C H A P T E R 9
Antibiotics
117
• 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• Do not save doxycycline; outdated products can be very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.
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.
Implementation with rationale
■
■
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.
■
■
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.
■
■
Provide the following teaching:
–– 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
