Antimicrobial Drugs – Cephalosporins 2nd Generation

Name of the Cephalosporins 2nd Generation Drugs

• Cefazolin
• Cefaclor
• Cefotetan
• Cefoxitin
• Cefprozil (Cefzil)
• Ceftin (Cefuroxime), (Zinacef)
• Raniclor (cefaclor)

1.Cefazolin

Mechanism of Action

Interferes with bacterial cell wall synthesis by inhibiting the final step in the crosslinking of peptidoglycan strands. Peptidoglycan makes cell membranes rigid and protective. Without it, bacterial cells rupture and die.

Pharmacokinetics

• Peak plasma time: 0.5-2 hr (IM); 5 min (IV)
• Crosses placenta; penetrates CSF poorly
• Protein bound: 74-86%
• Metabolism: Minimally metabolized in liver
• Half-life: 90-150 min
• Excretion: Urine (80-100% as unchanged drug)

Administration

• Obtain specimens for culture and sensitivity testing as needed before starting therapy.
•  For intermittent I.V. infusion, administer in volume-control set or in separate, secondary I.V. container over 30 to 60 minutes.
• For direct I.V. injection, dilute reconstituted dose in 5 ml of sterile water for injection and administer slowly over 3 to 5 minutes.
• Don’t mix premixed solution with other drugs. 2Don’t use flexible container in series connections because of risk of air embolism.
•   For I.M. use, reconstitute with sterile water for injection, bacteriostatic water, or normal saline solution for injection. Shake well until dissolved.
• Inject I.M. into large muscle mass.

Contraindications

Hypersensitivity to cephalosporins or penicillins

Precautions:

• renal impairment, phenylketonuria
• history of GI disease (especially colitis)
• emaciated patients
•   elderly patients
• pregnant or breastfeeding patients
• Children.

Adverse reactions

• CNS: headache, lethargy, confusion, hemiparesis, paresthesia, syncope, seizures
• CV: hypotension, palpitations, chest pain, vasodilation
• EENT: hearing loss
•  GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis
• GU: vaginal candidiasis, nephrotoxicity
•  Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression
• Hepatic: hepatic failure, hepatomegaly
• Musculoskeletal: arthralgia Respiratory: dyspnea
• Skin: urticaria, maculopapular or erythematous rash
• Other: chills, fever, superinfectieon, anaphylaxis, serum sickness

Patient monitoring

• If patient is receiving high doses, monitor for extreme confusion, tonic clonic seizures, and mild hemiparesis.
• Monitor CBC, prothrombin time, and kidney and liver function test results.
• Watch for signs and symptoms of superinfection and other serious adverse reactions.
• Be aware that cross-sensitivity to penicillins may occur.

 Patient teaching

• Tell patient to report reduced urinary output, persistent diarrhea, bruising, or bleeding.
•   Instruct patient to take drug exactly as prescribed and to complete full course of therapy even when he feels better.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above

Nursing Considerations

• Use cefazolin cautiously in patients with impaired renal function or a history of GI disease, particularly colitis. Also use cautiously in patients hypersensitive to penicillin because cross-sensitivity has occurred in about 10% of such patients.
• If possible, obtain culture and sensitivity test results, as ordered, before giving drug.
• Reconstitute 500-mg drug vial with 2 ml of sterile water for injection (or 1-g vial with 2.5 ml). Shake well until dissolved.
• For direct I.V. injection, further dilute reconstituted solution with at least 5 ml sterile water for injection. Inject slowly over 3 to 5 minutes through tubing of a flowing compatible I.V. solution.
• For intermittent I.V. infusion, reconstitute 500 to 1,000 mg in 50 to 100 ml normal saline solution, D5W, D10W, dextrose 5% in lactated Ringer’s solutoin, dextrose 5% in quarter-normal (0.2) saline solution, dextrose 5% in half-normal (0.45) saline solution, dextrose 5% in normal saline solution, lactated Ringer’s injection, 5% or 10% invert sugar in sterile water for injection, 5% sodium bicarbonate (Ancef), or Ringer’s injection.
• Administer I.M injection deep into large muscle mass, such as the gluteus maximus.
• Store reconstituted drug up to 24 hours at room temperature or 10 days refrigerated.
• Monitor I.V. site for irritation, phlebitis,and extravasation.
• Monitor BUN and serum creatinine for early signs of nephrotoxicity. Also monitor fluid intake and output; decreasing urine output may indicate nephrotoxicity.
• Be aware that an allergic reaction may occur a few days after therapy starts.
• Assess bowel pattern daily; severe diarrhea may indicate pseudomembranous colitis.
• Watch for evidence of superinfection: cough, diarrhea, drainage, fever, malaise, pain, perineal itching, rash, redness, swelling.
• Assess for pharyngitis, ecchymosis, bleeding, and arthralgia; they may indicate a blood dyscrasia

