Antibiotic Therapy, Types of Antibiotics
Because of our constant battles with lymphedema and infections, I thought it might be interesting to know more about antibiotics. What they are, how they work, what they do and why we should be careful in taking them so as to not build up an immunity to them. I have included information on the most commonly used antibiotics used with infections and lymphedema.
June 22, 2008
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 (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.
. 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.
. 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.
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: Antibacterial Agents
Antibiotics may be informally defined as the subgroup of anti-infectives that are derived from bacterial sources and are used to treat bacterial infections.
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?
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.
Here are some interesting links:
Background on Antibiotic Resistance
Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria. After their discovery in the 1940's they transformed medical care and dramatically reduced illness and death from infectious diseases. However, over the decades the bacteria that antibiotics control have developed resistance to these drugs. Today, virtually all important bacterial infections in the United States and throughout the world are becoming resistant. For this reason, antibiotic resistance is among CDC's top concerns.
Antibiotic resistance can cause significant danger and suffering for children and adults who have common infections, once easily treatable with antibiotics.
Antibiotic Resistance- what it is and how it happens:
Antibiotic use promotes development of antibiotic-resistant bacteria. Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm. Widespread use of antibiotics promotes the spread of antibiotic resistance. While antibiotics should be used to treat bacterial infections, they are not effective against viral infections like the common cold, most sore throats, and the flu.
Antibiotics kill bacteria, not viruses
Smart use of antibiotics is the key to controlling the spread of resistance.
What does CDC recommend?
Only use antibiotics when they are likely to be beneficial.
By visiting this website you are taking the first step to reducing your risk of getting antibiotic-resistant infections. It is important to understand that, although they are very useful drugs, antibiotics designed for bacterial infections are not useful for viral infections such as a cold, cough, or flu.
How can you prevent antibiotic-resistant infections?
Tackling Antibiotic Resistance:
Overuse of antibiotics is jeopardizing the usefulness of essential drugs. Decreasing inappropriate antibiotic use is the best way to control resistance. In 1995, the Centers for Disease Control and Prevention (CDC) launched a national campaign to reduce antimicrobial resistance through promotion of more appropriate antibiotic use.
Recommendations for appropriate antibiotic use for health care providers:
CDC's National Campaign:
Campaign for Appropriate Antibiotic Use has two OBJECTIVES:
To accomplish these objectives, the campaign uses the following approaches:
Current campaign activities include:
Center for Disease Control
Antibiotics: When They Can and Can't Help
What are antibiotics?
Antibiotics are strong medicines that can stop some infections and save lives. But antibiotics can cause more harm than good if they are not used the right way. You can protect yourself and your family by knowing when you should use antibiotics and when you shouldn't.
Do antibiotics work against all infections?
No. Antibiotics only work against infections caused by bacteria. They don't work against any infections caused by viruses. Viruses cause colds, the flu, and most coughs and sore throats.
What is "antibiotic resistance"?
When bacteria are repeatedly exposed to the same antibiotics, the antibiotic can't fight the germs anymore. Being exposed to the same antibiotic for a long time can make some germs change. And sometimes germs just change by themselves. Some of the changes make the germs so strong they can fight back against antibiotics and win the fight. Then these germs are said to be "resistant" to this antibiotic.
Antibiotic resistance is becoming a common problem in many parts of the United States. Resistant bacteria develop faster when antibiotics are used too often or are not used correctly.
Resistant bacteria sometimes can be treated with antibiotics to which the bacteria have not yet become resistant. These medicines may have to be given intravenously (through a vein) in a hospital. A few kinds of resistant bacteria are untreatable.
Why should I worry about antibiotic resistance?
If you take antibiotics that can't fight the germs they are supposed to kill, your infection can last longer. Instead of getting better, your infection might get worse. You might have to make several visits to your doctor's office. You might have to take different medicines or go to a hospital for antibiotics given in your veins.
At the same time, your family members or other people you come in contact with may catch the resistant germs that you have. Then they might also get infections that are hard to cure.
Every time you take antibiotics when you don't really need them, you increase the chance that you will get an illness someday that is caused by germs that are resistant to antibiotics.
How do I know when I need antibiotics?
The answer depends on what is causing your infection. The following are some basic guidelines:
How should I take the antibiotics that my doctor prescribes?
Follow your doctor's directions carefully. Your doctor will tell you to take all of the antibiotic. Don't save some of the medicine for the next time you are sick.
What else can I do to reduce the risk of antibiotic resistance?
Wash your hands with soap and water before you eat and after you use the bathroom. Regular handwashing during the daytime will help keep you healthy and prevent the spread of germs.
Ask your doctor if you have all the vaccinations (shots) you need to protect yourself from illness.
Where can I get more information about antibiotic resistance?
Centers for Disease Control and Prevention
for the Prudent Use of Antibiotics
*** Recommended site: ***
Layperson's guide to antibiotics, uses for, when not to use, news info and research articles
When and How to Take Antibiotics
Alliance for the Prudent Use of Antibiotics
Types of Antibiotics
Antibiotics: types and side effects
Last Updated: May 8, 2001 Rate this Article
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Synonyms and related keywords: medicine, antibiotic, penicillin, cephalosporin, macrolides, fluoroquinolone, sulfonamide, tetracycline, aminoglycoside
Author: Everett Stephens, MD, Assistant Clinical Professor, Department of Emergency Medicine, University of Lou
Antibiotics - A Compendium
The Alliance for the Prudent Use of Antibiotics
Keep Antibiotics Working.com
Types of antibiotics and related resistance
Penicillin and other antibiotics
Nurse Directories on: The Nurse Friendly
Antibiotics, Antiinfectives Drugs Links
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,
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.
AMOXICILLIN; CLAVULANATE POTASSIUM
Keflex is a semisynthetic cephalosporin antibiotic intended for oral administration. It is 7-(D-a-Amino-a-phenylacetamido)- 3-methyl-3-cephem-4-carboxylic acid monohydrate. Cephalexin has the molecular formula C16H17N3O4S·H2O and the molecular weight is 365.41.
The nucleus of cephalexin is related to that of other cephalosporin antibiotics. The compound is a zwitterion; i.e., the molecule contains both a basic and an acidic group. The isoelectric point of cephalexin in water is approximately 4.5 to 5.
The crystalline form of cephalexin which is available is a monohydrate. It is a white crystalline solid having a bitter taste. Solubility in water is low at room temperature; 1 or 2 mg/ml may be dissolved readily, but higher concentrations are obtained with increasing difficulty.
