Antibiotics - Tetracyclines and glycylcyclines: Nursing pharmacology

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ANTIBIOTICS: TETRACYCLINES AND GLYCYLCYCLINES
DRUG NAME
tetracycline, doxycycline (Vibramycin), minocycline (Minocin)
tigecycline (Tygacil)
CLASS
Antibiotics: Tetracyclines
Antibiotics: Glycylcyclines
MECHANISM OF ACTION
Enter inside bacteria → Inhibit protein synthesis → Stop bacterial growth
INDICATIONS
  • CNS infections - Meningitis
  • Respiratory infections - Community-acquired pneumonia
  • GI infections - Cholera
  • Skin infections - Acne
  • Genito-urinary infections - Chlamydia and syphilis
  • Complicated skin and intra-abdominal infections
ROUTE(S) OF ADMINISTRATION
  • Tetracycline: PO
  • Doxycycline, minocycline: PO, IV
  • Tigecycline: IV
SIDE EFFECTS

  • Headache, dizziness
  • Abdominal pain, nausea, vomiting, diarrhea
  • Phototoxicity, skin rash, injection site reactions, exfoliative dermatitis, Stevens-Johnson syndrome
  • Anaphylaxis
  • Superinfection
  • Discoloration of teeth
  • Delay in bone growth
  • Nephrotoxicity
CONTRAINDICATIONS AND CAUTIONS

  • Boxed warning (tigecycline): do not use when an alternative antibiotic is suitable, increased mortality risk
  • Combination with theophylline, warfarin, antacids, mineral supplements (multivitamins, iron, magnesium, calcium)
  • Pregnancy and breastfeeding
  • Children < 8 yo
  • Pre-existing hepatic and kidney disease
NURSING CONSIDERATIONS: TETRACYCLINES
ASSESSMENT & MONITORING
Assessment
  • Current symptoms: fever, chills, headache, stiff neck, muscle or joint pain; bull’s eye lesion
  • Laboratory test results: renal and liver function; ELISA, western blot results; negative pregnancy test for female clients

Monitoring
  • Side effects
  • Desired therapeutic effects: treat the infection and resolve current symptoms
CLIENT EDUCATION
  • Purpose of medication: treat infection and resolve symptoms of Lyme disease
  • Take medication twice a day on an empty stomach with a full glass of water
    • Remain upright for 30 mins afterwards
    • Avoid
      • taking around bedtime
      • consuming dairy products or products containing calcium, magnesium, iron, or zinc within two hours of administration
  • Complete entire course course of their medication, even if they start to feel better
  • Female clients of childbearing age: use a reliable birth control method during therapy
  • Side effects
    • Gastrointestinal discomfort
      • Increase fluid intake, eat small, frequent meals
    • Photosensitivity
      • Avoid sunlight, wear protective clothing, use sunscreen
    • Discoloration of the teeth
      • Frequent oral care
  • Side effects to report
    • Oral Candida albicans infection
      • white patches on the inner cheeks, tongue or roof of the mouth
    • Clostridioides difficile infection
      • Fever, abdominal pain, severe or bloody diarrhea
    • Esophageal injury
      • Dysphagia or retrosternal pain

Transcript

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Tetracyclines are a group of broad-spectrum antibiotics, which were originally derived from soil-dwelling Streptomyces bacteria.

These medications can be used to treat a wide variety of bacterial infections, including central nervous system infections like meningitis, respiratory infections like community-acquired pneumonia, gastrointestinal infections like cholera, skin conditions like acne, and genitourinary infections like chlamydia and syphilis.

In addition, tetracyclines can be used to treat rare infections like rocky mountain spotted fever, anthrax, lyme disease, and tularemia.

Tetracyclines are very effective against gram-positive bacteria like Bacillus anthracis and Clostridium spp, as well as some gram-negative bacteria like Shigella spp, Escherichia coli, Rickettsia spp, Borrelia burgdorferi, Helicobacter pylori, and Neisseria meningitidis, and finally some atypical bacteria like Mycoplasma pneumoniae, Chlamydia trachomatis, Vibrio cholerae, and Francisella tularensis.

However, some of these bacteria developed resistance against tetracyclines in time. So as a solution, tetracyclines were modified into a newer generation of antibiotics called glycylcyclines. These are commonly used in complicated skin infections and intra abdominal infections.

Glycylcyclines are very effective against some gram-positive bacteria like Streptococcus pyogenes, Clostridium perfringens, both methicillin susceptible and methicillin resistant Staphylococcus aureus; and gram-negative bacteria like Klebsiella pneumoniae.

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