AMOXICILLIN
A Drug Study presented to
The Faculty of the Nursing Department
In Partial Fulfillment of the
Requirements in NCM 209 - RLE
IMCI Nursing Rotation
Submitted to:
Ms. Karen Eve Mirafuentes, RN
Clinical Instructor
Mr. Prian Karl Escalona
Practicing Clinical Instructor
Submitted by:
Diane Louise B. Legarte
BSN 2E - Group 1
March 22, 2020
AMOXICILLIN
Generic Name: amoxicillin
Brand Name: Apo-Amoxi, Moxatag, Novamoxin
Classification: antiinfective; antibiotic; aminopenicillin
Pregnancy Category: B
Mode of Action
Broad-spectrum, acid-stable, semisynthetic aminopenicillin and analogue of
ampicillin. Acts by inhibiting mucoprotein synthesis in cell wall of rapidly multiplying
bacteria. It is bactericidal and is inactivated by penicillinase.
Dose / Route
Susceptible Infections
PO:
-Adults and elderly: 250–500 mg q8° or 500–875 mg q12° or 775 mg (Moxatag) once
daily.
-Children older than 3 months: 25–50 mg/kg/day
in divided doses q8°. Maximum single dose: 500 mg.
-Children 3 months and younger: 25–50 mg/kg/day in divided doses q8°.
-Neonate: 20–30mg/kg/day in divided doses q12h.
H. Pylori Infection
PO:
-Adults and elderly: 1 g twice daily in combination with at least 1 other antibiotic and an
acid-suppressing agent (proton pump inhibitor or H2 antagonist).
Otitis Media
PO:
-Children: 80–90 mg/kg/day in 2 divided doses.
-Neonates: 30–40mg/kg/day in divided doses q8°.
Dosage in Renal Impairment
PO:
-Immediate-release 875-mg tablet or 775-mg extended-release tablet
should not be used in pts with creatinine clearance less than 30 mL/min.
-Dosage interval is modified based on creatinine clearance. Creatinine clearance 10–
30mL/min: 250–500 mg q12°. Creatinine clearance less than 10 mL/min: 250–500 mg
q24°.
Dosage in Hepatic Impairment
-No dose adjustment.
Indication
Treatment of: Skin and skin structure infections, Otitis media, Sinusitis, Respiratory
infections, Genitourinary infections. Endocarditis prophylaxis. Postexposure inhalational
anthrax prophylaxis. Management of ulcer disease due to Helicobacter pylori.
Unlabeled Use:Lyme disease in children 8 yr.
Contraindication
Hypersensitivity to penicillins (cross-sensitivity exists to cephalosporins and other
beta-lactams)
Side Effects
GI disturbances (mild diarrhea, nausea, vomiting), headache, oral/vaginal
candidiasis. Occasional: Generalized rash, urticaria.
Adverse Effects
Seizures, anxiety, confusion, agitation, dizziness, reversible hyperactivity, anxiety,
insomnia, behavioral changes, pseudomembranous colitis, interstitial nephritis,
nephropathy, agranulocytosis, leukopenia, thrombocytopenia, thromocytopenic
purpura, anemia, eosinophilia, hemolytic anemia, anaphylaxis, hypersensitivity
reactions, and overgrowth of nonsusceptible organisms.
Drug Interactions
Drug-drug:
Beta blockers: maypotentiate anaphylactic reactions.
Hormonal contraceptives: may decrease contraceptive effectiveness.
Live virus vaccines: may decrease effectiveness of live virus vaccines.
Methotrexate: may increase methotrexate serum concentration.
Probenecid: may increase concentration.
Drug-herb:
Khat: may decrease antimicrobial effect of certain penicillins.
Nursing Interventions
1. Assess for infection (vital signs; appearance of wound, sputum, urine, and stool;
WBC) at beginning of and throughout therapy.
2. Obtain a history before initiating therapy to determine previous use of and reactions
to penicillins or cephalosporins. Persons with a negative history of penicillin
sensitivity may still have an allergic response.
3. Obtain specimens for culture and sensitivity prior to therapy. First dose may be
given before receiving results
4. Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools
should be reported to health care professional promptly as a sign of
pseudomembranous colitis. May begin up to several weeks following cessation of
therapy.
5. Monitor for S&S of an urticarial rash (usually occurring within a few days after start
of drug) suggestive of a hypersensitivity reaction. If it occurs, look for other signs of
hypersensitivity (fever, wheezing, generalized itching, dyspnea), and report to
physician immediately.
6. Administer around the clock. May be given without regard to meals or with meals to
decrease GI side effects. Capsule contents may be emptied and swallowed with
liquids. Extended-release tablets should be swallowed whole; do not crush, break,
or chew. Chewable tablets should be crushed or chewed before swallowing with
liquids.
7. Shake oral suspension before administering. Suspension may be given straight or
mixed in formula, milk, fruit juice, water, or ginger ale. Administer immediately after
mixing. Discard refrigerated reconstituted suspension after 10 days.
8. Instruct patient to notify health care professional immediately if diarrhea, abdominal
cramping, fever, or bloody stools occur and not to treat with antidiarrheals without
consulting health care professional.
