MEDICATION

Penicillin G
Benzathine

MEDICATION

CLASSIFICATION

ACTION

ANTIINFECTIVE; B
ETA-LACTAM
ANTIBIOTIC; NATU
RAL PENICILLIN

Acid-stable,
penicillinasesensitive, longacting form of
penicillin G.
Absorbed slowly in
body because of
extremely low
water solubility.
Produces lower
blood
concentrations
than other
penicillin G
compounds but
has the longest
duration of
antimicrobial
activity of all
other available
parenteral or
repository
penicillins.

CLASSIFICATION

Penicillin G Procaine
Broad-spectrum
antiinfective

CLIENTS
INDICATION
Infections highly
susceptible to
penicillin G, such
as Streptococcal,
Pneumococcal, and
Staphylococcal infec
tions, venereal
disease such as
syphilis (including
early, late, and
congenital forms),
and nonvenereal
diseases (e.g., yaws,
bejel, and pinta).
Also used in
prophylaxis of
rheumatic fever.

ACTION
Interferes with cell
wall replication of
susceptible
organisms;
osmotically unstable
cell wall swells,

CONTRAINDICAT
ION
Hypersensitivity
to penicillins or
cephalosporins;
lactation;
pregnancy
(category B).

CLIENTS
INDICATION
Respiratory
infections, scarlet
fever, erysipelas,
otitis media,
pneumonia, skin
and soft tissue
1

ADVERSE EFFECTS

NURSING
RESPONSIBILITIES

Body as a Whole:
Local pain, tenderness, Assessment & Drug
Effects
and
fever associated with
Determine history of
IM injection, chills,
hypersensitivity
fever,
reactions to
wheezing, anaphylaxis
penicillins,
,
cephalosporins, or
neuropathy, nephrotox
other allergens prior
icity; superinfections,
to initiation of drug
Jarisch-Herxheimer
therapy.
reaction in patients
with syphilis.
Lab tests: Perform
Skin: Pruritus,
culture and
urticaria and other skin
sensitivity tests prior
eruptions.
to initiation of
Hematologic: Eosino
therapy and
philia, hemolytic
periodically
anemia and other
thereafter. Perform
blood abnormalities.
periodic renal
function tests.

CONTRAINDICATI
ON
Hypersensitivity to
penicillins; neonates
Precautions:
Hypersensitivity to
cephalosporins,

ADVERSE
EFFECTS

CNS:
Lethargy,
hallucinations,
anxiety,
depression,

NURSING
RESPONSIBILITIES
Assessment

Assess
patient for
previous
sensitivity

bursts from osmotic

pressure, results in
cell death

infections,
gonorrhea;
prevention of
rheumatic fever;
glomerulonephritis

pregnancy (B),
lactation, severe
renal disease

twitching, coma,
seizures

GU: Oliguria,
proteinuria,
hematuria,
vaginitis,
moniliasis,
glomerulonephrit
is

HEMA:
Anemia,
increased
bleeding
time, bone
marrow
depression,
granulocytopeni
a

GI: Nausea,
vomiting,
diarrhea,
increased AST,
ALT, abdominal
pain, glossitis,
colitis

META:
Hyperkalemia,
hypokalemia,
alkalosis,
hypernatremia

reaction to
penicillins or
cephalosporins;
cross-sensitivity
between
penicillins and
cephalosporins is
common

Assess
patient for signs
and symptoms of
infection
including
characteristics of
wounds, sputum,
urine, stool, WBC
>10,000/mm3,
earache, fever;
obtain baseline
information and
information
during treatment

Obtain C&S
before beginning
drug therapy to
identify if correct
treatment has
been initiated

Assess for
allergic reactions:
rash, urticaria,

MISC: Anaphy
laxis, local pain,
tenderness and
fever with IM
injection

pruritis, chills,
fever, joint pain;
angioedema may
occur a few days
after therapy
begins;
epinephrine,
resuscitation
equipment should
be available for
anaphylactic
reaction

Identify urine
output; if
decreasing, notify
prescriber (may
indicate
nephrotoxicity);
also check for
increased BUN,
creatinine

Monitor
electrolytes:
potassium,
sodium, chloride
monthly if patient
is on long-term
therapy

Assess bowel
pattern daily; if
severe diarrhea

occurs, drug
should be
discontinued;
may indicate
pseudomembran
ous colitis

Monitor for
bleeding:
ecchymosis,
bleeding gums,
hematuria, stool
guaiac daily if on
long-term
therapy

Assess for
overgrowth of
infection:
perineal itching,
fever, malaise,
redness, pain,
swelling,
drainage, rash,
diarrhea, change
in cough, sputum
Implementation

Do not
give IV

Give deeply
in large muscle

mass

MEDICATION
Penicillin V

CLASSIFICATION
ANTIINFECTIVE; BET
A-LACTAM
ANTIBIOTIC; NATUR
AL PENICILLIN

ACTION
Acid-stable analog
of Penicillin G with
which it shares
actions; it is
bactericidal, and is

CLIENTS
INDICATION
Mild to moderate
infections caused by
susceptible
Streptococci,
Pneumococci,
5

CONTRAINDICATI
ON
Hypersensitivity to
any penicillin or
cephalosporin or
beta-lactamase
inhibitors;

ADVERSE
EFFECTS
Nausea,
vomiting, diarrhea,
epigastric distress.
Hypersensitivity
reactions (e.g.,

Reconstitute
with 0.9% NaCl,
sterile water for
inj, D5W;
refrigerate
unused portion

Shake
medication
before
administering

IM route may
include procaine
reactions: fear of
death,
depression,
seizures, anxiety,
confusion,
hallucination

NURSING
RESPONSIBILITIES
Assessment &
Drug Effects

Obtain careful

inactivated by
penicillinase

and Staphylococci.
Also Vincent's
infection and as
prophylaxis in
rheumatic fever.

pregnancy
(category B),
lactation.

Cautious Use
History of or
suspected allergy
(hay fever, asthma,
hives, eczema);
cystic fibrosis; renal
impairment, hepatic
impairment;
children <12 y,
newborns.

MEDICATION
Ampicillin

CLASSIFICATION
ANTIINFECTIVE;
ANTIBIOTIC;
AMINOPENICILLI

ACTION
A broadspectrum
semisynthetic,

CLIENTS
INDICATION
Infections of GU,
respiratory, and
GI tracts and
6

CONTRAINDICATI
ON
Hypersensitivity
to penicillin
derivatives;

flushing, pruritus,
urticaria or other
skin eruptions,
eosinophilia, anaphy
laxis; hemolytic
anemia, leukopenia,
thrombocytopenia,
neuropathy,
superinfections).

ADVERSE
EFFECTS
Body as a
Whole:
Similar to those

history
concerning
hypersensitivity
reactions to
penicillins,
cephalosporins,
and other
allergens before
therapy begins.

Lab tests:
Perform C&S
tests prior to
initiation and at
regular intervals
throughout
therapy. Evaluate
renal, hepatic,
and hematologic
systems at
regular intervals
in patients
receiving
prolonged
therapy.

NURSING
RESPONSIBILITIES
Assessment & Drug
Effects

aminopenicillin
is highly
bactericidal
even at low
concentrations,
but is
inactivated by
penicillinase
(betalactamase).

skin and soft

tissues; also
gonococcal
infections,
bacterial
meningitis, otitis
media, sinusitis,
and septicemia
and for
prophylaxis of
bacterial
endocarditis.
Used
parenterally
only for
moderately
severe to severe
infections.

infectious
mononucleosis.
Cautious Use
History of severe
reactions to
cephalosporins;
pregnancy
(category B) or
lactation.

for

penicillin G.
Hypersensitivity
(pruritus,
urticaria,
eosinophilia,
hemolytic
anemia,
interstitial

nephritis,
anaphylactoid
reaction);
superinfections.
CNS: Convulsive
seizures with
high doses.
GI: Diarrhea, na
usea, vomiting,
pseudomembran
ous colitis.
Other: Severe

pain (following
IM); phlebitis
(following
IV). Skin: Rash.

Determine
previous
hypersensitivity
reactions to penicillins,
cephalosporins, and
other allergens prior to
therapy.
Lab tests: Baseline
C&S tests prior to
initiation of therapy;
start drug pending
results. Baseline and
periodic assessments
of renal, hepatic, and
hematologic functions,
particularly during
prolonged or high-dose
therapy.
Note: Sodium
content of drug must
be considered in
patients on sodium
restriction.
Inspect skin daily
and instruct patient to
do the same. The
appearance of a rash
should be carefully
evaluated to
differentiate a
nonallergenic

ampicillin rash from a

hypersensitivity
reaction. Report rash
promptly to physician.

MEDICATION

Amoxicillin

CLASSIFICATION

ANTIINFECTIVE;
ANTIBIOTIC;
AMINOPENICILLIN

ACTION

Broad-spectrum,
acid-stable,
semisynthetic

CLIENTS
INDICATION
Infections of ear,
nose, throat, GU
tract, skin, and soft
8

CONTRAINDICATI
ON
Hypersensitivity to
penicillins;
infectious

Note: Incidence of
ampicillin rash is
higher in patients with
infectious
mononucleosis or
other viral
infections, Salmonella i
nfections, lymphocytic
leukemia, or
hyperuricemia or in
patients taking
allopurinol.

Take medication
around the clock;
continue taking
medication until it is all
gone (usually 10 d)
unless otherwise
directed by physician
or pharmacist.

ADVERSE
EFFECTS
Body as a Whole:
As with other
penicillins.

NURSING
RESPONSIBILITIE
S
Assessment &
Drug Effects

aminopenicillin and
analogue of
ampicillin. Acts by
inhibiting
mucoprotein
synthesis in cell
wall of rapidly
multiplying
bacteria. It is
bactericidal and is
inactivated by
penicillinase.

tissue caused by
susceptible
bacteria. Also used
in uncomplicated
gonorrhea.
Available in
combination with
potassium
clavulanate, which
extends
antibacterial
spectrum of
amoxicillin to
include betalactamaseproducing strains.

mononucleosis.

Cautious Use
History of or
suspected atopy or
allergy (hives,
eczema, hay fever,
asthma); history of
cephalosporin or
carbapenem
hypersensitivity;
colitis, dialysis,
diarrhea, GI
disease; infants,
neonates; viral
infection, syphilis,
renal impairment or
failure, diabetes
mellitus, leukemia,
pregnancy
(category B), or
lactation.

Hypersensitivity

(rash,
anaphylaxis),
superinfections.
GI: Diarrhea,
nausea,
vomiting,
pseudomembranous
colitis (rare).
Hematologic: Hem

olytic anemia,
eosinophilia,
agranulocytosis (rar
e).
Skin: Pruritus,
urticaria, or other
skin eruptions.
Special Senses:
Conjunctival
ecchymosis.
Interactions
TETRACYCLINES ma
y inhibit activity of
amoxicillin; proben
ecid
prolongs the
activity of
amoxicillin.

