PHARMACOLOGY

WEEK 15 - COURSE TASK

1. Make a drug study on the individual drugs discussed in this course unit. Type them in word and submit them here.

DRUG STUDY
DRUG DOSAGE THERAPEUTIC ADVERSE EFFECTS CONTRAINDICATION NURSING
ACTION CONSIDERATIONS

Ampicillin Usual Dosage Bactericidal in susceptible Antibiotic-associated
PO: Adults, Elderly: 250– microorganisms colitis, other
500 mg superinfections (abdominal
q6h. cramps, severe watery
Children: 50–100 diarrhea, fever) may result
mg/kg/day in divided from altered bacterial
doses q6h. balance in GI tract.
. ampicillin, may indicate
Severe hypersensitivity
reactions, including
anaphylaxis, acute
interstitial nephritis,
occur rarely
Hypersensitivity to
ampicillin or any penicillin.
Infections caused by
penicillinase-producing
organisms.
Question for history of
allergies, esp. penicillins,
cephalosporins; renal
impairment.
Promptly report rash
(although common with
hypersensitivity) or
diarrhea (fever, abdominal
pain, mucus and blood in
stool may indicate
antibiotic-associated
colitis).

Evaluate IV site for

phlebitis.

Check IM injection site for

pain, induration.
Amoxicillin Susceptible Infections Bactericidal in susceptible Antibiotic-associated Serious hypersensitivity to Question for history of
PO: Adults, Elderly, microorganisms. colitis, other amoxicillin, other beta- allergies (esp. penicillins,
Children, Adolescents (40 superinfections (abdominal lactams. ephalosporins), renal
KG OR MORE): Mild to cramps, severe watery impairment.
moderate: 250–500 mg diarrhea, fever) may result
q8h or 500–875 mg from altered bacterial
q12h or 775 mg (Moxatag) balance in GI tract. Promptly report rash,
once daily. diarrhea (fever,
Children Older Than 3 Mos, Severe hypersensitivity abdominal pain, mucus
 AdolesCents (LESS THAN 40 reactions, including and blood in stool may
KG): 25–50 mg/kg/ anaphylaxis, acute indicate antibiotic-
day in divided doses q8h. interstitial nephritis, associated colitis).
occur rarely.
Be alert for superinfection:
fever, vomiting, diarrhea,
anal/genital pruritus, black
“hairy” tongue, oral
mucosal changes
(ulceration, pain,
erythema).

