UNIT-8- Drugs used in treatment of communicable diseases (common infections, infestations)
Drugs Used in the Treatment of Communicable Diseases (Common Infections and Infestations)
Communicable diseases are caused by infectious agents such as bacteria, viruses, fungi, and parasites. The treatment of these diseases requires specific antimicrobial, antiviral, antifungal, or antiparasitic drugs. Below is a comprehensive list of the major drugs used in the treatment of common communicable diseases.
1. Bacterial Infections
Bacterial infections are treated with antibiotics, which inhibit bacterial growth or kill bacteria.
Ascaris lumbricoides, Necator americanus, Enterobius vermicularis
Albendazole, Mebendazole
Filariasis
Wuchereria bancrofti, Brugia malayi
Diethylcarbamazine (DEC), Ivermectin
5. Other Infestations
Scabies and Lice Infestation
Disease
Causative Agent
Common Drugs Used
Scabies
Sarcoptes scabiei
Permethrin cream, Ivermectin
Head Lice
Pediculus humanus capitis
Permethrin, Malathion
Key Points:
Antibiotics should only be used for bacterial infections and not for viral diseases.
Antiviral drugs do not kill viruses but inhibit their replication.
Fungal infections require long-term treatment with antifungal drugs.
Parasitic infections need specific antiparasitic agents, sometimes requiring combination therapy.
Drug resistance is a growing problem, so treatment should be based on confirmed diagnosis and guidelines.
General Principles for the Use of Antimicrobials
The proper use of antimicrobials (antibiotics, antivirals, antifungals, and antiparasitics) is essential to ensure effective treatment, prevent drug resistance, and minimize side effects. Below are the key principles to follow when using antimicrobial agents:
1. Rational Prescribing of Antimicrobials
Confirm the Diagnosis: Use clinical evaluation, laboratory tests (culture, PCR, serology), and imaging to ensure the infection is bacterial, viral, fungal, or parasitic.
Choose the Right Antimicrobial: Select the most narrow-spectrum drug that effectively targets the pathogen.
Follow Guidelines: Adhere to standard treatment protocols like WHO, CDC, and national guidelines.
Consider Host Factors: Take into account age, pregnancy, renal/liver function, allergies, and immune status before prescribing.
2. Principles of Effective Antimicrobial Use
Principle
Description
Appropriate Selection
Choose the correct antimicrobial based on the causative pathogen, site of infection, and drug susceptibility.
Correct Dosage
Use the recommended dose to achieve therapeutic levels without causing toxicity.
Optimal Duration
Avoid unnecessarily prolonged or short courses to reduce resistance and relapse risk.
Route of Administration
Prefer oral over IV if possible; use IV for severe infections (e.g., sepsis, meningitis).
Combination Therapy
Use multiple drugs only when necessary, e.g., TB (Isoniazid + Rifampicin + Pyrazinamide + Ethambutol).
Monitor Drug Levels
Especially for narrow therapeutic index drugs (e.g., aminoglycosides, vancomycin).
De-escalation Strategy
Start broad-spectrum if needed, then narrow-spectrum after pathogen identification.
3. Prevention of Antimicrobial Resistance (AMR)
Avoid Unnecessary Use: Do not use antimicrobials for viral infections (e.g., colds, flu).
Complete the Full Course: Ensure patients do not stop early even if they feel better.
Prevent Overuse in Agriculture: Minimize antibiotics in livestock and poultry.
Practice Infection Control: Hand hygiene, vaccination, and isolation of resistant cases.
4. Special Considerations for Specific Antimicrobials
Drug Class
Key Considerations
Penicillins & Cephalosporins
Check for allergy history (risk of anaphylaxis).
Aminoglycosides (e.g., Gentamicin)
Monitor for nephrotoxicity & ototoxicity.
Fluoroquinolones (e.g., Ciprofloxacin)
Avoid in pregnancy & children (risk of cartilage damage).
Macrolides (e.g., Azithromycin)
Risk of QT prolongation (avoid in heart patients).
Tetracyclines (e.g., Doxycycline)
Avoid in pregnant women & children <8 years (tooth discoloration).
Antifungals (e.g., Amphotericin B)
Monitor for renal toxicity in long-term use.
Antivirals (e.g., Oseltamivir, Remdesivir)
Most effective when started early in disease course.
5. Patient Education and Compliance
Explain the Importance: Educate patients about why and how to take antimicrobials.
Warn About Side Effects: Inform about potential gastrointestinal upset, allergic reactions, and toxicity signs.
Discourage Self-Medication: Avoid leftover antibiotics or using friends’ prescriptions.
6. Role of Health Professionals
Prescribe Judiciously: Use antibiotics only when necessary.
Surveillance & Reporting: Monitor local resistance patterns and report drug-resistant cases.
PENICILLIN:
1. Introduction
Penicillin is a β-lactam antibiotic that works by inhibiting bacterial cell wall synthesis, making it effective against Gram-positive and some Gram-negative bacteria. It was the first antibiotic discovered by Alexander Fleming in 1928 and remains one of the most widely used classes of antibiotics.
