Mezlocillin Sodium

 Action Inhibits biosynthesis of bacterial cell wall mucopeptide.

 Indications Treatment of infections of lower respiratory tract, urinary tract, skin or skin structure; intra-abdominal infections; uncomplicated gonorrhea; gynecological infections; septicemia; streptococcal infections; severe infections; and pseudomonas infections caused by susceptible strains of specific microorganisms and prophylaxis.

 Contraindications Hypersensitivity to penicillins.

 Route/Dosage

ADULTS: IM/IV 200 to 300 mg/kg/day in 4 to 6 divided doses. Usual doses are 3 g q 4 hr or 4 g q 6 hr. IM doses should not exceed 2 g/injection. CHILDREN > 1 MO to < 12 YR: IM/IV 50 mg/kg q 4 hr. NEONATES: IV 75 mg/kg q 6 to 12 hr.

 Interactions

Contraceptives, oral: May reduce efficacy of oral contraceptives. Tetracyclines: May impair bactericidal effects of mezlocillin. INCOMPATIBILITIES: Parenteral aminoglycosides may inactivate aminoglycosides in vitro; o not mix in same IV solution.

 Lab Test Interferences Antiglobulin (Coombs') test: Drug may cause false-positive results in certain patient groups. Urine glucose test: Drug may cause false-positive results with copper sulfate tests (eg, Benedict test, Fehling test, or Clinitest tablets); enzyme-based tests (eg, Clinistix, Tes-tape) are not affected. Urine protein determinations: Drug may cause false-positives with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction and nitric acid test; bromphenol blue test (Multi-Stix) not affected.

 Adverse Reactions

CNS: Neurotoxicity (eg, lethargy, neuromuscular irritability, hallucinations, convulsions, seizures); dizziness; fatigue; insomnia; reversible hyperactivity; rolonged muscle relaxation. DERM: Ecchymosis. EENT: Itchy eyes. GI: Nausea; vomiting; abdominal pain or cramp; diarrhea or bloody diarrhea; ectal bleeding; flatulence; enterocolitis; pseudomembranous colitis; anorexia. GU: Interstitial nephritis (oliguria, proteinuria, hematuria, hyaline casts, pyuria); nephropathy; elevated creatinine or BUN. HEPA: Transient hepatitis; cholestatic jaundice. HEMA: Anemias; thrombocytopenia; eosinophilia; leukopenia; granulocytopenia; eutropenia; bone marrow depression; agranulocytosis; reduced hemoglobin or hematocrit; prolongation of bleeding time and PT; altered blood cell counts. META: Elevated serum alkaline phosphatase; hypernatremia; reduced serum potassium, albumin, total proteins, and uric acid. OTHER: Hypersensitivity reactions that may lead to death; vaginitis; hyperthermia; ain at site of injection; deep vein thrombosis; hematomas; vein irritation; hlebitis; sciatic neuritis.

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Bleeding abnormalities: Hemorrhagic manifestations associated with abnormalities of coagulation tests (bleeding time, PT, platelet aggregation) may occur. Abnormalities should revert to normal when drug is discontinued. Hypersensitivity: Reactions range from mild to life threatening. Administer cautiously to cephalosporin-sensitive patients because of possible cross reactivity. Pseudomembranous colitis: Consider in patients with diarrhea. Sodium content: 1.85 mEq sodium/g. Superinfection: May result in bacterial or fungal overgrowth of nonsusceptible organisms.

 Administration/Storage

• For IV administration reconstitute each gram of mezlocillin sodium with 9 to 10 ml of sterile water, D5W, or 0.9% Sodium Chloride Injection; shake vigorously.
• Temporarily discontinue administration of any other solution during infusion.
• May inject reconstituted solution ³ 10% into vein or IV tubing; infuse slowly over 3 to 5 min.
• For IM administration reconstitute each gram of mezlocillin sodium with 3 to 4 ml of 0.5% to 1% lidocaine HCl without epinephrine. Inject into large muscle slowly (12 to 15 sec) to minimize discomfort.
• Store unreconstituted mezlocillin at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any allergies.
• Monitor I&O throughout therapy.
• Monitor liver function, hematology (WBC, RBC, hgb, hct, bleeding time), and renal function.
• Assess bowel function.
• Assess respiratory status.
• Observe IV site for thrombophlebitis.
• Notify physician of hemorrhagic manifestations associated with abnormalities in coagulation time.

 Patient/Family Education

• Instruct patient to report the following symptoms to physician: kin rash, itching, hives, severe diarrhea, shortness of breath, wheezing, black tongue, sore throat, nausea, vomiting, fever, swollen joints, or any unusual bleeding or bruising.