Determine
previous
hypersensitivity
reactions to
penicillins,
cephalosporins,
and other
allergens prior to
therapy.
Lab tests:
Baseline C&S
tests prior to
initiation of
therapy, start
drug pending
results; periodic
assessments of
renal, hepatic,
and hematologic
functions should
be made during
prolonged
therapy.
Monitor for
S&S of an
urticarial rash
(usually
occurring within
a few days after
start of drug)
suggestive of a
hypersensitivity

reaction. If it
occurs, look for
other signs of
hypersensitivity
(fever, wheezing,
generalized
itching,
dyspnea), and
report to
physician
immediately.

10

Report onset
of generalized,
erythematous,
maculopapular
rash (ampicillin
rash) to
physician.
Ampicillin rash is
not due to
hypersensitivity;
however,
hypersensitivity
should be ruled
out.

Closely
monitor diarrhea
to rule out
pseudomembran
ous colitis.

MEDICATION

Nafcillin

CLASSIFICATION

ANTIINFECTIVE;
BETA-LACTAM
ANTIBIOTIC;
PENICILLIN;
ANTISTAPHYLOCOC
CAL PENICILLIN

ACTION

Semisynthetic,
acid-stable,
penicillinaseresistant penicillin.
Mechanism of
bactericidal action
is by interfering
with synthesis of
mucopeptides
essential to
formation and
integrity of
bacterial cell wall.

CLIENTS
INDICATION

CONTRAINDICATI
ON

Primarily, infections
caused by
penicillinaseproducing Staphylo
cocci. May also be
used to initiate
treatment in
suspected
staphylococcal
infections pending
culture and
sensitivity test
results. As with
other penicillins,
serum
concentrations are
considerably
enhanced by
concurrent use of
probenecid

Hypersensitivity to
penicillins,
cephalosporins, and
other allergens; use
of oral drug in
severe infections,
gastric dilatation,
cardiospasm, or
intestinal
hypermotility;
lactation. Safety
during pregnancy
(category B) is not
established.

11

Cautious Use
History of or
suspected atopy or
allergy (eczema,
hives, hay fever,
asthma).

ADVERSE
EFFECTS

NURSING
RESPONSIBILITIE
S

Body as a Whole:
Assessment &
Drug
Drug Effects
fever, anaphylaxis
(particularly
Lab tests:
following parenteral
Perform C&S
therapy).
prior to initiation
GI: Nausea,
of therapy and
vomiting,
periodically
diarrhea, increase
thereafter.
in serum
Obtain twice
transaminase
weekly
activity (following
differential WBC
IM).
counts in
Hematologic:
patients
Eosinophilia,
receiving IV
thrombophlebitis
nafcillin therapy
following IV;
for longer than 2
neutropenia (longwk.
term therapy).
Metabolic: Hypoka
Obtain a
lemia (with high IV
careful
history
doses).
before therapy to
Skin: Urticaria,
determine any
pruritus, rash, pain
prior allergic
and tissue
reactions to
irritation.
penicillins,
Urogenital: Allergi

c interstitial
nephritis.

12

cephalosporins,
and other
allergens.

Inspect IV
site for
inflammatory
reaction. Also
check IV site for
leakage; in the
older adult
patient
especially, loss of
tissue elasticity
with aging may
promote
extravasation
around the
needle.

Note: Allergic
reactions,
principally rash,
occur most
commonly.
Nausea,
vomiting, and
diarrhea may
occur with oral
therapy.

Monitor
neutrophil count.
Nafcillin-induced

neutropenia
(agranulocytosis)
occurs commonly
during third week
of therapy. It may
be associated
with malaise,
fever, sore
mouth, or throat.
Perform periodic
assessments of
liver and kidney
functions during
prolonged
therapy.

13

Be alert for
signs of bacterial
or fungal
superinfections
(see Appendix F)
in patients on
prolonged
therapy.

Determine IV
sodium intake for
patients with
sodium
restriction.
Nafcillin sodium
contains
approximately 3
mEq of sodium

per gram.

MEDICATION

Oxacilin Sodium

CLASSIFICATION

ANTIINFECTIVE; ANTIBIOTIC
PENICILLIN; ANTISTAPHYLOC
OCCAL PENICILLIN

ACTION

Semisynthetic,
acid-stable,
penicillinaseresistant
isoxazolyl
penicillin.

CLIENTS
INDICATION

CONTRAINDICATI
ON

ADVERSE
EFFECTS

Primarily,
infections caused
by penicillinaseproducing
staphylococci and
penicillin-resistant
staphylococci.
May be used to
initiate therapy in
suspected
staphylococcal
infections pending
culture and
sensitivity test
results. As with
other penicillins,
serum
concentrations
are enhanced by
concurrent use of
probenecid.

Hypersensitivity to
penicillins or
cephalosporins.
Safe use during
pregnancy
(category B) is not
established.

Body as a Whole:
Thrombophlebitis
(IV therapy),
superinfections,
wheezing,
sneezing,
fever, anaphylaxis.
GI: Nausea,
vomiting,
flatulence, diarrhea
,
hepatocellular
dysfunction
(elevated AST, ALT,
hepatitis).
Hematologic:
Eosinophilia,
leukopenia,
thrombocytopenia,
granulocytopenia,
agranulocytosis;
neutropenia
(reported in
children).
Skin: Pruritus,
rash, urticaria.

14

Cautious Use
History of or
suspected atopy or
allergy (hives,
eczema, hay fever,
asthma);
premature infants,
neonates, lactation
(may cause infant
diarrhea).

NURSING
RESPONSIBILITIE
S

Ask patient
prior to first
dose about
hypersensitivi
ty reactions to
penicillins,
cephalosporin
s, and other
allergens.
Lab tests:
periodic liver
functions, CBC
with
differential,
platelet count,
and urinalysis.
Hepatic
dysfunction
(possibly a
hypersensitivi
ty reaction)
has been
associated
with IV
oxacillin; it is

Urogenital: Interst
itial nephritis,
transient
hematuria,
albuminuria,
azotemia
(newborns and
infants on high
doses).

15

reversible
with
discontinuatio
n of drug.
Symptoms
may resemble
viral hepatitis
or general
signs of
hypersensitivi
ty and should
be reported
promptly:
hives, rash,
fever, nausea,
vomiting,
abdominal
discomfort,
anorexia,
malaise,
jaundice (with
dark yellow to
brown urine,
light-colored
or claycolored stools,
pruritus).
Withhold next
drug dose and
report the
onset of
hypersensitivi
ty reactions
and

superinfection
s

MEDICATION

Ticarcillin

CLASSIFICATION

ACTION

CLIENTS
INDICATION

ANTIINFECTIVE;
ANTIBIOTIC
PENICILLIN
ANTIPSEUDOMONA
L

Semisynthetic
injectable penicillin
that is bactericidal
against grampositive and gramnegative
organisms.

Primarily for gramnegative bacterial

infections, bacterial
septicemia, skin
and soft-tissue
infections, acute
and chronic
respiratory
infections,
genitourinary tract
infection by
susceptible
organisms,
intraabdominal
infections and
infections of the
female pelvis and
reproductive
system

16

CONTRAINDICATI
ON
History of allergic
reaction to any
penicillin.
Cautious Use
Allergy to
cephalosporins;
pregnancy
(category C),
lactation; renal
impairment.

ADVERSE EFFECTS

Body as a Whole:
Hypersensitivity
reactions, pain,
burning, swelling at
injection site;
phlebitis,
thrombophlebitis;
superinfections.
CNS: Headache,
blurred vision, mental
deterioration,
convulsions,
hallucinations,
seizures, giddiness,
neuromuscular
hyperirritability.
GI: Diarrhea,
nausea, vomiting,
disturbances of taste
or smell, stomatitis,
flatulence.
Hematologic: Eosino
philia,
thrombocytopenia,
leukopenia,

NURSING
RESPONSIBILITIE
S
Assessment &
Drug Effects

Obtain baseline
C&S tests before
initiating
therapy; drug
may be started
pending results.

Be aware that
serious and
sometimes fatal
anaphylactoid
reactions have
been reported in
patients with
penicillin
hypersensitivity
or history of
sensitivity to
multiple
allergens.

neutropenia,
hemolytic anemia.
Metabolic: Hypernat
remia, transient
increases in serum
AST, ALT, BUN, and
alkaline phosphatase;
increases in serum
LDH, bilirubin, and
creatinine and
decreased serum uric
acid.

17

Assess IV access
site frequently
for vein irritation
and phlebitis.

Discontinue
ticarcillin if
bleeding
manifestations
occur (some
patients on high
doses may
develop
hemorrhagic
manifestations
associated with
abnormalities of
coagulation).

Lab tests:
Monitor kidney
and liver
functions, CBC,
platelet counts,
and serum
electrolytes
during
prolonged
treatment.

Monitor cardiac
status because
of the high
sodium content

in drug.

MEDICATION

Piperacillin

CLASSIFICATION

ACTION

CLIENTS
INDICATION

Antiinfective; BetaLactam antibiotic;

Antipseudomonal
Penicillin

Action is similar to
that of other
penicillins.
Interference with
bacterial cell wall
synthesis promotes
loss of membrane
integrity and leads
to death of the
organism.

Susceptible
organisms that
cause gynecologic,
skin and skin
structure,
gonococcal, and
streptococcal
infections; lower
respiratory tract,
intraabdominal,
and bone and joint
infections;
septicemia, urinary
tract infections.
Also
prophylactically
prior to and during
surgery and as
empiric
antiinfective
therapy in
granulocytopenic
18

CONTRAINDICATI
ON
Hypersensitivity to
penicillins,
cephalosporins, or
other drugs;
pregnancy
(category B);
lactation.
Cautious Use
Liver and kidney
dysfunction;
hypersensitivity to
cephalosporins

ADVERSE EFFECTS

Body as a Whole:
Coughing, sneezing,
feeling of uneasiness;
systemic anaphylaxis,
fever, widespread
increase in capillary
permeability and
vasodilation with
resulting edema
(mouth, tongue,
pharynx, larynx),
laryngospasm,
pruritus, urticaria,
lymphadenopathy,
arthralgia,
angioedema of face
and extremities,
neuritis prostration,
eosinophilia),
SLE-like syndrome,
Injection site reactions
(pain, inflammation,

Monitor for and

report for
hypokalemia

NURSING
RESPONSIBILITIE
S

Obtain history of
hypersensitivity
to penicillins,
cephalosporins,
or other drugs
prior to
administration.

Lab tests: C&S

prior to first
dose of the
drug; start drug
pending results.
Periodic CBC
with differential,
platelet count,
Hgb and Hct,
and serum
electrolytes.

Monitor for

patients.

abscess, phlebitis),
superinfections
(especially
with Candida and
gram-negative
bacteria),
neuromuscular
irritability (twitching,
lethargy, confusion,
stupor, hyperreflexia,
multifocal myoclonus,
localized or
generalized
seizures, coma).
CV: Hypotension, circu
latory collapse,
cardiac
arrhythmias, cardiac
arrest.
GI: Vomiting,
diarrhea, severe
abdominal cramps,
nausea, epigastric
distress, diarrhea,
flatulence, dark
discoloration of
tongue, sore mouth or
tongue.
Urogenital: Interstitia
l nephritis, Loeffler's
syndrome, vasculitis.
Hematologic: Hemol
ytic anemia,
thrombocytopenia.
Metabolic: Hyperkale
19

hypersensitivity
response;
discontinue
drug and notify
physician if
allergic
response noted.

