Peak Development for ...

Medication Administration

Vol. 15 Issue 10
October 2014
Antimicrobial Agents: Antibiotic Classes and Use
Peak Development Resources
P.O. Box 13267
Richmond, VA 23225

Phone: (804) 233-3707
Fax: (804) 233-3705
Email: editor@peakdev.com
After completion the learner should be able to:
1. Identify appropriate indications for use of
selected antibiotic classes.
2. Describe the action and spectrum of activity
of selected antibiotic classes.
3. Correctly calculate dosage for antibiotics.
Antibiotics are some of the most widely
used medications in the world. According to
data recently published by the CDC, over 55%
of patients in the US receive an antibiotic during
their hospital stay. For the purposes of this
newsletter, the term antibiotic will refer to those
drugs used to treat bacterial infections.
The key to the effectiveness of all
antibiotics is selective toxicitythe drugs ability
to harm the bacterial cells without harming
normal cells of the body. Antibiotics do this by
acting in different ways to disrupt essential cell
functions that are unique to bacteria. An
antibiotic can disrupt the bacterial cell wall or
prevent the cell from making protein, DNA, RNA
or folic acid.
When considering the effectiveness of an
antibiotic, the type of bacteria is important,
since each antibiotic is known to act on certain
types of bacteria. Bacteria are grouped by
several different classifications:
Gram-positive vs gram-negative: This is
determined based on how the bacteria respond
to staining under a microscope. Gram-positive
organisms, such as Staphylococcus,
Streptococcus, Enterococcus and Clostridium,
retain the violet dye on staining and appear
purple, due to their thick cell walls. Gram-
negative organisms, such as Escherichia coli,
Klebsiella, Pseudomonas, Proteus, Shigella,
Haemophilus influenzae, Enterobacter and
Salmonella have thinner cell walls and appear
red or pink after the staining process.
Shape of cells: Cocci are round bacterial
cells, found in such types as streptococcus and
staphylococcus. Bacilli (or rods) are rod-shaped
bacteria, such as E. coli, Pseudomonas and
Enterobacter and Klebsiella. Bacteria may also
be spiral-shaped, such as Helicobacter,
Campylobacter and Treponema pallidum.
Dependence on oxygen: Bacteria are also
grouped as aerobic, requiring oxygen to grow,
and anaerobic, those that do not require
oxygen. Aerobes include Pseudomonas,
Mycobacterium and Neisseria meningitides.
Anaerobes include Clostridium, Bacteroides
and Peptostreptococcus. Bacteria that can
grow with or without oxygen are called
facultative anaerobes, and include E. coli and
types of Staphylococcus, Streptococcus, and
Enterococcus.
Antibiotics differ in their effects on bacteria,
and in what types of bacteria they can affect.
Based on these groupings, for example, a
particular antibiotic may be effective primarily
on gram-negative rods, such as E. coli.
Antibiotics are classified as broad-spectrum,
affecting a variety of different bacteria, or
narrow-spectrum, affecting a limited range of
bacterial types. In general, use of narrow-
spectrum antibiotics is preferred, to target the
identified bacteria and reduce the risk of
developing antibiotic resistance. In addition,
some antibiotics are bactericidal, killing the
bacteria to treat the infection. Others are
bacteriostatic. These agents limit the growth of
bacteria, allowing the bodys natural immune
defenses to finish treating the infection.
Antibiotic Classes
Antibiotics are grouped into classes having
similar types of action and efficacy. Selected
groups and their representative drugs include:
Beta lactams: This group includes penicillins
and cephalosporins. These drugs are
bactericidal, and act by disrupting the bacterial
cell wall structure. They are used for treatment
of ear, throat, sinus, and soft tissue infections,
as well as bronchitis, pneumonia, septicemia,
Peak Development for Medication
Administration

and Competency
Assessment Tool for Medication
Administration

are components of
a site license for the Peak
Development Resources
Competency Assessment System
for Medication Administration

and may be reproduced for this
individual facility only. Sharing
of these components with any
other freestanding facility within
or outside the licensees corporate
entity is expressly prohibited.
The information contained in
Peak Development for Medication
Administration is intended only as
a guide for the practice of
licensed nursing personnel who
administer medications. Every
effort has been made to verify the
accuracy of the information
herein. Because of rapid changes
in the field of drug therapy, the
reader is advised to consult the
package insert, facility pharmacist
or patients physician for relevant
information. This is particularly
important for new or seldom used
drugs. Use of professional
judgment is required in all patient
care situations. It is the readers
responsibility to understand and
adhere to policies and procedures
set forth by the employing
institution. The editor and
publisher of this newsletter
disclaim any liability resulting
from use or misuse of
information contained herein.