Extended spectrum (Gram-positive & some Gram-negative)
Otitis media, Sinusitis, UTI, Bronchitis
Extended-Spectrum (Antipseudomonal) Penicillins
Piperacillin, Ticarcillin
Wider spectrum (Pseudomonas, Klebsiella)
Severe infections: Sepsis, Pneumonia, UTI
3. Composition
Penicillins contain a β-lactam ring, which is responsible for their antibacterial activity. They may be combined with β-lactamase inhibitors to prevent bacterial resistance:
Amoxicillin + Clavulanic Acid (Augmentin)
Ampicillin + Sulbactam (Unasyn)
Piperacillin + Tazobactam (Zosyn)
4. Mechanism of Action
Inhibits bacterial cell wall synthesis by blocking penicillin-binding proteins (PBPs).
Leads to cell lysis and death of bacteria.
Bactericidal action, effective during bacterial active growth phase.
Monitor for signs of hypersensitivity (rash, itching, swelling).
Assess renal function in patients with kidney disease.
B. Administration
IM Injections: Give deep in the gluteal or thigh muscle.
IV Infusion: Dilute with saline or dextrose, give over 30-60 minutes.
Oral: Take 1 hour before or 2 hours after food (Penicillin V) but Amoxicillin can be taken with food.
C. Monitoring
Watch for allergic reactions (rash, itching, swelling, difficulty breathing).
Monitor renal function (creatinine, BUN) in long-term therapy.
Observe for diarrhea, indicating possible C. difficile infection.
D. Patient Education
Complete full course to prevent resistance.
Report signs of allergy (swelling, rash, shortness of breath).
Avoid alcohol (can increase drug side effects).
Use backup contraception if on oral contraceptives.
Cephalosporins:
1. Introduction
Cephalosporins are β-lactam antibiotics structurally related to penicillins. They work by inhibiting bacterial cell wall synthesis, leading to bacterial lysis and death. They are broad-spectrum antibiotics and are used to treat a variety of Gram-positive and Gram-negative bacterial infections.
2. Classification of Cephalosporins
Cephalosporins are classified into five generations based on their spectrum of activity.
Hemodialysis in severe cases (especially Cefepime toxicity)
Seizure control with benzodiazepines (if needed)
11. Role of Nurse in Cephalosporin Administration
A. Pre-Administration Assessment
Check for allergy history (cross-sensitivity with penicillin).
Assess renal function (especially for Cefepime).
Monitor culture and sensitivity reports before choosing the antibiotic.
B. Administration Considerations
IM Injections: Give deep intramuscularly in the gluteal or thigh muscle.
IV Infusion:
Dilute before administration.
Ceftriaxone should not be mixed with Calcium-containing IV solutions (risk of fatal precipitates).
Oral Forms: Take with or without food, but avoid alcohol.
C. Monitoring During Treatment
Watch for signs of allergic reaction (rash, swelling, difficulty breathing).
Monitor renal function (especially in elderly or kidney disease patients).
Observe for signs of superinfection (e.g., oral thrush, vaginal candidiasis).
Check coagulation profile if used long-term (risk of bleeding).
D. Patient Education
Complete the full course to prevent resistance.
Report any signs of allergy (hives, difficulty breathing).
Avoid alcohol (may cause severe nausea, vomiting).
Take oral cephalosporins with food if stomach upset occurs.
12. Key Differences Between Cephalosporins & Penicillins
Feature
Cephalosporins
Penicillins
Allergy Risk
Lower than penicillin
Higher risk
Spectrum of Activity
Broad-spectrum
Narrow to extended-spectrum
Route of Administration
IV, IM, Oral
IV, IM, Oral
Common Uses
Meningitis, Gonorrhea, Pneumonia
Strep throat, Syphilis, Skin infections
β-Lactamase Resistance
More resistant
More susceptible
Aminoglycosides:
1. Introduction
Aminoglycosides are bactericidal antibiotics that work by inhibiting bacterial protein synthesis. They are highly effective against aerobic Gram-negative bacteria and some Gram-positive bacteria, especially in severe infections.
🔹 Common Uses: Sepsis, Pneumonia, Meningitis, Tuberculosis (TB), and Urinary Tract Infections (UTI). 🔹 Examples: Gentamicin, Amikacin, Tobramycin, Streptomycin, Neomycin.
2. Types of Aminoglycosides
Drug
Common Uses
Gentamicin
Sepsis, UTI, Endocarditis, Pneumonia
Amikacin
Multi-drug resistant infections, TB
Tobramycin
Pseudomonas infections, Cystic fibrosis
Streptomycin
Tuberculosis, Plague
Neomycin
Topical infections, Bowel sterilization before surgery
Kanamycin
Rarely used, previously for TB
3. Composition & Mechanism of Action
Composition: Contains amino sugars and aminocyclitol.
Mechanism of Action:
Binds to 30S ribosomal subunit, inhibiting protein synthesis.
Causes misreading of mRNA, leading to defective proteins.
Bactericidal (kills bacteria rather than just inhibiting growth).
4. Dosage & Route of Administration
Drug
Dosage
Route
Gentamicin
3-5 mg/kg/day
IV, IM
Amikacin
15 mg/kg/day
IV, IM
Tobramycin
3-5 mg/kg/day
IV, IM, Inhalation
Streptomycin
1 g/day (TB)
IM
Neomycin
500 mg 6-hourly (oral)
Oral, Topical
📌 Note: Aminoglycosides are not absorbed orally except Neomycin, which is used for bowel sterilization before surgery.
