Indications and Usage:
Upper, lower respiratory tract, urinary tract, skin infections; bone, joint, biliary, genital infections; endocarditis, surgical prophylazis, septicemia (Skidmore, 2011). Adverse Effects:
CNS- headache, dizziness, weakness, paresthesia, fever, chills, seizures (high doses) GI- nausea, vomiting, diarrhea, anorexia, pail, glossitis, bleeding; increased AST, ALT, bilirubin, LDH, alkaline phosphatase; abdominal pain, pseudomembranous colitis GU-proteinuria, vaginitis, pruritis, candidiasis, increased BUN, nephrotoxicity, renal failure HEMA- leukopenia, thrombocytopenia, anemia, neutopenia, lymphocytosis, eosinophilia, pancytopneia, hemolytic anemia INTEG- rash, uticaria, dermatitis RESP- dyspnea SYST- anaphylaxis, serum sickness, superinfection, Stevens-Johnson syndrome (Skidmore, 2011). Recommended Dosage & Routes:
Life-threatening infections- Adult: IM/IV 1-2 g q6hr, max 12 g/day Child > 1 month: IM/IV 100 mg/kg in 3-4 divided doses, max 6 g/day. Mild/moderate infections- Adult: IM/IV 250 mg- 1 g q8hr. Child > 1 month: IM/IV 25-50 mg/kg in 3-4 equal doses. Renal Dose- Adult: IM/IV following loading dose CCr 35-54 mL/min dose q8hr; CCr 10-34 mL/min 50% of dose q18-24hr. Child: IM/IV CCr > 70 mL/min, no dosage adjustment; CCr 40-70 mL/min following loading dose, reduce dose to 7.5-30 mg/kg q12hr; CCr 20-39mL/min, give 3.125-12.5 mg/kg after loading dose q12hr; CCr 5-19 mL/min, 2.5-10 mg/kg after loading dose q24hr (Skidmore, 2011). Available Forms:
Injections 250, 500 mg, 1, 5, 10, 20 g; infusion 500 mg, 1 g/50 ml vial (Skidmore, 2011). Administration Directions:
IM route: Reconstitute 250-500 mg of product with 2 mL sterile or bacteriostatic water for injection, or 0.9% NaCl; reconstitute 1 g of product with 2.5 mL; give deep in large muscle mass, massage. IV route: Check for irritation extravasation, phlebitis daily, and change site q72hr. For direct IV dilute in 10 mL of sterile water for injection; give over 5 minutes. For intermittent infusion, dilute reconstituted solution (500 mg or 1 mg) in 50-100 mL D5W, D10W, D5/0.25% NaCl, D5/0.45% NaCl, D5/0.9% NaCl, may be refrigerated up to 96 hours or stored 24 hours at room temperature (Skidmore, 2011). Nursing Implications:
As indicated by Skidmore (2011), “Assess patient for previous sensitivity reaction to penicillins or other cephalosporins; cross-sensitivity between penicillins and cephalosporins is common. Assess patient for signs and symptoms of infection including characteristics of wounds, sputum, urine, stool, WBC >...