Name of the Antimicrobial Drugs which Inhibits Protein synthesis
- Tetracyclines
- Chloramphenicol
- Erythromycin
- Clindamycin
- Linezolid
Tetracyclines
| Tetracyclines |
| Availability Capsules: 250 mg, 500 mg |
| Indications and dosages Mild to moderate infections caused by susceptible organisms Adults: 500 mg P.O. b.i.d. or 250 mg P.O. q.i.d Severe infections caused by susceptible organisms Adults: 500 mg P.O. q.i.d. Children older than age 8: 25 to 50 mg/kg P.O. q.i.d. Syphilis in penicillin-allergic patients Adults: 500 mg P.O. q.i.d. for 14 days Late syphilis (except neurosyphilis) Adults: 500 mg P.O. q.i.d. for 28 days Leptospirosis when penicillin is contraindicated or ineffective Adults:1 to 2 g P.O. daily in two to four divided doses for 5 to 7 days Yaws Adults: 1 to 2 g P.O. daily in two to four divided doses for 10 to 14 days Gonorrhea in penicillin-allergic patients Adults: Initially, 1.5 g P.O., followed by 500 mg P.O. q 6 hours for 4 days, up to a total of 9 g Uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis Adults: 500 mg P.O. q.i.d. for 7 days Rickettsial and mycoplasmal infections Adults: 1 to 2 g P.O. daily in two to four divided doses for 7 days Helicobacter pylori infection Adults: In patients with active duodenal ulcer, 500 mg P.O. q.i.d. at meals and bedtime for 14 days, given with other drugs (such as metronidazole, bismuth subsalicylate, amoxicillin, or omeprazole) Brucellosis Adults: 500 mg P.O. q.i.d. for 3 weeks, given with streptomycin I.M. b.i.d. during week 1 and streptomycin once daily during week 2 Granuloma inguinale; chancroid Adults: 1 to 2 g P.O. daily in two to four divided doses for 2 to 4 weeks Cholera Adults: 500 mg P.O. q 6 hours for 48 to 72 hours Plague when streptomycin is contraindicated or ineffective Adults: 2 to 4 g P.O. q.i.d. for 10 days Children older than age 8: 30 to 40 mg/kg P.O. q.i.d. for 10 to 14 days |
Mechanism of Action
Exerts a bacteriostatic effect against a wide variety of gram-positive and gram-negative organisms by passing through the bacterial lipid bilayer, where it binds reversibly to 30S ribosomal subunits. Bound tetracycline blocks the binding of aminoacyl transfer RNA to messenger RNA, thus inhibiting bacterial protein synthesis
Pharmacokinetics
- Protein Bound: 65%
- Half-life: 8-11 hr (normal renal function); 57-108 hr (end-stage renal disease)
- Metabolism: N/A
- Excretion: Urine (60% as unchanged drug); feces (as active form)
- Peak plasma Time: 2-4 hr (PO)
Administration
Give with 8 oz of water at least 1 hour before or 2 hours after a meal (especially if it includes milk or other dairy products), antacids, laxatives, or antidiarrheal drugs.
Contraindications
Hypersensitivity to drug, other tetracyclines, bisulfites, or alcohol (in some products)
Precautions :
- Renal disease, hepatic impairment, nephrogenic diabetes insipidus
- Cachectic or debilitated patients
- Pregnant or breastfeeding patients (except in anthrax treatment)
- Children younger than age 8 (except in anthrax treatment).
Adverse reactions
- CNS: paresthesia, benign intracranial hypertension
- CV: pericarditis
- EENT: abnormal conjunctival pigmentation, hoarseness, pharyngitis
- GI: nausea, vomiting, diarrhea, loose bulky stools, esophageal ulcers, epigastric distress, enterocolitis, oral and anogenital candidiasis, stomatitis, black hairy tongue, glossitis, anorexia, pancreatitis
- GU: dark yellow or brown urine, vaginal candidiasis, anogenital lesions
- Hematologic: eosinophilia, hemolytic anemia, neutropenia, thrombocytopenia, thrombocytopenia purpura
- Hepatic: fatty liver Musculoskeletal: retarded bone growth, polyarthralgia
- Respiratory: pulmonary infiltrates
- Skin: photosensitivity, maculopapular or erythematous rash, increased pigmentation, urticaria, onycholysis
- Other: permanent tooth discoloration (in children younger than age 8), tooth enamel defects, superinfection, hypersensitivity reactions including anaphylaxis, serum sickness–like reaction, exacerbation of systemic lupus erythematosus
Patient monitoring
- Monitor for signs and symptoms of superinfection and hypersensitivity reaction.
