Antimicrobials
3.9 Monobactams
Like penicillins, cephalosporins, and carbapenems, monobactams also have a beta-lactam ring structure.
Indications for Use: Monobactams are narrow-spectrum antibacterial medications that are used primarily to treat gram-negative bacteria such as Pseudomonas aeruginosa.
Mechanism of Action: Monobactams are bactericidal and work to inhibit bacterial cell wall synthesis.
Nursing Considerations Across the Lifespan: Monobactams are considered safe for use in pediatrics. Some dose adjustments are required based on renal dysfunction in older adults. Monobactams can be given during pregnancy if the client is allergic to other, more preferred, antibiotics.
Specific Administration Considerations: Clients taking monobactams may experience adverse effects similar to other beta-lactam medications, so nurses should monitor for GI symptoms, skin sensitivities, and coagulation abnormalities.
Client Teaching & Education: Clients should monitor for signs of superinfection and report any occurrence to the provider. If the client experiences fever and bloody diarrhea, they should contact the provider immediately. The client should also be advised to notify the provider immediately if symptoms progress or if any sign of allergic response occurs.[1]
Monobactams Medication Card
Now let’s take a closer look at the medication card for Monobactams.[2][3] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.
Medication Card 3.9.1: Monobactams (Azteronam)
Class: Monobactams
Prototypes: azteronam
Mechanism: Bactericidal. Narrow-spectrum.
Therapeutic Effects
- Monitor for systemic signs of infection:
- WBC
- Temperature
- Culture results
- Monitor site of infection for improvement
Administration
- Can be administered IM, IV, or via inhalation
- Peak: 60 minutes via IM
- ½ life: 1.5-2 hours with normal renal function
Indications
- used primarily to treat gram-negative bacteria such as Pseudomonas aeruginosa.
- Meropenem: only drug for bacterial meningitis
Contraindications
- Check for allergies to any beta lactams – penicillin, cephalosporins, or carbapenems
- Impaired renal function
Side Effects
- hematologic neutropenia
- increased serum liver enzymes
- GI: GI upset, N/V, diarrhea, dehydration, electrolyte imbalance
- Skin sensitivities
- Coagulation abnormalities
- Superinfection
Nursing Considerations
- Monitor renal and liver function
- Monitor for signs of anaphylaxis during first dose
- Monitor skin
- Monitor bowels
- Monitor labs
Clinical Reasoning and Decision-Making Activity 3.8a
Using the above information, consider the following clinical scenario question:
A client with cystic fibrosis is diagnosed with ventilator-associated pneumonia and is prescribed Aztreonam 1 gm IV daily for a suspected Pseudomonas aeruginosa infection. The nurse reviews the culture results that just arrived and notices that the results indicate the infection is caused by Methicillin-resistant Staphylococcus aureus. Will this medication be effective against this bacteria? What is the nurse’s next best response?
Note: Answers to the activities can be found in the “Answer Key” sections at the end of the book.
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- Daily Med, https://dailymed.nlm.nih.gov/dailymed/index.cfm, used for hyperlinked medications in this module. Retrieved June 27, 2019. ↵
- UpToDate (2021). Aztreonam. https://www.uptodate.com/contents/search ↵