Chapter 8 Antibacterial Drugs

Front 1

Doxycycline

Adverse Effects

Back 1

Adverse Effects

CNS: intracranial hypertension; minocycline, dizziness.EENT: minocycline, vestibular reactions. GI: HEPATOTOXICITY,CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA (CDAD),diarrhea, nausea, vomiting, esophagitis,pancreatitis. Derm: DRUG RASH WITH EOSINOPHILIAANDSYSTEMIC SYMPTOMS, ERYTHEMA MULTIFORME, STEVENS- JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, photosensitivity, rashes; minocycline, pigmentation of skin and mucous membranes. Hemat: blood dyscrasias.Endo: minocycline—thyroid disorders. MS:minocycline—lupus-like syndrome. Local: doxycycline,minocycline—phlebitis at IV site. Misc: hypersensitivity reactions, superinfection.

Front 2

Doxycycline

Indications for use

Back 2

Indications for Use:

Treatment of various infectionscaused by unusual organisms, including: Mycoplasma, Chlamydia, Rickettsia, Borelliaburgdorferi. Treatment of gonorrhea andsyphilis in penicillin-allergic patients. Prevention of exacerbations ofchronic bronchitis. Treatment of inhalational anthrax (postexposure) andcutaneous anthrax (doxycycline only). Treatment of acne. Malaria prophylaxis(doxycycline only). Inflammatory lesions of nonnodular acne vulgaris (Solodyn)

Front 3

Doxycycline

Contraindications

Back 3

Contraindications/PrecautionsHypersensitivity; Some productscontain alcohol or bisulfites; avoid in patients with known hypersensitivity orintolerance; OB: Risk of permanent staining of teeth in infant if used during last half ofpregnancy (doxycycline may be used to treat anthrax in pregnant women due to theseriousness of the disease); Lactation:Lactation; Pedi: Children _8 yr (permanent staining of teeth) (unless usedfor anthrax; doxycyclinemaybe used to treat anthrax in children due to the seriousness of the disease).Use Cautiously in: Renalimpairment; Hepatic impairment(minocycline);Nephrogenic diabetes insipidus;OB:Women of childbearing age.

Front 4

Gentamicin

Indications for Use

Back 4

Indicationsfor Use: Treatment of serious gram-negative bacterialinfections and infections caused by staphylococci when penicillins or otherless toxic drugs are contraindicated. Streptomycin:In combination with other agents in the management ofactive tuberculosis. Neomycin:Used orally to prepare the GI tract for surgery, todecrease the number of ammonia- producing bacteria in the gut as part of themanagement of hepatic encephalopathy, and to treat diarrhea caused by Escherichia coli. Tobramycin by inhalation: Management of Pseudomonasaeruginosa in cystic fibrosispatients. Gentamicin, streptomycin: In combination with other agents in the management ofserious enterococcal infections. GentamicinIV: Prevention of infective endocarditis. Gentamicin (topical): Treatment of localized infections caused bysusceptible organisms. UnlabeledUse: Amikacin: In combination with other agents in the management of Mycobacterium avium complexinfections.

Front 5

Gentamicin

Adverse Effects

Back 5

Adverse EffectsCNS: ataxia, vertigo. EENT: ototoxicity (vestibularand cochlear). GU: nephrotoxicity. GI:Neomycin—diarrhea, nausea, vomiting. F and E: hypomagnesemia.MS: muscleparalysis (high parenteral doses).Neuro:qneuromuscular blockade. Resp: apnea;Tobramycin, Inhaln only, bronchospasm, wheezing.Misc:hypersensitivity reactions.

Front 6

Gentamicin

Contraindications

Back 6

Contraindications/PrecautionsHypersensitivity toaminoglycosides;Mostparenteral products contain bisulfitesandshould be avoided in patients with known intolerance; Pedi: Products containingbenzyl alcohol should be avoided in neonates; Intestinal obstruction (neomycinonly).Use Cautiously in: Renalimpairment (dose adjustments necessary; blood level monitoring useful inpreventing ototoxicity and nephrotoxicity); Hearing impairment; Neuromusculardiseases such as myasthenia gravis; Obese patients (dose should be based onideal body weight); OB: Tobramycin and streptomycin may cause congenitaldeafness; Lactation: Safety not established; Pedi: Neonates haveqrisk of neuromuscular blockade; difficulty in assessingauditory and vestibular function and immature renal function; Geri: Difficultyin assessing auditory and vestibular function and age-related renal impairment.

