Antibiotics 2 Flashcards
Doxycycline
Vibramycin, Doxy 100
Minocycline
Minocin
Amoxicillin
Amoxil, Moxatag
Amoxicillin/Clavulanate
Augmentin
Penicillin
(No brand name listed)
Cephalexin
Keflex, Daxbia
Cefuroxime
Ceftin, Zinacef
Cefdinir
Omnicef
Chlorhexidine
Peridex, Paroex, Hibiclens, Periogard
Doxycycline - Therapeutic Class
Tetracycline Antibiotic
Minocycline - Therapeutic Class
Tetracycline Antibiotic
Amoxicillin - Therapeutic Class
Beta-Lactam Antibiotic
Amoxicillin/Clavulanate - Therapeutic Class
Beta-Lactam Antibiotic
Penicillin - Therapeutic Class
Beta-Lactam Antibiotic
Cephalexin - Therapeutic Class
First-Generation Cephalosporin
Cefuroxime - Therapeutic CLass
Second-Generation Cephalosporin
Cefdinir - Therapeutic Class
Third-Generation Cephalosporin
Doxycycline - Dosage Forms
IR Tablet: 20, 50, 75, 100, 150 mg DR Tablet: 50, 75, 100, 150, 200 mg IR Capsule: 50, 75, 100, 150 mg DR Capsule: 40 mg Oral Suspension: 25 mg/5 mL Oral Syrup: 50 mg/5 mL
Minocycline - Dosage Forms
IR Tablet: 50, 75, 100 mg
ER Tablet: 45, 55, 65, 80, 90, 105, 115, 135 mg
IR Capsule: 50, 75, 100 mg
DR Capsule: 45, 90, 135 mg
Amoxicillin - Dosage Forms
IR Tablet: 500, 875 mg ER Tablet: 775 mg Chewable Tablet: 125, 250 mg Capsule: 250, 500 mg Oral Suspension: 125 mg/5 mL
Amoxicillin/Clavulanate - Dosage Forms
IR Tablet: 250/125, 500/125, 875/125
ER Tablet: 1000/62.5
Chewable Tablet: 200/28.5, 400/57
Oral Suspension (per 5 mL): 125/31.25, 200/28.5, 250/62.5, 400/57, 600/42.9
Penicillin - Dosage Forms
Tablet: 250, 500 mg
Oral Solution: 125 mg/5 mL, 250 mg/5 mL
Cephalexin - Dosage Forms
Tablet: 250, 500 mg
Capsule: 250, 500, 750 mg
Powder for Oral Suspension: 125/5, 250/5
Cefuroxime - Dosage Forms
Tablet: 125, 250, 500 mg
Cefdinir - Dosage Forms
Capsule: 300 mg
Powder for Oral Suspension: 125/5, 250/5
Chlorhexidine - Dosage FOrms
Liquid Oral Rinse: 0.12%
Topical Solution: 2%, 4%
Periodontal Chip: 2.5 mg
Doxycycline - MOA
Broad-spectrum bacteriostatic compound that inhibits protein synthesis at the 30S ribosomal unit
Doxycycline - Activity
Gram (+)
Gram (-)
Aerobic and anaerobic bacteria
Spirochetes, mycoplasmas, rickettsiae, chlamydiae, and some protozoa
Doxycycline - FDA-Approved Indications (Children < 8 years and < 45 kg)
For all three: 2.2-4.4 mg/kg PO in 1-2 divided doses
- Acinetobacter infection
- Acne vulgaris
- Staphylococcal infection of skin
Doxycycline - FDA-Approved Indications (Adults and Children > 8 years and > 45 kg)
- Acinetobacter infection: 100 mg PO q12h, then 100 mg QD
- Acne vulgaris: 100 mg PO q12h on day 1, then 100 mg QD or BID
- Gonorrhea, uncomplicated: 100 mg PO BID x 7 days or 300 mg single dose followed in 1 hour by another 300 mg dose
- Staphylococcal infection of skin: 100 mg PO q12h on day 1, then 100 mg QD
- Pneumonia, community-acquired, empiric therapy: 100 mg PO BID
Doxycycline - Off-Label Uses (Adults and Children >8 years and >45 kg)
- Lyme disease, ppx: 200 mg PO once
- Prosthetic joint infection: 100 mg PO BID in combo w/ rifampin for a minimum of 3 months
- Otitis media, acute: 100 mg PO q12h x 5-7 days
- Cellulitis, mild to moderate: 100 mg PO BID x 5-14 days
Minocycline - MOA
Broad-spectrum bacteriostatic compound that inhibits protein synthesis at the 30S ribosomal unit
Minocycline - Activity
Gram (+)
Gram (-)
