which laboratroy tests should be monitored during the course of antibiotic treatment with linezolid

Laboratory tests that can be helpful in guiding antimicrobial therapy include antimicrobial susceptibility testing, determination of bacterial beta-lactamase production, assay of serum inhibitory and bactericidal activity, and assay of specific antibiotic levels in serum.

Full Answer

What is the best way to monitor the oxazolidinone antibiotic linezolid?

A new and rapid method for monitoring the new oxazolidinone antibiotic linezolid in serum and urine by high performance liquid chromatography-integrated sample preparation. J Chromatogr B Biomed Sci Appl. 2001;755:373–7. [PubMed] [Google Scholar] 91.

Does linezolid cross-resistance exist with other antibiotics?

Linezolid (Zyvox®-Pfizer) is an antimicrobial agent of the oxazolidinone class that possesses a wide spectrum of activity against gram-positive organisms, including MRSA and VRE. Because of linezolid’s novel mechanism of action, cross-resistance with other antimicrobial agents is not expected.

What is the contraindication for linezolid?

1.0 Linezolid is contraindicated in any person with a known hypersensitivity to linezolid or any of the product components.

What is the duration of linezolid administration?

Doses of linezolid are administered every 12 hours 2.0 Vancomycin-resistant Enterococcus faecium infections, including concurrent bacteremia: 600 mg IV or by mouth every 12 hours for 14 to 28 consecutive days. 3.0 Shorter courses of therapy (i.e., 10-14 days) may be suitable for other types of infections.

Which areas are most important for the nurse to observe for additional pressure ulcers?

High risk areas include; sacrum, heels, elbows, wrists, temporal region of skill, ears, shoulders, back of head (especially in children less than 36 months of age), knees, and toes.

What is skin integrity?

The term 'skin integrity' refers to the skin being a sound and complete structure in unimpaired condition. Conversely, impaired skin integrity is defined as an "altered epidermis and/or dermis... destruction of skin layers (dermis), and disruption of skin surface (epidermis)" (NANDA 2013).

When assessing the skin of a client with bulimia which data is important?

1. When assessing the skin of a client with bulimia, which data is important for the nurse to obtain? R: assessment of skin turgor, or degree of elasticity, provides data r/t fluid volume balance. The nurse assesses that Mandi's skin turgor is slightly inelastic.

What are 4 things to look for during a skin assessment?

Inspection should include assessment of the skin's colour, temperature, texture, moisture, integrity and include the location of any skin breakdown or wounds.

What are five 5 main criteria that should be included when examining and assessing a pressure injury?

Usual practice includes assessing the following five parameters:Temperature.Color.Moisture level.Turgor.Skin integrity (skin intact or presence of open areas, rashes, etc.).

What cues support the nurses assessment regarding the clients fluid status?

What cues support the nurse's assessment regarding the client's fluid status? Dry mucus membranes (Dry or cracked mucus membranes can be the result of inadequate hydration, which, like inelastic skin turgor, validates the initial finding of fluid volume deficit). (Jarvis, C., Eckhardt, A., & Thomas, P. (2020).

How do you perform an integumentary assessment?

Checklist 22: Integument AssessmentPerform hand hygiene.Introduce yourself to patient.Confirm patient ID using two patient identifiers (e.g., name and date of birth).Explain process to patient.Be organized and systematic in your assessment.Use appropriate listening and questioning skills.More items...

How do you do a nail assessment?

Assess the contour and shape of the nail.Assess the surface of the nail looking at the profile of the nail.The profile is the side view.Some patients' nails may be flat and some may be slightly round.The angle of the nail should be 160 degrees or less.

What antimicrobials are monitored?

Few antimicrobial drugs meet the requirements for therapeutic drug monitoring. Those that are monitored include the aminoglycosides (gentamicin, tobramycin , and amikacin ), chloramphenicol, and in some cases, vancomycin. For these drugs, there is evidence of a relationship between serum concentration, efficacy, and/or the incidence of adverse or toxic events. Monitoring begins with the appropriate timing of collection and continues through the analytical process to the integration of all data used to guide the clinician’s next decision.