The cephalosporins differ from penicillins in the structure of the bicyclic ring system. Cephalexin has a D-phenylglycyl group as substituent at the 7-amino position and an unsubstituted methyl group at the 3-position.
Each Pulvule contains cephalexin monohydrate equivalent to 250 mg (720 mcmol) or 500 mg (1,439 mcmol) of cephalexin. The Pulvules also contain cellulose, Dy & C Yellow No. 10, F Dy & C Blue No. 1, F Dy & C Yellow No. 6, gelatin, magnesium stearate, silicone, titanium dioxide, and other inactive ingredients.
Each capsule manufactured by Mylan contains cephalexin monohydrate equivalent to 250 mg (720 mcmol) or 500 mg (1,439 mcmol) of cephalexin. The capsules also contain cellulose, F Dy & C Blue No. 1, gelatin, magnesium stearate, silicone, titanium dioxide, and other inactive ingredients.
After mixing, each 5 ml of Keflex, for oral suspension, will contain cephalexin monohydrate equivalent to 125 mg (360 mcmol) or 250 mg (720 mcmol) of cephalexin. The suspensions also contain flavors, methylcellulose, silicone, sodium lauryl sulfate, and sucrose. The 125-mg suspension contains F Dy & C Red No. 40, and the 250-mg suspension contains F Dy & C Yellow No. 6.
Keflex - cephalexin
Keflex - cephalexin
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.
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.
Before taking cephalexin,
Cephalexin may cause an upset stomach. Take cephalexin with food or milk.
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.
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:
If you experience any of the following symptoms, call your doctor immediately:
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 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.
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
Gentamicin Sulfate Injection
|Gentamicin can cause severe hearing and kidney problems. Before administering gentamicin, 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.If you experience any of the following symptoms, call your health care provider immediately: dizziness, vertigo, ringing in the ears, hearing loss, numbness, muscle twitching or weakness, difficulty breathing, decreased urination, rash, itching, or sore throat.|
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,
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.
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:
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 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.
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:
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
UNASYN is an injectable antibacterial combination consisting of the semisynthetic antibiotic ampicillin sodium and the beta-lactamase inhibitor sulbactam sodium for intravenous and intramuscular administration.
UNASYN is indicated for the treatment of infections due to susceptible strains of the designated microorganisms in the conditions listed below.
Skin and Skin Structure Infections caused by beta-lactamase producing strains of Staphylococcus aureus, Escherichia coli, * Klebsiella spp. * (including K. pneumoniae * ), Proteus mirabilis, * Bacteroides fragilis, * Enterobacter spp., * and Acinetobacter calcoaceticus. *
NOTE: For information on use in pediatric patients see PRECAUTIONS -Pediatric Use and CLINICAL STUDIES sections.
Intra-Abdominal Infections caused by beta-lactamase producing strains of Escherichia coli, Klebsiella spp. (including K. pneumoniae * ), Bacteroides spp. (including B. fragilis), and Enterobacter spp. *
Gynecological Infections caused by beta-lactamase producing strains of Escherichia coli, * and Bacteroides spp. * (including B. fragilis * ).
* Efficacy for this organism in this organ system was studied in fewer than 10 infections.
While UNASYN is indicated only for the conditions listed above, infections caused by ampicillin-susceptible organisms are also amenable to treatment with UNASYN due to its ampicillin content. Therefore, mixed infections caused by ampicillin-susceptible organisms and beta-lactamase producing organisms susceptible to UNASYN should not require the addition of another antibiotic.
Appropriate culture and susceptibility tests should be performed before treatment in order to isolate and identify the organisms causing infection and to determine their susceptibility to UNASYN.
Therapy may be instituted prior to obtaining the results from bacteriological and susceptibility studies, when there is reason to believe the infection may involve any of the beta-lactamase producing organisms listed above in the indicated organ systems. Once the results are known, therapy should be adjusted if appropriate.
To reduce the development of drug-resistant bacteria and maintain effectiveness of UNASYN and other antibacterial drugs, UNASYN should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Azithromycin - Zithromax
Zithromax (azithromycin tablets, azithromycin capsules and azithromycin for oral suspension) contain the active ingredient azithromycin, an azalide, a subclass of macrolide antibiotics, for oral administration. Azithromycin has the chemical name (2R,3S,4R,5R,8R,10R,11R,12S,13S,14R)-13-[ (2,6-dideoxy-3-C-methyl-3-O -methyl-a-L-ribo-hexopyranosyl)oxy]-2-ethyl-3,4,10- trihydroxy-3,5,6,8,10,12,14-heptamethyl-11- [[3,4,6-trideoxy-3-(dimethylamino)-b-D- xylo-hexopyranosyl]oxy]-1-oxa-6- azacyclopentadecan-15-one. Azithromycin is derived from erythromycin; however, it differs chemically from erythromycin in that a methyl-substituted nitrogen atom is incorporated into the lactone ring. Its molecular formula is C38H72N2O12, and its molecular weight is 749.00.
Azithromycin, as the dihydrate, is a white crystalline powder with a molecular formula of C38H72N2O12•2H2O and a molecular weight of 785.0.
Zithromax is supplied for oral administration as film-coated, modified capsular shaped tablets containing azithromycin dihydrate equivalent to 250 mg azithromycin and the following inactive ingredients: dibasic calcium phosphate anhydrous, pregelatinized starch, sodium croscarmellose, magnesium stearate, sodium lauryl sulfate, hydroxypropyl methylcellulose, lactose, titanium dioxide, triacetin and D&C red #30 aluminum lake
Zithromax capsules contain azithromycin dihydrate equivalent to 250 mg of azithromycin. The capsules are supplied in red opaque hard-gelatin capsules (containing FD&C red #40). They also contain the following inactive ingredients: anhydrous lactose, corn starch, magnesium stearate, and sodium lauryl sulfate.
It is also supplied as a powder for oral suspension.
Zithromax for oral suspension is supplied in bottles containing azithromycin dihydrate powder equivalent to 300 mg, 600 mg, 900 mg, or 1200 mg azithromycin per bottle and the following inactive ingredients: sucrose; sodium phosphate; tribasic; anhydrous; hydroxypropyl cellulose; xanthan gum; FD&C red #40; and spray dried artificial cherry, creme de vanilla and banana flavors. After constitution, each 5 ml of suspension contains 100 mg or 200 mg of azithromycin.
Azithromycin - 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.
