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44 Cards in this Set
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Max Antibiotic Dosages
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max 4g daily for metronidazole, ceftriaxone, cephalexin, erythromycin, di/flucloxicillin
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Quinolones
-b'cidal; inhibit bacterial DNA synthesis |
I: mostly G-ve cover
complicated UTI Traveller’s diarrhoea Shigelosis Prostatitis Salmonella, Typhoid SE: rash/itch n&v, diarrhoea abdo pain/dyspepsia tendonitis, myalgia dizzy photosensitivity crystalluria CNS (dizziness, headache, dec. seizure threshold) **Cipro interacts with warfarin (Inc. INR) and phenytoin (dec. conc.) |
3b, 4, 8, 12, D
! drink plenty of fluids (prevents crystalluria) ! may INC. effects of caffeine ! stop taking, don’t exercise, and see your doctor if you experience any tendon pain or inflammation ! not for children (arthropathy) |
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Ciprofloxacin (C-flox®,
Profloxin®) 250, 500, 750 mg (14) |
250-750mg bd (M=1.5g d)
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MONITOR:
tendon rupture risk of seizure in patients for epilepsy or CNS |
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Norfloxacin (Roxin®, Noroxin®)
400 mg (14) |
400mg bd (M=800mg d)
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Cephalosporins same mechanism of
action as penicillins thus cross-sensitivity Moderate Spectrum G+ve: anti-strep, staph G-ve: E. coli, Klebsiella |
SE: GI disturbance (n, d,
electrolyte disturbance) rash headache rarely anaphylactic shock, bronchial obstruction 5-10% cross-reactivity with allergy to penicillins |
D
6, 7 (suspensions) ! Allergic to any antibiotics you’ve had in the past? Penicillins? ! Space doses as evenly as possible ! If skin rash, swollen lips or difficulty breathing seek medical advice ! Common adverse effects – nausea, diarrhoea, gastric upset |
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Cephalexin (Keflex)
250, 500 mg (20) 25, 50 mg/mL |
250–500 mg every 6 hours or
500 mg – 1 g every 6– 12 hours Cephalexin Staphylococcal and streptococcal infections in people with mild-tomoderate penicillin allergy UTIs due to susceptible Gram-negative bacteria Epididymo-orchitis Surgical prophylaxis (cephazolin) |
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+ anti-himophilus activity (against
Hib) |
cefaclor
cefuroxime Ceftriaxone |
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Cefaclor (Ceclor)
375 mg CR (10) 25, 50 mg/mL |
Adult, 375 – 750 mg every 12
hours Child, 20 mg/kg every 12 hours or 10-15mg/kg tds Otitis media (particularly in children) Respiratory tract infections caused by H. influenzae Acute bacterial sinusitis |
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Cefuroxime (Zinnat)
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250 mg bd
Otitis media (particularly in children) Respiratory tract infections caused by H. influenzae Acute bacterial sinusitis (cefuroxime - gonococcal infections) |
B
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Ceftriaxone (Rocephin)
% Broad Spectrum |
1g daily (max 4g)
Pneumonia Bacterial meningitis Septicaemia Sexually acquired epididymo-orchitis (with doxycycline) |
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Quinolones Monitoring
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RF
INC. risk of neuro and nephrotoxicity with high doses - FBC for tx longer than 10 days - allergic rxn |
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Lincosamides
Clindamycin (Cleocin, Dalacin) 150 mg |
1-3 tablets 3-4 times a day
Alternative in patients with severe allergy to penicillins and cephalosporins including endocarditis prophylaxis, aspiration pneumonia, dental, skin, soft tissue and bone infections Anaerobic infections Bacterial vaginosis Acne (topical) SE: Same as cephalosporins, i.e. GI disturbance (n, d, electrolyte disturbance) rash headache + pseudomembranous colitis (diarrhoea, clostridium-difficile) % treat with metronidazole |
Take with a full glass of water. Stop
