Macrolides and Miscellaneous Anti-Infective Agents

A patient on your unit has bacterial colitis and is being treated with oral vancomycin. Why is vancomycin given orally, rather than intravenously, in the treatment of bacterial colitis?

The oral version of the drug acts within the bowel lumen. For bacterial colitis, vancomycin is given orally because it is not absorbed from the GI tract and acts within the bowel lumen.

What medication could be prescribed orally to treat a sinus infection in a client needing an abbreviated therapy plan?

azithromycin

What response should the nurse provide to explain to a parent why chloramphenicol was likely not the drug of choice for the treatment of their child diagnosed with meningococcal meningitis?

"Chloramphenicol isn't used unless there is no adequate substitute drug available." Chloramphenicol is rarely used now to treat infections because of the effectiveness and low toxicity of alternative drugs. It is used in serious infections for which no adequate substitute drug is available.

After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following?

"I should drink a full 8-oz glass of water when I take the medicine." Food in the stomach decreases the absorption of oral macrolides such as erythromycin. Therefore, the drug should be taken on an empty stomach with a full, 8-oz glass of water, 1 hour before or at least 2 to 3 hours after meals.

What information will the nurse teach the client being switched to azithromycin from erythromycin?

"This drug has enhanced antibacterial activity." The newer antibiotics in the class of macrolides have reduced risk for side effects and increased antibacterial activity

A nurse is caring for a patient taking erythromycin (E-mycin). The patient reports having difficulty hearing since beginning the drug. What should the nurse tell the patient concerning this?

"This will be resolved once we stop the drug."

Which of the following would a nurse identify as being classified as a macrolide?

Azithromycin

A common reaction associated with the intravenous administration of vancomycin is "red man syndrome." What is the cause of red man syndrome?

Histamine release Red man syndrome is a histamine reaction characterized by hypotension and skin flushing.

A student asks the pharmacology instructor if there is a way to increase the benefits and decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor?

It is important to use antibiotics cautiously and to teach clients to complete the full course of an antibiotic prescription.

A client presents to the health care provider's office with a skin infection on the forearm. The infection is resistant to over-the-counter antibiotics. After receiving the culture and sensitivity results, the provider orders tigecycline. The nurse knows that this client has what illness?

MRSA

Common, potentially serious, adverse effects of antibiotic drugs include:

Skin rash Examine skin for any rash or lesions, examine injection sites for abscess formation, and note respiratory status—including rate, depth, and adventitious sounds to provide a baseline for determining adverse reactions. Report nausea, vomiting, diarrhea, skin rash, recurrence of symptoms for which the antibiotic drug was prescribed, or signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection

The health care provider suspects a client may be infected with an antibiotic-resistant pathogen. The nurse caring for this client knows that what course of action is best used to determine whether this type of pathogen is present?

perform a culture and susceptibility test

The nurse realizes that vancomycin is a powerful drug and can treat serious gram-positive infections that do not respond to treatment with other anti-infectives. Serious adverse effects classic for vancomycin include which of the following?

- nephrotoxicity - ototoxicity

A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider?

- drop in blood pressure - increase in respiratory rate - sudden increase in temperature

Which of the following drugs are considered to be macrolides?

- erythromycin - azithromycin (Zithromax) - clarithromycin (Biaxin)

Your patient is receiving a macrolide, ketolide, or miscellaneous antibacterial to treat an infection. Which of the following evaluations would be appropriate to include in your plan of care? Select all that apply.

- interview and observe for improvement in the infection being treated. - interview and observe for adverse drug effects.

A client has been prescribed daptomycin for treatment of an infection. What instruction is most important for the nurse to tell this client?

"Tell the health care provider immediately if you develop any muscle pain." The presence of muscle pain or weakness is an indication that the client is developing a severe musculoskeletal reaction, and the medication must be discontinued immediately.

The nurse should monitor the client for which common side effects of erythromycin therapy?

- nausea - vomiting - diarrhea

A client received erythromycin before dental surgery. The client has a past history of a cardiac surgery. The rest of the client's history is unremarkable. What does the nurse teach the client about this medication?

"You are receiving this medication to prevent infection that may affect your heart." The client with a prior history of a heart defect is at risk for bacteria growing in the area of the defect. The client should receive prophylactic antibiotics with any surgery or invasive procedure.

A client with-end stage renal disease has developed vancoymcin-resistant enterococci (VRE). Which medications could be used to treat this client?

