Minocycline

INTRODUCTION

Indications

Treatment of various infections caused by unusual organisms, including Mycoplasma, Chlamydia, Rickettsia. Treatment of gonorrhea and syphilis in penicillin-allergic patients. Prevention of exacerbations of chronic bronchitis. Treatment of acne. Inflammatory lesions of nonnodular acne vulgaris (Solodyn).

Action

Inhibit bacterial protein synthesis at the level of the 30S bacterial ribosome. Therapeutic Effects: Bacteriostatic action against susceptible bacteria. Spectrum: Include activity against some gram-positive pathogens: Bacillus anthracis, Clostridium perfringens, C. tetani, Listeria monocytogenes, Nocardia, Propionibacterium acnes, Actinomyces israelii. Active against some gram-negative pathogens: Haemophilus influenzae, Legionella pneumophila, Yersinia enterocolitica, Y. pestis, Neisseria gonorrhoeae, N. meningitidis. Also active against several other pathogens, including Mycoplasma, Treponema pallidum, Chlamydia, Rickettsia.

Adverse Reactions/Side Effects

CNS: benign intracranial hypertension (increased risk in children), dizziness. EENT: vestibular reactions. GI: diarrhea, nausea, vomiting, esophagitis, hepatotoxicity, pancreatitis. Derm: photosensitivity, rash, pigmentation of skin and mucous membranes. Hemat: blood dyscrasias. MS: lupus-like syndrome. Misc: hypersensitivity reactions, superinfection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions or anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, angioedema, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to physician or nursing staff.

• Monitor and report signs of benign intracranial hypertension, especially in children. Signs include dizziness, headache, tinnitus, nausea, and disturbed vision (e.g., blurry or double vision).

• Assess dizziness or vestibular reactions 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.

• Monitor signs of drug-induced lupus-like syndrome, including increased blood pressure (BP), fever, joint pain, skin rashes, and redness/irritation of the eye (uveitis). Notify physician promptly if these signs appear.

Interventions

• 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.

• Because of the risk of intracranial hypertension, avoid activities that might increase intracranial pressure such as elevating the feet above the head (Trendelenburg's position) or holding breath and straining during a bowel movement (Valsalva's maneuver).

• Causes photosensitivity; use care if administering UV treatments.

Patient/Client-Related Instruction

• Instruct patient to notify physician immediately of signs ...