Antibacterial drugs

Antibacterial drugs

Before selecting an antibacterial the clinician must first consider two factors—the patient and the known or likely causative organism. Factors related to the patient which must be considered include history of allergy, renal and hepatic function, susceptibility to infection, ability to tolerate drugs by mouth, severity of illness, ethnic origin, age, whether taking other medication and, if female, whether pregnant, breast-feeding or taking an oral contraceptive. The known or likely organism and its antibacterial sensitivity, in association with the above factors, will suggest one or more antibacterial, the final choice depending on the microbiological, pharmacological, and toxicological properties.

Penicillins

The penicillins are bactericidal and act by interfering with bacterial cell wall synthesis. They diffuse well into body tissues and fluids, but penetration into the cerebrospinal fluid is poor except when the meninges are inflamed. They are excreted in the urine in therapeutic concentrations. The most important side-effect of the penicillins is hypersensitivity which causes rashes and anaphylaxis and can be fatal. A rare but serious toxic effect of the penicillins is encephalopathy due to cerebral irritation. This may result from excessively high doses or in patients with severe renal failure. The penicillins should not be given by intrathecal injection because they can cause encephalopathy which may be fatal.

Benzylpenicillin and phenoxymethylpenicillin

 

BENZYLPENICILLIN (Penicillin G):

Indications: throat infections, otitis media, endocarditis, meningococcal disease, pneumonia, cellulites, anthrax; prophylaxis in limb amputation.

Contraindications:  Infectious Mononucleosis, Pseudomembranous
Enterocolitis, Renal Disease, penicillin hypersensitivity.

Dose and Administration: by slow intravenous injection or by infusion, 2.4– 4.8 g daily in 4 divided doses, increased if necessary in more serious infections, preterm neonate and neonate under 1 week, 50 mg/kg daily in 2 divided doses; neonate 1–4 weeks, 75 mg/kg daily in 3 divided doses; child 1 month–12 years, 100 mg/kg daily in 4 divided doses. Endocarditis (in combination with another antibacterial if necessary), by infusion, 7.2 g daily in 6 divided doses, increased if necessary (e.g. in enterococcal endocarditis or if benzylpenicillin used alone) to 14.4 g daily in 6 divided doses. Intrapartum prophylaxis against group B streptococcal infection, by infusion, initially 3 g then 1.5 g every 4 hours until delivery. Meningitis, meningococcal disease, by infusion, 2.4 g every 4 hours; preterm neonate and neonate, 225 mg/kg daily in 3 divided doses; child 1 month–12 years, 180–300 mg/kg daily in 4–6 divided doses.

 

PHENOXYMETHYLPENICILLIN (Penicillin V):

Indications: oral infections; tonsillitis, otitis media, erysipelas, cellulitis; group A streptococcal infection, rheumatic fever and pneumococcal infection prophylaxis.

Contraindications:       Infectious         Mononucleosis, Pseudomembranous
Enterocolitis, And Renal Disease

Dose and Administration: 500 mg every 6 hours increased up to 1 g every 6 hours in severe infections; child up to 1 year 62.5 mg every 6 hours, increased up to 12.5 mg/kg every 6 hours in severe infections; 1–6 years, 125 mg every 6 hours, increased up to 12.5 mg/kg every 6 hours in severe infections; 6–12 years, 250 mg every 6 hours, increased up to 12.5 mg/kg every 6 hours in severe infections.

 

BENZATHINE BENZYLPENICILLIN:

Indications: Rheumatic Fever Prevention, Secondary Syphilis, Streptococcal Tonsillitis, and Symptomatic Congenital Syphilis, Syphilis.

Contraindications:       Infectious         Mononucleosis,       Pseudomembranous
Enterocolitis, And Renal Disease.

Dose and Administration: Prevention of recurrent rheumatic fever, chorea and erysipelas, children under 12 years 25mg (1.2 M.I.U.) at intervals of 4 weeks. Adults 1 to 2 doses of 25mg at intervals of 4 weeks.

 

Penicillinase-resistant penicillins

Most staphylococci are now resistant to benzylpenicillin because they produce penicillinases. Flucloxacillin, however, is not inactivated by these enzymes and is thus effective in infections caused by penicillin-resistant staphylococci, which is the sole indication for its use.

 

FLUCLOXACILLIN:

Indications: infections due to beta-lactamase-producing staphylococci including otitis externa; adjunct in pneumonia, impetigo, cellulitis, and osteomyelitis and in staphylococcal endocarditis.

Contraindications:       Infectious         Mononucleosis,       Pseudomembranous
Enterocolitis, And Renal Disease.

Dose and Administration: by intravenous infusion, 0.25–2 g every 6 hours; child under 2 years quarter adult dose; 2–10 years half adult dose. Endocarditis (in combination with another antibacterial), body-weight under 85 kg, 8 g daily in

4 divided doses; body-weight over 85 kg, 12 g daily in 6 divided doses. Osteomyelitis, up to 8 g daily in 3–4 divided doses. Surgical prophylaxis, by intravenous infusion, 1–2 g at induction.

 

Broad-spectrum penicillins 

 

AMOXICILLIN:

Indications: urinary-tract infections, otitis media, sinusitis, oral infections, bronchitis, uncomplicated community-acquired pneumonia, Haemophilus influenzae infections, invasive salmonellosis; listerial meningitis.

Contraindications: Cholestasis, Disease of Liver, Infectious Mononucleosis, And Pseudomembranous Enterocolitis.

Dose and Administration: By mouth, 250 mg every 8 hours, doubled in severe infections; child up to 10 years, 125 mg every 8 hours, doubled in severe infections. Otitis media, 1 g every 8 hours; child 40 mg/kg daily in 3 divided doses (max. 3 g daily). Pneumonia, 0.5–1 g every 8 hours. By intravenous injection or infusion, 500 mg every 8 hours increased to 1 g every 6 hours in severe infections; child, 50–100 mg/kg daily in divided doses.

 

AMPICILLIN:

Indications: urinary-tract infections, otitis media, sinusitis, oral infections, bronchitis, uncomplicated community-acquired pneumonia, Haemophilus influenzae infections, invasive salmonellosis; listerial meningitis.