Lab tests:
Periodic CBC
with differential,
platelet count,
Hgb and Hct,
and serum
electrolytes.

Monitor for
hemorrhagic
manifestations
because high
doses may
induce
coagulation
abnormalities

mia (penicillin G
potassium);
hypokalemia,
alkalosis,
hypernatremia, CHF
(penicillin G sodium).
Respiratory: Broncho
spasm, asthma.
Skin: Itchy palms or
axilla,
pruritus, urticaria,
flushed skin, delayed
skin rashes ranging
from urticaria to
exfoliative dermatitis,
Stevens-Johnson
syndrome, fixed-drug
eruptions, contact
dermatitis.
MEDICATION

Cephalexin

CLASSIFICATION

Antiinfective;
antibiotic; First
Generation
Cephalosporin

ACTION

Semisynthetic
derivative of
cephalosporin C.
Broad-spectrum,
first-generation
cephalosporin
antibiotic with
antiinfective
activity similar to
that of cefazolin but
reportedly less

CLIENTS
INDICATION
To treat infections
caused by
susceptible
pathogens in
respiratory and
urinary tracts,
middle ear, skin,
soft tissue, and
bone.

CONTRAINDICATI
ON

ADVERSE EFFECTS

Hypersensitivity to
cephalosporins and
related antibiotics;
pregnancy
(category B),
lactation. Safe use
in infants <1 mo
not established.

Angioedema, anaph
ylaxis,
superinfections.
GI: Diarrhea (genera
lly mild), nausea,
vomiting, anorexia,
abdominal pain.
CNS: Dizziness,
headache, fatigue.
Skin: Rash,
urticaria.

Cautious Use
20

NURSING
RESPONSIBILITIE
S

Determine
history of
hypersensitivity
reactions to
cephalosporins
and penicillin
and history of
other drug
allergies before
therapy is

potent.
Preferentially binds
to one or more of
the penicillinbinding proteins
(PBP) located on
cell walls of
susceptible
organisms. This
inhibits third and
final stage of
bacterial cell wall
synthesis, thus
killing the
bacterium.
Ineffective against
many gramnegative or
anaerobic
organisms. Crossallergenicity
between
cephalosporins and
penicillins has been
reported.
MEDICATION

Cefazolin Sodium

CLASSIFICATION

Antiinfective;
antibiotic; First
Generation
Cephalosporin

History of
hypersensitivity to
penicillin or other
drug allergy;
severely impaired
renal function.

ACTION

CLIENTS
INDICATION

Semisynthetic, firstgeneration
derivative of
cephalosporin C;
antibiotic activity

Severe infections of
urinary and biliary
tracts, skin, soft
tissue, and bone,
and for bacteremia
21

CONTRAINDICATI
ON
Hypersensitivity to
any cephalosporin
and related
antibiotics;
pregnancy

initiated.

ADVERSE
EFFECTS
Body as a Whole:
Anaphylaxis, fever,
eosinophilia,
superinfections,
seizure (high doses

Lab tests:
Evaluate renal
and hepatic
function
periodically in
patients
receiving
prolonged
therapy.

Monitor for
manifestations
of
hypersensitivity.
Discontinue
drug and report
their
appearance
promptly.

NURSING
RESPONSIBILITIE
S

Determine
history of
hypersensitivity
to

similar to that of
cefazolin. Activity
against gramnegative organisms
is limited.
Bactericidal action:
preferentially binds
to one or more of
the penicillinbinding proteins
(PBP) located on
cell walls of
susceptible
organisms. This
inhibits third and
final stage of
bacterial cell wall
synthesis, thus
killing the
bacterium.

and endocarditis
caused by
susceptible
organisms; also
perioperative
prophylaxis in
patients undergoing
procedures
associated with
high risk of
infection, e.g., open
heart surgery.

22

(category B),
lactation.
Cautious Use
History of penicillin
sensitivity, impaired
renal function,
patients on sodium
restriction.

in patients with
renal insufficiency).
GI: Diarrhea, anore
xia, abdominal
cramps.
Skin: Maculopapula
r rash, urticaria.

cephalosporins,
penicillins, and
other drugs,
before therapy is
initiated.

Lab tests:
Perform culture
and sensitivity
testing prior to
and during
therapy. Therapy
may be initiated
pending results.

Monitor I&O
rates and
pattern: Be alert
to changes in
BUN, serum
creatinine.

If patient has
had a reaction to
penicillin, be
alert to signs of
hypersensitivity
with use of
cefazolin. Crossallergenicity
between
cephalosporins
and penicillin
has been

reported. Prompt
attention should
be given to
onset of signs of
hypersensitivity
Promptly report
the onset of
diarrhea, which
may or may not
be dose related.
It is seen
especially in
patients with
history of drugrelated GI
disturbances.
Pseudomembran
ous colitis, a
potentially lifethreatening
condition, starts
with diarrhea.

MEDICATION

Cefadroxil

CLASSIFICATION

Antiinfective;
antibiotic; First
Generation
Cephalosporin

ACTION

Semisynthetic,
first-generation
cephalosporin
antibiotic with

CLIENTS
INDICATION
Primarily in
treatment of urinary
tract infections
caused by
23

CONTRAINDICATI
ON

ADVERSE EFFECTS

Hypersensitivity to
cephalosporins and
related antibiotics;
pregnancy

Body as a
Whole: Hypersensitivity
[Rash, swollen eyelids
(angioedema),

NURSING
RESPONSIBILITIE
S

Determine
previous
hypersensitivity

antibacterial
spectrum similar
to that of
cefazolin.
Bactericidal action
(similar to that of
penicillins): drug
penetrates
bacterial cell wall,
resists betalactamases and
inactivates
enzymes essential
to cell wall
synthesis. At
equivalent doses,
reportedly attains
greater
concentrations in
serum and urine
than other oral
cephalosporins.

Escherichia coli,
Proteus
mirabilis, and Klebsie
lla sp;
infections of skin
and skin structures
caused
by Staphylococci and
Streptococci;
and for treatment of
group A betahemolytic
streptococcal
pharyngitis and
tonsillitis.

24

(category B),
lactation.
Cautious Use
Sensitivity to
penicillins or other
drug allergies;
impaired renal
function, history of
colitis.

pruritus, chills],
superinfections.
GI: Nausea, diarrhea, vo
miting, heartburn,
gastritis, bloating,
abdominal cramps.

to
cephalosporins,
penicillins, and
other drug
allergies,
before therapy
is initiated.

Lab tests:
Perform culture
and sensitivity
testing prior to
and periodically
during therapy.

Lab tests:
Perform
baseline and
periodic renal
function studies
in patients with
renal function
impairment,
and monitor
I&O ratio and
pattern.

Monitor for
manifestations
of drug
hypersensitivity
Discontinue
drug and
promptly report

them if they
appear.

MEDICATION

Cefuroxime

CLASSIFICATION

Antiinfective;
antibiotic; Second
Generation
Cephalosporin

ACTION

CLIENTS
INDICATION

CONTRAINDICATI
ON

ADVERSE
EFFECTS

Semisynthetic
second-generation
cephalosporin
antibiotic with
structure similar to
that of the
penicillins.
Resistance against
beta-lactamaseproducing strains
exceeds that of first
generation
cephalosporins.
Antimicrobial
spectrum of activity
resembles that of
cefonicid.

Infections caused
by susceptible
organisms in the
lower respiratory
tract, urinary tract,
skin, and skin
structures; also
used for treatment
of meningitis,
gonorrhea, and
otitis media and for
perioperative
prophylaxis (e.g.,
open-heart
surgery), early
Lyme disease.

Hypersensitivity to
cephalosporins and
related antibiotics;
pregnancy
(category B),
lactation.

Body as a Whole:
Thrombophlebitis
(IV site); pain,
burning, cellulitis
(IM site);
superinfections,
positive Coombs'
test.
GI: Diarrhea, naus
ea, antibioticassociated colitis.
Skin: Rash,
pruritus, urticaria.
Urogenital: Increa
sed serum
creatinine and BUN,
decreased

25

Cautious Use
History of allergy,
particularly to
drugs; penicillin
sensitivity; renal
insufficiency;
history of colitis or
other GI disease;
potent diuretics.

Monitor for
manifestations
of
superinfection
Promptly report
their
appearance.

NURSING
RESPONSIBILITIE
S

Determine
history of
hypersensitivity
reactions to
cephalosporins,
penicillins, and
history of
allergies,
particularly to
drugs, before
therapy is
initiated.

Lab tests:
Perform culture
and sensitivity

Preferentially binds
to one or more of
the penicillinbinding proteins
(PBP) located on
cell walls of
susceptible
organisms. This
inhibits third and
final stage of
bacterial cell wall
synthesis, thus
killing the
bacterium. Partial
cross-allergenicity
between other
beta-lactam
antibiotics and
cephalosporins has
been reported.

creatinine
clearance.

26

tests before
initiation of
therapy and
periodically
during therapy if
indicated.
Therapy may be
instituted
pending test
results. Monitor
periodically BUN
and creatinine
clearance.

Inspect IM and
IV injection sites
frequently for
signs of
phlebitis.

Report onset of
loose stools or
diarrhea.
Although
pseudomembran
ous colitis rarely
occurs, this
potentially lifethreatening
complication
should be ruled
out as the cause
of diarrhea
during and after

antibiotic
therapy.

MEDICATION

Ceftriaxone

CLASSIFICATION

Antiinfective;
antibiotic; third
generation
cephalosporin

ACTION

Semisynthetic
third-generation
cephalosporin
antibiotic.

CLIENTS
INDICATION

CONTRAINDICATI
ON

ADVERSE EFFECTS

Infections caused
by susceptible
organisms in lower
respiratory tract,

Hypersensitivity to
cephalosporins and
related antibiotics;
pregnancy

Body as a
Whole: Pruritus, fever,
chills, pain, induration
at IM injection site;

27

Monitor for
manifestations
of
hypersensitivity
Discontinue drug
and report their
appearance
promptly.

Monitor I&O
rates and
pattern:
Especially
important in
severely ill
patients
receiving high
doses. Report
any significant
changes.

NURSING
RESPONSIBILITIE
S

Determine
history of
hypersensitivity

Preferentially binds
to one or more of
the penicillinbinding proteins
(PBP) located on
cell walls of
susceptible
organisms. This
inhibits third and
final stage of
bacterial cell wall
synthesis, thus
killing the
bacterium.

skin and skin

structures, urinary
tract, bones and
joints; also intraabdominal
infections, pelvic
inflammatory
disease,
uncomplicated
gonorrhea,
meningitis, and
surgical
prophylaxis.

28

(category B).
Cautious Use
Lactation.

phlebitis (IV site).

