Ticarcillin/Clavulanate

INTRODUCTION

Indications

Treatment of Skin and skin structure infections; Bone and joint infections; Septicemia; Lower respiratory tract, Intra-abdominal, gynecologic, and urinary tract infections.

Action

Binds to bacterial cell wall membrane, causing cell death. Addition of clavulanate enhances resistance to beta-lactamase, an enzyme that can inactivate penicillins. Therapeutic Effects: Bactericidal action. Spectrum: Similar to penicillin but extended to include several gram-negative aerobic pathogens, notably: Pseudomonas aeruginosa, Escherichia coli, Citrobacter, Enterobacter, Haemophilus influenzae, Klebsiella, Serratia marcescens. Active against some anaerobic bacteria, including bacteroides.

Adverse Reactions/Side Effects

CNS: SEIZURES (HIGH DOSES), confusion, lethargy. CV: CHF, arrhythmias. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea. GU: hematuria (children only). Derm: rashes, urticaria. F and E: hypokalemia, hypernatremia. Hemat: bleeding, blood dyscrasias, increased bleeding time. Local: phlebitis. Metab: metabolic alkalosis. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS, superinfection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

• Assess signs of congestive heart failure (CHF), such as dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician immediately.

• 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 hypersensitivity 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.

• 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.

• Monitor any unusual bleeding (bruising, nose bleeds, bleeding gums) that might indicate thrombocytopenia. Also monitor signs of other blood dyscrasias such as leukopenia and neutropenia (fever, sore throat, signs of infection). Report these signs to the physician.

• Monitor neuromuscular signs of acid-base and electrolyte imbalances (alkalosis, hypokalemia, hypernatremia), including headache, lethargy, weakness, cramping, and muscle hyperexcitability and tetany. Notify physician immediately if these signs occur.

• Assess confusion that might affect gait, balance, and other functional activities (See Appendix D). 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.

• Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Because of the risk of CHF and arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, ...