| INDICATIONS & DOSAGE | | | | EFFECTS ON DIAGNOSTIC TESTS |
| Serious infections of the lower respiratory and | | | | Drug may interfere with glucose determination by |
| urinary tracts, intra-abdominal and gynecologic | | | | Benedict's solution or Clinitest. |
| infections, bacterial septicemia, bone and joint | | | | CONTRAINDICATIONS |
| infections, skin and softtissue infections, and | | | | Contraindicated in patients with hypersensitivity to |
| endocarditis. Most known microorganisms are | | | | drug. |
| susceptible: Acinetobacter, Enterococcus, | | | | SPECIAL CONSIDERATIONS |
| Staphylococcus, Streptococcus, Escherichia coli, | | | | Use cautiously in patients allergic to penicillins or |
| Haemophilus, Klebsiella, Morganella, Proteus, | | | | cephalosporins because drug has similar properties. |
| Enterobacter, Pseudomonas aeruginosa, and | | | | Also, use cautiously in patients with history of |
| Bacteroides, including B. fragilis- | | | | seizure disorders, especially if they also have |
| Adults weighing over 70 kg (154 lb): 250 mg to 1 | | | | compromised renal function. |
| g by I.V. infusion q 6 to 8 hours. Maximum daily | | | | Use with caution in children under age 3 months. |
| dose is 50 mg/ kg/day or 4 g/day, whichever is | | | | Culture and sensitivity tests should be obtained |
| less. Or, | | | | before giving first dose. Therapy may begin |
| 500 to 750 mg LM. q 12 hours. Maximum daily | | | | pending results. |
| dose is 1,500 mg. | | | | Dosage adjustment is necessary for patients with |
| Dosage adjustment: | | | | a creatinine clearance below 70 ml/minute. Renal |
| For children over age 12, patients under 70 kg, | | | | function tests must be monitored. |
| and those who are renally impaired, refer to | | | | • Alert: Drug should be discontinued if seizures |
| package insert for dosage adjustments based on | | | | develop and persist despite anticonvulsant |
| weight, creatinine clearance, and severity of | | | | therapy. |
| infection. | | | | Patient should be monitored for bacterial or fungal |
| ADVERSE REACTIONS | | | | superinfections and resistant infections during and |
| CNS: seizures, dizziness, somnolence. | | | | after therapy. |
| CV: hypotension. | | | | I.V. administration |
| GI: nausea, vomiting, diarrhea, pseudomembranous | | | | The drug must not be administered by direct I.V. |
| colitis. | | | | bolus injection. Each 250- or 500-mg dose should |
| GU: increased BUN or serum creatinine levels. | | | | be given by I.V. infusion over 20 to 30 minutes. |
| Hematologic: eosinophilia, thrombocytopenia, | | | | Each 1-g dose should be infused over 40 to 60 |
| leukopenia. | | | | minutes. If nausea occurs, the infusion may be |
| Hepatic: transient increases in AST, ALT, alkaline | | | | slowed. |
| phosphatase, and bilirubin. | | | | When reconstituting powder, shake until the |
| Skin: rash, urticaria, pruritus. | | | | solution is clear. Solutions may range from |
| Other: hypersensitivity reactions, anaphylaxis, | | | | colorless to yellow; variations of color within this |
| fever; increased LD; thrombophlebitis, injection site | | | | range don't affect drug's potency. After |
| pain. | | | | reconstitution, solution is stable for 10 hours at |
| INTERACTIONS | | | | room temperature and for 48 hours when |
| Drug-drug. Aminoglycosides: synergistic effect. | | | | refrigerated. |
| Monitor closely. | | | | Patient teaching |
| Beta-lactam antibiotics: possible in vitro antagonism. | | | | Report adverse reactions promptly. |
| Avoid concomitant use. Ganciclovir: may cause | | | | Alert health care provider if discomfort occurs at |
| seizures. Avoid concomitant use. | | | | I.V. insertion site. |
| Probenecid: increased serum levels of cilastatin. | | | | Notify health care provider if loose stool or |
| Avoid concomitant use. | | | | diarrhea occurs. |