GI: Diarrhea, abdomin
al
cramps, pseudomembr
anous colitis, biliary
sludge.
Urogenital: Genital
pruritus; moniliasis.

reactions to
cephalosporins
and penicillins
and history of
other allergies,
particularly to
drugs, before
therapy is
initiated.

Lab tests:
Perform culture
and sensitivity
tests before
initiation of
therapy and
periodically
during therapy.
Dosage may be
started pending
test results.
Periodic
coagulation
studies (PT and
INR) should be
done.

Inspect injection
sites for
induration and
inflammation.
Rotate sites.
Note IV injection
sites for signs of

phlebitis
(redness,
swelling, pain).

29

Monitor for
manifestations
of
hypersensitivity
(see Appendix
F). Report their
appearance
promptly and
discontinue
drug.

Watch for and

report signs:
petechiae,
ecchymotic
areas, epistaxis,
or any
unexplained
bleeding.
Ceftriaxone
appears to alter
vitamin K
producing gut
bacteria;
therefore,
hypoprothrombi
nemic bleeding
may occur.

Check for fever

if diarrhea
occurs: Report
both promptly.
The incidence of
antibioticproduced
pseudomembra
nous colitis is
higher than with
most
cephalosporins.
Most vulnerable
patients:
chronically ill or
debilitated older
adult patients
undergoing
abdominal
surgery.

MEDICATION

Cefepime

CLASSIFICATION

Antiinfective;
antibiotic; Fourth
generation
cephalosporin

ACTION

CLIENTS
INDICATION

CONTRAINDICATI
ON

ADVERSE
EFFECTS

Cefepime,
considered to be a
fourth-generation
cephalosporin
antibiotic, is similar
to third-generation
cephalosporins with
respect to broad

Uncomplicated and
complicated UTI,
skin and skin
structure infections,
pneumonia caused
by susceptible
organisms
(Escherichia coli,

Hypersensitivity to
cefepime, other
cephalosporins,
penicillins, or other
beta-lactam
antibiotics.

Body as a
Whole: Eosinophili
a.
GI: Antibioticassociated colitis,
diarrhea, nausea,
oral moniliasis,
vomiting, elevated

30

NURSING
RESPONSIBILITIE
S
Assessment &
Drug Effects

Determine
history of
hypersensitivity
reactions to

gram-negative
coverage; however,
cefepime has
broader grampositive coverage
than thirdgeneration
cephalosporins. It is
highly resistant to
hydrolysis by most
beta-lactamase
bacteria. Cefepime
preferentially binds
to one or more of
the penicillinbinding proteins
(PBPs) located on
cell walls of
susceptible
organisms. This
inhibits the third
and final stage of
bacterial cell wall
synthesis, thus
killing the bacteria
(bactericidal).

Klebsiella
pneumoniae,
Proteus mirabilis,
Staphylococcus
aureus[methicillinsensitive], Streptoc
occus pyogenes,
Streptococcus
pneumoniae,
Pseudomonas
aeruginosa,
Enterobacter sp).
Empiric
monotherapy for
febrile neutropenic
patients.

31

Cautious Use
Patients with
history of GI
disease, particularly
colitis, renal
insufficiency;
pregnancy
(category B),
lactation. Safety
and efficacy of
cefepime in
children <12 y not
known.

liver function tests

(ALT, AST).
CNS: Headache,
fever.
Skin: Phlebitis,
pain, inflammation,
rash, pruritus,
urticaria.
Urogenital: Vaginit
is.

cephalosporins,
penicillins, or
other drugs
before therapy is
initiated.

Lab tests:
Perform culture
and sensitivity
tests before
initiation of
therapy. Dosage
may be started
pending test
results.

Monitor for S&S

of
hypersensitivity
Report their
appearance
promptly and
discontinue
drug.

Monitor for S&S

of superinfection
or
pseudomembran
ous colitis (see
Appendix F);
immediately
report either to

physician.

MEDICATION

Meropenem

CLASSIFICATION

Antiinfective;
Carbapenem
Antibiotic

ACTION

CLIENTS
INDICATION

CONTRAINDICATI
ON

ADVERSE
EFFECTS

Broad-spectrum
carbapenem
antibiotic that
inhibits the cell wall
synthesis of grampositive and gramnegative bacteria
by its strong affinity
for penicillinbinding proteins of
bacterial cell wall.

Complicated
appendicitis and
peritonitis, bacterial
meningitis caused
by susceptible
bacteria,
complicated skin
infections.

Hypersensitivity to
meropenem, other
carbapenem
antibiotics including
imipenem,
penicillins,
cephalosporins, or
other beta-lactams;
lactation.

GI: Diarrhea,
nausea, vomiting,
constipation.
Other: Inflammati
on at injection site,
phlebitis,
thrombophlebitis.
CNS: Headache.
Skin: Rash,
pruritus, diaper
rash.
Body as a
Whole: Apnea, oral
moniliasis, sepsis,
shock.
Hematologic: Ane
mia.

Cautious Use
History of asthma
or allergies, renal
impairment,
epileptics, history of
neurologic
disorders, older
adult, pregnancy
32

With concurrent
high-dose
aminoglycoside
therapy, closely
monitor for
nephrotoxicity
and ototoxicity.

NURSING
RESPONSIBILITIE
S

Lab tests:
Perform C&S
tests prior to
therapy. Monitor
periodically liver
and kidney
function.

Determine
history of
hypersensitivity
reactions to
other betalactams,
cephalosporins,
penicillins, or

(category B). Safety

and effectiveness in
infants <3 mo not
established.

MEDICATION

Aztreonam

other drugs.

CLASSIFICATION

ACTION

CLIENTS
INDICATION

CONTRAINDICATI
ON

ADVERSE EFFECTS

Antiinfective; Betalactam Antibiotic

Differs structurally
from other betalactam antibiotics
(penicillins and
cephalosporins) in
having a
monocyclic rather
than a bicyclic
nucleus. Acts by
inhibiting synthesis

Gram-negative
infections of
urinary tract, lower
respiratory tract,
skin and skin
structures; and for
intraabdominal and
gynecologic
infections,
septicemia, and as

Safety during
pregnancy
(category B),
lactation, or in
infants and children
is not established.

Body as a
Whole: Hypersensitiv
ity (urticaria,
eosinophilia,
anaphylaxis).
CNS: Headache,
dizziness, confusion,
paresthesias,
insomnia,
seizures. GI: Nausea,

33

Cautious Use
History of
hypersensitivity

Discontinue drug
and immediately
report S&S of
hypersensitivity
Report S&S of
superinfection or
pseudomembran
ous colitis

Monitor for
seizures
especially in
older adults and
those with renal
insufficiency.

NURSING
RESPONSIBILITIE
S

Lab tests:
Obtain baseline
C&S test prior to
initiation of
therapy. Start
drug pending
results.

Baseline and

of bacterial cell
wall, primarily in
aerobic, gramnegative bacteria.

MEDICATION
Vancomycin HCl

CLASSIFICATION
Antiinfective;
antibiotic; No
lactam
(Glycopeptides)

ACTION
Prepared
from Streptomyces
orientalis, with
bactericidal and
bacteriostatic
actions. Acts by
interfering with cell
membrane
synthesis in

adjunctive therapy
for surgical
infections. Often
used in
combination with
other antibiotics
active against
gram-positive and
anaerobic bacteria
in mixed infections.

CLIENTS
INDICATION
Parenterally for
potentially lifethreatening
infections in
patients allergic,
nonsensitive, or
resistant to other
less toxic
antimicrobial drugs.
34

reaction to
penicillin,
cephalosporins, or
to other drugs;
impaired renal or
hepatic function.

CONTRAINDICATI
ON
Known
hypersensitivity to
vancomycin, allergy
to corn or corn
products, previous
hearing loss,
concurrent or
sequential use of
other ototoxic or

diarrhea, vomiting,
elevated liver
function tests.
Hematologic: Eosino
philia.
Special
Senses: Tinnitus,
nasal congestion,
sneezing, diplopia.
Skin: Rash, purpura,
erythema multiforme,
exfoliative dermatitis,
diaphoresis;
petechiae, pruritus.
Other: Local
reactions (phlebitis,
thrombophlebitis
(following IV), pain at
injection sites),
superinfections
(gram-positive cocci),
vaginal candidiasis.
ADVERSE EFFECTS
Special
Senses: Ototoxicity
(auditory portion of
eighth cranial
nerve).
Urogenital: Nephrot
oxicity leading to
uremia.
Body as a

periodic renal
function tests,
particularly in
older adults and
in those with
history of renal
impairment.

Inspect IV
injection sites
daily for signs of
inflammation.
Pain and
phlebitis occur
in a significant
number of
patients.

NURSING
RESPONSIBILITIES

Monitor BP and
heart rate
continuously
through period
of drug
administration.

Lab tests:

multiplying
organisms.

Used orally only

in Clostridium
difficile colitis (not
effective by oral
route for treatment
of systemic
infections).

35

nephrotoxic agents,
IM administration
Cautious Use
Neonates; children;
older adults;
impaired kidney
function, renal
failure, renal
impairment,
concomitant
administration of
aminoglycosides;
hearing impairment;
colitis, inflammatory
disorders of the
intestine; pregnancy
(category B),
lactation.
.

Whole: Hypersensiti
vity reactions (chills,
fever, skin rash,
urticaria, shock-like
state), anaphylactoid
reaction with
vascular collapse,
superinfections,
severe pain,
thrombophlebitis at
injection site,
generalized tingling
following rapid IV
infusion.
Hematologic: Transi
ent leukopenia,
eosinophilia.
GI: Nausea, warmth.
Other: Injection
reaction that
includes hypotension
accompanied by
flushing and
erythematous rash
on face and upper
body ("red-neck
syndrome") following
rapid IV infusion.

Monitor
urinalysis,
kidney & liver
functions, and
hematologic
studies
periodically.

Monitor serial
tests of
vancomycin
blood levels
(peak and
trough) in
patients with
borderline
kidney function,
in infants and
neonates, and in
patients >60 y.

Assess hearing.
Drug may cause
damage to
auditory branch
(not vestibular
branch) of eighth
cranial nerve,
with consequent
deafness, which
may be
permanent.

Be aware that

serum levels of
6080 mcg/mL
are associated
with ototoxicity.
Tinnitus and
high-tone
hearing loss may
precede
deafness, which
may progress
even after drug
is withdrawn.
Older adults and
those on high
doses are
especially
susceptible.

36

Monitor I&O:
Report changes
in I&O ratio and
pattern. Oliguria
or cloudy or pink
urine may be a
sign of
nephrotoxicity
(also manifested
by transient
elevations in
BUN, albumin,
and hyaline and
granular casts in
urine).

MEDICATION
Polymyxin b Sulfate

CLASSIFICATION
Antibiotic derived
from strains
of Bacillus
polymyxa. Binds to
lipid phosphates in
bacterial
membranes and,
through cationic
detergent action,
changes
permeability to
permit leakage of
cytoplasm.

