Drug name gentamicin

classification Antiinfectives, aminoglycoside antibiotic

dosage Moderate to Severe Infection Adult: IV/IM 1.52 mg/kg loading dose followed by 35 mg/kg/d in 23 divided doses Intrathecal48 mg preservative free q.d. Topical 12 drops of solution in eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d. Child: IV/IM 67.5 mg/kg/d in 34 divided doses Intrathecal >3 mo, 12 mg preservative free q.d. Neonate: IV/IM 2.5 mg/kg q1224h Acute Pelvic Inflammatory Disease Adult: IV/IM 2 mg/kg followed by 1.5 mg/kg q8h Prophylaxis of Bacterial Endocarditis Adult: IV/IM 1.5 mg/kg 30 min before procedure, may repeat in 8 h Child: IV/IM < 27 kg, 2 mg/kg 30 min before procedure, may repeat in 8 h

Mechanism of action Broad-spectrum aminoglycoside antibiotic derived from Micromonospora purpurea. Action is usually bacteriocidal.

Indication/contraindic ation Contraindication : History of hypersensitivity to or toxic reaction with any aminoglycoside antibiotic. Safe use during pregnancy (category C) or lactation is not established

Side effects/ adverse effects Special Senses: Ototoxicity (vestibular disturbances, impaired hearing), optic neuritis. CNS: neuromuscular blockade: skeletal muscle weakness, apnea, respiratory paralysis (high doses); arachnoiditis (intrathecal use). CV: hypotension or hypertension. GI: Nausea, vomiting, transient increase in AST, ALT, and serum LDH and bilirubin; hepatomegaly, splenomegaly. Hematologic: Increased or decreased reticulocyte counts; granulocytopenia , thrombocytopeni a (fever, bleeding tendency), thrombocytopeni c purpura, anemia. Body as a Whole: Hypersensitivity (rash, pruritus, urticaria, exfoliative dermatitis,

Nursing mgt. Lab tests: Perform C&S and renal function prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity. Draw blood specimens for peak serum gentamicin concentration 30 min1h after IM administration, and 30 min after completion of a 3060 min IV infusion.

streptomycin

antiinfectives

1 gram* / vial *Each vial contains Streptomycin Sulfate USP equivalent to 1 gram Streptomycin.

Inhibits CHON synthesis strains of gram negative bacteria, mechanisms of lethal action and fully understood, but functional integrity of cell membrane appears to be disrupted.

Indication : Infections caused by susceptible strain of mycobacterium tuberculosis. Serious infections ca used by susceptible strains of Yersinia Pestis Contraindication Allergy to aminoglycosides, pregnancy, lactation, Herpes vacinia fungal infection.

eosinophilia, burning sensation of skin, drug fever, joint pains, laryngeal edema, anaphylaxis). Urogenital: Nephrotoxicity: proteinuria, tubular necrosis, cells or casts in urine, hematuria, rising BUN, nonprotein nitrogen, serum creatinine; decre ased creatinine clearance. Deafness, agranulocytosis, aplastic anemia, renal failure,hemolytic anemia

Use in route only: give by deep IM injection. Ensure adequate hydration of patient before and during the therapy. Monitor for hearing changes. This drug can only be given by injection. Report hearing changes,dizziness, pain at injection site, rash.

CEFUROXIM E AXETIL

antiinfective; anti biotic; secondgeneration cephalosporin

Adult: PO Uncomplicate d UTI 125 mg twice daily. Resp tract infections 250-500 mg twice daily. Uncomplicatedgon orrhoea W/ oral

Probenecid decrea ses renal clearance of cefuro xime. Potentially Fatal: Nephrotoxicit y with

Hypersensitivity to cephalosporins.

Glaucoma, Dyspnoea, Eye Irritation, Diarrhoea, Eye Pain

Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. Report onset of loose

probenecid: 1 g as a single dose. IV Meningitis 3 g 8 hrly. IM Gonorrhoea W/ oral probenecid: 1.5 g as a single dose. IV/IM Surgical prophylaxis 1.5 g IV perop, then 750 mg IM 8 hrly for up to 24-48 hr.Susceptible infections 750 mg 8 hrly, up to 1.5 g 6-8 hrly for severe infections.

aminoglycosides and furosemide.

stools or diarrhea. Although pseudomembranous colitis (see Signs & Symptoms, Appendix F) rarely occurs, this potentially life-threatening complication should be ruled out as the cause of diarrhea during and after antibiotic therapy. Monitor for manifestations of hypersensitivity (see Appendix F). Discontinue drug and report their appearance promptly. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes.

cefotaxime

antiinfectives

Uncomplicated infections: 1g every 12 hours. Moderate to severe infections: 12g every 8 hours. Infections commonly needing a higher dosage (e.g., septicemia): 2g IV every 68 hours. Life-threatening infections: 2g IV every 4 hours. Gonococcal urethritis or cervicitis: 0.5g IM once. Rectal gonorrhea: 0.5g (women) or 1g (men) IM once. All: max 12g/day. Post-op prophylaxis: give 1g as single dose 3090mins before surgery. Cesarean section: 1st dose: 1g IV as soon as umbilical cord clamped; 2nd and 3rd dose: 1g at 6 and 12 hours after 1st dose. CrCl <20mL/min/1.73m2: consider reducing dose by one-half.

