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Antibiotics10 PDF
Antibiotics10 PDF
PENICILLINS
1 Benzyl penicillins : (penicillin G Vial 1.000.000 unit)
Adult dose 1 5 million unit / 6 hours IM or IV
Child dose 50.000 100.000 unit / kg / day IM or IV
Natural Penicillins
c -Lactamase (penicillinase) sensitive
d Narrow spectrum
Uses Of Penicillins
A) Treatment of :
1 Gram +ve Cocci 2 Gram ve Cocci 3 Gram +ve Bacilli
Pharyngitis , Abscess & Lobar Meningitis(Benzyl penicillin) Anthrax , Diptheria Tetanus & Gas
pneumonia & Gonorrhea gangrene
4 Gram ve Bacilli Use Broad spectrum Penicillins e .g Ampicillin & Amoxicillin :
a Urinary tract infection b Typhoid fever
c H-influenza : Broad spectrum penicillin + -Lactamase inhibitor.
d Helicobacter pylori Amoxicillin 500 mg tds for 2 weeks
B) Prophylaxis of :
Streptococcal infection in rheumatic fever : Benzathine penicillin 1.2 million unit IM/Month for 5 years
or up to age of 20 which is ever longer.
6 Ampicillin induces skin rash in 10 % of patients & in All patients with infective mononucleosis ,
leukemia & taking allopurinol
7 Carboxy-penicillins e.g Carbenicilin Platelet dysfunction bleeding .
CEPHALOSPORINS
First Generation Second generation Third generation Forth Generation
Cefixime (Ximacef)
Cephalexin (Ceporex) Cefaclor (Bacticlor) Cefpodoxime (Cepodem)
Cefadroxil (Duricef) Cefuroxime (Zinnat) Ceftriaxone (cefaxone) Cefepime (Maxipime)
Cephradine (Velosef) Cefprozil (Cefzil) Cefoperazone (Cefobid)
Cefotaxime (Cefotax)
Uses of Cephalosporins
1 Infections resistant to penicillins
2 Pseudomonal infections : Cefoperazone & Ceftazidime
3 Gram ve Meningitis : Cefotaxime & Ceftriaxone
4 Respiratory tract infection
5 Typhoid fever Ceftriaxone & Cefoperazone
6 - Urinary tract infection specially Gram ve
7 Gonorrhea Ceftriaxone
8 pre- & post-operative First or second generation Cephalosporins
Side effects of Cephalosporins
1 Allergy & partial Cross-allergy with penicillins (10%)
2 GIT upsets and super infections.
3 Irritant : - I.M. painful , so add lidocaine. - I.V. Thrombophlebitis
4 Nephrotoxicity.
It is augmented by concurrent use of Frusemide and Gentamicin.
5 Ceftriaxone + calcium Insoluble salts in Bile Biliary Sludge
6 Cefoperazone Hypoprothrombinemia
( can be prevented by vit k 10 mg twice weekly )
MONOBACTAM
Aztreonam (Azactam) 1-2g / 6-8 hours IV
1 -Lactamase resistant.
2 Not effective against Gram +ve or anaerobes.
3 100 % bioavailability after IM. Depend on renal excretion.
4 USES Gram ve infections specially is patients allergic to penicillins.
There is no cross allergy with penicillins.
CARBAPENEMS
1 - Imipenem (Tienem) 2 - Meropenem (Meronam)
Very wide spectrum, Gram +ve & Gram ve and aerobes, & anaerobes
1/2 1 g / 6 hours 1/2 1 g tds I.M or I.V
Polymixin B :
Used only locally :
A Topically (usually + Neomycin) as eye drops or skin preparations.
B Orally (Not absorpes) to sterilize the gut.
Bacitracin:
Used topically in staph aureus infections.
Macrolides
Erythromycin Azithromycin Clarithromycin Spiramycin
(Erythrocin) (Zithromax) (Klacid) (Rovamycin)
Erythromycin absorbed orally, but acid sensitive. Used as enteric coated or as an esteolate ester.
Distribution all over the body but not CSF & concentrated in prostatic fluid
Hepatic metabolism Excreted in bile
Azithromycin & Clarithromycin Similar to Erythromycin but longer duration of action and
Less side effects.
Uses of Macrolides
1 Drug of choise in chlamydial infection : Respiratory, Genital & Ocular specially in neonates & pregnancy
2 Sexually transimitted diseases : Gonorrhea, Syphilis & Chlamidia
3 Penicillin substitute in Staph, Strept & pneumococcal in patients allergic to penicillin.
4 In rheumatic patients taking penicillin as prophylaxis prior to dental procedures to avoid bacterial
endocarditis
5 Topically in Acne vulgaris
6 Clarithromycin is used to eradicate Helicobacter pylori infection in peptic ulcer
Ketolides
Telithromycin (Ketek) 800 mg/day for 5 10 days orally
Semisynthetic derivative of Erythromycin.
Similar mechanism and spectrum to Erythromycin
Used mainly in respiratory tract infections
Lincosamines
Lincomycin (Lincocin) Clindamycin (Dalacin-c) : 300 mg/6 hours orally
Uses : 1 Bone and Teeth infections
2 Intra-abdominal anaerobic infections (Add aminoglycoside)
3 Locally in acne vulgaris
Side Effects : 1 Fatal pseudomembranous colitis treated by Vancomycin or Metronidazole
2 GIT disturbances and impaired liver function
Fusidic Acid
Uses : 1 Orally & IV in severe Staphylococcal infection including osteomyelitis
2 Ointment and gel for Staphylococcal infection
Side Effects : Mild GIT upsets
Aminoglycosides
Drug Uses
1 Serious Gram ve Infection, and Staphylococcal & Enterococcal infections
2 Severe infection : Pneumonia , Ut , Osteomyelitis & Septicemia
Gentamicin 3 Pseudomonal infections. Add Carbenicillin or Ticariciilin
(Garamycin) 4 Bacterial endocarditis. Add Benzyl Penicillin
5 Methicillin-resitstant Staph.aureus (MRSA)
6 Topically (Cream, Ointment or solution) in burns , wounds & Skin lesions.
Tobramycin
Similar to Gentamycin but more effective against p.aeruginosa
(Nebcin)
Amikacin Useful in Gentamicin-resistant infections.
(Amikin)
1 Used for Local use only
2 Orally as intestinal antiseptic before intestinal operations acute intestinal
infections & Hepatic coma (Add lactulose).
Neomycin
3 Orally in Hyperlipidemia Absorption of cholesterol
4 Topically on skin & Mucous membranes.
5 Inhalation in chest infections.
2 Nephrotoxicity:
a - Usually reversible
b - Increases in patients with poor kidney function
5 Drug Interactions:
a - Polymixins , Cephalosporins & Frusemide increase their Nephrotoxicity
b - Loop diuretics , Chloroquine & Aspirin increase their Ototoxicity
c - Aminoglycosides + Penicillins Synergism.But Never mixed in same container
d - Chloramphenicol Bacterial Uptake of Aminoglycosides
Quinolones
Ciprofloxacin Gatifloxacin Norfloxacin Levofloxacin
Lomefloxacin Moxifloxacin Gemifloxacin Moxifloxacin
Ofloxacin Nalidixic acid
Uses Of Quinolones
Urinary Tract Infection , Prostatitis , GIT infections ,Typhoid fever & Respiratory Tract Infection
Co-Trimoxazole
Sulphamethoxazole + Trimethoprim (Sutrim)
Uses Of Co-Trimoxazole
1 Respiratory tract infection
2 Urinary tract infection and Prostatitis
3 Gonococcal infection (Urethral & Oropharyngeal)
4 Shigella & Salmonella enteritis
5 Systemic salmonella (Typhoid fever )
5 Prevention & Treatment of Toxoplasmosis
2 Blood dyscrasis:
a - Hemolysis in patients with G6PD deficiency.
b - Bone marrow inhibition.
3 Crystaluria: Avoided by , Fluid intake & alkanization of urine.
4 Diarrhea GIT disturb ances & Superinfection.
5 Hepatotoxicity & Nephrotoxicity
6 Drug interactions:
a - Displace Warfarin & Tolbutamide initial increase in their activity
b - Methenamine (Urinary antiseptic) Releases Formaldhyde Inactivate sulfa
7 Megaloblastic anemia
8Displace bilirubin avoid during pregnancy &Lactation
Amphenicols
Chloramphenicol (Cidocetine) Thaimphenicol (Thiophenicol)
Uses Of Chloramphenicol
1 Typhoid fever & Paratyphoid fever : Start by 750 mg / 6 hours till fever subsides then
250-500 mg / 6 hours for at least 10 14 days
2 Topically in eye and ear infections
3 Vancomycin-resistant enterococci
4 Bacterial meningitis
5 Other bacterial infections : ENT , Respiratory, Urinary & GIT
Tetracyclines
Low to moderate lipid solubility High lipid solubility
Tetracycline (Tetracid) Doxycycline (Vibramycin)
Oxytetracycline ( Oxytetracid)
Uses Of Tetracyclines
1 Enteritis
2 Bacillary infections : Brucelosis & Tularemia
3 Urinary tract infections
4 Sexually Transmitted diseases Syphilis and Gonorrhea
5 Skin infections : Acne vulgaris
6 Eye infections : Topical tetracycline
7 Intestinal Amebiasis
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ORAL DRUGS
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Amoxicillin+ 25 50 mg/kg/day of the 4 parts amoxicillin , 1 part clavulanic acid preparations (which
corresponds to a daily dosage of the equivalent of 20-40 mg/kg of amoxycillin and 5-10
clavulanic acid mg/kg of clavulanic acid) to be taken in divided doses every 8 hours at the start of a meal
Sulphamethoxazole+
0.5 1 ml / kg /day in divided doses every 12 hours
Trimethoprim
Parenteral
Amoxicillin 50 100 mg/kg/day in divided doses every 8 hours
Cefipime Experience with the use of MAXIPIME in paediatric patients <2 months of age is
limited. While this experience has been attained using the 50 mg/kg dose, modelling of
pharmacokinetic data obtained in patients >2 months of age suggests that a dosage of
30 mg/kg q12h or q8h may be considered for patients aged 1 month up to 2 months.
Gentamicin 3 5 mg/kg/day in divided doses every 8 hours
15 mg/kg/day divided into 2 or 3 equal doses. Treatment should preferably not continue
Amikacin for longer than 7 to 10 days, and the total dosage in adults should not exceed 15g .