Aerobic and anaerobic bacteria
Spirochetes, mycoplasmas, rickettsiae, chlamydiae, and some protozoa
Many bacteria have developed plasmid-mediated resistance
Most Enterobacteriaceae and P. aeruginosa are resistant
Minocycline - FDA-Approved Indications
- Acne vulgaris: Initiate with single 200 mg loading dose, then 100 mg BID (IR); 1 mg/kg/day PO QD for 12 weeks (ER)
- Allergy to penicillin - bacterial infectious disease: initial 200 mg PO, followed by 100 mg PO q12h (adults); 4 mg/kg PO followed by 2 mg/kg/dose q12h (Children >8 years - MDD = 200 mg)
Duration of therapy depends on indication
Amoxicillin - MOA
Semisynthetic penicillin derivative that inhibits the biosynthesis of bacterial cell wall mucopeptide
Amoxicillin - Activity
Streptococcus, Enterococcus, Staphylococcus, Enterobacteriaceae
Amoxicillin - FDA-Approved Indications
- Acute otitis media: 500 mg q8h or 875 mg q12h for 10 days (adults); 80-90 mg/kg/d in 2-3 divided doses (children)
- Lower respiratory tract infection: 1 g TID x 10 days (adults); 45 mg/kg/d divided q12h (children)
- Pharyngitis, tonsilitis: 775 mg QD x 10 days (adults and children >12 years)
- Streptococcal pharyngitis: 500 mg BID or 1 g QD x 10 days (adults); 50 mg/kg QD x 10 days (children - MDD = 1 g)
- Ear, nose, and throat infection, infection of skin and/or subcutaneous tissue, infection of genitourinary system: 500 mg q8h or 875 mg q12 x 5-10 days (adults); 25-45 mg/kg/d divided q12h (children)
- H. pylori GI tract infection: 1 g BID w/ PPI
Amoxicillin - Off-Label Uses
- Bacterial endocarditis, prophylaxis: 2 g PO 1 hour before procedure (adults); 50 mg/kg 1 hour before procedure [MDD = 2 g]
- Lyme disease: 500 mg TID x 14-28 days (adults); 50 mg/kg/d in 3 divided doses x 21-30 days (children)
Amoxicillin/Clavulanate - MOA
Amoxicillin is a semisynthetic penicillin derivative. Amoxicillin is not effective against beta-lactamase-producing bacteria
Clavulanate, a beta-lactamase inhibitor, has weak antibacterial activity but is a potent inhibitor of plasmid-mediated beta-lactamases and protects amoxicillin from degradation by beta-lactamases
Amoxicillin/Clavulanate - Activity
Typically active against Streptococcus, Enterococcus, Staphylococcus, and Enterobacteriaceae
Amoxicillin/Clavulanate - FDA-Approved Indications
- Acute otitis media: 500-875 mg q12h x 10 days (adults); 80-90 mg/kg/d in 2-3 divided doses (children)
- Community-acquired pneumonia: 2000 mg ER BID or 500 mg TID or 875 BID x 5 days (adults)
- Lower respiratory tract infection: 1000 mg TID x 10 days (adults); 45 mg/kg/d divided q12h (children)
- Sinusitis, infection of skin or subcutaneous tissue, infectious disease of genitourinary system: 500-875 mg q8-12h or 2000 mg ER q12h x 5-7 days (adults); 25-45 mg/kg/d divided q12h
- UTI, acute cystitis: 500 mg BID x 5-7 days
- UTI, pyelonephritis: 875 mg BID 10-14 days
Amoxicillin/Clavulanate - Off-Label Uses
- Streptococcal pharyngitis: 875 mg q12h or 500 mg q8h (adults); 45 mg/kg/d divided q12h
- Bite wound prophylaxis and treatment: 875 mg q12h x 3-5 days (prophylaxis); or 5-14 days (treatment)
Penicillin - MOA
Interfere with late stages of bacterial cell wall synthesis
Penicillin - Activity
Active against most Gram (+) organisms and some Gram (-) organisms, notably Neisseria spp.