IM Injection: Give deep intramuscularly (thigh or gluteal muscle).
Check Trough Levels:
Draw blood just before the next dose (to monitor toxicity).
Monitor Peak Levels:
Draw 30-60 min after administration.
C. Monitoring During Treatment
Watch for signs of toxicity: Kidney function, hearing, and muscle weakness.
Check urine output (for early signs of nephrotoxicity).
Monitor electrolytes (Aminoglycosides can cause Hypokalemia, Hypocalcemia).
D. Patient Education
Report any hearing changes (ringing in ears, dizziness).
Drink plenty of water to protect kidneys.
Do not take NSAIDs (Ibuprofen, Diclofenac) with aminoglycosides.
Complete the full course to prevent resistance.
12. Key Differences Between Aminoglycosides & Other Antibiotics
Feature
Aminoglycosides
Cephalosporins
Penicillins
Spectrum
Gram-negative
Broad-spectrum
Gram-positive & some Gram-negative
Route
IV, IM
IV, IM, Oral
IV, IM, Oral
Toxicity Risk
High (Kidney, Ear damage)
Low
Low
Common Uses
Sepsis, TB, Pseudomonas
Meningitis, Pneumonia
Strep throat, Syphilis
Macrolides:
1. Introduction
Macrolides are bacteriostatic antibiotics that work by inhibiting bacterial protein synthesis. They are effective against Gram-positive bacteria, some Gram-negative bacteria, and atypical pathogens (e.g., Mycoplasma, Chlamydia, Legionella).
H. pylori infection, Mycobacterium avium complex (MAC)
Roxithromycin
Gram-positive, Atypicals
Respiratory infections, Skin infections
3. Composition & Mechanism of Action
Composition: Macrolides contain a macrocyclic lactone ring.
Mechanism of Action:
Binds to 50S ribosomal subunit.
Inhibits protein synthesis by preventing peptide chain elongation.
Bacteriostatic, but can be bactericidal at high doses.
4. Dosage & Route of Administration
Drug
Dosage
Route
Erythromycin
250-500 mg every 6 hrs
Oral, IV
Azithromycin
500 mg once daily for 3-5 days
Oral, IV
Clarithromycin
250-500 mg every 12 hrs
Oral
Roxithromycin
150 mg every 12 hrs
Oral
📌 Note: Macrolides are well-absorbed orally, but some forms (e.g., erythromycin) can cause gastrointestinal side effects.
5. Indications (Uses)
A. Respiratory & ENT Infections
Disease
Causative Organism
Macrolide Used
Community-acquired pneumonia (CAP)
Mycoplasma pneumoniae, Chlamydia pneumoniae
Azithromycin, Clarithromycin
Streptococcal Pharyngitis
Streptococcus pyogenes
Erythromycin (alternative to penicillin)
Sinusitis & Otitis Media
Streptococcus pneumoniae, H. influenzae
Azithromycin, Clarithromycin
Diphtheria & Pertussis (Whooping Cough)
Corynebacterium diphtheriae, Bordetella pertussis
Erythromycin
B. Sexually Transmitted Infections (STIs)
Disease
Causative Organism
Macrolide Used
Chlamydia
Chlamydia trachomatis
Azithromycin (Single dose 1g)
Gonorrhea (Alternative Treatment)
Neisseria gonorrhoeae
Azithromycin (along with Ceftriaxone)
C. Gastrointestinal Infections
Disease
Causative Organism
Macrolide Used
Peptic Ulcer Disease (PUD)
Helicobacter pylori
Clarithromycin (with Amoxicillin + PPI)
D. Atypical & Mycobacterial Infections
Disease
Causative Organism
Macrolide Used
Legionnaires’ Disease
Legionella pneumophila
Azithromycin, Clarithromycin
Mycobacterium Avium Complex (MAC) in HIV
M. avium-intracellulare
Azithromycin, Clarithromycin
6. Contraindications
Severe liver disease (Risk of hepatotoxicity).
QT prolongation (Risk of arrhythmias).
Hypersensitivity to macrolides.
Myasthenia Gravis (Can worsen muscle weakness).
7. Drug Interactions
Interacting Drug
Effect
Warfarin
Increases bleeding risk
Digoxin
Increases toxicity risk
Statins (Simvastatin, Atorvastatin)
Increased risk of rhabdomyolysis
Theophylline
Increased toxicity
Antacids (Containing Aluminum or Magnesium)
Reduces absorption of Azithromycin
8. Side Effects
Common Side Effects
Nausea, Vomiting, Diarrhea
Abdominal pain
Metallic taste (Clarithromycin)
Headache, Dizziness
Rash, Pruritus
9. Adverse Effects
Serious Adverse Effects
Hepatotoxicity (Liver damage)
QT Prolongation → Arrhythmias (Torsades de Pointes)
Pseudomembranous Colitis (C. difficile Infection)
Steven-Johnson Syndrome (Rare but life-threatening skin reaction)
📌 Note: Azithromycin has a long half-life, so it stays in the body for several days, reducing the need for frequent dosing.
