Cefotaxime

INTRODUCTION

Indications

Treatment of the following infections caused by susceptible organisms: Skin and skin structure infections; Bone and joint infections; Urinary tract infections; Gynecologic infections, including gonorrhea; Lower respiratory tract infections; Intra-abdominal infections; Septicemia; Meningitis; Lyme disease. Perioperative prophylaxis.

Action

Binds to the bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Similar to that of second-generation cephalosporins, but activity against staphylococci is less, whereas activity against gram-negative pathogens is greater, even for organisms resistant to first- and second-generation agents. Notable is increased action against: Acinetobacter, Citrobacter, Enterobacter, Haemophilus influenzae (including β-lactamase–producing strains), Haemophilus parainfluenzae, Escherichia coli, Klebsiella pneumoniae, Morganella morganii, Neisseria gonorrhoeae and N. meningitidis, Proteus, Providencia, Serratia, Moraxella catarrhalis, Borrelia burgdorferi. Has some activity against anaerobes, including Bacteroides fragilis. Not active against methicillin-resistant staphylococci.

Adverse Reactions/Side Effects

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

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.

• Monitor signs of blood dyscrasias, including agranulocytosis and neutropenia (fever, sore throat, mucosal lesions, signs of infection), eosinophilia (fatigue, weakness, myalgia), hemolytic anemia (malaise, dizziness, jaundice, abdominal pain), 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 side effects such as severe or prolonged skin problems (rash, hives, itching) or GI problems (nausea, vomiting, diarrhea).

Pharmacokinetics

Absorption: Well absorbed following ...