CEFACLOR

(sef'a-klor)
Ceclor, Ceclor CD
Classifications: ANTIINFECTIVE; ANTIBIOTIC; SECOND-
GENERATION CEPHALOSPORIN
Prototype: Cefonicid sodium
Pregnancy Category: B

Availability

250 mg, 500 mg tablets; 375 mg, 500 mg sustained-release tablets;

125 mg/5 mL, 187 mg/5 mL, 250 mg/5 mL, 375 mg/5 mL suspension

Actions

Semisynthetic, second-generation oral cephalosporin antibiotic similar

to cefonicid. Possibly more active than other oral cephalosporins
against gram-negative bacilli, especially beta-lactamase-producing
Haemophilus influenzae, including ampicillin-resistant strains. Also
active against Escherichia coli, Proteus mirabilis, Klebsiella sp and
certain gram-positive strains, e.g., Streptococcus pneumoniae, S.
pyogenes, and Staphylococcus aureus. Preferentially binds to one or
more of the penicillin-binding proteins (PBPs) located on cell walls of
susceptible organisms. This inhibits third and final stage of bacterial
cell wall synthesis, thus killing the bacterium.

Therapeutic Effects

Effective in treating acute otitis media and acute sinusitis where the
causative agent is resistant to other antibiotics. Useful in treating
gonorrhea, respiratory and urinary tract infections. Partial cross-
allergenicity between penicillins and cephalosporins has been
reported.

Uses

Treatment of otitis media and infections of upper and lower respiratory

tract, urinary tract, and skin and skin structures caused by ampicillin-
resistant H. influenzae; acute uncomplicated UTI.

Contraindications

Hypersensitivity to cephalosporins and related antibiotics; pregnancy

(category B), lactation. Safe use in infants <1 mo not established.

Cautious Use

History of sensitivity to penicillins or other drug allergies; markedly

impaired renal function.

Route & Dosage

Mild to Moderate Infections

Child >1 mo: PO 20–40 mg/kg/d divided q8h (max: 2 g/d)
Administration

Oral

• Give sustained-release tablets with food to enhance absorption.

Food does not affect absorption of capsules.
• Ensure that sustained-release tablets are not chewed or crushed.
They must be swallowed whole.
• After stock oral suspension is prepared, it should be kept
refrigerated. Expiration date should appear on label. Discard
unused portion after 14 d. Shake well before pouring.
• Store pulvules in tightly closed container unless otherwise
directed.

Adverse Effects ( 1%)

Body as a Whole: Serum sickness-like reaction, eosinophilia, joint

pain or swelling, fever, superinfections. GI: Diarrhea, nausea, vomiting,
anorexia, pseudomembranous colitis (rare). Skin: Urticaria, pruritus,
morbilliform eruptions.

Diagnostic Test Interference

Cefaclor may produce positive direct Coombs' test, which can

complicate cross-matching procedures and hematologic studies.
False-positive urine glucose determinations may result with use of
copper sulfate reduction methods, e.g., Clinitest or Benedict's
reagent, but not with glucose oxidase (enzymatic) tests such as
Clinistix, Diastix, TesTape.

Interactions

Drug: Probenecid decreases renal excretion of cefaclor.

Pharmacokinetics

Absorption: Well absorbed; acid stable. Peak: 30–60 min.

Elimination: 60% of dose eliminated renally in 8 h; crosses placenta;
excreted in breast milk. Half-Life: 0.5–1 h.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Determine previous hypersensitivity to cephalosporins,

penicillins, and other drug allergies before therapy is initiated.
• Lab tests: Perform culture and sensitivity tests prior to and
periodically during therapy.
• Diarrhea, the most frequent adverse effect, may be due to a
pharmacologic effect or to associated change in intestinal flora. If
it persists, interruption of therapy may be necessary.
 • Monitor for manifestations of drug hypersensitivity (see Appendix
F). Discontinue drug and promptly report them if they appear.
• Monitor for manifestations of superinfection (see Appendix F).
Promptly report their appearance.