What drugs are monitored for TDM?

Currently, the exceptions include, at least in some cases, the aminoglycosides, chloramphenicol, and vancomycin ( 2 ) ( 3 ) ( 4 ) ( 5 ) ( 6 ) ( 7 ) ( 8 ) ( 9 ) ( 10 ) ( 11 ) ( 12 ). For the aminoglycosides and chloramphenicol, monitoring serum concentrations may be used to (a) guide and monitor dosing changes, (b) evaluate efficacy or potential toxicity, or (c) assess antibiotic penetration into other body fluids. For vancomycin, the necessity and appropriateness of monitoring are less obvious and even controversial ( 8 ) ( 9 ) ( 10 ) ( 11 ). The purpose of this article is to review the published data on effective TDM of these antimicrobial drugs.

What is aminoglycoside antibiotic?

The aminoglycoside antibiotics are used for the treatment of infections of susceptible strains of gram-negative microorganisms that are resistant to less toxic antibiotics. Organisms commonly susceptible to these drugs include Klebsiella species, Enterobacter species, Serratia species, Citrobacter species, Escherichia coli, Proteus species, Acinetobacter species, and Pseudomonas aeruginosa ( 12 ) ( 13 ) ( 14 ) ( 15 ) ( 16 ). Monotherapy is usually reserved for the treatment of less serious infections ( 12 ) ( 13 ) ( 14 ) ( 15 ), for example, uncomplicated urinary tract infections, and only when other antibiotics are not appropriate. Combination therapy with a β-lactam antibiotic or a quinolone may be needed for the treatment of more serious gram-negative infections. Combination therapy with a β-lactam permits the use of aminoglycosides in the treatment of infections caused by particular gram-positive organisms ( 12 ) ( 13 ) ( 14 ) ( 15 ), such as Staphylococcus aureus, enterococci, or S. viridans endocarditis. Because of the incidence of toxicity and the relationship between toxicity and serum concentration and because of the dosing protocols utilized, monitoring of these drugs can be useful.

What is the recommended trough serum concentration?

Trough serum concentrations ( Table 1) of 5–10 mg/L (5–10 μg/mL) are considered acceptable serum concentrations for the treatment of most gram-positive organisms. Although Saunders ( 149) suggests that concentrations of 10–12 mg/L (10–12 μg/mL) be considered early signs of drug accumulation and potential nephrotoxicity, a study by Zimmerman et al. ( 166) correlated serum concentrations with outcomes for patients with gram-positive bacteremia and concluded that the trough range should be raised slightly. As discussed earlier, there are reports of nephrotoxicity in patients whose trough serum concentrations were <10 mg/L (10 μg/mL). Until additional studies are conducted to clarify this issue, we recommend the use of this range. Results for samples below the trough range should be flagged as such when reported. Concentrations >40 mg/L (40 μg/mL) have been associated with toxic or adverse reactions ( Table 1 ). These samples should be verified and reported as critical values.

What are the three forms of chloramphenicol?

Three forms of chloramphenicol are used: chloramphenicol base, chloramphenicol palmitate, and chloramphenicol succinate. Both the palmitate and succinate pro-drugs undergo hydrolysis by pancreatic (palmitate) and hepatic (succinate) enzymes for conversion to the active chloramphenicol.

Why are multiple drug interactions possible?

Multiple drug interactions are possible because of the competitive inhibition by chloramphenicol on cytochrome P450 enzymes. The potential for drug interactions should be considered when chloramphenicol is co-administered with another drug metabolized by this enzyme system ( 85 ). Diuretics increase the renal excretion of chloramphenicol.

What fluid is used to measure aminoglycosides?

