Pharmacologic: second-generation cephalosporins
Treatment of the following infections caused by susceptible organisms: Lower respiratory tract infections, Skin and skin structure infections, Bone and joint infections, Urinary tract infections, Gynecologic infections, Intra-abdominal infections. Perioperative prophylaxis.
Binds to bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Similar to that of first-generation cephalosporins but has increased activity against several other gram-negative pathogens, including Haemophilus influenzae (including β-lactamase–producing strains), Escherichia coli, Klebsiella pneumoniae, Morganella morganii, Neisseria gonorrhoeae, Proteus, Providencia, Serratia marcescens, Moraxella catarrhalis. Also has activity against Bacteroides fragilis. Not active against methicillin-resistant staphylococci or enterococci.
Adverse Reactions/Side Effects
CNS: SEIZURES (HIGH DOSES). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea. Derm: rashes, urticaria. Hemat: bleeding, eosinophilia, hemolytic anemia, leukopenia, 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 eosinophilia (fatigue, weakness, myalgia), thrombocytopenia (bruising, nose bleeds, bleeding gums, other bleeding problems), hemolytic anemia (malaise, dizziness, jaundice, abdominal pain), and leukopenia (fever, sore throat, mucosal lesions, signs of infection). Report these signs to the physician.
Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician.
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.
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) or GI problems (nausea, diarrhea).
Absorption: Well absorbed following IM administration; IV administration results in complete bioavailability.
Distribution: Widely distributed. Penetration into CSF is poor. Crosses the placenta and enters breast milk in low concentrations.
Metabolism and Excretion: Excreted primarily unchanged by the kidneys. Protein Binding: 88%.