Pharmacological Effects of Antibiotics in Management of Sinusitis and the Nursing Implications - Research Paper Example

RESEARCH PAPER- NURSING Pharmacological Effects of Antibiotics in Management of Sinusitis and the Nursing Implications Lecturer’s Institution Date Abstract Sinusitis is an acute bacterial infection that affects the mucosal surfaces of the Para nasal sinuses and the nasal sinuses. It normally results as a secondary infection to an upper respiratory tract infection and as well develops from other factors such as swimming in contaminated water, introduction of a foreign body in the nasal cavity or from a dental infection. It results from an increased colonization of microorganisms such as H influenza, S pneumonia and M catarrhialis. Apart from bacteria, virus and fungi can also cause the condition. However, its presentation is highly variable and is difficult to differentiate from other medical conditions such as a simple rhinitis. Before making a final diagnosis, allergy testing is important since allergic rhinitis presents with the same symptoms of sinusitis. It is essential to look at the overall presentation of the patient’s history as well as the physical findings in order to make the diagnosis of uncomplicated sinusitis. When selecting an antibiotic regimen for sinusitis, it is crucial to consider drugs safety, their costs and the local patterns of bacteria resistance in order to maximize the therapy and avoid drug resistance. Antimicrobial regimens discussed below are for the uncomplicated cases, and the patients have been assumed that they do not have any orbital or intracranial complications with a normal immune system. For the complicated cases, they require broad-spectrum intravenous antibiotics in order to take full control of the pathogens. The paper discusses on the pharmacological effects of antibiotics in the management of sinusitis and the nursing implications. It discusses on all classes of drugs used for sinusitis management i.e. penicillin’s (Augmentin, Amoxil), cephalosporin’s (cefuroxime), fluoroquinolones (e.g. ciprofloxacin) and clindamycin. Keywords: antimicrobial regime, antibiotics, sinusitis, nursing, pharmacological, therapy, Patients, diarrhea, bacterial Patients all suffering from complicated sinusitis and do not respond to therapy because of drug resistance or other factors should be referred to an otorhinolaryngologist or an infectious disease specialist to guide for continued therapy (Dixon & O’Leary, 2012). The principal pathogens for sinusitis are bacteria agents referred to as respiratory pathogens. Other potential disease-causing organisms include Staphylococcus Aureus, Streptococcus pyogenes and anaerobic bacteria’s such as bacteroids. Anaerobic bacteria’s are likely to be seen in dental diseases resulting from the extension of infections from the roots of the molar teeth to the sinuses. The first-line antibiotics for treatment include Amoxicillin 500mg, Doxycycline 100mg and trimethoprim-sulfamethoxazole. Second-line medications include Azithromycin 500mg, Amoxicillin/clavulanate 875/125 mg, second-generation cephalosporin’s e.g. cefuroxime, cefpodoxime, cefdinir; fluoroquinolones e.g. ciprofloxacin and moxifloxacin as well as clindamycin (Brook, 2007). New guidelines for management of rhinosinusitis and signs and symptoms According to the new guidelines on treatment of sinusitis in the infectious Disease Society New guidelines for rhinosinusitis management, main aim is reducing inappropriate antimicrobial agents use in patients. The new guideline focus on separating bacterial and viral sinusitis based on their clinical presentation. An infection should be considered bacterial when symptoms last for more than 10 days and are not improving or if the symptoms are severe or get worse. According to the guideline, sinusitis symptoms include purulent nasal discharge, high fever and facial pain lasting for 3-4 days accompanied by headache. Thus, the new guideline recommends a 5 to 7 days period of antibiotics treatment for adult bacteria sinusitis rather than a 10 to 14 days treatment period to discourage the development of resistance. Moreover, the new guideline suggests treatment with Amoxicillin-clavulanate acid instead of the current standard that was utilized before of amoxicillin alone. The guideline also discourages the use of antihistamines and decongestants in bacteria sinusitis treatment. The main goal of the new guideline is to reduce inappropriate antibiotic use to reduce development of resistance. The guideline addresses several issues in bacteria sinusitis management to include the inability of existing clinical criteria of differencing viral and bacterial sinusitis. It also addresses the gaps of knowledge and quality evidence concerning antimicrobial therapy, it also addresses the changing antimicrobial susceptibility, and prevalence profiles of bacteria associated with sinusitis as well as the impact of utilization of conjugated vaccines for S. pneumonia. Pharmacological Effects of Antibiotics in Management of Sinusitis and the Nursing Implications Drug- Augmentin (amoxicillin/clavulanate) It is a