Antibiotic Treatment of Infections in Lymphoedema

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Antibiotic Treatment of Infections in Lymphoedema

Postby patoco » Sat Jun 10, 2006 9:22 pm

Antibiotic Treatment of Infections in Lymphoedema

Antibiotic Therapy, Types of Antibiotics

Home page: Lymphedema People


When a lymphoedema patient presents with an infection, it is imperative that immediate and adequate antibiotic treatment begins immediately and for a period of time to insure that infection is resolved.

The course of treatment and the type will depend on several factors:

1.) The type of infection and the causative bacterium.

2.) The stage of the lymphoedema. Stage two and three often require longer periods of treatment and even may require IV antibiotics. Due to tissue hardening it is more difficult for the antibiotic to reach the bacteria.

3.) Underlying or coexistant medical problems.

4.) Whether or not the infection has become systemic, meaning is it showing up in blood cultures.

Oral antibiotics used to treat cellulitis and other infections include:

Cephalexin (Keflex, Biocef)
Amoxicillin Clavulanate (Augmentin)
Cloxacillin (Tegopen)
Penicillins - (Bicillin, Wycillin, Pen Vee, V-Cillin)
Nafcillin (Nafcil, Unipen, Nallpen)
Erythromycin (E.E.S., E-Mycin, Eryc, Ery_tab, Erthrocin)
Clindamycin (Cleocin)

IV Antibiotics used to treat cellulitis and infections include:

Gentamicin (generally used for gram-negative bacteria)
Aminopenicillins (Amoxicillin, Ampicillin)
Azithromycin - Zithromax
Unasyn (generic names penicillins and beta-lactamase inhibitors)


Antibiotics - Definition

In common usage, an antibiotic is a drug that kills certain kinds of bacteria, but which is generally harmless to the host and is used to treat infection. The term was originally used to describe only antibacterial formulations derived from living organisms but is now used in reference to synthetic antimicrobials such as the Sulfonamides.

In general, the term can also apply to substances that affect prions, viruses, fungi, worms or any other intracellular or extracellular parasite, but the antibacterial kind are the most common. Generally, the antibiotics are not effective in viral infections.



Antibiotics are meant to fight off bacterial infections such as pneumonia (e.g. legionnaires' disease), meningitis, cystitis, ear infections, abscess, Lyme disease (tick-transmitted), leprosy & tuberculosis. They cannot be used against viral infections.

. The first antibiotic discovered by Alexander Fleming, a Scottish scientist in 1928 is penicillin. It was only in 1941 that penicillin made it's public debut.

. Antibiotic drugs are grouped into families such as cephalosporins, fluoroquinolones, penicillins, erythromycins, polypeptides, tetracyclines, aminoglycosides, quinolones, streptogramins & sulfonamides. Each family comprises of many members.

. Antibiotics are classified as narrow-spectrum drugs when they are effective against a few types of bacteria & broad-spectrum drugs when they are effective against a wider range of bacteria.

. Combination of antibiotics are sometimes used to treat certain infections like leprosy & tuberculosis.

. They are sometimes prescribed to treat conditions such as acne, food poisoning, gout & nosebleed.

. Preventive antibiotic therapy is meant to prevent bacterial infection, e.g. to reduce the risk of endocarditis (inflammation of the lining inside the heart chambers & heart valves) or to reduce the risk of contracting traveler's diarrhea or to protect people who have a weak immune system because of AIDS or undergoing chemotherapy treatment for cancer.

. Different antibiotics kill different bacteria differently.

. Though antibiotics can kill off sensitive bacteria, the resistant ones survive & even prosper (i.e. grow & multiply).

. Animals like chickens, pigs, turkeys, cattle also receive their dose of antibiotics in order to either promote growth or to treat & prevent diseases. Fruits & vegetables are also not spared as antibiotics are sprayed to prevent bacterial infections.

Antibiotic resistance

. Antibiotic resistance (AR) is the result of an overuse or misuse of antibiotics. This resistance is certainly a big worry.

. Did you know there are certain strains of bacteria that have become impossible to eliminate with almost all types of antibiotics?

. Broad-spectrum antibiotics are the ones that can promote AR as well as interfere with the absorption of vitamins B6 & B12, folic acid, minerals like magnesium, calcium & potassium.

Side effects

. Allergies may develop with the use of antibiotics, frequently with penicillin.