Monitor renal/hepatic
function tests
Bacampicillin Moderate to Severe Has a broad spectrum of Body as a Whole: Hypersensitivity to Determine previous
Infections antimicrobial activity Hypersensitivity penicillins; pregnancy; hypersensitivity reactions
Adult: PO 400–800 mg against both gram-positive (erythematous rash; infectious mononucleosis to penicillins,
q12h and gram-negative anaphylaxis). or other viral diseases; cephalosporins, and other
Child: PO 12.5–25 mg/kg organisms. GI: Nausea, vomiting, children <25 kg. allergens prior to therapy.
q12h anorexia, diarrhea.
Hematologic: Determine baseline C&S
Gonorrhea Thrombocytopenia, tests prior to initiation of
Adult: PO 1.6 g with 1 g eosinophilia, anemia. therapy; start drug
probenecid times 1 Other: Superinfections, pending results.
fixed drug eruption.
Determine baseline and
periodic checks of renal,
hepatic, and
hematopoietic status are
advised during prolonged
therapy, particularly in
patients with history of
impaired function of these
systems, and in premature
infants and neonates.
Cloxacillin Mild to Moderate Bind to bacterial cell wall, CNS: seizures. Sensitivity to penicillins; Watch for seizures; notify
Infections leading to cell death. Not GI: diarrhea, epigastric pregnancy, lactation. physician immediately if
Adult: PO 250–500 mg q6h inactivated by penicillinase distress, nausea, vomiting, patient develops or
Child: PO <20 kg: 12.5–25 enzymes. pseudomembranous increases seizure activity.
 mg/kg q6h (max: 4 g/d)
Dicloxacillin Mild to Moderate
Infections
Adult: PO 125–500 mg q6h
Child: PO <40 kg, 12.5–25
mg/kg q6h (max: 4 g/d)
Nafcillin sodium Usual Dosage
Adults, Elderly: 0.5–2 g q4–
6h.
Children: Mild to Moderate
Infections: 100–150
Bind to bacterial cell wall,
leading to cell death. Not
inactivated by penicillinase
enzymes.
Inhibits cell wall synthesis.
Bactericidal
colitis.
GU: interstitial nephritis.
Derm: rash, urticaria.
Hemat: eosinophilia,
leukopenia.
CNS: seizures.
GI: diarrhea, epigastric
distress, nausea, vomiting,
pseudomembranous
colitis.
GU: interstitial nephritis.
Derm: rash, urticaria.
Hemat: eosinophilia,
leukopenia.
Potentially fatal antibiotic-
associated colitis,
superinfections (abdominal
cramps, severe watery
diarrhea, fever) may result
Hypersensitivity to
penicillins.
Hypersensitivity to
nafcillin, other penicillins
Monitor signs of allergic
reactions and anaphylaxis,
including pulmonary
symptoms (tightness in the
throat and chest,
wheezing, cough dyspnea)
or skin reactions (rash,
pruritus, urticaria).
Assess muscle aches and
joint pain (arthralgia) that
may be caused by serum
sickness
Take care to establish
previous exposure and
sensitivity to penicillins
and cephalosporins as well
as other allergic reactions
of any kind before
initiating therapy.
Obtain C&S prior to
initiation of therapy to
determine susceptibility of
causative organism.
Monitor signs of
eosinophilia (fatigue,
weakness, myalgia) or
leukopenia (fever, sore
throat, signs of infection);
report these signs to the
physician.
Question for history of
allergies, esp. penicillins,
cephalosporins
Hold medication, promptly
 mg/kg/day in divided
doses q6h. Severe
Infections: 150–200
mg/kg/day in divided
doses q4–6h.
Neonates: 25 mg/kg/dose
in divided doses q6–12h.
Oxacillin Staphylococcal Infections
Adult: PO 250–1000 mg
q4–6h IM/IV 500 mg–2 g
q4–6h up to 12 g/d
Child: PO 50–100 mg/kg/d
in 4 divided doses IM/IV
50–150 mg/kg/d divided
q4–6h
Neonate: IV 50–100
mg/kg/d divided q6–12h
Cefazolin Usual Dosage Range
IV, IM: Adults: 1–1.5 g q6–
12h Maximum: 12 g/day.
Children Older Than 1 Mo:
25–100 mg/kg/day divided
q6–8h. Maximum: 6 g/day.
Neonates: 25 mg/kg/dose
q8–12h.
Cephalexin Usual Dosage Range
Bind to bacterial cell wall,
leading to cell death. Not
inactivated by penicillinase
enzymes.
Binds to bacterial cell
membranes, inhibits cell
wall synthesis
Binds to bacterial cell
from altered bacterial
balance in GI tract.
Hematologic effects (esp.
involving platelets, WBCs),
severe hypersensitivity
reactions, anaphylaxis
occur rarely.
Body as a Whole:
Thrombophlebitis (IV
therapy), superinfections,
wheezing, sneezing, fever,
anaphylaxis.
GI: Nausea, vomiting,
flatulence, diarrhea,
hepatocellular dysfunction
(elevated AST, ALT,
hepatitis).
Hematologic: Eosinophilia,
leukopenia,
thrombocytopenia,
granulocytopenia,
agranulocytosis;
