1

Generic Name: Cefoxitin sodium

Specific Name: Haxotin®, Mefoxin®

General Action: Antibiotic, Cephalosporin (2nd Generation), Antibacterial

Specific Action: Bactericidal: inhibits synthesis of bacterial cell wall,

causing cell death.

Indications:

• Perioperative prophylaxis

• Skin and skin structure infections caused by Streptococcus aureus,

Escherichia coli, Staphylococcus epidermidis

Contraindications and cautions:

• Contraindicated with allergy to cephalosporins or penicillins

• Use cautiously with renal failure, lactation, pregnancy.

Adverse Effects:

• CNS: Headache, dizziness, lethargy, paresthesias

• GI: nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence,

pseudomembranous colitis, hepatotoxicity

• GU: Nephrotoxicity

• Hematologic: Bone marrow depression- decreased WBC, decreased

platelets, decreased Hct

• Hypersensitivity: ranging from rash to fever to anaphylaxis, serum

sickness reaction

• Local: pain, abscess at injection site,, phlebitis, inflammation at IV site

• Other: superinfections

Available forms:

Powder for injection – 1, 2 g; injection- 1g/50ml, 2g/50ml in D5W

Dosages and Routes:

Adults

• Perioperative prophylaxis: 2 g IV or IM 30-60 min prior to initial incision

and every 6 hr after surgery

• Cesarean section: 2 g IV as the umbilical cord is clamped, followed by

2 g IM or IV at 4 and 8 hr, every 6 hr for up to 24 hr.

• Transurethral prostatectomy: 1 g prior to surgery and then 1 g every 8

hr for up to 5 days.

• 1-2 g IM or IV every 6-8 hr, depending on the severity of infection.

Pediatric patients 3 mos or older

80-160 mg/kg/day IM or IV in divided doses every 4-6 hr. do not exceed

12g/day.

• Prophylactic use: 30-40 mg/kg per dose IV or IM every 6 hr.

Nursing Responsibilities:

• Assess for hepatic and renal impairment, lactation, pregnancy

• Assess skin status, LFTs, renal function tests, culture of infected area,
sensitivity tests

• Reconstitute each gram for IM use with 2 ml sterile water for injection
or with 2 ml of 0.5% lidocaine HCL solution (without epinephrine) to
decrease pain at injection site. Inject deeply into large muscle group.

• Dry powder and reconstituted solutions darken slightly at room

temperature.

• Have vitamin K available in case hypoprothrombinemia occurs.

• Discontinue if hypersensitivity reaction occurs.

• Encourage patient to avoid alcohol while taking this drug and for 3
days after because severe reactions often occur.

• Inform patient that he may experience side effects like stomach upser
and diarrhea.
 • Advise patient to report severe diarrhea, difficulty breathing, unusual
tiredness or fatigue and pain at injection site.

2
Generic Name: Ceftriaxone sodium

Specific Name: Haxon®, Rocephin®

General Action: Antibiotic, Cephalosporin (3rd Generation), Antibacterial

Specific Action: Bactericidal: inhibits synthesis of bacterial cell wall,

causing cell death.

Indications:

• Perioperative prophylaxis for patients undergoing coronary artery

bypass surgery and in contaminated or potentially contaminated
surgical procedures (eg, vaginal or abdominal hysterectomy)

• Skin and skin structure infections caused by Streptococcus aureus,

Escherichia coli, Staphylococcus epidermidis

Contraindications and cautions:

• Contraindicated with allergy to cephalosporins or penicillins

• Use cautiously with renal failure, lactation, pregnancy.

Adverse Effects:

• CNS: Headache, dizziness, lethargy, paresthesias

• GI: nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence,

pseudomembranous colitis, hepatotoxicity

• GU: Nephrotoxicity

• Hematologic: Bone marrow depression- decreased WBC, decreased

platelets, decreased Hct

• Hypersensitivity: ranging from rash to fever to anaphylaxis, serum

sickness reaction
 • Local: pain, abscess at injection site,, phlebitis, inflammation at IV site

• Other: superinfections

Available forms:

Powder for injection –2 g; injection- 1,2 g

Dosages and Routes:

Adults

1-2 g/Day IM or IV once a day or in equal divided doses bid. Do not exceed
4g/day.

• Perioperative prophylaxis: Give 1 g IV 30-120 min before surgery

Pediatric patients

50-75 mg/kg/day IM or IV in divided doses every 12 hr. Do not exceed

2g/day.

