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Antibiotics: Understanding their Classifications

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Contact Hours: 4

This educational activity is credited for 4 contact hours at completion of the activity.

Course Purpose

The purpose of this course is to provide healthcare professionals with an overview of antibiotics, their classifications, mechanisms of action and selection criteria, and antibiotic resistance, side effects, and nursing considerations for antibiotic therapy.

Overview

In the United States, 236 million outpatient antibiotic prescriptions are dispensed annually, with penicillin, macrolides, and cephalosporins being among the most used. Despite their remarkable benefits, antibiotics have also brought about unforeseen challenges. Misuse and overuse of these compounds have fueled the emergence of antibiotic resistance, rendering some infections virtually untreatable. This course provides a comprehensive overview of antibiotics, their classifications, mechanisms of action, and selection criteria. Antibiotic resistance, side effects, and nursing considerations will also be examined to equip healthcare professionals with the necessary skills and understanding to optimize antibiotic therapy while minimizing risks and promoting patient safety.

Course Objectives

Upon completion of this course, the learner will be able to:

  • Review how antibiotics are selected to combat infections.
  • Differentiate between bactericidal and bacteriostatic antibiotics and their pharmacodynamic and pharmacokinetic properties.
  • Recognize the importance of taking antibiotics in completion, and as prescribed.
  • Review antibiotic resistance, and the three primary mechanisms how resistance genes can be transferred.
  • Identify side effects and allergic reactions commonly associated with antibiotics.

Policy Statement

This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.

Disclosures

Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.

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Definitions
30S RibosomeThe smaller subunit of the 70S ribosome found in prokaryotes. It is a complex of the 16S ribosomal RNA (RRNA) and 19 proteins.
AbscessA localized collection of pus in a cavity formed from tissues that have been broken down by infectious bacteria.
AcinetobacterA group of bacteria that can live in soil, water, and even on human skin without causing harm.
ActinomyceteAny member of a heterogeneous group of gram-positive, generally anaerobic bacteria noted for a filamentous and branching growth pattern that results, in most forms, in an extensive colony, or mycelium. 
AminoglycosideAny of several natural and semisynthetic compounds that are used to treat bacterial diseases. 
Amphenicols Broad-spectrum antibiotics.
AnaerobeBacteria that do not need oxygen to survive and grow.
AnsamycinsA family of bacterial secondary metabolites that show antimicrobial activity against many Gram-positive and some Gram-negative bacteria, and includes various compounds, including streptovaricins and rifamycins.
Antibiotic ResistanceLoss of susceptibility of bacteria to the killing (bactericidal) or growth-inhibiting (bacteriostatic) properties of an antibiotic agent.
AntibioticA type of antimicrobial substance active against bacteria.
AzolesA class of five-membered heterocyclic compounds containing a nitrogen atom and at least one other non-carbon as part of the ring.
Bacterial MeningitisAn infection and inflammation of the fluid and membranes surrounding the brain and spinal cord.
BactericideA substance which kills bacteria.
BacteriophageThe viruses that infect bacteria and can use lytic or lysogenic cycles to reproduce.
BacteriostaticBiological or chemical agent that stops bacteria from reproducing, while not necessarily killing them otherwise. 
Bacteriostatic AntibioticsMedications whose mechanism of action stalls bacterial cellular activity without directly causing bacterial death. 
Beta-LactamAntibiotics that inhibit bacterial cell wall synthesis.
Broad-Spectrum AntibioticsAn antibiotic that acts on the two major bacterial groups, Gram-positive and Gram-negative, or any antibiotic that acts against a wide range of disease-causing bacteria.
CarbapenemsBroad-spectrum antibiotics that are active against many gram-negative and gram-positive bacteria, including some multidrug-resistant strains. 
Cell Wall SynthesisThe process of making a protective mesh that surrounds the bacterial cell.
CephalosporinsA type of antibiotic that can treat a range of simple infections, especially for people who are allergic to penicillin.
Chronic EndometritisMild inflammation of the endometrium, typically due to microbial colonization not associated with pregnancy that lasts ≥30 days.
Coagulase-Negative StaphylococciAerobic, Gram-positive coccus, occurring in clusters. 
Cytochrome P-450Hemeprotein that plays a key role in the metabolism of drugs and other xenobiotics.
DihydropteroateAn essential enzyme in the metabolism of P. Jirovecii involved in the synthesis of folic acid.
Enterococcus FaecalisA species of bacteria that live harmlessly in the digestive tract, although some can be found in the oral cavity or vaginal tract. 
Exposure-Dependent AntibioticsThe amount of drug given relative to the minimal inhibitory concentration (MIC). 
FluoroquinolonesBactericidal agents that treat various infections by breaking down bacterial DNA.
FungiAny member of the group of organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms.  
GlycopeptidesSemisynthetic macromolecules that are structurally related to vancomycin and have antibacterial activity against several gram positive organisms including methicillin resistant Staphylococcus aureus (MRSA).
Gram-Negative BacilliBacteria that can cause various infections, such as urinary tract, diarrhea, and bloodstream infections.
Gram-Negative Bacteria Type of bacteria that stain red after a chemical process called Gram staining.
Gram-Negative CocciBacteria that have a spherical shape and stain pink in a test called Gram staining.
Gram-Positive BacteriaBacteria classified by the color they turn in the staining method.
Isoleucyl T-RNA SynthetaseAn aminoacyl trna synthetase whose essential function is to aminoacylate trna Ile with isoleucine.
LincosamidesA class of antibiotics that treat infections caused by gram-positive and anaerobic bacteria.
LipoglycopeptidesA class of antibacterial drugs that inhibit gram-positive bacteria cell wall synthesis. 
LipopeptidesA molecule consisting of a lipid connected to a peptide.
MacrolidesBacteriostatic drugs that inhibit protein synthesis in bacteria. 
MacrophagesA type of white blood cell that helps eliminate foreign substances by engulfing foreign materials and initiating an immune response. 
MastoiditisBacterial infection leading to inflammation of the mastoid bone located behind the ears.
Minimum Bactericidal Concentration (MBC)The lowest concentration of antibiotics that kills 99.9% of the inoculum. 
Minimum Inhibitory Concentration (MIC)The lowest concentration of an antimicrobial (like an antifungal, antibiotic or bacteriostatic) drug that will inhibit the visible growth of a microorganism after overnight incubation.
MoldsA superficial woolly growth produced especially on damp or decaying organic matter or on living organisms by a fungus. 
MonobactamsParenteral beta-lactam antibiotics with activity against some gram-negative bacteria.
MorbidityThe state of being symptomatic or unhealthy for a disease or condition.
MorganellaA gram-negative rod commonly found in the environment and in the intestinal tracts of humans, mammals, and reptiles.
MortalityThe quality or state of being mortal, the death of large numbers, or the number of deaths in a population or time.
MupirocinBelongs to the topical antibiotic class of medications and is utilized for managing and treating various skin and soft tissue infections.
Mura (UDP-Glcnac3-Enolpyruvyltransferase)A key enzyme involved in bacterial cell wall peptidoglycan synthesis and a target for the antimicrobial agent fosfomycin, a structural analog of the mura substrate phosphoenol pyruvate.
Narrow-Spectrum AntibioticsAct against specific species and do not generate resistance in other pathogens due to selection pressure.
NitrofuransAn antibiotic medication that is used for the treatment of uncomplicated lower urinary tract infections.
Non-LactamAntibiotics that lack the beta-lactam ring.
OxazolidinonesA class of antibiotics used to treat serious infections, often after other antibiotics have been ineffective. 
P-Aminobenzoic AcidA chemical that occurs naturally in the body and is also found in some foods. 
PenicillinAn antibiotic or group of antibiotics produced naturally by certain blue molds, and now usually prepared synthetically.
PharmacodynamicsThe study of how drugs affect the body.
PharmacokineticsThe study of how the body interacts with administered substances for the entire duration of exposure. 
PhosphonatesA broad family of organic molecules based on phosphorus.
Polymorphonuclear GranulocytesA type of white blood cell (WBC) that include neutrophils, eosinophils, basophils, and mast cells.
PolypeptidesChains of amino acids linked by peptide bonds, which are formed when a carboxyl group and an amine group react.
ProteusGram-negative bacterium which is well-known for its ability to robustly swarm across surfaces in a striking bulls’-eye pattern.
PseudomonasA group of bacteria that thrive in moist and warm environments, such as soil, water, and plants.
Pseudomonas AeruginosaA gram-negative, aerobic, non-spore forming rod that is capable of causing a variety of infections in both immunocompetent and immunocompromised hosts. 
RecombinationOccurs when genetic material is exchanged between two different chromosomes or between different regions within the same chromosome.
SepsisAn infection of the blood stream resulting in a cluster of symptoms such as drop in a blood pressure, increase in heart rate and fever.
SerratiaGram-negative bacilli that can be multidrug resistant.
Staphylococcus AureusInfection caused by specific round shaped bacteria called staphylococcus.
StreptograminsA class of antibiotics.
Streptomyces FradiaeA species of Actinomycetota, a group of bacteria that produce secondary metabolites.
SulfonamidesA group of antibiotics that fight bacteria by blocking their folic acid production, a vital nutrient for their growth and survival.
TetracyclinesA class of antibiotics that can fight many kinds of bacteria and other microbes, from acne to plague.
Time-Dependent AntibioticsEradicate microbes based on the time for which bacteria are exposed to the antibiotics at a concentration higher than the minimum inhibitory concentration (MIC).
Trichomonas VaginalisA common sexually transmitted infection caused by a parasite called Trichomonas vaginalis.
UropathogenA microorganism capable pf causing disease of the urinary tract.
VirusAn infectious agent of small size and simple composition that can multiply only in living hosts.
Introduction

