(CEPHALOSPORINS)

(Cefazolin) 1st

MECHANISM OF ACTION

- It is a first - generation cephalosporin antibiotic. It is active against s. aureus, streptococcus, E.

coli, proteus and klebsiella. It acts by inhibiting the cell wall synthesis of the bacteria. It is
available in the injectable form and used in the treatment of skin, soft tissue infections,
respiratory tract infections and bone infections.

INDICATIONS/CONTRAINDICATIONS

Indication

- Infection with gram – positive cocci (MSSA)

- Community – Acquired Pneumonia
- Bacterial endocarditis

Contraindication

- Documented hypersensitivity

ADVERSE EFFECT

- Anorexia, diarrhea, eosinophilia, fever, increased transaminases, leukopenia, nausea and

vomiting, neutropenia, oral candidiasis, pain at injection site, seizure

NURSING RESPONSIBILITIES

- Monitoring intake and output, as well as renal function tests for nephrotoxicity.
- Being aware that discomfort may occur with IM injection.
- Understanding that cefazolin binds to bacterial cell membranes and inhibit cell wall synthesis.
- Being alert for superinfection symptoms such as fever, committing, diarrhea, anal/genital
pruritus, and oral mucosal changes.
(Cephalexin)

MECHANISM OF ACTION

- Cephalexin is a first-generation cephalosporin antibiotic. Beta lactam and dihydrothiazide are

both parts of cephalosporins. Cephalosporins are more resistant to the effects of beta lactamase
than penicillin’s are. Cephalexin stops the bacterial cell walls from forming, which ultimately
leads to cell death.

INDICATIONS/CONTRAINDICATIONS

Indication

- Cephalexin is recommended for the treatment of specific infections brought on by bacterially

susceptible agents. These infections include otitis media, bone infections, respiratory tract
infections, skin and skin structure infections, and genitourinary tract infections.

Contraindication

- Cephalexin is contraindicated in patients with known allergy to the cephalosporin group of

antibiotics.

ADVERSE EFFECT

- Nausea and Vomiting, Abdominal pain, diarrhea, confusion, fatigue, arthritis, urticaria

NURSING RESPONSIBILITIES

- Monitor bowel function and infection

- Be aware of the risk of seizures, phlebitis at IV site, and anaphylaxis.
- Give drug with meals and arrange for small, frequent meals if GI complications occur.
(Cefuroxime) 2nd

MECHANISM OF ACTION

- The second-generation cephalosporin cefuroxime inhibits the final transpeptidation step of

peptidoglycan synthesis in the bacterial cell wall, interrupting cell wall biosynthesis and arresting
cell wall assembly, leading to bacterial cell lysis and death. Cefuroxime binds to one or more of
the penicillin-binding proteins (PBPs).

INDICATIONS/CONTRAINDICATIONS

Indication

- Cefuroxime is a cephalosporin antibiotic that is indicated for the treatment of skin infections,
urinary tract infections, gonorrhea, impetigo, and early Lyme disease.

Contraindication

- Cephalexin is contraindicated in patients with known allergy to the cephalosporin group of

antibiotics.

ADVERSE EFFECT

- Upset stomach or throwing up, Diarrhea, Bad taste in your mouth, rash, and urticaria.

NURSING RESPONSIBILITIES

- Assessing patient for signs and symptoms of infection and hypersensitivity.

- Monitoring LFTs, renal test, and blood counts.
- Shaking suspension well before each use and verifying patient’s identity.
(Cefoxitin)

MECHANISM OF ACTION

- Inhibits cell wall synthesis, promoting osmotic instability; generally bactericidal.

INDICATIONS/CONTRAINDICATIONS

Indication

- Treatment of the following infections caused by susceptible organisms: respiratory tract

infections, skin and skin structure infections, bone and joint infections, urinary tract infection
and intra-abdominal and gynecologic infections.

Contraindication

- Hypersensitivity to cefoxitin, any component of the formulation, or other cephalosporins.

ADVERSE EFFECT

- Diarrhea, Anaphylaxis, dyspnea, fever, hemolytic anemia, hypotension, nausea, increased blood
urea nitrogen, increased serum creatinine, and nephrotoxicity.

NURSING RESPONSIBILITIES

- Assessing the patient for signs and symptoms of infection prior to and throughout therapy.
- Instructing the patient to report signs of hypersensitivity.
- Obtaining a history of determine previous use of and reactions to penicillin’s or cephalosporin
before initiating therapy.
(Ceftriaxone) 3rd

MECHANISM OF ACTION

- A third-generation cephalosporin, ceftriaxone acts as a bactericide against both gram positive

and gram-negative organisms by preventing the production of bacterial cell walls. Ceftriaxone
suppresses cross-linking of the bacterial cell wall by inhibiting transpeptidase. Different types of
specialized binding proteins, such as transpeptidase and related proteins, have an affinity for
cephalosporins like ceftriaxone.

INDICATIONS/CONTRAINDICATIONS

Indications

- Ceftriaxone is used to treat infections caused by susceptible organisms in the respiratory system,
skin, soft tissues, urinary tract, and ear.

Contraindication

- Ceftriaxone should not be used by patients with allergy to ceftriaxone or other cephalosporin
class antibacterials, penicillins, or other beta-lactam antibacterials.

ADVERSE EFFECT

- Injection site inflammation, rash, pruritus, fever, eosinophilia, urticaria, anaphylaxis, colitis.

