Pharmacologic: third-generation cephalosporins
Treatment of the following infections caused by susceptible organisms: Skin and skin structure infections; Urinary tract infections; Gynecologic infections, including gonorrhea; Respiratory tract infections; Intra-abdominal infections; Septicemia.
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 Citrobacter, Enterobacter, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Morganella morganii, Neisseria gonorrhoeae, Proteus, Providencia, Pseudomonas aeruginosa, Serratia. Has some activity against enterococci. Has some activity against anaerobes, including Bacteroides fragilis.
Adverse Reactions/Side Effects
CNS: SEIZURES (HIGH DOSES). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting. Derm: rashes, urticaria. Hemat: bleeding, eosinophilia, neutropenia. 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 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, pruritis, urticaria). Notify physician or nursing staff immediately if these reactions occur.
Monitor signs of blood dyscrasias, including eosinophilia (fatigue, weakness, myalgia), 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.
Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.
Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or isolation procedures as indicated for specific patients.
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 problems (rash, hives) or GI problems (nausea, vomiting, diarrhea).
Absorption: Well absorbed following IM administration; IV administration results in complete bioavailability.
Distribution: Widely distributed. Crosses the placenta; enters breast milk in low concentrations. CSF penetration better than with first- and second-generation agents.