Resistance is caused by bacterial production of beta-lactamases; some organisms have altered penicillin-binding protein targets (e.g., Enterococci spp. and S. pneumoniae); others have impermeable outer cell wall layers
Penicillin - FDA-Approved Indications
- Bacterial endocarditis, prophylaxis with congenital heart disease or rheumatic/acquired valvular heart disease: 2 g PO 1 h prior to procedure and then 1 g PO 6 h later (adults); 1 g PO 1 h prior to procedure then 500 mg PO 6 h later (children <60 lb)
- Otitis media, mild-moderate, pneumococcal: 250-500 mg q6h until afebrile for at least 2 days (adults); 25-50 mg/kg/d in 3-4 divided doses (children < 12 years; MDD 3 g)
- Streptococcal pharyngitis: 500 mg BID x 10 days (adults); 250 mg BID x 10 days (children <60 lb)
- Erysipelas, mild infection or step-down therapy: 500 mg q6h x 5-10 days
Penicillin - Off-Label Uses
- Pneumococcal infectious disease, prophylaxis in patients with sickle cell disease or asplenia
Children 2 months - 5 years of age: 125 mg PO BID
Children >5 years of age: 250 mg PO BID; discontinue at age 5 y for children who received pneumococcal vaccination and who have not experienced invasive pneumococcal disease
Cephalexin - MOA
1st-generation cephalosporin that inhibits bacterial cell wall synthesis of actively dividing cells by binding to at least 1 penicillin-binding protein (PBP)
Cephalexin - Activity
Most Gram (+) bacteria including non-penicillinase and penicillinase-producing staphylococci and streptococci
Gram (-) bacteria activity is less than that observed with the 2nd and 3rd generation cephalosporins and is primarily restricted to E. coli, Klebsiella, and Proteus mirabilis
Cephalexin - FDA-Approved Indications
- Infection of skin and/or subcutaneous tissue:
Adults - 500 mg po q12h
Children - 25-50 mg/kg/d po divided q6h to q12h - Osteomyelitis:
Adults - 250 mg-1 g po q6h
Children - 25-100 mg/kg/d po divided q6h - Otitis media, respiratory tract infection, UTI:
Adults - 250 mg-1 g po q6h
Children - 25-100 mg/kg/d divided q6h - Streptococcal pharyngitis:
Adults - 500 mg po q12h x 10 days
Children - 25-50 mg/kg/d po divided q6h x 10 days - Impetigo, ecthyma: 250-500 mg po QID x 7 days
- Cellulitis (nonpurulent), erysipelas: 500 mg po QID x at least 5 days
Cephalexin - Off-Label Uses
- Bacterial endocarditis; prophylaxis for high-risk patients; dental, respiratory, or infected skin/skin structure or musculoskeletal tissue procedures:
Adults - 2 g po 30-60 min prior to procedure
Children - 50 mg/kg 30-60 min prior to procedure - Prosthetic joint infection: 500 mg po q6-8h or 1 g q8-12h
- Endocarditis, prophylaxis (dental or invasive respiratory tract procedures): 2 g po 30-60 min prior to procedure
Cefuroxime - MOA
2nd-generation cephalosporin
Cefuroxime - Activity
Better than cefazolin but less than cefotaxime against H. influenzae, including beta-lactamase-producing strains. The activity of cefuroxime against S. aureus is slightly less than that of cefazolin. Its activity against anaerobes is poor, similar to the 1st-generation cephalosporins
Cefuroxime - FDA-Approved Indications
- Acute infective exacerbation of COPD, uncomplicated skin and/or subcutaneous tissue infection, acute bacterial maxillary sinusitis, uncomplicated UTI: 250-500 mg po BID x 10 days
- Acute otitis media: (children) 250 mg po BID x 10 days
