Infectious and Dermatological Issues Drug Therapies

Antimicrobial Classes and Their Side Effects

  • Penicillin: antibacterial, cell wall inhibitor (Adams, Holland, & Urban, 2013). Side effects: diarrhea, nausea, possible pain at the injection site, risk of superinfections. The most serious possible side effect is anaphylaxis.
  • Cephalosporin: antibacterial, cell wall inhibitor. Side effects: “diarrhea, abdominal cramping, nausea, fatigue, rash, pruritus, pain at injection sites, oral or vaginal candidiasis” (Adams et al., 2013, p. 481).
  • Tetracycline: antibacterial, protein synthesis inhibitor. Side effects: may “affect vaginal, oral, and intestinal flora” (Adams et al., 2013, p. 483); superinfections also may be caused. Other side effects include nausea, vomiting, epigastric burning, diarrhea, photosensitivity, and discoloration of the teeth.
  • Macrolide: antibacterial, protein synthesis inhibitor. Side effects: “[n]ausea, vomiting, diarrhea, abdominal cramping, dry skin or burning” (Adams et al., 2013, p. 483). They are considered safer than penicillin.
  • Aminoglycoside: antibacterial, protein synthesis inhibitor. Side effects: “[p]ain or inflammation at the injection site, rash, fever, nausea, diarrhea, dizziness, tinnitus” (Adams et al., 2013, p. 485).
  • Fluoroquinolone: antibacterial, nucleic acid inhibitor. Side effects: “[n]ausea, diarrhea, vomiting, rash, headache, restlessness,…and corneal irritation (ophthalmic)” (Adams et al., 2013, p. 486).

Antimicrobial resistance is the ability of bacteria to prevent the effect of antimicrobials applied against them. It is important that resistance is not the same as tolerance, as the former refers to the context of infections, which is why “[m]icroorganisms become resistant to the effects of an antibiotic: They do not become tolerant” (Adams et al., 2013, p. 111). Growing resistance to various antimicrobials has been observed on a global scale within recent decades, which became a serious international health issue. According to Davies, Fowler, Watson, Livermore, and Walker (2013), a way to ensure that international antimicrobial resistance does not become a bigger problem is to support innovation and advanced research in medicine.

Drug Therapies for Dermatological Issues

Drug therapy for allergic dermatitis should include topical glucocorticosteroids and topical calcineurin inhibitors (immunomodulators) (Wolverton, 2012). The choice of particular medications should take into consideration the location of sites affected by dermatitis and the surface characteristics of inflammation. Disadvantages include the side effects of glucocorticosteroids, such as high blood pressure, dizziness, and eye problems.

For bacterial dermatitis, treatment should use topical antibiotics. For superficial infections, in order to prevent recurrences, disinfectants should be used as well (Wolverton, 2012). Disadvantages of this drug therapy include the side effects of antibiotics, which may vary in a wide range of types of antibiotics. Common side effects are nausea, vomiting, diarrhea, and abdominal cramps.

In the case of viral dermatitis, the main component of the drug therapy is oral penicillin (Wolverton, 2012). In most cases, a 7-day course is sufficient. Disadvantages include common side effects of antibiotics described above.

Although treatment of cellulitis can be limited to drainage sometimes (if the abscess is at a stage where it has not yet damaged tissues significantly), in most cases, antibiotics are needed (Wolverton, 2012). Penicillin is adequate in the majority of cases; people who are allergic to it should take clindamycin or vancomycin.

Among the therapies described above, the one for cellulitis was examined more closely to suggest additional recommendations. The effectiveness of dicloxacillin, amoxicillin, and cephalexin has been proved among pharmacologists (Horseman & Bowman, 2013). In case a patient has an allergy to penicillin, macrolide can be used. Depending on specific characteristics such as dynamics and location, cellulitis may require fluoroquinolones as part of treatment. Although, it should be considered that more resistance to them has been observed recently. Another possible recommendation is to inject a loading dose of antibiotics that have long half-lives, such as ceftriaxone. With these considerations, treatment can be more effective.

Articles Discussion

In their article, Harr and French (2010) explore two rare drug reactions: toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS). The symptoms of both include hemorrhagic erosions, superficial reddening of the skin, and skin detachment of various extents. The authors discuss how the reactions are identified and classified nowadays and suggest improvements in the theoretical understanding and clinical practice by challenging the current views on TEN and SJS. For example, it is noted that not only certain drugs but also virus infections may cause the reactions. In some cases, however, causes remain unidentified. Since TEN and SJS demonstrate rather high mortality rates, the authors stress the importance of rapid diagnosing. The article proposes scoring systems that are needed to “standardize the evaluation of risk and prognosis in patients with SJS/TEN” (Harr & French, 2010, p. 8). Special attention is paid to the diagnostic methods, including criteria for telling the reactions apart by the surface area of skin detachment and distinguishing them from autoimmune diseases.

Liu and Daum (2011) provide guidelines for healthcare practitioners in approaching patients with methicillin-resistant Staphylococcus aureus (MRSA). In the guidelines, eleven clinical questions are addressed that deal with the management of different symptoms of the disease, the role of adjunctive therapy, and some recommendations concerning certain medications, primarily vancomycin. The addressed symptoms include skin and soft tissue infections (SSTI), the presence of bacteria in the blood, inflammation of the membrane in the heart, inflammation of one or both lungs, bone and joint infections, and infections of the central nervous system. The authors pay special attention to providing thorough recommendations on using vancomycin for treatment, i.e., its dosing and monitoring. Some difficult cases were regarded, such as cases of reduced susceptibility in patients. Various kinds of evidence from clinical practice are gathered and presented to strengthen the guidelines with actual examples. Along with information for adults, the guidelines also provide information for pediatricians.

References

Adams, M. P., Holland, N., & Urban, C. (2013). Pharmacology for nurses: A pathophysiologic approach. New York, NY: Pearson Higher Education.

Davies, S. C., Fowler, T., Watson, J., Livermore, D. M., & Walker, D. (2013). Annual report of the Chief Medical Officer: Infection and the rise of antimicrobial resistance. The Lancet, 381(9878), 1606-1609.

Harr, T., & French, L. E. (2010). Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet Journal of Rare Diseases, 5(39), 1-11.

Horseman, M., & Bowman, J. D. (2013). Is community-acquired methicillin-resistant Staphylococcus aureus coverage needed for cellulitis? Infectious Diseases and Therapy, 2(2), 175-185.

Liu, C., & Daum, R. S. (2011). Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clinical Infectious Diseases, n/a.

Wolverton, S. E. (2012). Comprehensive dermatologic drug therapy. Atlanta, GA: Elsevier Health Sciences.