Copyright 2014
abdominal and pelvic infections and gonorrhea. Penicillins
include drugs such as penicillin, as well as amoxicillin and
ampicillin. Most penicillins are considered broad-spectrum, and
are effective against gram-positive cocci, such as
Staphylococcus and Streptococcus, and gram-negative bacilli,
such as E. coli and Haemophilus.
Cephalosporins are grouped into generations, one through
five. Earlier generations were primarily active against gram-
positive organisms, but each succeeding generation has
developed increased gram-negative activity. The later
generations, three to five, are considered more broad-spectrum.
Cephalosporins include cephalexin, cefaclor, ceftriaxone,
cefepime, and the newest agent, ceftaroline.
Macrolides/Ketolides: Macrolides include erythromycin,
azithromycin, and clarithromycin. A related drug, telithromycin, is
a ketolide. These drugs are bacteriostatic, and act by inhibiting
protein synthesis in the bacterial cell. Macrolides are more
narrow in spectrum, effective primarily against gram-positive
cocci. However, resistance has commonly developed with
enterococci and some Staph and Strep strains. Telithromycin is
effective against some of the drug-resistant strains. Macrolides
are commonly used to treat mild to moderate infections,
including bronchitis, sinusitis, pneumonia, skin infections, and
infections caused by chlamydia and mycoplasma organisms.
Tetracyclines: This drug group includes tetracycline,
doxycycline and minocycline. These are broad-spectrum
antibiotics, effective in treating infections caused by a variety of
gram-positive and gram-negative bacteria. They act by inhibiting
bacterial protein synthesis, and are considered bacteriostatic.
Use of tetracyclines has declined due to bacterial resistance,
and use of antibiotics that are more selective and with fewer
adverse effects. Tetracyclines may be used to treat conditions
such as mycoplasma pneumonia, Lyme disease, Rocky
Mountain spotted fever, chlamydia and acne.
Sulfonamides: These drugs were the first antibiotics in
widespread use, beginning in the 1930s. Today, this group has
limited but important uses. The most common sulfa drug
currently in use is sulfamethoxazole, which is combined with
trimethoprim and marketed under the trade names Bactrim and
Septra. This combination is commonly used to treat urinary tract
infections. Sulfonamides are broad-spectrum, and act by
inhibiting bacterial synthesis of folic acid. They are effective
against selected gram-positive cocci, such as streptococcus,
and gram-negative bacilli, such as E. coli.
Fluoroquinolones: This class includes ciprofloxacin, ofloxacin,
levofloxacin and moxifloxacin. These are broad-spectrum
agents, effective against gram-negative and some gram-positive
aerobes. The fluoroquinolones act by inhibiting bacterial DNA
synthesis, and are bactericidal. They are used for a wide variety
of infections, ranging from mild to serious. These include otitis
media, sinusitis, bronchitis, pneumonia, urinary tract infection,
chlamydia and prevention and treatment of anthrax.
Aminoglycosides: Gentamicin, tobramycin and amikacin are
members of the aminoglycoside group. These potent drugs are
bactericidal through their action of inhibiting bacterial protein
synthesis. They are narrow-spectrum, and are effective primarily
against aerobic and facultative gram-negative bacilli, such as E.
coli, Klebsiella and Pseudomonas. Aminoglycosides do not
affect anaerobic or gram-positive bacteria, and are commonly
administered in combination with another antibiotic if the
infection includes these organisms. Aminoglycosides are used
to treat serious infections, such as septicemia, meningitis,
peritonitis and pneumonia.
Lincosamides: Members of this drug class include lincomycin
and clindamycin. These drugs are bacteriostatic and act by
inhibiting protein synthesis. They are effective against most
anaerobic bacteria, such as Clostridium and Bacteroides, and
gram-positive aerobic/facultative bacteria, such as Staph and
Strep. Lincosamides are used for serious infections, including
pneumonia, lung abscess, septicemia, and abdominal, pelvic
and skin/soft tissue infections.
Oxazolidinones: This group has two drugs approved in the US,
linezolid and the newest member, tedizolid, just approved in
June 2014. These drugs are primarily bacteriostatic, and exert
their effects by inhibiting protein synthesis. Oxazolidinones are
broad-spectrum drugs, effective against a variety of aerobic and
facultative gram-positive bacteria. They are effective against
multi-drug-resistant organisms, such as resistant strains of
Staph, Strep and Enterococcus. To maintain this effectiveness,
these drugs should be used only for serious infections that
cannot be treated with standard antibiotics. Linezolid is used for
treatment of conditions such as pneumonia, septicemia and
wound, skin, abdominal and pelvic infections. Tedizolid is
approved only for use in treatment of serious infections of the
skin and skin structures.
Glycopeptides: Antibiotics in this group include vancomycin,
telavancin, dalbavancin (approved May 2014) and oritavancin
(approved August 2014). They act by disrupting the bacterial
cell wall structure, and may be either bacteriostatic or
bactericidal. Glycopeptides have a narrow spectrum of activity,
and are effective against gram-positive bacteria, such as Staph
and Strep, including drug-resistant strains. These potent drugs
are used for serious infections, such as pneumonia, septicemia,
endocarditis, enterocolitis and skin/soft tissue infections.
The safe, effective and appropriate use of antibiotics
promotes patient health and well-being, and reduces the risk of
antibiotic resistance.
Peak Development for Medication Administration
Antimicrobial Agents: Antibiotic Classes and Use Page 2
Peak Development for ...
Medication Administration