Front 7

Fidaxomycin

Indications for Use

Back 7

Indications for Use: Treatment of diarrhea associatedwith Clostridium difficile.

Front 8

Fidaxomycin

Adverse effects

Back 8

Adverse EffectsGI: GI HEMORRHAGE,nausea, abdominal pain. Hemat:anemia, neutropenia. Misc: HYPERSENSITIVITY REACTIONSn:

Front 9

Fidaxomycin

Contraindications

Back 9

Contraindications/PrecautionsUse Cautiously in: OB, Lactation: Use during pregnancy only if clearlyneeded, use cautiously during lactation; Pedi: Safe and effective use inchildren _18yr has not been established.

Front 10

Clindamycin

Indications for Use

Back 10

Indications for Use: PO, IM, IV: Treatmentof: Skin and skin structure infections,Respiratorytract infections, Septicemia, Intraabdominal infections, Gynecologicinfections, Osteomyelitis, Endocarditis prophylaxis. Topical: Severeacne. Vag: Bacterial vaginosis. UnlabeledUse: PO, IM, IV: Treatment of Pneumocystiscarinii pneumonia, CNS toxoplasmosis, andbabesiosis.

Front 11

Clindamycin

Adverse Effects

Back 11

Adverse EffectsCNS: dizziness, headache, vertigo. CV: arrhythmias,hypotension.GI: Clostridium difficile-ASSOCIATED DIARRHEA,diarrhea, bitter taste (IV only), nausea, vomiting.Derm: DRUGREACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS),ERYTHEMA MULTIFORME,TOXICEPIDERMAL NECROLYSIS, rash, urticaria. Local: localirritation (topical products), phlebitis at IV site.

Front 12

Clindamycin

Contraindications

Back 12

Contraindications/PrecautionsHypersensitivity; Regionalenteritisorulcerative colitis (topical foam); PreviousClostridium difficile-associated diarrhea; Severe liver impairment; Diarrhea;Known alcohol intolerance (topical solution, suspension).Use Cautiously in: OB:Safety not established for topical administration; systemic administrationduring2ndand 3rd trimesters not associated withqrisk of congenital abnormalities; approved for vaginaluse in 3rd trimester of pregnancy; injection contains benzyl alcohol which cancross placenta; Lactation: Has been used safely but appears in breast milk andexposes infant to drug and its side effects; Pedi: Injection contains benzylalcohol which can cause gasping syndrome in infants and neonates.

Front 13

Linezolid

Indications for Use

Back 13

Indications for Use: Treatment of: Infections caused byvancomycin-resistantEnterococcus faecium, Nosocomial pneumonia caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains),Complicated skin/skin structure infections caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains), Streptococcus pyogenes or Streptococcusagalactiae (including diabetic footinfections), Uncomplicated skin/ skin structure infections caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains), Streptococcus pyogenes, Community-acquired pneumonia caused by Streptococcus pneumoniae (including multi-drug resistant strains) or Staphylococcus aureus (methicillin-susceptible strains only).

Front 14

Linezolid

Adverse Effects

Back 14

Adverse EffectsCV: headache, insomnia. EENT:teeth discoloration,tonguediscoloration. GI: CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA (CDAD),diarrhea,qliverenzymes, nausea, taste alteration, vomiting. Endo:hypoglycemia.F and E: lacticacidosis. Hemat: thrombocytopenia.Neuro: opticneuropathy, peripheral neuropathy.Misc: SEROTONINSYNDROME.

Front 15

Linezolid

Contraindications

Back 15

Contraindications/PrecautionsHypersensitivity; Phenylketonuria(suspensioncontains aspartame); UncontrolledHTN,pheochromocytoma, thyrotoxicosis, or concurrent use of sympathomimetic agents,vasopressors, or dopaminergic agents (qrisk of hypertensive response); Concurrent or recent (_2wk) use of monoamine oxidase (MAO) inhibitors (qrisk of hypertensive response); Carcinoid syndrome orconcurrent use of SSRIs, TCAs, triptans, meperidine, or buspirone (qrisk of serotonin syndrome) Use Cautiously in: Thrombocytopenia,concurrent use of antiplatelet agents or bleeding diathesis (platelet countsshould be monitored more frequently); Diabetes (qrisk of hypoglycemia); OB: Safety not established; useonly if maternal benefit outweighs potential risk to fetus; Lactation:Lactation.