neutropenia (reported in
children)
Antibiotic-associated
colitis, other
superinfections (abdominal
cramps, severe watery
diarrhea, fever) may result
from altered bacterial
balance in GI tract.
Antibiotic-associated
Hypersensitivity to
penicillins or
cephalosporins.
History of hypersensitivity
or anaphylactic reaction to
ceFAZolin, cephalosporins.
History of hypersensitivity
report rash (possible
hypersensitivity), diarrhea
(fever, abdominal pain,
mucus/blood in stool may
indicate antibiotic-
associated colitis).
Evaluate IV site frequently
for phlebitis
Assess muscle aches and
joint pain (arthralgia) that
may be caused by serum
sickness. Notify physician if
these symptoms seem to
be drug-related rather
than caused by
musculoskeletal injury or if
muscle and joint pain are
accompanied by allergy-
like reactions (fever,
rashes, etc.)
Monitor signs of
eosinophilia (fatigue,
weakness, myalgia) or
leukopenia (fever, sore
throat, signs of infection);
report these signs to the
physician.
Obtain CBC, renal function
tests.
Question for history of
allergies, particularly
cephalosporins, penicillins.
Evaluate IM site for
induration and tenderness.
Obtain CBC, renal function
 PO: Adults, Elderly: 250–
1,000 mg q6h or 500 mg
q12h. Maximum: 4 g/
day.
Children 1 Yr and Older:
25–100 mg/kg/day in 3–4
divided doses. Maximum:
4 g/day.
Cefadroxil Usual Dosage
PO: Adults, Elderly: 1–2
g/day as single dose or in 2
divided doses.
Children: 30 mg/kg/day as
a single dose or in 2
divided doses. Maximum:2
g/day.
Cephradine Mild to Moderate Infection
Adult: PO 250–500 mg q6h
or 500 mg–1 g q12h up to
4 g/d. IM/IV 2–4 g/d in 4
divided doses (max: 8 g/d)
Child: PO 25–50 mg/kg/d in
2–4 divided doses up to 4
g/d. IM/IV 50–100
membranes, inhibits cell colitis, other
wall synthesis superinfections (abdominal
cramps, severe watery
diarrhea, fever) may result
from altered bacterial
balance in GI tract.
Nephrotoxicity may occur,
esp. in pts with preexisting
renal disease.
Binds to bacterial cell Antibiotic-associated
membranes, inhibits cell colitis, other
wall synthesis superinfections (abdominal
cramps, severe watery
diarrhea, fever) may result
from altered bacterial
balance in GI tract.
Nephrotoxicity may occur,
esp. in pts with preexisting
renal disease
Active against many gram- Body as a Whole: Joint
positive aerobic cocci and pains, eosinophilia,
much less active against tightness in chest, pain,
gram-negative bacteria. induration and tissue
sloughing (IM injection
Effectively treats bone site); thrombophlebitis (IV
infections, otitis media, site); paresthesias,
or anaphylactic reaction to
cephalexin, cephalosporins
History of hypersensitivity
or anaphylactic reaction to
cefadroxil, cephalosporins
Hypersensitivity to
cephalosporins and related
antibiotics; pregnancy
tests.
Question for history of
allergies, particularly
cephalosporins, penicillins.
Assess oral cavity for white
patches on mucous
membranes, tongue
(thrush).
Monitor daily pattern of
bowel activity, stool
consistency.
Obtain CBC, renal function
tests.
Question for history of
allergies, particularly
cephalosporins, penicillins.
Assess oral cavity for white
patches on mucous
membranes, tongue
(thrush).
Monitor daily pattern of
bowel activity, stool
consistency.
Determine history of
previous hypersensitivity
to cephalosporins,
penicillins, and other drug
allergies before therapy is
initiated.
 mg/kg/d in 4 divided doses
up to 8 g/d
Perioperative Prophylaxis
Adult: PO 1 g 30–60 min
before surgery; 1 g during
surgery; then 1 g q4–6h for
24 h
Cefoxitin Moderate to Severe
Infections
Adult: IV/IM 1–2 g q6–8h,
up to 12 g/d
Child >3 mo : IV/IM 80–160
mg/kg/d in 4–6 divided
doses (max: 12 g/d)
Neonate: IV/IM 90–100
mg/kg/d divided q8h
Cefaclor Usual Dosage
PO: Adults, Elderly: 250–
500 mg q8h or 500 mg
q12h (extended-release).
Children: 20–40 mg/kg/day
divided q8–12h.
Maximum: 1 g/day.
Cefuroxime Usual Dosage
respiratory tract infections,
septicemia and skin
infections, and urinary
tract infections, reducing
or eliminating infection.
Binds to bacterial cell wall
membrane, causing cell
death
Binds to bacterial cell
membranes, inhibits cell
wall synthesis
Binds to bacterial cell
superinfections.
GI: Diarrhea or loose
stools, abdominal pain,
heartburn.
CNS: Dizziness.
Skin: Urticaria, rash,
pruritus.
CNS: seizures (high doses).
GI: pseudomembranous