GENERIC AVAILABLE: no
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.
sulfamethoxazole and trimethoprim (sul
fa meth OX a zole and trye METH oh prim)
Brand Names: Bactrim, Bactrim DS, Bactrim Pediatric, Bethaprim, Bethaprim Pediatric, Cotrim, Cotrim DS, Cotrim Pediatric, Septra, Septra DS, Sulfatrim, Sulfatrim Pediatric, Sulfatrim Suspension, Uroplus, Uroplus DS
Sulfamethoxazole and trimethoprim are both antibiotics that treat different types of bacterial infections. Bactrim fights bacteria in your body.
Bactrim is used to treat infections such as urinary tract infections, bronchitis, ear infections (otitis), traveler's diarrhea, and Pneumocystis carinii pneumonia.
Bactrim may also be used for purposes other than those listed in this medication guide.
Before taking this medication, tell your doctor if you have
a glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency).
You may not be able to take this medication, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.Bactrim is in the FDA pregnancy category C. This means that it is not known whether this medication will harm an unborn baby. This medication affects folic acid in your body, which is necessary for the normal development of a baby. Do not take Bactrim without first talking to your doctor if you are pregnant. Bactrim passes into breast milk and may harm a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby. Bactrim is not approved for use in children younger than 2 months of age.
Take this drug exactly as directed by your physician. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.Take each dose with a full glass of water. Take Bactrim with food or milk if it upsets your stomach.
You may crush the tablets and put them in water or a soft food like applesauce or pudding if you cannot swallow them whole.To ensure that you get a correct dose, measure the liquid form of Bactrim with a special dose-measuring spoon or cup, not with a regular tablespoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one. Shake the suspension well before measuring a dose. Take all of the Bactrim that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infections is completely treated. Store the tablets and liquid at room temperature away from moisture and heat.
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication unless otherwise directed by your doctor.
If you have only missed one dose, you can take the rest of your scheduled doses for that day at evenly spaced intervals.
Symptoms of a Bactrim overdose include nausea, vomiting, decreased appetite, diarrhea, headache, yellowing of the skin or eyes, decreased urine production, bloody urine, and coma.
an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
unusual bleeding or bruising; or
yellow skin or eyes.
Other, less serious side effects may be more likely to occur. Continue to take your medication and talk to your doctor if you experience
headache, fatigue, or dizziness;
nausea, vomiting, decreased appetite, or diarrhea;
increased sensitivity to the sun.
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.
Bactrim may increase the effects of oral anticoagulants such as warfarin (Coumadin) and lead to bleeding. Tell your doctor if you are taking a blood thinner.
Bactrim may also increase the effects of drugs used to treat diabetes, such as glipizide (Glucotrol), glyburide (Glynase, Micronase, Diabeta), chlorpropamide (Diabinese), tolbutamide (Orinase), and tolazamide (Tolinase). Very low blood sugar levels may result. Watch for changes in your blood sugar if you are a diabetic.
Bactrim may increase the effects of phenytoin (Dilantin) and lead to dangerous side effects. Watch for unusual side effects during treatment.
Drugs other than those listed here may also interact with this medication. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Sulfamethoxazole and trimethoprim is available with a prescription under the brand names Bactrim and Septra. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.
Bactrim 400mg/80 mg - capsule-shaped, light-green, scored tablets
Bactrim DS 800 mg/160 mg - capsule-shaped, white, scored tablets
Bactrim Suspension 200 mg/40 mg per teaspoon - pink, cherry-flavored liquid
Septra 400 mg/80 mg - round, pink, scored tablets
Septra DS 800 mg/160 mg - oval, pink, scored tablets
Septra Suspension 200 mg/40 mg per teaspoon - pink, cherry-flavored liquid
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".
Ciprofloxacin is an antibiotic used to treat certain infections caused by bacteria. Ciprofloxacin tablets and suspension (liquid) are used to treat pneumonia (lung infection); bronchitis (infection of the tubes that lead to the lungs); some types of gonorrhea (a sexually transmitted disease); diarrhea caused by bacteria; typhoid fever (a contagious illness common in developing countries); and bone, joint, skin, prostate (a male reproductive gland), sinus, and urinary tract (bladder) infections. Ciprofloxacin is also used to prevent and/or treat anthrax in people exposed to anthrax germs in the air. Ciprofloxacin is also used with another medication to treat certain infections of the internal organs. Ciprofloxacin extended release (long-acting) tablets are used to treat urinary tract and kidney infections. Ciprofloxacin is in a class of antibiotics called fluoroquinolones. It works by killing bacteria. Antibiotics will not work for colds, flu, or other viral infections.
Ciprofloxacin comes as a tablet, a suspension (liquid) and an extended release (long-acting) tablet to take by mouth with or without food. The tablet and suspension are usually taken every 12 hours (twice a day). The extended release tablets are usually taken once a day. To help you remember to take ciprofloxacin, take it around the same time(s) every day. The length of your treatment depends on the type of infection you have. Your doctor will tell you how long you need to take ciprofloxacin. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ciprofloxacin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Swallow the extended release tablets whole; do not split, crush, or chew them.
If you are taking the liquid, shake the bottle for 15 seconds before each use to mix the medication evenly. Swallow the correct dose without chewing the granules in the liquid. Do not give the liquid to a patient through a feeding tube.
If you are taking the tablets or extended release tablets, swallow them with a full glass of water.
You should begin feeling better during the first few days of treatment with ciprofloxacin. If you do not, call your doctor.
Take ciprofloxacin until you finish the prescription, even if you feel better. If you stop taking ciprofloxacin too soon or skip doses, your infection may not be completely cured and bacteria may become resistant to antibiotics.
Ciprofloxacin is also sometimes used to treat patients with cystic fibrosis who have lung infections. Ciprofloxacin is sometimes used to treat various sexually transmitted diseases and various infections such as Legionnaire disease (a type of lung infection), cat scratch disease (an infection that may develop after a patient is bitten or scratched by a cat), and brucellosis (a type of infection that causes a rising and falling fever and other symptoms). In the event of biological warfare, ciprofloxacin may be used to treat and prevent dangerous illness that are deliberately spread such as plague, tularemia, and anthrax of the skin or mouth. Ciprofloxacin may also be used to reduce the amount of certain types of bacteria in the nose to prevent serious illness. Ciprofloxacin may be used with another medication to treat disseminated Mycobacterium avium complex (MAC) (a type of lung disease that often affects people with human immunodeficiency virus [HIV] ), and tuberculosis (TB) (a type of lung infection). Talk to your doctor about the possible risks of using this drug for your condition.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
Before taking ciprofloxacin,
Do not take ciprofloxacin with dairy products (like milk or yogurt) or calcium-added juices alone. You may take ciprofloxacin with a meal that includes these foods. Drink at least eight full glasses of water or liquid every day. Do not drink or eat a lot of caffeine-containing products such as coffee, tea, cola, or chocolate. Ciprofloxacin increases nervousness, sleeplessness, heart pounding, and anxiety caused by caffeine.