Contraindications: Cholestasis, Disease of Liver, Infectious Mononucleosis, And Pseudomembranous Enterocolitis.

Dose and Administration: By intravenous injection or infusion, 500 mg every 4–6 hours; child under 10 years, half adult dose. Endocarditis (in combination with another antibiotic if necessary), by intravenous infusion, 2 g every 6 hours, increased to 2 g every 4 hours. Listerial meningitis (in combination with another antibiotic), by intravenous infusion, 2 g every 4 hours for 10–14 days; neonate 50 mg/kg every 6 hours; infant 1–3 months, 50–100 mg/kg every 6 hours; child 3 months–12 years, 100 mg/kg every 6 hours (max. 12 g daily).

 

CO-AMOXICLAV:

Indications: infections due to beta-lactamase-producing strains (where amoxicillin alone not appropriate) including respiratory-tract infections, genito­urinary and abdominal infections, cellulitis, animal bites, and severe dental infection with spreading cellulitis.

Contraindications: penicillin hypersensitivity, history of co-amoxiclav­associated or penicillin-associated jaundice or hepatic dysfunction.

Dose and Administration: By mouth, expressed as amoxicillin, 250 mg every 8 hours, dose doubled in severe infections. Severe dental infections, expressed as amoxicillin, 250 mg every 8 hours for 5 days. By intravenous injection over 3–4 minutes or by intravenous infusion, expressed as amoxicillin, 1 g every 8 hours increased to 1 g every 6 hours in more serious infections; infants up to 3 months 25 mg/kg every 8 hours (every 12 hours in the perinatal period and in premature infants); child 3 months–12 years, 25 mg/kg every 8 hours increased to 25 mg/kg every 6 hours in more serious infections. Surgical prophylaxis, expressed as amoxicillin, 1 g at induction; for high risk procedures (e.g. colorectal surgery) up to 2–3 further doses of 1 g may be given every 8 hours.

 

Antipseudomonal penicillins

contains the ureidopenicillin piperacillin with the beta-lactamase inhibitor tazobactam. Piperacillin active against Ps. aeruginosa. The spectrum of activity is comparable to that of the carbapenems, imipenem and meropenem.

 

PIPERACILLIN-TAZOBACTAM:

Indications: Appendicitis, Bacterial Pneumonia, Bacteroides Appendicitis, Bacteroides Complicated Appendicitis, Bacteroides Peritonitis, Complicated Skin and Skin Structure Infection, Complicated Skin and Skin Structure Staphylococcus Aureus Infection, Diabetic Foot Infection, E. Coli Appendicitis, E. Coli Complicated Appendicitis, E. Coli Endometritis, E. Coli Pelvic Inflammatory Disease, E. Coli Peritonitis, Haemophilus Influenzae Pneumonia.

Contraindications:         Infectious       Mononucleosis,      Pseudomembranous
Enterocolitis, Renal Disease, And Severe Neutropenic Disorder.

Dose and Administration: Lower respiratory-tract, urinary-tract, intra­abdominal and skin infections, and septicaemia, adult and child over 12 years, by intravenous injection over 3–5 minutes or by intravenous infusion, 2.25–4.5 g every 6–8 hours, usually 4.5 g every 8 hours. Complicated appendicitis, by intravenous injection over 3–5 minutes or by intravenous infusion, child 2–12 years, 112.5 mg/kg every 8 hours (max. 4.5 g every 8 hours) for 5–14 days; child under 2 years, not recommended. Infections in neutropenic patients (in combination with an aminoglycoside), by intravenous injection over 3–5 minutes or by intravenous infusion, adult and child over 50 kg, 4.5 g every 6 hours; child less than 50 kg, 90 mg/kg every 6 hours

Cephalosporins and other beta-lactams  5.1.2.1. Cephalosporins

The cephalosporins are broad-spectrum antibiotics which are used for the treatment of septicaemia, pneumonia, meningitis, biliary-tract infections, peritonitis, and urinary-tract infections. The pharmacology of the cephalosporins is similar to that of the penicillins, excretion being principally renal. Cephalosporins penetrate the cerebrospinal fluid poorly unless the meninges are inflamed. Antibiotic-associated colitis may occur with the use of broad-spectrum cephalosporins.

 

CEFACLOR:

Indications: Acute Otitis Media Infection, Haemophilus Influenzae Pneumonia, Lower Respiratory Infections, Pharyngitis, Pneumonia, Skin and Skin Structure Infection, Streptococcal Pneumonia, Tonsillitis, Upper Respiratory Infection, Urinary Tract Infections.

Contraindications: Pseudomembranous Enterocolitis.

Dose and Administration: 250 mg every 8 hours, doubled for severe infections; max. 4 g daily; child over 1 month, 20 mg/kg daily in 3 divided doses, doubled for severe infections, max. 1 g daily; or 1 month–1 year, 62.5 mg every 8 hours; 1–5 years, 125 mg; over 5 years, 250 mg; doses doubled for severe infections.

 

CEFADROXIL:

Indications: E. Coli Urinary Tract Infection, Klebsiella Urinary Tract Infection, Pharyngitis due to Streptococcus Pyogenes, Proteus Urinary Tract Infection, Skin and Skin Structure Infection, Skin and Skin Structure Streptoccous Pyogenes Infection, Staphylococcus Aureus Skin and Skin Structure Infection, Streptococcal Tonsillitis, Tonsillitis, Urinary Tract Infections.

Contraindications: Pseudomembranous Enterocolitis.

Dose and Administration: Patients over 40 kg, 0.5–1 g twice daily; skin, soft tissue, and simple urinary-tract infections, 1 g daily; child under 1 year, 25 mg/kg daily in divided doses; 1–6 years, 250 mg twice daily; over 6 years, 500 mg twice daily.