- Linezolid (Zyvox), an oxazolidinone - Chloramphenicol (Chloromycetin), an amphenicol - Daptomycin (Cubicin), a cyclic lipopeptide

A health care provider is deciding what medication to prescribe for a client with an upper respiratory infection. What principles guide the provider's decision?

- resistance of the bacteria - other drugs the client is taking daily - the client's ability to tolerate the drug

Your patient is receiving a miscellaneous anitbacterial to treat an infection. Which of the following goals would be appropriate to include in your plan of care?

- the patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. - the patient will be monitored regularly for therapeutic and adverse drug effects. - the patient will verbalize and practice measures to prevent recurrent infection

A patient is required to be administered vancomycin for treatment of an abdominal abscess. What should the nurse ensure when monitoring the IV infusion of vancomycin in the patient when caring for him?

Administer each dose over 60 minutes.

A male client presents to the emergency department with an abdominal dehiscence. He states he had a hernia repair 18 days earlier, and the health care provider removed his wound staples 5 days ago. The client states that the dehiscence occurred when he lifted a box this morning for his wife. The wound is red, and there is evidence of foul-smelling drainage. The wound is cultured, and an anaerobic bacterium is identified. The nurse understands that the provider orders metronidazole because it is effective against which type of organism?

Anaerobic bacteria Metronidazole is effective against infections with anaerobic bacteria and some protozoa.

The nursing instructor is discussing the administration of azithromycin, a macrolide, with her clinical group. The instructor asks her students to identify the medication that will decrease the effects of azithromycin when administered concurrently. Which of the following medications would the students identify?

Antacids Since antacids will decrease the effect of azithromycin and other macrolides, the two medications should not be taken concurrently.

A patient has been administered linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. What should the nurse inform the patient about the risk involved when linezolid interacts with foods containing tyramine?

Causes severe hypertension. The nurse should inform the patient that if tyramine found in chocolates and coffee interacts with linezolid, the patient will develop an increased risk for severe hypertension

A client is given linezolid for a diagnosis of VREF. The drug will be administered for a period that extends beyond 2 weeks. Which laboratory test would the nurse expect the health care provider to order on a regular basis because of the length of administration of the drug?

Complete blood count With the drug linezolid, myelosuppression (anemia, leukopenia, pancytopenia, and thrombocytopenia) is a serious adverse effect that may occur with prolonged therapy lasting longer than 2 weeks. The client's complete blood count should be monitored

A client is taking clindamycin for an infectious process and presents to the health care provider's office with symptoms of dehydration. The nurse understands that the client is experiencing what adverse reaction from the administration of clindamycin?

Diarrhea A life-threatening adverse effect of clindamycin is the development of pseudomembranous colitis.

A client has been prescribed metronidazole for treatment of Giardia. What instruction is most important for the nurse to give to this client?

Do not drink alcohol while taking this medication. Clients who are receiving metronidazole should not drink alcohol because the client will develop a disulfiram-type reaction if alcohol is consumed while the client is receiving metronidazole.

A client has an upper respiratory infection and is allergic to penicillin. What medication does the nurse expect will be ordered?

Erythromycin

Rifaximin (Xifaxan) is effective to treat traveler's diarrhea from which of the following organisms?

Escherichia coli

A female client's medical history includes type 2 diabetes, CVA, dysphasia, and chronic renal failure. She develops an infectious process. The health care provider orders erythromycin. Based on the client's medical history, why is erythromycin the drug of choice?

It is metabolized in the liver. Erythromycin is generally considered safe. Because it is metabolized in the liver and excreted in bile, it may be an alternative in clients with impaired renal function.

A 78-year-old female, who lives alone and is forgetful, is being seen by her home health nurse. In reviewing the patient's medication the nurse discovers that the patient is taking azithromycin (Zithromax) for urethritis. Why would this be a good choice of antibiotics for this patient?

It is taken only once a day. Since the patient is "forgetful" and lives alone, a daily dose would likely promote compliance. Azithromycin (Zithromax) can be administered once daily because the half-life is 68 hours. Azithromycin (Zithromax) is associated with GI adverse effects and can cause pseudo membranous colitis and neurological symptoms can occur as well. Azithromycin (Zithromax) may adversely interact with cardiac glycosides, oral anticoagulants, theophyllines, carbamazepine, and corticosteroid

Which statement is true concerning macrolides?

