C H A P T E R 9
Antibiotics
111
KEY POINTS
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The penicillins are one of the oldest classes of
antibiotics, and many resistant strains have
developed. The penicillinase-resistant antibiotics were
created to combat bacteria that produce an enzyme
to destroy the penicillin. Penicillins are used to treat
a broad spectrum of infections, including respiratory
tract infections and UTIs.
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Monitor the person on penicillin for nausea,
vomiting, diarrhoea, superinfections and the
possibility of hypersensitivity reactions.
KEY POINTS
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■
Monitor renal function tests before and
periodically during therapy
to arrange for dose
reduction as needed.
■
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Ensure that the person receives the full course of
the penicillin as prescribed, in doses around the
clock,
to increase effectiveness.
■
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Explain storage requirements for suspensions
and the importance of completing the prescribed
therapeutic course even if signs and symptoms have
disappeared,
to increase the effectiveness of the
drug and decrease the risk of developing resistant
strains.
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Monitor the site of infection and presenting signs
and symptoms (e.g. fever, lethargy) throughout
the course of drug therapy.
Failure of these signs
and symptoms to resolve may indicate the need to
reculture the site.
Arrange to continue drug therapy
for at least 2 days after the resolution of all signs
and symptoms
to reduce the risk of development of
resistant strains.
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Provide small, frequent meals as tolerated, ensure
frequent mouth care and offer ice chips or sugarless
lollies to suck if stomatitis and sore mouth
are problems
to relieve discomfort and ensure
nutrition.
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Provide adequate fluids
to replace fluid lost with
diarrhoea.
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Monitor the person for any signs of superinfection
to arrange for treatment if superinfections occur.
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Monitor injection sites regularly, and
provide
warm compresses and gentle massage to injection
sites if they are painful or swollen.
If signs of
phlebitis occur, remove the IV line and reinsert it
in a different vein to continue the drug regimen.
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Instruct the person regarding the appropriate
dosage regimen and possible adverse effects
to
enhance knowledge about drug therapy and
promote compliance.
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Provide the following teaching:
–– Try to drink a lot of fluids and to maintain
nutrition (very important) even though nausea,
vomiting and diarrhoea may occur.
–– Report difficulty breathing, severe headache,
severe diarrhoea, dizziness, weakness, mouth
sores and vaginal itching or sores to a healthcare
provider. Box 9.5 contains a teaching checklist
for penicillins.
Evaluation
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Monitor person’s response to the drug (resolution
of bacterial infection).
■
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Monitor for adverse effects (GI effects; local
irritation, phlebitis at injection and IV sites;
superinfections).
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Evaluate the effectiveness of the teaching plan
(person can name the drug, dosage, possible
adverse effects to expect and specific measures to
help avoid adverse effects).
■
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Monitor the effectiveness of comfort and safety
measures and compliance with the therapeutic
regimen.
Penicillins
• The penicillins are used to help destroy specific
bacteria that are causing infections in the body.They
are effective against only certain bacteria; they are not
effective against viruses (such as cold germs) or other
bacteria.To clear up a bacterial infection, the penicillins
must act on the bacteria over a period of time, so it
is very important to complete the full course to avoid
recurrence of the infection.
• The drug should be taken on an empty stomach with a
full 150-mL glass of water—1 hour before meals or 2 to
3 hours after meals is best. Do not use fruit juice, soft
drinks or milk to take your drug, because these foods
may interfere with its effectiveness. (This does not
apply to amoxyicillin or penicillin V.)
• Common effects of these drugs include stomach upset,
diarrhoea, changes in taste and change in the colour
of the tongue. Small, frequent meals may help. It is
important to try to maintain good nutrition.These
effects should go away when the drug is stopped.
• Report any of the following to your healthcare
provider: hives, rash, fever, difficulty breathing, severe
diarrhoea.
• Tell any doctor, nurse, or other healthcare provider that
you are taking this drug.
• Keep this drug and all medications out of the reach of
children and pets.
• Do not share this drug with other people and do not use
this medication to self-treat other infections.
• It is very important that you complete the full course
of your prescription, even if you feel better before you
finish it.
Individual and family teaching
BOX 9.5
