A patient has been prescribed azithromycin, a macrolide antibiotic, for a respiratory infection.
The nurse should instruct the patient to report which of the following signs or symptoms of a potential adverse effect?

Here is why:

• Choice A:Monitor the client’s serum creatinine level.

This is correct because vancomycin can cause nephrotoxicity (damage to the kidneys) and serum creatinine is a marker of kidney function.A high serum creatinine level indicates impaired kidney function and may require dose adjustment or discontinuation of vancomycin.

• Choice B:Monitor the client’s serum vancomycin level.

This is correct because vancomycin has a narrow therapeutic range, meaning that there is a small difference between the effective dose and the toxic dose.Monitoring the serum vancomycin level can help to ensure that the drug is within the therapeutic range and avoid toxicity or suboptimal efficacy.

• Choice C:Infuse the drug over at least 60 minutes.

This is correct because vancomycin can cause a hypersensitivity reaction called “red man syndrome” or “red neck syndrome”, which is characterized by flushing, itching, rash, hypotension and tachycardia.

This reaction is not an allergy but a result of histamine release due to rapid infusion of vancomycin.Infusing the drug over at least 60 minutes can reduce the risk of this reaction.

• Choice D:Observe the client for signs of ototoxicity.

This is incorrect because vancomycin is not known to cause ototoxicity (damage to the ears) in humans.Ototoxicity has been reported in animal studies and in vitro studies, but not in clinical trials or case reports involving humans.

Therefore, there is no need to monitor for signs of ototoxicity such as hearing loss, tinnitus or vertigo.

Cefazolin can cause serious or life-threatening allergic reactions in some patients, especially those with a history of penicillin allergy.The most common allergic reactions to cefazolin are immediate reactions, such as anaphylaxis, urticaria, bronchospasm, and angioedema.These reactions usually occur within one hour of the drug administration and may involve symptoms such as rash, itching, swelling, difficulty breathing, low blood pressure, and shock.Immediate reactions are mediated by immunoglobulin E (IgE) antibodies that bind to the drug and trigger the release of inflammatory mediators from mast cells and basophils.

Choice D is wrong because Stevens-Johnson syndrome is not a typical allergic reaction to cefazolin.

Stevens-Johnson syndrome is a rare and severe skin reaction that can be caused by various drugs, infections, or autoimmune diseases.

It involves blistering and peeling of the skin and mucous membranes, fever, malaise, and eye inflammation.

Stevens-Johnson syndrome is not mediated by IgE antibodies, but by other immune mechanisms that damage the skin cells.

Cefazolin is not known to cause Stevens-Johnson syndrome, although other cephalosporins have been reported to do so in rare cases.