colitis, diarrhea, nausea,
vomiting.
Derm: rashes, urticaria.
Hemat: bleeding,
eosinophilia, hemolytic
anemia, leukopenia,
thrombocytopenia
Antibiotic-associated
colitis, other
superinfections (abdominal
cramps, severe watery
diarrhea, fever) may result
from altered bacterial
balance in GI tract.
Antibiotic-associated
Hypersensitivity to
cephalosporins and related
antibiotics; pregnancy
History of hypersensitivity
or anaphylactic reaction to
cefuroxime,
cephalosporins
History of hypersensitivity
Inspect IV insertion site
frequently for
thrombophlebitis (
Perform culture and
sensitivity tests and renal
function studies before
and periodically during
drug therapy.
Watch for seizures; notify
physician immediately if
patient develops or
increases seizure activity.
Monitor signs of
pseudomembranous
colitis, including diarrhea,
abdominal pain, fever, pus
or mucus in stools, and
other severe or prolonged
Gi problems (nausea,
vomiting, heartburn).
Notify physician or nursing
staff immediately of these
signs.
Obtain baseline CBC, renal
function tests.
Question for history of
allergies, particularly
cephalosporins, penicillins
Be alert for superinfection:
fever, vomiting, diarrhea,
anal/genital pruritus, oral
mucosal changes
(ulceration, pain,
erythema).
Assess oral cavity for white
 IV, IM: Adults, Elderly,
Children 12 Yrs and Older:
750 mg–1.5 g q8h up to 1.5
g q6h for severe infections.
Children: 3 Mos
To Younger Than 12 Yrs:
Mild to moderate
infection: 75–100
mg/kg/day divided q8h.
Neonates: 50 mg/kg/dose
q8–12h.
Cefmetazole Systemic Infections
Adult: IV 1–2 g q6–12h
Surgical Prophylaxis
Adult: IV 1–2 g 30–90 min
before surgery; then q8h
for 2 more doses
membranes, inhibits cell
wall synthesis
Active against a wide range
of gram-positive and gram-
negative aerobic and
anaerobic bacteria.
Effectively treats
abdominal and respiratory
tract infections, pelvic
inflammatory disease,
urinary tract infections,
skin and soft tissue
infections and used for
surgical prophylaxis,
reducing or eliminating
signs and symptoms of
infection.
colitis, other
superinfections (abdominal
cramps, severe watery
diarrhea, fever) may result
from altered bacterial
balance in GI tract.
Nephrotoxicity may occur,
esp. in pts with preexisting
renal disease.
Body as a Whole:
Hypersensitivity reactions.
GI: Diarrhea, loose stools,
nausea, vomiting,
dyspepsia, flatulence.
CNS: Drug fever,
headache, dizziness.
Skin: Rash, pruritus.
Urogenital: Vaginitis,
genital pruritus.
or anaphylactic reaction to
cefuroxime,
cephalosporins
Allergy to penicillin, history
of colitis, renal
insufficiency, pregnancy
patches on mucous
membranes, tongue
(thrush).
Monitor daily pattern of
bowel activity, stool
consistency.
Monitor I&O, renal
function tests for
nephrotoxicity.
Be alert for superinfection:
fever, vomiting, diarrhea,
anal/genital pruritus, oral
mucosal changes
(ulceration, pain,
erythema).
Determine previous
hypersensitivity to
cephalosporins, penicillins,
and history of other
allergies, particularly to
drugs, before therapy is
initiated.
Perform culture and
sensitivity tests before
initiation of therapy and
periodically during
therapy.
Monitor PT in patients with
renal or hepatic disease or
those receiving a long
course of antibiotic
therapy.
Assess for S&S of
 superinfections caused by
overgrowth of
nonsusceptible organisms,
particularly with prolonged
use.
Cefonicid Moderate to Severe Active against Body as a Whole: Hypersensitivity to Determine history of
Infections Haemophilus influenzae, Hypersensitivity, fever, cephalosporins and related hypersensitivity to
Adult: IV/IM 1 g q24h, up Providencia sp, Clostridium rash, pruritus, erythema, antibiotics; severely cephalosporins, penicillins,
to 2 g/24 h sp, Peptococcus sp, and myalgia, anaphylactoid impaired renal or hepatic or other drugs before
against some strains of reaction, pain with IM function; pregnancy therapy begins.
Surgical Prophylaxis Citrobacter, Enterobacter, injection; burning
Adult: IV/IM 1 g 60 min Serratia, Neisseria, sensation, phlebitis (IV Perform culture and
before surgery Proteus, Escherichia coli, administration), flu-like sensitivity tests before and
and Klebsiella that are syndrome, superinfections periodically during
resistant to first generation (by Candida, therapy, if indicated.
cephalosporins. Pseudomonas,
Enterobacter sp). Monitor I&O rates and
