Ampicillin

Oral: Ampicin (CAN), Apo-Ampi (CAN), NovoAmpicillin (CAN), Nu-Ampi (CAN), Penbritin (CAN), Principen Pregnancy Category B Drug classes Antibiotic Penicillin

Therapeutic actions Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death. Indications Treatment of infections caused by susceptible strains of Shigella, Salmonella, Escherichia coli, Haemophilus influenzae, Proteus mirabilis, Neisseria gonorrhoeae, enterococci, gram-positive organisms (penicillin Gsensitive staphylococci, streptococci, pneumococci) Meningitis caused by Neisseria meningitidis Unlabeled use: Prophylaxis in cesarean section in certain high-risk patients Dosage & Route Maximum recommended dosage, 814 g/day (reserve 14 g for serious infections, such as meningitis, septicemia); may be given IV, IM, or PO. Use parenteral routes for severe infections; switch to oral route as soon as possible.
ADULTS

Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 2 g ampicillin IM or IV with gentamicin 1.5 mg/kg IM or IV within 30 minutes of starting procedure. Six hours later, give 1 g ampicillin IM or IV or 1 g amoxicillin PO. Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 2 g ampicillin IM or IV within 30 minutes of procedure. STDs in pregnant women and patients allergic to tetracycline: 3.5 g ampicillin PO with 1 g probenecid. Prophylaxis in cesarean section: Single IV or IM dose of 25100 mg/kg immediately after cord is clamped.
ADULTS AND PEDIATRIC PATIENTS

Respiratory and soft-tissue infections: > 40 kg: 250500 mg IV or IM q 6 hr. < 40 kg: 2550 mg/kg/day IM or IV in equally divided doses at 68 hr intervals.

> 20 kg: 250 mg PO q 6 hr. < 20 kg: 50 mg/kg/day PO in equally divided doses q 68 hr. GI and GU infections, including women with N. gonorrhoeae: > 40 kg: 500 mg IM or IV q 6 hr. < 40 kg: 50100 mg/kg/day IM or IV in equally divided doses q 68 hr. > 20 kg: 500 mg PO q 6 hr. < 20 kg: 100 mg/kg/day PO in equally divided doses q 68 hr. Gonococcal infections: 500 mg q 6 hr for penicillin-sensitive organism or for patients > 45 kg, single dose of 3.5 g PO with 1 g probenecid. Bacterial meningitis: 150200 mg/kg/day by continuous IV drip and then IM injections in equally divided doses q 34 hr. Septicemia: 150200 mg/kg/day IV for at least 3 days, then IM q 34 hr.
PEDIATRIC PATIENTS

Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 50 mg/kg ampicillin IM or IV with 1.5 mg/kg gentamicin IM or IV within 30 minutes of procedure. Six hours later give 25 mg/kg ampicillin IM or IV or 25 mg/kg amoxicillin PO. Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 50 mg/kg ampicillin IM or IV within 30 minutes of procedure.

Adverse Effects CNS: Lethargy, hallucinations, seizures CV: CHF GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black hairy tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time Hypersensitivity: Rash, fever, wheezing, anaphylaxis Local: Pain, phlebitis, thrombosis at injection site (parenteral) Other: Superinfectionsoral and rectal moniliasis, vaginitis Contraindications and Cautions Contraindicated with allergies to penicillins, cephalosporins, or other allergens. Use cautiously with renal disorders. Nursing Considerations Assessment History: Allergies to penicillins, cephalosporins, or other allergens; renal disorders; lactation Physical: Culture infected area; skin color, lesion; R, adventitious sounds; bowel sounds; CBC, LFTs, renal function tests, serum electrolytes, Hct, urinalysis Interventions

Culture infected area before treatment; reculture area if response is not as expected. Check IV site carefully for signs of thrombosis or drug reaction. Do not give IM injections in the same site; atrophy can occur. Monitor injection sites. Administer oral drug on an empty stomach, 1 hr before or 2 hr after meals with a full glass of water; do not give with fruit juice or soft drinks.

Teaching Points Take this drug around-the-clock. Take the full course of therapy; do not stop taking the drug if you feel better. Take the oral drug on an empty stomach, 1 hour before or 2 hours after meals; do not take withfruit juice or soft drinks; the oral solution is stable for 7 days at room temperature or 14 days refrigerated. This antibiotic is specific to your problem and should not be used to self-treat other infections. You may experience these side effects: Nausea, vomiting, GI upset (eat frequent small meals), diarrhea. Report pain or discomfort at sites, unusual bleeding or bruising, mouth sores, rash, hives, fever, itching, severe diarrhea, difficulty breathing.

