Antimicrobial Drugs

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M34_ADAM9811_03_SE_CH34.QXD 12/30/09 1:16 PM Page 495 TABLE 34. 9 Selected Miscellaneous Antibacterials Drug Route and Adult Dose (max dose where indicated) Adverse Effects aztreonam (Azactam) IV/IM; 0.5–2.0 g bid–qid (max: 8 g/day) Nausea, vomiting, diarrhea, rash, fever, insomnia, cough Anaphylaxis, superinfections chloramphenicol PO/IV; 50 mg/kg qid Nausea, vomiting, diarrhea Anaphylaxis, superinfections, pancytopenia, bone marrow depression, aplastic anemia clindamycin (Cleocin) PO; 150–450 mg qid Nausea, vomiting, diarrhea, rash Anaphylaxis, superinfections, cardiac arrest, pseudomembranous colitis, blood dyscrasias daptomycin (Cubicin) IV; 4 mg/kg once every 24 h for 7–14 days Nausea, diarrhea, constipation, headache Anaphylaxis, superinfections, myopathy, pseudomembranous colitis ertapenem (Invanz) IV/IM; 1 g/day Nausea, diarrhea, headache Anaphylaxis, superinfections, pseudomembranous colitis, seizures fosfomycin (Monurol) PO; 3-g sachet dissolved in 3–4 oz of water as a single dose Nausea, diarrhea, back pain, headache Anaphylaxis, superinfections imipenem-cilastatin (Primaxin) IV; 250–500 mg tid–qid (max: 4 g/day) Nausea, vomiting, diarrhea, pain at injection site, headache Anaphylaxis, superinfections, pseudomembranous colitis lincomycin (Lincocin) PO; 500 mg tid–qid (max: 8 g/day) Nausea, vomiting, diarrhea Anaphylaxis, superinfections, cardiac arrest, pseudomembranous colitis, blood dyscrasias linezolid (Zyvox) PO; 600 mg bid (max: 1,200 mg/day) Nausea, diarrhea, headache Anaphylaxis, superinfections, pseudomembranous colitis, blood dyscrasias meropenem (Merrem IV) IV; 1–2 g tid Nausea, vomiting, diarrhea, pain at injection site, headache Anaphylaxis, superinfections, pseudomembranous colitis, seizures methenamine (Mandelamine, Hiprex, Urex) metronidazole (Flagyl) nitrofurantoin (Furadantin, Macrobid, Macrodantin) PO; 1 g bid (Hiprex) or qid (Mandelamine) PO; 7.5 mg/kg every 6 h (max: 4 g/day) IV loading dose; 15 mg/kg IV maintenance dose; 7.5 mg/kg every 6 h (max: 4 g/day) PO; 50–100 mg qid (max: 7 mg/kg/day) Nausea, vomiting, diarrhea, increased urinary urgency Anaphylaxis, crystalluria Dizziness, headache, anorexia, abdominal pain, metallic taste and nausea, Candida infections Seizures, peripheral neuropathy, leukopenia Nausea, vomiting, anorexia, dark urine Anaphylaxis, superinfections, hepatic necrosis, interstitial pneumonitis, Stevens–Johnson syndrome quinupristin–dalfopristin (Synercid) IV; 7.5 mg/kg infused over 60 min every 8 h Pain and inflammation at injection site, myalgia, arthralgia, diarrhea Superinfections, pseudomembranous colitis telithromycin (Ketek) PO; 800 mg/day Nausea, vomiting, diarrhea Visual disturbances, hepatotoxicity, dysrhythmias vancomycin (Vancocin, others) IV; 500 mg qid or 1 g bid PO; 125–500 mg every 6 h Nausea, vomiting Anaphylaxis, superinfections, nephrotoxicity, ototoxicity, red-man syndrome Italics indicate common adverse effects; underlining indicates serious adverse effects. # 102887 Cust: PE/NJ/CHET Au: ADAMS Pg. No. 495 Title: Pharmacology for Nurses Server: Jobs2 C/M/Y/K Short / Normal DESIGN SERVICES OF S4CARLISLE Publishing Services
M34_ADAM9811_03_SE_CH34.QXD 12/30/09 1:16 PM Page 496 496 Unit 5 The Immune System NURSING PROCESS FOCUS PATIENTS RECEIVING ANTIBACTERIAL THERAPY Assessment Potential Nursing Diagnoses Baseline assessment prior to administration: ■ Understand the reason the drug has been prescribed in order to assess for therapeutic effects. ■ Obtain a complete health history including neurologic, cardiovascular, respiratory, hepatic or renal disease, and the possibility of pregnancy. Obtain a drug history including allergies, including specific reactions to drugs, current prescription and OTC drugs, herbal preparations, and alcohol use. Be alert to