McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 9  Antibiotics

• Take this drug on an empty stomach, 1 hour before or 2 to 3 hours after meals, with a full glass of water. • Do not take this drug with food, dairy products, iron preparations or antacids. • Take the full course of this antibiotic. Do not stop taking it if you feel better. • Do not save doxycycline; outdated products can be very toxic to your kidneys. • Oral contraceptives may become ineffective while you are taking this drug. If you rely on oral contraceptives for birth control, use a second form of contraceptive while on this drug.

• You may experience stomach upset or diarrhoea. • You may develop other infections in your mouth or vagina. (If this occurs, consult with your healthcare provider for appropriate treatment.) • Tell any healthcare provider who is caring for you that you are taking this drug. • Keep this, and all medications, out of the reach of children and pets. • Report any of the following to your healthcare provider: changes in colour of urine or stool, severe cramps, difficulty breathing, rash or itching, yellowing of the skin or eyes. ■ ■ Ensure that the person receives the full course of the tetracycline as prescribed. The oral drug should be taken on an empty stomach 1 hour before or 2 hours after meals with a full 150 mL glass of water. Concomitant use of antacids or salts should be avoided because they interfere with drug absorption. These precautions will increase drug effectiveness and decrease the development of resistant strains of bacteria. ■ ■ Discontinue the drug immediately if hypersensitivity reactions occur to avoid the possibility of severe reactions. ■ ■ Provide small, frequent meals as tolerated, frequent mouth care and ice chips or sugarless lollies to suck if stomatitis and sore mouth are problems to relieve discomfort and ensure nutrition. Also provide adequate fluids to replace fluid lost with diarrhoea. ■ ■ Monitor for signs of superinfections to arrange for treatment as appropriate. ■ ■ Encourage the person to apply sunscreen and wear appropriate clothing to protect exposed skin from skin rashes and sunburn associated with photosensitivity reactions. ■ ■ Instruct the person about the appropriate dosage regimen, how to take the oral drug and possible side effects to enhance knowledge about drug therapy and to promote compliance. –– Try to drink a lot of fluids and maintain nutrition (very important) even though nausea, vomiting and diarrhoea may occur. –– Use a barrier contraceptive method because oral contraceptives may not be effective while a tetracycline is being used. –– Know that superinfections may occur. Appropriate treatment can be arranged through the healthcare provider. –– Use sunscreens and protective clothing if sensitivity to the sun occurs. –– Know when to report dangerous adverse effects, such as difficulty breathing, rash, itching, watery ■ ■ Provide the following teaching:

Care considerations for people receiving tetracyclines

Assessment: History and examination

■ ■ Assess for possible contraindications or cautions : known allergy to any tetracycline or to tartrazine in certain oral preparations because cross-sensitivity often occurs (obtain specific information about the nature and occurrence of allergic reactions); any history of renal or hepatic disease that could interfere with metabolism and excretion of the drug and lead to increased toxicity ; current pregnancy or breastfeeding status because of the potential for adverse effects to the fetus or infant ; and age because of the risk of damage to bones and teeth. ■ ■ Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy. ■ ■ Examine the skin for any rash or lesions to provide a baseline for possible adverse effects. ■ ■ Perform culture and sensitivity tests at the site of infection to ensure that this is the appropriate drug for this person. ■ ■ Note respiratory status to provide a baseline for the occurrence of hypersensitivity reactions. ■ ■ Evaluate renal and liver function test reports, including BUN and creatinine clearance, to assess the status of renal and liver functioning, which helps to determine any needed changes in dose. ■ ■ Check culture and sensitivity reports to ensure that this is the drug of choice for this person. Arrange for repeated cultures if response is not as anticipated. ■ ■ Monitor renal and liver function test results before and periodically during therapy to arrange for a dose reduction as needed. Implementation with rationale