Occasionally, aminoglycoside concentrations have been measured in other body fluids, such as cerebrospinal fluid (CSF), to assess the degree of antibiotic penetration into the space or to assure adequate intrathecal dosing ( 64 ) ( 65 ) ( 66 ).

Collect

Collect blood in an 8-10 mL plain red top tube. An 8-10 mL green top tube is also acceptable for this assay, but not preferred.

Specimen Preparation

Allow to clot for 30 minutes, separate serum from cells immediately by centrifugation and aliquot into a labeled polypropylene or similar plastic tube. Use a separate tube for each test ordered. Allow room for expansion of sample inside tube.

Storage Transport Temp

Fully complete PK requisition, including drug dose amount, frequency, method, and date and time of last dose prior to draw.

Stability

Freeze at -70C if possible, but at minimum -20C. Up to 24 hours at room temperature.

Notes

Ship samples to be received Monday through Friday. Do not ship on Friday or Saturday. For shipping and detailed collection instructions, click here.

What is the name of the phenomenon that occurs when staphylococci are resistant to penicillin?

This phenomenon is termed heteroresistance and occurs in staphylococci resistant to penicillinase-stable penicillins, such as oxacillin. Cells expressing heteroresistance grow more slowly than the oxacillin-susceptible population and may be missed at temperatures above 35°C.

What antimicrobials are resistant to MRSA?

Strains of MRSA causing healthcare-associated infections are often resistant to other commonly used antimicrobial agents, including erythromycin, clindamycin and fluoroquinolones, while strains causing community-associated infections are often resistant only to ß-lactam agents, erythromycin and occasionally to fluoroquinolones.

When was methicillin first used?

When resistance was first described in 1961, methicillin was used to test and treat infections caused by S. aureus. However, oxacillin, which is in the same class of drugs as methicillin, was chosen as the agent of choice for testing staphylococci in the early 1990s, and this was modified to include cefoxitin later.

Is MRSA resistant to oxacillin?

MRSA is resistant to all β-lactams because of the presence of mecA, a gene that produces a pencillin binding protein (PBP2a) with low affinity for β-lactam antibiotics. Mechanism of oxacillin resistance other than mecA are rare.

Is MRSA resistant to carbapenems?

aureus (MRSA), are resistant to all ß-lactam agents, including cephalosporins and carbapenems, although they may be susceptible to the newest class of MRSA-active cephalosporins (e.g, ceftaroline).

Is S. aureus resistant to penicillin?

Approximately 10% of S. aureus isolates in the United States are susceptible to penicillin. However, many S. aureus strains, while resistant to penicillin, remain susceptible to penicillinase-stable penicillins, such as oxacillin and methicillin.

Can broth test detect MRSA?

When used correctly, broth-based and agar-based tests usually can detect MRSA. The cefoxitin disk diffusion method can be used in addition to routine susceptibility test methods or as a back-up method. Top of Page.

When a patient does not benefit from antimicrobial therapy chosen on the basis of clinical presentation, are additional investigations needed

Similarly, when a patient does not benefit from antimicrobial therapy chosen on the basis of clinical presentation, additional investigations are needed to determine the etiologic agent or exclude noninfectious diagnoses.

When is the antimicrobial procedure useful?

This procedure is useful when the organism burden is very high or in the management of abscesses, for which the penetration and activity of antimicrobial agents are often inadequate. Other therapies used in the treatment of infectious diseases involve modulating the host inflammatory response to infection.

What is antimicrobial therapy?

Antimicrobial agents are some of the most widely, and often injudiciously, used therapeutic drugs worldwide. Important considerations when prescribing antimicrobial therapy include obtaining an accurate diagnosis of infection; understanding the difference between empiric and definitive therapy; identifying opportunities to switch ...

Why are gram positive bacteria endemic?

They are commonly caused by drug-resistant organisms, both gram-positive (eg, methicillin-resistant Staphylococcus aureus[MRSA]) and gram-negative (eg, Pseudomonas aeruginosa) bacteria, which are often endemic in hospitals because of the selection pressure from antimicrobial use.