Front 16

Sulfadiazine

Indications for Use

Back 16

Indications for Use: Skin infections, minor burns, wounds,skin grafts, Urinary Tract Infection

Front 17

Sulfdiazine

Adverse Effects

Back 17

Adverse EffectsINTEG: Rash, urticarial (Hives), scaling, rednessVomiting, Headache, Diarrhea, chills, fever, anorexia, (kidney stones)Ctystalluria, stomatitis, nausea Stephens Johnson Syndrome.Dosing rangeLoading dose 2-4g/day orally; maintenance dose: 2-4g/day orally in 4 -6 divided doses

Front 18

Sulfadiazine

Contraindications

Back 18

Contraindications/PrecautionsCONTRAINDICATIONS:Children younger than 2 Hypersensitivity, large areas, burns, ulcerations Precautions: Pregnancy C, breastfeed-ing, impaired renal function, Hepatic impairment and bronchial asthma external ear or perforated eardrum

Front 19

Penicillin G

Indications for Use

Back 19

UTI

Septicemia

Meningitis

Syphillis

Pneumonia

Respiratory Infections

Also used as Prophylaxis

Front 20

Penicillin G

Adverse Effects

Back 20

Adverse EffectsAdverse Reactions/Side EffectsCNS: SEIZURES. GI: CLOSTRIDIUMDIFFICILE-ASSOCIATEDDIARRHEA(CDAD), diarrhea, epigastric distress, nausea,vomiting.GU: interstitialnephritis. Derm:rash, urticaria.Hemat: eosinophilia,hemolytic anemia, leukopenia.Local: painat IM site, phlebitis at IV site.Misc: allergicreactions including ANAPHYLAXIS and SERUMSICKNESS, superinfection

Front 21

Penicillin G

Contraindications

Back 21

Contraindications/PrecautionsPrevious hypersensitivity topenicillins(cross-sensitivity may exist with cephalosporins and other beta-lactams);Hypersensitivity to procaine or benzathine (procaine and benzathinepreparations only); Some products may contain tartrazine and should be avoidedin patients with known hypersensitivity.000Bwritingasso

Front 22

Cefaclor

Indications for Use

Back 22

Infections due to susceptible microorganisms (ex: UTI, Prophylactically for secondary bacterial infections due to weakened immune systems

Front 23

Cefaclor

Adverse Effects

Back 23

Adverse EffectsCNS: SEIZURES (high doses). GI: CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA (CDAD), diarrhea, cramps,nausea, vomiting. Derm: rashes, urticaria. Hemat:agranulocytosis, bleeding (qwith cefotetan and cefoxitin),eosinophilia, hemolytic anemia, neutropenia,thrombocytopenia. Local: pain at IM site, phlebitis atIV site. Misc: allergic reactions including ANAPHYLAXISand SERUM SICKNESS, superinfection.

Front 24

Cefaclor

Contraindications

Back 24

Contraindications/PrecautionsHypersensitivity tocephalosporins;Serioushypersensitivity to penicillins.Use Cautiously in: Renalimpairment (pdose/qdosinginterval recommended for: cefotetanif CCr _30mL/min,cefoxitin if CCr _50 mL/min, cefprozilif CCr_30 mL/min, cefuroximeif CCr _30mL/min); Patientswithhepatic dysfunction, poor nutritional state, or cancermaybe atqrisk for bleeding; History of GIdisease,especiallycolitis; Cefprozil (oral suspension) containsaspartameand should be avoided in patients with phenylketonuria;Geri:Dose adjustment due to age-relatedpin renal function may be necessary; may also be atqriskfor bleeding with cefotetan or cefoxitin; OB, Lactation:nu/checkmark

Front 25

Meropenem

Indications for Use

Back 25

Intraabdominal and soft tissue infections caused by gram negative organisms

Front 26

Meropenem

Adverse Effects

Back 26

Adverse EffectsCNS: SEIZURES,dizziness, headache. Resp: APNEA. GI:CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA (CDAD),constipation,diarrhea, glossitis ( increased inchildren), nausea,thrush(increased in children), vomiting. Derm: moniliasis(childrenonly), pruritus, rash. Local:inflammationatinjection site, phlebitis. Neuro:paresthesias. Misc: allergic reactions including ANAPHYLAXIS.jSifelystsmeMl�g3bE

