Pharmacologic Profile

General Use

Treatment and prophylaxis of various bacterial infections. See specific drugs for spectrum and indications. Some infections may require additional surgical intervention and supportive therapy.

General Action and Information

Kill (bactericidal) or inhibit the growth of (bacteriostatic) susceptible pathogenic bacteria. Not active against viruses or fungi. Anti-infectives are subdivided into categories depending on chemical similarities and antimicrobial spectrum.

Contraindications

Known hypersensitivity to individual agents. Cross-sensitivity among related agents may occur.

Precautions

Culture and susceptibility testing are desirable to optimize therapy. Dosage modification may be required in patients with hepatic or renal insufficiency. Use cautiously in pregnant and lactating women. Prolonged inappropriate use of broad spectrum anti-infective agents may lead to superinfection with fungi or resistant bacteria.

Interactions

Penicillins and aminoglycosides chemically inactivate each other and should not be physically admixed. Erythromycin and clarithromycin may ↓ hepatic metabolism of other drugs. Probenecid ↑ serum levels of penicillins and related compounds. Highly protein-bound anti-infectives such as sulfonamides may displace or be displaced by other highly bound drugs. See individual drugs. Extended-spectrum penicillins (piperacillin/tazobactam) and some cephalosporins (cefoperazone, cefotetan) may ↑ the risk of bleeding with anticoagulants, thrombolytic agents, antiplatelet agents, or NSAIDs. Fluoroquinolone absorption may be ↓ by antacids, bismuth subsalicylate, calcium, iron salts, sucralfate, and zinc salts.

Nursing Implications

Assessment

• Assess patient for signs and symptoms of infection prior to and throughout therapy.
• Determine previous hypersensitivities in patients receiving penicillins or cephalosporins.
• Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results.
• Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridium difficile-associated diarrhea (CDAD).

Potential Nursing Diagnoses

• Risk for infection (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)
• Noncompliance (Patient/Family Teaching)

Implementation

• Most anti-infectives should be administered around the clock to maintain therapeutic serum drug levels.

Patient/Family Teaching

• Instruct patient to continue taking medication around the clock until finished completely, even if feeling better.
• Advise patient to report the signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy to health care professional.
• Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains pus, blood, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
• Instruct patient to notify health care professional if symptoms do not improve.

Evaluation/Desired Outcomes

• Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on organism and site of infection.