Fluoroquinolone patients

Infection treatment and prophylaxis Victims of radiological attacks are at risk for infection due to disruption of the skin or mucosal barriers and due immune suppression from a reduction in lymphohematopoietic cells (2). Studies in irradiated dogs have revealed a reduction in mortality following antibiotic administration. During the neutropenic phase, control of infections is especially important. Patients who are not neutropenic shonld receive antibiotics directed at specific foci of infection cansed by the most likely pathogens. On the other hand, nentropenic patients may benefit from prophylaxis with fluoroquinolones. Patients with severe nentropenia (absolute neutrophil count <0.500x10 cells L ) shonld receive prophylaxis with broad-spectrnm antibiotics while the nentropenia lasts. Prophylaxis may include (2) ... 

Fluoroquinolones in the treatment of pneumonia in elderly patients 99MI34. 

Discuss preadministration and ongoing assessment activities the nurse should perform on the patient taking the fluoroquinolones and aminoglycosides. 

List some nursing diagnoses particular to a patient receiving a fluoroquinolone or aminoglycoside. 

Discuss ways to promote an optimal response to therapy, how to manage adverse reactions, and important points to keep in mind when educating patients about the use of a fluoroquinolone or aminoglycoside. 

The fluoroquinolones are contraindicated in patients with a history of hypersensitivity to the fluoroquinolones, in children younger than 18 years, and in pregnant women (Pregnancy Category C). These drugs also are contraindicated in patients whose life-styles do not allow for adherence to the precautions regarding photosensitivity. 

The fluoroquinolones are used cautiously in patients with renal impairment or a history of seizures, in geriatric patients, and in patients on dialysis. 

Monitoring and Managing Adverse Drug Reactions A variety of adverse reactions can be seen with the administration of the fluoroquinolones or aminoglycosides. The nurse observes die patient, especially during the first 48 hours of tiierapy. It is important to report the occurrence of any adverse reaction to the primary health care provider before die next dose of the drug is duei If a serious adverse reaction such as a hypersensitivity reaction, respiratory difficulty, severe diarrhea, or a decided drop in blood pressure occurs, the nurse contacts die primary health care provider immediately. 

Initiation of prophylactic antibiotics is recommended during acute variceal bleeding this is typically done with an oral fluoroquinolone (e.g., ciprofloxacin 500 mg twice daily x 7 days) or an IV third-generation cephalosporin. Prophylactic antibiotic therapy reduces in-hospital infections and mortality in patients hospitalized for variceal bleeding.44... 

Common adverse effects of calcium salts include constipation, bloating, cramps, and flatulence. Changing to a different salt form may alleviate symptoms for some patients. Calcium salts may reduce the absorption of levothyroxine, iron and some antibiotics, such as tetracycline and fluoroquinolones. 

The comorbid conditions that can affect therapy and outcomes in patients with CAP include diabetes mellitus, COPD, congestive heart failure, and renal failure.27,28 If the patient has not received antibiotics in the past 3 months, then clarithromycin or azithromycin is the recommended first-line therapy by the IDSA. If the patient has received antibiotics in the last 3 months, then the IDSA recommends using either a respiratory fluoroquinolone alone or a combination of an oral P-lactam and an advanced macrolide/azalide (e.g., clarithromycin/azithromydn). The ATS recommends combination therapy or monotherapy with a respiratory fluoroquinolone for all patients with comorbidities. The p-lactam agents recommended include high-dose amoxicillin, high-dose amoxicillin-clavulanate, cefpodoxime, cefprozil, and cefuroxime. 

Failure to respond to initial therapy after 3 days requires patient reevaluation to consider changing therapy to cover pathogens not treated with the initial choice. Antibiotics traditionally have been given for at least 10 to 14 days, with up to 21 days needed for resolution in some patients.31 Recent data suggest that 5-day treatment courses of some fluoroquinolones and telithromycin are as effective as longer courses in adults with... 

The most effective agent for the treatment (and prophylaxis) of human and animal bite-wound infections is amoxicillin-clavulanate. Alternatives for patients with significant penicillin allergies include either a fluoroquinolone or TMP-SMX in combination with clindamycin. Doxycycline also may be prescribed. The durations of prophylaxis and treatment generally are 3 to 5 and 10 to 14 days, respectively.3... 

Patients with complicated typhoid fever (i.e., metastatic foci, ileal perforation, etc.) should receive parenteral therapy with ciprofloxacin 400 mg twice daily or ceftriaxone 2000 mg once daily. Antimicrobial therapy can be completed with an oral agent after initial control of the symptoms of typhoid fever. In persons with AIDS and a first episode of Salmonella bacteremia, a longer duration of antibiotic therapy (1-2 weeks of parenteral therapy followed by 4 weeks of oral fluoroquinolone) is recommended to prevent relapse of bacteremia. 

Treatment for septic patients with hospital-acquired, ventilator-acquired, and health care-associated pneumonia is dependent on risk factors for multi-drug resistant (MDR) organisms (Fig. 79-2). Recommended treatment for patients with no MDR risk factors are third-generation cephalosporins, fluoroquinolones, ampicillin-sulbactam, or ertapenem (see Table 79-3).35 Recommended treatment for patients with MDR risk factors are P-lactam/p-lactamase inhibitors (piperacillin-tazobactam), antipseudomonal cephalosporin, or carbapenem, plus an aminoglycoside, plus vancomycin or linezolid (see Table 79-3).35 If an aminoglycoside is undesirable, a antipseudomonal fluoroquinolone may be utilized with a P-lactam/p-lactamase inhibitor. 

Prophylactic antimicrobials should be started within an hour of the first incision to optimize patient outcomes. Exceptions to this include vancomycin and fluoroquinolones. 

Low-risk oral regimen Ciprofloxacin 750 mg PO every 12 hours and amoxicillin-clavulanate 500-875 mg PO every 12 hours For patients with MASCC score of 21 or greater not receiving fluoroquinolone prophylaxis. 

In a recent study, the bacterial populations contaminating the upper gut in SIBO patients and their antibiotic susceptibility were determined. Amoxicillin-clavulanic acid and cefoxitin were effective against >90% of anaerobic strains, while aminopenicillins, cephalosporins and cotrimoxazole were effective against the microaerophilic population. Erythromycin, clindamycin and rifampicin were ineffective. Data on metronidazole and fluoroquinolones are not available [32]. 

The answer is a. (Katzung, p 800.) Fluoroquinolones are not recommended in patients less than 18 years old. They have a tendency to damage growing cartilage and cause arthropathy The arthropathy is generally reversible. Tendinitis may occur, and in rare instances in adults, this finding may lead to tendon ruptures. 

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