 

CEFALEXIN (Cephalexin):

Indications: Acute Otitis Media Infection, Bacterial Urinary Tract Infection, Bone Infections, E. Coli Prostatitis, E. Coli Urinary Tract Infection, Haemophilus Influenzae Acute Otitis Media, Infectious Disorder of Joint, Klebsiella Prostatitis, Klebsiella Urinary Tract Infection, Moraxella Catarrhalis Acute Otitis Media, Pharyngitis due to Streptococcus Pyogenes, Proteus Prostatitis, Proteus Urinary Tract Infection, Skin and Skin Structure Infection, Skin and Skin Structure

Streptoccous Pyogenes Infection, Staphylococcus Acute Otitis Media, Staphylococcus Aureus Osteomyelitis, Staphylococcus Aureus Skin and Skin Structure Infection, Streptococcal Pneumonia, Streptococcal Tonsillitis, Streptococcus Acute Otitis Media, Streptococcus Osteomyelitis.

Contraindications: Pseudomembranous Enterocolitis.

Dose and Administration: 250 mg every 6 hours or 500 mg every 8–12 hours increased to 1–1.5 g every 6–8 hours for severe infections; child 25 mg/kg daily in divided doses, doubled for severe infections, max. 100 mg/kg daily; or under 1 year 125 mg every 12 hours, 1–5 years 125 mg every 8 hours, 5–12 years 250 mg every 8 hours. Prophylaxis of recurrent urinary-tract infection, adult 125 mg at night.

 

CEFUROXIME:

Indications: surgical prophylaxis; more active against Haemophilus influenzae and Neisseria gonorrhoeae; Lyme disease, Acute Bacterial Maxillary Sinusitis, Acute Gonococcal Cervicitis, Acute Gonococcal Endometritis, Acute Gonococcal Urethritis, Acute Lower Genitourinary Gonorrhea, Acute Maxillary Haemophilus Influenzae Sinusitis, Acute Maxillary Streptococcus Pneumoniae Sinusitis, Acute Otitis Media Infection, Bacterial Pneumonia, Bacterial Urinary Tract Infection, Chronic Bronchitis with Bacterial Exacerbation, E. Coli Urinary Tract Infection, Haemophilus Influenzae Acute Otitis Media, Haemophilus Influenzae Bronchitis, Haemophilus Influenzae Chronic Bronchitis, Haemophilus Influenzae Pneumonia, Haemophilus Parainfluenzae Bronchitis, Haemophilus Parainfluenzae Chronic Bronchitis, Impetigo, Klebsiella Urinary Tract Infection, Lower Respiratory Infections, Lyme Disease, Moraxella Catarrhalis Acute Otitis Media, Pharyngitis due to Streptococcus Pyogenes, Rectal Gonorrhea, Skin and Skin Structure Infection, Skin and Skin Structure Streptoccous Pyogenes Infection, Staphylococcus Aureus Skin and Skin Structure Infection, Streptococcal Pneumonia, Streptococcal Tonsillitis, Streptococcus Acute Otitis Media, Streptococcus Pneumoniae Bronchitis, Streptococcus Pneumoniae Chronic Bronchitis.

Contraindications: Pseudomembranous Enterocolitis.

Dose and Administration: By mouth (as cefuroxime axetil), 250 mg twice daily in most infections including mild to moderate lower respiratory-tract infections (e.g. bronchitis); doubled for more severe lower respiratory-tract infections or if pneumonia suspected. Urinary-tract infection, 125 mg twice daily, doubled in pyelonephritis. Gonorrhoea, 1 g as a single dose. Child over 3 months, 125 mg twice daily, if necessary doubled in child over 2 years with otitis media. Lyme disease, adult and child over 12 years, 500 mg twice daily for 20 days. By intravenous injection or infusion, 750 mg every 6–8 hours; 1.5 g every 6–8 hours in severe infections; single doses over 750 mg intravenous route only. child usual dose 60 mg/kg daily (range 30–100 mg/kg daily) in 3–4 divided doses (2–3divided doses in neonates). Surgical prophylaxis, 1.5 g by intravenous injection at induction; up to 3 further doses of 750 mg may be given by intramuscular or intravenous injection every 8 hours for high-risk procedures. Meningitis, 3 g intravenously every 8 hours; child, 200–240 mg/kg daily (in 3–4 divided doses) reduced to 100 mg/kg daily after 3 days or on clinical improvement; neonate, 100 mg/kg daily reduced to 50 mg/kg daily.

 

 

CEFRADINE (Cephradine):

Indications: E. Coli Urinary Tract Infection, Klebsiella Urinary Tract Infection, Pharyngitis due to Streptococcus Pyogenes, Proteus Urinary Tract Infection, Skin and Skin Structure Infection, Skin and Skin Structure Streptoccous Pyogenes Infection, Staphylococcus Aureus Skin and Skin Structure Infection, Streptococcal Tonsillitis, Tonsillitis, Urinary Tract Infections.

Contraindications: Pseudomembranous Enterocolitis.

Dose and Administration: By mouth, 250–500 mg every 6 hours or 0.5–1 g every 12 hours; up to 1 g every 6 hours in severe infections; child, 25–50 mg/kg daily in 2–4 divided doses.

 

CEFAZOLIN (Cephazolin):

Indications: Bacterial Endocarditis, Bacterial Pneumonia, Bacterial Septicemia, Bacterial Urinary Tract Infection, Biliary Tract Infection, Bone Infections, Genitourinary Tract Infections, Infectious Disorder of Joint, Lower Respiratory Infections, Prevention of Perioperative Infection, Skin and Skin Structure Infection, Staphylococcal Pneumonia, Streptococcal Pneumonia.

Contraindications: Pseudomembranous Enterocolitis.

Dose and Administration: I.M., I.V. Children >1 month: 25-100 mg/kg/day divided every 6-8 hours; maximum: 6 g/day. Adults: 250 mg to 2 g every 6-12 (usually 8) hours, depending on severity of infection; maximum dose: 12 g/day. Prophylaxis against bacterial endocarditis, Infants and Children: 25 mg/kg 30 minutes before procedure; maximum dose: 1 g, Adults: 1 g 30 minutes before procedure.

