DRUG INFORMATION CENTER.pdf

HIWOT FANA COMPREHENSIVE SPECIALIZED HOSPITAL
DRUG AND POISON INFORMATION SERVICE (DPIS)
PREPARED BY:- SALAHADIN MOHAMMED (B.PHARM)
APRIL, 2022
HARAR, ETHIOPIA

2 | P a g e
Cefazolin (Systemic) Drug Monograph
Introductory Information
Antibacterial; β-lactam antibiotic; first generation antibiotic.
Chemistry:
Class : First Generation Cephalosporins
Brands*: Ancef ®, Kefzol®, Zolicef®
Generic Name: Cefazolin Sodium
Preparation: Injection, powder for solution: 500mg and 1, 5, 10 and 20 g
various (Rx)
CAS Number: 27164-64-1
Uses:
Biliary Tract Infections
Treatment of biliary tract infections caused by susceptible Escherichia coli,
Klebsiella, Proteus mirabilis, Staphylococcus aureus, or various Streptococci.
Bone and Joint Infections
Treatment of bone and joint infections caused by susceptible S. aureus.
Endocarditis
Treament of endocarditis caused by Streptococcus pyogenes. AHA
recommends cefazolin as an alternative for treatment of staphylococcal

3 | P a g e
endocarditis or endocarditis caused by viridans streptococci, S. bovis, S.
pneumonia, S. pyogenes, or groups B, C, and G streptococci in penicillin-
allergic individuals; should not be used in those with immediate-type penicillin
hypersensitivity.
Alternative for prevention of α-hemolytic (viridans groups) streptococcal
endocarditis in individuals undergoing certain dental or respiratory upper
respiratory tract procedures who have cardiac conditions that put them in
highest risk. Oral amoxacillin is usual drug of choice for such prophylaxis;
cefaolin (or ceftriaxone) is an alternative in penicillin-allergic individuals or
when an oral anti-infective cannot be used. Should not be used in those with
immediate-type penicillin hypersensitivity. Consult most recent AHA
recommendations for specific information on which cardiac conditions are
associated with highest risk of endocarditis and which requires and which
procedures require prophylaxis.
Respiratory Tract Infections
Treatment of respiratory tract infections caused by susceptible S. pneumniae,
S. pyogenes (group A β-hemolytic streptococci), S. aureas (including penicillin-
resistant strains), Klebsiella, or Haemophilus influenza.
Septicemia
Treatment of septicemia caused by susceptible S. pneumoniae,S. aureas
(including penicillinase-producing strains), E. coli, or P. mirabilis.
Skin and Skin Structure Infections
Treatment of skin and skin structure infections caused by S. aureas (including
penicillinase-producing strains), S. pyogenes,or other streptococci.
Urinary Tract Infections (UTIs) and Urogenital Infections
Treatment of UTIs caused by susceptible E. coli, Klebsiella, P. mirabilis, some
strains of enterococci.
Prevention of Prenatal Group B Streptococcal Disease

4 | P a g e
Alternative penicillin G or ampicillin for prevention of prenatal group B
streptococcal B streptococcal (GBS) disease (early-onset neonate GBS disease)
in penicillin-allergic pregnant women who do not have immediate-type penicillin
hypersensitivity.
Intrapartum anti-infective prophylaxis to prevent early-onset neonatal GBS
disease is administered to women identified as GBS carriers during routine
prenatal GBS screening performed at 35-37 weeks during the current
pregnancy and to women who have GBS bacteriuria during the current
pregnancy, a previous infant with invasive GBS disease, unknown GBS status
with delivery <37 weeks gestation, amniotic membrane rupture for ≥18 hours,
or intrapartum temperature of ≥380C.
Preoperative prophylaxis
Perioperative prophylaxis in patients undergoing surgical procedures classified
as contaminated or potentially contaminated (e.g. vaginal hysterectomy, high
risk cesarean section, cholesystectomy in high-risk patients) and in those
undergoing surgical procedures in which the development of infection at the
surgical site would represent a serious risk (e.g. cardiac surgery, prosthetic
arthroplasty).
Drug of choice for preoperative prophylaxis for a variety of procedures,
including cardiac, noncardiac thoracic, esophageal, gastroduodenal, biliary
tract, gynecologic and obstetric, head and neck, neurologic, orthopedic, and
vascular surgery.
A drug or regimen with activity against anaerobic bacteria is recommended for
procedures that may involve exposure Bacteriodes fragile or other anaerobic
bowel bacteria (e.g. colorectal surgery, appendectomy). Cefoxitin and cefotetan
are more active than cefazolin against these bacteria; alternatively,
metronidazole can be used in conjunction with cefazolin to provide anaerobic
coverage.
Dosage and Administration