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillinbinding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Susceptible bacteremia, septicemia, lower respiratory and genitourinary tracts, skin and skin structure, bone and joint, gynecologic, CNS (e.g., meningitis), intraabdominal infections. Surgical prophylaxis.

Abdominal pain; Allergic skin reactions; An extreme allergic reaction (anaphylaxis); Confusion; Diaper rash in infants; Diarrhea; Diarrhoea; Disturbances in the normal numbers of blood cells in the blood; Disturbances of the gut such as diarrhoea nausea vomiting abdominal pain; Dizziness; Feeling or being sick; Headache; Hives; Hyperactivity;

Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results. Monitor periodically BUN and creatinine clearance. Inspect IM and IV injection sites frequently for signs of phlebitis. Report onset of loose stools or diarrhea. Although pseudomembranous colitis (see Signs & Symptoms, Appendix F) rarely occurs,

Neonates up to 1 week of age: 50mg/kg IV every 12 hours. 14 weeks of age: 50mg/kg IV every 8 hours. Over 1 month of age (<50kg): 50180mg/kg in 46 equally divided doses. 50kg: as adult; max 12g/day.

ERYTHROM YCIN

antiinfective; macrolide antibiotic

Moderate to Severe Infections Adult: PO 250500 mg q6h; 333 mg q8h Child: PO 3050 mg/kg/d divided q6h Topical Apply ointment to infected eye 1 or more times/d Neonate: PO 7 d, 10 mg/kg q12h; >7 d, 10 mg/kg q812h Topical 0.51 cm in conjunctival sac once Chlamydia trachomatis Infections Adult: PO 500 mg q.i.d. or 666 mg q8h

Macrolide antibiotic produced by a strain of Streptomyces erythreus. Bacteriostatic or bactericidal, depending on nature of organism and drug concentration used.

Indication: Pneumococcal pneumonia, Mycoplasma pneumoniae (primary atypical pneumonia), acute pelvic inflammatory disease caused by Neisseria gonorrhoeae in females sensitive to penicillin, infections caused by susceptible strains of staphylococci, streptococci, and certain strains of

Inflammation of the kidneys (nephritis); Mouth ulcers; Muscle tightness; Nausea; Nervousness; Overgrowth of the yeast candida with prolonged use (this may cause thrush infections); Pain or inflammation at the injection site; Problems sleeping; Rash; Skin rash; Temporary rise in liver enzymes; Tummy pains; Vaginitis; Vomiting; Yellowing of the skin and eyes (jaundice); GI: Nausea, vomiting, abdominal cramping, diarrhea, heartburn, anorexia. Body as a Whole: Fever, eosinophilia, urticaria, skin eruptions, fixed drug eruption, anaphylaxis. Superinfections by nonsusceptible bacteria, yeasts,

this potentially lifethreatening complication should be ruled out as the cause of diarrhea during and after antibiotic therapy. Monitor for manifestations of hypersensitivity (see Appendix F). Discontinue drug and report their appearance promptly. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes.

Report onset of GI symptoms after PO administration to physician. These are dose related; if symptoms persist after dosage reduction, physician may prescribe drug to be given with meals in spite of impaired absorption. Monitor for adverse GI effects. Pseudomembranous enterocolitis (see Appendix F), a potentially life-threatening condition, may occur during or after antibiotic therapy. Observe for S&S of superinfection by overgrowth of nonsusceptible bacteria or fungi. Emergence of resistant

Child: Topical Apply 0.51 cm ribbon in lower conjunctival sacs shortly after birth