NURSING RESPONSIBILITIES

- Determine history of hypersensitivity reactions to cephalosporins and penicillins and history of

other allergies, particularly.
- Monitor for manifestations of hypersensitivity.
- Inspect injection sites for induration and inflammation.
(Cefpodoxime)

MECHANISM OF ACTION

- Cefpodoxime's ability to block the formation of cell walls is what gives it its bactericidal
properties. Cefpodoxime's active metabolite preferentially binds to penicillin binding protein 3
and prevents the synthesis of peptidoglycan, the main component of bacterial cell walls.

INDICATIONS/CONTRAINDICATIONS

Indication

- Indicated for the treatment of patients with mild to moderate infections caused by susceptible
strains of the designated microorganisms.

Contraindication

- Contraindicated with allergy cephalosporin or penicillin. Use cautiously in patients with history
of colitis, and those with renal failure, lactation, and or pregnancy.

ADVERSE EFFECT

Chest pain, constipation, diarrhea, nausea, vomiting, anorexia, rash, dryness, and anemia

NURSING RESPONSIBILITIES

- Administer the right drug with the right dose at the right time.
- Regulate the IVF with the line prescribed flowrate.
- Monitor LFTs, renal function test, and blood counts
- Do not stop the therapy without notifying the physician.
(Cefepime) 4th

MECHANISM OF ACTION

- A bactericidal cephalosporin, cefepime disrupts bacterial cell walls by binding to and inhibiting
transpeptidases known as penicillin-binding proteins (PBPs), which are enzymes involved in the
last stages of peptidoglycan layer synthesis. This action is like that of other beta-lactam
antibiotics.5,6 Cefepime disrupts bacterial cell walls.

INDICATIONS/CONTRAINDICATIONS

Indication

- Cefepime is used for the treatment of febrile neutropenic individuals as well as pneumonia
brought on by susceptible bacteria. Cefepime is also used to treat adults with complicated intra-
abdominal infections brought on by susceptible bacteria, as well as uncomplicated and
complicated urinary tract infections (including pyelonephritis), uncomplicated skin and skin
structure infections, and complicated skin and skin structure infections.

Contraindication

- Contraindicated in patients with Diarrhea caused by C. difficile infection, renal impairment

administered unadjusted doses, Known immediate hypersensitivity reactions to cefepime or
other cephalosporins, penicillins or other beta-lactam antibacterial drugs.

ADVERSE EFFECT

- Stomach cramps, bleeding gums, swelling of foot/leg, bloody diarrhea, blurred vision, black or
tarry stool.

NURSING RESPONSIBILITIES

- Monitoring the patient’s renal function, blood pressure, and blood culture results.
- Educating the patient about the possible side effects of cefepime, such as rash, diarrhea,
headache, and nausea.
- Checking the patient’s pregnancy and lactation status, as cefepime can be prescribed to a
pregnant or lactating woman only if the benefit outweighs the risk.
ANTI INEFFECTIVE

(Rifamycin)

MECHANISM OF ACTION

- Rifamycin have a unique mechanism of action, selectively inhibiting bacterial DNA dependent
RNA polymerase. Rifampin and other rifamycin’s are typically used in combination with other
antibacterial drugs due to their high frequency of resistance.

INDICATIONS/CONTRAINDICATION

Indications

- Rifamycin is indicated for the treatment of adult patients with travelers' diarrhea caused by
noninvasive strains of E. coli.

Contraindication

- Contraindications Patients who have a history of hypersensitivity to rifamycin, any of the other
antimicrobials in the rifamycin class (such as rifaximin), or any of the ingredients in the
formulation of rifamycin sodium should not take rifamycin sodium.

ADVERSE EFFECT

- Abdominal discomfort, acute kidney injury, appetite decreased, dyspnea, eosinophilia,

Agranulocytosis, adrenal insufficiency.

NURSING RESPONSIBILITIES

- Providing information about storage and disposal of the drug.

- Monitoring for adverse reactions, such as dehydration, hepatic encephalopathy, or diarrhea
- Instructing patient not to skip or double dose.
(Streptomyces)

MECHANISM OF ACTION

- When less toxic medications are ineffective, streptomycin may also be used to treat a range of
different infections brought on by susceptible strains of aerobic bacteria.

INDICATION/CONTRAINDICATION

Indication

- Streptomycin is an aminoglycoside antibiotic indicated for the treatment to severe infections

caused by susceptible strains of mycobacterium tuberculosis and other bacteria.

Contraindications

- Hypersensitivity to streptomycin or other aminoglycosides; severe hypersensitivity to sulfites;

Concomitant live bacterial vaccines.

ADVERSE EFFECT

- Dark urine, deafness, dry mouth, bleeding gums, blurred vision, itching, loss of appetite, thirst,
skin rash, fast heartbeat, nosebleed, pinpoint red spots on the skin.

NURSING RESPONSIBILITIES

- Ensure adequate hydration of patient before and during the therapy.

- Monitor for hearing changes.
- Note that this drug can only be given by injection.
(Hydrazide)

MECHANISM OF ACTION

INDICATION/CONTRAINDICATION

Indication

ADVERSE EFFECT

- Dark urine, loss of appetite, nausea or vomiting, numbness, tingling, burning, clumsiness,
blurred vision, skin rash, mental depression.

NURSING RESPONSIBILIITIES

- Monitor the client’s blood pressure and pulse frequently during initial dosage adjustment and
periodically throughout therapy.
- Monitor frequency of prescription refills to determine adherence.
- Report significant changes to the physician.