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I. INTRODUCTION
Background of the Study
Osteomyelitis is a severe pyogenic infection of the bone and surrounding tissues
that requires immediate treatment. Though the bone is affected site, normally root cause
of such infection is not injuries caused to bone. Most often the infection is originated
from some other body parts and is spread to bone through blood stream. If the bone has
undergone trauma recently, such bone becomes predisposed to the infection. It is a bone
inflammation caused by bacteria. Generally there are three routes where a bacterium
enters the body such as in the bloodstream or hematogenous spread, adjacent soft tissue
infection or contiguous focus and direct introduction of microorganisms. Chronic
Osteomyelitis occurs due to loss of blood supply to bone. Such loss of blood supply is
caused when bone tissues dies. As is suggestive from the nomenclature chronic (which
means prolonged), the Osteomyelitis conditions persists for many years. People with
diabetes, hemodialysis, people who have suffered trauma recently and people who abuse
IV drugs are considered on higher risk of developing chronic Osteomyelitis. Fortunately,
it is a rare health condition. According to the available statistics, one person among 5000
people gets affected with Osteomyelitis.
Osteomyelitis is the medical term for an infection in a bone. Infections can reach
a bone by traveling through your bloodstream or spreading from nearby tissue. Infections
can also begin in the bone itself if trauma exposes your bone to germs. Bone infections
commonly affect the long bones of your body, such as your leg bones and upper arm
bone, as well as your spine and pelvis. Osteomyelitis often occurs in children as an acute
condition. In adults, osteomyelitis may occur as either the acute and chronic form. Once
considered incurable, osteomyelitis can be successfully treated today. Still, osteomyelitis
is a serious condition, requiring aggressive treatment to prevent spread of your infection
and to save the affected bone.
Etiology
Osteomyelitis is caused by
Contiguous spread (from infected tissue or an infected prosthetic joint)
Blood borne organisms (hematogenous osteomyelitis)
Open wounds (from contaminated open fractures or bone surgery
Age group Most common organisms
Newborns (younger than 4 mo) S. aureus, Enterobacter species, and group A and B
Streptococcus species
Children (aged 4 mo to 4 y) S. aureus, group A Streptococcus species,
Haemophilus influenzae, and Enterobacter species
Children, adolescents (aged 4 y to adult S. aureus (80%), group A Streptococcus species, H.
influenzae, and Enterobacter species
Adult S. aureus and occasionally Enterobacter or
Streptococcus species
Sickle Cell Anemia Patients Salmonella species
CLINICAL MANIFESTATIONS
Signs and symptoms of osteomyelitis depend on whether the condition is acute, lasting
several months or less, or chronic, lasting several months to years.
Signs and symptoms of acute osteomyelitis include:
Fever that may be abrupt
Irritability or lethargy in young children
Pain in the area of the infection
Swelling, warmth and redness over the area of the infection
Signs and symptoms of chronic osteomyelitis include:
Warmth, swelling and redness over the area of the infection
Pain or tenderness in the affected area
Chronic fatigue
Drainage from an open wound near the area of the infection
Fever, sometimes
Sometimes osteomyelitis causes no signs and symptoms or has signs and
symptoms that are difficult to distinguish from other problems. For instance,
osteomyelitis of the hip, spine or pelvis may have few signs and symptoms.
Osteomyelitis that occurs after a broken bone (fracture) or deep wound may cause
pain and swelling that you may attribute to your injury, not an infection.
RISK FACTORS
An increased risk of infections
Certain situations allow germs more opportunities to access your body, putting you at
an increased risk of infection, which can lead to osteomyelitis. Examples include people
who illegally inject drugs, people on dialysis, people who use urinary catheters and
people who have had tubes placed in their bodies to give doctors easier access to major
veins (central lines)
Poor circulation
People with poor circulation include those with diabetes, peripheral arterial disease
and sickle cell disease. When the arteries are damaged or blocked, your body has
difficulty distributing the infection-fighting cells needed to keep a small infection from
growing larger.
A recent injury
A broken bone that breaks the skin or a deep puncture wound exposes your body to
germs that can cause infection and increase your risk of osteomyelitis. Carefully follow
your doctor’s instructions on taking antibiotics and taking precautions to prevent
infection.