Front 27

Meropenem

Contraindications

Back 27

Contraindications/PrecautionsHypersensitivity to meropenemorimipenem; Serious hypersensitivity to other beta-lactams (penicillins orcephalosporins; cross-sensitivity may occur).InteractionsDrug-Drug: Probenecidlow prenalexcretion and increasesbloodlevels (coadministration not recommended).Maypserum valproatelevels (qrisk of seizures).C

Front 28

Vancomycin

Indications for Use

Back 28

nfections,including: Endocarditis, Meningitis, Osteomyelitis, Pneumonia, Septicemia,Soft-tissue infections in patients who have allergies to penicillin or itsderivatives or when sensitivity testing demonstrates resistance to methicillin.PO: Treatmentof staphylococcal enterocolitis or diarrhea due to Clostridium difficile. IV:Part of endocarditis prophylaxis in high-risk patientswho are allergic to penicillin.

Front 29

Vancomycin

Adverse Effects

Back 29

Adverse EffectsEENT: ototoxicity. CV: hypotension. GI: nausea, vomiting.GU: nephrotoxicity. Derm: rashes. Hemat: eosinophilia, leukopenia. Local: phlebitis. MS: back and neck pain. Misc: hypersensitivity reactions includingANAPHYLAXIS, chills, fever, “red man” syndrome(with rapid infusion), superinfection.

Front 30

Vancomycin

Contraindications

Back 30

Contraindications/PrecautionsUse Cautiously in: Renal impairment (dosage reduction required if CCr _80 mL/min); Hearing impairment; Intestinal obstruction or inflammation (qsystemic absorption when given orally); OB, Lactation: Safely not establishedDrug-Drug: May cause additive ototoxicity and nephrotoxicitywith other ototoxic and nephrotoxicdrugs (aspirin, aminoglycosides, cyclosporine,cisplatin, loop diuretics). May enhance neuromuscularblockade from nondepolarizing neuromuscularblocking agents.qrisk of histamine flush whenused with general anesthetics in children

Front 31

Ciprofloxacin

Indications for Use

Back 31

Contraindications/PrecautionsUse Cautiously in: Renal impairment (dosage reduction required if CCr _80 mL/min); Hearing impairment;Intestinal obstruction or inflammation (qsystemic absorption when given orally); OB, Lactation:Safely not establishedDrug-Drug: May cause additive ototoxicity and nephrotoxicitywithother ototoxic and nephrotoxicdrugs (aspirin,aminoglycosides, cyclosporine,cisplatin,loop diuretics). May enhance neuromuscularblockadefrom nondepolarizing neuromuscularblocking agents.qrisk of histamine flush whenused with generalanesthetics inchildren

Front 32

Ciprofloxacin

Adverse Effects

Back 32

Adverse EffectsCNS: ELEVATED INTRACRANIAL PRESSURE (includingpseudotumor cerebri), SEIZURES, dizziness, headache,insomnia, acute psychoses, agitation, confusion, depression, drowsiness, hallucinations, nightmares, paranoia, tremor. CV: gemifloxacin, levofloxacin, moxifloxacin— TORSADE DE POINTES, QT prolongation,vasodilation. GI: HEPATOTOXICITY (CIPROFLOXACIN),CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA (CDAD),diarrhea, nausea, abdominal pain,qliver enzymes(ciprofloxacin, moxifloxacin), vomiting. GU: vaginitis.Derm: photosensitivity, rash. Endo: hyperglycemia,hypoglycemia. Local: phlebitis at IV site. MS: tendinitis,tendon rupture. Neuro: peripheral neuropathy. Misc: hypersensitivity reactions including ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME.

Front 33

Ciprofloxacin

Contraindications

Back 33

Contraindications/PrecautionsHypersensitivity. Cross-sensitivityamong agents within class may occur; History of myasthenia gravis (may worsen symptoms including muscle weakness and breathing problems); Gemifloxacin and moxifloxacin: Concurrent use of Class IA antiarrhythmics (disopyramide, quinidine, procainamide) or Class III antiarrhythmics (amiodarone, sotalol) (qrisk of QTc interval prolongation and torsade de pointes); Known QT interval prolongation or concurrent use of agents causing prolongation; Ciprofloxacin:Concurrent use with tizanidine; OB: Do not use unless potential benefit outweighs potential fetal risk; Pedi: Use only for treatment of anthrax, plague, and complicated UTIs in children 1–17 yrs due to possible arthropathy.