5 | P a g e
Total daily dosages are same for intramascular (IM) and intravenous (IV)
administration.
Mild infections caused by susceptible gram-positive cocci – 250 to 500 mg
every 8 hours.
Moderate-to-severe infections – 500 mg to 1 g every 6 to 8 hours.
Administration
Administer by IV injection or infusion or by deep IM injection.
IV Injection
Reconstitution and Dilution
Reconstitute vials containing 500mg or 1g of cefazolin with 2 or 2.5 mL,
respectively. Then, further dilute reconstituted solution in approximately 5 mL
of sterile water for injection.
Rate of Administration
Inject directly into a vein over a period of 3-5 minutes or slowly into the tubing
of a freely flowing compatible IV solution.
IV Infusion
Reconstitution and Dilution
Reconstitute vials containing 500 mg or 1 g of cefazolin with 2 or 2.5 mL,
respectively, of sterile water for injection to provide solutions containing
approximately 225 or 330 mg/mL, respectively. Then further dilute
reconstituted solution in 50-100 mL of a compatible IV solution.
Reconstitute 10- or 20-g pharmacy bulk packages according to manufacturer’s
directions and then further dilute in a compatible IV solution prior to IV
infusion.
Reconstitute (activate) commercially available duplex® drug delivery system 1
or 2 g of lyophilized cefazolin and 50 mL of dextrose injection in separate
chambers according to the manufacturer’s direction.

6 | P a g e
Thaw commercially available premixed injection (frozen) at room temperature
(250C) or under refrigeration (50C); do not thaw by immersion in a water bath or
by exposure to microwave radiation. A precipitate may have formed in the
frozen injection, but should dissolve with little or no agitation after reaching
room temperature. Discard thawed injection if solution is cloudy or contains an
insoluble precipitate or if container seals or outlet ports are not intact or leaks
are found. Do not use in series connections with other plastic containers, since
such use could result in air embolism from residual air being from the primary
container before administration of fluid from the secondary is complete.
IM Injection
Inject IM deeply into a large muscle mass.
Reconstitution
Reconstitute vials containing 500 mg or 1 g of cefazolin with 2 or 2.5 mL,
respectively, of sterile water injection to provide solution containing
approximately 225 or 330 mg/mL, respectively. Shake well until dissolved.
Dosage
Available as cefazolin Sodium; dosage expressed in terms of cefazolin.
Pediatric Patients
Mild to Moderately Severe Infections
>IV or IM
Children >1 month of age: 25-50 mg/kg daily in 3 or 4 equally divided doses.
Severe Infections
>IV
Children >1month of age: 50-100 mg/kg daily in 3 or 4 equally divided doses.
Endocarditis

