Cephalosporin

Introductory Clinical
Pharmacology

Chapter 8
Cephalosporins

Copyright © 2008 Lippincott Williams & Wilkins.

Introduction

• Effective in the treatment of all strains of
bacteria affected by penicillins and some
strains resistant to penicillins
• Classification: Divided into first-, second-,
third-, and fourth-generation drugs (refer to
next slides please)
• Uses: Treat urinary tract infections; skin
infections; hospital-acquired pneumonias

Cephalosporins
• First generation Cephalosporins
– Cefazolin (Ancef) – MSSA, Surgical Prophylaxis
– Cephalexin – Pharyngitis, impetigo, cellulitis, mild
diabetic foot ulcers
• Second generation Cephalosporins
– Cefoxitin
– Cefotetan


Cephalosporins
• Third generation Cephalosporins
– Ceftriaxone – meningitis, pneumonnia, gonorrhae
– Ceftazidime – Pseudomonas, Pyelonephritis
• Fourth generation Cephalosporins
– Cefepime – febrile neutropenia


Cephalosporins: Actions

• Exert bactericidal effect
– Have a beta-lactam ring
•Targets the bacterial cell wall, making it
defective and unstable


Cephalosporins: Uses
• Used to treat infections caused by bacteria
– Respiratory
– Ear
– Bone/joint)
– Genitourinary tract infections
• Culture and sensitivity tests: Help determine
best antibiotic to control an infection
• Used throughout peri-operative period

Cephalosporins: Adverse Reactions

• Gastrointestinal reactions
– Nausea; vomiting; diarrhea
• Administration route reactions
– Intramuscularly; intravenously


Cephalosporins: Adverse Reactions
(cont’d)
• Other body system reactions
– Headache; dizziness; malaise; heartburn;
fever; nephrotoxicity; hypersensitivity;
aplastic anemia; toxic epidermal
necrolysis
– Nursing alert
•Allergy: Approximately 10% of people
allergic to penicillin are also allergic to
cephalosporins

Cephalosporins: Contraindications and
Precautions

• Contraindicated in patients allergic to
cephalosporins or penicillins
• Used cautiously in patients with:
– Renal disease; hepatic impairment;
bleeding disorder; pregnancy; known
penicillin allergy


Cephalosporins: Interactions

Drug Common use Effect of
interaction

Aminoglycosides Anti-infective Increased risk
for
(Gentamicin) nephrotoxicity
Oral Blood thinner Increased
anticoagulants risk for
bleeding
(Coumadin)

Cephalosporins: Interactions (cont’d)
• Nursing alert
– Disulfiram-like reaction: If alcohol
consumed within 72 hours (nausea,
vomiting)
– Symptoms: Flushing; throbbing;
respiratory problems; vomiting;
sweating; chest pain; hypotension
– Severe reaction: Arrhythmias and
unconsciousness

Nursing Process: Assessment
• Preadministration assessment
– Obtain general health history before first
dose
– Check for need of cultures and sensitivity
tests


Nursing Process: Assessment (cont’d)
• Ongoing assessment
– Evaluate response to therapy
– If infection worsens, notify primary health
care provider
– Check for signs and symptoms of
infection


Nursing Process: Nursing Diagnoses
• Risk for impaired skin integrity
• Risk for impaired comfort
• Impaired urinary elimination
• Diarrhea


Nursing Process: Planning
• The expected outcome includes an optimal
response to therapy
– Management of adverse drug reactions
– Understanding of and compliance with the
prescribed treatment regimen


Nursing Process: Implementation
• Promoting an optimal response to therapy
– Oral administration: Question patient
regarding allergy to cephalosporins or
penicillins; shake oral suspensions
– Administer around the clock
– Administer orally at least 1 hour before or
2 hours after meals
– If patient experiences GI upset:
Administer with food


Nursing Process: Implementation (cont’d)
(cont’d)
– Parenteral administration
•Read the manufacturer’s instructions –
injection; storage; life; methods;
precautions
– Methods of infusing cephalosporin: Direct,
intermittent, or continuous IV infusion


(cont’d)
– Nursing alert
•Inspect the needle insertion site for
signs of extravasation or infiltration
•Inspect several times a day for signs of
redness – phlebitis or thrombophlebitis


• Promoting an optimal response to therapy (cont’d)
– Gerontologic alert
• When given IM – inject the drug into a large
muscle mass
• Assess muscle for atrophy in nonambulatory
patient or if paralysis is present
• Warn patient about stinging or burning
sensation at site


(cont’d)
– Chronic care alert
•People with phenylketonuria need to be
aware that the oral suspension cefprozil
contains phenylalanine
•Interferes with urine test results –
diabetic patients


• Monitoring and managing patient needs
– Impaired skin integrity
• Inspect skin every 4 hours for redness, rash,
or lesions and report when found
• Emollients or antipyretic creams may be
prescribed; avoid harsh soaps and perfumed
lotions; avoid rubbing the area
• Warn about wearing rough or irritating
clothing


(cont’d)
– Impaired comfort
•Increased fever; take vital signs every
4 hours; administer an antipyretic drug
or change drug or dosage as prescribed


(cont’d)
– Impaired urinary elimination
•Nephrotoxicity may occur; measure and
record the fluid intake and output;
report changes



(cont’d)
– Impaired urinary elimination: Gerontologic
alert
•Nephrotoxic effects / renal impairment:
Monitor blood creatinine levels
•Diarrhea: Check the patient’s stools and
reports any presence of blood and mucus
immediately

• Educating the patient and family
– Review dosage regimen with the patient and
family
– Advise to complete full therapy and adhere to
timing
– Explain to shake oral suspensions and keep
refrigerated
– Advise to avoid alcohol and take with food if GI
upset

Nursing Process: Evaluation
• Therapeutic effect achieved
• Urine output at least 500 mL daily; diarrhea
not experienced
• Patient and family demonstrate
understanding of drug regimen
• Patient verbalizes importance of compliance
with prescribed therapeutic regimen
• Skin is free of inflammation, irritation, or
ulcerations

End of Presentation


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