 

CEFTAZIDIME:

Indications: Acute Pseudomonas Aeruginosa Pneumonia associated with Cystic Fibrosis, Bacterial Meningitis, Bacterial Pneumonia, Bacterial Septicemia, Bacterial Urinary Tract Infection, Bone Infections, Citrobacter Pneumonia, Complicated E. Coli UTI, Complicated Proteus UTI, Complicated UTI with Pseudomonas

Aeruginosa, E. Coli Cervicitis, E. Coli Endometritis, E. Coli Gynecological Infections, E. Coli Pelvic Cellulitis, E. Coli Pelvic Inflammatory Disease, E. Coli Peritonitis, E. Coli Septicemia, E. Coli Urinary Tract Infection, Ecthyma Gangrenosum, Endometritis, Enterobacter Cloacae Urinary Tract Infection, Enterobacter Complicated UTI, EnterobacterJoint Infection, Enterobacter Osteomyelitis, Enterobacter Pneumonia, Escherichia Coli Pneumonia, Gonococcal Meningitis, H. Influenzae Meningitis, Haemophilus Influenzae Pneumonia, Haemophilus Septicemia, Infectious Disease of Abdomen, Infectious Disorder of Joint, Inflammatory Disease of Female Pelvic Organs, Klebsiella Complicated UTI, Klebsiella Joint Infection, Klebsiella Pneumonia, Klebsiella Pneumoniae Osteomyelitis, Klebsiella Pneumoniae Peritonitis, Klebsiella Pneumoniae Septicemia, Klebsiella Urinary Tract Infection.

Contraindications: Pseudomembranous Enterocolitis.

Dose and Administration: By intravenous injection or infusion, 1 g every 8 hours or 2 g every 12 hours; 2 g every 8–12 hours or 3 g every 12 hours in severe infections; single doses over 1 g intravenous route only; elderly usual max. 3 g daily; child, up to 2 months 25–60 mg/kg daily in 2 divided doses, over 2 months 30–100 mg/kg daily in 2–3 divided doses; up to 150 mg/kg daily (max. 6 g daily) in 3 divided doses if immunocompromised or meningitis; intravenous route recommended for children. Urinary-tract and less serious infections, 0.5–1 g every 12 hours. Pseudomonal lung infection in cystic fibrosis, adult 100– 150 mg/kg daily in 3 divided doses; child up to 150 mg/kg daily (max. 6 g daily) in 3 divided doses. Surgical prophylaxis, prostatic surgery, 1 g at induction of anaesthesia repeated if necessary when catheter removed.

 

CEFOTAXIME:

Indications: Bacterial Meningitis, Bacterial Pneumonia, Bacterial Septicemia, Bacterial Urinary Tract Infection, Bacteroides Endometritis, Bacteroides Pelvic Cellulitis, Bacteroides Pelvic Inflammatory Disease, Bone Infections, Cesarean Section Infection Prevention, Citrobacter Urinary Tract Infection, Clostridium Endometritis, Clostridium Pelvic Cellulitis, Clostridium Pelvic Inflammatory Disease, Clostridium Peritonitis, E. Coli Endometritis, E. Coli Pelvic Cellulitis, E. Coli Pelvic Inflammatory Disease, E. Coli Peritonitis, E. Coli Septicemia, E. Coli Urinary Tract Infection, Enterobacter Cloacae Urinary Tract Infection, Enterobacter Endometritis, Enterobacter Pelvic Inflammatory Disease, Enterobacter Pneumonia, Enterococcus Endometritis, Enterococcus Pelvic Cellulitis, Enterococcus Pelvic Inflammatory Disease, Enterococcus Urinary Tract Infection, Escherichia Coli Meningitis, Escherichia Coli Pneumonia, Female Genital Tract Infection, Fusobacterium Endometritis, Fusobacterium Pelvic Inflammatory Disease, H. Influenzae Meningitis, Haemophilus Influenzae Pneumonia, Haemophilus Influenzae Type B Infections, Haemophilus Parainfluenzae Pneumonia, Infectious Disease of Abdomen, Klebsiella Endometritis, Klebsiella

Pelvic Inflammatory Disease, Klebsiella Pneumonia, Klebsiella Pneumoniae Peritonitis, Klebsiella Pneumoniae Septicemia, Klebsiella Urinary Tract Infection, Lower Respiratory Infections.

Contraindications: Pseudomembranous Enterocolitis, Severe Renal Disease. Dose and Administration: By intravenous injection or by intravenous infusion, 1 g every 12 hours increased in severe infections (e.g. meningitis) to 8 g daily in 4 divided doses; higher doses (up to 12 g daily in 3–4 divided doses) may be required; neonate 50 mg/kg daily in 2–4 divided doses increased to 150– 200 mg/kg daily in severe infections; child 100–150 mg/kg daily in 2–4 divided doses increased up to 200 mg/kg daily in very severe infections. Gonorrhoea, 500 mg as a single dose.

 

CEFTRIAXONE:

Indications: surgical prophylaxis; prophylaxis of meningococcal meningitis, Acute Otitis Media Infection, Haemophilus Influenzae Pneumonia, Lower Respiratory Infections, Pharyngitis, Pneumonia, Skin and Skin Structure Infection, Streptococcal Pneumonia, Tonsillitis, Upper Respiratory Infection, Urinary Tract Infections.

Contraindications: Pseudomembranous Enterocolitis, neonates with jaundice, hypoalbuminaemia, acidosis or impaired bilirubin binding; concomitant treatment with calcium in neonates—risk of precipitation in urine and lungs.

Dose and Administration: by intravenous injection over at least 2–4 minutes, or by intravenous infusion, 1 g daily; 2–4 g daily in severe infections; intramuscular doses over 1 g divided between more than one site; single intravenous doses above 1 g by intravenous infusion only. neonate by intravenous infusion over 60 minutes, 20–50 mg/kg daily (max. 50 mg/kg daily) infant and child under 50 kg, by deep intramuscular injection, or by intravenous injection over 2–4 minutes, or by intravenous infusion, 20–50 mg/kg daily; up to 80 mg/kg daily in severe infections; doses of 50 mg/kg and over by intravenous infusion only; 50 kg and over, adult dose. Surgical prophylaxis, by deep intramuscular injection or by intravenous injection over at least 2–4 minutes, 1 g at induction; colorectal surgery, by deep intramuscular injection or by intravenous infusion, 2 g at induction; intramuscular doses over 1 g divided between more than one site.