. Side effects from antibiotics can include diarrhea, lightheadness, headaches, cramp, vomiting & stomach discomfort. Consult your physician if these side effects persist or become serious.

. Taking the antibiotic erythromycin (primarily used to treat bacteria infections e.g. bronchitis, Legionnaires' disease, pneumonia, rheumatic fever & venereal disease) with Liptor, a statin drug shown to lower cholesterol can cause muscle damage. Check with your physician before combining these 2 drugs or learn how to lower cholesterol without drugs here.

. Antibiotics can destroy the beneficial flora (needed for digestion & protection against infection) in the gut.

. Antibiotic therapy can weaken the immune system, simply because it suppresses the body's natural defense system against illness.

Prolong use

. A deficiency in vitamin K can occur.

. A reduction of the manufacture of biotin in the intestines.

. Cause people to be light-sensitive. Examples of such antibiotics : doxycycline, ciproflaxacin & ofloxacin.

Consuming antibiotics

If you must consume antibiotics :

. Complete the full course even if symptoms improve, otherwise, the antibiotics are not given enough time to work on the infection completely, which can cause a relapse. What's more, the bacteria can become so resistant that the antibiotics no longer work for you the next time.

. Follow all the instructions carefully. Take the correct dosages on time.

. Do not take a double dose to make up for a missed one. Either resume to take the forgotten dose at once or if it's time for the next dose, just continue with it & skip the earlier missed dose.

. Do not share antibiotics with anyone.

. Never consume previously prescribed leftovers. Discard them.

. If side effects occur from the course of antibiotics or if the condition shows no signs of improvement, see your physician again.

. Keep capsules or tablets in a cool dry place. Store liquid mixtures in the refrigerator


Antibiotics Classifications


Antibiotics may be informally defined as the subgroup of anti-infectives that are derived from bacterial sources and are used to treat bacterial infections.

Antibiotics Classifications

Although there are several classification schemes for antibiotics, based on bacterial spectrum (broad versus narrow) or route of administration (injectable versus oral versus topical), or type of activity (bactericidal vs. bacteriostatic), the most useful is based on chemical structure.

PENICILLINS The penicillins are the oldest class of antibiotics, and have a common chemical structure which they share with the cephalosporins. The two groups are classed as the beta-lactam antibiotics, and are generally bacteriocidal -that is, they kill bacteria rather than inhibiting growth.

CEPHALOSPORINS Cephalopsorins are the usually preferred agents for surgical prophylaxis. Cefotaxime, ceftizoxime, ceftriaxone and others, cross the blood-brain barrier and may be used to treat meningitis and encephalitis.

FLUROQUINOLONES The fluroquinolones are synthetic antibacterial agents, and not derived from bacteria. They are included here because they can be readily interchanged with traditional antibiotics.

TETRACYCLINES Tetracyclines got their name because they share a chemical structure that has four rings. The tetracyclines may be effective against a wide variety of microorganisms, including rickettsia and amebic parasites.

MACROLIDES Erythromycin, the prototype of this class, has a spectrum and use similar to penicillin. Newer members of the group, azithromycin and clarithyromycin, are particularly useful for their high level of lung penetration. Clarithromycin has been widely used to treat Helicobacter pylori infections, the cause of stomach ulcers.

OTHERS Other classes of antibiotics include the aminoglycosides, which are particularly useful for their effectiveness in treating Pseudomonas aeruginosa infections; the lincosamindes, clindamycin and lincomycin, which are highly active against anaerobic pathogens.


How do antibiotics work?

Antibiotics work to kill bacteria. Bacteria are single-cell organisms. If bacteria make it past our immune systems and start reproducing inside our bodies, they cause disease. We want to kill the bacteria to eliminate the disease.

Certain bacteria produce chemicals that damage or disable parts of our bodies. In an ear infection, for example, bacteria have gotten into the inner ear. The body is working to fight the bacteria, but the immune system's natural processes produce inflammation.

Inflammation in your ear is painful. So you take an antibiotic to kill the bacteria and eliminate the inflammation.

An antibiotic is a selective poison. It has been chosen so that it will kill the desired bacteria, but not the cells in your body. Each different type of antibiotic affects different bacteria in different ways. For example, an antibiotic might inhibit a bacterium's ability to turn glucose into energy, or its ability to construct its cell wall. When this happens, the bacterium dies instead of reproducing. At the same time, the antibiotic acts only on the bacterium's cell-wall-building mechanism, not on a normal cell's.