Macrolides are bacteriocidal or bacteriostatic. Macrolides are absorbed well in body tissues and fluids and kill gram-positive bacteria. Depending on the concentration in the body, they can be bacteriocidal or bacteriostatic

A 22-year-old female is admitted to the unit with pseudomembranous colitis related to C. difficile. What drug would the nurse expect the provider to order for this client?

Metronidazole Clinical indications for metronidazole include prevention or treatment of anaerobic bacterial infections (e.g., in colorectal surgery, intra-abdominal infections) and treatment of C. difficile infections associated with pseudomembranous colitis

A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice?

Metronidazole In antibiotic-associated colitis, stopping the causative drug is the initial treatment. If symptoms do not improve within 3 or 4 days, oral metronidazole or vancomycin is given for 7 to 10 days.

John, 34 years old, is being treated with clindamycin for osteomyelitis of his tibia following an open fracture 3 months ago. The nurse is teaching John how to properly administer the medication at home and the side effects that he needs to report to the health care provider. Which would be the best instruction to give John?

Notify the provider if you have any blood in your stool or diarrhea. The most serious adverse effect is pseudomembranous colitis (a Black Box warning), also known as Clostridium difficile colitis. Diarrhea, abdominal cramps, and abdominal tenderness may suggest antibiotic-associated colitis. Nausea and vomiting and abdominal pain following oral administration are the most common adverse effects of clindamycin

A nurse is caring for a client with severe and life-threatening pseudomembranous colitis caused by C. difficile. Which drug would the nurse expect the client's provider to order?

Oral vancomycin Oral vancomycin is used to treat staphylococcal enterocolitis and pseudomembranous colitis caused by C. difficile when the colitis fails to respond to metronidazole

A client who underwent abdominal surgery 6 weeks ago is diagnosed with VREF. The nurse expects the physician to order which medication?

Quinupristin-dalfopristin Quinupristin-dalfopristin belongs to the streptogramin class of antibiotics. It is indicated for VREF and MSSA

The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring?

Red man syndrome With this syndrome, the client's face and upper trunk becomes bright red, and it has led to cardiovascular collapse.

Which client should be assessed further before receiving azithromycin (Zithromax) as ordered?

The client who is taking digoxin When a client is given azithromycin, digoxin serum levels can increase. The client taking digoxin should be assessed and a different antibiotic administered, if possible.

Which client should not receive erythromycin as ordered at 8 a.m.?

The client with elevated liver enzymes The medication is metabolized by the liver and excreted in the bile. The client with elevated liver enzymes will not be able to tolerate this medication. There is a risk it will build up in the system.

A client prescribed rifaximin for diarrhea has developed frank bleeding in the stool. What intervention should the nurse anticipate being implemented to best ensure client safety?

changing to a different antibiotic Because of its very limited systemic absorption (97% eliminated in feces), health care providers cannot use rifaximin to treat systemic infections, including infections due to invasive strains of E. coli. Therefore, diarrhea occurring with fever or bloody stools requires treatment with alternative agents

An 87-year-old resident of a long-term care facility has been prescribed oral clindamycin for the treatment of an infected pressure ulcer. The care providers at the facility should be instructed to monitor the resident closely for what potential adverse effect of clindamycin?

diarrhea The most serious adverse effect of clindamycin is pseudomembranous colitis, also known as Clostridium difficile colitis. Diarrhea, abdominal cramps, and abdominal tenderness may suggest antibiotic-associated coliti

A client reports having had a "bad reaction" the last time receiving penicillin. Prior to a scheduled dental procedure, the client is likely to be prescribed what drug?

erythromycin Prophylactically, erythromycin is administered to prevent alpha-hemolytic streptococcal endocarditis before dental or other procedures in clients who have valvular heart disease and are allergic to penicillin

In which condition present in the client should macrolides be used with caution?

liver dysfunction

What medication would the nurse anticipate being prescribed for a client diagnosed with trichomoniasis?

metronidazole .Metronidazole is effective against anaerobic bacteria, including gram-negative bacilli such as Bacteroides, gram-positive bacilli such as Clostridia, and some gram-positive cocci. It is also effective against protozoa that cause amebiasis, giardiasis, and trichomoniasis.

A client comes to the clinic for a follow-up visit. The nurse notes a sunburn-like appearance to the client's skin. The client's history reveals the use of ciprofloxacin. The nurse interprets which adverse effect regarding this finding?

photosensitivity

A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed?

vancomycin Vancomycin is active only against gram-positive microorganisms. It acts by inhibiting cell wall synthesis