2.Cefaclor

Mechanism of Action:

Interferes with bacterial cell wall synthesis by inhibiting cross-linking of peptidoglycan strands, which stiffen cell membranes. As a result, bacterial cells rupture

Administration

•   Obtain specimens for culture and sensitivity testing as necessary before starting therapy.
•  Be aware that cross-sensitivity to penicillins may occur.
•   Give extended-release tablets with food to enhance absorption.
• Don’t give antacids within 2 hours of extended-release form

Pharmacokinetics

Elimination

Half-life: 0.6-0.9 hr

Hemodialysis shortens half-life by 25-30%

Excretion: Urine (~60-80%, unchanged)

Contraindications

  Hypersensitivity to cephalosporins or penicillins

Precautions:

•   renal impairment, phenylketonuria
•   history of GI disease (especially colitis)
• emaciated patients
•  elderly patients
• pregnant or breastfeeding patients
• Children.

Adverse reactions

• CNS: headache, lethargy, paresthesia, syncope,seizures
• CV: hypotension, palpitations, chest pain, vasodilation
• EENT: hearing loss
• GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis
• GU: vaginal candidiasis, nephrotoxicity
• Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression
•  Hepatic: hepatic failure, hepatomegaly
• Musculoskeletal: arthralgia
• Respiratory: dyspnea
• Skin: urticaria, maculopapular or erythematous rash
• Other: chills, fever, superinfection, anaphylaxis, serum sickness

Patient monitoring

• Assess CBC and kidney and liver function test results.
• With long-term therapy, obtain monthly Coombs’ test
• Monitor for signs and symptoms of superinfection and other serious adverse reactions.

Patient teaching

• Instruct patient to take drug with food or milk to reduce GI upset.
•   Advise patient to complete entire course of therapy even if he feels better.
• Tell patient to report signs and symptoms of allergic response and other adverse reactions, such as rash, easy bruising, bleeding, severe GI problems, or difficulty breathing.
• Instruct patient to avoid taking antacids within 2 hours of extendedrelease cefaclor.  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

• Use cefaclor cautiously in patients with impaired renal function or a history of GI disease, particularly colitis, and in patients who are hypersensitive to penicillin; about 10% of them have cross-sensitivity.
• If possible, obtain culture and sensitivity test results, as ordered, before giving drug.
•   Monitor BUN and serum creatinine levels for early signs of nephrotoxicity. Also monitor fluid intake and output; decreasing urine output may indicate nephrotoxicity.
• Be aware that an allergic reaction may occur a few days after therapy starts.
• Assess bowel pattern daily; severe diarrhea may indicate pseudomembranous colitis.
•   Assess patient for superinfection: perineal itching, fever, malaise, redness, pain, swelling, rash, drainage, diarrhea, cough, sputum changes

3.Cefotetan

Mechanism of Action

Interferes with bacterial cell wall synthesis by inhibiting the final step in the crosslinking of peptidoglycan strands. Peptidoglycan makes cell membranes rigid and protective. Without it, bacterial cells rupture and die.

Pharmacokinetics

• Half-Life: 2.8-4.6 hr
• Peak Plasma Time: 1.5-3 hr (IM)
• Protein Bound: 76-90%
• Distribution: Body fluids & tissue, including bile, sputum, prostatic & peritoneal fluids, low in CSF
• Metabolism: Liver
• Excretion: urine primarily unchanged; feces (20%)

Contraindications

Hypersensitivity to cephalosporins or their components

Precautions:

• renal impairment, phenylketonuria
• history of GI disease (especially colitis)
• emaciated patients
•   elderly patients
• pregnant or breastfeeding patients
• Children.