Antibiotics do not work on viruses because viruses are not alive. A bacterium is a living, reproducing lifeform. A virus is just a piece of DNA (or RNA). A virus injects its DNA into a living cell and has that cell reproduce more of the viral DNA. With a virus there is nothing to "kill," so antibiotics don't work on it.

* * * * * * * * * *

Amoxicillin Clavulanate (Augmentin)

AUGMENTIN is an oral antibacterial combination consisting of the semisynthetic antibiotic amoxicillin and the ß-lactamase inhibitor, clavulanate potassium (the potassium salt of clavulanic acid). Amoxicillin is an analog of ampicillin, derived from the basic penicillin nucleus, 6-aminopenicillanic acid. The amoxicillin molecular formula is C16H19N3O5S•3H2O, and the molecular weight is 419.46. Chemically, amoxicillin is (2S,5R,6R)-6-[(R)-(-)-2-Amino-2- (p -hydroxyphenyl)acetamido]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2- carboxylic acid trihydrate

Clavulanic acid is produced by the fermentation of Streptomyces clavuligerus. It is a ß-lactam structurally related to the penicillins and possesses the ability to inactivate a wide variety of ß-lactamases by blocking the active sites of these enzymes. Clavulanic acid is particularly active against the clinically important plasmid-mediated ß-lactamases frequently responsible for transferred drug resistance to penicillins and cephalosporins. The clavulanate potassium molecular formula is C8H8KNO5, and the molecular weight is 237.25. Chemically, clavulanate potassium is potassium (Z)-(2R,5R)-3-(2-hydroxyethylidene)-7-oxo-4-oxa-1-azabicyclo[3.2.0]- heptane-2-carboxylate,

Inactive Ingredients

Colloidal silicon dioxide, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, sodium starch glycolate, and titanium dioxide. Each tablet of AUGMENTIN contains 0.63 mEq potassium.


Keflex - cephalexin

Why is this medication prescribed?

Cephalexin is a cephalosporin antibiotic used to treat certain infections caused by bacteria such as pneumonia and bone, ear, skin, and urinary tract infections. Antibiotics will not work for colds, flu, or other viral infections.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Cephalexin comes as a capsule, tablet, and liquid to take by mouth. It is usually taken every 6 hours (four times a day) or every 12 hours (twice a day) for 7-10 days. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take cephalexin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Shake the liquid well before each use to mix the medication evenly.

The capsules and tablets should be swallowed whole and taken with a full glass of water.

Continue to take cephalexin even if you feel well. Do not stop taking cephalexin without talking to your doctor.

What special precautions should I follow?

Before taking cephalexin

Tell your doctor and pharmacist if you are allergic to cephalexin or any other cephalosporin antibiotic such as cefadroxil (Duricef) or cephradine (Velosef), penicillin, or any other drugs.

Tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially other antibiotics, anticoagulants ('blood thinners') such as warfarin (Coumadin), probenecid (Benemid), and vitamins.

Tell your doctor if you have or have ever had kidney or liver disease, colitis, or stomach problems.

Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking cephalexin, call your doctor.

if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking cephalexin.

What special dietary instructions should I follow?

Cephalexin may cause an upset stomach. Take cephalexin with food or milk.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Although side effects from cephalexin are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

upset stomach
mild skin rash

If you experience any of the following symptoms, call your doctor immediately:

severe skin rash
difficulty breathing or swallowing
unusual bleeding or bruising
sore throat
painful mouth or throat sores
vaginal infection

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the capsules and tablets at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Keep liquid medicine in the refrigerator, tightly closed, and throw away any unused medication after 14 days. Do not freeze. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to cephalexin.

If you are diabetic, use Clinistix or TesTape (not Clinitest) to test your urine for sugar while taking this drug.

Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms of infection after you finish the cephalexin, call your doctor.

Last Revised - 01/01/2003 ... 82733.html



The Following Information Provided by Thomson MICROMEDEX

Also known as:

Penicillins and Beta-Lactamase Inhibitors (Systemic )
Penicillins and beta-lactamase inhibitors are used to treat infections caused by bacteria. They work by killing the bacteria or preventing their growth. The beta-lactamase inhibitor is added to the penicillin to protect the penicillin from certain substances (enzymes) that will destroy the penicillin before it can kill the bacteria.