7 | P a g e
Treatment of Staphylococcal Endocarditis
IV: 100 mg/kg daily (up to 6 g daily) in 3 or 4 divided doses.
For native valve endocarditis, duration of treatment is 6 weeks (with or without
gentamicin given during the first 3-5 days).
For endocarditis involving prosthetic valves or other prosthetic materials,
duration of treatment ≥6months (with or without rifampin given for ≥6 weeks).
Prevention of Endocarditis in Patients Undergoing Certain Dental or
Respiratory Tract Infections Procedures
IV or IM: a single dose of 50 mg/kg given 0.5-1 hour prior to the procedure.
Preoperative prophylaxis
Cardiac or Cardiothoracic Surgery
IV: 20-30 mg/kg given at induction of anesthesia (within 0.5-1 hour prior to
incision). Some clinicians suggest additional doses of 20-30 mg/kg every 8
hours for up to 72; most clinicians state postoperative doses usually
unnecessary may risk of bacterial resistance.
Neurosurgery
incision).
Head and Neck Surgery
incision) for clean head and neck surgery with placement of prosthesis. For
clean-contaminated head and neck surgery involving incision through oral or
pharyngeal mucosa, 30-40 mg/kg at induction of anesthesia.
GI, Pancreatic, or Biliary Tract Surgery
incision).
Vascular or Orthopedic Surgery

8 | P a g e
incision). Some clinicians suggest additional doses of 20-30 mg/kg every 8
hours for up to 24 hours; most clinicians’ state postoperative doses usually
unnecessary and may increase risk of bacterial resistance.
Adults
Mild Infections Caused by Gram-positive Bacteria
IV or IM
250-500 mg every 8 hours
Moderate to Severe Infections
IV or IM
500 mg-1g every 8 hours
Severe, Life-threatening Infections
IV or IM
1-1.5 g every 6 hours. Dosage up to 12 g daily has been used.
Endocarditis
Treatment of Endocarditis
IV or IM: 1-1.5 g every 6 hours. Dosage up to 12 g daily has been used. AHA
recommends 2g IV every 8 hours for 4-6 weeks for native valve staphylococcal
endocarditis (with or without gentamicin during the first 3-5 days).
Prevention of Endocarditis in Patients Undergoing Certain Dental or Upper
Respiratory Tract Procedures
IV or IM: A single 1-g dose given 0.5-1 hour prior to the procedure.
Respiratory Tract Infections
Pneumococcal pneumonia
IV or IM: 500 mg every 12 hours.

9 | P a g e
Severe, life-threatening infections (e.g, Endocarditis, septicemia) – 1 to 1.5 g
every 6 hours. Rarely, 12g/day have been used.
Septicemia
IV or IM
1-1.5 g every 6 hours. Doses up to 12g daily have been used.
Urinary Tract Infections (UTIs)
Acute Uncomplicated Infections
IV or IM: 1g every 12 hours.
Prevention of Perinatal Group B Streptococcal (GBS) Disease
IV
An initial 2-g dose (at time of labor or rupture membranes) followed by 1 g
every 8 hours until delivery.
Perioperative prophylaxis -
Perioperative: 1 g IV or IM, ½ to 1 hour prior to surgery.
Intraoperative (at least 2 h): 0.5 to 1 g IV or IM during surgery at appropriate
intervals.
Postoperative: 0.5 to 1 g IV or IM every 6 to 8 hours for 24 hours after surgery.
Perioperative prophylaxis
General adult dosage
IV or IM: Manufacturer’s recommend 1 g given 0.5-1 hour prior to surgery; 0.5-
1 g during surgery for lengthy procedures (e.g. ≥2hours); and 0.5-1 g every 6-8
hours for 24 hours postoperatively. Manufacturers also recommend that
prophylaxis be continued for 3-5 days following surgery where the occurrence
of infection may be particularly devastating (e.g. open-heart surgery, prosthetic
arthroplasty).