- Bronchitis, acute, secondary bacterial infection: (adults and children >12 years) 250-500 mg po BID x 5-10 days
- Gonorrhea, uncomplicated: 1 g po x 1 dose
- Pharyngitis, tonsillitis: 250 mg po BID x 10 d
- UTI (alternative agent), acute uncomplicated cystitis, acute simple cystitis: 250 mg po BID x 5-7 days
- Bite wound, prophylaxis, or treatment: 500 mg po BID in combination with an agent appropriate for anaerobes; duration of prophylaxis, 3-5 days
Cefuroxime - Off-Label Uses
Lyme disease (Borrelia spp. infection), early disseminated or late disease: 500 mg po BID x 14-21 days
Cefdinir - MOA
3rd generation cephalosporin
Cefdinir - Activity
Gram (+) and Gram (-) bacteria including beta-lactamase-producing strains
Cefdinir - FDA-Approved Indications
Children 6 months - 12 years
Acute otitis media, pharyngitis, and tonsillitis: 7 mg/kg po BID x 5-10 days or 14 mg/kg po daily for 10 days
MDD = 600 mg
Cefdinir - FDA-Approved Indications
Adults
Dosing for All: 300 mg po BID x 5-10 days
- Acute otitis media, pharyngitis, tonsillitis
- Bronchitis, acute, secondary bacterial infection
- Community-acquired pneumonia, uncomplicated skin, and/or subcutaneous tissue infection (10 days)
- COPD, acute exacerbation (or 600 mg once daily x 3-7 days)
- Streptococcal pharyngitis, group A (or 600 mg once daily x 10 days)
Cefdinir - Off-Label Uses
- Acute uncomplicated cystitis or acute simple cystitis: 300 mg po BID x 5-7 days
- UTI, including pyelonephritis: 300 mg po BID x 10-14 days
Chlorhexidine - MOA
Polybiguanide antiseptic and antimicrobial drug with bactericidal activity. Bactericidal effect of chlorhexidine is a result of the binding of this cationic molecule to negatively charged bacterial cell walls and extra-microbial complexes
Chlorhexidine - Activity
Gram (+) and Gram (-) organisms, facultative anaerobes, and yeast
It has both bacteriostatic and bactericidal effects, depending on its concentration
Chlorhexidine - FDA-Approved Indications
- Gingivitis: 15 ml oral rinse (undiluted, 0.12%), swish 30 seconds and spit BID (morning and evening) after tooth brushing
- Skin or wound cleansing: rinse area to be cleansed, apply minimum amount of solution necessary to cover skin or wound area, and wash gently; then rinse
- Periodontitis: insert 1 chip into a periodontal pocket with a probing pocket depth > 5 mm. Up to 8 chips may be inserted in a single visit
Chlorhexidine - Off-Label Uses
- Burn, prevention of nosocomial infectious disease: rinse area to be cleansed, apply minimum amount of 4% solution necessary to cover skin or wound area, and wash gently; then rinse
- Oropharyngeal decontamination, to reduce risk of ventilator-associated pneumonia in critically ill patients: 15 mL oral rinse (undiluted, 0.12%), swab oral area q8h
- Medication-related osteonecrosis of the jaw: swish rinse and expectorate after rinsing (do not swallow)
Doxycycline - Kinetics
Absorption: F = 100%
Distribution: Vd = 0.75 L/kg; 80% protein bound
Metabolism: hepatic, 50%
Elimination: renal 35%; T1/2 = 15-24 hours
Hepatic and Renal Dose Adjustment: None
Minocycline - Kinetics
Absorption: F = 90%
Distribution: Aqueous humor, CSF, gingival fluids, sinus, saliva, tears
Metabolism: hepatically metabolized, extent unknown
Elimination: renal 5-12%, fecal 20-34%; T1/2 = 16 hours
Hepatic Dose Adjustment: None
Renal Dose Adjustment: Consider dose reduction or extending dosing interval. MDD = 200 mg
