ANTIBIOTICS Flashcards
Bacteria
Gram positive
Gram negative
Infections
Community-acquired infection
Health care–associated infections
Community-acquired infection
An infection that is acquired by a person who has not been hospitalized (within the past year) or had a medical procedure (e.g., dialysis, surgery, catheterization) within the past year
Health care–associated infections
Contracted in a health care facility
Were not present or incubating in the patient on admission to the facility
Occurs more than 48 hours after admission
One of the top 10 causes of death in Canada
More difficult to treat because causative microorganisms are often drug resistant and the most virulent
Methicillin-resistant Staphylococcus aureus (MRSA) (most common) and vancomycin-resistant enterococcus(VRE)
Previously known as nosocomial infection
Health Care–Associated Infections: Prevention
Handwashing: the single most important prevention method
Antiseptics
Disinfectants
Disinfectant
Kills organisms
Used only on nonliving objects
Cidal agent
Antiseptic
Generally only inhibits the growth of microorganisms; does not necessarily kill them
Applied exclusively to living tissue
Static agents
Bactericidal
kills bacteria
aminoglycosides
beta-lactams
vancomycin
quinolones
rifampin
metronidazole
Bacteriostatic
prevents bacteria growth
chloramphenicol
erythromycin
clindamycin
sulfonamides
trimethoprim
tetracycline
Antibiotics
Medications used to treat bacterial infections
Ideally, before beginning antibiotic therapy, the suspected areas of infection should be cultured to identify the causative organism and potential antibiotic susceptibilities
Emperic therapy
treatment of an infection before specific culture information has been reported or obtained
Definitive therapy
antibiotic therapy tailored to treat organism identified with cultures
Prophylactic therapy
treatment with antibiotics to prevent an infection, as in intra-abdominal surgery or after trauma
Therapeutic response
Decrease in specific signs and symptoms of infection are noted (fever, elevated white blood cell count, redness, inflammation, drainage, pain).
Subtherapeutic response
Signs and symptoms of infection do not improve.
Antibiotic Therapy Indication
Superinfection
Pseudomembranous colitis:
Clostridium difficile
Secondary infection
Resistance
Antimicrobial stewardship (Accreditation Canada, 2014)
Food–drug interactions
Glucose-6-phosphate dehydrogenase (G6PD) deficiency and slow acetylation
Pregnancy-related host factors
Two abx families that causes severe allergic reactions
Penicillins and sulfonamides are two broad classes of antibiotic to which many people have allergic anaphylactic reactions.
Antibiotic’s most common severe reactions
difficulty breathing; significant rash, hives, or other skin reaction; and severe gastrointestinal (GI) intolerance
Host factors
age, allergies, kidney and liver function, pregnancy status, genetic characteristics, site of infection and host defences
Antibiotics: 8 Classes
Sulfonamides
Penicillins
Cephalosporins
Carbapenems
Macrolides
Aminoglycosides
Tetracyclines
Quinolones
Antibiotic Therapy: Mechanism of Action
Interference with cell wall synthesis
Interference with protein synthesis
Interference with deoxyribonucleic acid (DNA) replication
Acts as a metabolite to disrupt critical metabolic reactions inside the bacterial cell
Actions of Antibiotics
Bactericidal vs Bacteriostatic
Bactericidal (kill bacteria)
Bacteriostatic (inhibit growth of susceptible bacteria rather than killing them immediately; eventually leads to bacterial death)
Antibiotics: Sulfonamides
One of the first groups of antibiotics
Often combined with another antibiotic
Sulfamethoxazole combined with trimethoprim (a nonsulfonamide antibiotic) (Apo-Sulfratrim®, Protrim®, Teva-Trimel®, Septra®) and often abbreviated as SMX-TMP, is used commonly in clinical practice.
Sulfonamides: Mechanism of Action
Bacteriostatic action
Prevent synthesis of folic acid required for synthesis of purines and nucleic acid
Do not affect human cells or certain bacteria; can use preformed folic acid
Only affect organisms that synthesize their own folic acid
Sulfonamides:
Indications
effective againts which bacteria
Effective against both gram-positive and gram-negative bacteria
Treatment of urinary tract infections caused by susceptible strains of Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Proteus vulgaris, Staphylococcus aureus
Pneumocystis jiroveci pneumonia
sulfamethoxazole/trimethoprim (SMX-TMP)
Upper respiratory tract infections
SMX-TMP is commonly used for outpatient Staphylococcus infections because of the high rate of community-acquired MRSA infections.