For millennia, humanity has used antibiotics to treat infections, going as far back as the ancient Egyptians, who employed various molds and plant extracts to treat wound infections. However, it was not until centuries later, with the groundbreaking discovery of penicillin in 1928, that scientists began to witness the antibacterial effects of certain chemicals we now know as antibiotics. Antibiotics have revolutionized modern medicine, enabling radical medical procedures like cancer treatment, organ transplants, and open-heart surgery, saving countless lives and extending the average human lifespan by an astonishing 23 years. In the United States alone, 236 million outpatient antibiotic prescriptions are dispensed annually, with penicillins, macrolides, and cephalosporins being among the most used. Despite their remarkable benefits, antibiotics have also brought about unforeseen challenges. Misuse and overuse of these compounds have fueled the emergence of antibiotic resistance, rendering some infections virtually untreatable. This, coupled with the gradual decline of new antibiotic discoveries, has led to a public health crisis. Reports suggest that without urgent intervention, antibiotic-resistant infections could claim the lives of an estimated 10 million people annually by 2050.1,2

This course provides a comprehensive overview of antibiotics, discussing their mechanisms of action, selection criteria, and classification. Antibiotic resistance, side effects, and nursing considerations will also be examined to equip healthcare professionals with the necessary skills and understanding to optimize antibiotic therapy while minimizing risks and promoting patient safety.

Defining Antibiotics

Antibiotics are a class of antimicrobial drugs primarily used to treat bacterial infections. They can be derived from bacteria, fungi, or molds or be synthesized artificially. Also known as antibacterial drugs, these medications affect infection-causing bacteria through various mechanisms, including inhibiting cell wall synthesis, increasing cell membrane permeability, and interfering with essential bacterial processes such as protein synthesis, nucleic acid metabolism, and folic acid synthesis. Antibiotics are ineffective against viruses as these microorganisms have differing structures and replication mechanisms, making them resistant to antibacterial action.1,3

Antibiotics are often categorized into classes based on their chemical structure and functional similarities. While drugs within the same class may share certain characteristics, they can also exhibit differences in effectiveness based on pharmacodynamics, pharmacokinetics, spectrum of activity, and drug interactions. Pharmacodynamics refers to the antibiotic’s mechanisms of action, from the specific biochemical pathways to the cellular structures that antibiotics target within bacterial cells. Pharmacokinetics describes how effectively the drug reaches its target site of action, how long it remains in the body, and how quickly it is eliminated. Critical pharmacokinetic parameters for antibiotics include:

  • Absorption into the bloodstream.
  • Distribution throughout body tissues and fluids, including its ability to penetrate specific sites of infection.
  • Metabolism, which can affect the antibiotics’ efficacy, toxicity, and duration of action.
  • Excretion.

