Nitrofurantoin

INTRODUCTION

Indications

Prevention and treatment of urinary tract infections caused by susceptible organisms; not effective in systemic bacterial infections.

Action

Interferes with bacterial enzymes. Therapeutic Effects: Bactericidal or bacteriostatic action against susceptible organisms. Spectrum: Many gram-negative and some gram-positive organisms, specifically Citrobacter, Corynebacterium, Enterobacter, Escherichia coli, Klebsiella, Neisseria, Salmonella, Shigella, Staphylococcus aureus, S., Enterococcus.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, headache. EENT: nystagmus. Resp: pneumonitis. CV: chest pain. GI: PSEUDOMEMBRANOUS COLITIS, anorexia, nausea, vomiting, abdominal pain, diarrhea, drug-induced hepatitis. GU: rust/brown discoloration of urine. Derm: photosensitivity. Hemat: blood dyscrasias, hemolytic anemia. Neuro: peripheral neuropathy. Misc: hypersensitivity reactions.

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 of these signs immediately.

• Assess any breathing problems or signs of pneumonitis such as cough, shortness of breath, fever, rales, chest pain, and difficult, labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

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

• Be alert for signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Assess dizziness or drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor signs of blood dyscrasias including hemolytic anemia (unusual weakness and fatigue, dizziness, jaundice, abdominal pain), leukopenia (fever, sore throat, signs of infection), and thrombocytopenia (bruising, nose bleeds, bleeding gums). Report these signs 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.

• Causes photosensitivity; use care if administering UV treatments.

Patient/Client-Related Instruction

• Advise patient about the likelihood of GI reactions, including nausea, vomiting, diarrhea, loss of appetite. Instruct patient to report severe or prolonged GI problems or signs of drug-induced hepatitis (yellow skin or eyes, abdominal pain, severe nausea and vomiting, fever, sore throat, malaise, weakness, facial edema).

• Advise patient about photosensitivity and to use sunscreens, protective clothing, ...