Front 34

Metronidazole

Indications for Use

Back 34

Indications for Use: Treatment of the following anaerobic infections:Intra-abdominal infections (may be used with a cephalosporin), Gynecologicinfections, Skin and skin structure infections, Lower respiratory tractinfections, Bone and joint infections, CNS infections, Septicemia,Endocarditis. IV: Perioperative prophylactic agent in colorectal surgery.PO: Amebicide in the management of amebic dysentery, amebicliver abscess, and trichomoniasis: Treatment of peptic ulcer disease caused by Helicobacter pylori. Topical:Treatment of acne rosacea. Vag: Managementof bacterial vaginosis. UnlabeledUse: Treatment of giardiasis. Treatmentof anti-infective associated Clostridium difficile-associateddiarrhea (CDAD).i

Front 35

Metronidazole

Adverse Effects

Back 35

Adverse EffectsCNS: SEIZURES,dizziness, headache, aseptic meningitis(IV),encephalopathy (IV). EENT: optic neuropathy,tearing(topical only). GI: abdominal pain, anorexia,nausea,diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting. Derm: STEVENS-JOHNSON SYNDROME,rash,urticaria; topical only, burning, mild dryness,skinirritation, transient redness. Hemat:leukopenia. Local: phlebitis at IV site. Neuro: peripheral0neuropathy.Misc: superinfection.ramond-Bookl&.b

Front 36

Metronidazole

Contraindications

Back 36

Contraindications/PrecautionsHypersensitivity; Hypersensitivityto parabens (topical only); OB: First trimester of pregnancy. Use Cautiously in: History of blood dyscrasias; History of seizures or neurologic problems; Severe hepatic impairment (dosepsuggested); OB: Although safety not established, has been used to treat trichomoniasis in 2nd- and 3rd-trimester pregnancy—but not as single- dose regimen; Lactation: If needed, use single dose and interrupt nursing for 24 hr thereafter; Patients receiving corticosteroids or predisposed to edema (injection contains 28 mEq sodium/g metronidazole).

Front 37

Isoniazid

Indications for Use

Back 37

Indications for Use: First-line therapy of active tuberculosis, in combination with other agents. Prevention of tuberculosis in patients exposed to active disease (alone).

Front 38

Isoniazid

Adverse Effects

Back 38

Adverse EffectsCNS: psychosis, seizures. EENT: visual disturbances.GI: DRUG-INDUCED HEPATITIS, nausea, vomiting.Derm: rashes. Endo: gynecomastia. Hemat: blooddyscrasias. Neuro: peripheral neuropathy. Misc: fever.

Front 39

Isoniazid

Contraindications

Back 39

Contraindications/PrecautionsHypersensitivity; Acute liverdisease; History of hepatitis from previous use.Use Cautiously in: History of liver damage or chronic alcohol ingestion; Black and Hispanic women, women in the postpartum period, or patients _50 yr (qrisk of drug-induced hepatitis); Severe renal impairment (dosepmay be necessary); Malnourished patients, patients with diabetes, or chronic alcoholics (qrisk of neuropathy); OB, Lactation: Although safety is not established, isoniazid has been used with ethambutol to treat tuberculosis in pregnant women without harm to the fetus

Front 40

Rifampin

Indications for Use

Back 40

Indications for Use: Active tuberculosis (with other agents). Eliminationofmeningococcalcarriers. Unlabeled Use: Prevention of disease caused by Haemophilus influenzae type B in close contacts. Synergy with otherantimicrobial agents for S.aureus infections.

Front 41

Rifampin

Adverse Effects

Back 41

Adverse EffectsAdverse Reactions/Side EffectsCNS: ataxia, confusion, drowsiness, fatigue, headache,weakness. Derm: rash, pruritus. EENT: red discoloration of tears. GI: abdominal pain, diarrhea, flatulence, heartburn, nausea, vomiting,qliver enzymes, red discoloration of saliva. GU: red discoloration of urine. Hemat: hemolytic anemia, thrombocytopenia. MS:arthralgia, muscle weakness, myalgia. Misc: flu-like syndrome.

Front 42

Rifampin

Contraindications

Back 42

Contraindications/PrecautionsContraindications/PrecautionsContraindicated in: Hypersensitivity; Concurrent use of atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, or ritonavir-boosted saquinavir.

