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CHAPTER 7
Immunizations and Antimicrobials
7-2
Introduction
• This chapter covers
─Disease terminology/concepts
─Immunizations
─Antimicrobials
─Active and passive immunity
─Proper use of anti-infective agents
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General Disease Terminology
• Disease
– Not (dis) at ease
– Body fails to function properly
– Numerous causes
– Many due to infections
• Sign
– Objective
– Measurable
– Definitive
(Continues)
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General Disease Terminology
• Symptom
– Subjective
– Based on perception
– Cannot be measured consistently
• Syndrome
– Specific grouping of signs/symptoms (S/S)
• Diagnosis
– Identification of disease
(Continues)
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General Disease Terminology
• Prognosis
– Prediction of outcome of disease process
• Chief complaint
– Concern that caused patient to seek medical
help
• Etiology
– Cause of disease
(Continues)
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General Disease Terminology
• Chronic condition
– Long term
• Acute condition
– Short term
• Remission
– S/S of chronic disease may subside
• Relapse
– Recurrence of S/S
(Continues)
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General Disease Terminology
• Exacerbation
– Acute return of S/S
• Mortality
– Measure of deaths attributed to specific
disease
• Morbidity
– Measure of disability/problems related to
illness
(Continues)
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General Disease Terminology
• Epidemiology
– Study of patterns, causes, spread, and effects
of disease conditions (as determined by CDC)
• Endemic
– Disease continually present within a specific
population/region
• Epidemic
– Disease occurs suddenly over specific
geographic region
(Continues)
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General Disease Terminology
• Pandemic
– Disease spreads throughout country or worldwide
• Reminder
– It is better to prevent infections (such as with
the use of vaccinations) than it is to treat them
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Immunity
• Immune response produces antibodies
against foreign microbes; inherited,
acquired, induced
• Two broad types
– Active: produced artificially (vaccination), or
naturally (by contracting illness); long-lasting
– Passive: administration of immunoglobulins;
short-lived
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Microbial Resistance Mechanisms
• Resistance occurrence may be due to
– Antibiotic being destroyed by bacterial
enzymes
– Alteration in protein binding
– Bacteria pumping antibiotic out, preventing it
from destroying bacteria
– Use of antibiotics when not needed
7-12
Antibacterial Drug Classification
• Bacteriostatic (inhibits replications) versus
bactericidal (actively destroys bacteria)
• Broad-spectrum (effective against wide
range of bacteria) versus narrow spectrum
(used after specific organism is identified)
• Mechanism of action (commonly used to
classify HIV medications)
7-13
Antibacterial Agents
• Refer to text for in-depth information
concerning these agents
• Beta-lactams
– Chemically related drugs
– Inhibit materials needed for bacterial cell wall
synthesis
– For example, penicillins, cephalosporins,
monobactams, carbacephems, carbapenems
(Continues)
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Antibacterial Agents
• Quinolones
– Block two enzymes responsible for DNA
growth, leading to breakage of DNA, which
results in bactericidal activity
– Prolonged use may cause superinfection
– May cause tendon inflammation with rupture,
even after medication is discontinued
– Example of fluoroquinolones: ciprofloxacin
(Continues)
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Antibacterial Agents
• Aminoglycosides
– Gram-negative coverage
– Bactericidal
– Dosage based on patient weight, renal
function, and serum blood levels
– May cause hearing loss and kidney failure
– For example, amikacin, gentamicin,
tobramycin
(Continues)
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Antibacterial Agents
• Glycopeptides
– Bactericidal
– Bind to portion of cell wall of microorganism,
preventing cell wall development
– Effective against gram-positive cocci
– For example, vancomycin (monitor serum
blood levels), telavancin (has long duration;
given once daily)
(Continues)
7-17
Antibacterial Agents
• Macrolides
– Inhibit bacterial protein synthesis
– Commonly used for pulmonary infections
• Tetracyclines
– Broad spectrum
– Bacteriostatic
– Can cause permanent tooth discoloration
(Continues)
7-18
Antibacterial Agents
• Folate inhibitors
– Bacteriostatic
– Primary use: treatment of UTIs
– Sulfonamides
• Quinupristin-Dalfopristin
– Inhibit bacterial protein synthesis
– Bacteriostatic against gram-positive bacteria
– Administered IV
(Continues)
7-19
Antibacterial Agents
• Daptomycin
– Bactericidal against gram-positive bacteria
– Interferes with electrical activity of cell
membrane
– Useful in treatment of MRSA
• Clindamycin
– Oral or IV
– Active against gram-positive cocci, anaerobes
(Continues)
7-20
Antibacterial Agents
• Metronidazole
– Synthetic drug
– Anaerobic spectrum of activity
– Inhibits bacterial protein synthesis resulting in
cell death
– Part of cocktail drug to treat peptic ulcer
disease (PUD) due to H. pylori
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Antituberculosis Drugs
• TB
– May affect lungs, kidneys, spine, and brain;
air-borne transmission; chronic
• MDR TB
– Due to suboptimal treatment (inappropriate
drug doses/noncompliance)
• Treatment
– For example, rifampin, isoniazid
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Antivirals
• Vaccinations as prevention are preferred
over treatment of viruses
• HSV
– Treatment interferes with viral DNA synthesis,
thus inhibiting viral replication
– For example, valacyclovir
• Influenza
– Prevention available through oral
administration, inhalation, or vaccination
(Continues)
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Antivirals
• RSV
– Major cause of lung disease in children
– Treatment includes: ribavirin (inhibits RNA
and DNA viruses)
• HCV
– Most common blood-borne infection in the
United States
– Treatment examples: simeprevir,
peginterferon
(Continues)
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Antivirals
• HIV
– Infects cells of immune system
– May progress to AIDS
– Treatment: antiretrovirals that include several
drug classes
• NRTIs (e.g., abacavir)
• NNRTIs (e.g., efavirenz)
• PIs (e.g., ritonavir)
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Antifungal Agents
• Two basic forms of fungi in humans
– Yeasts
– Molds
• Fungi may be local or systemic
• Treatments prevent production of
ergosterol
• Example: nystatin (oral or topical cream),
miconazole (topical)
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Summary
• Learn and understand general disease
terminology to lay the foundation for
discussions on infectious diseases
• Immunity
– Passive
– Active
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Summary
• Microbial resistance mechanisms
• Anti-infective agents
– Antibacterial agents
– Antituberculosis drugs
– Antivirals
– Antifungals
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