Doripenem

INTRODUCTION

Indications

Infections caused by susceptible organisms, including complicated intra-abdominal infections, complicated urinary tract infections, including pyelonephritis.

Action

Inhibits bacterial cell wall formation. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Active against the following gram-positive organisms: Acinetobacter baumannii, Escherichia coli, Klebsiella pneumonia, Proteus mirabilis, and Pseudomonas aeruginosa. Also active against the following gram-negative organisms: Streptococcus constellatus and S. intermedius. Anaerobic spectrum includes Bacteroides caccae, B. fragiUs, B. thetaiotaomicron, B. uniformis, B. vulgatus, and Peptostreptococcus micros.

Adverse Reactions/Side Effects

CV: headache. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, ↑ liver enzymes. Hemat: anemia. Local: phlebitis. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, infection with resistant organisms, superinfection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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 anemia, including unusual fatigue, shortness of breath with exertion, and bruising. Report these signs to the physician or nursing staff.

• Assess injection site during and after IV administration, and report signs of phlebitis such as local pain, swelling, and inflammation.

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

• 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 headache or GI problems (nausea, diarrhea).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Penetrates renal and peritoneal and retroperitoneal tissues and fluids.

Metabolism and Excretion: Mostly excreted unchanged in urine; minimal metabolism.

Half-life: 1 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity to doripenem, other carbapenems, or beta-lactams.

Use Cautiously in: Geri: Consider age-related decrease in renal function when choosing dose; OB: Use cautiously during lactation; Pedi: Safe use in ...