35.1: Urinary Anti-infectives
By the end of this section, you should be able to:
- 35.1.1 Identify the characteristics of urinary anti-infective drugs used for urinary and bladder disorders.
- 35.1.2 Explain the indications, actions, adverse reactions, contraindications, and interactions of urinary anti-infective drugs used for urinary and bladder disorders.
- 35.1.3 Describe nursing implications of urinary anti-infective drugs used for urinary and bladder disorders.
- 35.1.4 Explain the client education related to urinary anti-infective drugs used for urinary and bladder disorders.
Urinary anti-infectives are a class of drugs specifically used to treat infections of the urinary tract, including the bladder, urethra, ureters, and kidneys (Figure 35.2). They are designed to target and eliminate the bacteria or other microorganisms causing urinary infection.
Adverse Effects and Contraindications
Common adverse effects of urinary anti-infectives include nausea, vomiting, abdominal pain, anorexia, rash, headache, photosensitivity, and dizziness. Serious adverse effects can occur with certain urinary anti-infectives, including exfoliative dermatitis, Stevens–Johnson syndrome, and fulminant hepatic necrosis.
Contraindications include renal and hepatic insufficiency and hypersensitivity to the drug or any of its components. Certain urinary anti-infectives are contraindicated in clients with blood dyscrasias and in specific pediatric populations.
Table 35.2 is a drug prototype table for urinary anti-infectives featuring TMP/SMX. It lists drug class, mechanism of action, adult dosage, indications, therapeutic effects, drug and food interactions, adverse effects, and contraindications.
|
Drug Class
Anti-infective Mechanism of Action Inhibits the bacterial synthesis of tetrahydrofolic acid, which is necessary in the synthesis of thymidine, purines, and bacterial DNA |
Drug Dosage
Regular-strength tablet: one 400 mg/80 mg tablet orally twice daily. Double-strength tablet: one 800 mg/160 mg tablet orally twice daily. |
|
Indications
Treatment of UTIs due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis , and Proteus vulgaris Therapeutic Effects Elimination of bacteria that cause UTIs |
Drug Interactions
Dofetilide Warfarin Nonsteroidal anti-inflammatory drugs Phenytoin Methotrexate Cyclosporine Digoxin Amantadine Food Interactions No significant interactions |
|
Adverse Effects
Nausea, vomiting, anorexia Rash, urticaria Severe cutaneous reactions Fulminant hepatic necrosis Blood dyscrasias Photosensitivity Hyperkalemia |
Contraindications
Hypersensitivity History of drug-induced immune thrombocytopenia with use of trimethoprim and/or sulfonamides Megaloblastic anemia due to folate deficiency Infants younger than 2 months of age Severe renal or hepatic insufficiency Caution: May cause Clostridioides difficile –associated diarrhea |
Nursing Implications
The nurse should do the following for clients who are taking urinary anti-infectives:
- Before administering the drug, check the client’s medical history, current drug list, and allergies.
- Before administering the drug, confirm the results of baseline laboratory tests, including, but not limited to, urinalysis, urine culture and sensitivity, complete blood cell count, and renal and hepatic function levels.
- For clients receiving nitrofurantoin, monitor for acute and subacute signs of respiratory reactions, such as dyspnea, chest pain, chills, fever, and cough, and notify the health care provider if these develop.
- For clients receiving TMP/SMX, monitor for early signs of blood dyscrasias, such as sore throat, fever, or pallor, and notify the health care provider if these develop.
- Monitor intake, output, and urine specific gravity. Report significant decreases in urinary output to the health care provider.
- Report any signs of superinfection, such as stomatitis, anogenital discharge, or itching, to the health care provider.
- Provide client teaching regarding the drug and when to call the health care provider. See below for client teaching guidelines.
Client Teaching Guidelines
The client taking a urinary anti-infective should:
- Increase their daily fluid intake (avoiding substances that cause diuresis, such as caffeine), if not contraindicated, to avoid the development of kidney stones.
- Rinse their mouth out thoroughly after taking nitrofurantoin because this drug may stain the teeth.
- Ask the health care provider before taking certain urinary anti-infectives, such as nitrofurantoin, if they are pregnant, are thinking of becoming pregnant, are breastfeeding, or are considering giving these medications to an infant younger than 1 month of age because they may cause serious adverse effects such as blood dyscrasias, anemia, and fetal abnormalities.
- Avoid excessive exposure to sunlight when taking TMP/SMX because photosensitivity may occur, and sun exposure may cause sunburn or skin rash.
The client taking a urinary anti-infective should not:
- Crush tablets or open capsules unless directed by a pharmacist because these drugs may cause esophageal or stomach irritation.
- Stop taking the drug unless directed by the health care provider. Drugs in this class help eliminate bacteria in the body and can result in a worsening infection if the drug course is stopped early. Stopping early may also contribute to antibiotic resistance.
FDA Black Box Warning
Urinary Anti-infectives
Nitrofurantoin may cause acute, subacute, or chronic pulmonary reactions (such as diffuse interstitial pneumonitis or pulmonary fibrosis, or both). Monitoring for these conditions is warranted.
Trimethoprim and sulfamethoxazole (TMP/SMX) may cause acute eosinophilic pneumonia, acute and delayed lung injury, interstitial lung disease, and acute respiratory failure resulting in prolonged mechanical ventilation, extracorporeal membrane oxygenation (ECMO), the need for lung transplantation, or death. Monitoring for these conditions is warranted.