ACTION
Antibiotic derived
from strains
of Bacillus
polymyxa. Binds to
lipid phosphates in
bacterial
membranes and,
through cationic
detergent action,
changes
permeability to
permit leakage of
cytoplasm.

CLIENTS
INDICATION
Topically and in
combination with
other antiinfectives
or corticosteroids
for various
superficial infections
of eye, ear, mucous
membrane, and
skin. Concurrent
systemic
antiinfective
therapy may be
required for
treatment of
intraocular infection
and severe
progressive corneal
ulcer. Used
parenterally only in
hospitalized
patients for
treatment of severe
acute infections of
urinary tract,
bloodstream, and
meninges; and in
combination with
Neosporin for
continuous bladder
irrigation to prevent
37

CONTRAINDICATI
ON
Hypersensitivity to
polymyxin
antibiotics;
concurrent and
sequential use of
other nephrotoxic
and neurotoxic
drugs; concurrent
use of skeletal
muscle relaxants,
ether, or sodium
citrate. Safety
during pregnancy
(category B) or
children <2 mo is
not established.
Cautious Use
Impaired kidney
function;
myasthenia gravis;
lactation.

ADVERSE
EFFECTS
Body as a Whole:
Irritability, facial
flushing, ataxia,
circumoral, lingual,
and peripheral
paresthesias
(stocking-glove
distribution); severe
pain (IM site),
thrombophlebitis (IV
site),
superinfections,
electrolyte
disturbances
(prolonged use; also
reported in patients
with acute
leukemia); local
irritation and
burning (topical
use), anaphylactoid
reactions (rare).
CNS: Drowsiness,
dizziness, vertigo,
convulsions,
coma; neuromuscul
ar blockade
(generalized muscle
weakness,
respiratory

NURSING
RESPONSIBILITIES

Lab tests: Obtain

C&S tests prior
to first dose and
periodically
thereafter to
determine
continuing
sensitivity of
causative
organisms.
Perform baseline
serum
electrolytes and
kidney function
tests before
parenteral
therapy.
Frequent
monitoring of
kidney function
and serum drug
levels is advised
during therapy.
Monitor
electrolytes at
regular intervals
during prolonged
therapy.

bacteremia
associated with use
of indwelling
catheter.

38

depression or
arrest); meningeal
irritation, increased
protein and cell
count in
cerebrospinal fluid,
fever, headache,
stiff neck
(intrathecal use).
Special
Senses: Blurred
vision, nystagmus,
slurred speech,
dysphagia,
ototoxicity
(vestibular and
auditory) with high
doses. GI: GI
disturbances.
Urogenital: Albumi
nuria, cylindruria,
azotemia,
hematuria.

Review
electrolyte
results. Patients
with low serum
calcium and low
intracellular
potassium are
particularly
prone to develop
neuromuscular
blockade.

Inspect tongue
every day.
Assess for S&S of
superinfection
Polymyxin
therapy supports
growth of
opportunistic
organisms.
Report
symptoms
promptly.

Monitor I&O.
Maintain fluid
intake sufficient
to maintain daily
urinary output of
at least 1500
mL. Some
degree of renal
toxicity usually

occurs within
first 3 or 4 d of
therapy even
with therapeutic
doses. Consult
physician.

39

Withhold drug
and report
findings to
physician for any
of the following:
Decreases in
urine output
(change in I&O
ratio),
proteinuria,
cellular casts,
rising BUN,
serum
creatinine, or
serum drug
levels (not
associated with
dosage
increase). All can
be interpreted as
signs of
nephrotoxicity.

Nephrotoxicity is
generally
reversible, but it
may progress

even after drug

is discontinued.
Therefore, close
monitoring of
kidney function
is essential, even
following
termination of
therapy.

MEDICATION
Gentamycin

CLASSIFICATION

ACTION

Aminoglycosides
Pregnancy Category
D

Gentamicin is
an aminoglycoside
that binds to 30s

CLIENTS
INDICATION
Parenteral
Serious infections
caused by
40

CONTRAINDICATI
ON
History of
hypersensitivity to
aminoglycoside;

ADVERSE
EFFECTS
Dizziness or vertigo;
acute renal failure,
interstitial nephritis,

Be alert for
respiratory arrest
after the first
dose and also as
long as 45 d
after initiation of
therapy. It occurs
most commonly
in patients with
kidney failure
and high plasma
drug levels and
is often preceded
by dyspnea and
restlessness.

NURSING
RESPONSIBILITIES
History: Allergy
to any
aminoglycosides;

and 50s ribosomal

subunits of
susceptible bacteria
disrupting protein
synthesis, thus
rendering the
bacterial cell
membrane
defective.

susceptible strains
of Pseudomonas
aeruginosa, Proteus
species, Escherichia
coli, KlebsiellaEnterobacterSerratia species,
Citrobacter,
Staphylococcus
species
Serious infections
when causative
organisms are not
known (often in
conjunction with a
penicillin or
cephalosporin)
Unlabeled use: With
clindamycin as
alternative regimen
in PID
Intrathecal
Gram-negative
infections
Serious CNS
infections, such as
meningitis,
ventriculitis,
infections caused by
susceptible
Pseudomonas
species
Ophthalmic
preparations
Treatment of
41

pregnancy; hepatic
impairment,
perforated ear
drum.

acute tubular
necrosis; electrolyte
imbalances;
transient elevation
of serum bilirubin
and
aminotransferases;
purpura; nausea,
vomiting;
convulsions, mental
depression,
hallucinations.
Atrophy or rat
necrosis at inj sites.
Potentially Fatal:
Nephrotoxicity,
ototoxicity and
neuromuscular
blockade (may
unmask or
aggravate
myasthaenia
gravis).

renal or hepatic
disease;
preexisting
hearing loss;
active infection
with herpes,
vaccinia,
varicella, fungal
infections,
myobacterial
infections
(ophthalmic
preparations);
myasthenia
gravis;
parkinsonism;
infant botulism;
lactation,
pregnancy
Physical: Site of
infection; skin
color, lesions;
orientation,
reflexes, eighth
cranial nerve
function; P, BP;
R, adventitious
sounds; bowel
sounds, liver
evaluation;
urinalysis, BUN,
serum
creatinine,
serum
electrolytes,

superficial ocular
infections due to
strains of
microorganisms
susceptible to
gentamicin
Topical
dermatologic
preparation
Infection
prophylaxis in minor
skin abrasions and
treatment of
superficial infections
of the skin due to
susceptible
organisms
amenable to local
treatment

42

LFTs, CBC
Interventions
Give by IM route
if at all possible;
give by deep IM
injection.
Culture infected
area before
therapy.
Use 2 mg/mL
intrathecal
preparation
without
preservatives,
for intrathecal
use.
Avoid long-term
therapies
because of
increased risk of
toxicities.
Reduction in
dose may be
clinically
indicated.
Patients with
edema or ascites
may have lower
peak
concentrations
due to expanded
extracellular
fluid volume.
Cleanse area
before

MEDICATION

Amikacin

CLASSIFICATION

Anti-infective;
Aminoglycoside
Pregnancy
Category: C

ACTION

Semisynthetic
derivative of
kanamycin with
broad range of

CLIENTS
INDICATION

Primarily for
short-term
treatment of
serious
43

CONTRAINDICATI
ON

History of
hypersensitivity
or toxic reaction
with an

ADVERSE EFFECTS

CNS: Neurotoxicity:
drowsiness,
unsteady gait,
weakness,

application of
dermatologic
preparations.
Ensure adequate
hydration of
patient before
and during
therapy.
BLACK BOX
WARNING:
Monitor hearing
with long-term
therapy;
ototoxicity can
occur.
BLACK BOX
WARNING:
Monitor renal
function tests,
CBCs, serum
drug levels
during long-term
therapy. Consult
with prescriber
to adjust dosage.

NURSING
RESPONSIBILITIE
S
Baseline
tests: Before
initial dose,
C&S; renal

antimicrobial
activity that
includes many
strains resistant
to other
aminoglycosides
.
Pharmacologic
properties are
essentially the
same as those
of gentamicin.
Appears to
inhibit protein
synthesis in
bacterial cell
and is usually
bactericidal.

infections of
respiratory
tract, bones,
joints, skin, and
soft tissue, CNS
(including
meningitis),
peritonitis
burns, recurrent
urinary tract
infections (UTIs).
Unlabeled
Uses: Intrathec
al or
intraventricular
administration,
in conjunction
with IM or IV
dosage.

44

aminoglycoside
antibiotic.
Safety during
pregnancy
(category C),
lactation,
neonates and
infants, or use
period
exceeding 14
years old is not
established.
Cautious Use
Impaired renal
function; eighth
cranial
(auditory) nerve
impairment;
preexisting
vertigo or
dizziness,
tinnitus, or
dehydration;
fever; older
adults,
premature
infants,
neonates and
infants;
myasthenia
gravis;
parkinsonism;
hypocalcemia.

clumsiness,
paresthesias,
tremors,
convulsions,
peripheral neuritis.
Special Senses:
Auditory
ototoxicity, highfrequency hearing
loss, complete
hearing loss
(occasionally
permanent);
tinnitus; ringing or
buzzing in ears;
Vestibular: dizzine
ss, ataxia.
GI: Nausea,
vomiting,
hepatotoxicity.
Metabolic: Hypoka
lemia,
hypomagnesemia.
Skin: Skin rash,
urticaria, pruritus,
redness.
Urogenital: Oliguri
a, urinary
frequency,
hematuria, tubular
necrosis, azotemia.
Other:
Superinfections.

function and
vestibulocochlea
r nerve function
(and at regular
intervals during
therapy; closely
monitor in the
older adult,
patients with
documented ear
problems, renal
impairment, or
during high dose
or prolonged
therapy).
Monitor peak
and trough
amikacin blood
levels: Draw
blood 1 h after
IM or
immediately
after completion
of IV infusion;
draw trough
levels
immediately
before the next
IM or IV dose.
Lab
tests: Periodic
serum creatinine
and BUN,
complete
urinalysis. With

45

treatment over
10 d, daily tests
of renal
function, weekly
audiograms, and
vestibular tests
are strongly
advised.
Monitor serum
creatinine or
creatinine
clearance
(generally
preferred) more
often, in the
presence of
impaired renal
function, in
neonates, and in
the older adult;
note that
prolonged high
trough (>8
mg/mL) or peak
(>3035 mg/mL)
levels are
associated with
toxicity.
Monitor S&S of
ototoxicity
(primarily
involves the
cochlear
(auditory)
branch; high-

46

frequency
deafness usually
appears first and
can be detected
only by
audiometer);
indicators of
declining renal
function;
respiratory tract
infections and
other symptoms
indicative of
superinfections
and notify
physician should
they occur.
Monitor for and
report auditory
symptoms
(tinnitus, roaring
noises,
sensation of
fullness in ears,
hearing loss)
and vestibular
disturbances
(dizziness or
vertigo,
nystagmus,
ataxia).
Monitor & report
any changes in
I&O, oliguria,
hematuria, or

cloudy urine.
Keeping patient
well hydrated
reduces risk of
nephrotoxicity;
consult
physician
regarding
optimum fluid
intake

MEDICATION

Doxycycline

CLASSIFICATION

Antiinfective;
tetracycline

ACTION

Semisynthetic
broad-spectrum
tetracycline
antibiotic derived

CLIENTS
INDICATION
Similar to those of
tetracycline, e.g.,
chlamydial and
mycoplasmal
47

CONTRAINDICATI
ON

ADVERSE EFFECTS

Sensitivity to any of
the tetracyclines;
use during period of
tooth development

Special
Senses: Interference
with color vision.
GI: Anorexia, nausea, vo

NURSING
RESPONSIBILITIE
S

Report sudden
onset of painful
or difficult

from
oxytetracycline.
More completely
absorbed with
effective blood
levels maintained
for longer periods
and excreted more
slowly than most
other tetracyclines.
Thus it requires
smaller and less
frequent dosing.

