Tigecycline

INTRODUCTION

Indications

Complicated skin/skin structure infections or complicated intra-abdominal infections caused by susceptible bacteria.

Action

Inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. Therapeutic Effects: Resolution of infection. Spectrum: Active against the following gram-positive bacteria: Enterococcus faecalis (vancomycin-susceptible strains only), Staphylococcus aureus, Streptococcus agalactiae, S. anginosus, and S. pyogenes. Also active against these gram-positive organisms: Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, and K. pneumoniae. Additionally active against the following anaerobes: Bacteroides fragilis, B. thetaiotaomicron, B. uniformis, B. vulgatus, Clostridium perfringens, and Peptostreptococcus micros.

Adverse Reactions/Side Effects

CNS: somnolence. CV: changes in heart rate, vasodilation. GI: PSEUDOMEMBRANOUS COLITIS, nausea, vomiting, altered taste, anorexia, dry mouth, jaundice. GU: ↑ creatinine. Endo: hyperglycemia. F and E: hypocalcemia, hyponatremia. Local: injection site reactions. Misc: allergic 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 or nursing staff immediately of these signs.

• Monitor signs of allergic reactions, 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 signs of electrolyte imbalances such as low calcium or low sodium levels (hypocalcemia, hyponatremia, respectively). Signs include headache, lethargy, weakness, cramping, and muscle hyperexcitability and tetany. Notify physician immediately if these signs occur.

• Monitor level of alertness and report any severe or prolonged sleepiness or somnolence.

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

• Advise patient and family/caregivers about symptoms of hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; unusual thirst). Insulin dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.

• Advise patient about the likelihood of GI reactions such as ...