Based on the pharmacokinetic parameters, antibiotics can be classified into concentration-dependent antibiotics, which rely on achieving peak concentrations; time-dependent antibiotics, where the duration of the drug concentration must remain above a specific level for optimal antimicrobial activity; and exposure-dependent antibiotics, where efficacy is strongly correlated on the total exposure of the drug to the bacteria over time.1,3,4

The spectrum of activity is the range of bacteria against which the antibiotic is effective. It can be either a narrow spectrum or a broad spectrum. Narrow-spectrum antibiotics act against a limited range of bacteria, targeting specific species or strains. They are preferred when the causative pathogen is known as they are less likely to disturb the normal balance of microorganisms in the body and may be associated with fewer side effects. Examples include penicillin G, vancomycin, and isoniazid. Broad-spectrum antibiotics are effective against a wide variety of bacteria, including both gram-positive and gram-negative bacteria. They are often prescribed when the specific bacteria causing the infection are unknown or when the infection involves multiple bacterial species. While broad-spectrum antibiotics offer broader coverage, they also have a higher risk of promoting antibiotic resistance and disrupting the body’s normal microbial flora. Examples include amoxicillin-clavulanate, fluoroquinolones, and macrolides like azithromycin. Antibiotics also have the potential to interact with other drugs, leading to changes in the serum levels of those drugs. These interactions can occur through mechanisms such as alterations in metabolism or other pharmacokinetic processes. Such interactions are particularly significant for drugs with a narrow therapeutic index, where small changes in serum levels can lead to adverse effects or treatment failure.1,3,4

Antibiotic Selection

When selecting the appropriate antibiotics, cultures and antibiotic susceptibility testing play a crucial role in treating severe infections. Based on this information, the general principle is to opt for drugs with the narrowest spectrum of activity that can effectively control the infection in the shortest duration. This approach discourages antibiotic resistance and reduces the potential for adverse effects. However, there are instances where prompt treatment is necessary before culture results become available. Healthcare providers must base treatment on the most likely pathogens, which can vary based on geographical location and may change over time, even within the same hospital. For severe infections where the causative pathogen is uncertain or where multiple pathogens are suspected, empiric therapy with a broader spectrum antibiotic or a combination of antibiotics that act synergistically may be warranted for a more rapid and complete response. In certain bacterial infections, such as abscesses or those involving foreign bodies, antibiotic use alone may not be adequate. In these situations, surgical intervention may be necessary to resolve the infection.4

Factors, including the likelihood of spontaneous resolution and potential complications without treatment, must also be considered when selecting antibiotics. For instance, in acute otitis media, a common infection of the middle ear in children, research indicates that most patients experience improvement within 24 hours, regardless of whether they receive antibiotics. Immediate antibiotic treatment does not significantly affect outcomes such as pain relief, prevention of deafness, tympanic membrane perforation, or recurrence of the infection. However, antibiotics can reduce the risk of serious complications, such as mastoiditis, which occurs in approximately 1 in 5000 cases. Therefore, professional guidelines often recommend a cautious and restrictive approach to antibiotic use when the benefits may be limited or uncertain.4,5

Benefits of Use

Antibiotics offer several key benefits in treating bacterial infections, often making them preferable to relying solely on the body’s natural defense mechanisms, especially when the immune system is compromised, or the infection is particularly aggressive. In such cases, antibiotics provide a targeted and immediate response to combat the invading bacteria, helping to prevent the infection from spreading and causing further damage. This action can shorten the duration and severity of bacterial infections, allowing individuals to recover more quickly and resume their normal activities. Without treatment, bacterial infections can lead to severe complications, including the spread of infection to other parts of the body, the development of abscesses, and the risk of systemic infection (sepsis). Even in the case of mild infection, the body may not be able to resolve the issue on its own due to underlying conditions or co-morbidities. Antibiotics are essential for eradicating these persistent infections and preventing them from reoccurring in the future.5-7

For life-threatening infections such as pneumonia and bacterial meningitis, prompt antibiotic therapy has been shown to reduce morbidity and mortality significantly, making them life-saving treatments. Antibiotics have also been shown to effectively control and prevent bacterial infections in surgical interventions and procedures. Before both invasive and non-invasive surgeries, antibiotics are routinely administered prophylactically to prevent postoperative infections. Treatment often continues following surgery to improve recovery. Studies have shown that courses of oral antibiotics following total knee arthroplasty prevent infection by 68.5%, reducing failure rates. It also improves implantation rate in women with chronic endometritis undergoing invitro fertilization (IVF) than those left untreated. Timely and appropriate use of antibiotics can aid in preventing secondary infections and complications, particularly in individuals with weakened immune systems or those predisposed to infections due to underlying medical conditions. For example, individuals with diabetes or human immunodeficiency virus (HIV) may benefit from antibiotics to prevent opportunistic infections and maintain optimal health.5-7

Types of Antibiotics

Antibiotics are classified into two primary categories based on their effects on bacteria: 8,9  

  • Bactericidal
  • Bacteriostatic

Bactericidal drugs are designed to kill bacteria outright by inhibiting cell wall synthesis, disrupting bacterial enzymes, and interfering with protein translation processes, leading to cell death. Bacteriostatic antibiotics inhibit bacterial growth and reproduction without directly causing bacterial death. This is accomplished by inhibiting essential processes such as protein synthesis or deoxyribonucleic acid  (DNA) replication. By targeting these vital functions, bacteriostatic antibiotics prevent bacteria from proliferating and allow the body’s immune system to effectively eliminate the bacteria over time. However, this distinction is not absolute. In large concentrations, some bacteriostatic drugs may kill susceptible bacterial species, while certain bactericidal drugs may only inhibit the growth of some bacteria. Therefore, selection should not solely rely on whether the drug is bactericidal or bacteriostatic. It should prioritize factors such as the minimum bactericidal concentration (MBC), the lowest concentration of an antibiotic required to eradicate 99.99% of the bacterial population present, and the minimum inhibitory concentration (MIC), the lowest concentration of an antibiotic that inhibits visible growth of bacteria. Typically, bactericidal antibiotics are favored for severe infections, where rapid bacterial eradication is crucial, particularly in patients with compromised immune systems. Bacteriostatic antibiotics are commonly used to treat less severe infections, where slowing bacterial growth allows the body’s immune system to clear the infection.1,8,9