taking this medication and tell your doctor immediately if you develop diarrhoea. Check with your doctor or pharmacist before taking any antidiarrhoeal medications. MONITOR: prolonged tx do FBC, RF & LFTs |
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Macrolides
b'static; inhibit bacterial protein synthesis by binding to 50S ribosomal subunit |
Class indications:
Alternatives to penicillins and cephalosporins in allergic patients. MAC and pertusis treatment and prophylaxis SE: n/v diarrhoea abdominal pain candidal infection rash (Stevens-Johnson syndrome) ototoxicity |
! this medicine interacts with
many drugs; tell your doctor and pharmacist that you are taking this medicine before starting or stopping any medicines, including herbal and over-the-counter products ! space doses as evenly as possible during waking hours ! any previous allergies to Abx? ! even though you may start feeling better after a couple of days, really important to complete full course **macrolides inhibit CYP3A4 ! interact with many drugs (e.g. warfarin, digoxin) |
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Macrolide Specific Indications
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Chlamydial infections
(azithromycin > clarithromycin) H. pylori eradication (clarithromycin) Respiratory tract infections (all except azithromycin) CAP (roxithromycin, azithromycin) Recurrent tonsillitis (roxithromycin) Skin infections (roxithromycin) |
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1. Roxithromycin (Rulide, Biaxsig)
150, 300mg 50mg dispersible |
150mg bd or 300mg daily
(m=300mg d) child: 2.5 - 4mg/kg bd - RTI - CAP Recurrent tonsillitis - skin infection |
3b, D
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Inc QT interval
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Erythromycin and clarithromycin can increase the QT interval.
QT elongation E>C>A (not with R) |
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2. Erythromycin (Eryc, E-mycin)
250, 400mg 40mg/mL, 80mg/mL EES |
250 - 500mg q6-8h (m=4g/d)
child: 25 - 50mg/kg daily in 2-4 divided doses - RTI |
5, 3b, D,
6, 7 (suspesions) Erythromycin is poorly tolerated due to GI side effects and has the most drug interactions of all macrolides. Drug interactions and abdo discomfort E>C>R>A |
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3. Clarithromycin (Klacid, Clarac)
250, 500mg |
250 - 500mg bd
child: 15mg/kg daily in 2 doses (m1g/day) - Chlamydial - H-pylori - RTI |
5, D
Suspension should not be refrigerated and expires after 14 days. |
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4. Azithromycin (Zithromax)
500, 600mg |
500mg daily for 3 days; or
500mg on day 1 and 250mg daily for 4 days (1g stat for sexually transmitted chlamydia) -Chlamydial -CAP |
D
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Macrolide Monitor
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- ECG
- QT prolongation - LFTs in E & R |
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Nitroimidazole
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Anaerobic bacterial infections
(G+ve and G-ve) Protozoal infections Dental infection Aspiration pneumonia Bacterial vaginosis H. pylori eradication Wounds (e.g. diabetic foot ulcer) SE: n/v abdominal pain diarrhoea anorexia metallic taste, furry tongue CNS effects (dizziness, headaches) Paraesthesia, peripheral neuropathy disulfuram reaction when taken with alcohol |
D, 2
B (tabs), 3b (liq) ! Take with food to reduce stomach upset. ! Avoid alcohol during treatment and for 24 hours after finishing the course to prevent nausea, vomiting, flushing, headache and palpitations (sometimes occur when alcohol is taken with metronidazole). ! Stop taking metronidazole and check with your doctor immediately if you have any numbness, tingling, pain or weakness in hands or feet. ! May make you feel dizzy or confused; avoid driving if you are affected like this. ! Metronidazole liquid is absorbed best if taken 1 hour before food. |
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Metronidazole (Flagyl, Metrogyl)
200, 400 mg 40mg/mL |
Adult, 200 - 400 mg q8-12hours, up to 4g daily
Child, 7.5mg/kg q8h |
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Tinidazole (Fasigyn, Simplotan)