Amoxicillin
is an antibiotic used to treat bacterial infections. It is commonly a drug of choice because it is easily absorbed by oral administration. Common brand names: Agcomen, Agpen, Alvonal, Amelox, Amoclav, Amoxil, Apo-Amoxi, Augmentin, Bactoclav, Cilfam, Clovimax, DisperMox, Klavic, Natravox, Novamox, Novamoxin, Polymox, Solclav, Trimox, and Wymox. Amoxicillin is classified as penicillin and an antibiotic. Indication for Amoxicillin Amoxicillin is used for the treatment of skin or skin structure infections; respiratory tract, GI tract, and GU tract infections; otitis media; gonorrhea. It is also used in the treatment of H. pylori associated with peptic ulcer. It can also be used in the treatment of Lyme disease and typhoid fever. Routes and Dosage of Amoxicillin Ear, Nose, Throat, GU, Skin, or Skin structure infections

PO: ADULTS, ELDERLY, CHILDREN >20 KG: 250-500 mg ever 8 hours (or 500-875 mg tablets for 2 times a day). CHILDREN <20 KG: 20-40 mg/kg/day in divided doses every 812 hours. Lower Respiratory Tract Infections PO: ADULTS, ELDERLY, CHILDREN >20 KG: 500 mg every 8 hours (or 875 mg tablets 2 times/day). CHILDREN <20 KG: 40 mg/kg/day in divided doses every 812 hours. Acute Uncomplicated Gonorrhea PO:ADULTS: 3 g one time with 1 g probenecid. Follow with tetracycline or erythromycin therapy. CHILDREN >2 YEARS: 50 mg/kg plus probenacid 25 mg/kg as a single dose. Acute Otitis Media PO: CHILDREN: 80-90 mg/kg/day in divided dose every 12 hours. H. Pylori PO: ADULTS, ELDERLY (in combination): 1 g two times/day. for 10 days. NEONATES, CHILDREN < 3 MOS: 20-30 mg/g/day in divided doses. Endocarditis Prophylaxis PO: ADULTS, ELDERLY: 2 g 1 hour prior to procedure. CHILDREN: 50 mg/kg as above. Renal Function Impairment Creatinine clearance 10-30 ml/min: Administer every 12 hours. Creatinine clearance <10 ml/min: Administer every 24 hours. Action of Amoxicillin Amoxicillin is bactericidal to susceptible microorganisms. It inhibits cell wall synthesis. Side Effects and Adverse Reactions of Amoxicillin Side Effects of Amoxicillin o GI disturbances (mild diarrhea, nausea, or vomiting) o Headache o Oral and Vaginal Candidiasis o Generalized Rash o Urticaria Adverse Reactions of Amoxicillin o Superinfections o Severe hypersensitivity reactions (anaphylaxis, acute interstitial nephritis) o Potentially fatal antibiotic colitis ( abdominal cramps, watery svere diarrhea, fever) Nursing Considerations for Clients Taking Amoxicillin o Question history of allergies, especially penicillin and cephalosporin. o Store capsules, tablets at room temperature. o After reconstitution, oral solution is stable for 14 days at eiter room temperature or refrigerated. o Give without regards to meals. o Hold medication and promptly report rash or diarrhea (with fever abdominal pain, mucus, and blood in stool may indicate antibiotic-associated colitis). o Be alert for superinfection: increased fever, sore throat, vomiting, diarrhea, black/hairy tongue, ulceration, or changes of oral mucosa, anal/genital pruritus

Patient Teachings for Clients Taking Amoxicillin o Continue antibiotic for full length of treatment. o Space doses evenly. o Take with meals if GI upset occurs. o Notify physician in event of rash, diarrhea, or other new symptom.