Nursing Responsibilities:

• Assess for history or presence of hepatic and renal impairment,

lactation, pregnancy.

• Assess skin status, LFTs, renal function tests, culture of infected area,
sensitivity tests

• Protect drug from light.

• Do not mix ceftriaxone with any other antimicrobial drug.

• Monitor cefriaxone blood levels in patients with severe renal

impairment and in patient with renal and hepatic impairment.

• Have vitamin K available in case hypoprothrombinemia occurs.

• Discontinue if hypersensitivity reaction occurs.

• Encourage patient to avoid alcohol while taking this drug and for 3
days after because severe reactions often occur.

• Inform patient that he may experience side effects like stomach upser
and diarrhea.
 • Advise patient to report severe diarrhea, difficulty breathing, unusual
tiredness or fatigue and pain at injection site.

3
Generic Name: Cefuroxime sodium

Specific Name: Lasuzef®, Zinacef®

General Action: Antibiotic, Cephalosporin (2nd Generation), Antibacterial

Specific Action: Bactericidal: inhibits synthesis of bacterial cell wall,

causing cell death.

Indications:

• Perioperative prophylaxis

• Skin and skin structure infections caused by Streptococcus aureus,

Escherichia coli, Staphylococcus epidermidis

Contraindications and cautions:

• Contraindicated with allergy to cephalosporins or penicillins

• Use cautiously with renal failure, lactation, pregnancy.

Adverse Effects:

• CNS: Headache, dizziness, lethargy, paresthesias

• GI: nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence,

pseudomembranous colitis, hepatotoxicity

• GU: Nephrotoxicity

• Hematologic: Bone marrow depression- decreased WBC, decreased

platelets, decreased Hct
 • Hypersensitivity: ranging from rash to fever to anaphylaxis, serum
sickness reaction

• Local: pain, abscess at injection site,, phlebitis, inflammation at IV site

• Other: superinfections

Available forms:

Powder for injection – 750mg; 1.5 g injection- 750 mg, 1.5 g

Tablets – 125, 250, 500 mg; suspension – 125 mg/5ml, 250 mg/5ml

Dosages and Routes:

Adults (Parenteral)

• Perioperative prophylaxis: 1.5 g IV 30-60 min prior to initial incision;

then 750 mg IV or IM every 8 hr or 24 hr after surgery.

Pediatric patients older than 3 mos

50-100 mg/kg/day IM or IV in divided doses every 6-8 hr.

Nursing Responsibilities:

• Assess for history or presence of hepatic and renal impairment,

lactation, pregnancy

• Assess skin status, LFTs, renal function tests, culture of infected area,
sensitivity tests

• Give oral drug to children who can swallow tablets; crushing the drug
results in a bitter, unpleasant taste.

• Have vitamin K available in case hypoprothrombinemia occurs.

• Discontinue if hypersensitivity reaction occurs.

• Encourage patient to avoid alcohol while taking this drug and for 3
days after because severe reactions often occur.

• Inform patient that he may experience side effects like stomach upser
and diarrhea.
 • Advise patient to report severe diarrhea, difficulty breathing, unusual
tiredness or fatigue and pain at injection site.

4
Generic Name: Dexamethasone sodium phosphate

Specific Name: Dexticort®, Decadron®

General Action: Corticosteroid, Glucocorticoid hormone

Specific Action: Enters target cells and binds to specific receptors,

initiating many complex reactions that are responsible for its anti-
inflammatory and immunosuppressive effects.

Indications:

• Hypercalcemia associated with cancer

• Cerebral edema associated with brain tumor, craniotomy, or head

injury

Contraindications and cautions:

• Contraindicated with infections, especially tuberculosis, fungal

infections, amebiasis, vaccinia andvaricella, and antibiotic resistant
infections, allergy to any component of preparation used.

• Use cautiously with renal or hepatic disease; hypothyroidism,

ulcerative colitis with impending perforation, diverticulitis; active or
latent peptic ulcer, inflammatory bowel disease, heart failure,
 hypertension, thromboembolic disorders; osteoporosis; seizure
disorders; diabetes mellitus;lactation.

Adverse Effects:

Adverse effects depend on dose, route, and duration of therapy.