10 | P a g e
Most clinicians recommend 1-2 g given within 60 minutes of initial incision
and, if surgery is >4 hours or major blood loss occurs, additional intraoperative
doses given 4-8 hours. Postoperative doses usually unnecessary and may
increase risk of bacterial resistance.
Cardiac, cardiothoracic, or Noncardiac Thoracic Surgery
IV: 1-2 g given at induction of anesthesia (within 0.5-1hour prior to incision)
In patients undergoing open-heart surgery, some experts recommend an
additional dose when the patient is removed bypass. For cardiothoracic surgery
and heart and/or lung transplantation, some experts suggest additional 1-g
doses every eight hours for up to 48-72 hours; others state that prophylaxis for
≤24 hours is appropriate. There is no evidence to support continuing
prophylaxis until chest and mediastenal drainage tubes are removed.
Neurosurgery or Head and Neck Surgery
IV: 1-2 g given at induction of anesthesia (within 0.5-1 hour prior to incision).
For clean, contaminated head and neck surgery, some experts suggest 2 g
given at induction of anesthesia and every 8 hours for 24 hours.
GI, Gastroduednal, Colorectal, Pancreatic, or Biliary Tract Surgery
For colorectal surgery, use in conjunction with IV metronidazole.
Vascular or Orthopedic Surgery
Some experts suggest additional 1-g doses every 8 hours for up to 24 hours.
Gynecological and Obstetric Surgery
IV: 1-2 g given at induction of anesthesia (within 0.5-1 hour prior to incision) for
hysterectomy or as soon as possible umbilical cord is clamped for cesarean
section.
Special Populations

11 | P a g e
Hepatic Impairment
No dosage recommendations.
Renal impairment
Dosage adjustments recommended in patients with Clcr<55 mL/minute.
Administer an initial loading dose appropriate for the severity of infection,
followed by dosage based on the degree of renal impairment.
Dosage for Adults with Renal Impairment
Clcr (mL/minute) Dose Frequency
35-54 Full dose ≥8-hours intervals
11-34 50% usual dose Every 12 hours
≤10 50% usual dose Every 18-24 hours
Dosage for Children >1 Month of Age with Renal Impairment
Clcr (mL/minute) Dose Frequency
40-70 60% of usual dose Every 12 hours
Renal function impairment – All reduced dosage recommendations apply after
initial loading appropriate to severity of the infection.

12 | P a g e
Cefazolin Dosage in Renal Function Impairment
Dose
Serum Creatinine
mg (%)
Crcl (ml/min) <1.5 ≥55 Dosage interval (h)
≤1.5 ≥55 250 to 500 500 to 1000 6 to 8
1.6 to 3 35 to 54 250 to 500 500 to 1000 ≥8
3.1 to 4.5 11 to 34 125 to 250 250 to 500 12
≥4.6 ≤10 125 to 250 250 to 500 18 to 24
Children –
Mild to moderately severe infections: A total daily dosage of 25 to 50 mg/kg
(approximately 10 to 20 mg/Ib) in 3 or 4 equal doses.
Severe infections: total daily dosage may be increased to 100 mg/kg (45
mg/Ib).
Cautions
Contradictions
 Known hypersensitivity to cefazolin or other cephalosphorins.
 Hypersensitivity to corn or corn products. Duplex® delivery system
containing lyophilized cefazolin and dextrose injection and premixed
injection (frozen) containing cefazolin in dextrose injection.
Warnings/precautions
Warnings
Superinfection/Clostridium difficile-associated Diarrhea and Colitis
Possible emergence and overgrowth of nonsusceptible organisms, especially
Enterobacter, Pseudomonas, Enterococci, or Candida. Careful observation of
the patient is essential. Institute appropriate therapy if super infection occurs.
Treatment with anti-infectives may permit overgrowth of Clostridium difficile. C.
difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-
associated diarrhea and colitis or pseudomembrenous colitis) has been