Bactericidal Antibiotics that Inhibit Cell Wall Synthesis

Bactericidal antibiotics that inhibit cell wall synthesis prevent bacteria from constructing and maintaining a protective outer covering, compromising its integrity and eventually leading to bacterial death. Within this class, antibiotics are either beta-lactam or non-lactam. Beta-lactam antibiotics are those with a characteristic beta-lactam ring in their chemical structure. This ring binds to and inhibits the activity of enzymes, which are essential for bacterial cell wall synthesis. Beta-lactam antibiotics include penicillins, cephalosporins, monobactams, and carbapenems. Non-lactam antibiotics encompass a diverse range of antimicrobial agents that exhibit alternative mechanisms of action, such as inhibition of protein synthesis, nucleic acid synthesis, or disruption of bacterial cell membranes. While non-lactam antibiotics may not contain the characteristic beta-lactam ring, they are equally vital in treating bacterial infections and contribute to the diverse arsenal of antimicrobial agents available to healthcare providers. Non-lactam antibiotics include lipopeptides, lipoglycopeptides, glycopeptides, polypeptides, and phosphonates.1,8,9

Beta-Lactam Bactericidal Antibiotics

Penicillin, discovered in 1929 and clinically introduced in 1943, represents the first natural antibiotics isolated. Derived from fungi, penicillin targets cell wall synthesis by binding to penicillin-binding proteins. Penicillins primarily target gram-positive bacteria and certain gram-negative cocci, proving effective against various infections, including syphilis, clostridial infections, and endocarditis. Penicillins such as amoxicillin and ampicillin extend their activity to include certain gram-negative bacilli and are used for urinary tract infections, meningitis, respiratory infections, and more. Penicillinase-resistant penicillins target resistant Staphylococcus aureus strains, while broad-spectrum penicillins address infections caused by Pseudomonas aeruginosa and other susceptible bacteria. For infections caused by bacteria that produce enzymes that render beta-lactam antibiotics ineffective, penicillins are often administered with beta-lactamase inhibitors like clavulanate or sulbactam. Despite their efficacy, penicillins should be used cautiously during pregnancy, weighing the benefits against potential risks. However, they are generally considered safe for use during breastfeeding.1,10

Clinically introduced in 1964, cephalosporins are potent broad-spectrum antibiotics that target cell wall synthesis in a wide range of bacteria, including both gram-positive and gram-negative strains. Cephalosporins are categorized into different generations, each offering varying levels of activity and coverage against different bacterial species. First-generation cephalosporins are effective against gram-positive cocci and are commonly used for skin and soft-tissue infections. Second-generation cephalosporins and cephamycins target gram-positive cocci and certain gram-negative bacilli, while third generation cephalosporins are efficacious against haemophilus influenzae and enterobacterales. Fourth generation cephalosporins, like cefepime, combine enhanced activity against gram-negative bacilli with effectiveness against gram-positive cocci. A recent addition, 5th-generation cephalosporins such as ceftaroline and ceftobiprole, target methicillin-resistant S. aureus (MRSA) and certain strains of enterococcus faecalis. Although cephalosporins are generally safe during pregnancy with no significant fetal risks demonstrated, caution is advised during breastfeeding due to potential alterations in infant bowel microbiota.1,11

Monobactams are a unique class of antibiotics, with aztreonam only available for clinical use. Discovered in 1981, aztreonam is derived from a synthetic molecule based on SQ 26,180 from chromobacterium violaceum. Monobactams target cell wall synthesis and are effective against specific gram-negative bacteria, including enterobacterales and pseudomonas aeruginosa, but not anaerobes or gram-positive bacteria. Typically, aztreonam is reserved for severe aerobic gram-negative infections, especially in patients with beta-lactam allergies who still require beta-lactam therapy. Their resistance to metallo-beta-lactamases adds therapeutic value in resistant infections. While cross-hypersensitivity is rare, caution is advised with ceftazidime and cefiderocol. During pregnancy, aztreonam use depends on the risk-benefit assessment. However, monobactams safety during breastfeeding is generally accepted. In renal failure, dosages need to be reduced.1,12

Carbapenems, such as ertapenem, imipenem, and meropenem, are part of a class of antibiotics originally isolated from actinomycetes species. Discovered in 1976 and clinically introduced in 1985, they are potent broad-spectrum antibiotics that disrupt bacterial cell wall synthesis, making them effective against numerous bacteria, including challenging strains like Pseudomonas aeruginosa and Enterococcus faecalis. Administered via injection, carbapenems are often combined with aminoglycosides to enhance therapeutic outcomes. Imipenem is usually co-administered with cilastatin and sometimes relebactam to prolong its effectiveness. While structurally akin to penicillins, carbapenems may induce allergic reactions in individuals sensitive to penicillins. Common applications of carbapenems include treating severe infections like gangrene, sepsis, pneumonia, and abdominal and urinary tract infections, especially those caused by bacteria resistant to other antibiotics. Excluding ertapenem, these antibiotics are effective against pseudomonas and enterococcal infections. Although animal studies show no fetal harm, data on pregnant women are scarce. Carbapenems present in breast milk may affect the infant’s gut bacteria balance.1,13,14

Non-Lactam Bactericidal Antibiotics

Glycopeptides are potent antibiotics derived from actinomycetes. Currently, vancomycin is the only glycopeptide available for clinical use. Glycopeptides target cell wall synthesis, particularly the D-Ala-D-Ala termini of lipid II and is effective against a broad range of gram-positive cocci and bacilli, including many strains of resistant staphylococcus aureus and coagulase-negative staphylococci. Vancomycin is primarily administered parenterally due to poor gastrointestinal absorption and is crucial for managing serious infections and endocarditis. However, its efficacy against methicillin-susceptible S. aureus is limited. Despite being an alternative for treating pneumococcal meningitis, its efficacy can be compromised due to inconsistent penetration into the cerebrospinal fluid. Vancomycin is also used orally for clostridioides difficile-induced diarrhea. While its use during pregnancy or breastfeeding is generally discouraged due to potential risks, vancomycin may be considered in certain situations where the benefits outweigh the drawbacks. However, its use during breastfeeding is discouraged due to potential adverse effects on the infant’s gastrointestinal microbiota.1,15

Lipoglycopeptides are intravenous bactericidals that combat gram-positive bacteria by impeding cell wall synthesis and disrupting membrane integrity. Antibiotics in this category include dalbavancin, oritavancin, teicoplanin, and telavancin. Telavancin has a shorter half-life, while dalbavancin and oritavancin offer extended half-lives for single-dose regimens. Lipoglycopeptides target a broad spectrum of gram-positive bacteria, encompassing streptococci, enterococcus faecalis, enterococcus faecium, and methicillin-resistant or vancomycin-intermediate-resistant Staphylococcus aureus strains. Notably, oritavancin demonstrates efficacy against vancomycin-resistant enterococci harboring the vanA gene. Telavancin is used for complex skin infections and pneumonia, while dalbavancin and oritavancin primarily treat acute bacterial skin infections. Though lipoglycopeptides present risks to fetal development in animal studies, their impact on pregnant women remains underexplored, urging cautious use. Additionally, data on breast milk excretion is limited. Thus, lipoglycopeptides should be employed during pregnancy only when potential benefits outweigh fetal risks.1,16