Orthopedic surgery
Surgery to repair broken bones or replace worn joints puts you at risk of infection.
Follow your surgeon's instructions to help avoid infection after your surgery.
PATHOPHYSIOLOGY
Osteomyelitis may be localized or it may spread through the periosteum, cortex,
marrow, and cancellous tissue. The bacterial pathogen varies on the basis of the patient's
age and the mechanism of infection. The following are the 2 primary categories of acute
osteomyelitis: hematogenous osteomyelitis and direct or contiguous inoculation
osteomyelitis.
Hematogenous osteomyelitis is an infection caused by bacterial seeding from the
blood. Acute hematogenous osteomyelitis is characterized by an acute infection of the
bone caused by the seeding of the bacteria within the bone from a remote source. This
condition primarily occurs in children. The most common site is the rapidly growing and
highly vascular metaphysis of growing bones. The apparent slowing or sludging of blood
flow as the vessels make sharp angles at the distal metaphysis predisposes the vessels to
thrombosis and the bone itself to localized necrosis and bacterial seeding.
Vertebral osteomyelitis at any age is most often a secondary complication of a remote
infection with hematogenous seeding. In approximately one half of vertebral
osteomyelitis cases, a source can be identified such as urinary tract or skin, and
approximately one third may be diagnosed with endocarditis.1 Acute hematogenous
osteomyelitis, despite its name, may have a slow clinical development and insidious
onset.
Direct or contiguous inoculation osteomyelitis is caused by direct contact of the
tissue and bacteria during trauma or surgery. Direct inoculation (contiguous-focus)
osteomyelitis is an infection in the bone secondary to the inoculation of organisms from
direct trauma, spread from a contiguous focus of infection, or sepsis after a surgical
procedure. Clinical manifestations of direct inoculation osteomyelitis are more localized
than those of hematogenous osteomyelitis and tend to involve multiple organisms.
Additional categories include chronic osteomyelitis and osteomyelitis secondary
to peripheral vascular disease. Chronic osteomyelitis persists or recurs, regardless of its
initial cause and/or mechanism and despite aggressive intervention. Although listed as an
etiology, peripheral vascular disease is actually a predisposing factor rather than a true
cause of infection.
Disease states known to predispose patients to osteomyelitis include diabetes
mellitus, sickle cell disease, acquired immune deficiency syndrome (AIDS), intravenous
(IV) drug abuse, alcoholism, chronic steroid use, immune suppression, and chronic joint
disease. In addition, the presence of a prosthetic orthopedic device is an independent risk
factor, as is any recent orthopedic surgery or open fracture.
DIAGNOSTIC PROCEDURES
ESR or C-reactive protein
X-rays, MRI, or radio isotopic bone scanning
Culture of bone, abscess, or both
MEDICAL MANAGEMENT
Medical management for clients with Osteomyelitis are as follows:
Analgesics as prescribed.
Antibiotics as prescribes.
Dressing changes- use sterile technique.
Maintain proper body alignment and change position frequently to prevent
deformities
Immobilization of affected part
Surgery if needed:
Incision ad Drainage of bone abscess.
Sequestrectomy- removal of dead, infected bone and cartilage.
Bone grafting is recommended after repeated infections
II.ANATOMY AND PHYSIOLOGY
Human musculoskeletal system
A musculoskeletal system (also known as the locomotors system) is an organ
system that gives animals (including humans) the ability to move using the muscular and
skeletal systems. The musculoskeletal system provides form, support, stability, and
movement to the body. It is made up of the body's bones (the skeleton), muscles,
cartilage, tendons, ligaments, joints, and other tissue that supports and binds tissues and
organs together). The musculoskeletal system's primary functions include supporting the
body, allowing motion, and protecting vital organs. The skeletal portion of the system
serves as the main storage system for calcium and phosphorus and contains critical
components of the hematopoietic system. This system describes how bones are connected
to other bones and muscle fibers via connective tissue such as tendons and ligaments. The
bones provide the stability to a body in analogy to iron rods in concrete construction.
Muscles keep bones in place and also play a role in movement of the bones. To allow
motion, different bones are connected by joints. Cartilage prevents the bone ends from
rubbing directly on to each other. Muscles contract (bunch up) to move the bone attached
at the joint.