What are some examples of adverse effects of metronidazole?

Examples include nephrotoxicity with aminoglycosides, neurotoxicity of penicillins, and peripheral neuropathy with prolonged use of metronidazole ; these potential adverse effects need to be discussed with patients before initiation of therapy.

What is the difference between antibacterial and bactericidal?

A commonly used distinction among antibacterial agents is that of bactericidal vs bacteriostatic agents. Bactericidal drugs, which cause death and disruption of the bacterial cell, include drugs that primarily act on the cell wall (eg, β-lactams), cell membrane (eg, daptomycin), or bacterial DNA (eg, fluoroquinolones).

Why is combination therapy used for HIV?

This is why combination drug therapy is used as the standard for treatment of infections such as tuberculosis and the human immunodeficiency virus (HIV) when treatment duration is likely to be prolonged, resistance can emerge relatively easily, and therapeutic agents are limited.

What is linezolid used for?

Linezolid is a synthetic antibacterial agent of the oxazolidinone class, which has clinical utility in the treatment of infections caused by aerobic Gram-positive bacteria. The in vitro spectrum of activity of linezolid also includes certain Gram-negative bacteria and anaerobic bacteria. Linezolid binds to a site on the bacterial 23S ribosomal RNA of the 50S subunit and prevents the formation of a functional 70S initiation complex, which is essential for bacterial reproduction. The results of time-kill studies have shown linezolid to be bacteriostatic against enterococci and staphylococci. For streptococci, linezolid was found to be bactericidal for the majority of isolates.

How much linezolid is in zyvox?

When constituted as directed, each bottle will contain 150 mL of a suspension providing the equivalent of 100 mg of linezolid per each 5 mL. ZYVOX for Oral Suspension is supplied as follows:

What is zyvox used for?

ZYVOX is indicated for the treatment of complicated skin and skin structure infections, including diabetic foot infections, without concomitant osteomyelitis, caused by Staphylococcus aureus (methicillin-susceptible and -resistant isolates), Streptococcus pyogenes, or Streptococcus agalactiae.

How to use Zyvox suspension?

ZYVOX for Oral Suspension is supplied as a powder/granule for constitution. Gently tap bottle to loosen powder. Add a total of 123 mL distilled water in two portions. After adding the first half, shake vigorously to wet all of the powder. Then add the second half of the water and shake vigorously to obtain a uniform suspension. After constitution, each 5 mL of the suspension contains 100 mg of linezolid. Before using, gently mix by inverting the bottle 3 to 5 times. Do not shake. Store constituted suspension at room temperature. Use within 21 days after constitution.

Does linezolid cause birth defects?

Available data from published and postmarketing case reports with linezolid use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. When administered during organogenesis, linezolid did not cause malformations in mice, rats, or rabbits at maternal exposure levels approximately 6.5 times (mice), equivalent to (rats), or 0.06 times (rabbits) the clinical therapeutic exposure, based on AUCs. However, embryo-fetal lethality was observed in mice at 6.5 times the estimated human exposure. When female rats were dosed during organogenesis through lactation, postnatal survival of pups was decreased at doses approximately equivalent to the estimated human exposure based on AUCs (see Data ).

Can zyvox cause lactic acidosis?

Lactic acidosis has been reported with the use of ZYVOX. In reported cases, patients experienced repeated episodes of nausea and vomiting. Patients who develop recurrent nausea or vomiting, unexplained acidosis, or a low bicarbonate level while receiving ZYVOX should receive immediate medical evaluation.

Is Zyvox I.V. infusion made of latex?

ZYVOX I.V. Injection is available in single-dose, ready-to-use flexible plastic infusion bags in a foil laminate overwrap. The infusion bags and ports are not made with natural rubber latex. The infusion bags are available in the following package sizes: