SPECTINOMYCIN HYDROCHLORIDE

SPECTINOMYCIN HYDROCHLORIDE
(spek-ti-noe-mye'sin)
Trobicin
Classifications: antibiotic;
Therapeutic: antibiotic

Pregnancy Category: B

Availability

400 mg injection

Action

Antibiotic produced by Streptomyces spectabilis. Action is usually bacteriostatic. Spectinomycin appears to exert its bacteriostatic effect by binding to the 30S ribosomal subunit, interfering with bacterial protein synthesis.

Therapeutic Effect

Variable activity against a wide variety of gram-negative and gram-positive organisms. Inhibits majority of Neisseria gonorrhoeae strains; effective for urethral and anorectal infections, but not pharyngeal.

Uses

Only for treatment of uncomplicated gonorrhea in patients sensitized or resistant to penicillin or other effective drugs approved by US Centers for Disease Control and Prevention.

Unlabeled Uses

Disseminated gonococcal infections caused by penicillinase-producing strains of N. gonorrhoeae (PPNG) and sexually transmitted epididymoorchitis.

Contraindications

Safe use in infants and children <8 y is not established.

Cautious Use

History of allergies; pregnancy (category B), lactation.

Route & Dosage

Uncomplicated Gonorrhea
Adult: IM 2 g as single dose
Child: IM <45 kg, 40 mg/kg (max: 2 g); >45 kg, use adult dosing

Disseminated Gonorrhea
Adult: IM 2 g q12h for 7 d or until switched to oral medication
Child (≥8 y, ≥45 kg): IM 2 g q12h for 7 d

Administration

Intramuscular
  • Give IM injection deep into upper outer quadrant of gluteus. No more than 5 mL should be injected into single site (using 20-gauge needle). Injection may be painful.
  • Reconstitute with supplied diluent (bacteriostatic water for injection with 0.9% benzyl alcohol). Shake vial vigorously immediately after adding diluent and before withdrawing drug.
  • Use solution within 24 h of reconstitution.
  • Store at 15°–30° C (59°–86° F) unless otherwise directed.

Adverse Effects (≥1%)

Skin: Pain and soreness at injection site, urticaria, pruritus, transient rash. Body as a Whole: Headache, dizziness, chills, fever, insomnia, nervousness. GI: Nausea, vomiting. Metabolic: Decrease in Hgb, Hct, Clcr, elevated serum alkaline phosphatase, ALT, BUN.

Pharmacokinetics

Absorption: Readily absorbed from IM site. Peak: 1 h. Metabolism: In liver. Elimination: In urine. Half-Life: 1.2–2.8 h.

Nursing Implications

Assessment & Drug Effects

  • Observe patient for 45–60 min after injection. Systemic anaphylaxis has been reported (apprehension, pruritus, hypertension, abdominal pain, collapse).
  • Obtain serologic tests for syphilis at time of diagnosis in patients with gonorrhea and again after 3 mo.
  • Monitor clinical effectiveness of drug to detect antibiotic resistance.
  • Culture all gonococcal infection sites 3–7 d after spectinomycin therapy is completed to verify eradication of infection.
  • Lab tests: Monitor Hgb and Hct when multiple doses are required.

Patient & Family Education

  • Notify sexual partners of their risk of infection.
  • Refrain from sexual intercourse until infection is resolved.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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