Medicines Knowledge Week 3 (Amoxicillin/Clavulanate, Doxycycline, Ciprofloxacin, Norfloxacin, Metronidazole)

Question 1

Amoxicillin/clavulunate drug class

Answer 1

Amoxicillin is a penicillin

Clavulanic acid is a beta-lactamase inhibitor

Question 2

Amoxicillin/clavulunate indication

Answer 2

Pneumonia

Epididymo-orchitis (urinary tract source)

PID –> pelvic inflammatory disease (not sexually acquired)

UTI –> urinary tract infection

Sinusitis

Bites and clenched fist injuries

Acute otitis media (unresponsive to amoxicillin)

Acute sinusitis (unresponsive to amoxicillin)

Question 3

Amoxicillin with clavulanate dosage range and timing (2 marks)

Answer 3

Comes in strengths of amoxicillin 500mg and clavulanic acid 125mg, amoxicllin 875mg and 125mg clavulanic acid.

• Oral, 500–875 mg every 12 hours for 5–10 days or longer, depending on the infection.

> doses are bases on amoxicillin component

Question 4

Amoxicillin with clavulanate counselling (3 marks)

Answer 4

This medicine is absorbed best if taken with food.

Amoxycillin and clavulanic acid works by killing the bacteria that cause these infections. It will not work against infections such as colds or the flu, which are caused by viruses

Swallow the tablet whole with a full glass of water.

Take with probiotics

The tablets may be broken in half but should not be chewed.

Question 5

Amoxicillin/clavulanate monitoring (2 marks)

Answer 5

Monitor hepatic function if treatment lasts for >14 days, especially if there are other risk factors.

Monitor complete blood count, renal and hepatic function during prolonged high-dose treatment (>10 days)

Monitor for rare side effects such as black tongue, rash and bleeding

Monitor to see if infection has resolved

Question 6

Doxycycline drug class

Answer 6

Tetracycline

Question 7

Doxycycline indication

Answer 7

Acne

Rosacea

Pelvic inflammtory disease (PID)

Community-acquired pneumonia

Acute bacterial sinusitis

Chronic prostatitis

Malaria prophylaxis

Question 8

Doxycyline dosage range and timing

Answer 8

Adult

• Oral, 200 mg on day 1 (as a single dose or 100 mg twice daily), then 100 mg once daily

> comes in 50 and 100mg

Prophylaxis of malaria

Start 2 days before entering and continue taking doxycycline until 4 weeks after leaving an endemic area.

Adult, oral 100 mg once daily.

Child >8 years

• Oral, initially 2 mg/kg twice daily on day 1 (maximum 200 mg daily); then 2 mg/kg once daily (maximum 100 mg daily). Round the dose to the nearest 25 mg

Take a single daily dose in the morning rather than at night.

Question 9

Doxycycline counselling

Answer 9

Take with a large glass of water, and remain upright (do not lie down) for an hour after 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 with food or milk to reduce stomach upset.

Do not take antacids, iron, calcium or zinc supplements within 2 hours of a tetracycline as they may interfere with its absorption.

Avoid sun exposure, wear protective clothing and use sunscreen while taking this medicine.

Question 10

Doxycycline monitoring

Answer 10

Monitor for adverse effects such as rash and tooth discolouration (occurs in children taking it long term for more than 21 days).

If you are taking doxycycline for an infection and your symptoms do not improve within a few days or they become worse, tell your doctor.

Monitor for side effects after you have stopped taking the doxycycline, this includes severe stomach cramps, watery diarrhoea and fever. Doxycycline can cause some bacteria that are normally harmless and present in the bowel to multiply and cause the above symptoms.

Question 11

Ciprofloxacin drug class

Answer 11

Quinolone

Question 12

Ciprofloxacin indication

Answer 12

Prostatitis

Bone or joint infections

Complicated UTIs

Shigellosis

> keratitis or severe bacterial conjunctivitis

> chornic suppurative otitis media

Question 13

Ciprofloxacin dosage range and timing

Answer 13

Adult

• Oral 250-500mg twice daily

> maximum of 1.5g daily

Child

• >1 month = oral 10-15mg/kg (maximum 500mg twice daily).

Question 14

Ciprofloxacin counselling

Answer 14

• Best absorbed if take it 1 hour before or 2 hours after meals. Drink plenty of fluids while taking it.
• Dairy products, iron, zinc or calcium supplements and aluminium or magensium containing antacids may reduce the absorption of ciprofloxacin –> do not take them within 2 hours of a ciprofloxacin dose.
• It may increase the effects of caffeine in some peiple, you may need to reduce your caffeine intake
• Avoid sun exposure, wear protective clothing and use sunscreen

Question 15

Ciprofloxacin monitoring

Answer 15

Monitor for signs of tendon soreness and inflammation, stop taking this medication and tell your doctor if this happens.

Monitor for side effects after you have stopped taking the ciprofloxacin. This includes severe stomach cramps, watery diarrhoea and fever. This medication can cause some bacteria that are normally harmless and present in the bowel to multiply and cause the above symptoms.

Question 16

Norfloxacin drug class

Answer 16

Quinolone

Question 17

Norfloxacin indications

Answer 17

• Uncomplicated UTIs caused by organisms resistant to other antibacterials
• Shigellosis
• Traveller’s diarrhoea
• Prostatitis (acute and chronic)

Question 18

Norfloxacin dosage range and timing

Answer 18

UTIs resistant to other antibacterials

• Uncomplicaterd: oral 400mg every 12 hours for 3 days
• Relapsed 400mg every 12 hours for 10-14 days

Travellers diarrhoea

• Moderate to severe: 800mg as a signle dose; or 400mg every 12 hours for 3 days.

Child

• >6 months = oral 7.5-10mg/kg (maximum 400mg) every 12 hours

Maximum dose: 800mg daily

Question 19

Norfloxacin counselling

Answer 19

Best absorbed if take it 1 hour before or 2 hours after meals. Drink plenty of fluids while taking it.

> if you are taking norflloxacin to treat shigellosis or traveller’s diarrhoea, you can take it with or without food.

Dairy products, antacids, iron, zinc or calcium supplements may rduce the absorption of this medication –> do not take them within 2 hours of a norfloxacin dose.

It may increase the effects of caffeine in some peiple, you may need to reduce your caffeine intake

Avoid sun exposure, wear protective clothing and use sunscreen

Question 20

Norfloxacin monitoring

Answer 20

Monitor for signs of tendon soreness and inflammation, stop taking this medication and tell your doctor if this happens.

Monitor for side effects after you have stopped taking the ciprofloxacin. This includes severe stomach cramps, watery diarrhoea and fever. This medication can cause some bacteria that are normally harmless and present in the bowel to multiply and cause the above symptoms.

Question 21

Metronidazole drug class

Answer 21

Antibacterial

Question 22

Metronidazole indications

Answer 22

Bacterial vaginosis

Pelvic inflammatory disease

Dental infections including acute gingivits

Surgical prophylaxis

Anaerobic bacterial infections e.g B.fragilis

Protozoal infections e.g. giardasis, trichomoniasis

Question 23

Metronidazole dosage range and timing

Answer 23

Adult

• 200-400mg every 8-12 hours, upto 4g daily.

> rectal 1g every 8-12 hours

bacterial vaginosis

• 400mg twice daily for 7 days

Child >1month

• Oral 7.5mg/kg (maximum 400mg) every 8 hours or 10mg/kg (maximum 400mg) every 12 hours.

Question 24

Metronidazole counselling

Answer 24

Take with food to reduce stomach upset.

This medicine may make you feel dizzy or confused; avoid driving if you are affected like this.

Avoid alcohol during treatment and for 24 hours after finishing the course to prevent nausea, vomiting, flushing, headache and palpitation.

Question 25

Metronidazole monitoring

Answer 25

Monitor blood count and for neurotoxic reactions when treating for >10 days

Monitor for adverse effects such as numbness, tingling, pain or weakness in hands or feet. If these side effects occur, stop taking the medication and tell your doctor ASAP.