Lipopeptides constitute a unique class of bactericidal antibiotics with a distinct mechanism of action. They bind to bacterial cell membranes, leading to rapid depolarization and potassium efflux, which disrupts DNA, RNA, and protein synthesis, ultimately causing concentration-dependent bacterial death. Daptomycin is the only clinically used lipopeptide. Daptomycin exhibits broad-spectrum activity against gram-positive bacteria, including multidrug-resistant strains. It is primarily employed for infections caused by vancomycin- and methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. However, resistance may develop during therapy, leading to persistent or relapsing infections. In pneumonia, daptomycin may be inferior to ceftriaxone, possibly due to its binding to pulmonary surfactant, which diminishes its activity in the alveolar epithelial lining fluid. Animal studies have not indicated fetal risk with daptomycin, but human pregnancy data are limited to case reports, and its placental crossing extent remains uncertain. Depending on the indication and severity of illness, using daptomycin during pregnancy may be considered. Although daptomycin enters breast milk, its low oral availability makes its effects on breastfeeding infants unclear.1,17

Polypeptides are a class of bactericidal antibiotics first discovered in 1939 and introduced clinically in 1941. They attack the bacterial cell wall, forming ion channels that increase membrane permeability, inhibiting cell wall synthesis to cause cell death. While most polypeptides are used topically due to negligible systemic absorption, polypeptides such as colistin and polymyxin B exhibit rapid concentration-dependent bactericidal activity against many gram-negative bacilli, including pseudomonas aeruginosa and acinetobacter species. However, they are ineffective against certain bacteria and obligate anaerobes. In hospitals, IV colistin has seen increased use against extensively drug-resistant gram-negative bacilli, particularly in serious systemic infections like ventilator-associated pneumonia and bacteremia. Still, its use is limited due to toxicity, and it is typically reserved for cases with no less toxic options. Combining polymyxins with other antibiotics, such as meropenem, is common for treating multidrug-resistant bacteria. The effectiveness of these combinations has not been extensively studied in clinical trials.1,18

Phosphonates represent a novel class of antibiotics with a unique chemical structure. Produced by Streptomyces fradiae, phosphonates target cell wall synthesis in bacteria by inhibiting MurA (UDP-GlcNAc3-enolpyruvyltransferase), disrupting peptidoglycan production. Fosfomycin is a phosphonate that exhibits broad-spectrum activity against both gram-positive and gram-negative organisms, including antibiotic-resistant strains like MRSA, VRE, ESBL-producing and carbapenem-resistant Klebsiella pneumoniae, and fluoroquinolone-resistant Escherichia coli. Oral fosfomycin is primarily indicated for uncomplicated urinary tract infections, while IV fosfomycin may be used for infections with multidrug-resistant organisms at various sites. Fosfomycin crosses the placenta but is generally considered safe for treating cystitis during pregnancy. Use of phosphonates is cautioned for breastfeeding women due to the unknown amount of fosfomycin excreted in breast milk.1,19

Bactericidal Antibiotics That Inhibiting Bacterial Enzymes or Protein Translation

Bactericidal antibiotics that inhibit bacterial enzymes or protein translation disrupt essential enzymatic reactions or protein synthesis pathways vital for bacterial survival and reproduction, ultimately leading to bacterial death. This category includes fluoroquinolones, mupirocin, sulfonamides, azoles, nitrofurans, and ansamycins.1,8,9

Fluoroquinolones represent a significant class of antibiotics renowned for their bactericidal activity against a diverse range of bacterial pathogens. With their discovery dating back to 1962 and their subsequent clinical introduction in the same year, fluoroquinolones, including ciprofloxacin, inhibit DNA synthesis by targeting DNA gyrase and topoisomerase IV enzymes, both crucial for bacterial DNA replication. Fluoroquinolones are categorized into older and newer groups, with drugs like ciprofloxacin, norfloxacin, and ofloxacin belonging to the former, while delafloxacin, gemifloxacin, levofloxacin, and moxifloxacin fall under the latter category. These antibiotics exhibit broad-spectrum activity against a plethora of bacterial pathogens, including haemophilus influenzae, pseudomonas aeruginosa, mycobacterium tuberculosis, and various enterobacterales. Despite their effectiveness, several newer fluoroquinolones have been withdrawn from the market due to systemic toxicity concerns. Also, they are no longer recommended as the primary treatment for conditions like gonorrhea due to increasing resistance.1,20

Mupirocin is a potent antibacterial agent that was discovered in 1971 and clinically introduced in 1985. It targets protein synthesis, explicitly inhibiting isoleucyl t-RNA synthetase, which disrupts bacterial RNA synthesis. One of the main advantages of mupirocin is its negligible systemic absorption when applied topically, minimizing the risk of systemic side effects. Mupirocin’s 2% topical preparation is particularly effective in treating various skin infections such as impetigo, minor superficial secondarily infected skin lesions, and staphylococcus aureus nasal carriage. However, it is important to note that chronic therapy with mupirocin may lead to the development of mupirocin-resistant staphylococci, which can limit its long-term effectiveness. Despite its efficacy, mupirocin may cause mild local adverse effects when applied to denuded skin or mucous membranes, including itching and burning sensations.1,21

Azoles, like metronidazole, represent a class of bactericidal antibiotics crucial in combating various infections. Discovered in 1959 and introduced clinically in 1960, metronidazole induces DNA damage upon entering bacterial cell walls, inhibiting DNA synthesis in susceptible microorganisms. Oral metronidazole demonstrates excellent absorption, with intravenous administration reserved for cases where oral treatment is not feasible. The antibiotic distributes widely in body fluids and can penetrate cerebrospinal fluid, achieving high concentrations at the site of infection. Its spectrum of activity encompasses infections caused by obligate anaerobes, including intra-abdominal, pelvic, soft-tissue, periodontal, and odontogenic infections. Metronidazole also has proven to be effective against certain protozoan parasites such as trichomonas vaginalis, entamoeba histolytica, and giardia intestinalis (lamblia). Notably, it stands as the first-line treatment for bacterial vaginosis.1,22

