Telithromycin

INTRODUCTION

Indications

Community-acquired pneumonia.

Action

Blocks bacterial protein synthesis at the level of the 50S ribosomal subunit. Therapeutic Effects: Resolution of infection. Spectrum: Active against the following organisms: Staphylococcus aureus (methicillin and erythromycin-susceptible strains only), Streptococcus pneumoniae (including multidrug-resistant strains), Haemophilus influenzae, Moraxella catarrhalis, Chlamydophila pneumoniae, and Mycoplasma pneumoniae.

Adverse Reactions/Side Effects

CNS: loss of consciousness. EENT: visual disturbances. CV: arrhythmias, QTc prolongation. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, hepatitis, HEPATIC FAILURE, nausea. Neuro: exacerbation of myasthenia gravis.

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.

• Be alert for signs of hepatitis and liver failure, including yellow skin or eyes, abdominal pain, severe nausea and vomiting, fever, sore throat, malaise, weakness, and facial edema. Report these signs to the physician immediately.

• Monitor level of alertness and report any loss of consciousness immediately.

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

• Be alert for signs of myasthenia gravis syndrome, such as drooping eyelids, facial muscle weakness, and difficulty swallowing and speaking. Report these signs to the physician immediately, and monitor other muscle groups for signs of unusual weakness and fatigue, especially after repeated contraction.

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.

• Because of the risk of arrhythmias, use 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 report any visual disturbances (e.g., blurred vision or double vision) or severe or prolonged GI reactions (diarrhea, nausea).

Pharmacokinetics

Absorption: 57% absorbed following oral administration; unaffected by food.

Distribution: Concentrates in bronchial mucosa, epithelial lining fluid, and alveolar macrophages.

Metabolism and Excretion: 70% metabolized by the liver (50% by CYP3A4), 13% excreted unchanged in urine, 7% excreted unchanged via biliary/intestinal elimination.

Half-life: 10 hr.