| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|---|---|---|
| Amoxicillin (Amoxil)—PO 250–500 mg q8h; sexually transmitted infection (STI): 3-gm single dose with probenecid | Ear, nose, and throat (ENT) infections; soft tissue infections (cellulitis); gonorrhea | Broad spectrum; bactericidal | Rash, diarrhea; anaphylaxis |
| NURSING IMPLICATIONS: Determine allergies to penicillin, cephalosporins. Instruct client to take drug around the clock, and to complete therapy | |||
| Cefazolin (Ancef, Kefzol)—IM, IV 250 mg–1.5 gm q6–12h | Staphylococcus aureus; Escherichia coli; Klebsiella; group A and B Streptococcus; Pneumococcus | Bactericida | Allergic reaction; urticaria, rash; abnormal bleeding |
| NURSING IMPLICATIONS: See Penicillin; may cause false-positive laboratory tests (Coombs’, urine glucose); oral probenecid may be taken concurrently to prolong effects of drug | |||
| Cephalexin (Keflex)—PO 1–4 gm daily in 2–4 equally divided doses | Infections caused by gram-positive cocci; infections: respiratory, biliary, urinary, bone, septicemia, abdominal; surgical prophylaxis | Bactericidal effects on susceptible organisms, inhibition of bacterial cell wall synthesis | Nausea, vomiting; urticaria; toxic paranoid reactions; dizziness; increased alkaline phosphatase; nephrotoxicity; bone marrow suppression |
| NURSING IMPLICATIONS: Peak blood levels delayed when given with food; report: nausea, flushing, tachycardia, headache; monitor for nephrotoxicity and for bleeding | |||
| Cephalothin (Keflin, Seffin)—IM, IV 2–12 gm/day in 4–6 equally divided doses | Same as cephalexin, except not recommended for biliary tract infections | See Cephalexin | See Cephalexin |
| NURSING IMPLICATIONS: See Cephalexin; pain at site of IM injection; given in large muscle; rotate sites | |||
| Ciprofloxacin (Cipro)—PO 250–750 mg q12h; IV 200–400 mg q12h; ophthalmic 1–2 gtt q15–30 min, then 4–6 times daily | Lower respiratory tract infections; skin, bone, and joint infections; urinary tract infection (UTI) | Inhibits bacterial DNA synthesis | Restlessness; nausea, diarrhea, vomiting, abdominal pain |
 NURSING IMPLICATIONS: Give PO on an empty stomach unless GI irritation occurs, then take with food; do not take with milk or yogurt; IV over 60 min | |||
| Clarithromycin (Biaxin)—PO 7.5 mg/kg q12h; usual 500 mg q12h | Peptic ulcer | Inhibits protein synthesis of bacterial ribosome | Hypersensitivity to other antibiotics; use with caution in liver/renal impairment |
| NURSING IMPLICATIONS: Take medication around the clock; report signs of superinfection, diarrhea; do not take during pregnancy | |||
| Cloxacillin (Tegopen)—PO 250–500 mg q6h | Penicillinase-producing staphylococci infections: respiratory, sinus, and skin | Binds to bacterial cell wall, leading to cell death | Nausea, vomiting, diarrhea; rashes, allergic reactions; seizures (high doses) |
| NURSING IMPLICATIONS: Give around the clock on an empty stomach; observe for signs of superinfection (black, furry tongue, vaginal itching, loose stools) | |||
| Co-trimoxazole (Bactrim, Septra)—PO 160 mg twice daily or 20 mg/kg/day for P. jiroveci pneumonia | Acute otitis media; urinary tract infection; shigellosis; P. jiroveci pneumonia; prostatitis | Bacteriostatic; anti-infective; antagonizes folic acid production; combination of sulfamethoxazole and trimethoprim | Hypersensitivity; see Sulfisoxazole |
| NURSING IMPLICATIONS: IV administration can cause phlebitis and tissue damage with extravasation | |||
| Doxycycline (Vibramycin)—PO 100 mg q12h on day 1; then 100 mg/day × 7 days; IV 200 mg in 1–2 infusions on day 1; then 100–200 mg/day | Chlamydia, other STIs; Lyme disease | Inhibits bacterial protein of the 30S bacterial ribosome | Urticaria, diarrhea; nausea, vomiting; photosensitivity |
| NURSING IMPLICATIONS: Take prescribed medications as ordered; use sunscreen or protective clothing due to photosensitivity; report signs of superinfection, if original symptoms not improved | |||
