Cefixime

INTRODUCTION

Indications

Treatment of Urinary and gynecologic infections, including gonorrhea, Respiratory tract infections, Otitis media.

Action

Binds to the bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Similar to that of second-generation cephalosporins, but activity against staphylococci is less, while activity against gram-negative pathogens is greater, even for organisms resistant to first- and second-generation agents. Notable is increased action against Enterobacter, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Neisseria, Proteus, Providencia, Serratia, Moraxella catarrhalis, Borrelia burgdorferi.

Adverse Reactions/Side Effects

CNS: SEIZURES (VERY HIGH DOSES). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, cramps. Derm: rashes, urticaria. Hemat: bleeding, blood dyscrasias, hemolytic anemia. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS AND SERUM SICKNESS, 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.

• Assess muscle aches and joint pain (arthralgia) that may be caused by serum sickness. Notify physician if these symptoms seem to be drug related rather than caused by musculoskeletal injury or if muscle and joint pain are accompanied by allergy-like reactions (fever, rashes, etc.)

• Monitor signs of blood dyscrasias, including hemolytic anemia (unusual weakness and fatigue, dizziness, jaundice, abdominal pain) and thrombocytopenia (bruising, nose bleeds, bleeding gums, other unusual bleeding). Report these signs 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, loose or foul-smelling stools.

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

Pharmacokinetics

Absorption: 40–50% absorbed following oral administration (oral suspension).

Distribution: Widely distributed. Crosses the placenta; enters breast milk in low concentrations. CSF penetration better than with first- and second-generation agents.

Metabolism and Excretion: 50% excreted unchanged in urine; ≥10% excreted ...