second-line medication for the treatment of sinusitis. A combination of antibiotics used for treating bacterial infections. It is in a group of medications called penicillins. Side effects associated after taking Augmentin include diarrhea, nausea, vomiting, nausea and mild skin rash. In some cases, it makes birth control pills less effective (Levison, 2004). Augmentin drug does not cause harm to the unborn baby in a pregnant woman, but it is important for a pregnant woman to tell the doctor that she is pregnant before treatment. This is because the drug has the ability of passing into the breast milk of the pregnant woman and may harm the baby. Therefore, it is crucial to take a good comprehensive history before administration of the medication. Pharmacological effects and signs of an allergic reaction to the medication include getting hives on the skin, breathing difficulties as well as swelling on the tongue, face, lips and the throat. This happens to those patients who are allergic to penicillin. Upon notification of the above symptoms, it is important to stop taking the drug and seek health care attention since the symptoms may result to death if they are persistent (Hamilos, 2000). Other drug reaction effects include patients having diarrhea that is watery or has blood on it and antidiarrheal medications may be administered, easy bleeding or bruising reported, skin rash, numbness and muscle weakness, confusion, agitation, unusual behavior and seizure, nausea, itching, upper stomach pain and jaundice. From the drug reaction effects, nursing implications entails; the nurse should check on the amount of diarrhea of the patient and in case of imbalances of fluid intake and fluid outtake, fluids need to be administered appropriately (Slavin et al., 2005). Care should be taken to the patient to avoid easy bruising as the patient is at a risk of bleeding. In cases of agitation and confusion, it is important for the nurse and medical personnel to ensure that the patient is safe and away from any harm or injury. The patient also needs to be oriented accordingly on the place time and condition as well as on the sides and symptoms that they will expect upon taking the medications. Analgesics should be administered in case of stomach upsets. Less serious effects include mild diarrhea and nausea and vomiting that can be prevented through administration of antiemetic’s (Improvement, 2001). Hepatic dysfunction i.e. hepatitis and cholestatic jaundice and the increase in serum transaminase, as well as bilirubin levels, have been reported on patients using the medication. These symptoms have been reported among the elderly or patients under prolonged treatment with the drug. These symptoms are usually irreversible, and it is important for the nurse to observe for such symptoms and if they are present stop administration of the medication. To avoid a repeat of such symptoms, good history taking from patients is important (O’Leary & Dixon, 2011). Cefuroxime Pharmacological Effects and the Nursing Implications Use of cefuroxime has various pharmacological implications such as the possible emergence and growth of organisms in the intestinal tract with prolonged therapy of the medication. This alters the normal colon flora and permits the growth clostridium difficile resulting to clostridium difficile associated colitis and diarrhea (CDAD) also referred to as antibiotic-associated diarrhea. This has been reported in cases of all anti-infectives and ranges in the cases of severity from mild diarrhea to fatal colitis. These toxins that result are associated with increased mortality and morbidity rate since they may be refractory, and colectomy may be required for the patient. It is important for the nurse and other medical personnel to consider CDAD if the patient present with diarrhea during and after therapy and manage the patients appropriately. Thus, it is essential to carefully observe the patient and institute the appropriate therapy (Levison, 2004). Careful medical history is also essential to obtain since the condition occurs as late as after two months when the therapy is discontinued. Thus, it is important to discontinue treatment upon suspicion of CDAD and institute the appropriate therapy such as monitoring the electrolyte and fluid levels of the patient as well as food supplementation i.e. protein. Surgical evaluation is also important is it is clinically evaluated. Sensitivity reactions also occur due to Cefuroxime drug administration. Possible reactions include maculopapular and erythematous rash, fever, urticaria, pruritus anaphylaxis, epidermal necrolysis and Steven- Johnson syndrome. Upon identification of the symptoms, it is important to discontinue treatment and institute for appropriate treatment i.e. corticosteroids administration to counteract the symptoms, maintenance of an adequate airway pattern and oxygen administration (Mehrtens & Spigarelli, 2010). Cefuroxime has cross sensitivity with B-lactam antibiotics that include other penicillin’s and cephamycin. Before administration of cefuroxime therapy, it is important to make a careful consideration on