Competency Assessment Tool
Vol. 15 Issue 10
October 2014
Antimicrobial Agents: Antibiotic Classes and Use
Directions: Place the letter of the one best answer in the space provided.
NAME: DATE:

_____1. According to data from the CDC, over half of hospitalized patients receive an antibiotic.
A. True
B. False

_____2. The first class of antibiotics in widespread use was the:
A. macrolides
B. beta-lactams
C. tetracylines
D. sulfonamides

_____3. Which of the following is an example of gram-negative bacteria:
A. Escherichia coli
B. Enterococcus
C. Clostridium
D. Staphylococcus

_____4. Antibiotics that are bacteriostatic act to:
A. stimulate the immune system to fight the infection
B. kill the bacteria
C. limit the growth of the bacteria
D. change the bodys chemistry so the bacteria cannot live

_____5. All antibiotics that inhibit bacterial protein synthesis are bactericidal.
A. True
B. False




UNIT:
Competency Assessment Tool
Antimicrobial Agents: Antibiotic Classes and Use Page 2


_____6. Use of tetracyclines has decreased due to:
A. availability of more selective antibiotics
B. development of bacterial resistance
C. availability of antibiotics with fewer adverse effects
D. all of the above

_____7. Aminoglycosides are commonly administered with another antibiotic because they are:
A. bacteriostatic
B. likely to cause allergic reactions
C. narrow-spectrum
D. rapidly cleared by the kidneys

_____8. Which of the following antibiotic classes is most appropriate for treatment of mild to
moderate infections:
A. lincosamides
B. oxazolidinones
C. glycopeptides
D. macrolides

_____9. Drug Order: clarithromycin suspension 7.5 mg/kg PO q 12h X 10 days
Drug Label: clarithromycin suspension 125 mg/5 ml
Patient weight: 22 lbs
Give:
A. 1.4 ml
B. 3 ml
C. 5.2 ml
D. 8 ml

_____10. Drug Order: gentamicin 75 mg IV q8h
Drug Label: gentamicin 40 mg/ml
Give:
A. 0.75 ml
B. 1.9 ml
C. 2.5 ml
D. 4.1 ml



Peak Development for ...
Medication Administration

Group Tracking Log
Month: October 2014
Issue: Antimicrobial Agents:
Antibiotic Classes and Use
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