Erythromycin (Oral)

INTRODUCTION

Indications

PO: Infections caused by susceptible organisms, including Upper and lower respiratory tract infections, Otitis media (with sulfonamides), Skin and skin structure infections, Pertussis, Diphtheria, Erythrasma, Intestinal amebiasis, Pelvic inflammatory disease, Nongonococcal urethritis, Syphilis, Legionnaires' disease, Rheumatic fever. Useful when penicillin is the most appropriate drug but cannot be used because of hypersensitivity, including Streptococcal infections, Treatment of syphilis or gonorrhea.

Action

Suppresses protein synthesis at the level of the 50S bacterial ribosome. Therapeutic Effects: Bacteriostatic action against susceptible bacteria. Spectrum: Active against many gram-positive cocci, including Streptococci, Staphylococci. Gram-positive bacilli, including Clostridium, Corynebacterium. Several gram-negative pathogens, notably: Neisseria, Legionella pneumophila. Mycoplasma and Chlamydia are also usually susceptible.

Adverse Reactions/Side Effects

CNS: seizures (rare). CV: QTC PROLONGATION (MAY RESULT IN TORSADES DE POINTES), VENTRICULAR ARRHYTHMIAS. GI: PSEUDOMEMBRANOUS COLITIS, nausea, vomiting, abdominal pain, cramping, diarrhea, drug-induced hepatitis, infantile hypertrophic pyloric stenosis, drug-induced pancreatitis (rare). Derm: rashes. Misc: allergic reactions, superinfection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any ventricular arrhythmias or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• 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.

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Monitor signs of allergic reactions, including rash and other skin reactions (pruritus, urticaria), and pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea). Notify physician or nursing staff immediately if these reactions occur.

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.

• Because of the risk of serious ventricular arrhythmias, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Instruct patient to notify physician immediately of signs of superinfection, including black, furry ...