GI: Nausea, vomiting, pattern.
diarrhea,
pseudomembranous
enterocolitis
Azithromycin Usual Dosage Range Binds to ribosomal Antibiotic-associated Hypersensitivity to Question for history of
PO: Adults, Elderly: 250– receptor sites of colitis, other azithromycin, hepatitis, allergies
600 mg once daily or 1–2 g susceptible organisms, superinfections (abdominal erythromycin, or other to azithromycin,
as single dose. inhibiting RNA-dependent cramps, severe watery macrolide antibiotics. erythromycins.
Children 6 Mos and Older: protein synthesis diarrhea, fever) may result
5–12 mg/kg (maximum: from altered bacterial History of cholestatic Assess for infection (WBC
500 mg) once daily or 30 balance in GI tract. jaundice/hepatic count, appearance of
mg/kg (maximum: 1,500 impairment associated wound, evidence of fever).
mg) as single dose. Acute interstitial nephritis, with prior azithromycin
Neonates: 10–20 mg/kg hepatotoxicity occur rarely therapy
once daily.
Clarithromycin Usual Dosage Range Binds to ribosomal Antibiotic-associated Hypersensitivity to Question pt for allergies to
PO: Adults, Elderly: 250– receptor sites of colitis, other clarithromycin, other clarithromycin,
500 mg q12h or 1,000 mg susceptible organisms, superinfections (abdominal macrolide antibiotics. erythromycins.
once daily (2 × 500-mg inhibiting protein cramps, severe watery
extended-release tablets). synthesis of bacterial cell diarrhea, fever) may result History of QT prolongation Monitor daily pattern of
Children 6 Mos And Older: wall. from altered bacterial or ventricular arrhythmias, bowel activity, stool
(Immediate Release): 7.5 balance in GI tract. including torsades consistency.
 mg/kg q12h. Maximum:
500 mg/dose.
Erythromycin Usual Dosage Range
PO: Adults, Elderly: (Base):
250–500 mg q6–12h.
Maximum: 4 g/day.
Children: 30–50 mg/kg/day
in 2–4 divided doses.
Clindamycin Usual Dosage
IV, IM: Adults, Elderly:
600–2,700 mg/day in 2–4
divided doses. Maximum
IM dose: 600 mg.
Children: 20–40 mg/kg/day
in 3–4 divided doses.
Maximum: 2,700 mg/day.
Children Younger Than 1
Mo: 5 mg/kg/dose
q6–12h.
Neonates: 15–20
mg/kg/day divided q6–8h.
Neomycin Intestinal Antisepsis
Adult: PO 1 g q1h times 4
doses, then 1 g q4h times 5
doses
Child: PO 10.3 mg/kg q4–
6h for 3 d
Penetrates bacterial cell
membranes, reversibly
binds to bacterial
ribosomes, inhibiting RNA-
dependent protein
synthesis.
Inhibits protein synthesis
of bacterial cell wall by
binding to bacterial
ribosomal receptor sites.
Topically, decreases fatty
acid concentration on skin
Inhibits protein synthesis
in bacteria at level of 30S
ribosome.
Hepatotoxicity,
thrombocytopenia occurs
rarely.
Antibiotic-associated
colitis, other
superinfections (abdominal
cramps, severe watery
diarrhea, fever), reversible
cholestatic hepatitis may
occur
Antibiotic-associated
colitis, other
superinfections (abdominal
cramps, severe watery
diarrhea, fever) may occur
during and several wks
after clindamycin therapy
(including topical form)
GI: diarrhea, nausea,
vomiting.
Misc: hypersensitivity
reactions.
de pointes.
History of cholestatic
jaundice or hepatic
impairment with prior use
of clarithromycin.
Hypersensitivity to
erythromycin.
Concomitant
administration with ergot
derivatives, lovastatin,
pimozide, simvastatin
Hypersensitivity to
clindamycin.
Use of oral drug in patients
with intestinal obstruction;
ulcerative bowel lesions;
topical applications over
large skin areas; parenteral
use in patients with kidney
disease or impaired
Question for history of
allergies (particularly
erythromycins), hepatitis.
Receive full medication
history and screen for
interactions
Monitor daily pattern of
bowel activity, stool
consistency.
Assess skin for rash
Obtain baseline WBC.
Question pt for history of
allergies.
Monitor daily pattern of
bowel activity, stool
consistency. Report
diarrhea promptly due to
potential for serious colitis
(even with topical or
vaginal administration)
Monitor signs of
hypersensitivity reactions,
including pulmonary
symptoms (tightness in the
throat and chest,
wheezing, cough dyspnea)
or skin reactions (rash,
 Hepatic Coma hearing; parkinsonism; pruritus, urticaria). Notify
Adult: PO 4–12 g/d in 4 myasthenia gravis; physician or nursing staff
divided doses for 5–6 d pregnancy immediately if these
Child: PO 437.5–1225 reactions occur.
mg/m2 q6h for 5–6 d