Nitrofurans, such as nitrofurantoin, was discovered in 1945 and clinically introduced in 1953. Nitrofurans target DNA synthesis to induce DNA damage and acts on common uropathogens, including escherichia coli, staphylococcus saprophyticus, and enterococcus faecalis. They are primarily indicated for the treatment or prophylaxis of uncomplicated lower urinary tract infections (UTIs) and may reduce the frequency of recurrent UTIs in women. Nitrofurantoin also remains a viable option for treating uncomplicated cystitis caused by these pathogens. However, most strains of proteus, providencia, morganella, serratia, acinetobacter, and pseudomonas species exhibit resistance, limiting nitrofurantoin’s spectrum. Nitrofurantoin is exclusively available for oral administration. Following a single dose, serum drug levels remain minimal, yet therapeutic concentrations are achieved in urine. Animal studies suggest nitrofurantoin is generally safe during pregnancy, with no observed fetal risks. However, nitrofurantoin is contraindicated during labor or delivery due to potential risks of neonatal hemolytic anemia arising from its interference with immature red blood cell enzyme systems. Nitrofurantoin should be avoided during the first month of breastfeeding as it enters breast milk, posing a risk of hemolytic anemia in neonates, particularly those with hyperbilirubinemia.1,23

Ansamycins, including rifamycins, rifampin, rifabutin, and rifapentine, are a class of antibiotics that target nucleic acid synthesis by inhibiting bacterial DNA-dependent RNA polymerase, thereby impeding RNA synthesis. These antibiotics demonstrate efficacy against a spectrum of bacteria, including most gram-positive and certain gram-negative bacteria and mycobacterium species. Orally administered, they exhibit excellent absorption, resulting in broad distribution throughout body tissues and fluids, including cerebrospinal fluid. Rifampin accumulates in polymorphonuclear granulocytes and macrophages, aiding bacterial clearance from abscesses. Rifampin finds application in treating tuberculosis, atypical mycobacterial infections, leprosy, staphylococcal infections, legionella infections, pneumococcal meningitis, and prevention for close contacts of patients with meningococcal or Haemophilus influenzae type B meningitis. Rifabutin serves as an alternative to rifampin in tuberculosis regimens for HIV-positive patients receiving antiretroviral therapy due to its lower potential for inducing cytochrome P-450 metabolic enzymes. Rifapentine is utilized in treating pulmonary and latent tuberculosis.1,24

Bacteriostatic Antibiotics

Bacteriostatic antibiotics prevent bacterial growth and reproduction but do not necessarily kill bacteria. Bacteriostatic antibiotics do this by interfering with bacterial protein production, DNA replication, or other aspects of bacterial cellular metabolism. They work with the immune system to remove the microorganisms from the body. High concentrations of some bacteriostatic agents are also bactericidal. Prevalent bacteriostatic antibiotics include sulfonamides, aminoglycosides, tetracyclines, macrolides, streptogramins, lincosamides, amphenicols, oxazolidinones, and pleuromutilin.1,8,9

Sulfonamides represent a class of synthetic bacteriostatic antibiotics renowned for inhibiting the pathway that converts p-aminobenzoic acid to dihydropteroate, a crucial process for bacterial folate synthesis and subsequent purine and DNA synthesis. Unlike humans, who obtain folate from dietary sources, bacteria heavily rely on this pathway, rendering them vulnerable to sulfonamide action while sparing human DNA synthesis, to a certain extent. Sulfonamides are available in various formulations for oral, topical, and ophthalmic use. These antibiotics are typically well-absorbed orally and have extensive distribution throughout the body. Clinically, sulfonamides treat a variety of infections. When used alone or combined with other drugs, they treat nocardiosis, urinary tract infections, and chloroquine-resistant falciparum malaria. Topical formulations offer targeted approaches for localized infections. These include silver sulfadiazine and mafenide acetate for burns, sulfanilamide for vaginitis, and sulfacetamide for superficial ocular infections. Notably, sulfasalazine stands out for its oral use in managing inflammatory bowel disease.1,25

Aminoglycosides are potent antibiotics used primarily for severe bacterial infections, particularly those caused by gram-negative bacteria like Pseudomonas aeruginosa. They inhibit bacterial protein synthesis by binding to the 30S ribosome, impeding bacterial protein production. These drugs are poorly absorbed orally but are effective when administered intravenously or intramuscularly. They distribute well into extracellular fluid but poorly into specific body compartments. Aminoglycosides are active against many gram-negative bacilli but lack efficacy against anaerobes and most gram-positive bacteria. Aminoglycosides such as tobramycin, gentamicin, and amikacin are effective against P. aeruginosa. Gentamicin and tobramycin are often used alongside broad-spectrum beta-lactams for severe infections. In endocarditis treatment, aminoglycosides like gentamicin may be combined with other antibiotics for streptococcal or enterococcal infections.1,26

Tetracyclines are a class of bacteriostatic antibiotics that inhibit bacterial protein generation by binding to the 30S subunit of bacterial ribosome. Examples include doxycycline, eravacycline, minocycline, and omadacycline. Absorption rates vary, with doxycycline and minocycline being absorbed better than tetracycline. Generally, tetracyclines penetrate well into most body tissues and fluids, with minocycline having high concentrations in tears and saliva. They are effective against a range of pathogens, including rickettsiae, spirochetes, helicobacter pylori, vibrio species, and some staphylococcus aureus strains. However, resistance is observed in some pneumococcal strains and group A beta-hemolytic streptococci. Minocycline is preferred for methicillin-resistant S. aureus infections. Doxycycline has been shown to be more tolerable for infections caused by rickettsiae, chlamydia, bronchitis exacerbations, Lyme disease, brucellosis, anthrax, plague, tularemia, granuloma inguinale, syphilis, and malaria prophylaxis against chloroquine-resistant P. falciparum.1,27

Macrolides such as erythromycin, azithromycin, and fidaxomicin are a class of antibiotics that bind to the 50S subunit of bacterial ribosomes, thereby inhibiting bacterial protein synthesis. First discovered in 1952, these antibiotics are relatively poorly absorbed orally, with fidaxomicin being minimally absorbed and active only locally in the gastrointestinal tract. Food can affect macrolide absorption, with varying effects depending on the specific formulation. Once absorbed, macrolides diffuse well into body fluids, with the exception of cerebrospinal fluid, and are concentrated in phagocytes. They are active against various pathogens, including aerobic and anaerobic gram-positive cocci, mycoplasma pneumoniae, chlamydia trachomatis, legionella species, and borrelia burgdorferi. Macrolides are typically considered the drug of choice for group A streptococcal and pneumococcal infections when penicillin cannot be used. They are also often used empirically for lower respiratory tract infections due to their activity against atypical respiratory pathogens.1,28

