Gemifloxacin

INTRODUCTION

Indications

Treatment of the following bacterial respiratory infections: Acute bacterial exacerbations of chronic bronchitis, Community-acquired pneumonia.

Action

Inhibits bacterial DNS synthesis by inhibiting DNA gyrase enzyme. Therapeutic Effects: Death of susceptible bacteria resulting in resolution of infection. Spectrum: Active against gram-positive pathogens, including Streptococcus pneumoniae. Gram-negative spectrum notable for Klebsiella pneumoniae, Haemophilus influenzae, H. parainfluenzae, Moraxella catarrhalis. Additional spectrum includes Chlamydophylia pneumoniae, Mycoplasma pneumoniae.

Adverse Reactions/Side Effects

CNS: drowsiness, dizziness, headache, confusion. CV: QTc prolongation, ARRHYTHMIAS. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, abdominal pain, nausea, vomiting. Derm: photosensitivity, rash. MS: tendinitis, tendon rupture.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor symptoms of pseudomembranous colitis (diarrhea, abdominal pain, fever, pus or mucus in stools) or other severe or prolonged GI problems (nausea, cramps, vomiting). Notify physician or nursing staff immediately of these symptoms.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess any tendon pain. Tendinopathy and rupture can occur, especially in large, weight-bearing tendons (Achilles, patellar tendons). Risk of tendon damage is greater in patients >65-yr-old, transplant recipients (i.e., kidney, heart, lung), patients with preexisting tendon damage, and patients taking corticosteroids concurrently.

• Assess dizziness and drowsiness 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

• If tendon symptoms occur, notify the physician and protect the affected area to avoid tendon ruptures. Do not stretch or exercise the affected tendon, and provide crutches, walker, or other assistive devices if lower extremities are involved.

• Because of the arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• 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.

• Causes photosensitivity; use care if administering UV treatments.

Patient/Client-Related Instruction

• Advise patient about photosensitivity, and to use sunscreens, protective clothing, and avoid prolonged sun exposure. Advise patient to also report any rashes or other skin reactions.

• Instruct patient to report other troublesome side effects such as severe or prolonged headache, confusion, or GI problems (nausea, vomiting, diarrhea, abdominal pain).

Pharmacokinetics

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