Cefepime

INTRODUCTION

Indications

Treatment of the following infections caused by susceptible organisms: Uncomplicated skin and skin structure infections, Bone and joint infections, Uncomplicated and complicated urinary tract infections, Respiratory tract infections, Complicated intra-abdominal infections (with metronidazole), Septicemia. Empiric treatment of febrile neutropenic patients.

Action

Binds to the bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Similar to that of second- and third-generation cephalosporins, but activity against staphylococci is less, whereas activity against gram-negative pathogens is greater, even for organisms resistant to first-, second-, and third-generation agents. Notable is increased action against Enterobacter, Haemophilus influenzae (including β-lactamase–producing strains), Escherichia coli, Klebsiella pneumoniae, Neisseria, Proteus, Providencia, Pseudomonas aeruginosa, Serratia, Moraxella catarrhalis (including β-lactamase–producing strains). Not active against methicillin-resistant staphylococci or enterococci.

Adverse Reactions/Side Effects

CNS: SEIZURES (HIGH DOSES IN PATIENTS WITH RENAL IMPAIRMENT), encephalopathy, headache. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting. Derm: rashes, pruritus, urticaria. Hemat: bleeding, eosinophilia, hemolytic anemia, neutropenia, thrombocytopenia. Local: pain at IM site, phlebitis at IV site. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, superinfection, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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.

• Be alert for signs of encephalopathy, including decreased alertness, lethargy, and incoordination. Notify physician of these signs before they progress to more severe changes in mental status such as dementia, seizures, and coma.

• Monitor signs of blood dyscrasias, including eosinophilia (fatigue, weakness, myalgia), hemolytic anemia (malaise, dizziness, jaundice, abdominal pain), neutropenia (fever, sore throat, mucosal lesions, signs of infection), and thrombocytopenia (bruising, nose bleeds, bleeding gums, other unusual bleeding). Report these signs to the physician.

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

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.

Patient/Client-Related Instruction

• 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 ...