaerobic microorganisms, GUT infections
• Adverse effects:
• GIT upsets, rash, superinfections, dysuria
• headaches, dizziness, insomnia, vertigo, tinnitus, seizures, hallucinations, disorientation
• joint pain, weakness, ECG changes, thrombophlebitis
• Patient education:
• warn patient to avoid alcohol for at least 24 hours after treatment
• can cause darkened urine
• educate to report symptoms of neuropathy

Question 7

IV Anti-microbial reminders:

Answer 7

• administer on time for optimum plasma levels of medications
• always check the injectable drugs handbook for preparation, administration, compatibility and precautions
• handle with care to avoid exposure
• use ANTT
• check with 2nd nurse and label medication and flush on preparation
• antibiotics can cause chemical phlebitis