- With long-term use, monitor CBC, liver function tests, and (in prepubertal patients) bone growth.
- Assess neurologic status. Stay alert for benign intracranial hypertension (especially in children)
Patient teaching
- Tell patient to take oral form with 8 oz of water at least 1 hour before or 2 hours after eating a meal, consuming dairy products, or taking antacids, laxatives, or antidiarrheal drugs. Advise him to take last daily dose at least 1 hour before bedtime.
- Stress importance of completing entire course of therapy as ordered, even after symptoms improve.
- Caution patient not to use outdated tetracycline, because it may cause serious kidney disease.
Nursing Considerations
- Avoid giving tetracycline to children under age 8 because drug may cause permanent brown or yellow tooth discoloration and enamel hypoplasia.
- Be aware that tooth discoloration and enamel hypoplasia may occur in breastfeeding infants, along with inhibition of linear skeletal growth, oral and vaginal candidiasis, and photosensitivity.
- To reduce the risk of esophageal irritation or ulceration, avoid bedtime dosing of tetracycline for patient with esophageal obstruction or compression.
- Assess for photosensitivity, which can develop within a few minutes or up to several hours after exposure to sunlight or other ultraviolet (UV) light. Effects may last for 1 to 2 days after discontinuation of drug.
- Be aware that citric acid in tetracycline preparations may accelerate drug deterioration and that using outdated drug may cause Fanconi’s syndrome, characterized by multiple defects in renal tubular function. Symptoms include acidosis, bicarbonate wasting, glycosuria, hypokalemia, osteomalacia, and phosphaturia.
Chloramphenicol
| Chloramphenicol |
| Availability injectable solution,1000mg/vial |
| Indications and Dosages To treat serious infections for which less potentially dangerous drugs are ineffective or contraindicated I.V. INFUSION Adults. 12.5 mg/kg every 6 hr. Maximum: 4 g daily. Children. 50 to 75 mg/kg daily in divided doses every 6 hr. Full-term infants age 2 weeks and over. 12.5 mg/kg every 6 hr or 25 mg/kg every 12 hr. Preterm and full-term infants up to age 2 weeks. 6.25 mg/kg every 6 hr. To treat bacteremia or meningitis I.V. INFUSION Children. 50 to 100 mg/kg daily in divided doses every 6 hr. |
Mechanism of Action
Produces a bacteriostatic effect on susceptible organisms by inhibiting protein synthesis, thus preventing amino acids from being transferred to growing polypetide chains.
Pharmacokinetics
- Protein Bound: 60%
- Normal renal function: 1.6-3.3 hr
- End-stage renal disease: 3-7 hr
- Cirrhosis: 10-12 hr
- Excretion: Urine: 5-15%, Feces: 4%
Contraindications
Hypersensitivity to chloramphenicol or its components
Adverse Reactions
- CNS: Confusion, delirium, depression, fever, headache, peripheral neuropathy
- CV: Gray syndrome in neonates
- EENT: Optic neuritis
- GI: Diarrhea, nausea, vomiting
- HEME: Aplastic anemia, bone marrow depression, granulocytopenia, hypoplastic anemia, leukopenia, reticulocytopenia, thrombocytopenia
- SKIN: Rash Other: Anaphylaxis, angioedema
Nursing Considerations
- As appropriate and ordered, obtain specimen for culture and sensitivity testing before starting chloramphenicol therapy.
- Keep in mind that chloramphenicol should never be used to treat minor infections or as prophylaxis because of its many serious toxicities.
