Cefditoren

INTRODUCTION

Indications

Treatment of the following infections caused by susceptible organisms: Acute exacerbations of chronic bronchitis, Community-acquired pneumonia, Pharyngitis and tonsillitis, Uncomplicated skin and skin structure infections.

Action

Binds to bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Active against the following gram-positive organisms: Staphylococcus aureus (methicillin-susceptible strains, including β-lactamase–producing strains), Streptococcus pneumoniae (penicillin-susceptible strains only), Str. pyogenes. Active against the following gram-negative organisms: Haemophilus influenzae (including β-lactamase–producing strains), H. parainfluenzae (including β-lactamase–producing strains), Moraxella catarrhalis (including β-lactamase–producing strains).

Adverse Reactions/Side Effects

CNS: SEIZURES (HIGH DOSES), headache. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, abdominal pain, dyspepsia, nausea, vomiting. GU: hematuria, vaginal moniliasis. Hemat: bleeding, eosinophilia, hemolytic anemia, lymphocytosis, neutropenia, thrombocytosis. 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 stools, 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 signs of blood dyscrasias, including eosinophilia (fatigue, weakness, myalgia), hemolytic anemia (malaise, dizziness, jaundice, abdominal pain), neutropenia (fever, sore throat, mucosal lesions, signs of infection), and thrombocytopenia (bruising, nose bleeds, bleeding gums, other unusual bleeding). Report these signs to the physician.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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 headache, skin problems (rash, hives), vaginal infections, blood in the urine, or GI problems (nausea, vomiting, diarrhea, abdominal pain, heartburn).

Pharmacokinetics

Absorption: Cefditoren pivoxil is a prodrug that is converted to cefditoren (the active component) in GI tract during absorption. Bioavailability 14% in fasting state, increased by high fat meal.