If you are taking ciprofloxacin tablets or suspension, 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.
If you are taking ciprofloxacin extended release tablets and forget to take your dose at the usual time, you may take the dose later in the day. However, do not take more than one ciprofloxacin extended release tablet in one day, even if you missed a dose.
Ciprofloxacin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them or those mentioned in the SPECIAL PRECAUTIONS section, call your doctor immediately:
You should know that ciprofloxacin has slowed the growth and damaged the joints of young laboratory animals. It is not known if ciprofloxacin has these effects on children. Therefore, ciprofloxacin should not normally be given to children younger than 18 years old. However, if a child has been exposed to anthrax in the air, the benefits of taking ciprofloxacin to prevent this serious illness may be greater than the risk of joint damage. Talk to your child's doctor about the risks of giving ciprofloxacin to your child.
Ciprofloxacin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Store the suspension in the refrigerator or at room temperature, closed tightly, for up to 14 days. Throw away any liquid that is left over after 14 days and any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
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.
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to ciprofloxacin.
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 ciprofloxacin, call your doctor.
Last Revised - 07/01/2004
In September, the US Food and Drug Administration (FDA) approved the first agent in a new class of antibiotics called cyclic lipopeptide antibacterial agents. Cubicin (daptomycin) is indicated for the treatment of complicated skin and skin structure infections caused by gram-positive microorganisms. Daptomycin binds to bacterial membranes and causes a rapid depolarization of membrane potential. The loss of membrane potential leads to inhibition of protein, DNA, and RNA synthesis, which results in bacterial cell death.
|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;|
|•||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:|
|·||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.|
In the U.S.—
Daptomycin (DAP-toe-mye-sin) belongs to the family of medicines called antibiotics. Antibiotics are medicines used in the treatment of infections caused by bacteria. They work by killing bacteria or preventing their growth. Daptomycin will not work for colds, flu, or other virus infections.
Daptomycin is used to treat complicated skin infections.
This medicine is available only with your doctor's prescription, in the following dosage forms:
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For daptomycin, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to daptomycin. Also tell your doctor and pharmacist if you are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy—Daptomycin has not been studied in pregnant women. However, daptomycin has not been shown to cause birth defects or other problems in animal studies.
Breast-feeding—It is not known whether daptomycin passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast feeding. Mothers who are taking this medicine and who wish to breast feed should discuss this with their doctor
Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of daptomycin in children with use in other age groups.
Older adults—Elderly people are especially sensitive to the effects of daptomycin. This may increase the chance of side effects during treatment.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
Proper Use of This Medicine
To help clear up your infection completely, daptomycin must be given for the full time of treatment, even if you begin to feel better after a few days. Also, this medicine works best when there is a constant amount in the blood. To help keep the amount constant, daptomycin must be given on a regular schedule.
The dose of daptomycin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of daptomycin. If your dose is different, do not change it unless your doctor tells you to do so.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take more than one dose each day.
To store this medicine:
Precautions While Using This Medicine
If you have muscle pain or weakness while receiving this medicine, check with your doctor right away.
If your symptoms do not improve within a few days or if they become worse, check with your doctor.
Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines, such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome.
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
NON-FDA APPROVED USES
500 mg, 1000mg
|$34.14 (500mg); $68.25 (1000mg)|
of P. aeruginosa and Acinetobacter. Risk of seizure is reported at 0.5% in clinical trials. T1/2 of 4-5h suggests caution in using q24h dosing for severely ill patients (i.e bacteremia and/or ICU). May be used as a convenient once-a-day outpatient IV antibiotic.
indicated for the treatment of adult patients with the following
moderate to severe infections caused by susceptible strains of the
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.
contraindicated in patients with known hypersensitivity to any
component of this product or to other drugs in the same class or in
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.
In the U.S.
Ertapenem (er-ta-PEN-em) is used in the treatment of infections caused by bacteria. It works by killing bacteria or preventing their growth. This medicine will not work for colds, flu, or other virus infections. Ertapenem is used to treat infections in many different parts of the body. It is sometimes given with other antibiotics.
This medicine is available only with your doctor's prescription, in the following dosage forms:
Use of This Medicine
To help clear up your infection completely, ertapenem must be given for the full time of treatment, even if you begin to feel better after a few days. Skipping doses or not completing the full course of therapy may decrease the usefulness of this medicine. It may also increase the likelihood that the bacteria causing your infection will develop resistance. If this happens, ertapenem and other medicines used to treat infections will not work in the future. Also, this medicine works best when there is a constant amount in the blood or urine. To help keep the amount constant, it must be given on a regular schedule.
Dosing - The dose of ertapenem will be different for different patients. If you are receiving this medicine at home, follow your doctor's orders. The following information includes only the average doses of ertapenem. If your dose is different, do not change it unless your doctor tells you to do so.
. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking ertapenem
Missed dose - If you miss a dose of this medicine, take it as soon as possible. Do not double doses.
Storage - To store this medicine:
Short-Course Levofloxacin as Effective as Standard Treatment for Uncomplicated Cellulitis
Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Release Date: August 11, 2004
Aug. 11, 2004 — Short-course (five days) and standard (10 days) of levofloxacin treatment are equally effective for uncomplicated cellulitis, according to the results of a double-blind randomized trial published in the Aug. 9 issue of the Archives of Internal Medicine.
"No previous study has compared a short (five days) vs. standard (10 days) course of therapy with the same antibiotic in patients with uncomplicated cellulitis," write MAJ Matthew J. Hepburn, MC, USA, from Brooke Army Medical Center in Fort Sam Houston, Texas, and colleagues. "We hypothesized that there would be no difference in outcomes."
Of 121 subjects evaluated after five days of therapy for cellulitis, 43 were randomized to receive five more days of levofloxacin therapy (500 mg/day; 10 days total), and 44 to receive five days of placebo therapy. Subjects with complicated cellulitis were excluded.
At both 14 and 28 days of therapy, there were no significant differences in outcome between the groups. Treatment was successful in 42 (98%) of 43 subjects receiving 10 days of antibiotic and in 43 (98%) of 44 subjects receiving five days of antibiotic.
Study limitations include exclusion of immunocompromised subjects or those with complications and lack of generalizability to other antibiotics.
"In patients with uncomplicated cellulitis, five days of therapy with levofloxacin appears to be as effective as 10 days of therapy," the authors write. "Our findings would not support the practice of short-course therapy for all cellulitis without appropriate follow-up."
