Dirithromycin

 Action Interferes with microbial protein synthesis.

 Indications Treatment of acute bacterial infection of chronic bronchitis, secondary bacterial infection of acute bronchitis, community-acquired pneumonia, pharyngitis/tonsillitis, and uncomplicated skin and skin structure infections caused by susceptible organisms.

 Contraindications Hypersensitivity to erythromycin or any macrolide antibiotic.

 Route/Dosage

ADULTS & CHILDREN ³ 12 YR: PO 500 mg once daily for 7 to 14 days.

 Interactions

Terfenadine: Since cardiotoxicity and death have occurred with other macrolide antibiotics, monitor patient during concurrent use; however, available clinical data indicate that there is no interaction. Theophylline: Slight decrease in theophylline serum concentrations may occur.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Headache; dizziness; vertigo; insomnia. DERM: Rash; pruritus; urticaria. GI: Abdominal pain; nausea; diarrhea; vomiting; dyspepsia; flatulence. HEMA: Increased platelet count; eosinophilia; increased segmented neutrophils. META: Decreased bicarbonate. RESP: Increased cough; shortness of breath. OTHER: Increased serum potassium; pain; weakness; increased CPK.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy in children < 12 yr not established. Pseudomembranous colitis: Consider possibility in patients who develop diarrhea. Superinfection: Prolonged use of antibiotics may result in bacterial or fungal overgrowth of nonsusceptible microorganisms.

 Administration/Storage

• Take tablets with food or within 1 hr after eating. Food helps increase absorption.
• Swallow each tablet whole. Do not cut, crush or chew tablets.
• Drink plenty of fluids as tablets are swallowed.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history.
• Obtain baseline lab work including albumin, CBC, WBC with diff, platelet count and total protein.
• Monitor for signs and symptoms of superinfections.
• Monitor for diarrhea, nausea, vomiting and abdominal cramping.
• Assess infection for indications of effectiveness of medication.

 Patient/Family Education

• Instruct patient to take medication with food or within 1 hr after meals.
• Instruct patient to notify healthcare provider if rash develops or difficulty breathing occurs.
• Stress to patient that entire course of therapy must be completed, and not to stop taking medication when feeling better.
• Warm patient that if infection does not seem to improve after 5 days, to notify healthcare provider.
• Instruct patient to drink 2 to 3 liters of fluid per day while taking oral antibiotics.