TROLEANDOMYCIN

TROLEANDOMYCIN
(troe-lee-an-doe-mye'sin)
Tao
Classifications: macrolide antibiotic;
Therapeutic: antibiotic

Prototype: Erythromycin
Pregnancy Category: C

Availability

250 mg capsules

Action

Binds to the 50S ribosomal subunit, resulting in inhibition of bacterial protein synthesis. Action is mainly bacteriostatic but can be bacteriocidal depending on bacterial sensitivity.

Therapeutic Effect

Effective against susceptible strains of Clostridium, Haemophilus, Neisseria, Staphylococcus, Streptococcus, and pneumonia.

Uses

Acute, severe infections of upper respiratory tract caused by susceptible strains of pneumococci and group A beta-hemolytic streptococci.

Contraindications

History of hypersensitivity to any of the macrolide antibiotics; bacteriemia; concurrent use with ergot derivatives, pimozide, astemizole, or cisapride; use for prophylaxis or for minor infections; pregnancy (category C); porphyria.

Cautious Use

Impaired liver function; lactation.

Route & Dosage

Upper Respiratory Tract Infections
Adult: PO 250–500 mg q6h
Child: PO 6.6–11 mg/kg (125–250 mg) q6h

Administration

Oral
  • Give on an empty stomach (1 h before or 2 h after meals).
  • Give in evenly spaced intervals throughout the day, preferably around the clock, in order to maintain effective blood levels.

Adverse Effects (≥1%)

GI: Abdominal cramps and discomfort, nausea, vomiting, diarrhea, cholestatic jaundice. Body as a Whole: Allergic reactions (urticaria, skin rash, anaphylaxis); superinfections.

Diagnostic Test Interference

Troleandomycin may cause false elevations of urinary 17-ketosteroids (Drekter), and 17-hydroxycorticosteroids (Porter-Silver method).

Interactions

Drug: May increase levels of carbamazepine, cyclosporines, and theophylline and their toxicity; oral contraceptives may cause cholestatic jaundice; warfarin may increase prothrombin time (PT); ergotamine may induce ischemia and peripheral vasospasm. Food: Grapefruit juice (>1 qt/d) may increase plasma concentrations and adverse effects.

Pharmacokinetics

Absorption: Incompletely from GI tract. Peak: 2 h. Distribution: Distributed throughout body fluids; diffusion into CSF is poor unless meninges are inflamed. Metabolism: In liver. Elimination: In bile and urine.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Obtain periodic liver function tests in patients receiving drug longer than 10 d or in repeated courses.
  • Some patients develop an allergic type of hepatitis with right upper quadrant pain, fever, nausea, vomiting, jaundice, eosinophilia, and leukocytosis. Liver changes are reversible if drug is discontinued immediately.
  • Be aware that superinfections are most likely to occur in patients on prolonged or repeated therapy. Withdraw if symptoms present (see Appendix F), and start appropriate therapy.

Patient & Family Education

  • Report signs of jaundice: Clay-colored stools, pruritus, yellow sclerae.
  • Do not stop drug before full course of therapy is completed. Do not interrupt and then restart therapy or increase or decrease dose or interval.

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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