The authors report no potential financial conflicts of interest.
Arch Intern Med. 2004;164:1669-1674
Cellulitis appears to be a paucibacillary skin infection with a strong inflammatory response. Attempts to culture bacteria from skin aspirates with cellulitis have been disappointing. Physical findings in cellulitis are associated with the strong inflammation that plays a predominant role in the disease process.
Cellulitis is one of the most common diagnoses encountered in primary care. The U.S. military recorded 104,738 cases from 1998 to 2001. Antibiotic therapy against Streptococcus and Staphylococcus aureus has generally been successful although the optimum duration of therapy has not been determined in randomized clinical trials, according to the authors of the study. The 32nd edition of the Sanford Guide to Antimicrobial Therapy published by Gilbert and colleagues in 2002 suggests treatment continue until three days after the acute inflammation resolves. Standard course are 10 to 14 days. However, in acute sinusitis and cystitis, studies suggest equivalent efficacy for shorter course of antibiotics.
The authors compared the use of five vs 10 days of levofloxacin in a randomized, double-blind, placebo-controlled study of uncomplicated cellulitis in a Veterans Affairs' outpatient health care population. They hypothesized that resolution of cellulitis would be equivalent in the two groups.
The US FDA has
approved Tygacil™ (tigecycline), a novel IV antibiotic with
a broad spectrum of antimicrobial activity, including activity against
drug-resistant bacteria methicillin-resistant Staphylococcus aureus
Tygacil is indicated for the treatment of complicated intra-abdominal
(cIAI) and complicated skin and skin structure infections (cSSSI) in
Approval of this first-in-class product comes at a time when the need
antibiotic options to combat serious, resistant infections is
“Life threatening infections are a growing concern globally,” says Dr. Joseph Camardo, Senior Vice President, Global Medical Affairs, Wyeth Pharmaceuticals. “Bacterial infections are becoming more difficult to treat, with resistant strains on the increase. The approval of TYGACIL will provide physicians with an important option for patients with complicated skin, skin structure, and intra-abdominal infections.”
TYGACIL can be used as an empiric monotherapy to treat a variety of cIAI and cSSSI, both hospital- and community-acquired, including complicated appendicitis, infected burns, intra-abdominal abscesses, deep soft tissue infections, and infected ulcers. TYGACIL provides clinicians with a novel, broad-spectrum option that can be used at the onset of treatment when the specific bacteria present are not yet known. In addition, TYGACIL does not require dosage adjustment in patients with impaired renal function, and is conveniently dosed every 12 hours.
A Clinical Challenge
The U.S. Centers for Disease Control and Prevention (CDC) states that persons infected with drug-resistant organisms are more likely to have longer hospital stays and require treatment with multiple drugs. The increasing prevalence of resistant bacteria often necessitates the use of combinations of antibiotics to fight infections. Antibiotic resistance costs U.S. society between $4 billion and $5 billion annually. According to the CDC, antibiotic resistance has become so widespread that many significant bacterial infections in the world are becoming resistant to commonly used antibiotics.
Additionally, few broad-spectrum antibiotic agents are currently in development. Antibiotic development has slowed to the point that FDA has had few opportunities to approve new agents. In fact, development and approvals of new antibacterial agents have decreased by 56 percent over the past 20 years (1998-2002 vs. 1983-1987). New classes of antibiotics are needed to address increasing antibiotic resistance among common pathogens.
TYGACIL, the first antibiotic approved in a new class called glycylcyclines, was developed by Wyeth to overcome key mechanisms of resistance that have affected antibiotic use.
TYGACIL is approved for adults with complicated skin and skin structure infections (cSSSI) caused by Escherichia coli, Enterococcus faecalis (vancomycin-susceptible isolates only), Staphylococcus aureus (methicillin-susceptible and -resistant isolates), Streptococcus agalactiae, Streptococcus anginosus grp. (includes S. anginosus, S. intermedius, and S. constellatus), Streptococcus pyogenes, and Bacteroides fragilis.
TYGACIL is also approved for adults with complicated intra-abdominal infections (cIAI) caused by Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Enterococcus faecalis (vancomycin-susceptible isolates only), Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus anginosus grp. (includes S. anginosus, S. intermedius, and S. constellatus), Bacteroides fragilis, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides vulgatus, Clostridium perfringens, and Peptostreptococcus micros.
The TYGACIL New Drug Application (NDA) submission included data from four pivotal phase III studies examining the safety and efficacy of TYGACIL for the treatment of cIAI and cSSSI. The submission also included in vitro data showing activity against both gram-negative and gram-positive bacteria, anaerobes, and certain drug-resistant pathogens.
In clinical trials, empiric monotherapy with TYGACIL provided comparable clinical cures rates in cSSSI to vancomycin and aztreonam, a combination treatment. Empiric monotherapy with TYGACIL also provided clinical cure rates comparable to imipenem/cilastatin, an empiric treatment for cIAI. The overall discontinuation rate for TYGACIL (5.0 percent) was comparable to vancomycin and aztreonam (5.3 percent) and imipenem/cilastatin (4.4 percent).
Wyeth now awaits decisions on approval of TYGACIL from other regulatory bodies around the world. TYGACIL was accepted by the European Medicines Agency (EMEA) for review, and Wyeth has filed for approval in other countries, including Brazil, Canada, Colombia, Mexico, Switzerland, Taiwan, and Venezuela. The Australian Therapeutic Goods Administration and the South African Medicines Control Council (MCC) granted priority evaluation to TYGACIL. Wyeth anticipates that TYGACIL will be available to hospitals in the U.S. in the near future.
Important Safety Information
TYGACIL is contraindicated in patients with known hypersensitivity to tigecycline. TYGACIL should be administered with caution in patients with known hypersensitivity to, and may have adverse effects similar to, tetracycline class antibiotics. In clinical trials, the most common treatment-emergent adverse events in patients treated with TYGACIL were nausea (29.5 percent) and vomiting (19.7 percent).
TYGACIL may cause fetal harm when administered to a pregnant woman. The safety and effectiveness of TYGACIL in patients below age 18 and lactating women have not been established. Use of TYGACIL during tooth development may cause permanent discoloration of the teeth. Pseudomembranous colitis has been reported with nearly all antibacterial agents and may range from mild to life threatening. Monotherapy should be used with caution in patients with clinically apparent intestinal perforation.
