DEFINITION CHEMOTHERAPY & ANTIBIOTICS CHEMOTHERAPY: Chemotherapy is the treatment of infections by substances which destroy or suppress bacteria and other microorganism. The substances / Agents used may natural synthetic or semi – synthetic in nature. ANTIBIOTICS: An antibiotic is a chemical substance produced by microorganism which prevents the growth of other microorganism or kills the other microorganism. These are natural substances CHEMOTHERAPY It is a method of therapy of infectious disease and cancer with chemical agents – chemotherapeutic medicines ANTIBIOTICS CLASSIFIED AS: According to the mode of action on Bacteria: According to the type of Bacteria: According to the effectiveness against microorganism: According to the mode of action on Bacteria: Bacteriostatic: These antibiotics inhibit the growth & multiplication of Bacteria. Eg. Tetracycline, Chloramphenicol, Sulphonamides, Dapsone, Erythromycin, Clindamycin. Bactericidal: These antibiotics destroy or kill all the Bacteria in the process of multiplication. Eg. Penicillin, Aminoglycosides, Cephalosporin, Fluoroquinolones, Rifampicin, Metronidazole etc. According to the type of Bacteria: Gram Positive: Some Antibiotics are effective mainly against Gram Positive Bacteria Eg. Penicillin. Gram Negative: Some Antibiotics are effective mainly against Gram Negative Bacteria Eg. Streptomycin. According to the effectiveness against microorganism: Broad Spectrum: The Antibiotics which acts against wide range of microorganisms. Eg. Tetracycline. Narrow Spectrum: These Antibiotics are useful against limited microorganisms. Eg. Erythromycin Toxic Effects: Gastrointestinal irritation, Nausea, Vomiting and diarrhea may occur when given by mouth. Skin sensitivity may develop with Penicillin or streptomycin causing rashes. Serious toxic effect may occur due to streptomycin on the vestibular & auditory nerve causing vertigo & deafness Drug Resistance: Many bacteria soon develops resistance to particular drug after a period of treatment, so that the bacteria will not respond to the same drug for example tubercle bacillus develops resistance to streptomycin quickly. Super infection: The antibiotics given by mouth kill the normal bacteria inhibiting the alimentary canal and permits the over growth of other insensitive organisms which can cause serious complications. Eg. Fungus cause thrush which may go to the lungs with fatal results. Hypersensitivity Reaction: Chemotherapeutic agents can cause Hypersensitivity reactions from mild rashes to serve anaphylactic shock. Eg. Penicillin & Sulphonamides. Vitamin Deficiency: Alteration in vitamin formation and absorption from the bowel take place . So there is deficiency of Vitamin B complex and Vitamin K. Anemia: In susceptible persons chloramphenicol may produce Aplastic anemia or agranulocytosis. (Action must be taken through proper history about previous drug reaction before administering penicillin sulphonamide and cephalosporin

1. NEHA BHARTI
M.Sc. (MEDICAL SURGICAL NURSING)
NURSING TUTOR, SMVDCoN

3. DEFINITION
CHEMOTHERAPY & ANTIBIOTICS
• CHEMOTHERAPY: Chemotherapy is the treatment
of infections by substances which destroy or
suppress bacteria and other microorganism. The
substances / Agents used may natural synthetic
or semi – synthetic in nature.
• ANTIBIOTICS: An antibiotic is a chemical
substance produced by microorganism which
prevents the growth of other microorganism or
kills the other microorganism. These are natural
substances

4. CHEMOTHERAPY
• It is a method of therapy of infectious disease
and cancer with chemical agents –
chemotherapeutic medicines

7. ANTIBIOTICS CLASSIFIED AS:
According to the mode of action on Bacteria:
According to the type of Bacteria:
According to the effectiveness against
microorganism:

8. According to the mode of action on
Bacteria:
• Bacteriostatic: These antibiotics inhibit the
growth & multiplication of Bacteria. Eg.
Tetracycline, Chloramphenicol, Sulphonamides,
Dapsone, Erythromycin, Clindamycin.
• Bactericidal: These antibiotics destroy or kill all
the Bacteria in the process of multiplication. Eg.
Penicillin, Aminoglycosides, Cephalosporin,
Fluoroquinolones, Rifampicin, Metronidazole etc.