Haemophilus influenzae. Also used in intestinal amebiasis, Legionnaires' disease, uncomplicated urethral, endocervical, and rectal infections caused by Chlamydia trachomatis, for prophylaxis of ophthalmia neonatorum caused by N. gonorrhoeae, C. trachomatis, and for chlamydial conjunctivitis in neonates. Considered an acceptable alternative to penicillin for treatment of streptococcal pharyngitis, for prophylaxis of rheumatic fever and bacterial endocarditis, for treatment of diphtheria as adjunct to antitoxin and for carrier state, and as alternate choice in treatment of primary syphilis in patients allergic to penicillins. Topical applications: Pyodermas, acne vulgaris, and external ocular infections, including neonatal chlamydial conjunctivitis and gonococcal

or fungi. Special Senses: Ototoxicity: reversible bilateral hearing loss, tinnitus, vertigo. Digestive: (Estolate) Cholestatic hepatitis syndrome. Skin: (topical use) Erythema, desquamation, burning, tenderness, dryness or oiliness, pruritus

staphylococcal strains is highly predictable during prolonged therapy. Lab tests: Periodic liver function tests during prolonged therapy. Monitor for S&S of hepatotoxicity. Premonitory S&S include: Abdominal pain, nausea, vomiting, fever, leukocytosis, and eosinophilia; jaundice may or may not be present. Monitor for ototoxicity that appears to develop most frequently in patients receiving 4 g/d or more, older adults, female patients, and patients with kidney or liver dysfunction. It is reversible with prompt discontinuation of drug.

ophthalmia. Contraindication Hypersensitivity to erythromycins. Estolate: History of erythromycinassociated hepatitis; liver dysfunction; treatment of skin disorders such as acne or furunculosis; prophylaxis of rheumatic fever.

amoxicillin

antiinfective; anti biotic; aminopeni cillin

For most infections in adults the dosing regimens for amoxicillin are 250 mg every 8 hours, 500 mg every 8 hours, 500 mg every 12 hours or 875 mg every 12 hours, depending on the type and severity of infection. For the treatment of adults with gonorrhea, the dose is 3 g given as one dose. For most infections, children older than 3 months but less than 40 kg are treated with 25 mg/kg/day in divided doses every 12 hours, 20 mg/kg/day in divided doses every 8 hours, 40 mg/kg/day in divided doses every 8 hours or 45 mg/kg/day in divided doses every 12 hours depending on type and severity of the infection.

Amoxicillin belongs to a class of antibiotics called penicillins. Other members of this class include ampicillin (Un asyn), piperacillin (Pipracil), ticarcillin (Ticar) and several others. These antibiotics all have a similar mechanism of action. They do not kill bacteria, but they stop bacteria from multiplying by preventing bacteria from forming the walls that surround them. The walls are necessary to protect bacteria from their environment and to keep the contents of the bacterial cell together. Bacteria cannot survive without a cell wall. Amoxicillin is effective against many different bacteria including H.

Side effects due to amoxicillin include diarrhea, dizziness, heartburn,insom nia, nausea, itchi ng, vomiting, confusion, abdo minal pain, easy bruising, bleeding, rash, and allergic reactions. Individuals who are allergic to antibiotics in the class of cephalosporins may also be sensitive to amoxicillin.

Determine previous hypersensitivity reactions to penicillins, cephalosporins, and other allergens prior to therapy. Lab tests: Baseline C&S tests prior to initiation of therapy, start drug pending results; periodic assessments of renal, hepatic, and hematologic functions should be made during prolonged therapy. Monitor for S&S of an urticarial rash (usually occurring within a few days after start of drug) suggestive of a hypersensitivity reaction. If it occurs, look for other signs of hypersensitivity (fever, wheezing, generalized itching, dyspnea), and report to physician immediately. Report onset of generalized, erythematous, maculopapular rash (ampicillin rash) to physician. Ampicillin rash is not due to hypersensitivity; however,

Amoxicillin can be taken with or without food.

influenzae, N. gonorrhoea, E. coli, Pneumococci, Streptococci, and certain strains of Staphylococci. Bactericidal action. Active against: Streptococci, Penumococci, Enterococci, Haemophilus influenzae, Use should be reserved for infections caused by beta-lactamaseproducing strains. Treatment of respiratory infections Adverse effects reported with ampicillin are similar to those reported with other aminopenicillins; however, diarrhea and rash have been reported more frequently with ampicillin than with other currently available aminopenicillins

hypersensitivity should be ruled out. Closely monitor diarrhea to rule out pseudomembranous colitis. Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, and WBCs) at beginning and throughout therapy. Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before therapy. First dose may be given before receiving results. Observe patients for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction. Caution patient to notify physician if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication. Instruct patient to notify physician if symptoms do not improve.

