Sulfisoxazole

INTRODUCTION

Indications

PO: Treatment of urinary tract infections, acute otitis media, meningitis, nocardiosis, and, in combination with other anti-infectives, malaria and toxoplasmosis. Prophylaxis for meningococcal meningitis for sensitive strains in family groups or large closed populations. Unlabeled Use: Prevention of recurrent otitis media.

Action

Interferes with bacterial folic acid synthesis. Therapeutic Effects: Bacteriostatic action against susceptible bacteria. Spectrum: Notable for activity against some gram-positive pathogens, including streptococci and staphylococci, Clostridium perfringens, C. tetani, Nocardia asteroides. Active against some gram-negative pathogens, including Enterobacter, Escherichia coli, Klebsiella, Proteus mirabilis, P. vulgaris, Salmonella, Shigella.

Adverse Reactions/Side Effects

CNS: ataxia, confusion, dizziness, drowsiness, mental depression, psychosis, restlessness. GI: nausea, diarrhea, anorexia, hepatitis, vomiting. GU: crystalluria. Derm: rash, exfoliative dermatitis, photosensitivity. Hemat: agranulocytosis, aplastic anemia, eosinophilia, thrombocytopenia. Neuro: peripheral neuropathy. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING SERUM SICKNESS AND STEVENS-JOHNSON SYNDROME, fever, superinfection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions, including serum sickness (muscle aches, joint pain, fatigue) and Stevens-Johnson syndrome (exfoliation, rash, hives, acne, abnormal sweating). Notify physician immediately because these signs may indicate serious hypersensitivity reactions

• Monitor signs of blood dyscrasias, including agranulocytosis (fever, sore throat, mucosal lesions, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), and aplastic anemia or eosinophilia (unusual fatigue, weakness, myalgia). Report these signs to the physician.

• Monitor signs of peripheral neuropathy (numbness, tingling). Perform objective tests (nerve conduction, monofilaments) to document any neuropathic changes.

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

• Be alert for confusion, restlessness, mental depression, psychosis, or other alterations in mental status. Notify health care professional promptly if these symptoms develop.

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 photosensitivity, and to use sunscreens, protective clothing, and avoid prolonged sun exposure. Advise patient to also report any rashes or other skin reactions.

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

• Instruct patient and family/caregivers to report other troublesome side effects such ...