9. According to the type of Bacteria:
Gram Positive: Some Antibiotics are effective
mainly against Gram Positive Bacteria Eg.
Penicillin.
Gram Negative: Some Antibiotics are effective
mainly against Gram Negative Bacteria Eg.
Streptomycin.

10. According to the effectiveness against
microorganism:
o Broad Spectrum: The Antibiotics which acts
against wide range of microorganisms. Eg.
Tetracycline.
o Narrow Spectrum: These Antibiotics are
useful against limited microorganisms. Eg.
Erythromycin

12. • Toxic Effects: Gastrointestinal irritation,
Nausea, Vomiting and diarrhea may occur
when given by mouth.
• Skin sensitivity may develop with Penicillin or
streptomycin causing rashes.
• Serious toxic effect may occur due to
streptomycin on the vestibular & auditory
nerve causing vertigo & deafness

13. • Drug Resistance: Many bacteria soon develops
resistance to particular drug after a period of
treatment, so that the bacteria will not respond
to the same drug for example tubercle bacillus
develops resistance to streptomycin quickly.
• Super infection: The antibiotics given by mouth
kill the normal bacteria inhibiting the alimentary
canal and permits the over growth of other
insensitive organisms which can cause serious
complications. Eg. Fungus cause thrush which
may go to the lungs with fatal results.

14. • Hypersensitivity Reaction: Chemotherapeutic
agents can cause Hypersensitivity reactions
from mild rashes to serve anaphylactic shock.
Eg. Penicillin & Sulphonamides.
• Vitamin Deficiency: Alteration in vitamin
formation and absorption from the bowel take
place . So there is deficiency of Vitamin B
complex and Vitamin K.

15. • Anemia: In susceptible persons
chloramphenicol may produce Aplastic
anemia or agranulocytosis. (Action must be
taken through proper history about previous
drug reaction before administering penicillin
sulphonamide and cephalosporin to the
patient.

16. Selection of Appropriate
antimicrobial Agents
The choice of antimicrobial agents depends on
following factors: Patient factors
1. Age.
2. History or Allergy.
3. Genetic abnormalities.
4. Pregnancy.
5. Host defence.
6. Hepatic dysfunction.
7. Renal dysfunction.

17. 2. Drug factor
1. Route of administration.
2. Spectrum of antimicrobial activity.
3. Bactericidal/Bacteriostatic effect.
4. Cost of the AMA (American Medical
Association)

18. 3. Organism related factor
1. Clinical Diagnosis.
2. Bacteriological reports.
3. Resistance to AMA drugs.
4. Cross resistance

19. Pharmacology of commonly used
Drugs:
•Penicillin •Cephalosporin’s •Aminoglycosides
•Macrolide & Broad Spectrum Antibiotics
•Sulphonamides •Quinolones •Ant amoebic •
Antimalarial • Antithelmintic • Antiscabies
agents • Antiviral & Antifungal agents
• Antitubercular drugs • Antileprosy drugs
• Anticancer drugs •Immune-suppressants

20. 1. PENICILLIN

21. BETA-LACTAM ANTIBIOTICS
• The beta lactam antibiotics have a beta lactam
ring. Penicillin, cephalosporins, monobactams.
They constitute one of the most important and
most frequently used groups of antibiotics
available to combat infectious disease.

23. PENICILLIN
The penicillins are the oldest class of antibiotics.
These have a common chemical structure.
It is first described by Sir ALEXENDER
FLEMING in 1928 and isolated by FLOREY
and CHAIN in 1940 from penicillin notatum.
The first clinical application was in 1941.
These drugs are produced by penicillin and
aspergillus species.
It had a significant impact in health care during
war times in the 1940s. They reduce the death rate
from pneumonia in American soldiers from 18%.

24. INTRODUCTION
• Penicillins were the first antibiotics to be
isolated and used clinically in 1941.
• Penicillins usually are bactericidal, they are
most effective against fast growing susceptible
bacteria.