9. Instruct the patient to notify health care professional if symptoms do not improve.
10. Teach patients with a history of rheumatic heart disease or valve replacement the
importance of using antimicrobial prophylaxis before invasive medical or dental
procedures.
11. Instruct female patients taking oral contraceptives to use an alternate or additional
nonhormonal method of contraception during therapy with amoxicillin and until next
menstrual period.
References:
Kizior, R. J., & Hodgson, K. J. (2019). Saunders nursing drug handbook 2019. St.
Louis, MO: Elsevier.
Mims. (2020). Amoxicillin. Retrieved March 21, 2020, from https://www.mims.com/
Wolters Kluwer (Firm). (2017). Nursing 2017 Drug Handbook (37th ed.). Philadelphia,
PA: Wolters Kluwer.
NALIDIXIC ACID
A Drug Study presented to
The Faculty of the Nursing Department
In Partial Fulfillment of the
Requirements in NCM 209 - RLE
IMCI Nursing Rotation
Submitted to:
Ms. Karen Eve Mirafuentes, RN
Clinical Instructor
Mr. Prian Karl Escalona
Practicing Clinical Instructor
Submitted by:
Diane Louise B. Legarte
BSN 2E - Group 1
March 22, 2020
NALIDIXIC ACID
Generic Name: nalidixic acid
Brand Name: NegGram
Classification: Urinary tract antiinfective; antibiotic, quinolone
Pregnancy Category: C
Mode of Action
Nalidixic acid is a 4-quinolone antibacterial. It interferes with the replication of
bacterial DNA by inhibiting DNA gyrase activity. It acts against gram-negative bacteria
including E. coli, Proteus, Klebsiella, Enterobacter, Salmonella and Shigella spp.
Dose / Route
Uncomplicated lower urinary tract infections
PO:
-Adult: 1 g 4 times daily for 1-2 wk. Long-term therapy: Reduce daily dose to 2 g.
-Child: >3 mth: 50 mg/kg daily in 4 equally divided doses. Long-term therapy: Reduce
dose to 30 mg/kg daily. Prophylaxis: 15 mg/kg bid.
Shigellosis
PO:
-Adult: 1 g 4 times daily for 5 days.
-Child: ≥3 mth: 15 mg/kg 4 times daily for 5 days.
Indication
Urinary tract infections caused by susceptible gram-negative organisms including
most Proteus strains, Klebsiella, Enterobacter, and Escherichia coli.
Contraindication
History of convulsive disorders; first trimester of pregnancy; infants <3 mo.
Side Effects
Nausea, vomiting, diarrhea, abdominal pain; photosensitivity reactions, allergic
rash, urticaria, pruritus
Adverse Effects
Visual disturbances, headache, dizziness or vertigo, drowsiness, confusion,
depression, excitement, hallucinations, toxic psychoses or convulsions (especially after
large doses), intracranial hypertension (especially in infants and young children),
metabolic acidosis; peripheral neuropathies, muscular weakness, myalgia; arthralgia,
tendon damage; cholestatic jaundice, thrombocytopenia, leucopenia.
Potentially Fatal: Erythema multiforme and Stevens-Johnson syndrome;
anaphylactoid reactions. Auto-immune haemolytic anaemia (particularly in elderly
patients).
Drug Interactions
Drug-drug:
antacids, sucralfate, calcium, magnesium, didanosine, multivitamins (containing iron or
zinc) may decrease absorption of nalidixic acid; may increase hypoprothrombinemic
effects of warfarin.
Nursing Interventions
1. Perform C&S tests prior to initiation of treatment and periodically thereafter. Obtain
blood counts and kidney or liver function tests if therapy is continued longer than 2 wk.
2. Watch for CNS reactions, which tend to occur 30 min after initiation of treatment or
after second or third dose. Infants, children, and older adults are especially susceptible.
Report immediately the onset of marked irritability, vomiting, bulging of anterior
fontanelle, headache, excitement or drowsiness, papilledema, vertigo.
3. Use drug exactly as prescribed and do not change dosage. Omitted doses,
especially in early days of therapy, may promote development of bacterial resistance.
Take full amount of medication.
4. Contact physician immediately for unexplained behavior changes or severe
headaches.
5. Maintain adequate hydration (2000–3000 mL/d if tolerated) during treatment period.
Consult physician if you notice a change in your urination pattern.
6. Avoid exposure to direct sunlight or ultraviolet light while receiving drug. Contact
physician if photosensitivity occurs. Patient may be photosensitive up to 3 mo after
termination of drug.
7. Contact the physician if visual disturbances are noticed during first few days of
therapy. Symptoms usually disappear promptly with reduction of dosage or
discontinuation of therapy.
8. Do not breast feed while taking this drug without consulting physician.
9. Educate client about the purpose of medication.
10. Instruct patient to follow doctor’s orders and report to NOD in case of missed dose.
References:
Drugs.com. (2020). Nalidixic Acid: Indications, Side Effects, Warnings. Retrieved March
21, 2020, from https://www.drugs.com/
Mims. (2020). Nalidixic acid. Retrieved March 21, 2020, from https://www.mims.com/
Rxlist. (2020). NegGram (Nalidixic Acid): Uses, Dosage, Side Effects, Interactions,
Warning. Retrieved March 20, 2020, from https://www.rxlist.com/neggram-drug.htm
