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INTRODUCTION

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imipenem/cilastatin (im-i-pen-em/sye-la-stat-in)

Primaxin

Classification

Therapeutic: anti-infectives

Pharmacologic: carbapenems

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Indications
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Treatment of Lower respiratory tract infections, urinary tract infections, abdominal infections, gynecologic infections, skin and skin structure infections, bone and joint infections, bacteremia, endocarditis, polymicrobic infections.

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Action
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Imipenem binds to the bacterial cell wall, resulting in cell death. Combination with cilastatin prevents renal inactivation of imipenem, resulting in high urinary concentrations. Imipenem resists the actions of many enzymes that degrades most other penicillins and penicillin-like anti-infectives. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Spectrum is broad. Active against most gram-positive aerobic cocci: Streptococcus pneumoniae, Group A beta-hemolytic streptococci, Enterococcus, Staphylococcus aureus. Active against many gram-negative bacillary organisms: Escherichia coli, Klebsiella, Acinetobacter, Proteus, Serratia, Pseudomonas aeruginosa. Also displays activity against: Salmonella, Shigella, Neisseria gonorrhoeae, Numerous anaerobes.

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Adverse Reactions/Side Effects
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CNS: SEIZURES, dizziness, somnolence. CV: hypotension. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting. Derm: rash, pruritus, sweating, urticaria. Hemat: eosinophilia. Local: phlebitis at IV site. Misc: ALLERGIC REACTION, INCLUDING ANAPHYLAXIS, fever, superinfection.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • 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 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.

  • Monitor for signs of eosinophilia (fatigue, weakness, myalgia); report these signs to the physician.

  • Assess dizziness or somnolence 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 injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

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Interventions
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  • 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.

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Patient/Client-Related Instruction
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  • 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 fever, skin problems (rash, hives, itching, sweating), or GI problems (nausea, vomiting, diarrhea).

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