| Erythromycin—adults, PO 250 mg q6h; children, PO 30–50 mg/kg daily | Pneumonia; pelvic inflammatory disease; intestinal amebiasis; ocular infections; used if allergic to penicillin | Inhibits protein synthesis of microorganism; more effective against gram-positive organisms | Abdominal cramping, distention, diarrhea |
| NURSING IMPLICATIONS: Be sure culture and sensitivity done before treatment; give on empty stomach 1 hr before or 3 hr after meals; do not crush or chew tablets; do not give with fruit juice | |||
| Gentamicin (Garamycin)—IM, IV 3–5 mg/kg/day in 3–4 divided doses; topical; skin, eye | Serious gram-negative infections; possible S. aureus, uncomplicated urinary tract infections | Bactericidal effects on susceptible gram-positive and gram-negative organisms and mycobacteria | Serious toxic effects: kidneys, ear; causes muscle weakness/paralysis |
| NURSING IMPLICATIONS: Monitor plasma levels (peak is 4–10 mcg/mL); clients with burns, cystic fibrosis may need higher doses | |||
| Metronidazole (Flagyl)—PO 7.5 mg/kg q6h (not to exceed 4 gm/day) | Diverticulosis | Disrupts DNA and protein synthesis in susceptible organisms | Cimetidine may decrease metabolism; seizures, dizziness, abdominal pain |
| NURSING IMPLICATIONS: Administer with food or milk to decrease GI symptoms; avoid alcohol; has unpleasant metallic taste; avoid OTC medication while on this drug | |||
| Penicillin: penicillin G, penicillin G potassium, penicillin G procaine, ampicillin—IM 400,000–1.2 million units q8h × 10 days, or single dose of 2.4 million units | Streptococcus; Staphylococcus; Pneumococcus; Gonococcus; Treponema pallidum Obstetric use: group B β-hemolytic streptococcus—prophylaxis | Primarily bactericidal Prophylaxis | Dermatitis and delayed or immediate anaphylaxis |
| NURSING IMPLICATIONS: Outpatients should be observed for 20 min after injection; hospitalized clients should be observed at frequent intervals for 20 min after injection | |||
| Pentamidine (Pentam)—IV 4 mg/kg once daily; inhalation 300 mg via nebulizer | Prevention or treatment of P. jiroveci pneumonia | Appears to disrupt DNA or RNA synthesis to protozoa | Anxiety, headache; bronchospasm, cough; hypotension, arrhythmias; nephrotoxicity; hypoglycemia; leukopenia, thrombocytopenia, anemia, chills |
| NURSING IMPLICATIONS: Assess for infection and respiratory status; unpleasant metallic taste may occur (not significant) | |||
| Sulfisoxazole (Gantrisin), sulfamethizole (Thiosulfil), and sulfisomidine (Elkosin)—PO 2.4-gm loading dose, then 1–2 gm 4 times daily × 7–10 days | Acute, chronic, and recurrent urinary tract infections | Bacteriostatic and bactericidal | Nausea, vomiting; oliguria, anuria; anemia, leukopenia; dizziness; jaundice, skin rashes, and photosensitivity |
| NURSING IMPLICATIONS: Maintenance of blood levels is important; encourage fluids to prevent crystal formation in kidney tubules—push up to 3,000 mL/day; avoid in later stage of pregnancy and first month of life for newborn (may cause kernicterus) | |||
| Tetracyclines: doxycycline hyclate (Vibramycin), oxytetracycline (Terramycin), tetracycline HCl (Sumycin)—PO 250–500 mg q6h; IM 250 mg/day; IV 250–500 mg q8–12h | Broad-spectrum antibiotic | Primarily bacteriostatic | GI upsets such as diarrhea, nausea, vomiting; sore throat; black, hairy tongue; glossitis; inflammatory lesions in anogenital region |
| NURSING IMPLICATIONS: Phototoxic reactions have been reported; clients should be advised to stay out of direct sunlight; medication should not be given with milk or snacks, because food interferes with absorption of tetracyclines; do not give to women who are pregnant and children under 8 yr | |||
| Trimethoprim (TMP)/sulfamethoxazole (SMZ) (Bactrim)—PO 160 mg TMP or 800 mg SMZ q12h for 14–21 days; IV 8–10 mg/kg (TMP 40–50 mg/kg) q6–12h | Bronchitis, Shigella enteritis, otitis media, P. jiroveci pneumonia, UTI, traveler’s diarrhea | Combination inhibits the metabolism of folic acid in bacteria; bactericidal | Nausea, vomiting; rashes; phlebitis at IV site; aplastic anemia; hepatic necrosis |
| NURSING IMPLICATIONS: Check IV site frequently; do not give IM; give PO on empty stomach; take around the clock; avoid exposure to sun | |||