KRISTI WRAY NUR 335 DRUG NAME CLASS/FAMILY MECHANISM OF ACTION

Generic: ceftaroline Trade Name: Teflaro, Cefotaxime BETA-LACTAM ANTIBIOTIC; THIRD-GENERATION CEPHALOSPORIN Broad-spectrum semi-synthetic third-generation cephalosporin antibiotic. 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 bacteria. Generally active against a wide variety of gram-negative bacteria including most of the Enterobacteriaceae. Also active against some organisms resistant to first- and second-generation cephalosporins, and currently available aminoglycoside antibiotics and penicillins. Serious infections of lower respiratory tract, skin and skin structures, bones and joints, CNS (including meningitis and ventriculitis), gynecologic and GU tract infections, including uncomplicated gonococcal infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG). Also used to treat bacteremia or septicemia, intra-abdominal infections, and for perioperative prophylaxis. Possible infection of surgical incisions IV, IM 600 mg IV BID Moderate to Severe Infections Adult: IV/IM 12 g q812h, up to 2 g q4h (max: 12 g/day) Child: IV/IM 1 wk or younger, 50 mg/kg q12h; 14 wk, 50 g/kg/q8h; 1 mo12 y, 50200 mg/kg/day divided q48h (max: 12 g/24 h) Disseminated Gonorrhea Adult: IV 1 g q8h Surgical Prophylaxis Adult: IV/IM 1 g 3090 min before surgery Renal Impairment Dosage Adjustment CrCl less than 20 mL/min: Give normal dose Hemodialysis Dosage Adjustment: Supplemental dose may be needed Peak: 30 min after IM; 5 min after IV. Intravenous IV administration to neonates, infants, and children: Verify correct IV concentration and rate of infusion with physician. Do not admix cefotaxime with sodium bicarbonate or any fluid with a pH greater than 7.5. Risk of phlebitis may be reduced by use of a small needle in a large vein. Prepare: Direct: Add 10 mL diluent to vial with 1 or 2 g drug providing a solution containing 95 or 180 mg/mL, respectively. Intermittent: To 1 or 2 g drug add 50 or 100 mL D5W, NS, D5/NS, D5/.45% NaCl, LR, or other compatible diluent.

INDICATIONS

WHY IS YOUR PATIENT GETTING THIS MEDICINE ROUTES PATIENT DOSAGE COMMON DOSAGE

ONSET, PEAK, DURATION FOR IV MEDS, COMPATIBILITY WITH IV DRIPS AND OR SOLUTIONS

KRISTI WRAY NUR 335 Continuous: Dilute in 5001000 mL compatible IV solution. Administer: Direct: Give over 35 min. Intermittent: Give over 2030 min, preferably via butterfly or scalp vein-type needles. Continuous: Infuse over 624 h. Incompatibilities: Solution/additive: AMINOGLYCOSIDES, aminophylline. Y-site: Allopurinol, azithromycin, cisatracurium, filgrastim, fluconazole, gemcitabine, hetastarch, pentamidine, vancomycin. Protect from excessive light. Reconstituted solutions may be stored in original containers for 24 h at room temperature; for 10 days under refrigeration at or below 5 C (41 F); or for at least 13 wk in frozen state. May cause falsely elevated serum or urine creatinine values (Jaffe reaction). False-positive reactions for urine glucose have not been reported using copper sulfate reduction methods (e.g., Benedict's, Clinitest); however, since it has occurred with other cephalosporins, it may be advisable to use glucose oxidase tests (Clinistix, TesTape, Diastix). Positive direct antiglobulin (Coombs') test results may interfere with hematologic studies and cross-matching procedures. Hypersensitivity to cefotaxime, cephalosporins and other beta-lactam antibiotics.

LAB VALUE ALTERATIONS CAUSE BY THIS MED

CONTRAINDICATIONS/ PRECAUTIONS

INTERACTIONS ADVERSE/SIDE EFFECTS

IMP NURS RESPONSIBILITIES

Drug: Probenecid decreases renal elimination; alcohol produces disulfiram reaction. Body as a Whole: Fever, nocturnal perspiration, inflammatory reaction at IV site, phlebitis, thrombophlebitis; pain, induration, and tenderness at IM site, superinfections. GI: Nausea, vomiting, diarrhea, abdominal pain, colitis, pseudomembranous colitis, anorexia. Metabolic: Transient increases in serum AST, ALT, LDH, bilirubin, alkaline phosphatase concentrations. Skin: Rash, pruritus. Determine previous hypersensitivity reactions to cephalosporins and penicillins, and history of other allergies, particularly to drugs, before therapy is initiated. Lab tests: Perform culture and sensitivity tests before initiation of therapy. Serum creatinine, creatinine clearance, BUN should be evaluated at regular intervals during therapy and for several months after drug has been discontinued. Perform periodic hematologic studies (including PT and/or PTT) and evaluation of hepatic functions with high doses or prolonged therapy.

KRISTI WRAY NUR 335 PT/FAMILY TEACHING Monitor I&O rates and patterns, especially with higher doses or concurrent aminoglycoside therapy. Report significant changes in I&O. Superinfection due to overgrowth of nonsusceptible organisms may occur, particularly with prolonged therapy. Report onset of diarrhea promptly. Check for fever. If diarrhea is mild, discontinuation of cefotaxime may be sufficient. If diarrhea is severe, suspect antibiotic-associated pseudomembranous colitis, a life-threatening superinfection (may occur in 49 days or as long as 6 wk after cephalosporin therapy is discontinued). Report any early signs or symptoms of superinfection promptly. Superinfections caused by overgrowth of nonsusceptible organisms may occur, particularly during prolonged use. Yogurt or buttermilk, 120 mL (4 oz) of either (if allowed), may serve as a prophylactic against intestinal superinfection by helping to maintain normal intestinal flora. Report loose stools or diarrhea.