The Skeletal System serves many important functions; it provides the shape and
form for our bodies in addition to supporting, protecting, allowing bodily movement,
producing blood for the body, and storing minerals. The number of bones in the human
skeletal system is a controversial topic. Humans are born with about 300 to 350 bones;
however, many bones fuse together between birth and maturity. As a result an average
adult skeleton consists of 206 bones. The number of bones varies according to the
method used to derive the count. While some consider certain structures to be a single
bone with multiple parts, others may see it as a single part with multiple bones. There are
five general classifications of bones. These are Long bones, Short bones, Flat bones,
Irregular bones, and Sesamoid bones. The human skeleton is composed of both fused and
individual bones supported by ligaments, tendons, muscles and cartilage. It is a complex
structure with two distinct divisions. These are the axial skeleton and the appendicular
skeleton.
The Skeletal System serves as a framework for tissues and organs to attach
themselves to. This system acts as a protective structure for vital organs. Major examples
of this are the brain being protected by the skull and the lungs being protected by the rib
cage.
Located in long bones are two distinctions of bone marrow (yellow and red). The
yellow marrow has fatty connective tissue and is found in the marrow cavity. During
starvation, the body uses the fat in yellow marrow for energy. The red marrow of some
bones is an important site for blood cell production, approximately 2.6 million red blood
cells per second in order to replace existing cells that have been destroyed by the liver.
Here all erythrocytes, platelets, and most leukocytes form in adults. From the red
marrow, erythrocytes, platelets, and leukocytes migrate to the blood to do their special
tasks.
Another function of bones is the storage of certain minerals. Calcium and
phosphorus are among the main minerals being stored. The importance of this storage
"device" helps to regulate mineral balance in the bloodstream. When the fluctuation of
minerals is high, these minerals are stored in bone; when it is low it will be withdrawn
from the bone.
Functions:
1. BONE
Bones have eleven main functions:
Mechanical
1. Protection — Bones can serve to protect internal organs, such as the skull
protecting the brain or the ribs protecting the heart and lungs.
2. Shape — Bones provide a frame to keep the body supported.
3. Movement — Bones, skeletal muscles, tendons, ligaments and joints function
together to generate and transfer forces so that individual body parts or the whole
body can be manipulated in three-dimensional space. The interaction between
bone and muscle is studied in biomechanics.
Synthetic
1. Blood production — The marrow, located within the medullary cavity of long
bones and interstices of cancellous bone, produces blood cells in a process called
haematopoiesis.
Metabolic
2. Mineral storage — Bones act as reserves of minerals important for the body, most
notably calcium and phosphorus.
3. Growth factor storage — Mineralized bone matrix stores important growth factors
such as insulin-like growth factors, transforming growth factor, bone
morphogenetic proteins and others.
4. Fat Storage — The yellow bone marrow acts as a storage reserve of fatty acids
5. Acid-base balance — Bone buffers the blood against excessive pH changes by
absorbing or releasing alkaline salts.
6. Detoxification — Bone tissues can also store heavy and other foreign elements,
removing them from the blood and reducing their effects on other tissues. These
can later be gradually released for excretion.
7. Endocrine organ - Bone controls phosphate metabolism by releasing fibroblast
growth factor - 23(FGF-23), which acts on kidney to reduce phosphate
reabsorption
CATEGORIES OF BONE
Short bones are roughly cube-shaped, and have only a thin layer of compact bone
surrounding a spongy interior. The bones of the wrist and ankle are short bones,
as are the sesamoid bones.
Flat bones are thin, flattened and generally curved; Most of the bones of the skull
are flat bones, as is the sternum.
Irregular bones as implied by the name, their shapes are irregular and
complicated. The bones of the spine and hips are irregular bones.
Long bones are characterized by a shaft, the diaphysis that is much greater in
length than width. Most bones of the limbs, including those of the fingers and
toes, are long bones.
STRUCTURE OF THE LONG BONE
The diaphysis, or shaft, is the long tubular portion of long bones. It is composed
of compact bone tissue.
The epiphysis (plural, epiphyses) is the expanded end of a long bone.
The metaphysis is the area where the diaphysis meets the
epiphysis . I t includes the epiphyseal line, a remnant of cartilage from
growing bones.