Sulfonamides: Contraindications
with celoxicib (Celebrex) if have known sulfonamide allergy
in pregnant women and infants younger than 2 months
Sulfonamides: Interactions
Sulfonamide + sulfonylureas = increased hypoglycemic effects
Sulfonamide + Phenytoin = toxicity of phenytoin (seizure med)
Sulf + Warfarin = increased bleeding
Sulf + cyclosporine = nephrotoxicity
Sulfonamides: Adverse Effects
Blood
Integumentary
GI
Other
Blood: Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia
Integumentary: Photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrolysis
GI: Nausea, vomiting, diarrhea, pancreatitis, hepatotoxicity
Other: Convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria, cough
Sulfonamides nursing consideration
Take with plenty of fluids to avoid crystalluria or precipitation in the kidneys
Take with food
ß-Lactam Antibiotics
Penicillins
Cephalosporins
Carbapenems
Monobactams
Penicillins 4 types
Natural penicillins
Penicillinase-resistant penicillins
Aminopenicillins
Extended-spectrum penicillins
2 Natural penicillins
penicillin G
penicillin V
Penicillinase-resistant drugs
cloxacillin sodium
Aminopenicillins
amoxicillin
ampicillin
Some bacteria developed the capacity to destroy penicillins which led to the advent of
β lactamase inhibitors
Two β lactamase inhibitors
Clavulanic acid (clavulanate)
tazobactam
Extended-spectrum drugs
piperacillin sodium/tazobactam sodium (Tazocin)
piperacillin sodium
clavulanic potassium/ticarcillin disodium
Penicillins: Mechanism of Action
Penicillins enter the bacteria via the cell wall.
Inside the cell, they bind to penicillin-binding protein.
Once they are bound, normal cell wall synthesis is disrupted.
As a result, bacteria cells die from cell lysis.
Penicillins do not kill other cells in the body.
Penicillins: Indications
Prevention and treatment of infections caused by susceptible bacteria, such as:
Gram-positive bacteria, including Streptococcus spp., Enterococcus spp., and Staphylococcus spp.
Penicillins: Contraindications and Concerns
Usually safe and well-tolerated medications
Known medication allergy
Type of reaction that occurs in patients who state they are allergic to penicillins
Many medication errors have occurred when a penicillin drug called by its trade name is given to a patient with a penicillin allergy.
Penicillin naming
Not all names end in “cillin” (e.g., Clavulin® A,). Combination of amoxicillin and clavulanic acid)
Penicillins: Adverse Effects
Common adverse effects:
Nausea, vomiting, diarrhea, abdominal pain
Allergic reactions to the penicillins occur in 0.7% to 4% of treatment courses.
-Urticaria, pruritus, angioedema
Patients allergic to penicillins have an increased risk of allergy to other ß-lactam antibiotics.
Only patients with a history of throat swelling or hives from penicillin should not receive cephalosporins.
Penicillins: Interactions
Many interactions!
NSAIDs compete for protein binding (increased effect of penicillin)
Oral contraceptives (decreased effect)
Potassium supplements (worsen hyper K+)
Probenecid (prolongs penicillin effect)
Rifampin (inhibit killing activity of penicillin)
Warfarin (enhances anticoag effect)
Avoid taking oral PEN form with
caffeine, citrus fruit/juice, tomato juice, colas
Cephalosporins
First generation
Second generation
Third generation
Fourth generation
Fifth generation (none available in Canada)
Semisynthetic antibiotics
Structurally and pharmacologically related to penicillins
Bactericidal action
Broad spectrum
Divided into groups according to their antimicrobial activity
Cephalosporins: First Generation
Good gram-positive coverage
Poor gram-negative coverage
Parenteral and oral forms
Example
cephalexin (Keflex®)
cefazolin
Cephalosporins: First Generation
Used for surgical prophylaxis and for susceptible staphylococcal infections
cefazolin: intravenous (IV) or intramuscular (IM)
cephalexin (Keflex): oral dosage
Cephalosporins: Second Generation
Good gram-positive coverage
Better gram-negative coverage than
first- generation cephalosporins
Examples
cefoxitin
cefuroxime
cefaclor
cefprozil
Cephalosporins: Second Generation
cefoxitin (Mefoxin®): IV and IM
TWO
Used prophylactically for abdominal or colorectal surgeries
Also kills anaerobes
Cephalosporins: Second Generation
cefuroxime
TWO
cefuroxime axetil (Ceftin®) is oral form
Surgical prophylaxis
Does not kill anaerobes
Cephalosporins: Third Generation
Most potent group against gram-negative bacteria
Less active against gram-positive bacteria
Examples
ceftazidime
ceftriaxone
cefotaxime sodium
cefixime
cefpodoxime proxetil
ceftizoxime
Cephalosporins: Third Generation
ceftriaxone sodium
IV and IM, long half-life, once-a-day dosing
Elimination is primarily hepatic
Easily passes meninges and diffused into cerebrospinal fluid to treat central nervous system infections
Cephalosporins: Third Generation
ceftazidime (Fortaz®)
IV and IM forms
Excellent gram-negative coverage
Used for difficult-to-treat organisms such as Pseudomonas spp.
