Acetohydroxamic Acid

INTRODUCTION

Indications

Adjunct therapy in chronic urea-splitting urinary tract infection.

Action

Reversibly inhibits the bacterial enzyme urease, which results in decreased hydrolysis of urea and subsequent production of ammonia in urine infected with urea-splitting bacteria. Therapeutic Effects: Decreased urinary ammonia levels and decreased urine pH, which increases the efficacy of anti-infective therapy and cure rates. Does not directly alter pH or have any direct antibacterial activity.

Adverse Reactions/Side Effects

CNS: headache, anxiety, depression, malaise, nervousness, tremulousness. CV: palpitations, superficial phlebitis of the lower extremities. Derm: alopecia, rash (in association with alcohol). GI: anorexia, nausea, vomiting. Hemat: anemia, hemolytic anemia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hemolytic anemia (unusual fatigue, weakness, dizziness, pallor, jaundice, abdominal pain) or fatigue and poor health that might be due to other anemias and blood dyscrasias. Report these signs immediately to the physician.

• Monitor and report signs of phlebitis in the lower extremities, including local pain, swelling, and inflammation.

• Monitor anxiety, depression, nervousness, or malaise. Repeated or excessive symptoms may require change in dose or medication.

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.

Patient/Client-Related Instruction

• Advise patient to avoid alcohol because of the increased risk of skin rash.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, skin rash, hair loss, palpitations, or GI problems (nausea, vomiting, loss of appetite).

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Distributed throughout body water.

Metabolism and Excretion: 36–65% excreted unchanged in urine.

Half-life: 5–10 hr (increased in renal impairment).

Contraindications/Precautions

Contraindicated in: Urinary tract infection with non–urea-splitting organisms; Urinary tract infections that can be controlled by culture-specific oral antibiotics; Serum creatinine >2.5 mg/dL or CCr <20 mL/min; OB: Causes birth defects; women of childbearing potential must use adequate contraception; Lactation: Safety not established.

Use Cautiously in: Renal impairment (increased risk of adverse reactions; dosage reduction recommended); Hepatic impairment; Preexisting thrombophlebitis or phlebothrombosis (increased risk of adverse reactions).