25. Mechanism of Action
• Penicillin inhibit the synthesis of bacterial cell
wall and causing rapid cell lysis

28. CLASSIFICATION
• NATURAL: Penicillin G
• SEMISYNTHETIC:
1. Acid resistant: Penicilin V
2. Penicillinase resistant: methicillin, oxacillin,
cloxacillin
3. Aminopenicillins: ampicillin, bacamipicillin,
amoxicillin
4. Antipseudomonal penicilli
 Carboxypenicillins: carbenicillin, carbenicillin-
indanyl, ticarcillin
 Ureidopenicillins: azlocillin, mezlocillin, piperacillin

31. Natural penicillins (Penicillin G)
• Penicillin G has a narrow antibacterial
spectrum and is effective against gram positive
cocci and bacilli and a few gram negative
cocci. Thus streptococci, pneumococci,
gonococci, meningococci, diptheria, clostridia
and spirochaetes are highly sensitive.

32. • Pharmacokinetics: it is destroyed by gastric juices,
food interferes with its absorption- hence it is given
2 hours after food. Half life is short of 30 mints. It
does not readily cross the BBB. It is excreted by the
kidneys.
• Preparation and dose: penicillin G is mainly given
parenterally though orally effective form. Oral
penicillin is used only in minor infections.
DRUG DOSE ROUTE TRADE NAME
SODIUM
PENICILLIN
0.5-5MU IM/IV CRYSTAPEN
PROCAINE
PENICILLIN G
0.5-1MU IM PROCAINE
PENICILLIN G
BENZATHINE
PENICILLIN G
1.2-2.4 MU DEEP IM PENIDURE LA

33. ADVERSE EFFECTS
• Hypersensitivity
• Hemolytic anemia
• LOCAL: Pain,
Thrombophlebitis
• CNS: Confusions, Muscle
Twitching, Convulsions And
Coma.
• JARISCH-HERXHEIMER
REACTION: Fever, Myalgia,
Shivering.

34. USES
• Pneumococcal Infections
• Streptococcal Infections
• Meningococcal Infections
• Staphylococcal Infections
• Syphillis
• Diptheria
• Anaerobic Infections
• Actinomycosis
• Tetanus And Gas Gangrene
• OTHER INFECTIONS: Anthrax, Trench Mouth, Rat
Bite Fever
• PROPHYLACTIC USES: Rheumatic Fever, Gonorrhea
And Syphillis, Vascular Heart Disease

35. DISADVANTAGES
• Narrow Spectrum Of Activity
• Not Effective Orally
• Susceptible To Penicillinase
• Risk of Hypersensitivity

36. SEMISYNTHETIC PENICILLINS
• ACID RESISTANT PENICILLIN: Penicillin V
(phenoxymethyl penicillin) is acid stable and can be
given orally. It is used only in, mild streptococcal
pharyngitis, sinusitis and trench mouth.
• Dose: 250-500 mg 6 hourly

37. PENICILLINASE RESISTANT PENICILLINS:
penicillin resistant penicillins are resistant to
hydrolysis by penicillinase produced by bacteria.
Methicillin is destroyed by gastric juices hence
given parenterally.
Cloxacillin is given orally
Nafcillin is highly resistant to penicillinase and also
has useful activity against non- penicillinase
producing organisms. It requires parenteral
administration because of its unreliable absorption
from the gut.

38. USES
• Penicillinase resistant penicillins are the drugs of
choice for infections with penicillinase producing
staphylococci.
• Methicillin resistant strains have now emerged and
are treated with vancomycin.

39. SEMISYNTHETIC PENICILLINS
DRUG DOSE ROUTE TRADE NAME
PENICILLIN 250-500MG QID ORAL CRYSTAPEN-V
CLOXACILLIN 250-500MG QID ORAL KLOX
DICLOXACILLIN 250-500 MG
QID
ORAL BIOCLOX
NAFCILLIN 1-2GM 4-6 HR IV UNIPEN
AMPICILLIN 250MG TO 1GM
QID
ORAL, IM/IV AMPILLIN,
ROSILLIN
AMPICILLIN+SULBACT
AM
1GM +0.5G QID
6-8HRS
IV SULBACIN
AMOXICILLIN 250-500MG TID ORAL NOVAMOX,
SYNAMOX
AMOXICILLIN+CLAVUL
ANIC ACID
250 MG+125
MG TID
ORAL AUGMENTIN

40. EXTENDED SPECTRUM
PENICILLINS
• AMINOPENICILLIN: these agents cover a wide
antibacterial spectrum including many gram-
negative bacilli. They are orally effective but are
sensitive to beta lactamase.
• ANTIBACTERIAL SPECTRUM: Both gram
positive and gram negative organisms including
streptococci, meningococci, H. Influenzae, E-coli,
proteus, salmonella, shigella and klebsiella are
sensitive. Many strains are now resistant.