Excellent spectrum of coverage
Resistance is limiting usefulness.
Cephalosporins: Fourth Generation
Broader spectrum of antibacterial activity than third-generation cephalosporins, especially against gram-positive bacteria
Uncomplicated and complicated urinary tract infection
cefepime hydrochloride (Maxipime®)
Cephalosporins: Adverse Effects
Similar to those of penicillins
Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema
Potential cross-sensitivity with penicillins if allergies exist
Carbapenems
Broadest antibacterial action of any antibiotics to date
Reserved for complicated body cavity and connective tissue infections in acutely ill hospitalized patients
Must be infused over 60 minutes
May cause drug-induced seizure activity
This risk can be reduced with proper dosage.
1 drug of Carbapenems
imipenem/cilastatin (Primaxin®)
meropenem (Merrem®)
ertapenem (Invanz®)
imipenem/cilastatin (Primaxin®)
Used for?
Cilastatin
Used for treatment of bone, joint, skin, and soft tissue infections; many other uses
Cilastatin inhibits an enzyme that breaks down imipenem.
Monobactams
aztreonam (Cayston®)
Synthetic ß-lactam antibiotic
Primarily active against aerobic gram-negative bacteria (E. coli, Klebsiella spp., Pseudomonas spp.)
Bactericidal
Parenteral use only
Used for management of cystic fibrosis patients with chronic pulmonary Pseudomonas aeruginosa infections
3 Macrolides
erythromycin (E-Mycin®, many others)
azithromycin (Zithromax®)
clarithromycin (Biaxin®)
fidaxomicin (Dificid®)
Macrolides:Mechanism of Action
Prevent protein synthesis within bacterial cells
Considered bacteriostatic
Bacteria will eventually die
In high enough concentrations, may also be bactericidal
Macrolides: Indications
“Strep” infections
-Streptococcus pyogenes (group A ß-hemolytic streptococci)
Mild to moderate upper and lower respiratory tract infections
-Haemophilus influenzae
Spirochetal infections
-Syphilis and Lyme disease
Gonorrhea, Chlamydia, Mycoplasma
Macrolides
Fidaxomicin (Dificid):
Indicated only for the treatment of
newest macrolide
The most common adverse effects are nausea, vomiting, and GI bleed.
Indicated only for the treatment of C. difficile–associated diarrhea
Reasonably safe for use in pregnancy
Minimal absorption
Macrolides: Adverse Effects
erythromycin
azithromycin and clarithromycin:
GI effects, primarily with erythromycin
Nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia, heartburn, abnormal taste.
fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration
2 Tetracyclines
doxycycline hyclate (Doxycin®, Vibramycin®, others)
tigecycline (Tygacil®)
minocycline hydrochloride (Minocin®)
Tetracyclines
Obtained from cultures of
Action
Natural and semisynthetic
Obtained from cultures of Streptomyces
Bacteriostatic: inhibit bacterial growth
Inhibit protein synthesis
Stop many essential functions of the bacteria
What reduces absorption of tetracyclines?
Dairy products, antacids, and iron salts reduce oral absorption of tetracyclines.
Tetracyclines binds to?
Bind (chelate) to Ca+++ and Mg++ and Al+++ ions to form insoluble complexes
Do not use Tetracyclines in?