CEFIXIME:

Indications: Acute Gonococcal Cervicitis, Acute Gonococcal Urethritis, Acute Lower Genitourinary Gonorrhea, Acute Otitis Media Infection, Bronchitis, Bronchitis with Bacterial Exacerbations, Chronic Bronchitis with Bacterial Exacerbation, E. Coli Urinary Tract Infection, Haemophilus Influenzae Acute Otitis Media, Haemophilus Influenzae Bronchitis, Haemophilus Influenzae Chronic Bronchitis, Moraxella Catarrhalis Acute Otitis Media, Pharyngitis, Pharyngitis due to Streptococcus Pyogenes, Proteus Urinary Tract Infection, Streptococcal Tonsillitis, Streptococcus Acute Otitis Media, Streptococcus Pneumoniae Bronchitis, Streptococcus Pneumoniae Chronic Bronchitis, Tonsillitis, Upper Respiratory Infection, Urinary                Tract        Infections.
Contraindications: Pseudomembranous Enterocolitis.

Dose and Administration: adult and child over 10 years, 200–400 mg daily in 1–2 divided doses; child over 6 months 8 mg/kg daily in 1–2 divided doses or 6 months–1 year 75 mg daily; 1–4 years 100 mg daily; 5–10 years 200 mg daily. Gonorrhoea, 400 mg as a single dose.

 

CEFDENIR:

Indications: Acute Maxillary Haemophilus Influenzae Sinusitis, Acute Maxillary Moraxella Catarrhalis Sinusitis, Acute Maxillary Streptococcus Pneumoniae Sinusitis, Acute Otitis Media Infection, Haemophilus Influenzae Bronchitis, Haemophilus Influenzae Pneumonia, Haemophilus Parainfluenzae Bronchitis, Haemophilus Parainfluenzae Pneumonia, Moraxella Catarrhalis Bronchitis, Moraxella Catarrhalis Pneumonia, Pharyngitis due to Streptococcus Pyogenes, Skin and Skin Structure Streptoccous Pyogenes Infection, Staphylococcus Aureus Skin and Skin Structure Infection, Streptococcal Pneumonia, Streptococcal Tonsillitis, Streptococcus Pneumoniae Bronchitis.
Contraindications: Pseudomembranous Enterocolitis.

Dose and Administration: The recommended daily dose is 600mg. This may be taken as 300mg every 12 hours or as 600mg once daily except in pneumonia or skin infections should be taken twice daily. The recommended children dose is 7mg/kg every 12 hours or 14mg/kg once daily up to maximum of 600mg per day.

 

Other beta-lactam antibiotics:

Imipenem, a carbapenem, has a broad spectrum of activity which includes many aerobic and anaerobic Gram-positive and Gram-negative bacteria. Imipenem is partially inactivated in the kidney by enzymatic activity and is therefore administered in combination with cilastatin, a specific enzyme inhibitor, which blocks its renal metabolism. Side-effects are similar to those of other beta-lactam antibiotics; neurotoxicity has been observed at very high dosage or in renal failure. Meropenem is similar to imipenem but is stable to the renal enzyme which inactivates imipenem and therefore can be given without cilastatin. Meropenem has less seizure-inducing potential and can be used to treat central nervous system infection.

 

IMIPENEM WITH CILASTATIN:

Indications: aerobic and anaerobic Gram-positive and Gram-negative infections including Bacterial Endocarditis, Bacterial Pneumonia, Bacterial Septicemia, Bacterial Urinary Tract Infection, Bone Infections, Diabetic Foot Infection, Endometritis, Enterobacter Pneumonia, Escherichia Coli Pneumonia, Female Genital Tract Infection, Gram-Negative Aerobic Bacillary Pneumonia, Haemophilus Influenzae Pneumonia, Infectious Disease of Abdomen, Infectious Disorder of Joint, Inflammatory Disease of Female Pelvic Organs, Intra­Abdominal Abscess, Klebsiella Pneumonia, Lower Respiratory Infections, Peritonitis, Skin and Skin Structure Infection.
Contraindications: CNS Disorder, Intracranial Lesion, Pseudomembranous Enterocolitis, Renal Disease, and Seizure Disorder.

Dose and Administration: By intravenous infusion, in terms of imipenem, 1–

2 g daily (in 3–4 divided doses); less sensitive organisms, up to 50 mg/kg daily (max. 4 g daily) in 3–4 divided doses; child 3 months and older, 60 mg/kg (up to max. of 2 g) daily in 4 divided doses; over 40 kg, adult dose. Surgical prophylaxis,

1 g at induction repeated after 3 hours, supplemented in high risk (e.g. colorectal) surgery by doses of 500 mg 8 and 16 hours after induction.

MEROPENEM:

Indications: aerobic and anaerobic Gram-positive and Gram-negative infections including Bacterial Meningitis, Bacteroides Complicated Appendicitis, Bacteroides Peritonitis, Complicated Appendicitis, Complicated Skin and Skin Structure Infection, E. Coli Complicated Appendicitis, E. Coli Peritonitis, H. Influenzae Meningitis, Infectious Disease of Abdomen, Intra-Abdominal Abscess, Klebsiella Complicated Appendicitis, Klebsiella Pneumoniae Peritonitis, Meningococcal Meningitis, Peptostreptococcus Complicated Appendicitis, Peptostreptococcus Peritonitis, Peritonitis, Pneumococcal Meningitis, Pseudomonas Aeruginosa Complicated Appendicitis, Pseudomonas Aeruginosa Peritonitis, Streptococcal Meningitis, Streptococcal Peritonitis, Streptococcus Complicated Appendicitis.

Contraindications: Pseudomembranous Enterocolitis, Renal Disease.

Dose and Administration: By intravenous injection over 5 minutes or by intravenous infusion, 500 mg every 8 hours, dose doubled in hospital-acquired pneumonia, peritonitis, septicaemia and infections in neutropenic patients; child

3 months–12 years [not licensed for infection in neutropenia] 10–20 mg/kg every 8 hours, over 50 kg body weight adult dose. Meningitis, 2 g every 8 hours; child 3 months–12 years 40 mg/kg every 8 hours, over 50 kg body weight adult dose. Exacerbations of chronic lower respiratory-tract infection in cystic fibrosis, up to

2 g every 8 hours; child 4–18 years 25–40 mg/kg every 8

Tetracyclines

The tetracyclines are broad-spectrum antibiotics whose value has decreased owing to increasing bacterial resistance. They remain, however, the treatment of choice for infections caused by chlamydia (trachoma, psittacosis, salpingitis, urethritis, and lymphogranuloma venereum), rickettsia (including Q-fever), brucella (doxycycline with either streptomycin or rifampicin), and the spirochaete, Borrelia burgdorferi.