- Repeated courses of therapy should be avoided because of the risk of serious adverse reactions.
- For I.V. use, prepare a 10% solution by adding 10 ml sterile water for injection or D5W to each 1-g vial. Administer over at least 1 minute.
- Know that diluted I.V. solution is stable for 24 to 48 hours when stored at room temperature or refrigerated. Don’t use if cloudy.
- Assess patient for fever, sore throat, tiredness, unusual bleeding, or ecchymosis; these may indicate a blood dyscrasia.
- Perform neurologic assessments regularly, looking for signs of peripheral neuropathy.
- Monitor blood chloramphenicol level as appropriate. Keep in mind that therapeutic peak levels are 10 to 20 mcg/ml and trough levels are 5 to 10 mcg/ml.
- Monitor CBC and platelet and reticulocyte counts as ordered to detect signs of blood dyscrasia. Notify prescriber immediately about abnormal results.
Patient Teaching
Instruct patient to immediately report to prescriber signs of blood dyscrasia.
WARNING Tell patient to stay alert for signs of potentially fatal, irreversible bone marrow depression that leads to aplastic anemia and is characterized by fever, pallor, pharyngitis, severe fatigue and weakness, and unusual bleeding or bruising. Bone marrow depression may occur weeks to months after therapy stops. Stress the need for follow-up care.
Erythromycin
| Erythromycin |
| Availability Erythromycin base Capsules (delayed-release): 250 mg Ointment (ophthalmic): 0.5% Tablets: 250 mg, 500 mg Tablets (delayed-release, enteric-coated): 250 mg, 333 mg, 500 mg Tablets (particles in tablets): 333 mg, 500 mg erythromycin ethylsuccinate Oral suspension: 200 mg/5 ml, 400 mg/5 ml Powder for suspension: 100 mg/2.5 ml, 200 mg/5 ml, 400 mg/5 ml Tablets: 400 mg erythromycin lactobionate Powder for injection: 500 mg, 1 g erythromycin stearate Tablets (film-coated): 250 mg, 500 mg erythromycin (topical) Gel: 2% Ointment: 2% Solution: 2% Swabs: 2% |
| Indications and dosages Pelvic inflammatory disease Adults: 500 mg (base) I.V. q 6 hours for 3 days, then 250 mg (base, estolate, or stearate) or 400 mg (ethylsuccinate) q 6 hours for 7 days Syphilis Adults: 500 mg (base, estolate, or stearate) P.O. q.i.d. for 14 days Most upper and lower respiratory tract infections; otitis media; skin infections; Legionnaires’ disease Adults: 250 mg P.O. q 6 hours, or 333 mg P.O. q 8 hours, or 500 mg P.O. q 12 hours (base, estolate, or stearate); or 400 mg P.O. q 6 hours or 800 mg P.O. q 12 hours (ethylsuccinate); or 250 to 500 mg I.V. (up to 1 g) q 6 hours (gluceptate or lactobionate) Children: 30 to 50 mg/kg/day (base, estolate, ethylsuccinate, or lactobionate) I.V. or P.O., in divided doses q 6 hours when giving I.V. and q 6 to 8 hours when giving P.O. Maximum dosage is 2 g/day for base or estolate, 3.2 g/day for ethylsuccinate, and 4 g/ day for lactobionate. Intestinal amebiasis Adults: 250 mg (base, estolate, or stearate) or 400 mg (ethylsuccinate) P.O. q 6 hours for 10 to 14 days Children: 30 to 50 mg/kg/day (base, estolate, ethylsuccinate, or stearate) P.O. in divided doses over 10 to 14 days Prophylaxis of ophthalmia neonatorum caused by Neisseria gonorrhoeae or Chlamydia trachomatis Neonates: 0.5- to 1-cm ribbon of ointment into each lower conjunctival sac once Treatment of conjunctivitis of the newborn caused by susceptible organisms Neonates: 50 mg/kg/day (ethylsuccinate) P.O. in four divided doses for at least 14 days Pertussis Children: 40 to 50 mg/kg/day (estolate preferred) P.O. in four divided doses for 14 days Pneumonia of infancy Infants: 50 mg/kg/day (estolate or ethylsuccinate) P.O. in four divided doses for at least 3 weeks Acne Adults and children older than age 12: 2% ointment, gel, or solution applied topically b.i.d. |
Mechanism of Action
Binds with the 50S ribosomal subunit of the 70S ribosome in many types of aerobic, anaerobic, gram-positive, and gram-negative bacteria. This action inhibits RNAdependent protein synthesis in bacterial cells, causing them to die.
