What are the nursing actions for a patient receiving azithromycin (Zithromax) intravenous (IV) therapy, including laboratory tests, vital signs monitoring, and rate of administration?

Nursing Actions for Azithromycin IV Administration

For patients receiving azithromycin (Zithromax) IV therapy, administer at a concentration of 1 mg/mL over 3 hours or 2 mg/mL over 1 hour, never as a bolus or intramuscular injection. 1

Preparation and Administration

Reconstitution

1. Add 4.8 mL of Sterile Water for Injection to the 500 mg vial
2. Shake until completely dissolved (concentration: 100 mg/mL)
3. Dilute further prior to administration:
   • For 1 mg/mL: Transfer 5 mL of reconstituted solution to 500 mL of compatible diluent
   • For 2 mg/mL: Transfer 5 mL of reconstituted solution to 250 mL of compatible diluent

Compatible Diluents

• Normal Saline (0.9% sodium chloride)
• 1/2 Normal Saline (0.45% sodium chloride)
• 5% Dextrose in Water
• Lactated Ringer's Solution
• Other compatible solutions as listed in the drug label 1

Rate of Administration

• 1 mg/mL concentration: Infuse over 3 hours
• 2 mg/mL concentration: Infuse over 1 hour (minimum 60 minutes)
• Never administer as a bolus or intramuscular injection 1

Vital Signs Monitoring

Before Administration

• Obtain baseline vital signs including temperature, pulse, respiratory rate, blood pressure
• Perform baseline ECG to check for QTc prolongation (contraindicated if QTc >450 ms for men, >470 ms for women) 2

During Administration

• Monitor vital signs every 5 minutes after initiation of sedation if used
• Monitor for signs of hypotension during infusion 2
• Observe IV site for signs of phlebitis or infiltration

After Administration

• Monitor vital signs according to facility protocol, typically every 4-6 hours 3
• Continue to assess IV site for 24-48 hours after completion

Laboratory Tests

Before Initiation

• Baseline liver function tests (LFTs)
• Baseline renal function tests (BUN, creatinine)
• Complete blood count (CBC)
• Baseline serum electrolytes

During Therapy

• LFTs at 1 month and then every 6 months during prolonged therapy 2
• Monitor renal function tests if patient has impaired renal function
• Monitor CBC periodically to assess for leukopenia, neutropenia, or thrombocytopenia 1

Patient Assessment

Monitor for Common Side Effects

• Gastrointestinal: nausea, vomiting, diarrhea, abdominal pain (most common side effects, occurring in 1.4-4.3% of patients) 1
• Local IV site reactions: pain at injection site (6.5%), local inflammation (3.1%) 1
• Cardiac: Monitor for signs of QT prolongation (dizziness, palpitations, syncope)

Monitor for Serious Adverse Events

• Allergic reactions: rash, urticaria, angioedema, anaphylaxis (rare)
• Hepatotoxicity: jaundice, right upper quadrant pain, dark urine
• Ototoxicity: hearing disturbances, tinnitus
• C. difficile-associated diarrhea: watery or bloody stools

Special Considerations

• For patients with renal impairment: No dosage adjustment is recommended for GFR >10 mL/min, but use caution with severe renal impairment 1
• For patients with hepatic impairment: Use caution as azithromycin is primarily eliminated via the liver 1
• Drug interactions: Monitor patients on warfarin for increased anticoagulant effects; check prothrombin times 1
• Storage: Reconstituted solution is stable for 24 hours when stored below 30°C (86°F) 1
• Diluted solution (1-2 mg/mL) is stable for 24 hours at room temperature or 7 days if refrigerated 1

Documentation

• Document vital signs, administration time, dose, rate, and site
• Record patient's response to therapy
• Document any adverse reactions and interventions
• Record patient education provided

By following these nursing actions, you can ensure safe and effective administration of IV azithromycin while monitoring for potential adverse effects and complications.