Should not be used in children younger than 8 years of age or in pregnant or lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth
Tetracyclines: Indications
Wide spectrum
Gram-negative and gram-positive organisms, protozoa, Mycoplasma spp., Rickettsia spp., Chlamydia, syphilis, Lyme disease, acne, others
Tetracyclines: Adverse Effects
Strong affinity for?
calcium
preludes use in…
Children younger than 8 years of age
Results in discolouration of permanent teeth
Pregnant women and nursing mothers
can be another route of exposure leading to tooth discoloration in nursing children
May stunt fetal skeletal development if taken during pregnancy
Tetracyclines: Adverse Effects
Alteration of the intestinal flora
May also cause:
Vaginal candidiasis
Gastric upset
Enterocolitis
Maculopapular rash
Nursing Implications
Before beginning therapy, assess drug allergies; renal, liver, and cardiac function; and other laboratory studies.
Be sure to obtain a thorough patient health history, including immune status.
Assess conditions that may be contraindications to antibiotic use or that may indicate cautious use.
Assess potential drug interactions.
Monitor adverse reactions.
Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better.
Watch for for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge.
For safety reasons, check the name of the medication carefully, because there are many drugs that sound alike or have similar spellings.
Each class of antibiotics has specific adverse effects and drug interactions that must be carefully assessed and monitored.
The most common adverse effects of antibiotics are nausea, vomiting, and diarrhea.
All oral antibiotics are absorbed better if taken with at least 180 mL of water.
It is essential to obtain ____ from appropriate sites before beginning antibiotic therapy.
cultures
Sulfonamides Nursing Implications
Take with 2 000 to 3 000 mL of fluid per 24 hours.
Take oral doses with food.
Encourage patients to immediately report worsening abdominal cramps, stomach pain, diarrhea, hematuria, severe or worsening rash, shortness of breath, and fever.
Penicillins Nursing Implications
Take oral doses with water (not juices) because acidic fluids may nullify the drug’s antibacterial action.
Monitor patients taking penicillin for an allergic reaction for at least 30 minutes after administration.
Cephalosporins Nursing Implications
Assess for penicillin allergy; patient may have cross-allergy.
Give orally administered forms with food to decrease GI upset even though this will delay absorption.
Some of these drugs may cause a disulfiram (acute alcohol intolerance) reaction when taken with alcohol.
Macrolides Nursing Implications
These drugs are highly protein bound and will cause severe interactions with other protein-bound drugs.
The absorption of oral erythromycin is enhanced when the medication is taken on an empty stomach. However, because of the high incidence of GI upset, many medications are taken after a meal or snack.
Tetracyclines Nursing Implications
Avoid milk products, iron preparations, antacids, and other dairy products because of the chelation and drug binding that occur.
Take all medications with at least 180 mL of fluid, preferably water.
Because of photosensitivity, avoid sunlight and tanning beds.
Monitor therapeutic effects.
Improvement of signs and symptoms of infection
Return to normal vital signs
Negative culture and sensitivity tests
Disappearance of fever, lethargy, drainage, and redness
Multidrug-Resistant Organisms
Organisms that are resistant to one or more classes of antimicrobial drugs
Methicillin-resistant Staphylococcus aureus (MRSA)
Vancomycin-resistant Enterococcus (VRE)
Organisms producing extended-spectrum ß-lactamases (ESBLs)
Organisims producing Klebsiella pneumoniae carbapenemase (KPC)
Newer antibiotics have been developed to successfully treat VRE and MRSA.
MRSA
Threat of MRSA becoming resistant to all antibiotics currently available
No longer seen just in hospitals. It has spread to the community setting, and approximately 50% of staphylococcal infections contracted in the community involve MRSA.
VRE
usually seen in urinary tract infections (UTIs)
Extended-spectrum ß-lactamases (ESBL)
Organisms that produce ESBL are resistant to all ß-lactam antibiotics and aztreonam.
Can be treated only with carbapenems or sometimes quinolones
Use of carbapenems: resistance occurred; bacteria created a new means of resistance known as
Klebsiella pneumoniae carbapenemase
tigecycline and colistimethate sodium
Aminoglycosides
Natural and semisynthetic
Several routes available but not given orally because of poor oral absorption
Very potent antibiotics with serious toxicities
Bactericidal; prevent protein synthesis
Kill mostly gram-negative bacteria, some gram-positive bacteria
Aminoglycosides medications
gentamicin sulphate
tobramycin sulphate
neomycin sulphate
streptomycin sulphate
amikacin sulphate
paromomycin sulphate
Aminoglycosides: Indications
Used to kill gram-negative bacteria such as Pseudomonas spp., Escherichia coli, Proteus spp., Klebsiella spp., Serratia spp.