Amoxicillin - Kinetics
Absorption: F = 85%
Distribution: 17-20% protein bound; lung, pleural fluid, bile, liver, and inner ear
Metabolism: partially hepatic
Elimination: renal 50-70%; T1/2 = 1-2 hours
Hepatic Dose Adjustment: None
Renal Dose Adjustment: Moderate - q8-12h; Severe - q24h and reduce dose
Amoxicillin/Clavulanate - Kinetics
Absorption: F = 85%
Distribution: 17-20% protein bound; lung, pleural fluid, bile, liver, and inner ear
Metabolism: Amoxicillin not metabolized, extensive metabolism of clavulanic acid
Elimination: renal 50-70% (amoxicillin); T1/2 = 1-2 hours
Hepatic Dose Adjustment: Consider dosage adjustment in severe impairment
Renal Dose Adjustment: 10-30 mL/min = q12h; <10 mL/min = q24h; avoid 875 mg and ER tablets for those on hemodialysis or CrCl <30 mL/min
Penicillin - Kinetics
Absorption: F = 25%; food delays but doesn’t reduce absorption
Distribution: Pericardium, pleural fluid and inner ear
Metabolism: Not metabolized
Elimination: Rena 20-40%; T1/2 = 30 minutes
Hepatic and Renal Dose Adjustment: None
Cephalexin - Kinetics
Absorption: F = 90%; food has little effect
Distribution: Widely into body tissues and fluid
Metabolism: Not metabolized
Elimination: Renal 80-100%; T1/2 = 1 hour
Hepatic Dose Adjustment: None
Renal Dose Adjustment: <50 mL/min: max 500 mg q12h
Cefuroxime - Kinetics
Absorption: F = 37%; food increased to 52%; suspension must be taken with food, tablets do not
Distribution: Aqueous humor, bronchial secretions, ear fluid, placenta, sinus
Metabolized: Rapidly hydrolyzed by plasma and GI esterases
Elimination: Renal 50%: T1/2 = 2 hours
Hepatic Dose Adjustment: None
Renal Dose Adjustment: 10-30 mL/min = full dose q24h; <10 mL/min = full dose q48, administer after dialysis
Cefdinir - Kinetics
Absorption: F = 25%; food decreases by 30%
Distribution: Lung, maxillary sinus, middle earl fluid, skin sputum
Metabolism: Not metabolized
Elimination: Renal 18%; T1/2 = 2 hours
Hepatic Dose Adjustment: None
Renal Dose Adjustment: <30 mL/min = decrease interval to daily (300 mg po once daily)
Chlorhexidine - Kinetics
Not absorbed and no adjustments needed
Doxycycline - Drug Interactions
- Typhoid vaccine, BCG, cholera vaccine = AVOID
- Sodium Picosulfate = use alternative agent
- Antacids = separate use by 1-2 hours
- Retinoic acid derivatives = contraindicated w/exceptions (adapalene, bexarotene, tretinoin)
- Digoxin = monitor and consider dose adjustments
- Penicillin = AVOID
- Calcium salts, carbamazepine = consider therapy modification
- Barbiturates = monitor
Minocycline - Drug Interactions
- Typhoid vaccine, BCG, cholera vaccine = AVOID
- Sodium picosulfate = use alternative agent
- Vitamin K antagonists (warfarin) = monitor warfarin
- Antacids = separate use by 1-2 hours (specifically aluminum, calcium, and magnesium containing acids + iron)
- Retinoic acid derivatives = contraindicated
- Digoxin = monitor and consider digoxin dose adjustments
- Penicillin = AVOID
- Ethinyl estradiol and other estrogen-based birth control products = use alternative form of birth control
Amoxicillin - Drug Interactions
- Typhoid vaccine, BCG, cholera vaccine = AVOID
- Sodium picosulfate = use alternative agent
- Vitamin K antagonists (warfarin) = increase warfarin monitoring
- Venlafaxine = AVOID
- Methotrexate = AVOID
Amoxicillin/Clavulanate - Drug Interactions
- Typhoid vaccine, BCG, cholera vaccine = AVOID