Front 43

Rimantadine

Indications for Use

Back 43

Indications for Use: Prophylaxis or treatment of influenza type A

Front 44

Rimantadine

Adverse Effects

Back 44

Adverse EffectsCNS: Headache, dizziness, fatigue, depres-sion, hallucinations, tremors, seizures, insomnia, poor concentration, asthenia,gait abnormalities, anxiety, confusion PallorCV: palpitations,EENT: edema Tinnitus, taste abnormality, eye painGI: Nausea, vomiting, constipation, dry mouth, anorexia, abdominal pain, diarrhea, dyspepsiaINTEG: Rash

Front 45

Rimantadine

Contraindications

Back 45

Contraindications/PrecautionsHypersensitivity to products of adamantine class (this product, amantadine)

Front 46

Acyclovir

Indications of Use

Back 46

Indications for Use: PO: Recurrent genital herpes infections. Localized cutaneousherpes zoster infections (shingles) and chickenpox (varicella). Buccal: Recurrent herpes labialis (cold sores) in nonimmunosuppressed patients. IV: Severe initial episodes of genital herpes in nonimmunosuppressed patients. Mucosal or cutaneous herpes simplex infections or herpes zoster infections (shingles) in immunosuppressed patients. Herpes simplex encephalitis. Topical: Cream—Recurrent herpes labialis (cold sores). Ointment—Treatment of limited non– life-threatening herpes simplex infections in immunocompromised patients (systemic treatment is preferred)

Front 47

Acyclovir

Adverse Effects

Back 47

Adverse EffectsCNS: SEIZURES, dizziness, headache, hallucinations,trembling. GI: diarrhea, nausea, vomiting,qliver enzymes,hyperbilirubinemia, abdominal pain, anorexia.GU: RENAL FAILURE, crystalluria, hematuria, renal pain.Derm: STEVENS-JOHNSON SYNDROME, acne, hives, rash,unusual sweating. Endo: changes in menstrual cycle.Hemat: THROMBOTIC THROMBOCYTOPENIC PURPURA/HEMOLYTIC UREMIC SYNDROME (high doses in immunosuppresse patients). Local: pain, phlebitis, local irritation. MS: joint pain. Misc: polydipsia.

Front 48

Acyclovir

Contraindications

Back 48

Contraindications/PrecautionsHypersensitivity to acyclovir orvalacyclovir; Hypersensitivity to milk protein concentrate (buccal only). Use Cautiously in: Pre-existing serious neurologic, hepatic, pulmonary, or fluid and electrolyte abnormalities; Renal impairment (dose alteration recommended if CCr _50 mL/min); Geri: Due to age relatedpin renal function; Obese patients (dose should be based on ideal body weight); Patients with hypoxia; OB, Lactation: Safety not established.

Front 49

Fluconazole

Indications of Use

Back 49

Indications for Ue: PO, IV: Fungalinfections caused by susceptible organisms,including:Oropharyngeal or esophageal candidiasis, Serious systemic candidal infections,Urinary tract infections, Peritonitis, Cryptococcal meningitis. Prevention ofcandidiasis in patients who have undergone bone marrow transplantation. PO: Single-doseoral treatment of vaginal candidiasis. UnlabeledUse: Prevention of recurrent vaginalyeast infections.@l�j7a�

Front 50

Fluconazole

Adverse Effects

Back 50

Adverse EffectsIncidence of adverse reactions isincreased in HIV patients.CNS: headache,dizziness, seizures. GI: HEPATOTOXICITY,abdominal discomfort, diarrhea, nausea, vomiting. Derm: exfoliativeskin disorders including STEVENSJOHNSONSYNDROME. Endo:hypokalemia, hypertriglyceridemia.Misc:allergic reactions, including ANAPHYLAXIS

Front 51

Fluconazole

Contraindications

Back 51

Contraindications/PrecautionsContraindicated in: Hypersensitivity to fluconazole or other azole antifungals; Concurrent use with pimozide, erythromycin, or quinidine. Use Cautiously in: Renal impairment (doseprequired if CCr _50 mL/min); Underlying liver disease; OB: Safety not established; congenital defects have occurred with use of high-dose fluconazole (400–800mg/day); Lactation: Usually compatible with breast feeding; Geri:qrisk of adverse reactions (rash, vomiting, diarrhea, seizures); consider age-relatedpin renal function in determining dose.