500 mg |
2g stat as a single dose
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nitroimidazole MONITORING
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Blood count and neurotoxic rxns when treating for > 10 days
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Penicillins;
b'cidal; interfere with bacterial cell wall peptidoglycan synthesis BROAD SPECTRUM |
G+ve, some G-ve
URTI (G+ve) Pneumonia UTI (G-ve) Bites, clenched fist injuries Otitis media, sinusitis H. pylori eradication |
SE:
WT diarrhoea nausea rash urticaria **ALLERGY** occurs in 10% of ppl – cross-reactivity between penicillins, cephalosporins, and carbapenems ! space doses as evenly as possible during waking hours ! any previous allergies to penicillin/Abx? ! if skin rash develops or notice swelling of lips or difficulty breathing, contact your doctor ! even though you may start feeling better after a couple of days, really important to complete full course |
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Amoxycillin (Amoxil, Moxacin)
250, 500, 1000mg 25mg/mL, 50mg/mL, 100mg/mL |
250 - 500mg q8h/tds or 1g bd
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D
6, 7, D (suspensions) |
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Amoxycillin + Clavulanic acid
(Augmentin, Clavulin) 500/125, 875/125 25mg/mL, 6.25mg/mL 80mg/mL, 11.4mg/mL |
250/125-500/125 q8h or
875/125 bd SE: cholestatic hepatitis |
F (amoxy+clav)
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Narrow spectrum:
G+ve |
Staph. skin infections
Pneumonia Osteomyelitis Septicaemia - SE: cholestatic hepatitis |
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Dicloxacillin (Diclocil, Dicloxsig)
250, 500mg |
250 - 500mg q6h (M=4g/day)
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Di/flucloxacillin
3a, D |
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Flucloxacillin (Flopen, Staphylex)
250, 500mg 25mg/mL, 50mg/mL |
250 - 500mg q6h (M=4g/day)
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Di/flucloxacillin
3a, D |
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Phenoxymethylpenicillin (Abbocillin
VK, Cilicaine VK) 250, 500 mg |
250 - 500mg q6-8h
12.5mg/kg q6h SE: cholestatic hepatitis I: tonsillitis/pharyngitis skin infections |
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Peniccillin monitoring
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allergic reactions
hepatic functionesp >2wks |
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Tetracyclines
b’static; inhibit bacterial protein synthesis by reversibly binding to 30S sub-unit of the ribosome |
I: Acne
Malaria prophylaxis Respiratory tract infections CAP Exacerbation of chronic bronchitis Acute bacterial sinusitis Chronic prostatitis SE: GI upset (n/v, dairrhoea, epigastric burning) teeth discolouration enamel dysplasia photosensitivity oesophageal ulcers $ intracranial BP ! causes headache (doxycycline) inhibition of bone growth Minocycline; abdominal cramps and vestibular toxicity (dizziness, vertigo, ataxia) |
B, D, 4, 8
12 (minocycline only) ! Take with food or milk to reduce stomach upset. ! Take with a large glass of water, and remain upright (do not lie down) within 1 hour of taking a tetracycline. This is to stop tablets or capsules sticking on the way to your stomach, and causing painful damage to the lining of your throat. ! Take a single daily dose in the morning rather than at night. ! May decrease effectiveness of OC ! use barrier methods or abstain |
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Doxycycline (Doxylin, Doxy,
Vibramycin) 50, 100 mg |
Adult, 200mg on day 1, then
100mg daily (m=200mg/day) Acne, 50 mg daily for at least 6 weeks Malaria prophylaxis, Start taking 2 days before entering, and continue for 2–4 weeks after leaving, an endemic area. Maximum recommended course 6 months. Adult, 100 mg once daily. |
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Minocycline (Akamin, Minomycin)
50, 100 mg |
200mg stat, then 100mg bd
(m=400mg/day) |
Monitor;
Pigmentation |
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Malaria prophylaxis
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Malaria prophylaxis (personal