Adverse reactions

• CNS: headache, lethargy, confusion, hemiparesis, paresthesia, syncope, seizures
• CV: hypotension, palpitations, chest pain, vasodilation
• EENT: hearing loss
• GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis
• GU: vaginal candidiasis, nephrotoxicity
• Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression
• Hepatic: hepatic failure, hepatomegaly
• Musculoskeletal: arthralgia Respiratory: dyspnea
• Skin: urticaria, maculopapular or erythematous rash
• Other: chills, fever, superinfection, anaphylaxis, serum sickness

Patient monitoring

• If patient is receiving high doses, monitor for extreme confusion, tonic clonic seizures, and mild hemiparesis.
• Monitor CBC, prothrombin time, and kidney and liver function test results.
• Watch for signs and symptoms of superinfection and other serious adverse reactions.
• Be aware that cross-sensitivity to penicillins may occur.

 Patient teaching

• Tell patient to report reduced urinary output, persistent diarrhea, bruising, or bleeding.
•   Instruct patient to take drug exactly as prescribed and to complete full course of therapy even when he feels better.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above

Nursing Considerations

• Use cefazolin cautiously in patients with impaired renal function or a history of GI disease, particularly colitis. Also use cautiously in patients hypersensitive to penicillin because cross-sensitivity has occurred in about 10% of such patients.
• If possible, obtain culture and sensitivity test results, as ordered, before giving drug.
• Reconstitute 500-mg drug vial with 2 ml of sterile water for injection (or 1-g vial with 2.5 ml). Shake well until dissolved.
• For direct I.V. injection, further dilute reconstituted solution with at least 5 ml sterile water for injection. Inject slowly over 3 to 5 minutes through tubing of a flowing compatible I.V. solution.
• For intermittent I.V. infusion, reconstitute 500 to 1,000 mg in 50 to 100 ml normal saline solution, D5W, D10W, dextrose 5% in lactated Ringer’s solutoin, dextrose 5% in quarter-normal (0.2) saline solution, dextrose 5% in half-normal (0.45) saline solution, dextrose 5% in normal saline solution, lactated Ringer’s injection, 5% or 10% invert sugar in sterile water for injection, 5% sodium bicarbonate (Ancef), or Ringer’s injection.
• Administer I.M injection deep into large muscle mass, such as the gluteus maximus.
• Store reconstituted drug up to 24 hours at room temperature or 10 days refrigerated.
• Monitor I.V. site for irritation, phlebitis,and extravasation.
• Monitor BUN and serum creatinine for early signs of nephrotoxicity. Also monitor fluid intake and output; decreasing urine output may indicate nephrotoxicity.
• Be aware that an allergic reaction may occur a few days after therapy starts.
• Assess bowel pattern daily; severe diarrhea may indicate pseudomembranous colitis.
• Watch for evidence of superinfection: cough, diarrhea, drainage, fever, malaise, pain, perineal itching, rash, redness, swelling.
• Assess for pharyngitis, ecchymosis, bleeding, and arthralgia; they may indicate a blood dyscrasia

4.Cefoxitin

Mechanism of Action

Interferes with bacterial cell wall synthesis by inhibiting the final step in the crosslinking of peptidoglycan strands. Peptidoglycan makes cell membranes rigid and protective. Without it, bacterial cells rupture and die.

Pharmacokinetics

Half-Life: 45-60 min

Peak Plasma Time: 20-30 min (IM); within 5 min (IV)

Protein Bound: 65-79%

Distribution: Widely distributed to body tissues & fluids, including pleural, synovial, ascitic fluid, bile, poor CSF penetration

Excretion: Unchanged in urine (85%)

Administration

•   Obtain specimens for culture and sensitivity testing as necessary before starting therapy.
• Reconstitute 1-g dose with 10 ml of sterile water; reconstitute 2-g dose with 10 to 20 ml.
• For direct I.V. injection, give 10 ml of sterile water with each gram of cefoxitin over 3 to 5 minutes. Inject into large vein and rotate sites, or give through existing I.V. tubing.
• For intermittent or continuous I.V. infusion, add reconstituted drug to compatible solution, such as D5W, normal saline solution, or D5W and normal saline solution.
• For I.M. injection, reconstitute each gram with 2 ml of sterile water or 2 ml of 0.5% lidocaine hydrochloride (without epinephrine).
•   Inject I.M. deep into large muscle mass; divide 2-g dose in half and inject into separate large muscle masses.
•   Know that dry powder and solution may darken, but this does not alter drug efficacy