Precautions & Side Effects


Gentamicin Sulfate Injection

About your treatment

Your doctor has ordered gentamicin, an antibiotic, to help treat your infection. The drug will be either injected into a large muscle (such as your buttock or hip) or added to an intravenous fluid that will drip through a needle or catheter placed in your vein for at least 30 minutes, one to three times a day.

Gentamicin eliminates bacteria that cause many kinds of infections, including lung, skin, bone, joint, stomach, blood, and urinary tract infections. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Your health care provider (doctor, nurse, or pharmacist) may measure the effectiveness and side effects of your treatment using laboratory tests and physical examinations. It is important to keep all appointments with your doctor and the laboratory. The length of treatment depends on how your infection and symptoms respond to the medication.


Before administering gentamicin,

Tell your doctor and pharmacist if you are allergic to amikacin (Amikin), gentamicin, kanamycin (Kantrex), neomycin, netilmicin (Netromycin), streptomycin, tobramycin (Nebcin), or any other drugs.

Tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially diuretics ('water pills'), cisplatin (Platinol), amphotericin (Amphotec, Fungizone), other antibiotics, and vitamins.

Tell your doctor if you have or have ever had kidney disease, vertigo, hearing loss, ringing in the ears, myasthenia gravis, or Parkinson's disease.

Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking gentamicin, call your doctor immediately. Gentamicin can harm the fetus.

Administering your medication

Before you administer gentamicin, look at the solution closely. It should be clear and free of floating material. Gently squeeze the bag or observe the solution container to make sure there are no leaks. Do not use the solution if it is discolored, if it contains particles, or if the bag or container leaks. Use a new solution, but show the damaged one to your health care provider.

It is important that you use your medication exactly as directed. Do not stop your therapy on your own for any reason because your infection could worsen and result in hospitalization. Do not change your dosing schedule without talking to your health care provider. Your health care provider may tell you to stop your infusion if you have a mechanical problem (such as a blockage in the tubing, needle, or catheter); if you have to stop an infusion, call your health care provider immediately so your therapy can continue.

Side effects

Gentamicin occasionally causes side effects. To reduce this risk, your health care provider may adjust your dose based on your blood test results. Follow the directions in the IMPORTANT WARNING section for the symptoms listed there and tell your health care provider if any of the following symptoms are severe or do not go away:

upset stomach
pale skin

Storing your medication

Your health care provider probably will give you a several-day supply of gentamicin at a time. If you are receiving gentamicin intravenously (in your vein), you probably will be told to store it in the refrigerator or freezer.

Take your next dose from the refrigerator 1 hour before using it; place it in a clean, dry area to allow it to warm to room temperature.

If you are told to store additional gentamicin in the freezer, always move a 24-hour supply to the refrigerator for the next day's use.

Do not refreeze medications.

If you are receiving gentamicin intramuscularly (in your muscle), your health care provider will tell you how to store it properly.

Store your medication only as directed. Make sure you understand what you need to store your medication properly.

Keep your supplies in a clean, dry place when you are not using them, and keep all medications and supplies out of reach of children. Your health care provider will tell you how to throw away used needles, syringes, tubing, and containers to avoid accidental injury.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Signs of infection

You should be aware of the symptoms of infection in case your infection worsens or a new infection develops. If you notice any of the following symptoms, tell your health care provider as soon as possible:

unusual tiredness or weakness
nighttime sweating
loss of appetite

If you are receiving gentamicin in your vein or under your skin, you need to know the symptoms of a catheter-related infection (an infection where the needle enters your vein or skin). If you experience any of these effects near your intravenous catheter, tell your health care provider as soon as possible:

Last Revised - 01/01/2003 ... 82275.html


Azithromycin - Zithromax

GENERIC NAME: azithromycin
BRAND NAME: Zithromax
DRUG CLASS AND MECHANISM: Azithromycin is a semi-synthetic macrolide antibiotic chemically related to erythromycin and clarithromycin (Biaxin). It is effective against a wide variety of bacteria organisms, such as Hemophilus influenzae, Streptococcus pneumoniae, Mycoplasma pneumoniae, Staphylococcus aureus, and mycobacterium avium, and many others. It is unusual in that it stays in the body for quite a while, allowing for once a day dosing and for shorter treatment courses for most infections.

Azithromycin, like all macrolide antibiotics, prevents bacteria from growing by interfering with their ability to make proteins. Due to the differences in the way proteins are made in bacteria and humans, the macrolide antibiotics do not interfere with humans' ability to make proteins.



