Penicillin and Patient Education - Pharmacology

The patient must be instructed to monitor his or her temperature to be sure that the infection is subsiding. Generally, healthy patients can expect to see some improvement in the infection within 48 hours. They should be instructed to return to or contact the prescriber if symptoms worsen or do not improve somewhat in 48 hours. Patients with diabetes, immunosuppressed conditions such as AIDS, or some cancers might not respond as quickly to antibiotic therapy.

In addition to information described for generic antibiotics, female patients should be informed that penicillin can interfere with the effectiveness of birth control pills that contain estrogen. It is recommended that females use alternative forms of birth control while being treated with penicillin.

CEPHALOSPORINS

The cephalosporin family of medications is a chemically modified version of penicillin that stops growth and kills a broad spectrum of bacteria by making it impossible for bacteria to create a cell wall. There are four generations of cephalosporins.

Cephalosporin can be prescribed for patients who are allergic to penicillin. However, about 10% of those patients might also be allergic to cephalosporins. Do not administer cephalosporins to patients who have had a serious reaction to penicillin such as anaphylaxis.

Prescribers use cephalosporins to combat a wide variety of infections and typically use it as a prophylaxis to prevent a bacterial infection to occur during or after surgery.

Cephalosporins also have side effects which include diarrhea, abdominal cramps or distress, oral and/or vaginal candidiasis, rash, pruritis, redness, or edema. There is also an increase of bleeding and bruising with four commonly prescribed cephalosporins: cefamandole, cefmetazole, cefoperazone, and cefotetan.

The patient assessment for cephalosporins is the same as for penicillin. However, pay particular attention to any previous bleeding disorder reported by the patient because cephalosporins can exacerbate this condition.

Before administering cephalosporins, assess for allergies, vital signs, and urine output. Check laboratory results, especially those that indicate renal and liver function such as BUN, serum creatinine, AST, ALT, ALP, and bilirubin. Also monitor bleeding time (PT and PTT) and white blood cell count. Obtain a tissue or blood specimen for a culture and sensitivity if possible to determine if cephalosporins are the right antibiotic.

Administer cephalosporins using the same methods as used for penicillin. If given IM, it should be injected deeply into a large muscle mass. This decreases pain, induration (becoming hard), and a sterile abscess.

The patient should be provided with the same instructions as is given to a patient who is receiving penicillin (see Penicillin and Patient Education).

CEPHALOSPORINS AND DRUG-DRUG INTERACTIONS

Alcohol should be avoided when taking certain cephalosporins (cefamandole, cefoperazone, or moxalactam) because patients might experience adverse side effects that include:

  • Stomach pain
  • Nausea
  • Vomiting
  • Headaches
  • Hypotension
  • Tachycardia (fast heart rate)
  • Difficulty breathing
  • Sweating
  • Flushed face

Some medications include alcohol and the patient should be advised to check the labels carefully if taking one of these cephalosporins.

Besides alcohol, some cephalosporins (cefamandole, cefmetazole, cefopera-zone, or cefotetan) expose the patient to an increased risk of hemorrhaging if administered with anticoagulants such as coumarin or indanedione, heparin, and with clot-busting drugs such as thrombolytics. The same adverse reaction might occur if the patient takes NSAIDs, especially aspirin, or sulfinpyrazone (Anturane) while on cephalosporins.

Probenecid (Benemid) may extend the half-life of cephalosporins and can result in toxicity. However, cephalosporins and probenecid are sometimes given together to treat sexually transmitted diseases when a high serum level and prolonged level of cephalosporins are desirable.

patient who is undergoing treatment with cephalosporins might experience other problems. These are a fever and rash brought about by hypersensivity, an allergic reaction such as anaphylaxis, Stevens-Johnson syndrome, renal dysfunction, serum sickness-like reaction, or seizures.


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