Gentamycin Usual Parenteral Dosage Interferes with bacterial Nephrotoxicity (increased Hypersensitivity to Establish baseline
IM, IV: Adults, Elderly: protein synthesis. Binds to serum BUN, creatinine; gentamicin, other hearing acuity.
(Conventional):3–5 30S ribosomal subunit, decreased creatinine aminoglycosides
mg/kg/day in divided causing a defective cell clearance) may be (crosssensitivity) or their Question for history of
doses q8h. membrane reversible if drug is components allergies, esp.
Children 5 Yrs and Older: stopped at first sign of aminoglycosides, sulfites
2–2.5 mg/kg/dose q8h. symptoms. (parabens for
Infants, Children Younger topical/ophthalmic routes).
Than 5 Yrs: 2.5 mg/kg/dose Irreversible ototoxicity
q8h. (tinnitus, dizziness, Screen for risk of acute
Neonates (MORE THAN 2 diminished hearing), kidney injury, esp. pts at
KG): PNA 8–28 days: 4–5 neurotoxicity (headache, risk for renal failure
mg/kg/dose q24h dizziness, lethargy, tremor, (baseline renal
visual disturbances) occur insufficiency, elderly, HF,
occasionally hypertension, septic
shock).
Amikacin Usual Parenteral Dosage Inhibits protein synthesis Serious reactions include Hypersensitivity to Obtain BUN, serum
IV, IM: Adults, Elderly, in susceptible bacteria by nephrotoxicity (increased amikacin, other creatinine. Dehydration
Children, Infants: 5–7.5 binding to 30S ribosomal thirst, decreased appetite, aminoglycosides. must be treated prior to
mg/kg/dose q8h. unit. nausea, vomiting, aminoglycoside therapy.
Neonates: 15 mg/kg/dose increased BUN and serum Establish baseline hearing
q12–48h (based on creatinine levels, acuity before beginning
weight). decreased creatinine therapy.
clearance); neurotoxicity
(muscle twitching, visual Question for history of
disturbances, seizures, allergies, esp. to
paresthesia); ototoxicity aminoglycosides and
(tinnitus, dizziness, loss of sulfite.
hearing)
Tobramycin Usual Parenteral Dosage Irreversibly binds to Nephrotoxicity (acute Hypersensitivity to monitor i&O (maintain
IV: Adults, Elderly: 3–7.5 protein on bacterial kidney injury, acute tobramycin, other hydration), urinalysis, renal
mg/kg/day in 3 divided ribosomes tubular necrosis, renal aminoglycosides function.
doses. failure) may be reversible if (cross-sensitivity) and their
 Children 5 Yrs and Older: drug is stopped at first sign
2–2.5 mg/kg/dose q8h. of symptoms.
Children Younger Than 5
Yrs: 2.5 mg/kg/dose Irreversible ototoxicity
q8h. (dizziness, ringing/roaring
Neonates Less Than 1 Kg in ears, hearing loss),
(14 DAYS OR YOUNGER): 5 neurotoxicity (headache,
mg/kg/dose q48h dizziness, lethargy, tremor,
visual disturbances) occur
occasionally
components Monitor results of
peak/trough blood tests
Evaluate IV site for
phlebitis (heat, pain, red
streaking over vein).
Be alert for superinfection,
particularly
anal/genital pruritus,
changes of oral mucosa,
diarrhea.

