Oral antibiotics

- Dr. B. Akash(CRRI)
Antibiotics
• Substances produced by micro organisms
• Selectively kills or suppresses growth of other micro organisms at very
low concentration
• Two types(by effect) – Bactericidal and bacteriostatic
Oral route
Advantages Disadvantages

Simple and convenient Noncompliance

Drug reactions – less severe Titration to clinical endpoint impossible

Less objectionable than parenteral Erratic absorption

Minimal training required Cant be used in extremely apprehensive patients

Readily available by prescription Doses are emperical

Factors affecting the choice
• Age – Tetracyclines CID in children less than 6; Aminoglycosides – half
life prolonged
• Pregnancy – All antibiotics pose a risk
• Impaired host defences
• Renal function – Nitrofurantoin, tetracyclines CID in KD
• Liver function – PZD, Tetracyclines, erythromycin CID in LD
• Genetic factors – Eg. G6PD deficiency patients – hemolysis
Classification - MOA
• Penicillin G – Only naturally occurring penicillin. Given parenterally
• Amoxycillin, dicloxacillin are given orally
• B lactamase inhibtors – Clavulanic acid, tazobactam, sulbactam
• Cephalosporins – 5 generations. 4th and 5th are only parenteral
• 1st gen oral drugs – Cephalexin, Cefadroxil
• 2nd gen – Cefaclor, Cefuroxime axetil
• 3rd gen – Cefixime, Ceftibuten
• 1st used for staph and strep
• 2nd for gram –ve
• 3rd is extended coverage
• Drugs inhibiting protein synthesis – Broad spectrum –
Chloramphenicol and tetracyclines
• Moderate spectrum – macrolides and ketolides
• Narrow spectrum – Lincosamides
• Tetracyclines :
• Absorption impaired by food
• Cross the placenta
• Undergo enterohepatic circulation
• Most tetracyclines excreted in urine except doxycycline
• Bacteriostatic
• Adverse effects – GI distress, discolouration of teeth &inhibition of
bone growth, CID in pregnancy
• Uses : PNEMONIC – RBC IN PLASMA
• R – Rickettsia, relapsing fever
• B – Brucellosis
• C – Cholera, Chlamydia
• IN- Inguinale
• P- Plague, peptic ulcer
• L – LGC, Leprosy
• A – Atypical pneumonia
• S – SIADH
• M- Malaria
• A - Amebiasis
• Macrolides – absorbed well orally
• Uses: PNEMONIC – CLAW
• C – Corynebacterium, C.bacter
• L- Legionella
• A- Atypical pneumonia
• W- Whooping cough
• Adverse Effects – PNEMONIC – MACRO
• M – Motility issues in GI
• A – Arrythmia due to prolonged QT interval
• C- Cholestatic hepatitis
• R – Rash
• O - eOsiniphilia
• Sulfonamides – Sulfamethoxazole, sulfadiazine
• Bacteriostatic
• Used for Gm +,-ve and TMP-SMX for UTI
• Adverse effects – PNEMONIC – ABC of RASH
• A – Aplastic anemia
• B – Bilirubin displacement
• C – Crystalluria
• R- Rash
• A – Acetylation
• S – SLE
• H – Hemolysis in G6PD deficiency
• Cotrimoxazole:
• Fixed dose of sulfamethoxazole and trimethoprim in the dose of 5:1
• Indications – PNEMONIC - SEPTRAN
• S – STD
• E- Enteritis
• P – PCP
• T – Typhoid
• R – RTI
• A- Acute uncomplicated UTI
• N – Nocardia
• Fluoroquinolones – Ciprofloxacin, levofloxacin, moxifloxacin
• Used for Gram –ve rods of UTI and GI, also otitis externa
• Adverse effects – GI distress, superinfections, skin rashes, headache
Metronidazole
Choice of antibiotic for OP patients
•Thank you!