Patient & Family Education

• Report promptly any signs or symptoms of superinfection (see

Appendix F).
• Yogurt or buttermilk (if allowed) may serve as a prophylactic
against intestinal superinfections by helping to maintain normal
intestinal flora.
• Take your medication for the full course of therapy as directed by
physician.
• Do not breast feed while taking this drug.

CEFAZOLIN SODIUM
(sef-a'zoe-lin)
Ancef, Kefzol, Zolicef
Classifications: ANTIINFECTIVE; ANTIBIOTIC; FIRST-
GENERATION CEPHALOSPORIN
Pregnancy Category: BAvailability

250 mg, 500 mg, 1 g, injection

Actions

Semisynthetic, first-generation derivative of cephalosporin C; antibiotic

activity similar to that of cefazolin. Activity against gram-negative
organisms is limited. Bactericidal action: preferentially binds to one or
more of the penicillin-binding proteins (PBP) located on cell walls of
susceptible organisms. This inhibits third and final stage of bacterial
cell wall synthesis, thus killing the bacterium.

Therapeutic Effects

Effective treatment for bone and joint infections, biliary tract

infections, enocarditis prophylaxis and treatment, respiratory tract and
genital tract infections, septicemia and skin infections, and surgical
prophylaxis.

Uses

Severe infections of urinary and biliary tracts, skin, soft tissue, and
bone, and for bacteremia and endocarditis caused by susceptible
organisms; also perioperative prophylaxis in patients undergoing
procedures associated with high risk of infection, e.g., open heart
surgery.

Contraindications
Hypersensitivity to any cephalosporin and related antibiotics;

Cautious Use

History of penicillin sensitivity, impaired renal function, patients on

sodium restriction.

Route & Dosage

Moderate to Severe Infections

Child: IV/IM 25–100 mg/kg/d in 3–4 divided doses, up to 100
mg/kg/d (not to exceed adult doses)
Neonate: IV = 7 d: 40 mg/kg/d divided q12h; >7 d: 40–60
mg/kg/d divided q8–12h

Adjustment for Renal Impairment

Clcr <35 mL/min: dose q12h

Surgical Prophylaxis
Child: IV/IM 25–50 mg/kg 30–60 min before surgery, then
q8h for 24 hAdministration

Intramuscular

• Preparation of IM solution: Reconstitute with sterile water for

injection, bacteriostatic water for injection, or 0.9% sodium
chloride injection. Reconstituted solutions are stable for 24 hr at
room temperature and for 96 hr refrigerated.
• IM injections should be made deep into large muscle mass. Pain
on injection is usually minimal. Rotate injection sites.

Intravenous

• IV administration to neonates, infants, and children: Verify

correct IV concentration and rate of infusion with physician.

PREPARE: Direct: Dilute each 1 g with 10 mL of sterile water for

injection. Intermittent: Further dilute with 50–100 mL of NS or D5W.

ADMINISTER: Direct/Intermittent: Infuse 1 g over 5 min or longer

as determined by the amount of solution. The risk of IV site reactions
may be reduced by proper dilution of IV solution, use of small bore IV
needle in a large vein, and by rotating injection sites.

INCOMPATIBILITIES Solution/additive: AMINOGLYCOSIDES,

ascorbic acid, atracurium, bleomycin, cimetidine,
hydromorphone, lidocaine, ranididine, vitamin B complex with
C. Y-site: Amiodarone, AMINOGLYCOSIDES, amphotericin B
cholesteryl complex, idarubicin, pentamidine, vinorelbine.

Adverse Effects ( 1%)

Body as a Whole: Anaphylaxis, fever, eosinophilia, superinfections,

seizure (high doses in patients with renal insufficiency). GI: Diarrhea,
anorexia, abdominal cramps. Skin: Maculopapular rash, urticaria.
Diagnostic Test Interference

Because of cefazolin effect on the direct Coombs' test, transfusion

cross-matching procedures and hematologic studies may be
complicated. False-positive urine glucose determinations are possible
with use of copper sulfate tests (e.g., Clinitest or Benedict's
reagent) but not with glucose oxidase tests such as TesTape,
Diastix, or Clinistix.