ampicillin

antiinfective

Adults: The usual adult dosage of ampicillin for the treatment of respiratory tract or skin and skin structure infections is 250500 mg every 6 hours. For the treatment of GI or urinary tract infections, the usual adult dosage is 500 mg every 6 hours. For severe infections, larger doses may be required. The usual adult dosage of ampicillin for the treatment of septicemia or bacterial meningitis is 814 g or 150200 mg/kg daily given parenterally in equally divided doses every 34 hours. For the initial treatment of septicemia or meningitis, ampicillin should be given IV for at least 3 days but may then be given IM Food reduces the absorption of tetracycline. Therefore, tetracycline should be taken at least two hours before or after meals. For most infections, tetracycline is taken two to four times daily for 7 to 14

tetracycline

antiinfective

Tetracycline is an antibiotic with a broad spectrum, that is, it is active against many different bacteria. It is effective against Hemophilus influenzae, Streptoco

Indication: Tetracycline is used for treating several types of infections caused by susceptible bacteria. Some examples include infections of

Tetracycline is generally welltolerated. The most common side effects are diarrhea or loose stools, nausea, a

days. The usual adult dose is 1-2 g/day in 2 or 4 divided doses.

ccus pneumoniae, Mycopl asma pneumoniae, Chlamy dia psittaci, Chlamydia trachomatis, Neisseria gonorrhoeae, and many others. Tetracycline prevents growth of bacteria by preventing the bacteria to manufacture proteins that they need to survive. The first drug of the tetracycline family, chlortetracycline, was introduced in 1948. Interferes with bacterial protein synthesis by binding to 30S ribosomal subunits

the respiratory tract, urinary tract, and skin. It also is prescribed for nongonococcal urethritis, Rocky Mountain spotted fever, typhus, chancr oid, cholera, brucello sis, anthrax, syphilis, and acne. It is used in combination with other medications to treat Helicobacter pylori, the bacteria associated with ulcers and inflammation of the stomach and duodenum.

neomycin

Antibiotic , Aminoglycosi de Antibiotic , Topical

Children: Oral: Preoperative intestinal antisepsis: 90 mg/kg/day divided every 4 hours for 2 days; or 25 mg/kg at 1 PM, 2 PM, and 11 PM on the day preceding surgery as an adjunct to mechanical cleansing of the intestine and in combination with erythromycin base Hepatic encephalopathy: 50-100 mg/kg/day in divided doses every 6-8 hours or 2.5-7 g/m2/day divided every 4-6 hours for 5-6 days not to exceed 12 g/day Children and Adults:

Contraindications Hypersensitivity to neomycin or any component of the formulation, or other aminoglycosides; intestinal obstruction

bdominal pain, rash, and vomiting. He adacheand dizziness may also occur. Tetracycline may cause discoloration of teeth if used in patients below 8 years of age. Exaggerated sun burn can occur with tetracycline (photosensitivity) . Therefore, sunlight or sunlamp exposure should be minimized during treatment. Nausea, diarrhea, vomiting, irritation or soreness of the mouth or rectal area

Assess effectiveness and interactions of other medications patient may be taking. Assess results of laboratory tests, therapeutic effectiveness, and adverse response (eg, ototoxicity, nephrotoxicity, neurotoxicity). Assess knowledge/teach patient appropriate use (application of cream/ointment), possible side effects/interventions, and adverse symptoms to report. Minimal absorption across GI mucosa or skin surfaces; however with ulceration, open or burned surfaces (especially large surfaces), absorption is possible.

Topical: Topical solutions containing 0.1% to 1% neomycin have been used for irrigation Adults: Oral: Preoperative intestinal antisepsis: 1 g each hour for 4 doses then 1 g every 4 hours for 5 doses; or 1 g at 1 PM, 2 PM, and 11 PM on day preceding surgery as an adjunct to mechanical cleansing of the bowel and oral erythromycin; or 6 g/day divided every 4 hours for 2-3 days Hepatic encephalopathy: 500-2000 mg every 6-8 hours or 4-12 g/day divided every 4-6 hours for 5-6 days Chronic hepatic insufficiency: 4 g/day for an indefinite period cefalexin Anti-bacterial Agents Cephalosporin Cephalexin, like the penicillins, is a betalactam antibiotic. By binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall, it inhibits the third and last stage of bacterial cell For the treatment of respiratory tract infections caused by Streptococcus pneumoniaeand Streptococcus pyogenes Pain at inj site; The drug should be taken with hypersensitivity; or without food. (May be taken GI disturbances; with meals to reduce GI eosinophilia, discomfort) neutropenia, 2.Before administration, ask leucopenia, patient if he is allergic to thrombocytopeni penicillins or cephalosporins. a 3.Tell patient to take entire .Potentially amount of drug exactly as prescribed, even after he feels

wall synthesis. Cell lysis is then mediated by bacterial cell wal

better. Fatal: Anaphylactic 4.Advise patient to notify prescriber if rash develops or reactions; signs and symptoms of nephrotoxicity superinfection appear. 5.Inform patient not to crush, cut or chew extended-release tablets