10. Toxicity & Management
Toxic Effects: Liver damage, Cardiac arrhythmias.
Management of Overdose:
Stop the drug immediately.
IV fluids & supportive care.
Cardiac monitoring for arrhythmias.
Activated charcoal in early overdose cases.
11. Role of Nurse in Macrolide Administration
A. Pre-Administration Assessment
Check for drug allergies (especially to macrolides).
Assess liver function (AST, ALT levels).
Monitor ECG in high-risk patients (QT prolongation risk).
Check for drug interactions (e.g., Warfarin, Statins).
B. Administration Considerations
Oral: Take on empty stomach (except Clarithromycin, which can be taken with food).
IV Infusion: Give slowly to prevent cardiac side effects.
Avoid antacids (Reduce drug absorption).
C. Monitoring During Treatment
Watch for signs of liver damage (jaundice, dark urine).
Monitor cardiac function (QT prolongation risk).
Observe for gastrointestinal side effects (diarrhea, nausea).
D. Patient Education
Complete the full course to prevent resistance.
Report severe diarrhea (Risk of C. difficile infection).
Avoid grapefruit juice (Increases drug levels).
Take Azithromycin once daily due to its long half-life.
12. Key Differences Between Macrolides & Other Antibiotics
Feature
Macrolides
Aminoglycosides
Penicillins
Spectrum
Broad-spectrum
Gram-negative
Gram-positive
Route
Oral, IV
IV, IM
IV, IM, Oral
Common Uses
Pneumonia, Chlamydia, H. pylori
Sepsis, TB, Pseudomonas
Strep throat, Syphilis
Toxicity Risk
Liver, Heart (QT)
Kidney, Ear
Low
Broad-Spectrum Antibiotics:
1. Introduction
Broad-spectrum antibiotics are antimicrobial agents effective against a wide range of bacteria, including Gram-positive and Gram-negative organisms. They are used when the exact causative organism is unknown or in mixed infections.
📌 Note: Some broad-spectrum antibiotics (like Carbapenems) can lower the seizure threshold, increasing the risk of seizures in epileptic patients.
8. Role of Nurse in Broad-Spectrum Antibiotic Administration
A. Pre-Administration Assessment
Check for allergies (especially to β-lactams).
Monitor renal and liver function tests before starting therapy.
Assess infection site and obtain cultures before starting antibiotics.
B. Administration Considerations
IV Infusion: Administer over the recommended time to avoid vein irritation.
Oral Administration: Avoid dairy with tetracyclines (reduces absorption).
Monitor for Drug Interactions: Avoid antacids with Fluoroquinolones.
C. Monitoring During Treatment
Watch for signs of allergic reactions (rash, swelling, breathing difficulty).
Monitor renal function (for nephrotoxic drugs like Aminoglycosides).
Observe for gastrointestinal side effects (risk of C. difficile infection).
D. Patient Education
Complete the full course to prevent resistance.
Take antibiotics with or without food as advised.
Report severe diarrhea (risk of C. difficile colitis).
Avoid alcohol with certain antibiotics (e.g., Metronidazole).
Sulfonamides: A Complete Overview
1. Introduction
Sulfonamides (Sulfa drugs) are bacteriostatic antibiotics that inhibit bacterial folic acid synthesis, preventing bacterial growth. They are broad-spectrum antibiotics, effective against both Gram-positive and Gram-negative bacteria.
📌 Important:Stop immediately if rash or fever develops, as SJS/TEN is life-threatening.
10. Toxicity & Management
Toxic Effects: Severe allergic reactions, Liver toxicity, Blood disorders.
Management of Overdose:
Stop the drug immediately.
IV fluids & urine alkalinization (for crystalluria).
Hemodialysis in severe cases.
Folic acid supplementation (to prevent bone marrow suppression).
11. Role of Nurse in Sulfonamide Administration
A. Pre-Administration Assessment
Check for Sulfa Allergy (Cross-reactivity with some diuretics & sulfonylureas).
Assess renal function (Creatinine, BUN levels).
Monitor liver function tests.
Check for G6PD Deficiency (Risk of hemolysis).
B. Administration Considerations
Oral: Take with plenty of water to prevent kidney stones.
IV Infusion: Administer slowly to prevent vein irritation.
Topical (Silver Sulfadiazine): Apply thin layer over burn wounds.
C. Monitoring During Treatment
Observe for allergic reactions (rash, fever, breathing difficulty).
Monitor for skin reactions (Stevens-Johnson Syndrome).
Assess urine output (risk of crystalluria).
Check blood counts regularly (risk of bone marrow suppression).
D. Patient Education
Drink plenty of water to prevent kidney stones.
Avoid direct sunlight (risk of photosensitivity).
Report skin rash or unusual bleeding immediately.
Do not take with antacids (may reduce effectiveness).
Quinolones:
1. Introduction
Quinolones (Fluoroquinolones) are bactericidal antibiotics that work by inhibiting bacterial DNA synthesis, leading to bacterial cell death. They are effective against Gram-negative and some Gram-positive bacteria, making them broad-spectrum antibiotics.