Interactions

Drug: Probenecid decreases renal elimination of cefazolin.

Pharmacokinetics

Peak: 1–2 h after IM; 5 min after IV. Distribution: Poor CNS
penetration even with inflamed meninges; high concentrations in bile
and in diseased bone; crosses placenta. Elimination: 70% excreted
unchanged in urine in 6 h; small amount excreted in breast milk. Half-
Life: 90–130 min.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Determine history of hypersensitivity to cephalosporins,

penicillins, and other drugs, before therapy is initiated.
• Lab tests: Perform culture and sensitivity testing prior to and
during therapy. Therapy may be initiated pending results.
• Monitor I&O rates and pattern: Be alert to changes in BUN, serum
creatinine.
• If patient has had a reaction to penicillin, be alert to signs of
hypersensitivity with use of cefazolin. Cross-allergenicity
between cephalosporins and penicillin has been reported. Prompt
attention should be given to onset of signs of hypersensitivity
(see Appendix F).
• Promptly report the onset of diarrhea, which may or may not be
dose related. It is seen especially in patients with history of drug-
related GI disturbances. Pseudomembranous colitis, a potentially
life-threatening condition, starts with diarrhea.

Patient & Family Education

• Report promptly any signs or symptoms of superinfection (see

Appendix F).
• Report signs of hemostatic defects: ecchymoses, petechiae,
nosebleed.
• Do not breast feed while taking this drug.
 AZITHROMYCIN
(a-zi-thro-mye'sin)
Zithromax
Classifications: ANTIINFECTIVE; MACROLIDE ANTIBIOTIC
Prototype: Erythromycin

250 mg, 600 mg tablets; 100 mg/5 mL, 200 mg/5 mL, 1 g/packet oral
suspension; 500 mg injection

Actions

A macrolide antibiotic that reversibly binds to the 50S ribosomal

subunit of susceptible organisms and consequently inhibits protein
synthesis.

Therapeutic Effects

Effective for treatment of mild to moderate infections caused by

pyogenic streptococci, Streptococcus pneumoniae, Haemophilus
influenzae, and Staphylococcus aureus.

Uses

Pneumonia, lower respiratory tract infections, pharyngitis/tonsillitis,

gonorrhea, nongonococcal urethritis, skin and skin structure infections
due to susceptible organisms, otitis media, Mycobacterium avium–
intracellulare complex infections, acute bacterial sinusitis.

Unlabeled Uses

Bronchitis, Helicobacter pylori gastritis.

Contraindications

Hypersensitivity to azithromycin, erythromycin, or any of the macrolide

antibiotics.

Cautious Use

Older adults or debilitated persons, hepatic or renal impairment; GI

disease; ventricular arrhythmias, QT prolongation; UV exposure;
pregnancy (category B), and lactation.

Route & Dosage

Bacterial Infections
Child: PO 6 mo, 10 mg/kg on day 1, then 5 mg/kg for 4
more d (max: 250 mg/d)

Acute Bacterial Sinusitis

Child: PO 6 mo, 10 mg/kg once daily x 3 d

Otitis Media
Child: PO >6 mo, 30 mg/kg as a single dose or 10 mg/kg
 once daily (not to exceed 500 mg/d) for 3 days or 10 mg/kg
as a single dose on day 1 followed by 5 mg/kg/d on days 2–
5.

Chancroid
Child: PO 20 mg/kg as single dose (max: 1 g)Administration

Oral

• Give capsule at least 1 h before or 2 h after a meal. Tablets may

be taken without regard to food.
• Do not give within 2 h of an aluminum or magnesium-containing
antacid.

Intravenous

PREPARE: Intermittent: Reconstitute 500-mg vial with 4.8 mL of

sterile water for injection and shake until dissolved. Final concentration
is 100 mg/mL. Solution must be further diluted to 1.0 or 2.0 mg/mL by
adding 5 mL of the 100-mg/mL solution to 500 mL or 250 mL,
respectively, of D5W, D5/NS, 0.45NS, or other compatible solution.