• CNS: Seizures, vertigo, headache, euphoria, insomnia, mood swings,

depression, psychosis, intracerebral hemorrhage, glaucoma

• CV: hypertension, heart failure, necrotizing angitis

• Endocrine: growth retardation, decreased carbohydrate tolerance,

diabetes mellitus, cushingoid state, secondary adrenocortical and
pituitary unresponsiveness.

• GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention

• GU: Amenorrhea, irregular menses

• Hematologic: Fluid and electrolyte disturbances, negative nitrogen

balance, increased blood sugar, glycosuria, increased serum
cholesterol, decreased serum T3 and T4 levels.

• Hypersensitivity: Anaphylactoid or hyerensitivity reactions

• Musculoskeletal: muscle weakness, loss of muscle mass, osteoporosis,

spontaneous fractures

• Other: Impaired wound healing, ecchymoses, increased sweating,

fragile skin, acne, immunosupression

Available forms:

4mg/ml, sol. for injection

Dosages and Routes:

Adults

IM or IV – 0.5

Cerebral edema: 10 mg IV and then 4 mg IM every 6 hr until cerebral edema

symptoms subside; change to oral therapy, 1-3 mg tid, as soon as possible
and taper over 5-7 days.
Pediatric patients 3 mos or older

Individualize dosage based on severity of condition and response, rather

than by strict adherence to formula that correct adult doses for age or body
weight. Carefully observe growth and development in infants and children on
long-term therapy.

Nursing Responsibilities:

• Assess for active infections, renal or hepatic disease, hypothyroidism,

ulcerative colitis, diverticulitis, active or latent peptic ulcer,
inflammatory bowel disease, heart failure, hypertension,
thromboembolic disorder, osteoporosis, seizure disorder.

• Do not give drug to nursing mothers, since drug may be secreted in

breast milk.

• Give daily doses before 9am to mimic normal peak corticosteroid blood
levels.

• Increase dosage when patient is subject to stress.

• Taper doses when discontinuing high-dose or long-term therapy

• Do not give live virus vaccines with immunosuppressive doses of

corticosteroids.

• Instruct patient to avoid exposure to infections

• Encourage to report unusual weight gain, swelling of extremities,

muscle weakness, black tarry stool, fever, prolonged sore throat, colds
or other infections, worsening of this disorder

5
Generic Name: Ceftazidime

Specific Name: Hacef®, Tazidime®

General Action: Antibiotic, Cephalosporin (3rd Generation), Antibacterial

Specific Action: Bactericidal: inhibits synthesis of bacterial cell wall,

causing cell death.

Indications:
 • Skin and skin structure infections caused by Streptococcus aureus,
Escherichia coli, Staphylococcus epidermidis

• Treatment of infection due to sensitive gram positive & gram negative

bacteria.

Contraindications and cautions:

• Contraindicated with allergy to cephalosporins or penicillins

• Use cautiously with renal failure, lactation, pregnancy.

Adverse Effects:

• CNS: Headache, dizziness, lethargy, paresthesias

• GI: nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence,

pseudomembranous colitis, hepatotoxicity

• GU: Nephrotoxicity

• Hematologic: Bone marrow depression- decreased WBC, decreased

platelets, decreased Hct

• Hypersensitivity: ranging from rash to fever to anaphylaxis, serum

sickness reaction

• Local: pain, abscess at injection site,, phlebitis, inflammation at IV site

• Other: superinfections

Available forms:

Powder for injection – 500mg, 1, 2 g ; injection- 1, 2 g

Dosages and Routes:

Adults

Usual dose, 1 g (range 250 mg – 2 g) every 8-12 hr IM or IV. Do not exceed

6g/day. Dosage will vary with infection.

Pediatric patient 1 mo- 12 yr

30-50 mg/kg IV every 8 hr. Do not exceed 6g/day.

Pediatric patient 0-4 weeks

30 mg/kg IV every 12 hr.

Nursing Responsibilities:

• Assess for hepatic and renal impairment, lactation, pregnancy

• Assess skin status, LFTs, renal function tests, culture of infected area,
sensitivity tests

• Reconstitute drug for IM use with sterile water or bacteriostatic watrer

for injection or with 0.5% or 1% lidocaine HCL injection to reduce pain;
inject deeply into large muscle group.

• Do not mix aminoglycoside solutions. Administer this drugs separately.

• Powder and reconstituted solution darken with storage.

• Have vitamin K available in case hypoprothrombinemia occurs.