For a copy of TYGACIL Prescribing Information, please visit http://www.wyeth.com
|FDA Approval:||June 17, 2005|
|Indication:||Complicated skin and intra-abdominal infections|
|Usual Dose:||100 mg IV, followed by 50 mg IV every 12 hours|
|Contraindications:||Hypersensitivity to ingredients|
|Warnings:||May have similar side effects as tetracyclines
May cause permanent discoloration of teeth if used during last half of pregnancy and in children <8 years
Caution if considering monotherapy for complicated intra-abdominal infections secondary to intestinal perforation
Reduce dose in severe hepatic impairment (Child-Pugh C)
Safety and efficacy not established in patients <18 years
|Side Effects:||nausea, vomiting, diarrhea, dyspepsia, constipation
anemia, leukocytosis, thrombocythemia
increased SGOT, SGPT, alkaline phosphatase, amylase, BUN, lactic dehydrogenase
hyperglycemia, hypokalemia, hypoproteinemia, bilirubinemia
hypertension, hypotension, phlebitis, injection site reactions
increased cough, dyspnea
pruritus, rash, sweating
Antibiotic Selection and Hospital Discharge of Patients With Cellulitis
Lawrence J. Eron, MD; Paula King, MSN, APRN; Michelle Marineau, MSN, APRN
Patients presenting to the hospital with moderate to severe cellulitis were randomized to receive either provider-administered ceftriaxone or self-administered cefazolin to determine the ease with which each regimen facilitated discharge from the hospital and the relative cost-effectiveness of the 2 medications in this setting. Patients who received ceftriaxone returned to the hospital daily for administration of their medication. Since cefazolin requires twice- or thrice-daily administration, an attempt was made to teach patients to self-administer this drug before discharge. Because of refusal to self-medicate or problems in learning the dosing procedure, it was more difficult to discharge patients for whom cefazolin was prescribed. There were no significant differences between the groups with regard to the rate of resolution of erythema, fever, and leukocytosis and the rate of cure. The higher cost of ceftriaxone was offset by its benefit in allowing immediate discharge from the hospital.
Because of its frequent occurrence and potential severity, cellulitis is an important cause of morbidity and mortality. Management of cellulitis is complicated by its acute onset and the difficulty in identifying infecting pathogens. For these reasons, an empiric approach to initiating antibiotic treatment is warranted. Guidelines for the management of moderate to severe cellulitis, largely based on expert opinion, have concentrated on the clinical interface of hospital and outpatient environments.
To validate some of the guidelines' recommendations (such as the choice and duration of intravenous antibiotic therapy and the timing of the switch to oral antibiotics), we examined the response of moderate to severe cellulitis to 2 of the most frequently used antibiotics—cefazolin and ceftriaxone. Both drugs require parenteral administration. Cefazolin, with its shorter serum half-life, is administered multiple times daily; for outpatient use, this requires instructing patients or family members in administering the drug. Ceftriaxone's pharmacokinetics make once-daily dosing possible, so that it can be more easily administered by a health care provider either in a home visit or an outpatient infusion center. While ceftriaxone is more expensive, we hypothesized that this factor might be offset by the advantage of provider administration, which could potentially reduce costs by facilitating immediate discharge from the hospital.
An open-label prospective study was conducted of patients presenting to our hospital with moderate to severe cellulitis. The patients in this study were referred from our urgent care clinic and our emergency department. Cellulitis was defined as an acute inflammatory process of the skin (localized erythema, induration, warmth, and pain) accompanied by fever. Patients were included in the study if they were febrile and ill-appearing but with stable comorbidities, described previously as class II cellulitis. "Stable" comorbidities implies that the patients' chronic illnesses were in a compensated state and did not require acute remediation, as opposed to the "unstable" state, in which they were in a decompensated state and did require acute remediation.
Patients were excluded if they were afebrile with only mild (class I) cellulitis or if they had limb-threatening infection or sepsis syndrome (class III cellulitis). Patients were also excluded if they had received previous antibiotic therapy, lacked the recommended criteria to ensure the safe administration of outpatient parenteral antibiotic therapy (OPAT), or had a history of allergy to penicillin or a cephalosporin.
The study was approved by the institutional review board of the Kaiser Moanalua Medical Center in Honolulu. After written informed consent was obtained, patients were randomized to receive either cefazolin or ceftriaxone. Patients were subsequently evaluated as to the ease of discharge from the hospital and their clinical course, based on an intent-to-treat analysis.
We calculated a required sample size of 100 patients (50 in each group) to achieve a power of 0.8, assuming a 50% difference between the 2 groups with regard to discharge from the hospital. The α level was .05. Discharge was the primary outcome of the study. Since there was no expectation of any difference between these 2 regimens in terms of rate of cure, the study was not powered to detect a difference between the 2 arms with regard to this outcome. Of 100 patients, 92 agreed to participate in the study and gave written informed consent.
Cultures of blood and wound material (if present) were obtained, and acute and convalescent blood samples were analyzed for the presence of a high (greater than 1:300) or a rising (4-fold increase) titer of antibodies to Streptococcus DNase B. Either 1 g (for patients who weighed 70 kg or less) or 2 g (for patients who weighed more than 70 kg) was administered twice or thrice daily for cefazolin and once daily for ceftriaxone. The frequency of administration of cefazolin was reduced from thrice to twice daily for patients with creatinine clearances of less than 40 mL/min by the Cockcroft-Gault method.
Patients were taught self-administration of the antibiotic while the first dose was infused. Their mastery of sterile technique and their manual dexterity in self-administering test doses of normal saline were evaluated after they observed the initial infusion of antibiotic by the nursing staff. Those who could not master the self-administration technique or who refused to self-administer cefazolin were considered failures of the discharge process and were switched to provider-administered ceftriaxone. Those who suffered an adverse drug reaction during the initial infusion of antibiotic were also considered to have failed the discharge process. After a period of 1 to 4 hours of observation in the infusion center, patients who were clinically stable (normotensive with adequate pain and nausea control) were discharged and instructed to return the following day for further clinical evaluation.
On their return to the infusion clinic, patients with resistant organisms, such as Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA), were categorized as clinical failures and excluded from further participation in the study. The remainder of the patients were followed in the infusion center on a daily basis for the first 3 days and then as frequently as every other day for another 2 weeks to determine their clinical outcome; the time to the resolution of their erythema, fever, and leukocytosis; and the occurrence of adverse events.
When fever and leukocytosis resolved and a 50% reduction in erythema was observed, treatment was switched to oral cephalexin. Clinical success was determined at the conclusion of oral therapy on an intent-to-treat basis and was defined as the resolution of the signs of inflammation. Clinical failure was defined as the failure of the signs of inflammation to resolve along with the need for drainage of abscesses and/or hospitalization. Those patients with bacterial isolates resistant to the antibiotics were grouped with clinical failures.