ADMINISTER: Intermittent: Administer diluted solution over at least

60 min. Do not give a bolus dose.

• Store drug when diluted as directed for 24 h at or below 30° C

(86° F) or for 7 d under 5° C (41° F).

Adverse Effects ( 1%)

CNS: Headache, dizziness. GI: Nausea, vomiting, diarrhea, abdominal

pain; hepatotoxicity, mild elevations in liver function tests.

Diagnostic Test Interference

Liver function tests: reversible, asymptomatic elevations in liver

enzymes (AST, ALT, gamma glutamyl transferase, alkaline
phosphatase) have been reported in some patients treated with
azithromycin.

Interactions

Drug: ANTACIDS may decrease peak level of azithromycin; may

increase toxicity of dihydroergotamine, ergotamine. Food: Food
will decrease the amount of azithromycin absorbed by 50%.

Pharmacokinetics

Absorption: 37% of dose reaches the systemic circulation. Onset: 48

h. Peak: 2.5–4 h. Distribution: Extensively distributed to most tissues
including sputum, blister, and vaginal secretions; tissue concentrations
are often higher than serum concentrations. Metabolism: Metabolized
in liver. Elimination: 5%–12% of dose is excreted in urine. Half-Life:
Increases with time after the dose due to slow elimination from tissue
sites; ranges from 9.6–40 h.
NURSING IMPLICATIONS

Assessment & Drug Effects

• Monitor for and report loose stools or diarrhea, since

pseudomembranous colitis (see Appendix F) must be ruled out.
• Monitor PT and INR closely with concurrent warfarin use.

Patient & Family Education

• Direct sunlight (UV) exposure should be minimized during

therapy with drug.
• Take aluminum or magnesium antacids 2 h before or after drug.
• Report onset of loose stools or diarrhea.
• Do not breast feed while taking this drug without consulting
physician.

MEBENDAZOLE
(me-ben'da-zole)
Vermox
Classifications: ANTIINFECTIVE; ANTHELMINTIC Availability

100 mg tablets

Actions

Carbamate with unusually broad spectrum of anthelmintic activity.

Mechanism of action not known.

Therapeutic Effects

Inhibits formation of worm's microtubules and inhibits glucose and

other nutrient uptake by susceptible helminths.

Uses

Treatment of Trichuris trichiura (whipworm), Enterobius vermicularis

(pinworm), Ascaris lumbricoides (roundworm), Ancylostoma duodenale
(common hookworm), Necator americanus (American hookworm) in
single or mixed infections.
Unlabeled Uses

Beef, dwarf, and pork tapeworm and threadworm infections.

Contraindications

Safety during pregnancy (category C), lactation, or in children <2 y is

not established.

Route & Dosage

Enterobiasis
Child: PO 100 mg as single dose

Other Infestations
Child: PO 100 mg b.i.d. times 3 d Administration

Oral

• Allow tablets to be chewed and swallowed, or crushed and mixed

with food if needed.

Adverse Effects ( 1%)

GI: Transient abdominal pain, diarrhea. Body as a Whole: Dizziness,

fever (possibly due to tissue necrosis in cysts).

Interactions

Drug: Carbamazepine, phenytoin can increase metabolism of

mebendazole.

Pharmacokinetics

Absorption: Minimal absorption from GI tract (2%–10% of oral dose).

Metabolism: Metabolized to inactive metabolite. Elimination:
Primarily eliminated in feces. Half-Life: 3–9 h.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Initiate second course of treatment if cure does not occur within

3 wk.
• Examine and treat all family members simultaneously because
pinworms are readily transmitted from person to person.

Patient & Family Education

• Practice thorough hand washing after touching any potentially

contaminated item.
• Change underclothing, bedclothes, towels, and facecloths daily;
bathe frequently, preferably by showering. Infected person
should sleep alone.
• Do not breast feed while taking this drug without consulting
physician.