Pharmacokinetics
- Protein Bound: 75-80%
- Metabolism: Via P450 enzyme CYP3A4
- Half-Life: 1.4 hr
- Excretion: Primarily feces; urine (2-15% as unchanged drug)
- Peak Plasma Time: 4 hr (base)
Administration
- Be aware that ventricular arrhythmias and sudden death may occur if drug is given concurrently with potent CYP3A inhibitors (such as clarithromycin, diltiazem, nitroimidazole antifungal agents, protease inhibitors, verapamil, and troleandomycin).
- Give erythromycin ethylsuccinate and delayed-release products without regard to meals but avoid giving with grapefruit juice.
- Give erythromycin base or stearate 1 hour before or 2 hours after meals for optimal absorption.
- Follow label directions to reconstitute drug for I.V. use. For intermittent infusion, infuse each 250 mg in at least 100 ml of normal saline solution over 20 to 60 minutes. Continuous infusion may be given over 6 to 24 hours as directed
Contraindications
- Hypersensitivity to drug or tartrazine
- Concurrent use of astemizole, cisapride, pimozide, or terfenadine
- Hepatic impairment (with estolate)
- Pregnancy (with estolate)
Precautions :
- Myasthenia gravis
- Hepatic disease
Adverse reactions
- CV: torsades de pointes, arrhythmias
- EENT: ototoxicity
- GI: nausea, vomiting, diarrhea, abdominal pain or cramps
- Hepatic: hepatic dysfunction, hepatitis
- Skin: rash
- Other: increased appetite, aggravation of weakness in myasthenia gravis, allergic reactions, superinfection, phlebitis at I.V. site
Patient monitoring
- Check temperature, and watch for signs and symptoms of superinfection.
- Monitor liver function tests. Watch for signs and symptoms of hepatotoxicity.
- Assess patient’s hearing for signs of ototoxicity
Patient teaching
- Instruct patient to take with 8 oz of water 1 hour before or 2 hours after meals, and to avoid grapefruit juice.
- If drug causes GI upset, encourage patient to take it with food.
- Tell patient not to swallow chewable tablets whole and not to chew or crush enteric-coated tablets.
- Advise patient to immediately report irregular heart beats, unusual tiredness, yellowing of skin or eyes, or signs and symptoms of new infection.
- Tell patient he’ll undergo periodic blood tests to monitor liver function.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.
Nursing Considerations
- Use erythromycin cautiously in patients with impaired hepatic function because drug is metabolized by the liver.
- Use erythromycin cautiously in elderly patients, especially those with renal or hepatic dysfunction, because these patients are at increased risk of hearing loss and torsades de pointes. They’re also at increased risk of bleeding if taking an oral anticoagulant.
- Before giving first erythromycin dose, expect to obtain body fluid or tissue sample for culture and sensitivity testing.
- Reconstitute parenteral form before administration. Add at least 10 ml of preservative-free sterile water for injection to each 500-mg vial or at least 20 ml of diluent to each 1-g vial.
- For prolonged infusion, expect to infuse a buffered solution up to 24 hours after dilution.
- For intermittent infusion, dilute dose in 100 to 250 ml normal saline solution or D5W if needed; give slowly over 20 to 60 minutes.
- When giving I.V. erythromycin gluceptate, dilute the solution if needed to 1 g/L in normal saline solution or D5W injection for slow, continuous infusion. Diluted solution remains potent for 7 days if refrigerated.