Cefuroxime
is an antibiotic used to treat infections, like bronchitis; gonorrhea; Lyme disease; and infections of the ears, throat, sinuses, urinary tract, and skin. Common brand names are Aeruginox, Altacef, Ambixime, Bactipoz, Cefogen, Ceftin, Cefucil, Cefuzime, Zefur, Zinacef, and Zinnat. Cefuroxime is classified as a second-generation cephalosporin and antibiotic. Indication for Cefuroxime Cefuroxime is used to treat otitis media, respiratory tract, genitourniary tract, gynecologic, skin, and bone infections. It is also used in the treatment of speticemia, bacterial meningitis, gonorrhea, and other gonococcal infections. Cefuroxime can also be used for ampicillin-resistant influenza, perioperative prophylaxis, impetigo, acute bacterial maxillary sinusitis, and early Lyme disease. Routes and Dosage of Cefuroxime IM/IV: ADULTS, ELDERLY: 750 mg to 1.5 g every 8 hours. CHILDREN: 75-100 mg/kg/day divided every 8 hours. Maximum: 8 g/day. NEONATES: 50-100 mg/kg/day divided every 12 hours. PO: ADULTS, ELDERLY: 125-500 mg 2 times a day depending on the infection. Pharyngitis, Tonsillitis PO: CHILDREN 3 MONTHS-12 YEARS: Tablet: 125 mg every 12 hours. Suspension: 20 mg/kg/day in 2 divided doses. Acute Otitis Media, Acute Bacterial Maxillary Sinusitis, Impetigo PO: CHILDREN 3 MONTHS-12 YEARS: Tablet: 250 mg every 12 hours. Suspension: 30 mg/kg/day in 2 divided doses. Bacterial Meningitis IV: CHILDREN 3 MONTHS-12 YEARS: 200-240 mg/kg/day in divided doses every 6-8 hours Perioperative Prophylaxis IV: ADULTS, ELDERLY: 1.5 g 30-60 minutes before surgery and 750 mg every 8 hours post operative. IM/IV: NEONATES: 20-100 mg/kg/day in divided doses every 12 hours.

Dosage in Renal Impairment Adult dosage is modified based on creatinine clearance and/or severity of infection. Action of Cefuroxime Cefuroxime binds to bacterial membranes. It inhibits synthesis of bacterial cell wall. Side Effects and Adverse Reactions of Cefuroxime Side Effects of Cefuroxime Discomfort with IM administration Oral candidiasis (mouth and/or tongue sores) Mild diarrhea Mild abdominal cramping Vaginal candidiasis Nausea Serum sickness reaction (joint pain, fever) Allergic reactions Thrombophlebitis Adverse Reactions of Cefuroxime Antibiotic-associated colitis Superinfection Nephrotoxicity Severe hypersensitivity reactions Nursing Considerations for Clients Taking Cefuroxime
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Question for history of allergies, particularly cephalosporins and penicillins. Give without regards to meals. If GI upset occurs give with food or milk. Avoid crushing tablets due to bitter taste. Suspension must be given with food. Intramuscular injections must be administered deep IM to minimize discomfort. Assess mouth for white patches on mucous membranes and tongue. Monitor bowel activity and stool consistency carefully. Mild GI effects may be tolerable but increasing severity may indicate onset of antibioticassociated colitis. Monitor input and output and renal function reports for nephrotoxicity. Be alert for superinfection: severe genital or anal pruritus, abdominal pain, severe mouth soreness, moderate to severe diarrhea. Patient Teachings for Clients Taking Discomfort may occur with IM injection. Doses should be evenly spaced. Continue antibiotic therapy for full length of treatment. May cause GI upset (may take with food or milk).

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Ceftriaxone Sodium
Generic: Ceftriaxone Sodium Brand: Rocephin Classification: 3rd generation Cephalosporin Mode of Action: Inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal Suggested Dose: 50 to 70 mg/kg IM or IV, not to exceed 2g/day, given in divided doses every 12 hours Indication: Lower Respiratory Tract Infections caused by Streptococcus pneumoniae, Haemophilus Influenzae, Staphylococcus aureus, Haemophilus Parainfluenzae, Klebsiella pneumoniae, Escherichia Coli, Enterobacter aerogenes, Proteus mirabilis or Serratia marcescens. Contraindication: Patients who are hypersensitive to cephalosporins or penicillins (due to the possibility of cross-sensitivity with other beta-lactam antibiotics and those with history of colitis and renal insufficiency Side Effects: fever, dizziness, headache, chills, thrombocytosis, nausea and vomiting Adverse Effects: phlebitis, colitis, general pruritus or rashes, pain, anaphylaxis, bloody, watery stools, stomach pain or bleeding Drug Interactions: DRUG-DRUG - Aminoglycosides may cause synergistic effect against some strains of P. Aeruginosa amd Enterobacteriaceae species. Monitor Patient - Probenecid high doses ( 1-2 g daily ) may enhance hepatic clearance of ceftriaxone and shorten its half-life. Avoid using together - Calcium-containing products such as Ringers Solution or Hartmanns solution for reconstitution of ceftriaxone vials or to further dilute reconstituted vial for IV administration precipitation may occur.

DRUG-LAB - May increase BUN, ALT, AST, alkaline phosphatase, bilirubin and LDH levels

- May increase eosinophil and platelet counts. May decrease WBC count. - May falsely increase serum or urine creatinine level in tests using Jaffe reaction. - May cause false-positive results of urine glucose tests using cupric sulfate (Benedicts reagent of Clinitest)

Nursing Responsibilities: - Observe the 10 rights of drug administration - Check the Medical Order - Assess for presence of any of the contraindications in the patient, especially hypersensitivity through skin testing - Acquire baseline VS and Monitor VS frequently over the whole therapy - Administer the drug slowly via IVTT - Assess for presence of phlebitis and pain upon administration of drug, as well as other side and adverse effects - Assess for consistency of stools - Raise side rails and encourage to remain on complete bed rest - Give tepid sponge bath if with fever, and antipyretic agents if fever persists - Keep patient thermo regulated by regulating room temperature, providing dry and warm blankets - Keep patient free from infection by advising visitors with cough, colds or other illnesses to temporarily keep away from the patient, maintaining and aseptic technique in certain procedures to be done to the patient, performing proper hand washing before and after handling the patient and cleaning the patients room regularly. - Instruct patient to report any side or adverse effects promptly

Cefoxitin
Indication & Dosage Parenteral Treatment and prophylaxis of anaerobic and mixed bacterial infections Adult: 1-2 g deep IM, slow IV over 3-5 minutes or by intermittent or continuous IV infusion every 4-8 hr. Up to 12 g/day in severe infections. Child: and neonates: 20-40 mg/kg every 12 hr (neonates up to 1 wk), every 8 hr (neonates 1-4 wk), every 6-8 hr (for child and older infants). Up to 200 mg/kg/day in severe infections. Renal impairment: Loading dose: 1-2 g. Maintenance dose: According to CrCl. Haemodialysis patients: Repeat loading dose after each dialysis session.

CrCl (ml/min) Dosage Recommendation 30-50 10-29 5-9 <5 1-2 g every 8-12 hr. 1-2 g every 12-24 hr. 0.5-1 g every 12-24 hr. 0.5-1 g every 24-48 hr.

Intramuscular Uncomplicated urinary tract infections Adult: 1 g bid. Renal impairment: Loading dose: 1-2 g. Maintenance dose: According to CrCl. Haemodialysis patients: Repeat loading dose after each dialysis session. CrCl (ml/min) Dosage Recommendation 30-50 10-29 5-9 <5 1-2 g every 8-12 hr. 1-2 g every 12-24 hr. 0.5-1 g every 12-24 hr. 0.5-1 g every 24-48 hr.

Intramuscular Uncomplicated gonorrhoea Adult: 2 g as a single dose with probenecid 1 g given orally. Parenteral Prophylaxis of surgical infections Adult: 2 g IM or IV 30-60 min prior to procedure then every 6 hr, usually not for >24 hr. Child: and infants: 30-40 mg/kg at the same time intervals as adults. Neonates: 30-40 mg/kg at 8-12 hr intervals. Intravenous Prophylaxis of endometritis at caesarean section Adult: Single 2-g dose to the mother as soon as umbilical cord is clamped. If necessary, dose may be repeated at 4 and 8 hr after initial dose. Contraindications Hypersensitivity to cephalosporins. Special Precautions Hypersensitivity to penicillins; renal impairment; Porphyria. Monitor renal and haematologic status.

Adverse Drug Reactions Nausea; vomiting; diarrhoea; hypersensitivity reactions; nephrotoxicity; convulsions; CNS toxicity; hepatic dysfunction; haematologic disorders; pain at Inj site (IM); thrombophloebitis (IV infusion); superinfection with prolonged use. Headache. Potentially Fatal: Pseudomembranous collitis. Drug Interactions Enhanced nephrotoxicity with aminoglycosides and loop diuretics e.g. furosemide. Renal excretion inhibited by probenecid. Bacteriostatic antibacterials. Lab Interference Positive direct antiglobulin Coombs' test; falsely high values with Jaffe method of measuring creatinine concentrations; +ve reactions for false glucose using copper-reduction reactions; transient increases in liver enzyme values. Pregnancy Category (US FDA) Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters). Mechanism of Action Cefoxitin can induce -lactamase production by some bacteria. It is resistant to a wide range of -lactamases, including those produced by Bacteroides spp.

Benzylpenicillin
Intravenous Bacterial endocarditis Adult: 1.2 g every 4 hr by slow inj or infusion, usually used with an aminoglycoside. Renal impairment: Dose adjustments may be necessary. Intravenous Intrapartum prophylaxis against group B Streptoccocal infection in neonates Adult: Initially, 3 g via IV inj, followed by 1.5 g every 4 hr until delivery. Child: 150 mg/kg daily in 4 divided doses. Renal impairment: Dose adjustments may be necessary. Intravenous Meningococcal meningitis

Adult: 2.4 g every 4 hr by slow inj or infusion. Up to 18 g/day in meningococcal meningitis. Administer high doses (>1.2 g) at a rate not >300 mg/minute to prevent CNS irritation and electrolyte imbalance. Child: 1 mth-12 yr: 180-300 mg/kg daily in 4-6 divided doses. Infant 1-4 wk: 150 mg/kg daily in 3 divided doses. Premature infant and neonate: 100 mg/kg daily in 2 divided doses. Renal impairment: Dose adjustments may be necessary. Intravenous Pneumococcal meningitis Adult: 2.4 g every 4 hr by slow inj or infusion. Up to 18 g/day in meningococcal meningitis. Administer high doses (>1.2 g) at a rate not >300 mg/minute to prevent CNS irritation and electrolyte imbalance. Child: 1 mth-12 yr: 180-300 mg/kg daily in 4-6 divided doses. Infant 1-4 wk: 150 mg/kg daily in 3 divided doses. Premature infant and neonate: 100 mg/kg daily in 2 divided doses. Renal impairment: Dose adjustments may be necessary. Parenteral Infections due to susceptible organisms Adult: 0.6-4.8 g/day in 2-4 divided doses via IM, slow IV inj or infusion, higher doses may be needed in more serious infections. IV doses >1.2 g should be given at a rate of not >300 mg/minute. Child: 1 mth-12 yr: 100 mg/kg daily in 4 divided doses. Infant 1-4 wk: 75 mg/kg daily in 3 divided doses. Premature infant and neonate up to 7 days old: 50 mg/kg daily in 2 divided doses. Renal impairment: Dose adjustments may be necessary. Administration Should be taken on an empty stomach. (Take w/ a full glass of water on an empty stomach 1 hr before or 2 hr after meals. Do not take acidic beverages within 1 hr of a dose.) Contraindications Hypersensitivity to penicillins. Special Precautions Very high doses in poor renal function (risk of neurotoxicity) or heart failure. Avoid contact, skin sensitization may occur. Monitor serum potassium concentration, renal and haematological status. Spirochete infections particularly syphilis; suprainfection with penicillin-resistant organisms with prolonged use; avoid intrathecal route. Lactation. Adverse Drug Reactions Hypersensitivity reactions including uticaria; fever; joint pains; rashes; angioedema; serum sickness-like reactions; haemolytic anaemia; interstitial nephritis; neutropenia; thrombocytopenia; CNS toxicity including convulsions; diarrhoea; antibiotic-associated colitis.

Potentially Fatal: Anaphylaxis. Drug Interactions Probenecid prolongs T1/2 of benzylpenicillin. Bacteriostatic drugs e.g. chloramphenicol, tetracyclines; other antibacterials; anticoagulants. Lab Interference. May interfere with diagnostic tests for urinary glucose using copper sulfate, direct Coomb's test, and test for urinary or serum proteins. May interfere with diagnostic tests that use bacteria. Pregnancy Category (US FDA) Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters). Mechanism of Action Benzylpenicillin has a bactericidal action against gram-positive bacteria, gram-negative cocci, some other gram-negative bacteria, spirochetes and actinomycetes. It inhibits final cross-linking stage of peptidoglycan production through binding and inactivation of transpeptidases on the inner surface of the bacterial cell membrane thus inhibiting bacterial cell wall synthesis. It is inhibited by penicillinase and other -lactamases. Absorption: Rapidly inactivated by gastric acid; up to about 30% is absorbed after oral admin. Distribution: Widely distributed. 60% bound to plasma proteins. Metabolism: Limited metabolism. Excretion: Plasma half-life: about 30 min, may increase to 10 hr in renal impairment. Rapidly excreted in the urine.