13 | P a g e
reported with nearly all anti-infectives, including cefazolin, and may range in
severity from mild diarrhea to fatal colitis.
Consider CDAD if diarrhea develops during or after therapy and manage
accordingly. Careful medical history is necessary since CDAD has been
reported to occur as late as 2 months or longer after anti-infective therapy is
discontinued.
If CDAD is suspected or confirmed, anti-infective therapy not direct against C.
difficile may need to be discontinued. Some mild cases may respond to
discontinuance alone. Manage moderate to severe cases with fluid, electrolyte,
and protein supplementation, anti-infective therapy active against C.difficile
(e.g. oral metronidazole or vancomycin), and surgical evaluation when clinically
indicated.
Sensitivity Reactions
Hypersensitivity Reactions
Possible hypersensitivity reactions such as urticaria, pruritus, rash
(maculopapular, erthymatous, morbiliform), fever and chills, esinophilia, joint
pain or inflammation, edema, erythema, genital and anal pruritus,
angioedema, shock, hypotension, vasodilation, Steven-Johnson syndrome,
erythema multiforme, toxic epidermal necrolysis, exfoliative dermatitis, and
anaphylaxis.
If an allergic reaction occurs, discontinue cefazolin and institute appropriate
therapy as indicated (e.g., epinephrine, corticosteroids, and maintenance of
adequate airway and oxygen).
Cross-hypersensitivity
Partial cross-sensitivity among cephalosporins and other β-lactam antibiotics,
including penicillins and cephamycins.
Prior to initiation of therapy, make careful inquiry concerning previous
hypersensitivity reactions to cephalosporins, penicillins, or other drugs.
Cautious use recommended to individuals hypersensitive to penicillins. Avoid
use in those who have had an immediate-type (anaphylactic) hypersensitivity

14 | P a g e
reaction and administer with caution in those who have had a delayed-type
(e.g., rash, fever, esonophilia) reaction.
General Precautions
History of GI disease
Use with caution in those with a history of GI disease, particularly colitis.
Prolonged PT
Prolonged PT reported with some cephalosporins.
Monitor PT in patients at risk, including those with renal or hepatic impairment,
poor nutritional state, receiving prolonged therapy, or stabilized on
anticoagulant therapy. Administer vitamin K when indicated.
Selection and use of anti-infectives
To reduce the development of drug-resistant bacteria and maintain
effectiveness of cefazolin and other anti-bacterials, use only for treatment or
prevention of infections proven or strongly suspected to be caused by
susceptible bacteria.
When selecting or modifying anti-infective therapy, use results of culture and in
vitro susceptibility testing. In the absence of such data, local epidemiology and
susceptibility patterns when selecting anti-infectives for empiric therapy.
Patients with diabetes
The commercially available duplex® delivery system containing 1g of
lyophilized cefazolin and 50mL of dextrose 4% injection should be used with
caution in patients with overt or known subclinical diabetes mellitus or in
patients with carbohydrate intolerance for any reason.
Sodium content
Contains approximately 48 mg (2mEq) of sodium per g of cefazolin.

15 | P a g e
Specific populations
Pregnancy
Category B.
Lactation
Distributed into milk. Use with caution.
Pediatric Use
Safety and efficacy not established in premature infants or neonates ≤1month
of age.
Geriatric Use
No overall differences in safety and efficacy in those ≥65 years of age
compared with younger adults, but the possibility of increased sensitivity in
some geriatric individuals cannot be ruled out.
Substantially eliminated by kidneys; risk of toxicity may be greater in those with
impaired renal function. Select dosage with caution and consider monitoring
renal function because of age-related decreases in renal function.
Renal Impairment
Possible increased serum concentrations and serum half-life.
Possibility of seizures if inappropriately high dosage used in patients with
impaired renal function.
Use with caution and reduce dosage.
Common adverse effects
GI effects (diarrhea, nausea, vomiting, stomach cramps, oral candidiasis),
hypersensitivity reactions.
Interactions
Specific Drugs and Laboratory Tests

