Linezolid

INTRODUCTION

Indications

Treatment of Infections caused by vancomycin-resistant Enterococcus faecium, Nosocomial pneumonia caused by Staphylococcus aureus (methicillin-susceptible and methicillin-resistant strains), Complicated skin/skin structure infections caused by S. aureus (methicillin-susceptible and methicillin-resistant strains), Streptococcus pyogenes or S. agalactiae (including diabetic foot infections), Uncomplicated skin/skin structure infections caused by S. aureus (methicillin-susceptible and methicillin-resistant strains), S. pyogenes, Community-acquired pneumonia caused by Streptococcus pneumoniae (including multidrug-resistant strains) or S. aureus (methicillin-susceptible strains only).

Action

Inhibits bacterial protein synthesis at the level of the 23S ribosome of the 50S subunit. Therapeutic Effects: Bactericidal action against streptococci; bacteriostatic action against enterococci and staphylococci.

Adverse Reactions/Side Effects

CV: headache, insomnia. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, increased liver function tests, nausea, taste alteration, vomiting. F and E: lactic acidosis. Hemat: thrombocytopenia. Neuro: optic neuropathy, peripheral neuropathy.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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 lactic acidosis, including confusion, lethargy, stupor, shallow rapid breathing, tachycardia, hypotension, nausea, and vomiting. Notify physician or nursing staff immediately if these signs occur.

• 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 blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

• Be alert for signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Report signs of thrombocytopenia, including bruising, nose bleeds, and bleeding gums.

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

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.

• Because of the risk of lactic acidosis, 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).

Patient/Client-Related Instruction

• Advise patient to report any vision disturbances (blurred vision, double vision) that might indicate optic neuropathy.

• Advise patient about the likelihood of GI reactions ...