DRUG STUDY BRAND NAME: Garamycin, Garamycin Ophthalmic, Genoptic Classifications: antiinfective; aminoglycoside antibiotic Action: Broad-spectrum aminoglycoside

antibiotic derived from Micromonospora purpurea. Action is usually bacteriocidal. Indication: Parenteral use restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are ineffective or are contraindicated. Has been used in combination with other antibiotics. Also used topically for primary and secondary skin infections and for superficial infections of external eye and its adnexa. Dosage and Route: Moderate to Severe Infection Adult: IV/IM 1.52 mg/kg loading dose followed by 35 mg/kg/d in 23 divided doses Intrathecal 48 mg preservative free q.d. Topical 12 drops of solution in eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d. Child: IV/IM 67.5 mg/kg/d in 34 divided doses Intrathecal >3 mo, 12 mg preservative free q.d. Neonate: IV/IM 2.5 mg/kg q1224h Acute Pelvic Inflammatory Disease Adult: IV/IM 2 mg/kg followed by 1.5 mg/kg q8h Prophylaxis of Bacterial Endocarditis Adult: IV/IM 1.5 mg/kg 30 min before procedure, may repeat in 8 h Child: IV/IM < 27 kg, 2 mg/kg 30 min before procedure, may repeat in 8 h Adverse Effects: Special Senses: Ototoxicity (vestibular disturbances, impaired hearing), optic neuritis. CNS: neuromuscular blockade: skeletal muscle weakness, apnea, respiratory paralysis (high doses); arachnoiditis (intrathecal use). CV: hypotension or hypertension. GI: Nausea, vomiting, transient increase in AST, ALT, and serum LDH and bilirubin; hepatomegaly, splenomegaly. Hematologic: Increased or decreased reticulocyte counts; granulocytopenia, thrombocytopenia (fever, bleeding tendency), thrombocytopenic purpura, anemia. Body as a Whole: Hypersensitivity (rash, pruritus, urticaria, exfoliative dermatitis, eosinophilia, burning sensation of skin, drug fever, joint pains, laryngeal edema, anaphylaxis). Urogenital: Nephrotoxicity: proteinuria, tubular necrosis, cells or casts in urine, hematuria, rising BUN, nonprotein nitrogen, serum creatinine; decreased creatinine clearance. Other: Local irritation and pain following IM use; thrombophlebitis, abscess, superinfections, syndrome of hypocalcemia (tetany, weakness, hypokalemia, hypomagnesemia).

Nursing Responsibility: Assessment & Drug Effects Lab tests: Perform C&S and renal function prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity. Repeat C&S if improvement does not occur in 35 d; reevaluate therapy. Note: Dosages are generally adjusted to maintain peak serum gentamicin concentrations of 4 10 g/mL, and trough concentrations of 12 g/mL. Peak concentrations above 12 g/mL and trough concentrations above 2 g/mL are associated with toxicity. Draw blood specimens for peak serum gentamicin concentration 30 min1h after IM administration, and 30 min after completion of a 3060 min IV infusion. Draw blood specimens for trough levels just before the next IM or IV dose. Use nonheparinized tubes to collect blood.

Brand Name: Erceflora Classification: Antidiarrheals Suggested Dose: Adults 2-3 vials of 2 billion/5 mL susp Children 2-11 years 1-2 vials of 2 billion/5 mL susp Infants >1 month 1-2 vials of 2 billion/5 mL susp. Mode of Action: Contributes to the recovery of the intestinal microbial flora altered during the course of microbial disorders of diverse origin. It produces various vitamins, particularly group B vitamins thus contributing to correction of vitamin disorders caused by antibiotics & chemotherapeutic agents. Promotes normalization of intestinal flora. Indication: Acute diarrhea with duration of 14 days due to infection, drugs or poisons. Chronic or persistent diarrhea with duration of >14 days. Contraindication: Not for use in immunocompromised patients (cancer patients on chemotherapy, patients taking immunosuppressant meds) Drug Interaction: No known drug interactions. Side Effects/Adverse Reactions: No known side effects.

Adverse Effects: No known adverse effects. Nursing Responsibility: 1.) Shake drug well before administration. Allows equal distribution of the drug in the fluid it is in. 2.) Monitor patient for any unusual effects from drug. Monitoring allows detection of possible side effects of the drug since there has been no known side effect of the drug. 3.) Administer drug within 30 minutes after opening container. To avoid contamination of the drug. 4.) Dilute drug with sweetened milk, orange juice or tea. To allow easy administration of the drug. 5.) Administer drug orally. Proper administration allows better effects of the drug and prevent possible complications Bacillus clausii is Gram-positive, motile, spore-forming and like most of the Bacillus bacteria, it is rod-shaped. Colonies of B. clausii form filamentous margins that appear cream-white in color. B. clausii is alkaliphilic and produces a class of subtilisins known as high-alkaline proteases. The protease from Bacillus clausii strain 221, the H-221 protease, was the first enzyme to be identified in an alkaliphilic Bacillus. The alkaliphilic nature of the organism has also proved it to be useful in preventing and treating various gastrointestinal disorders as an oral bacteriotherapy. This organism can be found in many alkaline environments, including soil and marine habitat.

Unasyn