• Discontinue if hypersensitivity reaction occurs.

• Encourage patient to avoid alcohol while taking this drug and for 3
days after because severe reactions often occur.

• Inform patient that he may experience side effects like stomach upser
and diarrhea.

• Advise patient to report severe diarrhea, difficulty breathing, unusual

tiredness or fatigue and pain at injection site.

6
Generic Name: Clindamycin

Specific Name: Tidact®, Dalacin C®

General Action: Lincosamide antibiotic

Specific Action: Inhibits protein synthesis in susceptible bacteria, causing

cell death.

Indications:

• Adjunct to surgical treatment of chronic bone and joint infections due to

susceptible organisms
 • Indicated for lung abscess, intra-abdominal abscess; nongonococcal tubo-
ovarian abscess, pelvic cellulitis & post-surgical vaginal cuff infection.

Contraindications and cautions:

• Contraindicated with allergy to clindamycin, lactation

• Use cautiously with new borns and infants due to benzyl alcohol
content (associated with gasping syndrome) and in patients with
tartrazine sensitivity or hepatic or renal impairment.

Adverse Effects:

• Diarrhea, nausea, vomiting, abdominal cramps & taste abnormality.

Pseudomembranous colitis. Skin rash, urticaria, leucopenia, eosinophilia,
abnormality of liver function tests, jaundice, agranulocytosis,
thrombocytopenia & erythema multiforme.

• Available forms:

• 150 mg/ml sol. For inj.

• Dosages and Routes:

Adults

Oral

• 150-300 mg every 6 hr, up to 300-450 mg every hr in more severe

infections.

Parenteral

• 600-2700 mg/day in two to four equal doses, uo to 4.8 g/day IV or IM

may be used for life-threatening situations.

Pediatric patients

Oral

• For clindamycin HCL, 8-16 mg/kg/day (serious infections) or 16-20

mg/kg/day (more serious infections) in three of four equal doses.

Parenteral

• Neonates: 15-20 mg/kg/day in three or four equal doses.

 • Older than 1 mo: 15-40 mg/kg/day in three or four equal doses or 350
mg/m2/day to 450 mg/m2/day

Geriatric patients or patients with renal failure

• Reduce dose, and monitor patient closely.

Pediatric patients 3 mos or older

Nursing Responsibilities:

• Assess for allergy to clindamycin, history of asthma or other allergies,

hepatic and renal impairment, lactation, pregnancy and ulcerative
colitis.

• Assess BP, respirations, adventitious sounds, bowel sounds, CBC, I and

O.

• 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 infection.

• Be aware of the serious to fatal colitis that may occur, reserve use, and
monitor patient closely.

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

• Take full prescribed course of oral drug, do not stop taking without
notifying the doctor.

• Advice patient that he may experience side effects like nausea and
vomiting, superinfections

• Report severe or watery diarrhea, abdominal pain, inflamed mouth or

vagina

• If as vaginal, use it for 7 or 3 consecutive days, preferably at bedtime.

• Report vaginal irritation, itching, diarrhea, or if no improvement in

complaint being treated.
7
Generic Name: Cefazolin sodium

Specific Name: Hazolin®

General Action: 1st generation cephalosporin, Anti-infective, antibacterial

Specific Action: Inhibits bacterial cell wall synthesis, rendering cell wall
osmotically unstable, Interferes with bacterial cell-wall synthesis, causing cell to
rupture and die

Indications:

• Surgical prophylaxis

Contraindications and cautions:

• Hypersensitivity to cephalosporins or penicillins

• Use cautiously in renal impairment, phenylketonuria, history of GI disease
(especially colitis), emaciated patients, elderly patients, pregnant or
breastfeeding patients, children.

Adverse Effects:

• CNS: headache, lethargy, confusion, hemiparesis, paresthesia, syncope,

seizures
• CV: hypotension, palpitations, chest pain, vasodilation
• EENT: hearing loss
• GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis,
pseudomembranous colitis
• GU: vaginal candidiasis, nephrotoxicity
• Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic
anemia, hypoprothrombinemia, neutropenia, thrombocytopenia,
agranulocytosis, bone marrow depression
• Hepatic: hepatic failure, hepatomegaly
• Musculoskeletal: arthralgia
• Respiratory: dyspnea
• Skin: urticaria, maculopapular or erythematous rash
• Other: chills, fever, superinfection, anaphylaxis, serum sickness

Available forms:
 • 1g powder for inj

Dosages and Routes:

Adults

Oral

• 150-300 mg every 6 hr, up to 300-450 mg every hr in more severe

infections.