41. • AMPICILLIN is well absorbed orally, food interferes
with absorption and is excreted mainly through
kidneys.
• ADVERSE EFFECTS: Diarrhea due to irritation of
the gut by the unabsorbed drug is the most common
adverse effects with ampicillin. Skin rashes are also
fairly frequent.
• USES:
 Respiratory tract infections
 Urinary tract infections
 Meningitis
 Typhoid
 Septicemia due to gram negative organism

42. • BACAMPICILLIN: It is an ester of ampicillin. It is a
prodrug that is better absorbed and having longer
acting.
• AMOXYCILLIN: It is differs from ampicillin in the
following:
 It is better absorbed orally
 Food does not interfere with its absorption
 Diarrhea is rare
 It is given thrice daily, whereas ampicillin is given four
times a day.
• USES: Amoxycillin is used in similar infections,
salmonella gastroenteritis and UTI. It is a component of
the various regimens to eradicate H. Pylori. Amoxicillin
is preferred over ampicillin by many.

43. ANTIPSEUDOMONAL
PENICILLIN
• CARBOXYPENICILLINS: In addition to
activity against gram positive and gram negative
organisms is also effective against pseudomonas
aeruginosa and proteus infection. Carbenicillin is
given parenterally in the dose of 2-5 gms 6 hourly
IM or IV while Carbenicillin indanyl is effective
orally. It may be given both IM and IV.
• ADVERSE EFFECTS: It is used as a sodium
salts and in higher doses this excess sodium may
cause edema.

44. • UREIDOPENICILLINS: It have a wider
antibacterial spectrum than Ticarcillin and are
effective against a variety of gram negative
organisms including pseudomonas and Klebsiella.
Moreover, their sodium content is low.
• AZLOCILLIN, MEZLOCILLIN AND
PIPERACILLIN: These are all administered
intravenously. When combined with a beta-
lactamase inhibitors, piperacillin can be
considered to have the broadest antibacterial
spectrum among the penicillins. It crosses the
BBB and is therefore useful in meningitis. Dose
3-4 grams 4-6 hourly. Piperacillin is indicated in
severe infections particularly due to
Pseudomonas.

46. CLAVULANIC ACID SULBACTAM TAZOBACTAM
Beta lactamases and is
combined with amoxicillin for
both oral and parenteral
administration. It extends the
antibacterial spectrum of
amoxicillin and the
combination inhibits
organisms like betalactamase
producing staphylococci,
gonococci, E. Coli and H.
Influenzae. The combination is
used for mixed aerobic –
anaerobic and nosochomial
infections. Clavulanic acid is
also combined with ticarcillin
for parenteral use.
It is combined with ampicillin.
It is given parenterally for
mixed pelvic and other
infection infections.
Iit is combined with
piperacillin for parenteral
administration.

47. NURSING IMPLICATIONS
A penicillin should never be injected without taking
history of allergy and conducting an intradermal
sensitivity test.
If an outpatient receives a penicillin injection,
preferably the patient should be asked to stay on and
observed for 30 minutes for the fear of development
of allergic reactions.
A patient allergic to penicillin may also be allergic
to cephalosporin's.

48. DRUG INTERACTIONS
1. Penicillin's may decrease the effect of
aminoglycosides.
2. Bacterial effects of penicillin may decrease
with tetracycline drugs.
3. Use of penicillin with clavulanate or
sulbactum increase resistance against
bacteria that produce beta – lactamase

49. NURSING RESPONSIBILITIES
• Before administration of drug, obtain patients
allergic history.
• After administration observe sign and
symptoms of an allergic reaction.
• Do not allow to take oral contraceptive with
this therapy.

50. THANKYOU