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.


  1. uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral
  2. Daily Med, https://dailymed.nlm.nih.gov/dailymed/index.cfm, used for hyperlinked medications in this module. Retrieved June 27, 2019.
  3. UpToDate (2021). Aztreonam. https://www.uptodate.com/contents/search

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Fundamentals of Nursing Pharmacology - Mohawk College Edition Copyright © 2023 by Chippewa Valley Technical College; Amanda Egert; Kimberly Lee; and Manu Gill is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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