Front 52

Metronidazole

Indications for Use

Back 52

Indications for Use: Treatment of the following anaerobic infections: Intra-abdominal infections (may be used with a cephalosporin), Gynecologic infections, Skin and skin structure infections, Lower respiratory tract infections, Bone and joint infections, CNS infections, Septicemia, Endocarditis. IV: Perioperative prophylactic agent in colorectal surgery. PO: Amebicide in the management of amebic dysentery, amebic liver abscess, and trichomoniasis: Treatment of peptic ulcer disease caused by Helicobacter pylori. Topical: Treatment of acne rosacea. Vag: Management of bacterial vaginosis. Unlabeled Use: Treatment of giardiasis. Treatment of anti-infective associated Clostridium difficile-associateddiarrhea (CDAD).

Front 53

Metronidazole

Adverse Effects

Back 53

Adverse EffectsCNS: SEIZURES, dizziness, headache, aseptic meningitis(IV), encephalopathy (IV). EENT: optic neuropathy,tearing (topical only). GI: abdominal pain, anorexia,nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting. Derm: STEVENS-JOHNSON SYNDROME,rash, urticaria; topical only, burning, mild dryness,skin irritation, transient redness. Hemat:leukopenia. Local: phlebitis at IV site. Neuro: peripheral 0neuropathy.Misc: superinfection.

Front 54

Metronidazole

Contraindications

Back 54

Contraindications/PrecautionsHypersensitivity; Hypersensitivityto parabens (topical only); OB: First trimester of pregnancy. Use Cautiously in: History of blood dyscrasias; History of seizures or neurologic problems; Severe hepatic impairment (dosepsuggested); OB: Although safety not established, has been used to treat trichomoniasis in 2nd- and 3rd-trimester pregnancy—but not as single- dose regimen; Lactation: If needed, use single dose and interrupt nursing for 24 hr thereafter; Patients receiving corticosteroids or predisposed to edema (injection contains 28 mEq sodium/g metronidazole).

Front 55

Nitrofurantoin

Indications for Use

Back 55

Indications for Use: Prevention and treatment of urinary tract infectionscaused by susceptible organisms; not effective in systemic bacterial infections.

Front 56

Nitrofurantoin

Adverse Effects

Back 56

Adverse EffectsCNS: dizziness, drowsiness, headache. EENT: nystagmus.Resp: PNEUMONITIS, PULMONARY FIBROSIS. CV: chest pain. GI: HEPATOTOXICITY, CLOSTRIDIUM DIFFICILEASSOCIATED DIARRHEA (CDAD), anorexia, nausea, vomiting, abdominal pain, diarrhea. GU: rust/brown discolorationof urine. Derm: photosensitivity. Hemat:blood dyscrasias, hemolytic anemia. Neuro: peripheralneuropathy. Misc: hypersensitivity reactions.

Front 57

Nitrofurantoin

Contraindications

Back 57

Contraindications/PrecautionsHypersensitivity; Hypersensitivityto parabens (suspension); Oliguria, anuria, or significantrenal impairment (CCr _60 mL/min); Historyof cholestatic jaundice or hepatic impairment with previoususe of nitrofurantoin; Pregnancy near term andinfants _1 mo (qrisk of hemolytic anemia).Use Cautiously in: Glucose–6–phosphate dehydrogenase(G6PD) deficiency (qrisk of hemolytic anemia,especially in Blacks and Mediterranean and Near-Eastern ethnic groups); Patients with diabetes ordebilitated patients (neuropathy may be more common);OB: Safety not established but has been usedsafely in pregnant women. Lactation: May cause hemolysisin infants with G6PD deficiency who are breast fed;Geri: Appears on Beers list;qrisk for renal, hepatic,and pulmonary reactions.

Front 58

Phenazopyridine

Indications for Use

Back 58

Indications for Use:Provides relief from the following urinary tract symptoms, which may occur in association with infection or following urologic procedures: Pain, Itching, Burning, Urgency, Frequency

Front 59

Phenazopyridine

Adverse Effects

Back 59

Adverse EffectsCNS: headache, vertigo. GI: hepatotoxicity, nausea.GU: bright-orange urine, renal failure. Derm: rash. Hemat: hemolytic anemia, methemoglobinemia

Front 60

Phenazopyridine

Contraindications

Back 60

Contraindications/PrecautionsContraindicated in: Hypersensitivity; Glomerulonephritis; Severe hepatitis, uremia, or renal failure; Renal insufficiency; Glucose-6–phosphate dehydrogenase (G6PD) deficiency. Use Cautiously in: Hepatitis; OB, Lactation: Safety not established.