measures): - DEET containing insect repellent - Clothing that covers most of the body - Mosquito nets sprayed with permethrin - Air conditioning |
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Hexamine Hippurate
hydrolysed in acidic pH to formaldehyde, which is bactericidal against Gram-positive and Gram-negative bacteria and fungi Hiprex® 1g |
1g twice daily
Prophylaxis of UTI WT GI upset, rash, dysuria |
Avoid taking medications like
sodium bicarbonate, Ural®, Citralite® or Citravescent® as they make hexamine less effective. Encourage adequate intake of fluid |
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Trimethoprim
b'static; competitively inhibits bacterial folate production essential for bacterial growth(G -ve) Alprim, Triprim 300 mg |
UTI
Women, 300mg at night for 3 days Men/recurrent, 300mg at night for 14 days Prostatitis 300mg at night for 4 days Uncomplicated lower UTI Epidymo-orchitis Prostatitis Shigellosis (GI infection) Traveller’s diarrhoea SE: Trimethprim fever itch rash n/v, gastric upset hyperkalaemia* blood dyscrasias megablastic anaemia Stevens-Johnsons syndrome |
Trimethoprim
D ! take at night to maximise urinary concentration for UTI ! stop taking this medicine if rash develops, seek medical advice |
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Co-trimoxazole
trimethoprim + sulfamethoxazole Bactrim, Resprim, Septrim 80mg/400mg 160mg/800mg DS, Forte 8mg/mL, 40mg/mL susp. |
SE: Sulfamethoxazole
photosensitivity headache, drowsiness anorexia sore mouth |
D, B, 8
! take with food to reduce stomach upset – drink a lot of water whilst taking this medication (prevents crystalluria) ! to reduce risk of rash from the sun avoid sun exposure, wear protective clothing and use sunscreen ! stop taking this medicine if rash develops, seek medical advice avoid use in elderly or children due to increased risk of serious side effects |
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Trimethoprim
MONITORING |
FBC
Folate status during long or high doses - serum K begining on day 3 if patient has renal failure, is on other drugs that can cause hyperkalaemia or @ high doses |
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Bactrim MONITORING
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RF each month
and as above+ |
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Nitrofurantoin
inhibits bacterial protein, DNA, RNA and cell wall synthesis Macrodantin® 50, 100 mg |
Acute, uncomplicated UTI
50 – 100 mg qid for 3 days UTI prophylaxis 50 – 100 mg at bedtime SE: drowsiness vertigo headache n/v anorexia peripheral neuropathy hepatotoxicity pulmonary toxicity rash |
12, B, D
! Take with food or milk to reduce nausea and increase absorption. ! Tell your doctor immediately if you have any trouble breathing, develop a cough or get numbness or tingling. ! Nitrofurantoin may cause drowsiness or dizziness; do not drive or operate machinery if you are affected. avoid Ural® as requires acidic environment for activity may cause staining of soft contacts lenses |
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Nitrofuratoin Monitoring
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Long term Tx
- pulmonary function - LFT every month for 3months then every 3 months - RF as peripheral polyneuropathy is more likely to occur - paraesthesia development, stopping treatment early can prevent neuropathy |
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Aminoglycoside
Gentamicin |
4 – 7 mg/kg daily according to
renal function, TDM and clinical response Empirical treatment of serious Gram-negative infections SE: Ototoxicity (hearing loss, tinnitus, balance problems, n/v) Hepatotoxicity Neuromuscular toxicity (potentially fatal e.g.respiratory depression – treat with calcium gluconate) |
IV—if you are given this drug for >7–
10 days your kidneys may work less well than usual but this should improve when the drug is stopped. Sometimes hearing and balance is affected and there may be some permanent hearing loss. Tell your doctor if your hearing becomesworse or you are unsteady or dizzy (especially when you sit up, stand up or walk). |