- When giving I.V. erythromycin lactobionate, dilute the solution if needed to 1 to 5 mg/ml in normal saline solution, lactated Ringer’s solution, or other electrolyte solution for slow, continuous infusion. Diluted solution remains potent for 14 days if refrigerated and for 24 hours at room temperature.
- Be aware that infusions prepared in piggyback infusion bottles stay potent for 30 days if frozen, 24 hours if refrigerated, or 8 hours at room temperature. Don’t store infusions prepared in the ADDvantage system.
- Don’t use diluent with benzyl alcohol if parenteral erythromycin is for a neonate. It may cause a fatal toxic syndrome of CNS depression, hypotension, metabolic acidosis, renal failure, respiratory problems, and, possibly, seizures and intracranial hemorrhage.
- Periodically monitor liver function test results to detect hepatotoxicity, which is most common with erythromycin estolate. Signs typically appear within 2 weeks after continuous therapy starts and resolve when it stops.
- Assess hearing regularly, especially in elderly patients and those who receive 4 g or more daily or have hepatic or renal disease. Hearing impairment begins 36 hours to 8 days after treatment starts and usually begins to improve 1 to 14 days after it stops.
- During I.V. therapy, watch for evidence of fluid overload, such as acute dyspnea and crackles.
- Monitor infants for vomiting or irritability with feeding because infantile hypertrophic pyloric stenosis has been reported.
- Assess myasthenia gravis patients for weakness because drug may aggravate it. Keep in mind that myasthenic syndrome may arise in patients previously undiagnosed with myasthenia gravis.
- Watch closely for signs and symptoms of superinfection. If they occur, notify prescriber and expect to stop drug and provide appropriate therapy.
- Monitor patient for diarrhea during and for at least 2 months after erythromycin therapy; diarrhea may signal pseudomembranous colitis caused by Clostridium difficile. If diarrhea occurs, notify prescriber and expect to withhold drug and treat with fluids, electrolytes, protein, and an antibiotic effective against C. difficile.
- If patient receives an order for urine catecholamine analysis, notify prescriber because erythromycin interferes with fluorometric measurement of urine catecholamines
Clindamycin
| Clindamycin |
| Availability Aerosol foam: 1% Capsules: 75 mg, 150 mg, 300 mg Granules for oral suspension: 75 mg/5 ml Injection: 150 mg base/ml Topical: 1% gel, lotion, single-use applicators, solution, and suspension Vaginal cream: 2% Vaginal suppositories (ovules): 100 mg |
| Indications and dosages Severe infections caused by sensitive organisms (such as Bacteroides fragilis, Clostridium perfringens, Fusobacterium, pneumococci, staphylococci, and streptococci) Adults: 300 to 450 mg P.O. q 6 hours, or (for other than C. perfringens) 1.2 to 2.7 g/day I.M. or I.V. in two to four equally divided doses Children: 16 to 20 mg/kg/day P.O. (hydrochloride) in three to four equally divided doses, or 13 to 25 mg/kg/day P.O. (palmitate hydrochloride) in three to four equally divided doses Neonates younger than 1 month: 15 to 20 mg/kg/day I.M. or I.V. in three to four equally divided doses Acute pelvic inflammatory disease Adults: 900 mg I.V. q 8 hours (given with gentamicin) Acne vulgaris Adults and children older than age 12: Apply a thin film of topical gel, lotion, or solution locally to affected area b.i.d |
Mechanism of Action
Inhibits protein synthesis in susceptible bacteria by binding to the 50S subunits of bacterial ribosomes and preventing peptide bond formation, which causes bacterial cells to die.
Pharmacokinetics
- Bioavailability: Oral (rapid; 90%)
- Peak serum time: Within 60 min (PO); 1-3 hr (IM)
- Metabolism: Hepatic
- Half-life: 2-3 hr (adults); 8.7 hr (premature neonates); 3.6 hr (full-term neonates); 2 hr (children); 4 hr (elderly)
- Excretion: Urine (10%) as active drug; feces (~4%) as active drug
Administration
- Give oral doses with full glass of water, with or without food.
- Don’t give as I.V. bolus injection.