Often used in combination with other antibiotics for synergistic effects
Used for certain gram-positive infections that are resistant to other antibiotics such as Enterococcus spp.,
S. aureus, and bacterial endocarditis, which is usually streptococcal in origin
Aminoglycosides: Indications
Most often given parenterally
neomycin sulphate
-Topical antibacterial
gentamicin
Available in injections, topical ointments, and ophthalmic drops and ointments
Aminoglycosides: Adverse Effects
Serious toxicities
-Nephrotoxicity (kidney damage)
-Ototoxicity (auditory impairment and vestibular impairment [eighth cranial nerve])
Must monitor drug levels to prevent toxicities
Minimum inhibitory concentration
Other less common effects:
Headache
Paresthesia
Fever
Vertigo
Skin rash
Overgrowth of nonsusceptible organisms
Neuromuscular paralysis (very rare and reversible)
Ototoxicity
ear poisoning
damages a person’s inner ear or auditory nerve
can be permanent
symptoms: ear fullness, unsteadiness, unable to tolerate head movement
Nephrotoxicity
kidney toxicity
reversible upon d/c of drug
symptoms: not noticeable, or decrease urination, thirst increased HR, dizziness, and decreased appetite
Aminoglycosides
Therapeutic drug monitoring required
Aminoglycosides: Therapeutic Drug Monitoring
Serum levels measured to prevent toxicity
Serum level needs to be higher than the minimum inhibitory concentration to kill the bacterial.
Time-dependent killing
Concentration-dependent killing
Postantibiotic effect
Resistance
Drug interactions
Aminoglycosides: Therapeutic Drug Monitoring
Peak & Trough
Peak: highest drug levels for once-daily regimens
Trough: lowest, to ensure adequate renal clearance of the drug and avoid toxicity
Aminioglycosides Interactions
Concurrent use of nephrotoxic drugs increase nephrotoxicity
-vancomycin, cylcosporine, amphotericin B
Loop diuretics increase risk for ototoxicity
Increased effect of warfarin/warfarin toxicity
Aminoglycosides Nursing Considerations
Plenty of fluids up to 3000mL/day
Consumption of probiotic type foods
Monitor peak and trough levels
Peak for gentamicin & tobramycin
5-10 mcg/mL
Trough for gentamicin & tobramycin
Less than 2 mcg/mL
Quinolones
Also called fluoroquinolones
Excellent oral absorption, except for norfloxacin hydrochloride
Absorption reduced by antacids, calcium, magnesium, iron, others
Effective against gram-negative organisms and some gram-positive organisms
Quinolones drugs
ciprofloxacin (Cipro®)*
levofloxacin (Levaquin®)*
norfloxacin hydrochloride (Apo-Norflox®)
moxifloxacin hydrochloride (Avelox®)
Quinolones is not recommended in?
- Not normally recommended for children less than 18 years of age because of adverse MSK effects
Quinolones: Mechanism of Action
Bactericidal
Alter deoxyribonucleic acid (DNA) of bacteria, causing death
Do not affect human DNA
Used to treat S. aureus, Serratia marcescens, and
Mycobacterium fortuitum
Bacterial resistance to quinolone antibiotics: Pseudomonas aeruginosa, S. aureus, Pneumococcus spp., Enterococcus spp., and the broad Enterobacteriaceae family that includes E. coli.
Quinolones: Indications
Gram-negative and gram-positive bacteria
Complicated urinary tract, respiratory, bone and joint, gastrointestinal, and skin infections
ciprofloxacin and levofloxacin, both oral and injection
norfloxacin hydrochloride has limited oral absorption and is available only in oral form, so its use is limited to genitourinary infections.
fluoroquinolones
PO/ IV
infections of bone, joint, soft tissues, ophthalmic, resp, GI, abd, prostate, UTIs, STDs
inhibits DNA gyrase and topoisomerase
bactericidal
Quinolones: Interactions
Oral quinolones: antacids, calcium, magnesium, iron, zinc preparations, or sucralfate
Patients need to take the interacting drugs at least 1 hour before or after taking quinolones.