🔹 Common Uses: Urinary tract infections (UTI), Respiratory infections, Gastrointestinal infections, Bone infections, and Sexually transmitted infections (STIs). 🔹 Examples: Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin, Norfloxacin.
2. Types of Quinolones
Quinolones are divided into four generations based on their antimicrobial spectrum.
Generation
Examples
Spectrum
Common Uses
First-Generation
Nalidixic Acid
Narrow (Only Gram-negative)
Uncomplicated UTI
Second-Generation
Ciprofloxacin, Norfloxacin, Ofloxacin
Broad (More Gram-negative, some Gram-positive)
UTI, GI infections, Respiratory infections
Third-Generation
Levofloxacin
Extended spectrum (More Gram-positive, including Streptococcus pneumoniae)
Pneumonia, Sinusitis, Skin infections
Fourth-Generation
Moxifloxacin, Gemifloxacin
Broad-spectrum (Gram-positive, Anaerobes)
Severe pneumonia, Complicated infections
📌 Note:Ciprofloxacin has strong Gram-negative activity, while Moxifloxacin covers anaerobes.
Check for drug allergies (especially previous fluoroquinolone use).
Assess renal & liver function (Creatinine, ALT, AST).
Monitor ECG in high-risk patients (QT prolongation risk).
B. Administration Considerations
Oral: Take on an empty stomach for better absorption.
IV Infusion: Give slowly over 60 minutes.
Avoid dairy & antacids (reduces absorption).
C. Monitoring During Treatment
Watch for signs of tendon pain/swelling.
Monitor cardiac function (QT prolongation risk).
Observe for neurological side effects (confusion, seizures).
D. Patient Education
Complete the full course to prevent resistance.
Avoid strenuous exercise (risk of tendon rupture).
Use sunscreen to prevent photosensitivity.
Do not take with dairy, iron, or antacids.
Miscellaneous Antimicrobials:
1. Introduction
Miscellaneous antimicrobials are a diverse group of antibiotics that do not fit into the major categories like β-lactams, aminoglycosides, macrolides, fluoroquinolones, or sulfonamides. They have unique mechanisms of action and are used for specific infections, including drug-resistant bacteria, anaerobic infections, and atypical pathogens.
Anaerobic infections are caused by bacteria that thrive in low-oxygen (anaerobic) environments. These infections often occur in deep wounds, abscesses, the gastrointestinal (GI) tract, oral cavity, and female reproductive organs.
Evaluate patient history (drug allergies, kidney/liver function).
B. Administration Considerations
Metronidazole:Avoid alcohol (causes severe nausea, vomiting).
IV Vancomycin: Infuse slowly over 60 min to avoid Red Man Syndrome.
Monitor Clindamycin use: Risk of C. difficile colitis (persistent diarrhea).
Piperacillin-Tazobactam: Check for penicillin allergy before administration.
C. Monitoring During Treatment
Watch for allergic reactions (rash, swelling, breathing difficulty).
Monitor kidney & liver function (especially with Metronidazole & Carbapenems).
Assess for C. difficile-associated diarrhea (especially with Clindamycin use).
D. Patient Education
Complete the full course of antibiotics to prevent resistance.
Avoid alcohol with Metronidazole (causes severe vomiting).
Report severe diarrhea (sign of C. difficile colitis).
Use probiotics to prevent antibiotic-associated diarrhea.
Antitubercular Drugs:
1. Introduction
Antitubercular drugs are used to treat Tuberculosis (TB), a bacterial infection caused by Mycobacterium tuberculosis. The treatment requires long-term therapy with a combination of drugs to prevent resistance and relapse.
🔹 Commonly Used Drugs: Isoniazid (INH), Rifampin, Pyrazinamide, Ethambutol, Streptomycin. 🔹 Standard Therapy:Directly Observed Treatment, Short-course (DOTS) under the Revised National TB Control Program (RNTCP).
2. Classification of Antitubercular Drugs
Antitubercular drugs are classified into First-Line Drugs (most effective with fewer side effects) and Second-Line Drugs (used for drug-resistant TB).
A. First-Line Antitubercular Drugs (Standard TB Treatment)
Drug
Mechanism of Action
Common Side Effects
Isoniazid (INH)
Inhibits mycolic acid synthesis (essential for cell wall)
Inhibits protein synthesis by binding to the 30S ribosome
Nephrotoxicity, Ototoxicity
📌 Mnemonic for First-Line Drugs:“RIPE-S” (Rifampin, Isoniazid, Pyrazinamide, Ethambutol, Streptomycin).
B. Second-Line Antitubercular Drugs (Used in Drug-Resistant TB)
Drug
Mechanism of Action
Common Uses
Levofloxacin, Moxifloxacin
Inhibits DNA Gyrase
MDR-TB, XDR-TB
Kanamycin, Amikacin
Inhibits protein synthesis
Drug-resistant TB
Ethionamide
Inhibits mycolic acid synthesis
MDR-TB
Cycloserine
Inhibits cell wall synthesis
MDR-TB, XDR-TB
Bedaquiline
Inhibits ATP Synthase (New TB drug)
MDR-TB
Delamanid
Inhibits mycolic acid synthesis
XDR-TB
📌 Note:MDR-TB (Multidrug-Resistant TB) is resistant to INH & Rifampin, while XDR-TB (Extensively Drug-Resistant TB) is resistant to INH, Rifampin, Fluoroquinolones, and at least one injectable second-line drug.