PREPARATIONS: Capsules (red): 250mg; Suspension: 100 mg/teaspoon; 200 mg/teaspoon.

STORAGE: Capsules should be kept below 30°C (86°F). Suspension should be kept between 5° and 30°C (41° and 86°F).

PRESCRIBED FOR: Azithromycin is effective against susceptible bacteria causing infections of the middle ear, tonsillitis, throat infections, laryngitis, bronchitis, pneumonia, sinuses and. It is also effective against certain sexually transmitted infectious diseases, such as nongonococcal urethritis and cervicitis.

DOSING: Azithromycin should be taken at least one hour before or two hours after meals since it may bind to food and not be absorbed from the intestine. For most infections, azithromycin is taken once daily for a relatively short course of treatment (usually five days). The first dose is often a "double dose," twice as much as the remainder of the doses given. For acute bacterial sinusitis, azithromycin way be taken once daily for three days.

DRUG INTERACTIONS: Unlike erythromycin and clarithromycin, azithromycin is generally considered free of interactions with most other medicines. It is recommended that azithromycin not be taken at the same time as aluminum- or magnesium- based antacids, such as Mylanta or Maalox because antacids will bind the azithromycin and prevent it from being absorbed from the intestine.

PREGNANCY: There are no adequate studies of azithromycin in pregnant women. However, studies in animals suggest no important effects on the fetus. Azithromycin therefore can be used in pregnancy if the physician feels that it is clearly necessary.

NURSING MOTHERS: It is not known if azithromycin is secreted in breast milk.

SIDE EFFECTS: Azithromycin is generally well tolerated. The most common side effects are diarrhea or loose stools, nausea, abdominal pain, and vomiting, each of which may occur in fewer than one in twenty persons who receive azithromycin. Rarer side effects include abnormal liver tests, allergic reactions, and nervousness.



CIPRO® (ciprofloxacin hydrochloride) Tablets and CIPRO (ciprofloxacin*) Oral Suspension are synthetic broad spectrum antimicrobial agents for oral administration. Ciprofloxacin hydrochloride, USP, a fluoroquinolone, is the monohydrochloride monohydrate salt of 1-cyclopropyl-6-fluoro-1, 4-dihydro-4-oxo-7-(1-piperazinyl)-3-quinolinecarboxylic acid. It is a faintly yellowish to light yellow crystalline substance with a molecular weight of 385.8. Its empirical formula is C17H18FN3O3•HCl•H2O

Ciprofloxacin is 1-cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-3- quinolinecarboxylic acid. Its empirical formula is C17H18FN3O3 and its molecular weight is 331.4. It is a faintly yellowish to light yellow crystalline substance

CIPRO film-coated tablets are available in 100 mg, 250 mg, 500 mg and 750 mg (ciprofloxacin equivalent) strengths. Ciprofloxacin tablets are white to slightly yellowish. The inactive ingredients are cornstarch, microcrystalline cellulose, silicon dioxide, crospovidone, magnesium stearate, hypromellose, titanium dioxide, polyethylene glycol and water.

Ciprofloxacin Oral Suspension is available in 5% (5 g ciprofloxacin in 100 mL) and 10% (10 g ciprofloxacin in 100 mL) strengths. Ciprofloxacin Oral Suspension is a white to slightly yellowish suspension with strawberry flavor which may contain yellow-orange droplets. It is composed of ciprofloxacin microcapsules and diluent which are mixed prior to dispensing (See instructions for use/handling). The components of the suspension have the following compositions:

Microcapsules - ciprofloxacin, povidone, methacrylic acid copolymer, hypromellose, magnesium stearate, and Polysorbate 20.

Diluent - medium-chain triglycerides, sucrose, lecithin, water, and strawberry flavor.

* Does not comply with USP with regards to "loss on drying" and "residue on ignition".



What is the most important information I should know about daptomycin?

• In some cases, daptomycin has been reported to cause damage to the muscles and/or nerves. Notify your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness, or numbness or tingling. These may be early signs of muscle or nerve problems.

What is daptomycin?

• Daptomycin is an antibiotic. It fights bacteria in the body.

• Daptomycin is used to treat bacterial infections of the skin and underlying skin structures.

• Daptomycin may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking daptomycin?

• Do not take daptomycin without first talking to your doctor if you have
· kidney disease; or
· nerve or muscle problems.