The medullary cavity, or marrow cavity, is the open area within the diaphysis.
The adipose tissue inside the cavity stores lipids and forms the yellow marrow.
Articular cartilage covers the epiphysis where joints occur.
The periosteum is the membrane covering the outside of the diaphysis (and
epiphyses where articular cartilage is absent). It contains osteoblasts
(bone-forming cells), osteoclasts(bone-destroying cel ls) , nerve
f ibers , and blood and lymphat ic ve ssels . Ligaments and tendons
attach to the periosteum.
The endosteum is the membrane that lines the marrow cavity.
TYPES OF BONES
Compact bone or (Cortical bone)
The hard outer layer of bones is composed of compact tissue, so-called due to its
minimal gaps and spaces. This tissue gives bones their smooth, white, and solid
appearance, and accounts for 80%of the total bone mass of an adult skeleton.
Compact bone may also be referred to as dense bone.
Trabecular bone
Filling the interior of the organ is the bone tissue (an open cell porous
network also called cancellous or spongy bone), which is composed of a network of
rod- and plate-like elements that make the overall organ lighter and allowing
room for blood vessels and marrow. Trabecular bone accounts for the remaining
20% of total bone mass but has nearly ten times the surface area of compact bone.
2. Joints
Human synovial joint composition Joints are structures that connect individual
bones and may allow bones to move against each other to cause movement. There are
two divisions of joints, diarthroses which allow extensive mobility between two or more
articular heads, and false joints orsynarthroses, joints that are immovable, that allow little
or no movement and are predominantly fibrous. Synovial joints, joints that are not
directly joined, are lubricated by a solution called synovia that is produced by the
synovial membranes. This fluid lowers the friction between the articular surfaces and is
kept within an articular capsule, binding the joint with its taut tissue.
3. Tendons
A tendon is a tough, flexible band of fibrous that connects muscles to
bones. Muscles gradually become tendon as the cells become closer to the origins and
insertions on bones, eventually becoming solid bands of tendon that merge into the
periosteum of individual bones. As muscles contract, tendons transmit the forces to
the rigid bones, pulling on them and causing movement.
4. Ligaments
A ligaments a small band of dense, white, fibrous elastic tissue. Ligaments
connect the ends of bones together in order to form a joint. Most ligaments limit
dislocation, or prevent certain movements that may cause breaks. Since they are only
elastic they increasingly lengthen when under pressure. When this occurs the ligament
may be susceptible to break resulting in an unstable joint. Ligaments may also restrict
some actions: movements such as hyperextension and hyper flexion are restricted by
ligaments to an extent. Also ligaments prevent certain directional movement.
Lower Limb
The thigh, leg, and foot constitute the lower limb. The bones of the lower
limbs are considerably larger and stronger than comparable bones of the upper
limbs because the lower limbs must support the entire weight of the body while
walking, running, or jumping. Illustrates features of the 30 bones of each lower
limb.
III. PATHOPHYSIOLOGY
Predisposing factors: vascular insufficiency disorders genitourinary infections
respiratory infections
IV drug use
Immuno compromising diseases
history of blood- stream infections
Indwelling prosthetic devices
Injury/ Trauma↓
Invasion of pathogenic microorganism (staphylococcus aureus)↓
Bacteria lodge in adjacent tissues↓
Increase WBC and enters the affected area↓
Bacteria release enzyme Leukocidins↓
WBC engulf dead cell↓
Pus formation↓
Pus will spread in the bones and blood vessel impairing blood flowHematoma
↓Increase pressure
↓Vascular compromise of the periosteum
↓Infection through the bone cortex and marrow
↓Cortical devascurization
↓Necrosis
↓ ↓ ↓ ↓
Medullar cavity periosteum soft tissues and joints ↓ ↓
Pus (pain,swelling, redness and blisters↓ ↓ ↓
Sequestrum form pain swelling
IV. DIAGNOSTIC PROCEDURES
The following studies are indicated in patients with osteomyelitis:
CBC count: The WBC count may be elevated, but it is frequently normal.
o A leftward shift is common with increased polymorphonuclear leukocyte
counts.
o The C-reactive protein level is usually elevated and nonspecific; this study
may be more useful than the erythrocyte sedimentation rate (ESR) because
it reveals elevation earlier.
o The ESR is usually elevated (90%); however, this finding is clinically
nonspecific.
o CRP and ESR have limited roles in the setting of chronic osteomyelitis
and are often normal
Culture: Superficial wound or sinus tract cultures often do not correlate with the
bacterium that is causing osteomyelitis and have limited use. Blood culture results
are positive in approximately 50% of patients with hematogenous osteomyelitis.