previous hypersensitivity reactions to cephalosporin’s and other drugs. Therefore, it is essential to be act cautiously when administering the medication on patients hypersensitive to penicillin’s as well as avoid utilization on individuals with immediate and delayed hypersensitive reactions. It is also important to use the medication with caution among patients with gastrointestinal conditions particularly colitis (Slavin et al., 2005). Patients with prolonged therapy have a risk of renal and hepatic impairment; thus, close monitoring is important as well as patients with poor nutritional status or anticoagulant therapy. Vitamin K should be administered when indicated. To reduce the development of drug resistance as well as maintenance of cefuroxime effectiveness, it is important to administer the correct dosage and ensure adherence thus patient education is important. Amoxicillin Pharmacological Effects and the Nursing Implications Amoxicillin is a semisynthetic penicillin and is a bactericidal agent against sensitive organisms. Its mode of action is through the inhibition of mucopeptide synthesis in the bacterial cell wall. Its spectrum of the antimicrobial agents includes H. influenza, salmonella, E. coli and Shigella species. It is quickly absorbed by the gastrointestinal tract after oral administration, and the drug is stable under the presence of gastric acid. It is indicated for the treatment of sinusitis, bronchitis, pharyngitis, pneumonia, acute otitis media and urinary tract infections (Levison, 2004). Serious and occasionally fatal hypersensitivity reactions occur as a result of Amoxicillin administration especially patients who are sensitive to penicillin therapy and have a history of multiple allergens sensitivity. Therefore, before initiating therapy it is important for the nurse to carefully inquire from the patients for any history of hypersensitivity. These hypersensitive reactions have been reported in up to 10 percent of patients, includes urticarial rash, erythematous rash, anaphylaxis, urticaria, edema, and exfoliate dermatitis (Improvement, 2001). Upon identification of the symptoms, it is important to stop the medication and seek for an alternative medication. Gastrointestinal side effects include vomiting, nausea, anorexia, gastritis, epigastric distress, black hairy tongue and diarrhea. Glossitis, stomatitis and abdominal pain have also been reported on the patients. Amoxicillin has also been associated with hemorrhagic and inflammatory colitis that typically affects the ascending colon. Therefore, it is very essential for the nurse to administer adequate fluids to the patient to prevent dehydration in the cases of vomiting, diarrhea and nausea. Antiemetic medications are also important to prevent cases of nausea and vomiting. The nurse should also ensure that the nutritional pattern of the patients is met by ensuring appropriate nutrition is maintained in instances of Glossitis, stomatitis and abdominal pain (Brook, 2004). Hematological effects include anemia, purpura, thrombocytopenia, neutropenia, agranulocytosis and leukopenia. These reactions of amoxicillin therapy are usually reversible upon discontinuation of the medication. Anemia can be corrected through blood transfusion is it is severe but dietary support, and patient education on appropriate nutrition will help reverse the condition. In the case of an overdose of the drug, serious toxicity is unlikely following a large dose. However, the acute ingestion of the medications may result to vomiting, nausea, abdominal pain, and diarrhea. Hematuria and renal failure may also occur. Treatment is usually by emptying the stomach when the patient is conscious and not experiencing any seizures. Activated charcoal is also administered in order to decrease further drug absorption to reduce the side effects. For patients who are experiencing severe diarrhea and vomiting, fluids and electrolytes are essential to monitor (Levison, 2004). Ciprofloxacin Pharmacological Effects and the Nursing Implications It is a drug that is used in the treatment of bacterial infections i.e. sinusitis a second-generation fluoroquinolones. Serious hypersensitive reactions result among individual with hypersensitivity. Therefore, it is important to determine the history of the quinolone therapy sensitivity before administration of the medication. Symptoms of hypersensitivity include urticarial, itchiness, facial edema, loss of consciousness, dyspnea and cardiovascular collapse. Upon identification of the above symptoms, administration of the medication needs to be stopped, and airway management, oxygen therapy and intravenous steroids should be opened to clear the airway (Levison, 2004). Fluoroquinolones including ciprofloxacin exhibit neuromuscular blocking activity leading to muscle weakness especially in patients with Myasthenia Gravis. Nursing implications for such patients include conducting ventilator support (Brook, 2004). Ciprofloxacin should be avoided in patients with myasthenia gravis. Clostridium difficile associated diarrhea is also associated with the use of ciprofloxacin causing mild to severe