Metronidazole
Brand Name: Apo-Metronidazole (CAN), Flagyl, Flagyl 375, Flagyl ER, Flagyl IV, Flagyl IV RTU, MetroCream (CAN), MetroGel, Metro I.V., Neo-Tric (CAN), NidaGel (CAN), Noritate, Novonidazol (CAN), PMSMetronidazole (CAN), Protostat, Trikacide (CAN) Pregnancy Category B Drug classes: Antibiotic, Antibacterial, Amebicide, Antiprotozoal

Therapeutic actions Bactericidal: inhibits DNA synthesis in specific (obligate) anaerobes, causing cell death; antiprotozoal-trichomonacidal, amebicidal: biochemical mechanism of action is not known. Indications Acute infection with susceptible anaerobic bacteria Acute intestinal amebiasis Amebic liver abscess Trichomoniasis (acute and partners of patients with acute infection) Preoperative, intraoperative, postoperative prophylaxis for patients undergoing colorectal surgery Topical application in the treatment of inflammatory papules, pustules, and erythema of rosacea Unlabeled uses: prophylaxis for patients undergoing gynecologic, abdominal surgery; hepatic encephalopathy; Crohn's disease; antibiotic-associated pseudomembranous colitis; treatment of Gardnerella vaginalis, giardiasis (use recommended by the CDC) Contraindications Contraindicated with hypersensitivity to metronidazole; pregnancy (do not use for trichomoniasis in first trimester). Use cautiously with CNS diseases, hepatic disease, candidiasis (moniliasis), blood dyscrasias, lactation. Adverse effects Headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures, peripheral neuropathy, fatigue Unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset, cramps Dysuria, incontinence, darkening of the urine Thrombophlebitis (IV); redness, burning, dryness, and skin irritation (topical) Severe, disulfiram-like interaction with alcohol, candidiasis (superinfection) Drug Interactions: Decreased effectiveness with barbiturates Disulfiram-like reaction (flushing, tachycardia, nausea, vomiting) with alcohol Psychosis if taken with disulfiram Increased bleeding tendencies with oral anticoagulants

Nursing considerations Avoid use unless necessary. Metronidazole is carcinogenic in some rodents. Administer oral doses with food. Apply topically (MetroGel, MetroCream) after cleansing the area. Advise patient that cosmetics may be used over the area after application. Reduce dosage in hepatic disease.

Cefazolin
Generic Name: Cefazolin Brand Name: Ancef Dosage: 250 mg CLASSIFICATIONS Therapeutic: Anti-infectives Pharmacologic: First generation cephalosphorins ACTIONS Bind to bacterial cell wall membrane, causing cell death. Active against many gram-positive cocci including: Streptococcus pneumoniae, Group A beta-hemolytic streptococci; Penicillinas-producing staphylococci. INDICATION Treatment of: Skin & skin structure infections; pneumonia; urinary tract infections; bone & joint infections

CONTRAINDICATIONS Contraindicated in: Hypersensitivity to cephalosphorins. Serious hypersensitivity to penicillin. Use Cautiously in:

 Renal impair- ment History of GI disease, especially colitis Geriatric patients (consider age-related decrease in body mass, renal/hepatic/ cardiac function, concurrent medications and chronic disease states) Pregnancy or Lactation SIDE EFFECTS/ ADVERSE EFFECTS CNS: Seizures (high doses) GI: Pseudomembranous colitis, diarrhea, nausea, vomiting, cramps GU: Interstitial nephritis DERM: Rashes, urticaria HEMAT: Blood dyscrasias, hemolytic anemia LOCAL: Pain at IM site, phlebitis at IV site MISC: Allergic reactions including Anaphylaxis and Serum sickness, superinfection NURSING CONSIDERATIONS Assess patient for infection (vital signs; appearance of surgical site, urine; WBC) at beginning and during therapy. Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosphorins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before initiating therapy. Observe patient for signs and symptoms of anaphylaxis (rash, pruritis, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of anaphylactic reaction. Monitor site for thrombophlebitis (pain, redness, swelling). Change sites every 48-72 hr to prevent phlebitis. Instruct patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy. Instruct patient to notify health care professional if fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise not to treat diarrhea without consulting healthcare professional.