The area of cellulitis was determined by measuring the diameter of the erythema. The intensity of the erythema was determined by a 4-point scale in which 4+ was bright red, 3+ was dull red, 2+ was pink, and 1+ was dull pink to light purple. Statistical analyses were conducted in SAS V.8, employing the 2-sample t test, the chi-square test, and the Wilcoxon rank sum test
Of 100 patients presenting to the hospital acutely ill with cellulitis, 8 were excluded from the study. Seven of these were excluded because of a home environment inadequate to support OPAT, and 1 because she refused to give informed consent. Of the remaining 92 patients, 46 were randomized to receive cefazolin and 46, ceftriaxone. The groups were evenly matched by age, gender, comorbidities, ethnic origins, location of the cellulitis, initial white blood cell counts, and number of days of intravenous therapy (Table 1). No patients were lost to follow-up.
Culture results were similar in the 2 groups. S aureus was cultured from 9 patients in the cefazolin group (including 1 that was MRSA) and 8 in the ceftriaxone group (including 3 that were MRSA). β-Streptococci were identified in 4 patients in the cefazolin group and 6 in the ceftriaxone group. Positive blood cultures were obtained in 2 in the cefazolin group (groups B and G streptococci) and 4 in the ceftriaxone group (1 each of groups A and B streptococci and 2 with P aeruginosa).
Of patients in the cefazolin group, 18 (39%) of 46 were discharged, compared with 45 (98%) of the 46 in the ceftriaxone group (P < .0001) (Table 2). Of those in the cefazolin group who failed to be discharged, 2 suffered adverse drug reactions and 26 were unable to learn self-administration of the drug. These 26 patients were switched to provider-administered ceftriaxone and were followed further as a separate group. Of the 18 patients who were discharged on a regimen of cefazolin, 16 were cured (89% clinical success rate). Therapy was considered to have failed in 1 patient because of infection with an MRSA strain and in 1 other because of the development of an abscess.
Of the ceftriaxone group, 1 patient could not be discharged on a regimen of ceftriaxone because of an adverse drug reaction. Therapy was considered to have failed in 1 of the remaining 45 patients because of the development of an abscess and in 5 others because resistant organisms were identified; in 2 patients, blood cultures were positive for P aeruginosa, and in 3 patients, MRSA was cultured from wounds (87% success rate, Table 2). Those patients with infections caused by resistant organisms were subsequently cured of their infection after being switched to therapy with appropriate antibiotics.
Patients in both groups were monitored for decreases in the intensity and area of erythema. In the first 24 hours, 10 (12%) of 83 patients actually had an increase in the area of erythema. None of these 10 had resistant organisms isolated from their wounds; 7 of the 10 did have elevated titers of Streptococcus DNase B antibodies. All 10 patients responded to either cefazolin or ceftriaxone after the initial increase in erythema.
For cefazolin-treated patients, an average of 2.9 days of treatment was required to achieve a 50% reduction in the area and an average of 3.7 days, to achieve a 50% reduction in the intensity of the erythema (Table 3). Patients were switched to oral cephalexin after an average of 3.5 days of intravenous therapy.
For ceftriaxone-treated patients, 3.4 and 3.2 days, respectively, were required for a 50% reduction in the area and intensity of the erythema (Table 3). Patients were switched to oral cephalexin after 3.4 days of intravenous therapy. There were no significant differences in the response to antibiotics between the 2 groups and the cure rates were nearly identical (87% with ceftriaxone versus 89% with cefazolin). Of those patients successfully discharged, leukocytosis and fever resolved in an average of 2 days in both groups (Table 3).
Guidelines for the management of patients with moderate to severe cellulitis have provided recommendations for the choice of antibiotic, route of administration, and timing of oral switch therapy. These guidelines, largely based on expert opinion, offer a stepwise approach to the decision-making process in the management of cellulitis, particularly with reference to the interface between the hospital and outpatient environments. The OPAT registry used in the treatment of cellulitis lists ceftriaxone and cefazolin as 2 of the top 3 choices. However, a randomized study comparing these 2 drugs for OPAT has not evaluated cost-effectiveness.
We therefore undertook this study to examine the facility with which these 2 antibiotics assist in the immediate hospital discharge of patients with moderate to severe cellulitis. These patients were discharged more easily if they received once-daily provider-administered ceftriaxone rather than twice- or thrice-daily self-administered cefazolin. The main reason for this difference was the difficulty in teaching these acutely ill patients or their care providers the technique of intravenous antibiotic administration.
These acutely ill patients, referred from the urgent care clinic and the emergency department, were understandably more anxious about discharge from the hospital than were patients whose condition had been stabilized in the hospital and who then were discharged in a delayed fashion 1 to 2 days later. The delayed-discharge patients can be instructed in a more leisurely fashion to self-administer their antibiotics. In this latter group, multiple daily dosing with cefazolin might be a more reasonable option.
In the case of immediate discharge, the anxious patient was more easily discharged if the teaching of antibiotic self-administration could be obviated by prescribing ceftriaxone, the pharmacokinetics of which allows for once-daily administration. The patient is required to return on subsequent days to receive additional doses of intravenous antibiotic and to have the clinician reevaluate the infection. Alternatively, the patient can receive the once-daily ceftriaxone infusion at home by a visiting nurse, but this is not a practical alternative in the case of the multiple infusions required daily with cefazolin.
Immediate discharge from the hospital and subsequent management as an outpatient may result in the earlier return of a patient to his or her normal activities of daily living.
The use of a once-daily antibiotic to treat cellulitis need not be restricted to ceftriaxone; other antibiotics with similar pharmacokinetics that are appropriate for treatment of cellulitis include ertapenem, moxifloxacin, and the combination of cefazolin and probenecid.[8,9] However, each antibiotic regimen has its negative aspect. For example, ertapenem and moxifloxacin, as well as ceftriaxone, are broad-spectrum antibiotics, whose overuse may contribute to the problem of antibiotic resistance. Nafcillin is a narrow-spectrum drug that would be ideal for the treatment of cellulitis except that it is associated with a much greater incidence of phlebitis than the cephalosporins.
Cefazolin, with its intermediate spectrum of activity, is a good compromise except that it must be administered several times daily, which restricts its use in outpatient settings to situations in which patients or their families can learn the technique of antibiotic administration. The addition of probenecid to cefazolin to allow once-daily administration of the antibiotic increases the possibility of adverse drug reactions, especially in those patients with hyperuricemia or sulfa allergies.