- Dilute I.V. solution to a concentration of 18 mg/ml using normal saline solution, dextrose 5% in water, or lactated Ringer’s solution. Infuse no faster than 30 mg/minute.
- Don’t administer I.M. dosages above 600 mg.
- Inject I.M. doses deep into large muscle mass to prevent induration and sterile abscess.
Contraindications
Hypersensitivity to drug or lincomycin
Precautions:
Renal or hepatic impairment
Adverse reactions
- GI: nausea, vomiting, diarrhea, abdominal pain, esophagitis, pseudomembranous colitis
- Hematologic: neutropenia, leukopenia, agranulocytosis, thrombocytopenia purpura
- Hepatic: jaundice, hepatic dysfunction
- Skin: maculopapular rash, generalized morbilliform-like rash
- Other: bitter taste (with I.V. use), phlebitis at I.V. site, induration and sterile abscess (with I.M. use), anaphylaxis
Patient monitoring
- Monitor creatinine level closely in patients with renal insufficiency.
- Monitor hepatic enzyme levels in patients with hepatic disease.
- Assess for signs and symptoms of hypersensitivity reactions, including anaphylaxis.
- Assess for diarrhea and signs and symptoms of colitis
Patient teaching
- Tell patient to take drug with food if it causes stomach upset.
- Urge patient to contact prescriber immediately if he develops rash, unusual fatigue, or yellowing of skin or eyes or if diarrhea occurs during or after treatment.
- Tell patient that I.V. use may cause bitter taste. Reassure him that this effect will resolve on its own.
- Caution patient not to rely on condoms or diaphragm for contraception for 72 hours after using vaginal preparation; drug may weaken latex products and cause breakage.
- Instruct patient taking hormonal contraceptives to use supplemental birth control method, such as condoms (unless she’s using a vaginal preparation); drug may reduce hormonal contraceptive efficacy.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Nursing Considerations
- Expect to obtain a specimen for culture and sensitivity testing before giving first dose.
- Use clindamycin cautiously in patients who have a history of asthma, significant allergies, or GI disease; in those with renal or hepatic dysfunction; and in elderly or atopic patients
- Store oral solution for up to 2 weeks at room temperature or reconstituted parenteral solution for up to 24 hours at room temperature.
- Give I.V. dose by infusion only; don’t give bolus dose. Dilute 300 mg of clindamycin in 50 ml of diluent and give over 10 minutes. Dilute 600 mg of clindamycin in 100 ml of diluent and give over 20 minutes. Dilute 900 mg of clindamycin in 100 ml of diluent and give over 30 minutes
- Give I.M. injection deep into large muscle mass, such as the gluteus maximus. Rotate injection sites, and avoid giving more than 600 mg by I.M. injection.
- Check I.V. site often for phlebitis and irritation.
- For topical foam, wash the affected area with mild soap, let it dry fully, and then apply foam to entire affected area.
- Monitor results of liver function tests, CBC, and platelet counts during prolonged therapy.
- Observe patient for signs and symptoms of superinfection, such as vaginal itching and sore mouth, which may occur 2 to 9 days after therapy begins.
- Assess patient’s bowel pattern daily; severe diarrhea may indicate pseudomembranous colitis caused by Clostridium difficile. If diarrhea occurs, notify prescriber and expect to withhold clindamycin and treat with fluids, electrolytes, protein, and an antibiotic effective against C. difficile.