16 | P a g e
Drug Interactions Comments
Nephrotoxic Drugs Potential for increased
risk of nephrotoxicity
Avoid concomitant use of
nephrotoxic drugs (e.g.,
aminoglycosides,
colistin, polymixin B,
vancomycin) if possible
Probenecid Decreased renal
clearance and increased
concentration of
cefazolin
Tests for glucose Possible false-negative
reactions in urine
glucose tests using
clinitest®, Benedict’s
solution, or fehlingh’s
solution
Use glucose tests based
on enzymatic glucose
oxidase reactions (e.g.,
clinistix®)
Pharmacokinetics
Absorption
Bioavailability
Not appreciably absorbed from GI tract; must be administered parentrally.
After IM injection, peak serum concentrations attained within 1-2hours.
Distribution
Extent
Widely distributed into tissues and fluids, including synovial fluid.
Only concentrations distribute into CSF.
Crosses the placenta and is distributed into milk.
Plasma Protein Binding
74-86%.
Elimination

17 | P a g e
Metabolism
Not appreciably metabolized.
Elimination Route
Excreted unchanged in urine. Approximately 60% of a dose excreted within 6
hours and 70-80% within 24 hours in those with renal impairment.
Half-life
Serum half-life approximately 1.8 hours after IV administration and 2 hours IM
administration.
Special populations
Half-life increased in renal impairment.
Stability
Storage
Parentral
Powder for injection or IV infusion
20-250C; protect from light.
Powder and reconstituted solutions may darken; does not indicate loss of
potency.
Reconstituted solutions containing 225 or 330 mg of cefazolin per mL
prepared using sterile or bacteriostatic water for injection or sodium chloride
injection are stable for 24 hours at room temperature or 10 days at 50C.
Store commercially available duplex® drug delivery system 1 or 2g of
lyophilized cefazolin and 50 mL of dextrose injection at 20-250C (may be
exposed to 15-300C). Following reconstitution (activation), use within 24 hours
if stored at room temperature or within 7 days if stored in a refrigerator; do not
freeze.
Injection (Frozen) for IV Infusion

18 | P a g e
-200C or lower. Thawed solutions stable for 48 hours when stored at room
temperature (250C) or 30 days under refrigeration (50C).
Do not freeze after thawing.
Compatability
For information on systemic interactions resulting from concomitant use, see
interactions.
Parentral
Solution compatability
Compatibe
Amino acids 4.25%, dextrose 25%
Dextrose 5 or 10%
Dextrose 5% in Ringer’s injection, lactated
Dextrose 5% in sodium chloride 0.2, 0.45, or 0.9%
Ionosol B in dextrose 5% in water
Normosol M in dextrose 5% in water
Plasma-Lyte in dextrose 5% in water
Ringer’s injection, lactated
Sodium bicarbonate 5%
Sodium chloride 0.9%
Actions and spectrum
 Based on spectrum activity, classified as a first generation cephalosporin.
Has a limited spectrum of activity compared with second, third, and fourth
generation cephalosporins.
 Usually bactericidal.
 Like other β-lactam antibiotics, antibacterial activity results from inhibition
bacterial cell wall synthesis.

19 | P a g e
 Spectrum of activity includes many gram-positive aerobic bacteria and some
gram-negative aerobic bacteria; inactive against fungi and viruses.
 Gram positive aerobes: active in vitro and in clinical infections against
penicillinase-producing and nonpenicillinase-producing staphylococcus
aureus and S. epidermidis; Streptococcus pyogenes (group A β-hemolytic
streptococci); S. agalactie (group B streptococci); and S. pnuemoniae.
Enterococci and oxacillin resistant (methicillin resistant) staphylococci are
resistant.
 Gram-negative aerobes; active in vitro and in clinical infections against
some strains of Hemophilus Influezae, Escherichia coli, klebseilla, Proteus
mirabilis, and Enterobacter aerogenes. In active against most other gram-
negative bacteria, including Citrobacter, E. cloacae, Morganella,
Provedencia, Pseudomonas, and Serratia.
Advice to patients
 Advise patients that antibacterials (including cefazolin) should only be used
to treat bacterial infections; they do not treat viral infections (e.g., the
common cold)
 Importance of completing full coarse of therapy, even if feeling better after a
few days.
 Advise patients that skipping doses or not completing the full coarse of
therapy may decrease effectiveness and increase the likelihood that
bacteria will develop resistance and will not be treatable with cefazolin or
antibacterials in the future.
 Advise patients that diarrhea is a common problem caused by anti-
infectives and usually ends when the drug is discontinued. Importance
of contacting a clinician if watery and bloody stools (with or without cramps
and fever) occur during or as late as 2 months or longer after the last dose.
 Importance of discontinuing cefazolin and informing clinician if an allergic
reaction occurs.
 Importance of informing clinicians of existing or contemplated therapy,
including prescription and OTC drugs.
 Importance of women informing clinicians if they are or plan to become
pregnant or plan to breast feed.