MEDICATION
Tetracycline HCl

CLASSIFIC
ATION
Antiinfectiv
e;
Antibiotic;
Tetracyclin
e

infections;
gonorrhea, syphilis
in penicillin-allergic
patients; rickettsial
diseases; acute
exacerbations of
chronic bronchitis.

including last half of

pregnancy
(category D),
lactation, infants,
and children <8 y
(causes permanent
yellow discoloration
of teeth, enamel
hypoplasia, and
retardation of bone
growth).

miting, diarrhea,
enterocolitis; esophageal
irritation (oral capsule
and tablet).
Skin: Rashes,
photosensitivity
reaction.
Other:Thrombophlebitis
(IV use), superinfections.

swallowing
promptly to
physician.
Doxycycline
(capsule and
tablet forms) is
associated with
a comparatively
high incidence
of esophagitis,
especially in
patients >40 y.

Cautious Use
Alcoholism.

ACTION

CLIENTS INDICATION

CONTRAINDICATION

Broad
spectrum
antibiotic
derived
from Streptom
yces
aureofaciens o
r produced
semisynthetica
lly from
oxytetracycline
. Tetracyclines

Chlamydial infections
(e.g., lymphogranuloma
venereum, psittacosis,
trachoma, inclusion
conjunctivitis,
nongonococcal
urethritis); mycoplasmal
infections
(e.g., Mycoplasma
pneumoniae); rickettsial
infections (e.g., Q fever,
Rocky Mt spotted fever,

Hypersensitivity to
tetracyclines or to any
ingredient in the
formulation; severe
renal or hepatic
impairment, common
bile duct obstruction.
Use during tooth
development [last half
of pregnancy (category
D)], during infancy and
childhood to the 8th
48

ADVERSE EFFECTS
CNS: Headache, intracranial
hypertension (rare).
Special
Senses: Pigmentation of
conjunctiva due to drug
deposit.
GI: Reported mostly for
oral administration,
but also may occur with
parenteral tetracycline
(nausea, vomiting, epigastric
distress,

Report evidence
of
superinfections

NURSING
RESPONSIBILITIES

Lab tests: Obtain

baseline and
periodic C&S
tests to confirm
susceptibility of
infecting
organism to
tetracycline.
Also, preform
initial and
periodic kidney,

usually are
bacteriostatic
but may be
bactericidal in
high
concentrations
. Exerts
antiacne action
by suppressing
growth
of Propionibact
erium
acnes within
sebaceous
follicles,
thereby
reducing free
fatty acid
content in
sebum. Free
fatty acids are
thought to be
largely
responsible for
inflammatory
skin lesions
(papules,
pustules,
cysts) and
comedones of
acne.

typhus); spirochetal
infections: relapsing
fever (Borrelia), leptospi
rosis, syphilis (penicillinhypersensitive
patients); amebiases;
uncommon gramnegative bacterial
infections [e.g.,
brucellosis, shigellosis,
cholera, gonorrhea
(penicillinhypersensitive
patients), granuloma
inguinale, tularemia];
gram-positive infections
(e.g., tetanus). Also
used orally and topically
(solution) for
inflammatory acne
vulgaris; topical
ointment is used for
superficial skin
infections. See
tetracycline HCl,
ophthalmic, for
ophthalmic uses.

year, or lactation.
Safety of topical
tetracycline
preparations in children
<8 y is not established.
Cautious Use
History of kidney or liver
dysfunction; myasthenia
gravis; history of
allergy, asthma, hay
fever, urticaria;
undernourished
patients.

49

heartburn, diarrhea, bulky

loose stools, steatorrhea,
abdominal discomfort,
flatulence, dry mouth);
dysphagia,
retrosternal pain,
esophagitis,
esophageal ulceration with
oral administration,
abnormally high liver
function test values,
decrease in serum
cholesterol, fatty
degeneration of liver
[jaundice,
increasing nitrogen retention
(azotemia),
hyperphosphatemia,
acidosis,
irreversible shock]; foulsmelling
stools or vaginal discharge,
stomatitis, glossitis; black
hairy tongue (lingua nigra),
diarrhea: staphylococcal
enterocolitis.
Body as a Whole:Drug
fever,
angioedema, serum
sickness,
anaphylaxis.
Urogenital: Particularly in
patients with kidney
disease; increase in
BUN/serum creatinine, renal

liver, and
hematopoietic
function tests,
particularly
during high-dose,
long-term
therapy.
Determine serum
tetracycline
levels in patients
at-risk for
hepatotoxicity
(sometimes
associated with
pancreatitis and
occurs most
frequently in
patients
receiving other
hepatotoxic
drugs or with
history of renal or
hepatic
impairment).

Report GI
symptoms (e.g.,
nausea,
vomiting,
diarrhea) to
physician. These
are generally
dose-dependent,
occurring mostly

impairment even with

therapeutic doses
Skin: Dermatitis,
phototoxicity: discoloration
of nails, onycholysis
(loosening of nails); cheilosis;
fixed drug eruptions
particularly on genitalia;
thrombocytopenic purpura;
Urticaria, rash,
exfoliative dermatitis; With
topical applications: skin
irritation, dry scaly skin,
transient stinging or burning
sensation, slight yellowing of
skin at application site, acute
contact dermatitis.

50

with oral forms in

patients
receiving 2 g/d or
more and during
prolonged
therapy.
Frequently,
symptoms are
controlled by
reducing dosage
or administering
with compatible
foods.

Be alert to
evidence of
superinfections.
Regularly inspect
tongue and
mucous
membrane of
mouth for
candidiasis
(thrush). Suspect
superinfection if
patient
complains of
irritation or
soreness of
mouth, tongue,
throat, vagina, or
anus, or
persistent itching
of any area,

diarrhea, or foulsmelling excreta

or discharge.

51

Withhold drug
and notify
physician if
superinfection
develops.
Superinfections
occur most
frequently in
patients
receiving
prolonged
therapy, the
debilitated, or
those who have
diabetes,
leukemia,
systemic LE, or
lymphoma.
Women taking
oral
contraceptives
reportedly are
more susceptible
to vaginal
candidiasis.

Obtain follow-up
cultures from all
gonococcal
infection sites 3

7 d after
completion of
tetracycline
therapy to verify
eradication of
infection.
Monitor I&O in
patients
receiving
parenteral
tetracycline.
Report oliguria or
any changes in
appearance of
urine or in I&O.
NURSING
RESPONSIBILITIES

MEDICATION
Quinupristin/Dalf
opristin

CLASSIFIC
ATION
Streptogra
mins

ACTION

CLIENTS INDICATION

CONTRAINDICATION

ADVERSE EFFECTS

Streptogramin
(cyclic
macrolide)
antibiotic that
is produced by
various
streptomyces
bacteria.
Active against
gram-positive
pathogens
including
vancomycinresistant Enter
ococcus
faecium (VREF)

Serious or lifethreatening infections

associated with VREF
bacteremia;
complicated skin and
skin structure infections
caused
by Staphylococcus
aureus or Streptococcus
pyogenes.

Hypersensitivity to
quinupristin/dalfopristin
or pristinamycin;
lactation.

Body as a
Whole: Headache,
pain, myalgia, arthralgia.
GI: Nausea, diarrhea,
vomiting. Skin: Rash,
pruritus.
Other: Inflammation, pain,
or edema at infusion site,
other infusion site reactions,
thrombophlebitis.

Cautious Use
Renal or hepatic
dysfunction; pregnancy
(category B).

52

Monitor for S&S

of infusion site
irritation; change
infusion site if
irritation is
apparent.

Monitor for
cutaneous
reaction (e.g.,
pruritus/erythem
a of neck, face,
upper body).

Lab tests: C&S

, as well as
some gramnegative
anaerobes.

MEDICATION
Erythromycin

CLASSIFIC
ATION
Macrolide
Antibiotic

from site of
infection prior to
initiating
therapy; WBC
with differential;
and liver function
(especially with
preexisting
hepatic
insufficiency).

ACTION

CLIENTS INDICATION

CONTRAINDICATION

Macrolide
antibiotic
produced by a
strain
of Streptomyc
es erythreus.
Bacteriostatic
or bactericidal,
depending on
nature of
organism and
drug
concentration
used.

Pneumococcal
pneumonia, Mycoplasm
a pneumoniae (primary
atypical pneumonia),
acute pelvic
inflammatory disease
caused by Neisseria
gonorrhoeae in females
sensitive to penicillin,
infections caused by
susceptible strains of
staphylococci,
streptococci, and
certain strains
of Haemophilus
influenzae. Also used in
intestinal amebiasis,
Legionnaires' disease,
uncomplicated urethral,
endocervical, and rectal

Hypersensitivity to
erythromycins. Estolat
e: History of
erythromycinassociated hepatitis;
liver dysfunction;
treatment of skin
disorders such as acne
or furunculosis;
prophylaxis of
rheumatic fever.
Cautious Use
Impaired liver function;
pregnancy (category B),
lactation.

53

ADVERSE EFFECTS
GI: Nausea, vomiting,
abdominal
cramping, diarrhea,
heartburn, anorexia.
Body as a Whole: Fever,
eosinophilia, urticaria, skin
eruptions, fixed drug
eruption, anaphylaxis.
Superinfections by
nonsusceptible bacteria,
yeasts, or fungi.
Special Senses: Ototoxicity:
reversible bilateral hearing
loss, tinnitus, vertigo.
Digestive: (Estolate)
Cholestatic hepatitis
syndrome.
Skin: (topical use)
Erythema, desquamation,
burning, tenderness, dryness

NURSING
RESPONSIBILITIES

Report onset of
GI symptoms
after PO
administration to
physician. These
are dose related;
if symptoms
persist after
dosage
reduction,
physician may
prescribe drug to
be given with
meals in spite of
impaired
absorption.