Adverse reactions

• CNS: headache, lethargy, paresthesia, syncope,seizures
• CV: hypotension, palpitations, chest pain, vasodilation, thrombophlebitis
• EENT: hearing loss
• GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis
• GU: vaginal candidiasis, nephrotoxicity
• Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression
• Hepatic: hepatic failure, hepatomegaly
• Musculoskeletal: arthralgia
• Respiratory: dyspnea
• Skin: urticaria, maculopapular or erythematous rash
• Other: chills, fever, superinfection, pain at I.M. site, anaphylaxis, serum sickness

Patient monitoring

• Assess CBC and kidney and liver function test results.
• Monitor fluid intake and output. Report significant decrease in output.
• Monitor for signs and symptoms of superinfection and other serious adverse reactions.
• Be aware that cross-sensitivity to penicillins may occur.

Patient teaching

• Instruct patient to report reduced urinary output, persistent diarrhea, bruising, and bleeding.
• 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

• Use cefoxitin cautiously in patients hypersensitive to penicillin; cross-sensitivity has occurred in about 10% of such patients.
• Also use cautiously in patients with a history of GI disease, particularly colitis, because of an increased risk of pseudomembranous colitis.
• If possible, obtain culture and sensitivity test results, as ordered, before giving drug.
• For I.V. use, reconstitute 1 g with 10 ml sterile water for injection or 2 g with 10 to 20 ml diluent.
•   For I.V. injection, give slowly over 3 to 5 minutes through tubing of a flowing compatible I.V. solution. • For intermittent infusion, further dilute with 50 to 100 ml D5W or normal saline solution.
• For continuous high-dose infusion, add cefoxitin to I.V. solutions of D5W, normal saline solution, or dextrose 5% in normal saline solution.
• For I.M. use, reconstitute each 1 g with 2 ml sterile water for injection.
• Discard unused drug after 24 hours if stored at room temperature or after 1 week if refrigerated.
• Be aware that powder or solution may darken during storage, which doesn’t reflect altered potency.
• Be aware that an allergic reaction may occur a few days after therapy starts.
• Monitor BUN and serum creatinine for early signs of nephrotoxicity. Also monitor fluid intake and output; decreasing urine output may indicate nephrotoxicity.
•   Assess patient’s bowel pattern daily; severe diarrhea may indicate pseudomembranous colitis.
• Assess for pharyngitis, ecchymosis, bleeding, and arthralgia; they may indicate a blood dyscrasia.

5.Cefprozil

Mechanism of Action

 Interferes with bacterial cell wall synthesis by inhibiting the final step in the crosslinking of peptidoglycan strands. Peptidoglycan makes the cell membrane rigid and protective. Without it, bacterial cells rupture and die.

Pharmacokinetics

• Half-Life: 1.3 hr
• Peak Plasma Time: 1.5 hr
• Protein Bound: 35-45%
• Absorption: oral 94%
• Metabolism: liver
• Excretion: unchanged in urine: 61%

Administration

• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.
• Give drug with food.

Contraindications

• Hypersensitivity to cephalosporins or penicillins
• Renal failure

Precautions:

• renal or hepatic impairment
• pregnant or breastfeeding patients
•   children.

Adverse reactions

• CNS: headache, dizziness, drowsiness, hyperactivity, hypotonia, insomnia, confusion, seizures
• GI: nausea, vomiting, diarrhoea, abdominal pain, dyspepsia, pseudomembranous colitis
• GU: haematuria, vaginal candidiasis, genital pruritus,renal dysfunction, toxic nephropathy
• Hematologic: eosinophilia, aplastic anaemia, haemolytic anaemia, haemorrhage, bone marrow depression, hypoprothrombinaemia
• Hepatic: hepatic dysfunction
• Skin: toxic epidermal necrolysis, diaper rash, erythema multiforme, Stevens Johnson syndrome
• Other: allergic reactions, carnitine deficiency, drug fever, superinfection, serum sickness–like reaction, anaphylaxis

Patient monitoring

• Stay alert for life-threatening reactions, including anaphylaxis, serum sickness–like reaction, Stevens-Johnson syndrome, and pseudomembranous colitis.
• Monitor neurologic status, particularly for signs and symptoms of impending seizures.
•   Monitor kidney and liver function test results and assess fluid intake and output.
• Monitor CBC with white cell differential, prothrombin time, and bleeding time. Watch for signs and symptoms of blood dyscrasias, especially hypoprothrombinemia.
• Monitor temperature. Stay alert for signs and symptoms of superinfection.

