Aztreonam

INTRODUCTION

Indications

Treatment of serious gram-negative infections including Septicemia; Skin and skin structure infections; Intra-abdominal infections; Gynecologic infections; Respiratory tract infections; Urinary tract infections. Useful for treatment of multiresistant strains of some bacteria, including aerobic gram-negative pathogens.

Action

Binds to the bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Displays significant activity against gram-negative aerobic organisms only: Escherichia coli, Serratia, Klebsiella oxytoca or K. pneumoniae, Citrobacter, Proteus mirabilis, Pseudomonas aeruginosa, Enterobacter, Haemophilus influenzae. Not active against: Staphylococcus aureus, Enterococcus, Bacteroides fragilis, Streptococci.

Adverse Reactions/Side Effects

CNS: SEIZURES. GI: PSEUDOMEMBRANOUS COLITIS, altered taste, diarrhea, nausea, vomiting. Derm: rash. Local: pain at IM site, phlebitis at IV site. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, superinfection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stool, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Instruct patient to notify physician immediately of signs of superinfection, including black, furry overgrowth on tongue, vaginal itching or discharge, and loose or foul-smelling stools.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged skin rash or GI problems (nausea, vomiting, diarrhea, altered taste).

Pharmacokinetics

Absorption: Well absorbed following IM administration.

Distribution: Widely distributed. Crosses the placenta and enters breast milk in low concentrations.

Metabolism and Excretion: 60–70% excreted unchanged by the kidneys. Small amounts metabolized by the liver.

Half-life: 1.5–2 hr (increased in renal impairment).

Contraindications/Precautions

Contraindicated in: Hypersensitivity.

Use Cautiously in: Renal impairment (dosage reduction required if CCr 30 ...