diarrhea and colitis. If CDAD is suspected ongoing therapy needs to be discontinued and appropriate electrolyte, fluid and protein supplementation started. Ciprofloxacin mediction is associated with increased risk of tendon rupture and tendinitis among the individuals who utilize the medication (Damuth, Heidelbaugh, Malani, & Cinti, 2008). The reaction involves the Achilles tendon that may require surgical repair. The risk of developing ciprofloxacin and other fluoroquinolones associated tendon the rupture is increased by age usually more prevalent among elderly individuals using the medication and are more than 60 years (O’Leary & Dixon, 2011). This occurs during or after completion of therapy thus ciprofloxacin should be discontinued if the patient experiences any swelling, pain and inflammation or rupture of a tendon. The patient should also be advised to rest with the first sign of tendon rupture or tendinitis while the medication is changed to a non-quinolone antimicrobial drug (Antoniou, Gomes, Mamdani, & Juurlink, 2011). Other fatal and serious effects from hypersensitivity include rash, fever, dermatological reactions and diarrhea. The drug should be discontinued upon identification of the first appearances of skin rash or any other hypersensitive reaction. Fatal reactions have been reported in patients who receive concurrent therapy with theophylline. Reactions include difficulty in breathing, cardiac arrest and seizures. It is important to avoid the combined therapy if such symptoms are noticed. If the combined therapy cannot be avoided, the drug dosages should be adjusted and monitored appropriately. Increased intracranial pressures, confusion, tremors, depression, hallucinations and convulsions have also been reported among patients using the drug and at such instances, the drug should be stopped. The medication should be used with cautiously in patients with suspected central nervous disorders as it may predispose episodes of seizures (Becker, 2003). Clindamycin Pharmacological Effects and the Nursing Implications Clostridium associated difficile diarrhea (CDAD) has been reported with the utilization of nearly all the antibacterial agents including clindamycin ranging from the symptoms of diarrhea to fatal symptoms of colitis. Prolonged treatment with an antimicrobial agent leads to an alteration of colon normal flora leading to overgrowth of C. difficile. Thus, the drug therapy ought to be reserved for serious sinusitis infections where other less toxic antimicrobial agents are less effective. It should never be utilized in patients with nonbacterial infections i.e. in most upper respiratory tract infections (Mahmood, Younas & Rasheed, 2011). The hypertoxin strains of C. Difficile leads to an increased mortality and morbidity as the infections can be refractory needing colectomy. Careful medical history is also essential to obtain since the condition occurs as late as after two months when the therapy is discontinued. Thus, it is important to discontinue treatment upon suspicion of CDAD and institute the appropriate therapy such as monitoring the electrolyte and fluid levels of the patient as well as food supplementation i.e. protein. Surgical evaluation is also important is it is clinically evaluated. Conclusion Patients need to be educated on the antimicrobial drugs for the treatment of sinusitis as well as the signs and symptoms to expect upon medication administration. This is important to help in discovering hypersensitive cases and change regime treatment when necessary to avoid adverse drug reactions and interactions. When antimicrobials are prescribed in treating bacterial infections, the patients should be informed that although it is common to feel better at the course of the therapy, the medications needs to be taken as prescribed. Skipping a drug dose and not taking a full, complete dosage decreases the effectiveness of immediate treatment as well increases the likelihood of bacteria to develop resistance and will be difficult to treat in the future. Diarrhea, nausea and vomiting are common problems that are associated with antibiotics administration. At times, diarrhea will result during the cause of the therapy will at others it may result in months after therapy administration. It is important to advise the patients to seek care from their healthcare providers upon identification of the symptoms. References Antoniou, T., Gomes, T., Mamdani, M. M., & Juurlink, D. N. (2011). Ciprofloxacin-induced theophylline toxicity: A population-based study. European Journal of Clinical Pharmacology, 67, 521–526. doi:10.1007/s00228-010-0985-0 Becker, D. G. (2003). Medical treatment of sinusitis. Journal of Long-Term Effects of Medical Implants, 13, 195–205. Brook, I. (2004). Microbiology and antimicrobial management of sinusitis. Otolaryngologic Clinics of North America. doi:10.1016/S0030-6665(03)00155-5 Brook, I. (2007). Acute and Chronic Bacterial Sinusitis. Infectious Disease Clinics of North America. doi:10.1016/j.idc.2007.02.001 Damuth, E., Heidelbaugh, J., Malani, P. N., & Cinti, S. K. (2008). 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