3. Standard Tuberculosis Treatment Regimen (DOTS Therapy)
Check baseline liver function tests (LFTs) before starting therapy.
Assess vision before starting Ethambutol (to detect early optic neuritis).
Check for symptoms of neuropathy (tingling, numbness) in patients on INH.
Assess kidney function before giving Streptomycin.
B. Administration Considerations
Take Rifampin on an empty stomach (better absorption).
Avoid alcohol during TB treatment (increases liver toxicity).
Give Pyridoxine (Vitamin B6) with INH to prevent neuropathy.
Ensure patient compliance with DOTS therapy.
C. Monitoring During Treatment
Watch for signs of liver toxicity (jaundice, dark urine, nausea).
Monitor vision regularly in Ethambutol therapy.
Assess for hearing loss in patients taking Streptomycin.
Monitor kidney function in patients on Aminoglycosides (Streptomycin, Amikacin).
D. Patient Education
Complete the full TB course (prevents resistance & relapse).
Report any jaundice, vision changes, or numbness.
Avoid alcohol (reduces liver damage).
Expect orange-colored urine/sweat with Rifampin (Harmless).
Use alternative contraception (Rifampin reduces oral contraceptive effectiveness).
7. TB Prevention Strategies
BCG Vaccine (Bacillus Calmette-Guérin): Given to newborns for TB protection.
Preventive Therapy: Isoniazid for latent TB in high-risk individuals.
Isolation of TB patients (Airborne precautions).
DOTS therapy adherence to prevent MDR-TB.
Anti-Leprosy Drugs:
1. Introduction
Leprosy (Hansen’s disease) is a chronic infectious disease caused by Mycobacterium leprae. It primarily affects the skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes. Treatment requires long-term multidrug therapy (MDT) to prevent drug resistance and complications.
🔹 Standard Therapy:Multidrug Therapy (MDT) recommended by WHO. 🔹 First-Line Drugs: Dapsone, Rifampin, Clofazimine. 🔹 Second-Line Drugs: Minocycline, Ofloxacin, Clarithromycin.
2. Classification of Anti-Leprosy Drugs
Anti-leprosy drugs are classified into First-Line (MDT drugs) and Second-Line (used for drug-resistant or relapsed cases).
A. First-Line Anti-Leprosy Drugs (Standard MDT Therapy)
📌 Key Point:Thalidomide is highly effective for Type 2 reactions but should never be given in pregnancy.
6. Diagnosis of Leprosy
Test
Purpose
Skin Smear Test
Identifies M. leprae under a microscope
Lepromin Test
Differentiates Tuberculoid & Lepromatous Leprosy
Skin Biopsy
Confirms histological changes
Nerve Examination
Assesses sensory loss & thickened nerves
📌 Lepromin Test is only used for classification, not for diagnosis.
7. Drug Interactions
Interacting Drug
Effect
Rifampin + Warfarin
Decreases Warfarin levels (increases clot risk)
Rifampin + Oral Contraceptives
Reduces contraceptive effectiveness (Use alternative contraception)
Dapsone + Probenecid
Increases Dapsone toxicity
Clofazimine + Antacids
Reduces Clofazimine absorption
📌 Note:Patients on Rifampin should be advised to use alternative contraceptive methods.
8. Role of Nurse in Leprosy Treatment
A. Pre-Administration Assessment
Assess nerve function before starting treatment.
Check for signs of G6PD deficiency before Dapsone use.
Monitor liver function (ALT, AST) in patients on Rifampin.
Check skin condition and sensory loss for leprosy reactions.
B. Administration Considerations
Dapsone and Clofazimine are given daily, but Rifampin is given once a month.
Clofazimine should be taken with food to reduce GI upset.
Monitor for orange-colored urine with Rifampin (harmless side effect).
Avoid alcohol during treatment (reduces liver toxicity risk).
C. Monitoring During Treatment
Watch for signs of leprosy reactions (pain, swelling, nerve damage).
Monitor blood counts for Dapsone-induced anemia.
Assess vision regularly in patients on Clofazimine (skin pigmentation).
Check for signs of peripheral neuropathy in Thalidomide users.
D. Patient Education
Complete the full MDT course (prevents relapse & resistance).
Expect orange-colored urine with Rifampin (normal side effect).
Use sunscreen if taking Minocycline (risk of photosensitivity).
Pregnant women should avoid Thalidomide (severe birth defects).
Report any nerve pain, skin rash, or fever immediately.
9. Leprosy Prevention & Control
Early diagnosis and MDT to prevent transmission.
BCG vaccine provides some protection against leprosy.
Contact tracing and prophylactic treatment in high-risk individuals.
Community awareness programs to reduce social stigma.
Antimalarial Drugs:
1. Introduction
Malaria is a life-threatening protozoal disease caused by Plasmodium species and transmitted by Anopheles mosquitoes. The most common types of malaria include:
📌 Before prescribing Primaquine, always check for G6PD deficiency to prevent hemolysis.
5. Drug Interactions
Interacting Drug
Effect
Chloroquine + Digoxin
Increases Digoxin toxicity
Quinine + Warfarin
Increases bleeding risk
Mefloquine + SSRIs
Increases risk of psychiatric effects
Doxycycline + Antacids
Decreased absorption of Doxycycline
📌 Patients taking psychiatric medications should avoid Mefloquine due to neuropsychiatric effects.
6. Role of Nurse in Malaria Treatment
A. Pre-Administration Assessment
Assess for G6PD deficiency before prescribing Primaquine.
Monitor liver function in patients taking Artemisinin-based drugs.
Check ECG in patients receiving Chloroquine or Quinine (QT prolongation risk).
Assess for psychiatric history before prescribing Mefloquine.
B. Administration Considerations
Chloroquine should be taken with food to reduce GI upset.
IV Artesunate must be given slowly (risk of hemolysis).
Quinine infusion should be monitored for hypoglycemia (stimulates insulin release).
Doxycycline should be taken with a full glass of water to prevent esophagitis.
C. Monitoring During Treatment
Monitor blood glucose in patients on IV Quinine (risk of hypoglycemia).
Watch for signs of neuropsychiatric effects in Mefloquine users.
Assess vision regularly in patients on long-term Chloroquine therapy.
Monitor for jaundice and dark urine (possible drug-induced hemolysis).
D. Patient Education
Complete the full course of treatment to prevent resistance.
Use mosquito nets and repellents to avoid reinfection.
Take antimalarial prophylaxis before, during, and after travel.
Avoid alcohol with antimalarial drugs (reduces liver toxicity risk).
7. Malaria Prevention & Control
Vector Control: Insecticide-treated bed nets (ITNs), Indoor residual spraying (IRS).
Chemoprophylaxis: For travelers to endemic areas.
Prompt Diagnosis & Treatment: Reduces transmission and complications.
Vaccination: The RTS,S/AS01 (Mosquirix) vaccine is approved for P. falciparum malaria.
📌 The RTS,S vaccine is now included in WHO’s malaria control strategies for children in endemic regions.
Antiretroviral Drugs:
Antiretroviral drugs (ARVs) are used to manage and treat HIV/AIDS by suppressing the replication of the virus in the body. They are classified into different groups based on their mechanism of action.
Elderly Patients: Monitor closely for metabolic complications (diabetes, osteoporosis).
Antiviral Agents:
Antiviral agents are medications used to treat viral infections by inhibiting virus replication and reducing the severity of illness. Unlike antibiotics, which target bacteria, antivirals specifically interfere with viral replication processes.
1. Classification and Composition
Antiviral agents are classified based on their mechanism of action:
Strict adherence to treatment to prevent resistance.
Hydration advice for nephrotoxic drugs like Acyclovir.
Oseltamivir should be taken within 48 hours of flu symptoms.
3. Monitoring & Nursing Care
Watch for allergic reactions (rash, anaphylaxis).
Monitor for organ toxicity (renal function for Acyclovir, liver function for Sofosbuvir).
Encourage vaccination for viral prevention.
4. Special Considerations
Pregnant women with HIV → Zidovudine to prevent mother-to-child transmission.
Immunocompromised patients → Need early intervention for viral infections.
Elderly patients → Higher risk of adverse effects (renal impairment).
Antihelminthic Drugs: Comprehensive Overview
1. Introduction
Antihelminthic drugs are used to treat parasitic worm infections caused by different types of helminths, including nematodes (roundworms), trematodes (flukes), and cestodes (tapeworms). These drugs work by targeting the metabolism, neuromuscular system, or other vital functions of the parasite, leading to its paralysis or death.
2. Classification and Composition
Antihelminthic drugs are classified based on their action against specific worm types:
Class
Examples
Effective Against
Benzimidazoles
Albendazole, Mebendazole
Nematodes (roundworms), Cestodes (tapeworms)
Macrocyclic Lactones
Ivermectin
Nematodes (strongyloides, filarial worms)
Tetrahydropyrimidines
Pyrantel Pamoate
Nematodes (hookworms, pinworms)
Piperazine Derivatives
Piperazine
Ascaris (roundworms)
Isoquinoline Derivatives
Praziquantel
Trematodes (flukes), Cestodes (tapeworms)
Salicylanilides
Niclosamide
Cestodes (tapeworms)
3. Mechanism of Action
Different antihelminthic drugs work through various mechanisms:
Albendazole, Mebendazole: Inhibit microtubule formation, leading to paralysis and death of worms.
Ivermectin: Enhances GABA neurotransmission, leading to paralysis of nematodes.
Pyrantel Pamoate: Causes neuromuscular blockade, leading to paralysis of worms.
Praziquantel: Increases calcium permeability, leading to spastic paralysis and death of flukes and tapeworms.
Niclosamide: Inhibits glucose uptake, leading to tapeworm death.
4. Dosage and Route of Administration
Drug
Dose
Route
Albendazole
400 mg single dose (Ascariasis, Hookworm)
Oral
Mebendazole
100 mg twice/day for 3 days
Oral
Ivermectin
200 mcg/kg single dose (Strongyloidiasis)
Oral
Praziquantel
40 mg/kg single dose (Schistosomiasis)
Oral
Niclosamide
2 g single dose (Tapeworms)
Oral
Pyrantel Pamoate
11 mg/kg single dose (Pinworms)
Oral
✅ Most antihelminthics are given orally. ✅ For severe infections, repeat doses may be needed.