Monitor for
adverse GI

infections caused
by Chlamydia
trachomatis, for
prophylaxis of
ophthalmia neonatorum
caused by N.
gonorrhoeae, C.
trachomatis, and for
chlamydial
conjunctivitis in
neonates. Considered
an acceptable
alternative to penicillin
for treatment of
streptococcal
pharyngitis, for
prophylaxis of
rheumatic fever and
bacterial endocarditis,
for treatment of
diphtheria as adjunct to
antitoxin and for carrier
state, and as alternate
choice in treatment of
primary syphilis in
patients allergic to
penicillins. Topical
applications: Pyoderm
as, acne vulgaris, and
external ocular
infections, including
neonatal chlamydial
conjunctivitis and
gonococcal ophthalmia.

or oiliness, pruritus.
effects.
Pseudomembran
ous enterocolitis,
a potentially lifethreatening
condition, may
occur during or
after antibiotic
therapy.

54

Observe for S&S

of superinfection
by overgrowth of
nonsusceptible
bacteria or fungi.
Emergence of
resistant
staphylococcal
strains is highly
predictable
during prolonged
therapy.

Lab tests:
Periodic liver
function tests
during prolonged
therapy.

Monitor for S&S

of hepatotoxicity.
Premonitory S&S
include:
Abdominal pain,

nausea,
vomiting, fever,
leukocytosis, and
eosinophilia;
jaundice may or
may not be
present.
Symptoms may
appear a few
days after
initiation of drug
but usually occur
after 12 wk of
continuous
therapy.
Symptoms are
reversible with
prompt
discontinuation
of erythromycin.

55

Monitor for
ototoxicity that
appears to
develop most
frequently in
patients
receiving 4 g/d or
more, older
adults, female
patients, and
patients with
kidney or liver
dysfunction. It is

reversible with
prompt
discontinuation
of drug.

MEDICATION
Azithromycin

MEDICATION
Clarithromycin

CLASSIFIC
ATION
Macrolide

CLASSIFIC
ATION
Macrolide
Antibiotic

ACTION

CLIENTS INDICATION

CONTRAINDICATION

A macrolide
antibiotic that
reversibly
binds to the
50S ribosomal
subunit of
susceptible
organisms and
consequently
inhibits protein
synthesis.

Pneumonia, lower
respiratory tract
infections,
pharyngitis/tonsillitis,
gonorrhea,
nongonococcal
urethritis, skin and skin
structure infections due
to susceptible
organisms, otitis
media, Mycobacterium
aviumintracellulare co
mplex infections, acute
bacterial
sinusitis. Zmax: acute
bacterial sinusitis and
community acquired
pneumonia.

Hypersensitivity to
azithromycin,
erythromycin, or any of
the macrolide
antibiotics.

ACTION

CLIENTS INDICATION

CONTRAINDICATION

A
semisynthetic
macrolide
antibiotic that
binds to the

Treatment of upper
respiratory, lower
respiratory infections;
acute maxillary
sinusitis; otitis media;

Cautious Use
Older adults or
debilitated
persons, hepatic or
renal impairment; GI
disease; ventricular
arrhythmias, QT
prolongation; UV
exposure; pregnancy
(category B), and
lactation.

Hypersensitivity to
clarithromycin,
erythromycin, or any
other macrolide
antibiotics; patients
56

ADVERSE EFFECTS
CNS: Headache,
dizziness. GI: Nausea,
vomiting, diarrhea,
abdominal
pain; hepatotoxicity, mild
elevations in liver function
tests.

ADVERSE EFFECTS
GI: Diarrhea, abdominal
discomfort, nausea,
abnormal taste, dyspepsia.
Hematologic:
Eosinophilia

NURSING
RESPONSIBILITIES

Monitor for and

report loose
stools or
diarrhea, since
pseudomembran
ous colitis must
be ruled out.

Monitor PT and
INR closely with
concurrent
warfarin use.

NURSING
RESPONSIBILITIES

Inquire about
previous
hypersensitivity
to other

50S ribosomal
subunit of
susceptible
bacterial
organisms and
thus inhibits
protein
synthesis of
the bacteria.

and skin and soft tissue

infections caused by
clinically significant
aerobic and anaerobic
gram-negative and
gram-positive
organisms, including S.
aureus, H. influenzae, S.
pneumoniae, M.
catarrhalis, S.
pyogenes, M.
pneumoniae. Prevention
and treatment
of Mycobacterium
avium complex (MAC)
infections in patients
with HIV. Used in
combination
for Helicobacter pylori.

receiving pimozide;
suspected or potential
bacteremias; acute
porphyria; severe
hepatic or biliary
disease; pregnancy
(category C). Safety and
efficacy in children <6 y
not established.
Cautious Use
Renal impairment, older
adults, and lactation.

57

CNS: Headache.
Skin: Rash, urticaria.

macrolides (e.g.,
erythromycin)
before treatment.

Withhold drug
and notify
physician, if
hypersensitivity
occurs (e.g.,
rash, urticaria).

Monitor for and

report loose
stools or
diarrhea, since
pseudomembran
ous colitis must
be ruled out.

When
clarithromycin is
given
concurrently with
anticoagulants,
digoxin, or
theophylline,
blood levels of
these drugs may
be elevated.
Monitor
appropriate
serum levels and
assess for S&S of

drug toxicity.

MEDICATION
Clindamycin

CLASSIFIC
ATION
Lincosa
mide
antibioti
c
Pregnan
cy
Categor
yB

ACTION
Inhibits protein
synthesis in
susceptible
bacteria,
causing cell
death.

CLIENTS INDICATION

Systemic
administration:
Serious infections
caused by
susceptible strains of
anaerobes,
streptococci,
staphylococci, pneu
mococci; reserve use
for penicillin-allergic
patients or when
penicillin is
inappropriate; less
toxic antibiotics
(erythromycin)
should be considered
Parenteral:
Treatment of
septicemia caused
by staphylococci,
streptococci;
acute hematogenous
osteomyelitis;
adjunct to surgical
treatment of chronic
bone and joint
infections due to
susceptible
organisms; do not

CONTRAINDICATION

ADVERSE EFFECTS

Systemic administration

Systemic administration

Contraindicated with
allergy
to clindamycin,
history of asthma or
other
allergies, tartrazine (i
n
75- and 150-mg
capsules); hepatic or
renal dysfunction;
lactation.
Use cautiously in
newborns and
infants due to benzyl
alcohol content;
associated with
gasping syndrome.

Topical dermatologic
solution, vaginal
preparation

58

Contraindicated with
allergy

CV: Hypotension,
cardiac arrest
(with rapid IV infusion)
GI: Severe colitis,
including
pseudomembranous co
litis,
nausea, vomiting,
diarrhea,
abdominal pain,
esophagitis,
anorexia, jaundice, liver
function changes
Hematologic: Neutropen
ia,
leukopenia,
agranulocytosis, eosinoph
ilia
Hypersensitivity: Rashe
s,
urticaria to
anaphylactoid reactions
Local: Pain following
injection, induration and
sterile abscess after IM
injection, thrombophlebiti
s

NURSING
RESPONSIBILITIES

Culture
infection before
therapy.

Administer
oral drug with a
full glass of
water or with
food to prevent
esophageal
irritation.

Do not give IM
injections of
more than
600 mg; inject
deep into large
muscle to avoid
serious
problems.

Do not use for

minor bacterial
or viral
infections.

Monitor renal
and liver
function tests,
and blood
counts with
prolonged
therapy.

use to treat
meningitis; does not
cross the bloodbrain
barrier.
Topical dermatologic
solution: Treatment
of acne vulgaris
Vaginal preparation:
Treatment of
bacterial vaginosis

to clindamycin or linc
omycin.
Use cautiously with
history of regional
enteritis or
ulcerative colitis;
history of antibioticassociated colitis.

after IV use
Topical dermatologic
solution
CNS: Fatigue,
headache
Dermatologic: Conta
ct dermatitis,
dryness, gram-negative f
olliculitis
GI: Pseudomembran
ous colitis,
diarrhea, bloody
diarrhea; abdominal pain,
sore throat
GU: Urinary frequency

Vaginal preparation
GU: Cervicitis,
vaginitis, vulvar irritati

on
MEDICATION
Levoflaxacin

CLASSIFICA
TION
Fluorquinolon
es

ACTION

CLIENTS INDICATION

CONTRAINDICATION

A broadspectrum
fluoroquinolo
ne antibiotic
that inhibits
DNA-gyrase,
an enzyme
necessary
for bacterial
replication,
transcription

Treatment of maxillary
sinusitis, acute
exacerbations of
bacterial bronchitis,
community-acquired
pneumonia,
uncomplicated skin/skin
structure infections, UTI,
acute pyelonephritis
caused by susceptible
bacteria; acute bacterial

Hypersensitivity to
levofloxacin and
quinolone antibiotics;
hypokalemia, tendon
pain, pregnancy
(category C); syphilis;
viral infections;
phototoxicity; lactation.
Cautious Use
59

ADVERSE EFFECTS
CNS: Headache, insomnia,
dizziness.
GI: Nausea, diarrhea,
constipation, vomiting,
abdominal pain, dyspepsia.
Skin: Rash, pruritus.
Special Senses:
Decreased vision, foreign
body sensation,
transient ocular burning,
ocular pain, photophobia.

NURSING
RESPONSIBILITIES

Lab tests: Do
C&S test prior to
beginning
therapy and
periodically.

Withhold therapy
and report to
physician
immediately any

, repair, and
recombinatio
n.

MEDICATION
Nalidixic Acid

CLASSIFICA
TION
Urinary Tract
Antiinfective;

ACTION
Synthetic
quinolone.

sinusitis; chronic
bacterial prostatitis;
bacterial conjunctivitis.

CLIENTS INDICATION
Urinary tract infections
caused by susceptible

Known or suspected
CNS disorders
predisposed to seizure
activity (e.g., severe
cerebral
atherosclerosis), risk
factors associated with
potential seizures (e.g.,
some drug therapy,
renal insufficiency),
dehydration, colitis; QT
prolongation, cardiac
arrhythmias; renal
impairment; diabetes;
patients receiving
theophylline or caffeine;
older adults. Safety and
efficacy in children <18
y are not established.

Urogenital: Vaginitis.
Body as a Whole: Injection
site pain or inflammation,
chest or back pain, fever,
pharyngitis.
Other: Cartilage erosion.

CONTRAINDICATION

ADVERSE EFFECTS

History of convulsive
disorders; first trimester
60

Body as a
Whole: Angioedema, fever,

of the following:
Skin rash or
other signs of a
hypersensitivity
reaction; CNS
symptoms such
as seizures,
restlessness,
confusion,
hallucinations,
depression; skin
eruption
following sun
exposure;
symptoms of
colitis such as
persistent
diarrhea; joint
pain,
inflammation, or
rupture of a
tendon;
hypoglycemic
reaction in
diabetic on an
oral
hypoglycemic
agent.

NURSING
RESPONSIBILITIES

Lab tests:

Quinolones

Intracellular
action (by
unknown
mechanism)
inhibits
microbial
DNA
replication
and RNA
synthesis

gram-negative
organisms
including
most Proteus strains,
Klebsiella,
Enterobacter, and Esche
richia coli.

of pregnancy; infants
<3 mo.
Cautious Use
Prepubertal child;
second and third
trimesters of pregnancy
(category B); kidney or
liver disease; epilepsy;
cerebral arteriosclerosis;
respiratory insufficiency;
patients and breastfeeding infants with
G6PD deficiency.