- Sodium picosulfate = use alternative agent
- Vitamin K antagonists (warfarin) = increase warfarin monitoring
- Venlafaxine = AVOID
- Methotrexate = AVOID
Penicillin - Drug Interactions
- Typhoid vaccine, BCG, cholera vaccine = AVOID
- Sodium picosulfate = use alternative agent
- Probenacid = AVOID
- Tetracyclines = AVOID
Cephalexin - Drug Interactions
- Typhoid vaccine, BCG, cholera vaccine = AVOID
- Sodium picosulfate = use alternative agent
- Multivitamins and minerals = consider therapy modification
- Cholestyramine = administer 1 hour before or 6 hours after cholestyramine
- Metformin = use with caution
Cefuroxime - Drug Interactions
- Typhoid vaccine, BCG, cholera vaccine = AVOID
- Sodium picosulfate = use alternative agent
- Vitamin K antagonists (warfarin) = monitor
- Antacids = AVOID
- Ethinyl estradiol and other estrogen-based birth control products = use alternative form of birth control
- PPIs = AVOID
Cefdinir - Drug Interactions
- Typhoid vaccine, BCG, cholera vaccine = AVOID
- Sodium picosulfate = use alternative agent
- Vitamin K antagonists (warfarin) = monitor
- Antacids, iron and vitamins = separate administration by 2 hours
- Aminoglycosides = monitor
Doxycycline in Pregancy/Lactation
Pregnancy: CONTRAINDICATED in 2nd and 3rd trimesters
Lactation: compatible
Minocycline in Pregnancy/Lactation
Pregnancy: CONTRAINDICATED in 2nd and 3rd trimesters
Lactation: Compatible
Amoxicillin in Pregnancy/Lactation
Pregnancy: risk 1st and 3rd trimesters
Lactation: compatible
Amoxicillin/Clavulanate in Pregnancy/Lactation
Pregnancy: clavulanate is compatible
Lactation: probably compatible
Contraindications with Amoxicillin/Clavulanate
ER products in patients on dialysis or severe renal dysfunction, history of cholestatic jaundice or hepatic dysfunction with amoxicillin/clavulanate therapy
Penicillin in Pregnancy/Lactation
Compatible
Cephalexin, Cefuroxime, and Cefdinir in Pregnancy/Lactation
Compatible
Chlorhexidine in Pregancy/Lactation
Pregnancy: compatible
Lactation: probably compatible
Doxycycline - Adverse Effects
- Common: esophageal injury, photosensitivity, skin hyperpigmentation, tooth discoloration in children <8 years
- Less common: N/V/D
- Rare but serious: esophageal ulceration, hypersensitivity, hepatotoxicity, renal toxicity, C. difficile colitis, increased intracranial pressure, decreased growth in children
Minocycline - Adverse Effects
- Common: dizziness and vertigo, tooth discoloration in children <8 years, headache
- Less common: N/V/D, fatigue, pruritis, urticaria
- Rare but serious: hypersensitivity, hepatotoxicity, renal toxicity, C. difficile colitis, increased intracranial pressure, decreased growth in children, tissue hyperpigmentation
Amoxicillin - Adverse Effects
- Common: D/N
- Less common: skin rash, vomiting, headahce
- Rare but serious: severe hepatotoxicity, renal failure, hepatic failure, pancytopenia
Amoxicillin/Clavulanate - Adverse Effects
- Common: N/D
- Less common: skin rash, vomiting, mycosis, candidiasis
- Rare but serious: severe hypersensitivity, renal failure, hepatic failure, pancytopenia
Penicillin - Adverse Effects
- Common: N/V/D
- Less common: skin rash
- Rare but serious: severe hypersensitivity, renal failure, hepatic failure, hemolytic anemia
Cephalexin - Adverse Effects
- Common: nausea
- Less common: vomiting