 

DOXYCYCLINE:

Indications: Acne Vulgaris, Actinomycosis, Acute Gonococcal Cervicitis, Acute Gonococcal Endometritis, Acute Gonococcal Epididymo-Orchitis, Acute Gonococcal Urethritis, Acute Lower Genitourinary Gonorrhea, Acute Staph. Aureus Sinusitis, Bacterial Pneumonia, Bacterial Urinary Tract Infection, Bartonellosis, Boutonneuse Fever, Bronchitis, Brucellosis, Chancroid, Chlamydial Infections, Chloroquine-Resistant Plasmodium Falciparum Malaria Prevention, Cholera, Cutaneous Anthrax, Disseminated Gonococcal Infection, Gastrointestinal Anthrax, Genitourinary Chlamydia Trachomatis Infection, Gonococcal Pharyngitis, Granuloma Inguinale, Inclusion Conjunctivitis, Inhaled Anthrax, Listeriosis, Louse-Borne Typhus.

Contraindications: Pregnancy, Esophageal Dysmotility, Pseudomembranous Enterocolitis.

Dose and Administration: 200 mg on first day, then 100 mg daily; severe infections (including refractory urinary-tract infections), 200 mg daily. Early syphilis, 100 mg twice daily for 14 days; late latent syphilis 200 mg twice daily for 28 days. Uncomplicated genital chlamydia, non-gonococcal urethritis, 100 mg twice daily for 7 days.

 

Aminoglycosides

These are bactericidal and active against some Gram-positive and many Gram-negative organisms also active against Pseudomonas aeruginosa. Most side-effects of this group of antibiotics are dose-related therefore care must be taken with dosage and whenever possible treatment should not exceed 7 days. The important side-effects are ototoxicity, and nephrotoxicity; they occur most commonly in the elderly and in patients with renal failure.

 

GENTAMICIN:

Indications: septicaemia and neonatal sepsis; meningitis and other CNS infections; biliary-tract infection, acute pyelonephritis or prostatitis, endocarditis; pneumonia in hospital patients, adjunct in listerial meningitis.

Contraindications: Pregnancy, Dehydration, Disorder of the 8th Cranial Nerve, Hypocalcemia, Infant Botulism, Myasthenia Gravis, Parkinsonism, Renal Disease, Tinnitus, Vertigo.

Dose and Administration: Multiple daily dose regimen, by intramuscular or by slow intravenous injection over at least 3 minutes or by intravenous infusion, 3– 5 mg/kg daily (in divided doses every 8 hours), see also notes above; neonate up to 2 weeks, 3 mg/kg every 12 hours; child 2 weeks–12 years, 2 mg/kg every 8 hours. Endocarditis (in combination with other antibacterials), adult 1 mg/kg every 8 hours.

 

AMIKACIN:

Indications: serious Gram-negative infections resistant to gentamicin. Acinetobacter Meningitis, Acinetobacter Pneumonia, Bacterial Meningitis, Bacterial Pneumonia, Bacterial Septicemia, Bacterial Urinary Tract Infection, Biliary Tract Infection, Bone Infections, Burn Wound Infections, Complicated Bacterial Peritonitis, Complicated E. Coli UTI, Complicated Proteus UTI, Complicated Urinary Tract Infection due to Acinetobacter, Complicated Urinary Tract Infections, Complicated UTI with Pseudomonas Aeruginosa, Diverticulitis of Gastrointestinal Tract, E. Coli Septicemia, Enterobacter Complicated UTI, Enterobacter Meningitis, Enterobacter Pneumonia, Enterobacter Septicemia. Contraindications: Pregnancy, Dehydration, Disorder of the 8th Cranial Nerve, Hypocalcemia, Infant Botulism, Myasthenia Gravis, Parkinsonism, Renal Disease, Tinnitus, Vertigo.

Dose and Administration: By intramuscular or by slow intravenous injection or by infusion, 15 mg/kg daily in 2 divided doses, increased to 22.5 mg/kg daily in 3 divided doses in severe infections; max. 1.5 g daily for up to 10 days (max. cumulative dose 15 g); child 15 mg/kg daily in 2 divided doses; neonate loading dose of 10 mg/kg then 15 mg/kg daily in 2 divided doses.

 

Macrolides

 

ERYTHROMYCIN:

Indications: susceptible infections in patients with penicillin hypersensitivity; oral infections; campylobacter enteritis, syphilis, non-gonococcal urethritis, respiratory-tract infections (including Legionnaires’ disease), skin infections; chronic prostatitis; prophylaxis of diphtheria, group A streptococcal infection, and whooping cough; acne vulgaris and rosacea.

Contraindications: Cholestatic Hepatitis, Cholestasis, Congenital Long QT Syndrome, Prolonged QT Interval, Pseudomembranous Enterocolitis, Torsades de Pointes, Ventricular Arrhythmias.

Dose and Administration: By mouth, adult and child over 8 years, 250– 500 mg every 6 hours or 0.5–1 g every 12 hours (see notes above); up to 4 g daily in severe infections; neonate 12.5 mg/kg every 6 hours; child 1 month–2 years 125 mg every 6 hours, 2–8 years 250 mg every 6 hours, doses doubled for

severe infections. Early syphilis, 500 mg 4 times daily for 14 days. Uncomplicated genital chlamydia, non-gonococcal urethritis, 500 mg twice daily for 14 days. By intravenous infusion, adult and child severe infections, 50 mg/kg daily by continuous infusion or in divided doses every 6 hours; mild infections (oral treatment not possible), 25 mg/kg daily; neonate 30–45 mg/kg daily in 3 divided doses.

 

AZITHROMYCIN:

Indications: respiratory-tract infections; otitis media; skin and soft-tissue infections; uncomplicated genital chlamydial infections and non-gonococcal urethritis; mild or moderate typhoid due to multiple-antibacterial-resistant organisms; prophylaxis of group A streptococcal infection.