However, a positive blood culture may preclude the need for further invasive
procedures to isolate the organism. Bone cultures from biopsy or aspiration have a
diagnostic yield of approximately 77% across all studies.
Imaging Studies
Radiography
o Radiographic evidence of acute osteomyelitis is first suggested by
overlying soft-tissue edema at 3-5 days after infection. Examples of
radiographic evidence of osteomyelitis are presented in the images below.
o Bony changes are not evident for 14-21 days and initially manifest as
periosteal elevation followed by cortical or medullary lucencies. By 28
days, 90% of patients demonstrate some abnormality.
o Approximately 40-50% focal bone loss is necessary to cause detectable
lucency on plain films.
MRI
o The MRI is effective in the early detection and surgical localization of
osteomyelitis.
o Studies have shown its superiority compared with plain radiography, CT,
and radionuclide scanning and is considered to be the imaging of choice.
o Sensitivity ranges from 90-100%.
Positron emission tomographic (PET) scanning has accuracy similar to MRI.
Radionuclide bone scanning
o Three phase bone scan, gallium scan and tagged WBC scan are
considerations in patients who are unable to have MRI imaging. A three
phase bone scan has high sensitivity and specificity in adults with normal
findings on radiograph. Specificity is dramatically decreased in the setting
of previous surgery or traumatized bone.
o In special circumstances, additional information can be obtained from
further scanning with leukocytes labeled with gallium 67 and/or indium
111.
CT scanning
o CT scans can depict abnormal calcification, ossification, and intracortical
abnormalities.
o It is not recommended for routine use for diagnosing osteomyelitis but is
often the imaging of choice when MRI is not available
Ultrasonography
o This simple and inexpensive technique has shown promise, particularly in
children with acute osteomyelitis.
o Ultrasonography may demonstrate changes as early as 1-2 days after onset
of symptoms.
o Abnormalities include soft tissue abscess or fluid collection and periosteal
elevation.
o Ultrasonography allows for ultrasound-guided aspiration.
o It does not allow for evaluation of bone cortex.
V. MEDICAL MANAGEMENT
PHARMACOLOGIC THERAPY
The primary treatment for osteomyelitis is parenteral antibiotics that penetrate bone and
joint cavities. Treatment is required for at least 4-6 weeks. After intravenous antibiotics
are initiated on an inpatient basis, therapy may be continued with intravenous or oral
antibiotics, depending on the type and location of the infection, on an outpatient basis.
The following are recommendations for the initiation of empiric antibiotic treatment
based on the age of the patient and mechanism of infection:
With hematogenous osteomyelitis (newborn to adult), the infectious agents
include S aureus, Enterobacteriaceae organisms, group A and B Streptococcus
species, and H influenzae. Primary treatment is a combination of penicillinase-
resistant synthetic penicillin and a third-generation cephalosporin. Alternate
therapy is vancomycin or clindamycin and a third-generation cephalosporin,
particularly if methicillin-resistant S aureus (MRSA) is considered likely.
Linezolid is also used in these circumstances. In addition to these above-
mentioned antibacterials, ciprofloxacin and rifampin may be an appropriate
combination therapy for adult patients. If evidence of infection with gram-
negative bacilli is observed, include a third-generation cephalosporin.
In patients with sickle cell anemia and osteomyelitis, the primary bacterial causes
are S aureus and Salmonellae species. Thus, the primary choice for treatment is a
fluoroquinolone antibiotic (not in children). A third-generation cephalosporin (eg,
ceftriaxone) is an alternative choice.
When a nail puncture occurs through an athletic shoe, the infecting agents may
include S aureus and Pseudomonas aeruginosa. The primary antibiotics in this
scenario include ceftazidime or cefepime. Ciprofloxacin is an alternative
treatment.