Despite its cost and broad spectrum of antimicrobial activity, ceftriaxone is perhaps the best choice for use in outpatient settings from a cost-effective perspective. While the cost of a hospital bed is reported to vary from $250 to $1000 per night, our hospital costs are close to $500 per night. The cost of OPAT in our hospital system is $187 per day, well within the range of reported costs of $58 to $214 per day. The average wholesale price of ceftriaxone is $22 per gram compared with $1.40 per gram for cefazolin. Therefore, 1 day of OPAT with ceftriaxone costs $209 to $231 (depending on whether the dosage is 1 or 2 g/d) in our hospital system. At our hospital, a patient who begins treatment with ceftriaxone is more than twice as likely to be discharged immediately as is a patient who receives cefazolin; therefore, we can treat more than 2 patients with ceftriaxone OPAT for every patient receiving cefazolin who is hospitalized for 1 day.
In our study, no differences were demonstrated between the 2 antibiotics with respect to the resolution of erythema, fever, and leukocytosis. When all patients were analyzed together, the time required to normalize the temperature and the white blood cell count was 2 days, compared with 3.4 days to achieve a 50% reduction in the area of erythema.
The switch from intravenous to oral antibiotics occurred after 3 to 4 days of antibiotic therapy. All patients were cured following the switch to oral medication. It is likely that a change from parenteral to oral medication may be safely contemplated even before a 50% reduction in erythema area and intensity is observed. In fact, a recently published study demonstrated that a majority of patients with cellulitis required only 2 days of treatment with ceftriaxone before changing to oral medication. With the development of oral antibiotics with superior bio availability, such as linezolid and the fluoroquinolones, we may be able to treat cellulitis entirely with oral antibiotics, as is done with pyelonephritis and community-acquired pneumonia.
One interesting observation from our study is the extension of erythema in 12% of patients observed during the first 24 hours of antibiotic administration. These patients all ultimately had their cellulitis resolve without the necessity of switching antibiotics. This phenomenon likely represents the inflammatory response lagging behind infection rather than ongoing infection. In a study of patients with erysipelas, a more rapid response of the erythema was demonstrated with the addition of anti-inflammatory medications.
There are certain limitations to our study. First of all, the evaluator was not blind to the antibiotic to which the patient was initially assigned, which may have introduced biases. Second, the substantial failure rate of the cefazolin group in being discharged from the hospital significantly lowered the power of further clinical evaluation of this group. While it is conceivable that the small sample size resulted in the failure to observe differences between the 2 groups, it is unlikely that increasing sample size would have demonstrated a difference, since this has not been shown in any other studies. Despite the increased cost and the broader spectrum of activity (compared with cefazolin), it would appear that the use of ceftriaxone for treatment of acute cellulitis would be a reasonable approach to actively encourage outpatient management without the necessity for hospitalization.
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Tetracyclines are used to treat infections and to help control acne. Demeclocycline, doxycycline, and minocycline also may be used for other problems as determined by your doctor. Tetracyclines will not work for colds, flu, or other virus infections.
Tetracyclines are available only with your doctor's prescription.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, tetracyclines are used in certain patients with the following medical conditions:
For patients taking this medicine for SIADH:
This product is available in the following dosage forms:
Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Tetracyclines may cause permanent discoloration of teeth and slow down the growth of bones. These medicines should not be given to children 8 years of age and younger unless directed by the child's doctor.
Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of tetracyclines in the elderly with use in other age groups.
Use is not recommended during the last half of pregnancy. If tetracyclines are taken during that time, they may cause the unborn infant's teeth to become discolored and may slow down the growth of the infant's teeth and bones. In addition, liver problems may occur in pregnant women, especially those receiving high doses by injection into a vein.
Use is not recommended since tetracyclines pass into breast milk. They may cause the nursing baby's teeth to become discolored and may slow down the growth of the baby's teeth and bones. They may also increase the sensitivity of nursing babies' skin to sunlight and cause fungus infections of the mouth and vagina. In addition, minocycline may cause dizziness, light-headedness, or unsteadiness in nursing babies.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Other Medical Problems
The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:
Do not give tetracyclines to infants or children 8 years of age and younger unless directed by your doctor. Tetracyclines may cause permanently discolored teeth and other problems in patients in these age groups.
Tetracyclines should be taken with a full glass (8 ounces) of water to prevent irritation of the esophagus (tube between the throat and stomach) or stomach. In addition, most tetracyclines (except doxycycline and minocycline) are best taken on an empty stomach (either 1 hour before or 2 hours after meals). However, if this medicine upsets your stomach, your doctor may want you to take it with food.
Do not take milk, milk formulas, or other dairy products within 1 to 2 hours of the time you take tetracyclines (except doxycycline and minocycline) by mouth. They may keep this medicine from working properly.
If this medicine has changed color or tastes or looks different, has become outdated (old), or has been stored incorrectly (too warm or too damp area or place), do not use it. To do so may cause serious side effects. Throw away the medicine. If you have any questions about this, check with your health care professional.
For patients taking the oral liquid form of this medicine:
For patients taking doxycycline or minocycline:
To help clear up your infection completely, keep taking this medicine for the full time of treatment, even if you begin to feel better after a few days. If you stop taking this medicine too soon, your symptoms may return.
This medicine works best when there is a constant amount in the blood or urine. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times day and night. For example, if you are to take four doses a day, the doses should be spaced about 6 hours apart. If this interferes with your sleep or other daily activities, or if you need help in planning the best times to take your medicine, check with your health care professional.
The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Keep out of the reach of children.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Do not keep outdated medicine or medicine no longer needed.
If your symptoms do not improve within a few days (or a few weeks or months for acne patients), or if they become worse, check with your doctor.
Oral contraceptives (birth control pills) containing estrogen may not work properly if you take them while you are taking tetracyclines. Unplanned pregnancies may occur. You should use a different or additional means of birth control while you are taking tetracyclines. If you have any questions about this, check with your health care professional.
Before having surgery (including dental surgery) with a general anesthetic, tell the medical doctor or dentist in charge that you are taking a tetracycline. This does not apply to doxycycline, however.
Tetracyclines may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking this medicine:
You may still be more sensitive to sunlight or sunlamps for 2 weeks to several months or more after stopping this medicine. If you have a severe reaction, check with your doctor.
For patients taking minocycline:
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:For all tetracyclinesMore common
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:For all tetracyclinesMore common
In some patients tetracyclines may cause the tongue to become darkened or discolored. This effect is only temporary and will go away when you stop taking this medicine.
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
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