Dairy products
Enteral tube feedings
probenecid
nitrofurantoin
Oral anticoagulants
Quinolones: Adverse Effects
Body system/adverse effects
Central nervous: Headache, dizziness, insomnia, depression, restlessness, convulsions
Gastrointestinal: Nausea, vomiting, diarrhea, constipation, oral candidiasis, dysphagia, increased liver function study results, others
Integumentary: Rash, pruritus, urticaria, flushing
Other: Ruptured tendons, tendonitis, fever, chills, blurred vision, tinnitus
Quinolones HC warning
*Health Canada warning: increased risk of tendonitis and tendon rupture
Miscellaneous Antibiotics
clindamycin (Dalacin C®)
metronidazole (Flagyl®)
vancomycin hydrochloride (Vancocin®)
linezolid (Zyvoxam®)
nitrofurantoin (MacroBID®, Furantoin®)
quinupristin and dalfopristin (Synercid®)
colistimethate sodium (Coly-Mycin®)
clindamycin (Cleocin®)
Used for chronic bone infections, genitourinary infections, intra-abdominal infections, other serious infections
May cause pseudomembranous colitis (also known as antibiotic-associated colitis, Clostridium difficile diarrhea, or C. difficile infection)
Potential interaction with vecuronium bromide
linezolid (Zyvoxam)
New class: oxazolidinones
Used to treat vancomycin-resistant Enterococcus faecium (commonly referred to as VRE), hospital-acquired, and skin structure infections, including infections with MRSA
Strengthens effects of vasopressive drugs, serotonin syndrome if taken with selective serotonin reuptake inhibitors (SSRIs), and reactions if taken with tyramine-containing foods
metronidazole (Flagyl)
Used for anaerobic organisms
Intra-abdominal and gynecological infections
Protozoal infections
Several drug interactions
nitrofurantoin (Furantoin, MacroBID)
Primarily used for UTIs (E. coli, S. aureus,
Klebsiella spp., Enterobacter spp.)
Use carefully if kidney function is impaired.
Drug concentrates in the urine.
May cause fatal hepatotoxicity; very rare
quinupristin–dalfopristin (Synercid)
30:70 combination; works synergistically
Used for bacteremia and infections caused by
VRE and for treatment of complicated skin and skin structure infections caused by S. pyogenes and S. aureus, including MRSA
May cause arthralgias or myalgias
Drug interactions are limited; most severe cyclosporine
Injectable form only
vancomycin hydrochoride (Vancocin)
Treatment of choice for MRSA and other gram-positive infections
Oral vancomycin is indicated for the treatment of antibiotic-induced colitis (C. difficile) and for the treatment of staphylococcal enterocolitis.
Must monitor blood levels to ensure therapeutic levels and prevent toxicity
May cause ototoxicity and nephrotoxicity
vancomycin hydrochoride (Vancocin)
Red man syndrome may occur.
Flushing or itching of head, neck, face, upper trunk
Additive neuromuscular blocking effects in patients receiving neuromuscular blockers
Should be infused over 60 minutes
Rapid infusions may cause hypotension.
Colistimethate sodium (Coly-Mycin)
Polypeptide antibiotic that penetrates and disrupts the bacterial membrane of susceptible strains of gram-negative bacterial
Indicated for Klebsiella pneumoniae carbapenemase–producing organisms
Serious adverse effects
IV, intramuscular, inhalation administration
Nursing Implications
Before beginning therapy, assess drug allergies; hepatic, kidney, and cardiac function; and other laboratory study results.
Be sure to obtain a thorough patient health history, including immune status.
Assess for conditions that may be contraindications to antibiotic use or that may indicate cautious use.
Assess for potential drug interactions.
It is essential to obtain cultures from appropriate sites before beginning antibiotic therapy.
Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early even if they feel better.
Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge
For safety reasons, check the name of the medication carefully because there are many drugs that sound alike or have similar spellings.
Each class of antibiotics has specific adverse effects and drug interactions that must be carefully assessed and monitored.
Monitor therapeutic effects.
Improvement of signs and symptoms of infection
Return to normal vital signs
Negative culture and sensitivity tests
Disappearance of fever, lethargy, drainage, and redness
Observe for and monitor adverse reactions.
