Tetracyclines and Sulfonamides

8/7/2019 Tetracyclines and Sulfonamides

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Broad spectrum antibiotic

Composed of four tetra hydro carbon

rings

Resistance to tetracyclines has limitedtheir use

Includes Sumycin, Doxycycline, Minocin,Demeclocycline


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Bind to microbial ribosome and inhibits

protein synthesis of bacteria

Resistance to tetracyclines occurs whenthe permeability of the cell changes

Can be toxic to human cells in high

concentrations


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First line therapy for Rocky MountainSpotted Fever, Q fever, psittacosis, and

lymphogranuloma venerum Recommended for prophylactic

treatment of malaria in areas wheremalaria is endemic

Can also be used to treat acne andcertain protozoan infections

Can be used as a marker for bonegrowth in humans


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Patients with known allergies to the

components or to tartrazine

Should not be used in pregnancy as itaffects developing bones and teeth and

can cause permanent staining

Metabolites are toxic and can causeFanconi Syndrome, a fatal disease that

affects the proximal tubular function inkidneys


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May increase muscle weakness in

patients with myasthenia gravis and

increase exacerbations in patient withlupus

Should be used with caution in patientswith hepatic or renal dysfunction


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Decreases effectiveness of oral

contraceptives

Accutane and supplements with vitaminA: Can increase the risk of pseudo tumor

cerebri or benign intracranialhypertension

Methotrexate: may elevate serum

methotrexate levels leading tomethotrexate toxicity


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Foods high in calcium (cheese, milk, yogurt,and cottage cheese) can decreaseabsorption of tetracycline. Administrationof tetracyclines should be done one hourbefore consuming these foods

Absorption of iron containing foods andsupplements can be decreased by

tetracyclines, so administration oftetracyclines should occur one hour prior toconsuming these foods.


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Irritation of the GI tract

Nausea, vomiting, diarrhea, and

abdominal pain

Hepatotoxicity

Damage to teeth and bones

Anaphylaxis Severe headache and vision problems


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Tetracycline (Sumycin)

Chlortetracycline (Aureomycin)

Oxytetracycline (Terramycin)

Doxycycline (Vibramycin)


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Available in the following forms: Capsule

Syrup Tablet Suspension Powder for Suspension

Capsule, Extended Release Tablet, Delayed Release Capsule, Delayed Release Tablet, Extended Release


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1 gram as 500 mg b.i.d. or 250 mg q.i.d.

Higher doses such as 500 mg q.i.d. may

be required for severe infections Syphilis in patients allergic to penicillin:

early syphilis (less than one yearsduration)-500 mg q.i.d. for15 days.

Syphilis of more than one years duration

(except neurosyphilis)-500 mg q.i.d. for

30 days


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Acne: The recommended initial dosage

is 1 gram daily in divided doses.

Children above eight years of age Usual daily dose, 10 to 20 mg/lb (25 to 50

mg/kg) body weight divided in four

equal doses Tetracyclines are not recommended for

children under 8 years of age and

pregnant women.


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Tetracycline antibiotics have been

reported to cause increased sensitivity to

the sun, increasing the risk of sunburn orskin rash. Because St. John's Wort and

Dong Quai may also cause this problem,

taking these herbal supplements during

tetracycline treatment might add to thisrisk.


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Include several groups of drugs

Original antibacterial sulfonamides (also

called sulfa drugs) are syntheticantimicrobial agents

Some sulfonamides do not haveantimicrobial activity (such as Sultiame)

The distinction should be made betweensulfa drugs and drugs that contain sulfaadditives which do not cause the samehypersensitivity.


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Sulfonamides interfere with PABA and

folic acid synthesis.

Since folic acid is not synthesized inhumans, but taken as a dietary

supplement, selective toxicity of thesecells occurs.

Action is effects seen are usually

bacteriostatic


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Sulfonamides are active against:

Toxoplasma

Urinary tract infections

Sexually transmitted infections

Klebisella

Pneumonia

E-coli infections


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Allergy or sensitivity to components

Porphyria

Pregnant patients and nursing mothers

Patients with megloblastic anemia due

to folate deficiency

Patients with hepatic or renalinsuffiencency


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Coumadin: may increase the plasmaconcentration of Coumadin

anticoagulants Cyclosporine: may reduce serum

cyclosporine concentrations leading toallograft rejection.

Leucovorin: use of leucovorin andsulfonamides in the treatment of PCP hasbeen associated with increasedtreatment failure rates and morbidity


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Avoid alcoholic beverages, especially

beer. Patients have reported

experiencing, dyspnea, headache,flushing, palpitations, and nausea

Patients should be encouraged to takemedication with food if GI upset occurs.


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Hypersensitivity such as rashes, Stevens-

Johnson syndrome, serum sickness, drug

fever, and angioedema Crystalluria, anuria, and oliguria

Thrombocytopenia, hemolytic anemia

Photosensitivity Neurologic effects (insomnia and

headache)


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Sulfamethoxazole/Trimethoprim

Sulfisoxazole (Gantrisin)

Cotrimoxazole (Bactrim, Septra)

Sulfasalazine (Azulfidine )


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Sulfadiazine: Adult: 2-4 g PO loadingdose, then 2-4 g/d PO in 4 to 6 divided

doses Pediatric: 75mg/kg PO then 120-150

mg/kg/d PO in four to six divided doses

Sulfisoxazole: Adult: 2-4 g PO loading

dose, then 4-8 g/d PO in four to 6 divideddoses

Pediatric: 75 mg/kg PO, then 120-150mg/kg/d PO in four to six divided doses


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Salicite containing herbs such as aspen

bark, black cohash, popular, sweet birch

may interfere with sulfonamides similarlyas aspirin does

There may be an increased risk ofbleeding when using sulfonamides and

celery, anise, ginger, feverfew, and

clove.


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Assess drug allergies, hepatic, liver, andkidney function prior to beginning therapy

Assess for conditions that may becontraindications to use of medication

Assess for potential drug-drug, drug-food,and herbal interactions

Instruct patients to take medication exactlyas directed until medication is complete.Encourage them to discard unusedmedication


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Assess for s/s of super-infection Encourage patients to increase fluid (water)

intake Avoid sunlight and tanning beds Instruct patients to notify physician/health

practitioner if experiencing allergicreactions

Some GI irritability is to be expected.Patients should notify physician/healthpractitioner if nausea, vomiting, or diarrheais persistent.


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You are discharging Ms. Jackson home fromthe hospital with a prescription for Doxycycline.Ms. Jackson states she drinks carrot juice 3

times a day to help with her night vision. Whichof the following responses is an appropriateresponse to Ms. Jacksons statement?

A: Carrots are excellent for eyesight. Goodjob

B: Carrots contain Vitamin A and this mayinterfere with the absorption of yourmedication.

C: Eating carrots in their raw form is a bettersource of Vitamin A


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Which of the following herbal

supplements can interfere with the

absorption of sulfonamides? Basil

Vitamin C

Protein drinks


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Ms. Smith is taking Doxycycline. She is gettingmarried and has made an appointment for atanning salon. What is the most appropriate

response to her statement? A You will look pretty in your white dress with a

tan.

B Drink plenty of water to keep hydrated.

C use of a tanning bed is not recommendedwhile on Doxycycline therapy. The medicationcauses skin to become sensitive to light andyou may burn.


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Karch, A. M. (2011). Focus on Nursing

Pharmacology (5th ed.). Philadelphia:

Wolters Kluwer/ Lippincott Williams &Wilkins.

www.drugs.com

www.merckmanual.com www.wikipedia.com

Tetracyclines and Sulfonamides

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