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How should the macrolide drug erythromycin (E-Mycin) be given?
- Erythromycin base (E-Mycin) is available in tablets, capsules, topical, and ophthalmic ointment.
- Erythromycin stearate (Erythrocin) is available in tablets.
- Erythromycin ethylsuccinate (EES) is available in tablets.
- Erythromycin lactobionate is available in IV form.
- Give tablets on an empty stomach 1 hr before or 2 hr after a meal for best absorption; give with 8 oz of water.
- If gastrointestinal symptoms occur, give with food.
- Give enteric-coated forms of erythromycin with or without meals.
- For IV form, follow dilution and rate recommendations to prevent thrombophlebitis.
How should the fluoroquinolone drug ciprofloxacin (Cipro) be given?
- Available in oral, ophthalmic drops and ointment, and IV forms.
- For IV form, infuse slowly over at least 60 min; follow recommendations for dilution.
- Incompatible with multiple other drugs in IV solution or IV tubing
How should the antiviral drug acyclovir (Zovirax) be given?
- Available in oral capsules and tablets, an oral liquid suspension, topical cream and ointment, and IV forms.
- Wear gloves, and instruct patients to wear gloves (or finger cots) when applying topical forms to prevent transferring virus.
- Infuse at recommended rate and dilution.
- Hydrate the patient during and for 2 hr following IV infusion.
How should the monobactam drug aztreonam (Azactam) be given?
- Available in IM and IV forms.
- Administer IM injections into large muscle, and rotate sites.
- For IV, give as a slow bolus or infusion; follow recommendations for dilution and rate.
How should the polyene antibiotic drug amphotericin B (Fungizone) be given?
- Available for IV infusion; treatment may be given daily or on alternate days for up to 8 weeks.
- Infuse IV form at recommended dilution and rate; monitor IV site carefully for thrombophlebitis.
- If prescribed, administer a test dose to determine how the patient tolerates the drug.
- There is a lipid-based form available for IV use with fewer adverse effects, but it is more expensive.
- The patient may "swish and swallow" oral suspension for oral candida (thrush) infections; instruct the patient to swish well in mouth before swallowing.
How should the antimycobacterial drug rifampin (Rifadin) be given?
- Available as capsules, in two fixed-dose combinations of capsules or tablets with isoniazid (INH), and IV form.
- Give with other tuberculosis drugs to prevent resistance.
- Give oral dose 1 hr before or 2 hr after meals.
- Give IV infusion in recommended dilution and rate.
How should the antibacterial drug tetracycline (Sumycin) be given?
- Give orally on an empty stomach 1 hr before or 2 hr after meals; give with nondairy food if patient is unable to tolerate.
- Do not give right before bedtime.
- Topical form treats acne vulgaris.
- IM and IV tetracycline are given only if oral form cannot be tolerated.
- Shake solution well before measuring.
- Ensure that outdated drug is not administered (causes a type of kidney dysfunction).
How should the carbapenem drug imipenem (Primaxin) be given?
- Only available for IM or IV use.
- IM and IV forms are not interchangeable.
- Follow recommendations for rate and dilution when infusing IV doses.
How should the antiparasitic drug metronidazole (Flagyl) be given?
- Available as tablets, capsules, sustained-release capsules, topical cream, vaginal gel, and IV infusion.
- IV powdered form is reconstituted and diluted as recommended for slow IV infusion.
- Sustained-release form must be swallowed whole and not crushed or chewed.
- Regular tablets may be crushed if patient cannot swallow them.
- Give oral dose 1 hr before or 2 hr after a meal for best absorption.
How should the cephalosporin drug cephalexin (Keflex) be given?
- Available as capsules, tablets, or oral suspension.
- Be careful to differentiate between cephalosporin prescriptions; generic names can be similar.
How should the penicillin drugs amoxicillin (Amoxil) and amoxicillin and clavulanic acid (Augmentin) be given?
- Patient should not crush or chew extended-release form.
- Patient should chew chewable forms before swallowing.
- For an infant or young child, place drops directly on tongue or mix with a small amount of juice or formula; ensure that child takes full dose.
- Give at the beginning of meals to decrease gastrointestinal symptoms and increase absorption.
- Give amoxicillin with probenecid, if prescribed, to increase therapeutic activity of amoxicillin.
How should the antiparasitic drug chloroquine (Aralen) be given?
- Available in oral tablets.
- Give 500 mg tablets once weekly beginning 1 to 2 weeks before travel and continuing four weeks after leaving a region with malaria.
- Give 1 g of the drug orally for acute attacks. Give a smaller dose 6, 24, and 48 hr later.
- Dose for a child is based on weight.
- Give at least 4 hr before or after antacids or laxatives for adequate absorption.
- Give with food to prevent gastrointestinal effects.
How should the urinary tract antiseptic nitrofurantoin (Macrodantin) be given?
- Available in oral capsules (Macrodantin and Macrobid) and liquid suspension (Furadantin).
- Instruct patient to swallow capsules whole.
- Dilute liquid suspension, and instruct patient to rinse mouth after taking.
How should the sulfonamide drug trimethoprim and sulfamethoxazole (Bactrim, Septra) be given?
- Available as a fixed-dose combination in tablets, liquid solution, and IV form.
- Give oral dose with 8 oz of water.
- Administer intermittent IV infusion slowly (over 60 to 90 min) and with recommended dilution.
- Instruct patient to drink at least 2,500 to 3,000 mL water a day during treatment.
How should the antimycobacterial drug isoniazid (INH) be given?
- Available as tablets and oral syrup.
- Give tablets in combination with rifampin (Rifadin).
- Give oral drug on an empty stomach (1 hr before a meal).
- Give IM dose in large muscle mass; rotate sites.
- If IM form contains crystals, warm it to room temperature before using.
- Give with one or more other drugs for active tuberculosis (TB) to prevent resistance.
- Give by itself daily for latent TB (six- to nine-month treatment).
How should the azole drug ketoconazole (Nizoral) be given?
- Available in tablets, a topical preparation, and as a shampoo for fungal infections of the scalp.
- Oral form requires acid medium for absorption; give with water, coffee, tea, or juice.
- Give solution of 4 mL of 0.2 N hydrochloric acid to a patient who has achlorhydria (lack of hydrochloric acid in the stomach). Instruct patient to sip through a straw to prevent damage to tooth enamel; follow with 8 oz of water.
How should the antibacterial drug vancomycin (Vancocin) be given?
- Give orally for colitis.
- Give IV for all other infections.
- Administer slowly through IV, and follow recommendations for dilution.
- Infuse separately if possible (incompatible in solution with many other IV drugs).
How should the aminoglycoside drug gentamicin (Garamycin) be given?
- Gently press the inner canthus for 1 to 2 min after instilling drops to prevent systemic absorption.
- Instruct the patient to keep eyes shut for 1 to 2 min to maximize local absorption.
- Don't apply to large skin areas.
- There is a risk for toxicity with systemic absorption.
Inject deeply into a large muscle.
Give as an intermittent infusion, using recommendations for rate and dilution.
- Use a preservative-free form
- Discard unused portions.