Antimicrobial Drugs- Monobactams

Name of the Monobactams Drugs

Aztreonam

Mechanism of Action

Inhibits bacterial cell-wall synthesis during active multiplication by binding with penicillin-binding protein 3, resulting in cell-wall destruction

Pharmacokinetics

• Peak plasma time: IM/IV push, ≤60 min; IV infusion, 1.5 hr
• Protein bound: 58%
• Metabolized in liver
• Half-life: Adults with normal renal function, 1.7-2.9 hr; adults with end-stage renal disease, 6-8 hr
• Excretion: Urine (60-70% as unchanged drug), feces (13-15%)

Administration

• Flush I.V. tubing with compatible solution before and after giving drug.
• Compatible solutions include 0.9% sodium chloride injection, 5% or 10% dextrose injection, Ringer’s or lactated Ringer’s injection, 5% dextrose and 0.9% sodium chloride injection, and 5% dextrose and 0.45% sodium chloride injection.
• After adding diluent to vial or infusion bottle, shake immediately and vigorously.
• For I.V. bolus injection, reconstitute powder for injection by adding 6 to 10 ml of sterile water for injection. Inject prescribed dosage into tubing of compatible I.V. solution slowly over 3 to 5 minutes.
• For intermittent I.V. infusion, reconstitute powder for injection by adding compatible I.V. solution to yield a concentration not exceeding 20 mg/ml. Administer prescribed dosage over 20 to 60 minutes.
• Thaw commercially available frozen drug at room temperature and give by intermittent I.V. infusion only.
• For I.M. injection, reconstitute powder for injection by adding 3 ml of sterile water for injection or 0.9% sodium chloride injection.
• Give I.M. injection deep into large muscle mass.
• Reconstitute inhalation solution with 1 ml sterile diluent supplied and administer only with nebulizer supplied. Don’t reconstitute until ready to administer.
• Know that patient should use a bronchodilator as prescribed before using inhalation solution.

Adverse reactions

• CNS: dizziness, confusion, seizures
• CV: phlebitis, thrombophlebitis
• EENT: diplopia, tinnitus
• GI: nausea, vomiting, diarrhea (including diarrhea associated with Clostridium difficile), pseudomembranous colitis
• Hematologic: neutropenia, pancytopenia
• Hepatic: hepatitis
• Respiratory: bronchospasm
• Skin: rash, toxic epidermal necrolysis
• Other: altered taste, angioedema, anaphylaxis

Patient monitoring

• Assess patient closely for signs and symptoms of pseudomembranous colitis.
• Monitor patient carefully for hypersensitivity reaction, especially if he’s allergic to penicillin, carbapenems, or cephalosporins.
• Monitor CBC with differential, AST, ALT, PT, PTT, and serum creatinine values.
• Monitor renal and hepatic function.

Patient teaching

• Show patient how to reconstitute inhalation solution using diluent supplied and tell patient not to reconstitute until ready to use. Advise patient to use only the nebulizer supplied and to use a bronchodilator as prescribed before using inhalation solution.
• Instruct patient to immediately report severe diarrhea or signs or symptoms of hypersensitivity reaction, such as rash or difficulty breathing.
• Tell female patient to notify prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above

Nursing Considerations

Obtain culture and sensitivity test results, if possible, before starting aztreonam therapy. If patient is acutely ill, expect to begin therapy before results are available.

• Keep in mind that other antimicrobials may be used with aztreonam in seriously ill patients at risk for gram-positive infection.
• Expect to use I.V. route for patients who need single doses over 1 g and those with life-threatening systemic infections, such as septicemia or peritonitis.
• To reconstitute aztreonam for I.V. bolus injection, use sterile water for injection.
• Immediately after adding diluent to vial, shake it vigorously to mix. After obtaining correct dose, discard unused solution.  Reconstituted solution may turn light pink on standing at room temperature. This doesn’t affect drug potency.
• Give I.V. bolus injection directly into I.V. tubing over 3 to 5 minutes.
• Know that I.V. infusion may be administered over 20 to 60 minutes.
• Flush I.V. tubing with solution, such as normal saline solution, before and after administering I.V. infusion to reduce risk of incompatibilities.
• If prescribed, mix aztreonam in same I.V. solution with other antibiotics (such as ampicillin sodium, cefazolin sodium, clindamycin phosphate, gentamicin sulfate, or tobramycin sulfate), or mix it with cloxacillin sodium and vancomycin hydrochloride in peritoneal dialysis solution.
• Prepare solution for I.M. injection using sterile or bacteriostatic water or sodium chloride for injection. Administer injection deep into large muscle, such as in dorsogluteal or ventrogluteal area.
• Assess for signs of bacterial or fungal superinfection, which may occur with prolonged or repeated therapy. If superinfection occurs, treat it as prescribed.
• Monitor bowel elimination; if needed, obtain stool culture to rule out pseudomembranous colitis. If it occurs, expect to discontinue aztreonam and administer fluid, electrolytes, and antibiotics effective against Clostridium difficile.
• Evaluate patient’s renal and liver function test results, as ordered, if patient has renal or hepatic impairment.
• Monitor renal function if patient is receiving an aminoglycoside because of the increased risk of nephrotoxicity.

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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