Parenteral

• 600-2700 mg/day in two to four equal doses, uo to 4.8 g/day IV or IM

may be used for life-threatening situations.

Pediatric patients

• Adults: 1g I.V. or I.M. 30 to 60 minutes before surgery, then 0.5 to 1 g I.V. or

I.M. q 6 to 8 hours for 24 hours. If surgery exceeds 2 hours, another 0.5- to 1-
g dose I.M. or I.V. may be given intraoperatively.

Geriatric patients or patients with renal failure

• Reduce dose, and monitor patient closely.

Nursing Responsibilities:

• Assess for allergy to cefazolin sodium, hepatic and renal impairment,

lactation, pregnancy.

• If patient is receiving high doses, monitor for extreme confusion, tonic-clonic

seizures, and mild hemiparesis.

• Monitor CBC, prothrombin time, and kidney and liver function test results.
Watch for signs and symptoms of superinfection and other serious adverse
reactions.

• Be aware that cross-sensitivity to penicillins may occur.

• Tell patient to report reduced urinary output, persistent diarrhea, bruising, or

bleeding.

• Instruct patient to take drug exactly as prescribed and to complete full

course of therapy even when he feels better.
 • As appropriate, review all other significant and life-threatening adverse
reactions and interactions, especially those related to the drugs, tests, and
behaviors mentioned above.

8
Generic Name: Benzylpenicillin sodium

Specific Name: Harbipen®

General Action: Penicillins

Specific Action: Inhibits bacterial cell wall synthesis, rendering cell wall
osmotically unstable, Interferes with bacterial cell-wall synthesis, causing cell to
rupture and die

Indications:

• Surgical prophylaxis

Contraindications and cautions:

• Hypersensitivity to cephalosporins or penicillins

• Use cautiously in renal impairment, phenylketonuria, history of GI disease
(especially colitis), emaciated patients, elderly patients, pregnant or
breastfeeding patients, children.

Adverse Effects:

• CNS: headache, lethargy, confusion, hemiparesis, paresthesia, syncope,

seizures
• CV: hypotension, palpitations, chest pain, vasodilation
• EENT: hearing loss
• GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis,
pseudomembranous colitis
• GU: vaginal candidiasis, nephrotoxicity
• Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic
anemia, hypoprothrombinemia, neutropenia, thrombocytopenia,
agranulocytosis, bone marrow depression
• Hepatic: hepatic failure, hepatomegaly
• Musculoskeletal: arthralgia
• Respiratory: dyspnea
 • Skin: urticaria, maculopapular or erythematous rash
• Other: chills, fever, superinfection, anaphylaxis, serum sickness

Available forms:

• 1g powder for inj

Dosages and Routes:

Adults

Oral

• 150-300 mg every 6 hr, up to 300-450 mg every hr in more severe

infections.

Parenteral

• 600-2700 mg/day in two to four equal doses, uo to 4.8 g/day IV or IM

may be used for life-threatening situations.

Pediatric patients

• Adults: 1g I.V. or I.M. 30 to 60 minutes before surgery, then 0.5 to 1 g I.V. or

I.M. q 6 to 8 hours for 24 hours. If surgery exceeds 2 hours, another 0.5- to 1-
g dose I.M. or I.V. may be given intraoperatively.

Geriatric patients or patients with renal failure

• Reduce dose, and monitor patient closely.

Nursing Responsibilities:

• Assess for allergy to cefazolin sodium, hepatic and renal impairment,

lactation, pregnancy.

• If patient is receiving high doses, monitor for extreme confusion, tonic-clonic

seizures, and mild hemiparesis.

• Monitor CBC, prothrombin time, and kidney and liver function test results.
Watch for signs and symptoms of superinfection and other serious adverse
reactions.

• Be aware that cross-sensitivity to penicillins may occur.

• Tell patient to report reduced urinary output, persistent diarrhea, bruising, or
bleeding.

• Instruct patient to take drug exactly as prescribed and to complete full

course of therapy even when he feels better.

• As appropriate, review all other significant and life-threatening adverse

reactions and interactions, especially those related to the drugs, tests, and
behaviors mentioned above.