Ciprofloxacin Usual Dosage Range Inhibits enzyme, DNA Superinfection (esp. Hypersensitivity to Question for history of
PO: Adults, Elderly: 250– gyrase, in susceptible enterococcal, fungal), ciprofloxacin, other hypersensitivity to
750 mg q12h. bacteria, interfering with nephropathy, quinolones. ciprofloxacin, quinolones;
Children: Mild to moderate bacterial cell replication cardiopulmonary arrest, myasthenia gravis,
infections: 10 mg/kg twice cerebral thrombosis may Concurrent use of renal/hepatic impairment.
daily. Maximum: 500 mg/ occur. tiZANidine
dose. Severe infections: Obtain urinalysis for
15–20 mg/kg twice daily. Hypersensitivity reaction microscopic analysis for
Maximum: 750 mg/dose. (rash, pruritus, blisters, crystalluria prior to and
edema, burning skin), during treatment.
photosensitivity have
occurred. Evaluate food tolerance.

Monitor daily pattern of

bowel activity, stool
consistency.
Norfloxacin Urinary Tract Infection Inhibits bacterial DNA CNS: seizures, dizziness, Use in individual with Watch for seizures; notify
Adult: PO 400 mg b.i.d. synthesis by inhibiting DNA drowsiness, headache, known factors that physician immediately if
gyrase enzyme. T insomnia, agitation, predispose to seizures; patient develops or
Conjunctivitis confusion. history of hypersensitivity increases seizure activity.
Adult: Ophthalmic 1–2 CV: arrhythmias, QTc to norfloxacin and other
drops q.i.d. prolongation. quinolone antiinfectives; Monitor signs of
GI: heptatoxicity, pregnancy hypersensitivity reactions
Gonorrhea or Gonococcal pseudomembranous and anaphylaxis, including
Urethritis colitis, abdominal pain, pulmonary symptoms
Adult: PO 800 mg once/d diarrhea, nausea. (tightness in the throat and

