ISPN Review Anti-Infectives 抗感染药
Anti-infective is an agent that is capable of acting against infection, either by inhibiting the spread of an infectious organism or by killing the infectious organism outright. It encompasses specific agents used to treat particular infections: antibiotics for bacterial infections; antivirals; antifungals; antiprotozoals for infections caused by specific protozoa, including malaria; and anthelmintics for infections caused by worms.
Therapeutic Actions治疗作用
Anti-infective agents may act on the cells of invading organisms in several different ways. The goal is interference with the normal function of the invading organism to prevent it from reproducing and to cause cell death without affecting host cells.
• Some anti-infectives interfere with biosynthesis of the bacterial cell wall. Because bacterial cells have a slightly different composition than human cells, this is an effective way to destroy the bacteria without interfering with the host. The penicillins work in this way.
• Some anti-infectives prevent the cells of the invading organism from using substances essential to their growth and development, leading to an inability to divide and eventually to cell death. The sulfonamides, the antimycobacterials drugs, and trimethoprim-sulfamethoxazole (a combination drug frequently used to treat urinary tract infections) work in this way.
• Many anti-infectives interfere with the steps involved in protein synthesis, a function necessary to maintain the cell and allow for cell division. The aminoglycosides, the macrolides, and chloramphenicol work in this way.
• Some anti-infectives interfere with DNA synthesis in the cell, leading to inability to divide and cell death. The fluoroquinolones work in this way.
有些抗感染药干扰细胞DNA合成，导致细胞分裂不能和细胞死亡。氟喹诺酮类就是如此。
• Other anti-infectives alter the permeability of the cell membrane to allow essential cellular components to leak out, causing cell death. Some antibiotics, antifungals, and antiprotozoal drugs work in this manner.
General Principles 一般原则
Below are general principles of use of anti-infectives across the lifespan.以下是抗感染药物使用的一般原则 CHILDREN 儿童
Use anti-infectives with caution; early exposure can lead to early sensitivity.
谨慎使用抗感染药；初期使用可能导致早期敏感性。
Controversy is widespread regarding the use of antibiotics to treat ear infections, a common pediatric problem. Some believe that the habitual use of antibiotics for what might well be a viral infection has contributed greatly to the development of resistant strains.
Because children can have increased susceptibility to the gastrointestinal and nervous system effects of anti-infectives, monitor hydration and nutritional status carefully.
鉴于儿童对抗感染药胃肠道和神经系统效应易感性的增强，应谨慎监测其水合和营养状况。
ADULTS 成人
Adults often demand anti-infectives for a “quick cure” of various signs and symptoms. Drug allergies and the emergence of resistant strains can be a big problem with this group.
Pregnant and nursing women must exercise extreme caution in the use of anti-infectives. Many of them can affect the fetus and also cross into breast milk, leading to toxic effects in the neonate.
孕妇和授乳妇女对使用抗感染药必须极端小心。很多药物可能影响胎儿，并进入母乳，导致新生儿毒性效应。
OLDER ADULTS 老年人
Older patients often do not present with the same signs and symptoms of infection that are seen in younger people.
老年病人常常不会出现与年轻人相同的感染症状体征。
Culture and sensitivity tests are important to determine the type and extent of many infections.
细菌培养和敏感性试验对确定很多感染的种类和程度很重要。
The older patient is susceptible to severe adverse gastrointestinal, renal, and neurological effects and must be monitored for nutritional status and hydration during drug therapy.
老年病人易感严重的胃肠、肾及神经不利效应，药物治疗期间，应监测其牵头状况及水合情况。
Anti-infectives that adversely affect the liver and kidneys must be used with caution in older patients, who may have decreased organ function.
老年病人使用对肝和肾有不利效应的抗感染药时必须谨慎。这些患者可能有器官功能下降。
Vocabulary for Today
anti-infective – n. a. 抗感染药；抗感染的
encompass – v. 包括，包含，围绕
antiprotozoal – a. 抗原生动物的
protozoa – n. 原生动物
anthelmintics – n. 抗蠕虫药
biosynthesis – n. 生物合成
antimycobacterials – n. 抗分支杆菌药
trimethoprim-sulfamethoxazole – n. 氧苄啶磺胺甲异恶唑合剂
aminoglycosides – n. 氨基糖苷类
macrolides – n. 大环内酯类
chloramphenicol – n. 氯霉素
fluoroquinolones – n. 氟喹诺酮类
controversy – n. 长期争论
combination drugs – 复方抗菌药
Test 1. Which anti-infective agent exerts its effect by interfering with steps in protein synthesis?
A. Macrolide
B. Sulfonamides
C. Antimycobacterial
D. Trimethoprim-sulfamethoxazole
2. A 60 year old male patient on fourth day of his antibiotic therapy complains of dizziness and nausea. Which is the most appropriate nursing action?
A. Institute safety precaution and raise side rails.
B. Collaborate with the doctor about antibiotic therapy’s dosage and duration.
C. Provide comfort measures.
D. Instruct client to inform you if symptoms get worse.
本期ISPN Review答案： 1. A. Macrolide.
All other options are correct but it is best to address the main cause of the patient’s manifestations. Elderly patients are more sensitive to neurologic and GI adverse effects of drugs. 2. B. Collaborate with the doctor about antibiotic therapy’s dosage and duration.
It occurs when the cells of the invading pathogens no longer respond to the drug.
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