Antibiotics: Correct Use, Stewardship, Clostridioides difficile, and Allergic Reactions
Teach the client to take every dose at evenly spaced times for the full prescribed course, or as the provider directs, even after symptoms improve. Never save, share, or take leftover antibiotics; antibiotics do not treat viral infections such as colds or influenza. Report 3 or more watery stools in 24 hours, and call 911 for hives with difficulty breathing or swelling of the face, lips, tongue, or throat.
Who needs this teaching
Every client who receives an outpatient antibiotic prescription, and the caregiver who gives doses to a child or an older adult. Correct use treats the infection and limits antimicrobial resistance. Antibiotic stewardship means an antibiotic only when indicated, with the right drug, dose, and duration.
The priority teaching points
- Full course and timing. Take each dose at evenly spaced times, such as every 12 hours for a twice-daily drug. Take every dose for the full prescribed course, even after symptoms improve, unless the provider changes the plan. For a missed dose, follow the label or the pharmacist's instructions. Never double a dose.
- Food and administration. Take the drug with or without food as the label directs. Take doxycycline with a full glass of water and remain upright for at least 30 minutes to prevent esophageal irritation. Shake liquid suspensions and measure each dose with an oral syringe. Refrigerate when the label directs.
- Stewardship. Antibiotics treat bacterial infections. They do not treat colds, influenza, most sore throats, or most bronchitis. Never save, share, or take leftover antibiotics. Unnecessary use promotes resistance and adverse effects.
- Common adverse effects. Nausea, mild diarrhea, and vaginal candidiasis (itching, thick white discharge) are common. Doxycycline and fluoroquinolones cause photosensitivity; use sunscreen and protective clothing.
- Clostridioides difficile. Antibiotics disrupt the normal intestinal flora and allow C. difficile overgrowth. Infection occurs during treatment or in the weeks after it. Report 3 or more watery stools in 24 hours, abdominal cramping, or fever. Do not take antidiarrheal medication without the provider's approval. Wash hands with soap and water; alcohol-based hand rub does not kill C. difficile spores.
- Interactions. Tetracyclines and fluoroquinolones bind calcium, magnesium, aluminum, iron, and zinc, and absorption decreases. Take these antibiotics at least 2 hours before or 6 hours after dairy products taken alone, antacids, and mineral supplements, or follow the pharmacist's timing. Rifampin reduces the effectiveness of hormonal contraceptives; ask the pharmacist whether a backup method is needed with the prescribed antibiotic. Report tendon pain during fluoroquinolone therapy because of the risk of tendon rupture.
- Allergic reactions. Report every antibiotic allergy and reaction to each provider and pharmacist. Report a new rash or itching before the next dose. Anaphylaxis presents with urticaria, dyspnea, wheezing, and swelling of the face, lips, tongue, or throat. Call 911.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| 3 or more watery stools in 24 hours, abdominal cramping, or fever | Hives with difficulty breathing or wheezing |
| New rash or itching without breathing difficulty: call before the next dose | Swelling of the face, lips, tongue, or throat |
| Symptoms not improving after 48 to 72 hours, or worsening | Blistering or peeling rash with fever or mouth sores |
| Tendon pain or swelling during fluoroquinolone therapy, or vaginal itching and discharge | Syncope or severe dizziness after a dose |
Teach-back questions
- "What times will you take your doses each day?"
- "What will you do with tablets left over if you feel better?"
- "Why will an antibiotic not help your next cold?"
- "How many watery stools in a day mean you call?"
- "Which allergy signs mean you call 911?"
Teaching tips
- Write the dose times and the end date on the handout.
- Confirm the client's allergy history and the type of past reactions.
- Review dairy, antacid, and supplement timing for tetracyclines and fluoroquinolones.
- Demonstrate oral syringe measurement for liquid doses.
Read more on NCLEXPace
Sources
- Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core Elements of Outpatient Antibiotic Stewardship. MMWR Recomm Rep. 2016;65(6):1-12.
- McDonald LC, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-e48.
- Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Infection.
- Ciprofloxacin Tablets, Doxycycline Hyclate Tablets, and Rifampin Capsules: FDA prescribing information (DailyMed).
Why this matters for the NCLEX
Teaching is effective when the client states, "I will take every dose, even after I feel better," and "I will call if I have 3 or more watery stools in a day." Statements requiring further teaching include, "I will save the leftover pills for my next cold," "I take my doxycycline with a glass of milk," and "I will take loperamide for the diarrhea and finish my antibiotic."
Frequently asked questions
Why does the client not save leftover antibiotics?
Partial courses and self-treatment promote antimicrobial resistance and delay correct diagnosis. Viral infections do not respond to antibiotics.
Does every antibiotic reduce the effectiveness of birth control pills?
No. Rifampin reduces it. The client asks the pharmacist whether a backup method is needed with the prescribed antibiotic.
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