• You may not be able to take daptomycin, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

• Daptomycin is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby. Do not take daptomycin without first talking to your doctor if you are pregnant or could become pregnant during treatment.

• It is not known whether passes into breast milk. Do not take daptomycin without first talking to your doctor if you are breast-feeding a baby.

How should I take daptomycin?

• Daptomycin is intended for administration by intravenous (into a vein) injection. Daptomycin is usually administered by a healthcare provider.

• If you are using daptomycin at home, your healthcare provider will give you detailed instructions regarding preparation, administration, and storage of the medication.

• Your healthcare provider will store daptomycin as directed by the manufacturer.

What happens if I miss a dose?

• Since the medication will be administered by a healthcare provider, missing a dose should not occur. Contact your doctor if a dose is missed.

What happens if I overdose?

• Seek emergency medical attention if an overdose of daptomycin is suspected.

• Symptoms of a daptomycin overdose are not known.
What should I avoid while taking daptomycin?

• There are no restrictions on food, beverages, or activity while taking daptomycin unless otherwise directed by your doctor.

What are the possible side effects of daptomycin?

• In some cases, daptomycin has been reported to cause damage to the muscles and/or nerves. Notify your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness, or numbness or tingling. These may be early signs of muscle or nerve problems.

• If you experience a rare but serious allergic reaction (shortness of breath; closing of the throat; swelling of the lips, face, or tongue; or hives), stop taking daptomycin and seek emergency medical attention.

• Other, less serious side effects may also occur. Continue to take daptomycin and talk to your doctor if you experience
· skin itching or rash;
· redness, discomfort, or irritation at the injection site;
· nausea; or
· diarrhea.

• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect daptomycin?

• Before taking daptomycin, talk to your doctor if you are taking any of the following medicines:
· warfarin (Coumadin);
· tobramycin (Nebcin); or
· an HMG CoA reductase inhibitor such as atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altocor, Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), or simvastatin (Zocor).

• You may not be able to take daptomycin, or you may require a dosage adjustment or special monitoring during treatment.

• Drugs other than those listed here may also interact with daptomycin. Do not take any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, without first talking to your doctor during treatment with daptomycin.

Where can I get more information?

• Your pharmacist has additional information about daptomycin written for health professionals that you may read.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.



INVANZ is indicated for the treatment of adult patients with the following moderate to severe infections caused by susceptible strains of the designated microorganisms: ... /index.jsp

Complicated intra-abdominal infections due to Escherichia coli, Clostridium clostridioforme, Eubacterium lentum, Peptostreptococcus species, Bacteroides fragilis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, or Bacteroides uniformis.

Complicated skin/skin structure infections due to Staphylococcus aureus (methicillin-susceptible strains only), Streptococcus pyogenes, Escherichia coli, or Peptostreptococcus species.

Community-acquired pneumonia due to Streptococcus pneumoniae (penicillin-susceptible strains only), including cases with concurrent bacteremia, Haemophilus influenzae (beta-lactamase–negative strains only), or Moraxella catarrhalis.

Complicated urinary tract infections, including pyelonephritis, due to Escherichia coli, including cases with concurrent bacteremia, or Klebsiella pneumoniae.

Acute pelvic infections, including postpartum endomyometritis, septic abortion, and postsurgical gynecologic infections, due to Streptococcus agalactiae, Escherichia coli, Bacteroides fragilis, Porphyromonas asaccharolytica, Peptostreptococcus species, or Prevotella bivia.

Appropriate specimens for bacteriological examination should be obtained in order to isolate and identify the causative organisms and to determine their susceptibility to ertapenem. Therapy with INVANZ may be initiated empirically before results of these tests are known; once results become available, antimicrobial therapy should be adjusted accordingly.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of INVANZ and other antibacterial drugs, INVANZ should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

INVANZ is contraindicated in patients with known hypersensitivity to any component of this product or to other drugs in the same class or in patients who have demonstrated anaphylactic reactions to beta-lactams.

Due to the use of lidocaine HCl as a diluent, INVANZ administered intramuscularly is contraindicated in patients with a known hypersensitivity to local anesthetics of the amide type. (Refer to the prescribing information for lidocaine HCl.)

Pseudomembranous colitis has been reported with nearly all antibacterial agents, including ertapenem, and may range in severity from mild to life threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents. ... /index.jsp





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