Patient teaching

• Advise patient to immediately report rash, bleeding tendency, or CNS changes.
• Teach patient to recognize signs and symptoms of superinfection and instruct him to report these right away.
• Tell patient to take drug with food.
• 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 cefprozil cautiously in patients who have impaired renal function or a history of GI disease, especially colitis. Also use drug cautiously in patients who are hypersensitive to penicillin because crosssensitivity has occurred in about 10% of such patients.
• If possible, obtain culture and sensitivity test results, as ordered, before giving drug
• Monitor BUN and serum creatinine levels to detect early signs of nephrotoxicity. Also monitor fluid intake and output; decreasing urine output may indicate nephrotoxicity.
• Be aware that an allergic reaction may occur a few days after therapy starts.
• Assess patient’s bowel pattern daily; severe diarrhea may indicate pseudomembranous colitis

6.Ceftin (Cefuroxime)

Mechanism of Action

 Interferes with bacterial cell wall synthesis by inhibiting the final step in the crosslinking of peptidoglycan strands. Peptidoglycan makes the cell membrane rigid and protective. Without it, bacterial cells rupture and die.

Pharmacokinetics

• Bioavailability: Fasting, 37%; postprandial, 52%
• Peak serum time: 2-3 hr (PO); 15-60 min (IM); 2-3 min (IV)
• Distribution: Widely distributed to body tissues and fluids, including cerebrospinal fluid (CSF)
• Protein bound: 33-50%
• Metabolism: Partially metabolized in liver
• Half-life: 1-2 hr (prolonged with renal impairment)
• Excretion: Urine (66-100% as unchanged drug)

Administration

• Reconstitute drug in vial with sterile water for injection.
• Given by direct I.V. injection over 3 to 5 minutes into large vein or flowing I.V. line.
• For intermittent I.V. infusion, reconstitute drug with 100 ml of dextrose 5% in water or normal saline solution; administer over 15 minutes to 1 hour. For continuous infusion, give in 500 to 1,000 ml of compatible solution; infuse over 6 to 24 hours.
•   Inject I.M. doses deep into large muscle mass.
• Give oral form with food.
• Be aware that tablets and oral suspension are exchangeable on a milligram-for-milligram basis.

Contraindications

• Hypersensitivity to cephalosporins or penicillin’s
• Carnitine deficiency

Precautions:

• renal or hepatic impairment
• pregnant or breastfeeding patients
• Children.

Adverse reactions

• CNS: headache, hyperactivity, hypertonia,seizures
• GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, pseudomembranous colitis
• GU: hematuria, vaginal candidiasis, renal dysfunction, acute renal failure Hematologic: hemolytic anemia, aplastic anemia, hemorrhage
• Hepatic: hepatic dysfunction
•  Metabolic: hyperglycemia
• Skin: toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome
• Other: allergic reaction, drug fever, superinfection, anaphylaxis

Patient monitoring

• Monitor patient for life-threatening adverse effects, including anaphylaxis, Stevens-Johnson syndrome, and pseudomembranous colitis.
• Monitor neurologic status, particularly for signs of impending seizures.
• Monitor kidney and liver function test results and intake and output.
• Monitor CBC with differential and prothrombin time; watch for signs and symptoms of blood dyscrasias.
•  Monitor temperature; watch for signs and symptoms of superinfection.