- Rare but serious: SJS, renal failure, severe hypersensitivity, anemia, neutropenia, seizure
Cefuroxime - Adverse Effects
- Common: diarrhea
- Less common: N/V, vaginitis, increased liver enzymes, diaper rash, local thrombophlebitis
- Rare but serious: SJS, hepatotoxicity, severe hypersensitivity, anemia, neutropenia, pancytopenia, seizure
Cefdinir - Adverse Effects
- Common: diarrhea
- Less common: N/V, vaginitis, headache
- Increased liver enzymes, hypersensitivity
Chlorhexidine - Adverse Effects
- Common: mouth irritation, tongue irritation, tooth aches and discolored teeth with oral rinse
- Less common: GI irritation
- Rare but serious: allergic reactions, skin irritation
Doxycycline - Drug Monitoring
Efficacy: resolution of sx of infection
Toxicity: burning or pain in the stomach, extreme headache, bloody diarrhea, tooth darkening
Minocycline - Drug Monitoring
Efficacy: resolution of s/sx of infection or decreased acne
Toxicity: Seek medication attn if extreme headache, bloody diarrhea, tooth darkening, or yellowing of the eyes/skin occurs. LFTs, BUN, SCr in patients receiving long-term treatment
Amoxicillin - Drug Monitoring
Efficacy: resolution of clinical signs of infection
Toxicity: Severe diarrhea, dark urine, yellowing of skin or eye, unusual bruising or bleeding, blistering skin rash, or shortness of breath
Amoxicillin/Clavulanate - Drug Monitoring
Efficacy: resolution of clinical signs of infection
Toxicity: Severe diarrhea, dark urine, yellowing of skin or eye, unusual bruising or bleeding, blistering skin rash, or shortness of breath
Penicillin - Drug Monitoring
Efficacy: resolution of clinical signs of infection
Toxicity: assess SCr and CBC if prolonged therapy
Cephalexin - Drug Monitoring
Efficacy: resolution of clinical signs of infection
Toxicity: Seek medical attention if decreased urination, blistering skin rash or extreme fatigue, unusual bruising or bleeding, shortness of breath
Cefuroxime - Drug Monitoring
Efficacy: resolution of infection
Toxicity: Yellowing of the eyes, blistering skin rash or extreme fatigue, unusual bruising or bleeding, shortness of breath
Cefdinir - Drug Monitoring
Efficacy: Resolution of infection, renal function, observe for signs and symptoms of anaphylaxis during first dose
Toxicity: severe diarrhea
Chlorhexidine - Drug Monitoring
Efficacy: Oral rinse: resolution of gingivitis. Topical: no signs of bacterial infection (redness, pruritus, burning, swelling)
Toxicity: tooth discoloration, skin irritation
Counseling and Pearls for ALL Antibiotics
Counseling: Complete full course of therapy
Symptoms should improve within 2-3 d; if they worsen, seek follow-up with health-care practitioner.
Pearls: may resume normal activities after 24 h of antibiotics and if afebrile
Doxycycline - Counseling and Pearls
Counseling: May take with food that does not contain calcium. May cause photosensitivity; discontinue at first sign of skin erythema. Wear sunscreen and avoid prolonged exposure to sunlight and ultraviolet light. Administer with 240 mL of water.
Pearls: Not for use in children <8 y of age (causes bone and tooth discoloration).
Minocycline - Counseling and Pearls
Counseling: May take with food that does not contain calcium (dairy). Acne should improve within 1-2 wk. Wear sunscreen. Avoid driving or using hazardous machines until side effects are known (dizziness). Warn patients (both male and female) to avoid pregnancy.