61

chills, arthralgia,
hypersensitivity
pneumonitis, anaphylaxis (ra
re). CNS: Drowsiness,
headache, malaise,
dizziness, vertigo, syncope,
weakness, myalgia,
peripheral neuritis,
confusion, excitement,
mental depression, seizures,
insomnia. GI: Abdominal
pain, nausea,
vomiting, diarrhea,
cholestasis, transient
increase in
AST. Hematologic: Eosinoph
ilia, hemolytic anemia
(especially in G6PD
deficiency). Skin: Photosensi
tivity, pruritus, urticaria,
rash. Other: Cartilage
erosion.

Perform C&S
tests prior to
initiation of
treatment and
periodically
thereafter. Obtain
blood counts and
kidney or liver
function tests if
therapy is
continued longer
than 2 wk.

Watch for CNS

reactions, which
tend to occur 30
min after
initiation of
treatment or
after second or
third dose.
Infants, children,
and older adults
are especially
susceptible.
Report
immediately the
onset of marked
irritability,
vomiting, bulging
of anterior
fontanelle,
headache,
excitement or

drowsiness,
papilledema,
vertigo.

MEDICATIO
N
Trimethoprim
Sulfamethox
azole

CLASSIFICATIO
N
Urinary Tract
agent;
Sulfonamide

ACTION

CLIENTS INDICATION

CONTRAINDICATION

ADVERSE EFFECTS

Fixed
combination
of
sulfamethoxa
zole (SMZ),
an
intermediate
acting
antiinfective
sulfonamide,
and
trimethoprim
(TMP), a
synthetic
antiinfective.
Both
components
of the
combination
are synthetic
folate
antagonist
antiinfectives.
Mechanism of
action is

Pneumocystis
carinii pneumonitis, Shi
gellosis enteritis, and
severe complicated UTIs
due to most strains of
the Enterobacteriaceae.
Also children with acute
otitis media due to
susceptible strains
ofHaemophilus
influenzae, and acute
episodes of chronic
bronchitis in adults.

Hypersensitivity to TMP,
SMZ, sulfonamides, or
bisulfites; group A betahemolytic streptococcal
pharyngitis;
megaloblastic anemia
due to folate deficiency;
creatinine clearance
<15 mL/min; pregnancy
(category C), lactation.
Not recommended for
infants <2 mo.

Skin: Mild to moderate

rashes (including fixed
drug eruptions), toxic
epidermal necrolysis.
GI: Nausea,
vomiting, diarrhea, anorex
ia,
hepatitis, pseudomembran
ous enterocolitis,
stomatitis, glossitis,
abdominal pain.
Urogenital: Kidney
failure,
oliguria, anuria,
crystalluria.
Hematologic:
Agranulocytosis (rare), apl
astic anemia (rare),
megaloblastic anemia,
hypoprothrombinemia,
thrombocytopenia (rare).
Body as a
Whole: Weakness,
arthralgia, myalgia,
photosensitivity, allergic

Cautious Use
Impaired kidney or liver
function; possible folate
deficiency; severe
allergy or bronchial
asthma; G6PD
deficiency,
hypersensitivity to
sulfonamide derivative
drugs (e.g.,
acetazolamide,
62

NURSING
RESPONSIBILITIES

Be aware that IV
Septra contains
sodium
metabisulfite, which
produces allergictype reactions in
susceptible
patients: Hives,
itching, wheezing,
anaphylaxis.
Susceptibility (low
in general
population) is seen
most frequently in
asthmatics or
atopic
nonasthmatic
persons.

Lab tests: Baseline

and followup
urinalysis; CBC with
differential, platelet
count, BUN and

principally
enzyme
inhibition,
which
prevents
bacterial
synthesis of
essential
nucleic acids
and proteins.

thiazides, tolbutamide).

myocarditis.
creatinine
clearance with
prolonged therapy.

63

Monitor coagulation
tests and
prothrombin times
in patient also
receiving warfarin.
Change in warfarin
dosage may be
indicated.

Monitor I&O volume

and pattern. Report
significant changes
to forestall renal
calculi formation.
Also report failure
of treatment (i.e.,
continued UTI
symptoms).

Older adult patients

are at risk for
severe adverse
reactions,
especially if liver or
kidney function is
compromised or if
certain other drugs
are given. Most
frequently
observed:

Thrombocytopenia
(with concurrent
thiazide diuretics);
severe decrease in
platelets (with or
without purpura);
bone marrow
suppression; severe
skin reactions.

MEDICATIO
N
Metronidazol
e

CLASSIFICATIO
N
ANTIINFECTIVE;
ANTITRICHOMO
NAL; AMEBICIDE
;
ANTIBIOTIC

ACTION
Synthetic
compound
with direct
trichomonaci
dal and
amebicidal
activity as

CLIENTS INDICATION
Asymptomatic and
symptomatic
trichomoniasis in
females and males;
acute intestinal
amebiasis and amebic
liver abscess;

CONTRAINDICATION
Blood dyscrasias; active
CNS disease; first
trimester of pregnancy
(category B), lactation.
Cautious Use
64

ADVERSE EFFECTS
Body as a
Whole: Hypersensitivity
(rash, urticaria, pruritus,
flushing), fever, fleeting
joint pains, overgrowth
of Candida. CNS: Vertigo,
headache, ataxia,

Be alert for
overdose symptoms
(no extensive
experience has
been reported):
Nausea, vomiting,
anorexia,
headache,
dizziness, mental
depression,
confusion, and
bone marrow
depression.

NURSING
RESPONSIBILITIES

Discontinue therapy
immediately if
symptoms of CNS
toxicity develop.
Monitor especially
for seizures and

well as
antibacterial
activity
against
anaerobic
bacteria and
some gramnegative
bacteria.

preoperative
prophylaxis in colorectal
surgery, elective
hysterectomy or vaginal
repair, and emergency
appendectomy. IV
metronidazole is used
for the treatment of
serious infections
caused by susceptible
anaerobic bacteria in
intraabdominal
infections, skin
infections, gynecologic
infections, septicemia,
and for both pre- and
postoperative
prophylaxis, bacterial
vaginosis. Topical: Rosac
ea.

Coexistent candidiasis;
second and third
trimesters of pregnancy
(category B);
alcoholism; liver
disease.

65

confusion, irritability,
depression, restlessness,
weakness, fatigue,
drowsiness, insomnia,
paresthesias, sensory
neuropathy
(rare). GI: Nausea, vomitin
g, anorexia, epigastric
distress, abdominal
cramps, diarrhea,
constipation, dry mouth,
metallic or bitter taste,
proctitis.
Urogenital: Polyuria,
dysuria, pyuria,
incontinence, cystitis,
decreased libido,
dyspareunia, dryness of
vagina and vulva, sense of
pelvic pressure.
Special Senses: Nasal
congestion.
CV: ECG changes
(flattening of T wave).

peripheral
neuropathy (e.g.,
numbness and
paresthesia of
extremities).

Lab tests: Obtain

total and
differential WBC
counts before,
during, and after
therapy, especially
if a second course
is necessary.

Monitor for S&S of

sodium retention,
especially in
patients on
corticosteroid
therapy or with a
history of CHF.

Monitor patients on
lithium for elevated
lithium levels.

Report appearance
of candidiasis or its
becoming more
prominent with
therapy to
physician promptly.

MEDICATIO
N
Rifampin

CLASSIFICATIO
N
Antiinfective;
Antituberculosis
agent; mRNA
synth
Preg Cat: C

ACTION

CLIENTS INDICATION

CONTRAINDICATION

ADVERSE EFFECTS

Semisyntheti
c derivative
of rifamycin
B, an
antibiotic
derived
from Streptoc
occus
mediterranei,
with
bacteriostatic
and
bactericidal
actions.
Inhibits DNAdependent
RNA
polymerase
activity in
susceptible
bacterial
cells, thereby
suppressing
RNA

Primarily as adjuvant
with other
antituberculosis agents
in initial treatment and
retreatment of clinical
tuberculosis; as shortterm therapy to
eliminate meningococci
from nasopharynx of
asymptomatic carriers
of N. meningitidis when
risk of meningococcal
meningitis is high.

Hypersensitivity to
rifampin; obstructive
biliary disease;
meningococcal disease;
intermittent rifampin
therapy; lactation. Safe
use during pregnancy
(category C) or in
children <5 y is not
established.

CNS: Fatigue, drowsiness,

headache, ataxia,
confusion, dizziness,
inability to concentrate,
generalized numbness,
pain in extremities,
muscular
weakness. Special
Senses: Visual
disturbances, transient
low-frequency hearing
loss,
conjunctivitis. GI: Heartbu
rn, epigastric distress,
nausea, vomiting,
anorexia, flatulence,
cramps,
diarrhea, pseudomembran
ous colitis, transient
elevations in liver function
tests(bilirubin, BSP,
alkaline phosphatase, ALT,
AST),
pancreatitis. Hematologic

Cautious Use
Hepatic disease; history
of alcoholism;
concomitant use of
other hepatotoxic
agents.

66

Repeat feces
examinations,
usually up to 3 mo,
to ensure that
amebae have been
eliminated.

NURSING
RESPONSIBILITIES

Lab tests:
Periodic liver
function tests
are advised.
Closely monitor
patients with
hepatic disease.

Check
prothrombin
time daily or as
necessary to
establish and
maintain
required
anticoagulant
activity when
patient is also
receiving an
anticoagulant.

Patient & Family

synthesis.

: Thrombocytopenia,
transient leukopenia,
anemia, including
hemolytic anemia. Body
as a
Whole: Hypersensitivity
(fever, pruritus, urticaria,
skin eruptions, soreness of
mouth and tongue,
eosinophilia, hemolysis),
flu-like
syndrome. Urogenital: H
emoglobinuria,
hematuria, acute renal
failure, light-chain
proteinuria, menstrual
disorders, hepatorenal
syndrome, (with
intermittent
therapy). Respiratory: He
moptysis. Other: Increasin
g lethargy, liver
enlargement and
tenderness, jaundice,
brownish-red or orange
discoloration of skin,
sweat, saliva, tears, and
feces; unconsciousness.

67

Education

Do not interrupt
prescribed
dosage regimen.
Hepatorenal
reaction with flulike syndrome
has occurred
when therapy
has been
resumed
following
interruption.

Be aware that
drug may impart
a harmless redorange color to
urine, feces,
sputum, sweat,
and tears. Soft
contact lenses
may be
permanently
stained.

Report onset of
jaundice,
hypersensitivity
reactions, and
persistence of GI
adverse effects

to physician.

68

Use or add
barrier
contraceptive if
using hormonal
contraception.
Concomitant use
of rifampin and
oral
contraceptives
leads to
decreased
effectiveness of
the
contraceptive
and to
menstrual
disturbances
(spotting,
breakthrough
bleeding).

Keep drug out of

reach of
children.

Do not breast
feed while
taking this drug.

69