For patients with osteomyelitis due to trauma, the infecting agents include S
aureus, coliform bacilli, and Pseudomonas aeruginosa. Primary antibiotics include
nafcillin and ciprofloxacin. Alternatives include vancomycin and a third-
generation cephalosporin with anti pseudomonal activity.
SURGICAL MANAGEMENT
Surgery Drain the infected area. Opening up the area around your infected bone allows
your surgeon to drain any pus or fluid that has accumulated in response to the infection.
Remove diseased bone and tissue.
In a procedure called debridement, the surgeon removes as much of the diseased bone as
possible, taking a small margin of healthy bone to ensure that all the infected areas have
been removed. Surrounding tissue that shows signs of infection also may be removed.
Restore blood flow to the bone.
Your surgeon may fill any empty space left by the debridement procedure with a piece of
bone or other tissue, such as skin or muscle, from another part of your body. Sometimes
temporary fillers are placed in the pocket until you're healthy enough to undergo bone
graft or tissue graft. The graft helps your body repair damaged blood vessels and form
new bone.
Remove any foreign objects.
In some cases, foreign objects, such as surgical plates or screws placed during a previous
surgery, may need to be removed.
Antibiotics
Once the bacterium or fungus causing your infection has been identified and
you've undergone surgery, if necessary, your doctor selects the antibiotic most likely to
be effective in fighting your particular type of infection. Antibiotics are administered
most often through a vein in your arm (intravenously) or, in some cases, they can be
taken orally. You typically take antibiotics for four to six weeks, or even longer. In some
cases, you may need to take antibiotics for the rest of your life.
Antibiotics carry a risk of side effects, including nausea, vomiting and diarrhea.
Allergic reactions can also occur.
VI. DRUG STUDY
1. Generic Name: Nafcillin
Brand Name: Nafcil, Unipen
Classification: Antibiotic
Penicillinase- resistant penicillin
Mechanism of Action: Bactericidal; Inhibits cell wall synthesis of sensitive
organisms, causing cell death
Dosage and Frequency: 500- 1000 mg q 4 hours for 14 days
Route: IV
Adverse Effects:
Nausea/ vomiting
Diarrhea
Rash
Fever
Wheezing
Pain
Sore mouth
Side Effects:
Stomach upset
Diarrhea
DOB
Fatigue
Nursing Responsibilities
1. Culture the infection before treatment; re culture if response is not as
expected.
2. Continue therapy for at least 2 days after signs of infection have
disappeared, at last 14 days.
3. This drug must be given intravenously every 4 hours.
2. Generic Name: Ceftriaxone
Brand Name: Rocephin
Classification: Antibiotic
Cephalosporin (third generation)
Mechanism of Action: Bactericidal; Inhibits cell wall synthesis of sensitive
organisms, causing cell death
Dosage and Frequency:
Adult: 1- 2 g OD
Pediatric: 50- 75 mg/kg/day q 12 hours
Route: IV
IM
Adverse Effects:
Nausea/ vomiting
Diarrhea
Abdominal pain
Anorexia
Flatulence
Ranging from rash to fever
Pain
Side Effects:
Stomach upset
Fatigue
Diarrhea
DOB
Nursing Responsibilities
1. Protect drug from light.
2. Do not mix ceftriaxone with any other antimicrobial drug.
3. Monitor ceftriaxone blood levels in patients with severe renal impairment
and patients with renal and hepatic impairment.
4. Have Vitamin K available in case hypoprothrombinemia occurs.
5. Discontinue if hypersensitivity occurs.
3. Generic Name: Cefazolin
Brand Name: Ancef
Classification: Antibiotic
Cephalosporin (first generation)
Mechanism of Action: Bactericidal; Inhibits cell wall synthesis of sensitive
organisms, causing cell death
Dosage and Frequency:
Adult: 250- 500 mg q 6- 12 hours
Pediatric: 25- 50 mg/kg/day in three or four equally divided doses
Route: IV
IM
Adverse Effects:
Nausea/ vomiting
Diarrhea
Abdominal pain
Anorexia
Flatulence
Ranging from rash to fever
Pain
Side Effects:
Stomach upset
Loss of appetite
Nausea
Headache
Dizziness
Diarrhea
Nursing Responsibilities
1. Inject IM doses deeply into large muscle group.
2. Solution is stable for 24 hours at room temperature, redissolve by
warming to room temperature and agitating slightly
3. Have Vitamin K available in case hypoprothrombinemia occurs.
4. Generic Name: Ciprofloxacin
Brand Name: Cipro
Classification: Antibacterial
Fluoroquinolone
Mechanism of Action: Bactericidal; Interferes with DNA replication in
susceptible bacteria preventing cell rep[roduction
Dosage and Frequency:
Adult: 1g/day in 2- 4 divided doses for 7- 14 days
Pediatric: not recommended for children < 12 yrs. old
Route: Oral
Adverse Effects:
Headache
Dizziness
Nausea
Rash
Pruritus
Urticaria
Perineal burning
Side Effects:
Nausea/ vomiting
Abdominal pain
Diarrhea
Drowsiness
Blurring of vision
Dizziness
Nursing Responsibilities
1. Do not mix with aminoglycoside solutions. Administer these drugs
separately.
2. Powder and reconstituted solution darken with storage.
3. Have Vitamin K available in case hypoprothrombinemia occurs.
4. Discontinue if hypersensitivity occurs.
5. Generic Name: Ceftazidime
Brand Name: Fortaz, Ceptaz
Classification: Antibiotic
Cephalosporin (third generation)
Mechanism of Action: Bactericidal; Inhibits cell wall synthesis of sensitive
organisms, causing cell death
Dosage and Frequency:
Adult: 1g (range 250 mg -2 g) q 8- 12 hours
Pediatric:
0- 4 wks - 30 mg/ kg q 12 hours
1 mo. - 12 yrs- 30- 50 mg/ kg q 8 hours
Route: IV
IM
Adverse Effects:
Nausea/ vomiting
Diarrhea
Abdominal pain
Anorexia
Flatulence
Ranging from rash to fever
Pain
Side Effects:
Stomach upset
Diarrhea
Nursing Responsibilities
1. Continue therapy for 2 days after sign and symptoms of infection are
gone.
2. Ensure that patient is well hydrated.
3. Give antacids at least 2 hours after dosing.
4. Monitor clinical response, if no improvement is seen or a relapse
occurs, repeat culture and sensitivity.
5. Encourage patient to complete full course of therapy.
6. Generic Name: Clindamycin
Brand Name: Cleocin
Classification: Lincosamide Antibiotic
Mechanism of Action: Inhibits protein synthesis in susceptible bacteria causing
cell death.
Dosage and Frequency:
Adult:150- 300 mg q 6 hours up to 300- 450 mg q 6 hours in severe
infection
Pediatric: 8- 20 mg/ kg/ day in 3 or 4 equal doses
Route: Oral
Adverse Effects:
Hypotension
Nausea/ vomiting
Diarrhea
Esophagitis
Anorexia
Rashes
Pain
Abdominal pain
Side Effects:
Nausea/ vomiting
Super infection in the mouth, vagina
Nursing Responsibilities
1. Administer oral drug with a full glass of water or with food to prevent
esophageal irritation.
2. Do not use for minor bacterial or viral infections.
3. Monitor renal and liver function tests, and blood counts with prolonged
therapy.
4. Take full prescribed course of oral drug. Do not stop taking without
notifying health care provider.
7. Generic Name: Vancomycin
Brand Name: Vancocin
Classification: Antibiotic
Mechanism of Action: Bactericidal; Inhibits cell wall synthesis of sensitive
organisms, causing cell death
Dosage and Frequency:
Adult: 500 mg q 6 hours or 1 g q 12 hours
Pediatric: 10 mg/ kg/ dose q 6 hours
Route: IV
Adverse Effects:
Hypotension
Ototoxicity
Urticaria
Nausea
Nephrotoxicity
“Red neck or red man syndrome”
Side Effects:
Nausea
Changes in hearing
Super infection in the mouth, vagina
Nursing Responsibilities
1. Observe the patient very closely when giving parenteral solution
particularly the first doses, “red neck syndrome” can occur; slow
administration decreases the risk of adverse effects.
2. Culture site of infection before beginning therapy.
3. Monitor renal function tests with prolonged therapy.
4. Evaluation for safe serum level, concentrations of 60- 80 mcg/ ml are
toxic.