Streptogramins are antibiotics used in combination to treat serious infections, especially skin infections, caused by bacteria resistant to other antibiotics. Streptogramins work by inhibiting bacterial protein synthesis, preventing the bacteria from producing the proteins they need to grow and multiply. Streptogramins such as quinupristin and dalfopristin are administered intravenously, typically through a central catheter inserted into a large central vein, such as in the neck, or through a peripherally inserted central catheter (PICC) threaded to a large central vein in the upper arm. These antibiotics target various bacteria, including streptococci and staphylococci (including resistant strains), some gram-negative anaerobic bacilli, clostridium perfringens, peptostreptococcus species, and atypical respiratory pathogens like mycoplasma pneumoniae, chlamydophila pneumoniae, and legionella pneumophila. Streptogramins inhibit enterococcus faecium, including vancomycin-resistant strains, but enterococcus faecalis is resistant.29,30

Lincosamides are bacteriostatic antibiotics that impede bacterial protein synthesis, specifically the 50S ribosomal subunit, which is essential for bacterial growth and multiplication. Clindamycin is well-absorbed orally and can be given parenterally. It distributes well in body fluids, with the exception of cerebrospinal fluid, and is concentrated in phagocytes. Lincosamides like clindamycin treat various infections, including those resistant to other antibiotics, including anaerobes, community-acquired methicillin-resistant staphylococcus aureus, and macrolide-resistant streptococcus pneumoniae. Clindamycin is often part of combination therapy for various infections, including toxigenic streptococci infections, cerebral toxoplasmosis, babesiosis or falciparum malaria, and pneumocystis jirovecii pneumonia. Topical clindamycin is also used for acne treatment. However, it is unsuitable for central nervous system infections.29,31

Oxazolidinones are a class of synthetic bacteriostatic antibiotics introduced clinically in 2000. They target the 50S ribosomal subunit, preventing bacteria from multiplying. Linezolid and tedizolid are examples of oxazolidinones that exhibit activity against a wide range of pathogens, including streptococci, enterococci (including vancomycin-resistant strains), staphylococci (including methicillin-resistant S. aureus and other resistant strains), mycobacteria (including mycobacterium tuberculosis), and anaerobes such as fusobacterium, prevotella, porphyromonas, bacteroides species, and peptostreptococci. These antibiotics are typically reserved for treating severe infections, especially when other antibiotics have proven ineffective. Oxazolidinones have become critical therapeutic options in the management of multidrug-resistant bacterial infections.29,32

Amphenicols such as chloramphenicol are antibiotics that inhibit bacterial protein synthesis by binding to the 50S subunit of the ribosome. Amphenicols were introduced clinically in 1949 and are well absorbed orally but are typically administered intravenously. Amphenicols are distributed widely in body fluids, including cerebrospinal fluid, and are excreted in urine. Chloramphenicol exhibits a broad spectrum of activity against gram-positive and gram-negative cocci and bacilli, including anaerobes, as well as against rickettsia, mycoplasma, chlamydia, and chlamydophila species. However, chloramphenicol is no longer the preferred choice for most infections due to its potential for bone marrow toxicity, the availability of alternative antibiotics, and the emergence of resistance. It is reserved for infections caused by multidrug-resistant bacteria susceptible to this type of antibiotic, and specific conditions like plague meningitis or endophthalmitis, where other drugs penetrate poorly.33

Taking Antibiotics as Prescribed

Proper use of antibiotics is paramount to ensure their value in treating bacterial infections while minimizing the risk of adverse effects and antibiotic resistance. When prescribed antibiotics, it is crucial to adhere to the instructions provided by healthcare providers or pharmacists. Instructions include taking the prescribed dose at the recommended intervals and not stopping the medication early, even if symptoms improve. Completing the entire course of antibiotics as prescribed is essential, as incomplete treatment can contribute to developing antibiotic-resistant bacteria, making future infections more challenging to treat. Antibiotics should never be shared with others or saved for future use. Each antibiotic prescription is tailored to specific bacterial infections and individual health conditions. Sharing antibiotics or using leftover medication can lead to inappropriate use and also contribute to antibiotic resistance. It is imperative to promptly report any adverse reactions or side effects to healthcare providers for proper management and treatment adjustments. Patients should also be mindful of potential interactions between antibiotics and other substances, including alcohol and other medications. Consulting healthcare providers or pharmacists, these interactions can prevent adverse effects and ensure the effectiveness of the treatment. Proper storage of antibiotics is also critical to maintain the stability and efficacy of the drugs. Antibiotics should be stored in their original packaging at room temperature, away from moisture and heat, and out of reach of children and pets. Expired antibiotics should be disposed of properly according to local regulations.1-5,34

Antibiotic Resistance

Antibiotic resistance is the ability of bacteria to withstand the effects of antimicrobial drugs that were previously effective against them. These microorganisms evolve and adapt in ways that render antibiotics less effective or completely ineffective in killing or inhibiting their growth. Resistance to antibiotics can either be inherent in a particular bacterial species, acquired through mutations, or attained through the assimilation of antibiotic-resistance genes from other microorganisms. Resistance genes can be transferred between bacterial cells through three primary mechanisms:

  • Transformation
  • Transduction
  • Conjugation

Transformation involves the uptake of naked DNA from the environment, and where the bacteria secure DNA fragments released by other resistant bacteria upon cell death. These DNA fragments contain resistance genes, among other genetic material. Once internalized, the bacteria incorporate the foreign DNA into its own genome through recombination. This mechanism allows bacteria to acquire antibiotic resistance and other new traits, adapting to changing environments. 1,4,5,9

Transduction is a process by which bacterial DNA is transferred from one bacterium to another via bacteriophages; viruses that infect bacteria. A bacteriophage infects a bacterial cell and integrates its genetic material, which includes its resistance genes, into the bacterial genome.