Patient teaching

• Advise patient to immediately report rash or bleeding tendency.
• Instruct patient to take drug with food every 12 hours as prescribed.
• Teach patient how to recognize signs and symptoms of superinfection. Instruct him to report these right away.
• Advise patient to report CNS changes.
• 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 cefuroxime cautiously in patients hypersensitive to penicillin because cross sensitivity has occurred in about 10% of such patients.
• If possible, obtain culture and sensitivity results, as ordered, before giving drug.
• Give oral form with food to decrease GI distress, as needed.
• Remember that oral forms—tablets and suspension—aren’t bioequivalent.
• For I.V. use, reconstitute using manufacturer’s instructions according to type of preparation available. Solution ranges in color from light yellow to amber.
• For I.M. use, add 3 or 3.6 ml sterile water for injection to each 750-mg vial to yield 220 mg/ml.
•   If using a container of frozen parenteral solution, thaw at room temperature or under refrigeration before administration; make sure all ice crystals have melted. Don’t force thawing by microwaving.
• Store reconstituted parenteral drug for up to 24 hours at room temperature or 96 hours in refrigerator. (Thawed solutions may be stable 24 hours at room temperature or 28 days if refrigerated.) Store reconstituted oral suspension in refrigerator or at room temperature up to 10 days.
• Give I.V. injection over 3 to 5 minutes through tubing of a flowing compatible I.V. fluid.
• Monitor I.V. site for extravasation and phlebitis.
• Monitor BUN and serum creatinine levels and fluid intake and output to detect signs of nephrotoxicity. Monitor patients with renal impairment closely because they may have greater toxic reactions to cefuroxime.
• Monitor patient for allergic reactions continuing up to a few days after therapy starts. Patients with a history of some form of allergy, especially to drugs, are at increased risk for an allergic reaction.
• Assess bowel pattern daily; severe diarrhea may indicate pseudomembranous colitis. If it’s suspected, stop drug, as ordered, and provide treatment as prescribed.
• Assess patient for pharyngitis, ecchymosis, bleeding, and arthralgia, which may indicate a blood dyscrasia.
• Monitor PT and bleeding time, as ordered. Be prepared to administer vitamin K, if ordered, to treat hypothrombinemia

7.Raniclor (cefaclor)

Mechanism of Action

 Interferes with bacterial cell wall synthesis by inhibiting cross-linking of peptidoglycan strands, which stiffen cell membranes. As a result, bacterial cells rupture.

Pharmacokinetics

Half-life: 0.6-0.9 hr

Haemodialysis shortens half-life by 25-30%

Excretion: Urine (~60-80%, unchanged)

Administration

• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.
• Be aware that cross-sensitivity to penicillins may occur.
• Give extended-release tablets with food to enhance absorption.
• Don’t give antacids within 2 hours of extended-release form

Contraindications

Hypersensitivity to cephalosporins or penicillins

Precautions Use cautiously in:

• renal impairment, phenylketonuria
• history of GI disease (especially colitis)
• emaciated patients
• elderly patients
• pregnant or breastfeeding patients
• Children.

Adverse reactions

• CNS: headache, lethargy, paresthesia, syncope,seizures
• CV: hypotension, palpitations, chest pain, vasodilation
• EENT: hearing loss
• GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis
• GU: vaginal candidiasis, nephrotoxicity
• Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression
• Hepatic: hepatic failure, hepatomegaly
• Musculoskeletal: arthralgia
• Respiratory: dyspnea
• Skin: urticaria, maculopapular or erythematous rash
• Other: chills, fever, superinfection, anaphylaxis, serum sickness

Patient monitoring

• Assess CBC and kidney and liver function test results.
• With long-term therapy, obtain monthly Coombs’ test.
• Monitor for signs and symptoms of superinfection and other serious adverse reactions.

Patient teaching

•   Instruct patient to take drug with food or milk to reduce GI upset.
• Advise patient to complete entire course of therapy even if he feels better.
•  Tell patient to report signs and symptoms of allergic response and other adverse reactions, such as rash, easy bruising, bleeding, severe GI problems, or difficulty breathing.
• Instruct patient to avoid taking antacids within 2 hours of extended release cefaclor.
•  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

• Use cefaclor cautiously in patients with impaired renal function or a history of GI disease, particularly colitis, and in patients who are hypersensitive to penicillin; about 10% of them have cross-sensitivity.
•   If possible, obtain culture and sensitivity test results, as ordered, before giving drug.
• Monitor BUN and serum creatinine levels for early signs of nephrotoxicity. Also monitor fluid intake and output; decreasing urine output may indicate nephrotoxicity.
• Be aware that an allergic reaction may occur a few days after therapy starts.
• Assess bowel pattern daily; severe diarrhoea may indicate pseudomembranous colitis.
• Assess patient for superinfection: perineal itching, fever, malaise, redness, pain, swelling, rash, drainage, diarrhoea, cough, sputum changes.

REFERENCES

1. Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
2. McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
3. April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
4. Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
5. Nursebro.com, Search – Nursebro

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