Pregnancy Category: C
ClassificationTherapeutic: anti infectives
Treatment of skin/skin structure infections due to susceptible bacteria.
Binds to bacterial cell wall resulting in cell death.
Bactericidal action against susceptible bacteria with resolution of infection.Active against Staphylococcus aureus (including methicillin-susceptible and resistant strains), Streptococcus agalactiae, Streptococcus anginosus (including S. anginosus, S. intermidius and S. constellatus) and Streptococcus pyogenes.
Absorption: IV administration results in complete bioavailability.
Distribution: Penetrates tissues and fluids.
Metabolism and Excretion: 33% eliminated unchanged in urine, 12% eliminated as inactive metabolite, 20% excreted in feces.
Half-life: 346 hr.
Time/action profile (blood levels)
|IV||unknown||end of infusion||1 wk|
Contraindicated in: Hypersensitivity.
Use Cautiously in: Renal impairment (dose adjustment required for CCr <30 mL/min; Moderate to severe hepatic impairment; Geriatric: Consider age-related decrease in renal function; Obstetric: Use during pregnancy only if potential benefit justifies potential risk to the fetus; Lactation: Use cautiously if breastfeeding; Pediatric: Safe and effective use in children has not been established.
Adverse Reactions/Side Effects
Central nervous system
- diarrhea including Clostridium difficile (life-threatening)
- ↑ ALT
- hypersensitivity reactions including anaphylaxis (life-threatening)
- infusion reactions including “Red-Man Syndrome”
Drug-Drug interactionNone noted.
Intravenous (Adults) 1000 mg followed one wk later by 500 mg.
Renal ImpairmentIntravenous (Adults) CCr <30 mL/min—750 mg followed one wk later by 375 mg.
Lyophylized powder for intravenous injection (requires reconstitution and further dilution): 500 mg single-use vial
- Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
- Obtain specimens for culture and sensitivity prior to therapy. First dose may be given before receiving results.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to 2 mo following cessation of therapy.
- Monitor for infusion reactions (Red-man syndrome — flushing of upper body, urticaria, pruritus, rash). May resolve with stopping or slowing infusion.
- Lab Test Considerations: Monitor hepatic function tests. May cause ↑ ALT, AST, and bilirubin.
Potential Nursing DiagnosesRisk for infection (Indications)
Diarrhea (Adverse Reactions)
- Intermittent Infusion: Reconstitute with 25 mL of Sterile water in each 500 mg vial. Alternate gentle swirling and inverting to avoid foaming, until completely dissolved. Do not shake. Reconstituted vial contains a clear colorless to yellow solution. Do not administer solutions that are discolored or contain particulate matter. Transfer reconstituted solution into D5W. Concentration: 1 mg/mL to 5 mg/mL. Discard unused solution. May be refrigerated or kept at room temperature; do not freeze. Infuse within 48 hr of reconstitution. Do not administer solutions containing particulate matter.
- Rate: Infuse over 30 min.
- Y-Site Incompatibility: Do not infuse with other medications or electrolytes. Saline solutions may cause precipitation. Flush line before and after infusion with D5W.
- Instruct patient to notify health care professional if signs and symptoms of hypersensitivity reactions (rash, hives, dyspnea, facial swelling) occur.
- Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professionals
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- Advise female patients to use effective contraception during therapy and to notify health care professional if pregnancy is suspected or if breastfeeding.
- Instruct the patient to notify health care professional if symptoms do not improve.
- Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.