Drug Study: Levofloxacin (Levox)

Classification: Antibiotic, Quinolones

Action: Semisynthetic antibacterial agent that inhibits bacterial DNA gyrase, necessary for supercoiling (conversion of intermediate fragments into high molecular weight DNA) of the DNA, thereby preventing DNA replication, transcription, repair and recombination i susceptible bacteria.

Indication: Infections caused by susceptible strains of microorganisms in acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, community-acquired pneumonia, nosocomial pneumonia, uncomplicated skin and skin structure infections, complicated and uncomplicated urinary tract infection (UTI) and acute pyelonephritis.

Adverse Reactions: Nausea, diarrhea, headache, dizziness, insomnia, musculoskeletal effects, pain, reddening of the infusion site, phlebitis, increase in liver enzymes, eosinophilia, leukopenia, asthenia, fungal overgrowth and proliferation of other resistant microorganisms. Eye irritation, eyelid itching, shock-like symptoms. Hypersensitivity, corneal lesion.

Nursing Considerations

Assessment

  • Obtain baseline assessment of patient signs and symptoms of infections and reassess during treatment: characteristics of wound, sputum, urine, stool, fever and WBC count (> 10,000/ mm³)
  • Obtain C&S before starting drug therapy to identify if correct treatment has been initiated.
  • Assess patient for previous sensitivity reaction and reassess for allergic an anaphylactic reaction during therapy: rash, urticaria, pruritus, chills, fever, joint paint. (Epinephrine and resuscitation equipment must be available for anaphylactic reaction)
  • Obtain history of seizure disorder or other CNS disease before initiating therapy
  • Monitor for possible drug induced adverse reactions
  • Assess hematologic status: bleeding, ecchymosis, bleeding gums, hematuria, and stool guaiac. Monitor CBC, Hgb, Hct
  • Assess renal function: urine output. Monitor BUN, creatinine, serum electrolytes: potassium, sodium, chloride.
  • Assess liver function: jaundice, clay colored stools. Monitor: AST, ALT, LDH, bilirubin, alkaline phosphatase and Coombs’ test monthly if patient is on long-term therapy.
  • Assess bowel pattern: if severe diarrhea occurs, drug should be discontinued.
  • Assess for overgrowth of infection:  perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum.
  • Assess patient’s and family’s knowledge of drug therapy.

Planning

  • Give oral administration 4 hours before or 2 hours after antacids, iron, calcium, zinc
  • Check for irritation, extravasation, phlebitis daily

Implementation

  • Instruct patient to continue taking drug as prescribed for the length of time ordered, even if felling better and to avoid taking other medications unless approved by physician.
  • Advice patient to take drug with plenty of fluids, at least 2 L/day and to avoid antacids, sucralfate and products containing iron or zinc for at least 2 hours before and after each dose.
  • Inform patient that toxicity may result if drug is used with theophylline. Contact physician before using theophylline with this drug.
  • Warn patient to avoid hazardous tasks and activities requiring alertness until CNS effects are known. The drug must be taken around the clock to maintain blood levels.
  • Teach patient to report: sore throat, bruising, bleeding, joint pain, vaginal itching, loose foul-smelling stools, furry tongue, itching, rash, pruritus, urticaria, diarrhea with blood or pus and other adverse reactions.
  • Instruct diabetic patients to monitor glucose levels, a hypoglycemic reaction may indicate need to stop medication.
  • Instruct patient to rinse mouth frequently and use sugarless coated candy or gum for dry mouth.
  • Advise patient to avoid sun exposure or use sunscreen to prevent phototoxicity.

Evaluation

  • Absence of signs and symptoms of infection (WBC < 10,000 mm³, temp within normal level)
  • Reported improvement in symptoms of infection
  • Absence of drug induced adverse reactions.
  • Patient and family state understanding of drug therapy.

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