5. Indications
Antihelminthics are used for treating various parasitic infections:
Family treatment: Treat all family members for pinworms.
3. Monitoring & Nursing Care
Monitor liver function (Albendazole, Praziquantel).
Check for side effects (dizziness, nausea, GI upset).
Encourage follow-up stool examination to confirm cure.
4. Special Considerations
Children: Pyrantel Pamoate is preferred for pinworms.
Elderly patients: Watch for drug-induced dizziness (Praziquantel).
Neurocysticercosis: Give steroids to reduce brain inflammation.
Anti-Scabies Agents: Comprehensive Overview
1. Introduction
Scabies is a contagious skin infestation caused by the Sarcoptes scabiei mite. It spreads through direct skin contact and infested clothing, bedding, or furniture. Anti-scabies agents are used to kill the mites and relieve symptoms like itching and rash.
2. Classification of Anti-Scabies Agents
Anti-scabies drugs are classified based on their mode of action:
Class
Examples
Mechanism of Action
Topical Scabicides
Permethrin 5% cream
Paralyzes and kills mites by disrupting their nervous system
Lindane 1% lotion
Neurotoxin that kills mites but can be toxic to humans
Benzyl Benzoate (10–25%)
Suffocates mites and destroys their cell membranes
Sulfur ointment (5–10%)
Toxic to mites, safe for infants and pregnant women
Crotamiton 10% (Eurax)
Kills mites and relieves itching
Oral Scabicides
Ivermectin (200 mcg/kg)
Paralyzes and kills mites via GABA-mediated action
✅ Topical agents are first-line treatment. ✅ Oral Ivermectin is used in severe or resistant cases.
3. Mechanism of Action
Anti-scabies drugs work by:
Neurotoxicity (Permethrin, Lindane, Ivermectin) – Paralysis and death of mites.
Apply overnight, wash after 8-12 hours, repeat after 7 days
Topical
Lindane 1% lotion
Apply for 8 hours, wash off, (Avoid in infants, pregnant women, epilepsy)
Topical
Benzyl Benzoate 10-25%
Apply for 24 hours, repeat if needed
Topical
Sulfur ointment 5-10%
Apply for 3 nights, leave overnight
Topical
Crotamiton 10%
Apply daily for 5 days
Topical
Ivermectin (200 mcg/kg)
Single oral dose, repeat after 7-14 days
Oral
✅ Permethrin 5% is the preferred treatment. ✅ Ivermectin is used for crusted scabies or widespread outbreaks. ✅ Benzyl Benzoate and Sulfur are economical options.
Antifungal agents are medications used to treat fungal infections affecting the skin, nails, mucous membranes, and internal organs. These infections are caused by yeasts, molds, and dimorphic fungi and can range from superficial to systemic mycoses.
2. Classification of Antifungal Agents
Antifungal drugs are classified based on their mechanism of action and fungal targets:
Class
Examples
Mechanism of Action
Indications
Polyenes
Amphotericin B, Nystatin
Binds to ergosterol, forming pores in fungal cell membrane
Systemic mycoses (Amphotericin B), Oral and vaginal candidiasis (Nystatin)
Cryptococcal Meningitis – Amphotericin B + Flucytosine
Systemic Candidiasis – Fluconazole, Caspofungin
Aspergillosis – Itraconazole, Voriconazole
Histoplasmosis, Blastomycosis – Itraconazole, Amphotericin B
6. Contraindications
Drug
Contraindications
Amphotericin B
Kidney disease (Nephrotoxicity)
Azoles (Fluconazole, Itraconazole)
Liver disease, Pregnancy
Echinocandins (Caspofungin)
Hypersensitivity
Terbinafine
Liver failure
Griseofulvin
Pregnancy (Teratogenic)
✅ Avoid Fluconazole in pregnancy unless necessary. ✅ Monitor liver and kidney function with systemic antifungals.
7. Drug Interactions
Fluconazole + Warfarin → Increased bleeding risk
Itraconazole + Statins → Rhabdomyolysis risk
Amphotericin B + Nephrotoxic Drugs → Kidney damage
Echinocandins + Cyclosporine → Liver toxicity
8. Side Effects
Drug Class
Common Side Effects
Polyenes (Amphotericin B)
Fever, chills, kidney toxicity
Azoles (Fluconazole, Itraconazole)
Nausea, liver toxicity, hormonal imbalance
Echinocandins (Caspofungin)
Rash, fever, liver enzyme elevation
Allylamines (Terbinafine)
GI upset, headache, liver toxicity
Griseofulvin
Dizziness, photosensitivity
✅ Amphotericin B is highly nephrotoxic (kidney damage risk). ✅ Fluconazole and Itraconazole can cause liver damage. ✅ Griseofulvin should be taken with fatty foods for better absorption.
9. Adverse Effects & Toxicity
Amphotericin B → Severe nephrotoxicity, infusion reactions (fever, chills)