Conjugation involves the direct transfer of genetic material between bacterial cells. This process requires physical contact between the recipient cell and the donor cell, which harbors the resistance genes on extrachromosomal DNA elements such as plasmids or transposons. Plasmids are circular DNA molecules capable of independent replication within bacteria. They often carry genes encoding antibiotic resistance and can be transferred between bacterial cells during conjugation. Transposons, or “jumping genes,” are segments of DNA that can move from one location to another within the bacterial genome or between plasmids and chromosomes. During conjugation, plasmids or transposons containing resistance genes are transferred from the donor to the recipient cell through a specialized protein bridge called a pilus. Once transferred, the resistance genes enable the recipient cell to survive in the presence of antibiotics.1,4,5,9

Antibiotic resistance presents a critical challenge in healthcare and public health due to several interconnected factors. As bacteria evolve and develop resistance mechanisms, they render widely used antibiotics ineffective against them. This means that common bacterial infections, such as pneumonia, urinary tract infections, and skin infections, may become increasingly difficult to treat. When antibiotics fail to eradicate bacterial infections, patients may experience prolonged illness, increased hospitalizations, and a higher risk of complications. In severe cases, antibiotic resistance can lead to treatment failure and death, raising the rates of morbidity and mortality. As antibiotic resistance spreads, the number of effective antibiotics available to treat bacterial infections decreases. This limitation in treatment options leaves healthcare providers with fewer choices for managing infections, particularly those caused by multidrug-resistant bacteria. In some cases, infections may become untreatable with currently available antibiotics, leading to dire clinical outcomes. This leads to extended hospital stays, additional medical interventions, and the need for more expensive antibiotics, resulting in increased healthcare costs. Concurrently, resistant bacteria can spread within healthcare settings, communities, and across geographical borders, making containment challenging, leading to outbreaks and the potential for widespread transmission of resistant bacteria. 1,4,5,9

Side Effects and Allergic Reactions

Antibiotics, while effective in treating bacterial infections, can also cause side effects, adverse reactions, and allergic reactions in some individuals. Reactions can range from mild to severe and may vary depending on the type of antibiotic and individual patient factors. Mild side effects include taste disturbances, as seen with lipoglycopeptides, and black hairy tongue caused by oral penicillin. These types of side effects are generally harmless and resolve after the drug is stopped. At the other end of the spectrum, severe adverse reactions may include bone marrow depression (from chloramphenicol), reversible neutropenia and thrombocytopenia (from vancomycin), and renal toxicity (from polypeptides). These reactions usually arise from prolonged use and/or frequent or high doses.1,10-33

Many antibiotics disrupt the normal balance of bacteria in the patient’s microbiome. For example, antibiotics may deplete normal gut flora within the gastrointestinal tract, leading to symptoms such as nausea, vomiting, diarrhea, or abdominal pain. Prolonged use can increase the risk of Clostridium difficile infection, which can cause severe diarrhea and colitis. Certain antibiotics, such as tetracyclines and fluoroquinolones, can make the skin more sensitive to sunlight, increasing the risk of sunburn and skin reactions when exposed to sunlight or ultraviolet (UV) light. These drugs may also interact with other medications, either increasing or decreasing their effectiveness or causing adverse effects. For example, the polypeptides colistin methane sulfonate and polymyxin B should not be given simultaneously with drugs that block neuromuscular transmission (rocuronium) or are nephrotoxic (aminoglycosides).1,10-33

Allergic reactions to antibiotics can vary widely in severity. Mild allergic reactions may include rash, itching, or hives. In contrast, more severe reactions can lead to difficulty breathing, swelling of the face or throat, or anaphylaxis, which is a life-threatening emergency and requires immediate medical attention. Some antibiotics, such as certain aminoglycosides, can cause damage to specific organs, such as the kidneys or liver, especially with prolonged use or in patients with pre-existing conditions. Tetracycline antibiotics, when given to children under the age of 8 or during pregnancy, can lead to permanent discoloration of developing teeth and bones. Given the variety, healthcare providers must be aware of potential side effects and allergic reactions associated with specific antibiotics before prescribing. These risks should be carefully deliberated with the benefits of antibiotic therapy, the patient’s condition, and their medical history.1,10-33

Nursing Considerations

Nursing considerations play a crucial role in ensuring the safe and effective use of antibiotics and encompass a wide array of responsibilities, including antibiotic administration, monitoring, and patient education. This involves diligent observation of vital signs, laboratory values, and localized symptoms to track the response to antibiotic therapy and promptly detect any adverse reactions. Additionally, nurses are tasked with accurately administering antibiotics according to prescribed dosages, routes, and schedules, ensuring optimal drug absorption and effectiveness while adhering to established medication safety protocols to prevent errors. Documentation of antibiotic administration, patient responses, and any adverse reactions must be meticulously maintained to ensure accurate records and facilitate effective communication among healthcare team members. Collaboration within the interdisciplinary team is essential, as nurses collaborate with physicians, pharmacists, and infection control specialists to deliver coordinated and evidence-based care to patients receiving antibiotics.1,3

In addition, the responsibilities mentioned, patient education must not be forgotten. Nurses should provide comprehensive information about antibiotic treatment, emphasizing key aspects, including the importance of completing the course as prescribed, the risks associated with antibiotic resistance, potential side effects, and when to seek medical attention. These efforts ensure patients adhere to the treatment regimens for optimal therapeutic outcomes. Infection control measures must also be upheld to prevent the spread of bacteria and other healthcare-associated infections. This includes practices such as: 1,3

  • Regular and thorough handwashing with soap and water or using alcohol-based hand sanitizers to remove potentially harmful microorganisms from hands.
  • The use of appropriate personal protective equipment (PPE) such as gloves, gowns, masks, and goggles to protect themselves and others from exposure to infectious agents.
  • Isolating patients with contagious infections to prevent the spread of pathogens.
  • Proper injection handling and disposal techniques to prevent needle injuries and the transmission of bloodborne pathogens.
Conclusion

Antibiotics are indispensable agents in the management of bacterial infections, offering a diverse array of mechanisms to combat microbial pathogens. Types of antibiotics, including bactericidal to bacteriostatic antibiotics target various aspects of bacterial physiology, disrupting essential processes to eradicate pathogens, limit growth, and halt the progression of infections. However, antibiotic resistance continues to pose a significant challenge to global health. This concern demands more stringent stewardship practices to preserve the efficacy of existing antibiotics and develop novel therapeutic strategies. It is essential for healthcare providers to understand the nuances of antibiotic therapy, including side effects, allergic reactions, and nursing considerations. Then, through careful selection and adherence to dosing regimens, patients can gain the therapeutic benefits of antibiotics while minimizing the risk of resistance and adverse reactions. Through judicious use and prudent management, healthcare providers can mitigate the emergence of antibiotic resistance and safeguard the health of individuals and populations worldwide.

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