Contraindications: Hearing Disorder, Immunosuppression, Pseudomembranous Enterocolitis, Severe Infection, Torsades de Pointes.

Dose and Administration: 500 mg once daily for 3 days or 500 mg on first day then 250 mg once daily for 4 days; child over 6 months 10 mg/kg once daily for 3 days; or body-weight 15–25 kg, 200 mg once daily for 3 days; body-weight 26–35 kg, 300 mg once daily for 3 days; body-weight 36–45 kg, 400 mg once daily for 3 days. Uncomplicated genital chlamydial infections and non-gonococcal urethritis, 1 g as a single dose. Typhoid, 500 mg once daily for 7 days. Infuse 500 mg over 30 minute(s) by intravenous route once daily for 2 days

 

CLARITHROMYCIN:

Indications: respiratory-tract infections, mild to moderate skin and soft tissue infections, otitis media; Helicobacter pylori eradication.

Contraindications: Prolonged QT Interval, Pseudomembranous Enterocolitis, Severe Renal Disease, Torsades de Pointes, Ventricular Tachycardia.

Dose and Administration: By mouth, 250 mg every 12 hours for 7 days, increased in severe infections to 500 mg every 12 hours for up to 14 days; child body-weight under 8 kg, 7.5 mg/kg twice daily; 8–11 kg (1–2 years), 62.5 mg twice daily; 12–19 kg (3–6 years), 125 mg twice daily; 20–29 kg (7–9 years), 187.5 mg twice daily; 30–40 kg (10–12 years), 250 mg twice daily.

 

JOSAMYCIN:

Indications: Upper respiratory-tract infections, nasopharyngitis, tonsillitis, pharyngitis and sinusitis.

Contraindications: Prolonged QT Interval, Pseudomembranous Enterocolitis, Severe Renal Disease, Torsades de Pointes, Ventricular Tachycardia.

Dose and Administration: By mouth, 1gm every 12 hours before meals.

 

 

 

Clindamycin

Clindamycin is active against Gram-positive cocci, including streptococci and penicillin-resistant staphylococci, and also against many anaerobes, especially Bacteroides fragilis. It is well concentrated in bone and excreted in bile and urine. Clindamycin is recommended for staphylococcal joint and bone infections such as osteomyelitis, and intra-abdominal sepsis; it is an alternative to macrolides for erysipelas or cellulitis in penicillin-allergic patients.

 

CLINDAMYCIN:

Indications: Anaerobic Lung Abscess, Anaerobic Pelvic Cellulitis, Anaerobic Peritonitis, Anaerobic Pneumonia, Anaerobic Septicemia, Anaerobic Tubo-Ovarian Abscess, Bacterial Septicemia, Bacteroides Endomyometritis, Infectious Disease of Abdomen, Inflammatory Disease of Female Pelvic Organs, Intra-Abdominal Anaerobic Abscess, Pleural Empyema, Pneumococcal Pneumonia, Postsurgical Vaginal Cuff Anaerobic Infections, Prevention of Bacterial Endocarditis, Skin and Skin Structure Anaerobic Infection, Skin and Skin Structure Infection, Skin and Skin Structure Streptoccous Pyogenes Infection, Staphylococcal Pneumonia, Staphylococcus Aureus Skin and Skin Structure Infection, Streptococcal Pneumonia.

Contraindications: Crohn’s Disease, Pseudomembranous Enterocolitis, Ulcerative Colitis, Bloody Stools, Severe Hepatic Disease.

Dose and Administration: By mouth, 150–300 mg every 6 hours; up to 450 mg every 6 hours in severe infections; child, 3–6 mg/kg every 6 hours. By deep intramuscular injection or by intravenous infusion, 0.6–2.7 g daily (in 2–4 divided doses); life-threatening infection, up to 4.8 g daily; single doses above 600 mg by intravenous infusion only; single doses by intravenous infusion not to exceed 1.2 g; child over 1 month, 15–40 mg/kg daily in 3–4 divided doses; severe infections, at least 300 mg daily regardless of weight.

 

Glycopeptide antibiotics

 

VANCOMYCIN:

Indications: Prophylaxis and treatment of endocarditis and other serious infections caused by Gram-positive cocci such as Bacterial Septicemia, Bone Infections, Diphtheroid Prosthetic Heart Valve Endocarditis, Enterococcus Endocarditis, Infectious Disorder of Joint, Neonatal Group B Streptococcal Septicemia, Neonatal Pneumonia, Prosthetic Heart Valve Endocarditis, Sepsis of Newborn, Severe Staphylococcus Infections, Staphylococcal Pneumonia,

Staphylococcal Prosthetic Heart Valve Endocarditis, Staphylococcal Septicemia, Staphylococcus Aureus Endocarditis, Staphylococcus Aureus Osteomyelitis, Staphylococcus Aureus Skin and Skin Structure Infection, Staphylococcus Epidermidis Skin and Skin Structure Infection, Streptococcal Endocarditis.

Contraindications: Hearing Disorder, Pseudomembranous Enterocolitis.

Dose and Administration: By intravenous infusion, 1–1.5 g every 12 hours; elderly over 65 years, 500 mg every 12 hours or 1 g once daily; child over 1 month, 15 mg/kg every 8 hours (max. 2 g daily).

 

TEICOPLANIN:

Indications: potentially serious Gram-positive infections including endocarditis, dialysis-associated peritonitis, and serious infections due to Staphylococcus aureus; prophylaxis in orthopaedic surgery at risk of infection with Gram-positive organisms.

Contraindications: should not be used during pregnancy and lactation.

Dose and Administration: By intramuscular injection or by intravenous injection or infusion, initially 400 mg (for severe infections, by intravenous injection or infusion, initially 400 mg every 12 hours for 3 doses), then 200 mg once daily (400 mg once daily for severe infections); higher doses may be required in patients over 85 kg and in severe burns, or meticillin-resistant Staphylococcus aureus infection. Child over 2 months by intravenous injection or infusion, initially 10 mg/kg every 12 hours for 3 doses, subsequently 6 mg/kg once daily (severe infections or in neutropenia, 10 mg/kg once daily); subsequent doses can be given by intramuscular injection (but intravenous administration preferred in children); neonate by intravenous infusion, initially a single dose of 16 mg/kg, subsequently 8 mg/kg once daily.