20 | P a g e
 Importance of informing patients of other important precautionary
information. (see cautions)
Preparations
Excipients in commercially available drug preparations may have clinically
important effects in some individuals; consult specific product labeling for
details.
Cefazolin Sodium
Routes Dosage Forms Strengths Brand Names Manufacturer
Parentral For injection 500 mg (of cefazolin)*
1 g (of cefazolin)*
10 g (of cefazolin)
pharmacy bulk package*
20 g (of cefazolin)
pharmacy bulk package*
Cefazolin sodium for
injection
injection
injection
injection
For injection, for IV
infusion
1 g (of cefazolin)*
2 g (of cefazolin)*
Cefazolin for injection
and dextrose injection
(available in dual-
chambered Duplex®
drug delivery system)
Braun
Cefazolin for injection
and dextrose injection
(available in dual-
chambered Duplex®
drug delivery system)
Braun
*available from one or more manufacturer, distributer, and/or repackager by
generic (nonproprietary) name

21 | P a g e
Cefazolin Sodium in Dextrose
Routes Dosage Forms Strengths Brand Names Manufacturer
Parentral Injection
(frozen), for IV
Infusion
20 mg (of
cefazolin) per
mL (1g) in 4%
Dextrose*
Cefazolin
Sodium Iso-
osmotic in
Dextrose
injection
*available from one or more manufacturer, distributer, and/or repackager by
generic (nonproprietary) name
†Use is not currently included in the labeling approved by the US Food and
Drug Administration.
Patient/Family Education
 Instruct patient to check body temperature daily. If fever persists for more
than a few days or if higher (>1020F) or shaking chills are noted, physician
should be notified immediately.
 Advise patient normal fluid intake while using this medication.
 Advise to report signs of superinfection: black ‘’furry’’ tongue, white patches
in mouth, foul-smelling stools, vaginal itching or discharge.
 Instruct patient in good personal hygiene (especially mouth and perineal
area).
 Advise patient to report any increase in ecchymoses, petechiae, nose
bleeds.
 Instruct patient to eat/drink 4 oz of yogurt or butter milk a day as a
prophylaxis against superinfection.
 Advise diabetic patient to use enzyme-based tests (eg, Clinistix, Testape) for
monitoring urine glucose because drug may give false results with other
tests.
 Advise patient to report these symptoms to physician: nausea, vomiting,
diarrhea, skin rash, hives, sore throat, bruising, bleeding, muscle or joint
pain.
 Warn patients that diarrhea that contains blood or pus may be sign of
serious disorder. Tell to patient to seek medical care and not to treat at
home.

22 | P a g e
 Instruct patient to seek emergency care if wheezing or difficulty in breathing
occurs.

23 | P a g e
References
1. AHFS Drug Information Essentials, 2011.
2. A to Z Drug facts, 2003.
3. Drug facts and comparisons, 2009.

DRUG INFORMATION CENTER.pdf

Recommended

Recommended

More Related Content

Similar to DRUG INFORMATION CENTER.pdf

Similar to DRUG INFORMATION CENTER.pdf (20)

More from Haramaya University

More from Haramaya University (20)

Recently uploaded

Recently uploaded (20)

DRUG INFORMATION CENTER.pdf