possible drug interactions. ■ Assess signs and symptoms of current infection noting location, characteristics, presence or absence of drainage and character of drainage, duration, and presence or absence of fever or pain. ■ Evaluate appropriate laboratory findings (e.g., CBC, C&S, hepatic and renal function studies). Assessment throughout administration: ■ Assess for desired therapeutic effects (e.g., diminished signs and symptoms of infection and fever). ■ Continue periodic monitoring of CBC, hepatic and renal function, urinalysis, C&S, peak and trough drug levels. ■ Assess for adverse effects: nausea, vomiting, abdominal cramping, diarrhea, drowsiness, dizziness, and photosensitivity. Severe diarrhea, especially containing mucus, blood, or pus; yellowing of sclera or skin; and decreased urine output or darkened urine should be reported immediately. Planning: Patient Goals and Expected Outcomes The patient will: ■ Experience therapeutic effects (e.g., diminished signs and symptoms of infection, decreased fever). ■ Be free from, or experience minimal, adverse effects. ■ Verbalize an understanding of the drug’s use, adverse effects, and required precautions. ■ Demonstrate proper self-administration of the medication (e.g., dose, timing, when to notify provider). Interventions and (Rationales) Ensuring therapeutic effects: ■ Continue assessments as described earlier for therapeutic effects. (Diminished fever, pain, or signs and symptoms of infection should begin after taking the first dose and continue to improve.The health care provider should be notified if fever and signs of infection remain after 3 days or if entire course of the drug has been taken and signs of infection are still present.) Minimizing adverse effects: ■ Continue to monitor vital signs. Immediately report undiminished fever, changes in level of consciousness (LOC), or febrile seizures to the health care provider. (Fever should begin to diminish within 1 to 3 days after starting the drug. A continued fever may be a sign of worsening infection, adverse drug effects, or antibiotic resistance.) ■ Continue to monitor periodic lab work: hepatic and renal function tests, CBC, urinalysis, C&S, and peak and trough drug levels. (Many antibacterials are hepatic and/or renal toxic. Periodic C&S tests may be ordered if infections are severe or are slow to resolve to confirm appropriate therapy. Drug levels will be monitored with drugs with known severe adverse effects.) ■ ■ ■ ■ ■ ■ ■ Infection Pain (related to infection) Hyperthermia Deficient Knowledge (drug therapy) Risk for Injury (related to adverse drug effects) Risk for Deficient Fluid Volume (related to fever, diarrhea caused by adverse drug effects) Risk for Noncompliance (related to adverse drug effects, deficient knowledge, or cost of medication) Implementation Patient and Family Education ■ ■ ■ ■ Teach the patient to report a fever that does not diminish below 100°F within 3 days; increasing signs and symptoms of infection; or symptoms that remain present after taking the entire course of the drug. Teach the patient to not stop antibacterial when “feeling better” but to take the entire course of antibacterial; do not share doses with other family members with similar symptoms; and return to the health care provider if symptoms have not resolved after entire course of therapy. Teach the patient to immediately report a fever that does not diminish below 100°F; febrile seizures; and changes in behavior or LOC to the health care provider. Instruct the patient on the need for periodic lab work. # 102887 Cust: PE/NJ/CHET Au: ADAMS Pg. No. 496 Title: Pharmacology for Nurses Server: Jobs2 C/M/Y/K Short / Normal DESIGN SERVICES OF S4CARLISLE Publishing Services
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Antimicrobial Drugs

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