Linezolid
| Linezolid |
| Availability Injection: 2 mg/ml Powder for oral suspension: 100 mg/5 ml Tablets: 400 mg, 600 mg |
| Indications and dosages Vancomycin-resistant Enterococcus faecium infections Adults and children ages 12 and older: 600 mg P.O. or I.V. infusion q 12 hours for 14 to 28 days Children from birth to age 11: 10 mg/ kg I.V. q 8 hours for 14 to 28 days Nosocomial pneumonia; community-acquired pneumonia; complicated skin and skin-structure infections Adults and children ages 12 and older: 600 mg P.O. or I.V. infusion q 12 hours for 10 to 14 days Children from birth to age 11: 10 mg/ kg P.O. or I.V. q 8 hours for 10 to 14 days Uncomplicated skin and soft-tissue infections Adults: 400 mg P.O. q 12 hours for 10 to 14 days Adolescents: 600 mg P.O. or I.V. q 12 hours for 10 to 14 days Children ages 5 to 11: 10 mg/kg P.O. or I.V. q 12 hours for 10 to 14 day Children younger than age 5: 10 mg/kg P.O. or I.V. q 8 hours for 10 to 14 days |
Mechanism of Action
Selectively binds to bacterial 23S ribosomal RNA of 50S subunit, preventing formation of essential component of bacterial protein synthesis. Bacteriostatic or bactericidal against gram-positive and some gram-negative bacteria
Pharmacokinetics
- Bioavailability: 100%
- Peak plasma time: 1-2 hr
- Protein bound: 31%
- Metabolism: Hepatic via oxidation of the morpholine ring, resulting in 2 inactive metabolites (aminoethoxy acetic acid, hydroxyethyl glycine); does not involve CYP
- Half-life: 4-5 hr (adults); 1.5-3hr
- Excretion: Urine (80% of administered dose [30% unchanged, 50% metabolites]); feces (9% [metabolites])
Administration
- Give oral drug with or without food.
- For I.V. injection, use single-use, ready-to-use infusion bag. Check for particulate matter before giving. Infuse over 30 minutes to 2 hours.
- For I.V. infusion, mix with dextrose 5% in water, normal saline solution, or lactated Ringer’s injection.
- Flush I.V. line before and after administering, to avoid incompatibilities
Contraindications
Hypersensitivity to drug or its components
Precautions:
- Hepatic dysfunction, hypertension, hyperthyroidism, pheochromocytoma, bone marrow depression, pseudomembranous colitis
- Phenylketonuria (oral suspension only)
- Pregnant or breastfeeding patients
Adverse reactions
- CNS: anxiety, confusion, difficulty speaking, dizziness, hallucinations, lethargy, paraesthesia, light-headedness, fatigue, drowsiness, headache, seizures
- GI: nausea, vomiting, diarrhea, gastritis, anorexia, dry mouth, pseudomembranous colitis
- Hematologic: thrombocytopenia Skin: rash, photosensitivity, diaphoresis
- Other: fever, fungal infections
Patient monitoring
- Monitor neurologic status. Institute safety measures as needed to prevent injury.
- Check I.V. site for infiltration.
- Watch for bleeding and signs and symptoms of other adverse reactions (especially pseudomembranous colitis).
- Monitor CBC, coagulation studies, and culture and sensitivity tests.
Patient teaching
- Tell patient he may take with or without food but should avoid foods containing tyramine. 2Tell patient to promptly report bleeding or severe diarrhea.
- Instruct patient to minimize adverse GI effects by eating small, frequent servings of healthy food.
- Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.
Nursing Considerations
- Obtain body tissue and fluid specimens for culture and sensitivity tests, as ordered, before giving first dose of linezolid. Expect to start drug before test results are known.
- Be aware that linezolid shouldn’t be used to treat catheter-related bloodstream infections, catheter-site infections, or infections caused by gram-negative bacteria because the risk of death is higher in these infections.
- Infuse I.V. solution over 30 to 120 minutes with D5W, normal saline solution, or lactated Ringer’s solution
- Notify prescriber if patient develops visual impairment that suggests optic neuropathy, such as changes in visual acuity or color vision, blurred vision, lost vision, or visual field defect. If optic or peripheral neuropathy develops, the drug may need to be stopped.
- If patient takes a dopaminergic agent, sympathomimetic agent, or vasopressive agent, monitor blood pressure closely; if monitoring isn’t possible, linezolid shouldn’t be prescribed.
- If patient takes buspirone, meperidine, a serotinergic, or a tricyclic antidepressant, watch closely for signs and symptoms of serotonin syndrome; if monitoring isn’t possible, linezolid shouldn’t be prescribed.
- Assess bowel pattern daily. Also watch for secondary infection, including oral candidiasis and profuse, watery diarrhea.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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