Levofloxacin Usual Dosage Range
PO, IV: Adults, Elderly:
250–500 mg q24h; 750 mg
q24h for severe or
complicated infections.
Moxifloxacin Usual Dose
PO, IV: Adults, Elderly: 400
mg q24h.
Duration dependent on
severity of infection.
Acute Bacterial Sinusitis
PO, IV: Adults, Elderly: 400
mg q24h for 10 days.
Acute Bacterial
Exacerbation of Chronic
Bronchitis
PO, IV: Adults, Elderly: 400
mg q24h for 5 days.
Sulfisoxazole Infection by Susceptible
Organisms
Inhibits DNA enzyme
gyrase in susceptible
microorganisms,
interfering with bacterial
cell replication, repair.
Inhibits two enzymes,
topoisomerase II and IV, in
susceptible
microorganisms
Exhibits broad
antimicrobial spectrum
GU: vaginitis.
Antibiotic-associated
colitis, other
superinfections (abdominal
cramps, severe watery
diarrhea, fever) may occur.
Superinfection
(genital/anal pruritus,
ulceration/changes in oral
mucosa, moderate to
severe diarrhea) may occur
from altered bacterial
balance in GI tract.
Pseudomembranous colitis
(severe abdominal
cramps/pain, severe
watery diarrhea, fever)
may occur.
Superinfection
(anal/genital pruritus,
moderate to severe
diarrhea, stomatitis) may
occur.
CNS: Headache,
peripheral neuritis,
Hypersensitivity to
levoFLOXacin, other
fluoroquinolones
Hypersensitivity to
moxifloxacin, other
quinolones.
History of hypersensitivity
to sulfonamides,
chest, wheezing, cough,
dyspnea) or skin reactions
(rash, angioedema,
pruritus, urticaria). Notify
physician or nursing staff
immediately if these
reactions occur.
Question for
hypersensitivity to
levoFLOXacin, other
fluoroquinolones.
Question history as listed
in Precautions.
Receive full medication
history, and screen for
interactions, esp.
medications that prolong
QT interval.
Obtain baseline ECG.
Obtain serum BUN,
creatinine; CrCl, GFR in pts
with renal impairment; LFT
in pts with hepatic
impairment.
Obtain bacterial culture
and sensitivity prior to
administration.
Question pt’s usual stool
characteristics (color,
frequency, consistency)
Obtain a specimen for C&S
prior to initiation of
 Adult: PO 2–4 g initially,
followed by 4–8 g/d in 4–6
divided doses Vaginal 1
applicator full 1–2 times/d
Child: PO >2 mo, 75 mg/kg
initially, followed by 150
mg/kg/d in 4–6 divided
doses (max: 6 g/d)
Sulfadiazine Ulcerative Colitis
PO: Adults, Elderly:
Initially, 3-4 g/
day in divided doses q8h.
May initiate at 1-2 g/day to
reduce GI intolerance
Children 6 Yrs And
Older: Initially, 40–70
mg/kg/day in 3–6 divided
doses.
against both gram-positive peripheral neuropathy,
and gram-negative tinnitus, hearing loss,
organisms. vertigo, insomnia,
drowsiness, mental
depression, acute
psychosis, ataxia,
convulsions, kernicterus
(newborns).
GI: Nausea, vomiting,
diarrhea, abdominal pains,
hepatitis, jaundice,
pancreatitis, stomatitis.
Hematologic: Acute
hemolytic anemia
(especially in patients with
G6PD deficiency), aplastic
anemia,
methemoglobinemia,
agranulocytosis,
thrombocytopenia,
leukopenia, eosinophilia,
hypoprothrombinemia.
Modulates local mediators Anaphylaxis, Stevens-
of inflammatory response. Johnson syndrome,
Inhibits tumor necrosis hematologic toxicity
factor (TNF). (leukopenia,
agranulocytosis),
hepatotoxicity,
nephrotoxicity occur rarely
salicylates, or chemically
related drugs; use in
treatment of group A beta-
hemolytic streptococcal
infections; infants <2 mo of
age (except in treatment of
congenital toxoplasmosis);
porphyria; advanced
kidney or liver disease;
intestinal and urinary
obstruction; pregnancy
Hypersensitivity to
sulfaSALAzine, sulfa,
salicylates; porphyria; GI
or GU obstruction
therapy.
Perform frequent kidney
function tests and
urinalyses; complete blood
counts and liver function
tests, especially during
regimens longer than 2 wk.
Monitor I&O. Report
oliguria and changes in I&O
ratio.
Check urine pH daily with
Nitrazine paper or Labstix
Question for
hypersensitivity to
medications.
Check initial urinalysis,
CBC, serum renal function,
LFT.
Monitor I&O, urinalysis,
renal function tests; ensure
adequate hydration
(minimum output 1,500
mL/24 hrs) to prevent
nephrotoxicity.
Assess skin for rash
(discontinue drug, notify

Sulfamethoxazole Usual Adult/Elderly Interferes with bacterial Rash, fever, sore throat,
Dosage Range folic acid synthesis and pallor, purpura, cough,
PO: 1–2 double-strength growth. shortness of breath may be
tablets q12–24h. IV: 8–20 early signs of serious
mg/kg/day as adverse effects.
trimethoprim in divided
doses q6–12h Fatalities are rare but have
occurred in sulfonamide
therapy following Stevens-
Johnson syndrome, toxic
epidermal necrolysis,
fulminant hepatic necrosis,
agranulocytosis, aplastic
anemia, other blood
dyscrasias.
Hypersensitivity to any
sulfa medication,
trimethoprim.
History of drug-induced
immune
thrombocytopenia with
sulfonamides or
trimethoprim, infants
younger than 4 wks,
megaloblastic anemia due
to folate deficiency, severe
hepatic/renal impairment.
physician at first
sign).
Obtain history for
hypersensitivity to
trimethoprim or any
sulfonamide, sulfite
sensitivity, bronchial
asthma.
Determine serum renal,
hepatic, hematologic
baselines.
Monitor daily pattern of
bowel activity, stool
consistency.
Assess skin for rash, pallor,
purpura.