Pearls: Dosing is not interchangeable with extended-release and immediate-release products. Dizziness occurs more frequently in women than men. Less hepatotoxicity then is usually seen with doxycycline. Not for use in children <8 y of age due to bone and tooth discoloration. Injectable formulation also available.
Amoxicillin - Counseling and Pearls
Counseling: For the suspension, shake well and store in the refrigerator. Note short expiration after reconstitution. Can take with food if causes upset stomach. Avoid mixing suspension with food or beverages and use with measuring device that comes with prescription. May decrease effectiveness of oral contraceptives; encourage patients to use backup contraceptive method (eg, condom).
Pearls: There is cross-hypersensitivity between penicillin and cephalosporins; use with caution in cephalosporin allergic patients. ER tablet not approved for children <12 y of age. Combination with clavulanate preferred for acute bacterial rhinosinusitis.
Amoxicillin/Clavulanate - Counseling and Pearls
Counseling: Take dose with food to ensure proper absorption. For the suspension, shake well and store in the refrigerator. Note short expiration after reconstitution of 10 d. Avoid mixing suspension with food or beverages. May decrease effectiveness of oral contraceptives; encourage patients to use backup contraceptive method (eg, condom).
Pearls: There is cross-hypersensitivity between penicillin and cephalosporin; use with caution in cephalosporin-allergic patients. Incidence of diarrhea is higher than with amoxicillin alone.
Penicillin - Counseling and Pearls
Counseling: Take on an empty stomach. Seek care for severe diarrhea, dark urine, yellowing of skin or eyes, unusual bruising or bleeding, blistering skin rash, or shortness of breath
Pearls: ere is cross-hypersensitivity between penicillin and cephalosporins (<10%); use with caution in cephalosporin allergy if severe penicillin reaction. Use caution in those with severe renal impairment and in those with seizure disorders. First antibiotic, produced in 1943, referred to as the “magic bullet.” Aminopenicillins have replaced use of penicillin for many indications, including endocarditis and otitis media.
Cephalexin - Counseling and Pearls
Counseling: Seek medical attention if rash develops. For the suspension, shake well and store in the refrigerator. Note short expiration after reconstitution. Avoid mixing suspension with food or beverages, but food can be taken afterward.
Pearls: Approximately 10% of patients allergic to penicillins are also allergic to cephalosporins; use with caution in penicillin-allergic patients.
Cefuroxime - Counseling and Pearls
Counseling: Seek medical attention if rash develops. For the suspension, shake well and store in the refrigerator. Note 10 d expiration after reconstitution. Avoid mixing suspension with food or beverages, but food can be taken afterward.
Pearls: Approximately 10% of patients allergic to penicillins are also allergic to cephalosporins; use with caution in penicillin-allergic patients. Also available in injectable formulation. Suspension formulation discontinued by brand-name manufacturer and no generic suspension available for over 2 years.
Cefdinir - Counseling and Pearls
Counseling: For the suspension, shake well and can be stored at room temperature. Note 10 d expiration after reconstitution. Avoid mixing suspension with food or beverages, but food can be taken afterward. Separate administration of antacids, iron, and vitamins by 2 h.
Pearls: Approximately 10% of patients allergic to penicillin are also allergic to cephalosporin; use with caution in penicillin-allergic patients.
Chlorhexidine - Counseling and Clinical Pearls
Counseling: For oral rinse, measure out 1/2 fluid ounce (15 mL) as marked in the cap that comes with the bottle, swish the solution in mouth for at least 30 seconds; do not swallow. Wait several hours after use of chlorhexidine to eat or drink. Likely to cause tooth discoloration, which can be removed by dental cleaning. For topical product, use only on unbroken skin, do not swallow, or get in the eyes, ears, mouth, nose, genital area, or anal area. Contains large amounts of alcohol (70%) and is flammable. Apply the medicine in a well-ventilated place. Do not cover the treated area until the skin is completely dry after application. This is usually 3 min or longer for hairless skin. If you must apply the medicine to a hairy area of the body, wipe the area with a towel to remove extra chlorhexidine.
Pearls: Not for use in children. Several OTC products also available.