 

Sulphonamides and trimethoprim

 

CO-TRIMOXAZOLE:

Indications: Acute Otitis Media Infection, Bacterial Urinary Tract Infection, Chronic Bronchitis with Bacterial Exacerbation, E. Coli Urinary Tract Infection, Enterobacter Cloacae Urinary Tract Infection, Gastroenteritis due to Shigella, Haemophilus Influenzae Acute Otitis Media, Haemophilus Influenzae Chronic Bronchitis, Klebsiella Urinary Tract Infection, Morganella Morganii Urinary Tract Infection, Pneumocystis Carinii Pneumonia, Pneumocystis Carinii Pneumonia Prevention, Proteus Urinary Tract Infection, Streptococcus Acute Otitis Media, Streptococcus Pneumoniae Chronic Bronchitis.

Contraindications: Deficiency of Glucose-6-Phosphate Dehydrogenase, Folic Acid Deficient Megaloblastic Anemia, Hemolytic Anemia from Pyruvate Kinase

and G6PD Deficiencies, Third Trimester of Pregnancy, Neutropenic Disorder, Porphyria, Pseudomembranous Enterocolitis, Thrombocytopenic Disorder.

Dose and Administration: By mouth, 960 mg every 12 hours; child, every 12 hours, 6 weeks–5 months, 120 mg; 6 months–5 years, 240 mg; 6–12 years, 480 mg. Treatment of Pneumocystis jiroveci (Pneumocystis carinii) infections, by mouth or by intravenous infusion, adult and child over 4 weeks, 120 mg/kg daily in 2–4 divided doses for 14 days.

 

Antituberculosis drugs

 

ETHAMBUTOL HYDROCHLORIDE:

Indications: Acute Tuberculosis, Pulmonary Tuberculosis, Atypical

Mycobacterial Infection, and Disseminated Mycobacterium Avium Complex

Infection, Tuberculosis Meningitis.

Contraindications: Optic Neuritis, Renal Disease.

Dose and Administration: take 15 mg/kg by oral route once daily not to

exceed 2.5 grams in 24hrs.

 

ISONIAZID:

Indications: Acute Tuberculosis, Inactive Tuberculosis, Pulmonary Tuberculosis, and Tuberculosis Prevention.

Contraindications: Acute Hepatic Failure, Acute Hepatitis, Alcoholism, Hemolytic Anemia from Pyruvate Kinase and G6PD Deficiencies, Severe Hepatic Disease.

Dose and Administration: 300 mg by oral route daily in single dose or 3 divided doses.

 

PYRAZINAMIDE:

Indications: Acute Tuberculosis, Pulmonary Tuberculosis, and Tuberculosis

Meningitis.

Contraindications: Porphyria, Severe Hepatic Disease.

Dose and Administration: 30 mg/kg by oral route daily.

 

RIFAMPICIN:

Indications: Brucellosis, Legionnaires’ disease, endocarditis and serious staphylococcal infections, in combination with other drugs, Tuberculosis, Leprosy

and Prophylaxis of meningococcal meningitis and Haemophilus influenzae (type b) infection.

Contraindications: jaundice.

Dose and Administration: by mouth 0.6–1.2 g daily (in 2–4 divided doses)

RIFAMPICIN-ISONIAZID:

Indications: Acute Tuberculosis, Pulmonary Tuberculosis, and Tuberculosis Meningitis.

Contraindications: Acute Hepatic Failure, Acute Hepatitis, Alcoholism, Hemolytic Anemia from Pyruvate Kinase and G6PD Deficiencies, Severe Hepatic Disease and jaundice.

Dose and Administration: adult 50 kg and over, 2 tablets (each contain rifampicin 300 mg, isoniazid 150 mg) daily, preferably before breakfast. adult under 50 kg, 3 tablets ( each contain rifampicin 150 mg, isoniazid 100 mg) daily.

Metronidazole and tinidazole

 

METRONIDAZOLE:

Indications: anaerobic infections (including dental) protozoal infections; Helicobacter pylori eradication, Acute Intestinal Amebiasis due to Entamoeba Histolytica, Anaerobic Infections, B. Fragilis Infections, Bacterial Endocarditis, Bacterial Septicemia, Bacteroides Brain Abscess, Bacteroides Empyema,

Bacteroides       Endocarditis,        Bacteroides       Endometritis,       Bacteroides
Endomyometritis, Bacteroides Joint Infection, Bacteroides Liver Abscess.

Contraindications: Lactating Mother, Alcohol Intoxication, Alcoholism, Lower Seizure Threshold, Peripheral Neuropathy, Seizure Disorder, And Severe Hepatic Disease.

Dose and Administration: Anaerobic infections (usually treated for 7 days and for 10 days in antibiotic-associated colitis), by mouth, either 800 mg initially then 400 mg every 8 hours or 500 mg every 8 hours, child 7.5 mg/kg every 8 hours; by rectum, 1 g every 8 hours for 3 days, then 1 g every 12 hours, child every 8 hours for 3 days, then every 12 hours, age up to 1 year 125 mg, 1–5 years 250 mg, 5– 10 years 500 mg, over 10 years, adult dose; by intravenous infusion over 20 minutes, 500 mg every 8 hours; child 7.5 mg/kg every 8 hours. Surgical prophylaxis, by mouth, 400–500 mg 2 hours before surgery; up to 3 further doses of 400–500 mg may be given every 8 hours for high-risk procedures; child 7.5 mg/kg 2 hours before surgery; up to 3 further doses of 7.5 mg/kg may be given every 8 hours for high-risk procedures.

 

TINIDAZOLE:

Indications: Anaerobic infections, Acute Intestinal Amebiasis due to Entamoeba Histolytica, Bacterial Vaginosis, Giardiasis, Liver Abscess Amebiasis due to Entamoeba Histolytica, Trichomoniasis.

Contraindications: Lactating Mother, Pregnancy, Epilepsy, And Peripheral Neuropathy.

Dose and Administration: Anaerobic infections, 2 g initially, followed by 1 g daily or 500 mg twice daily, usually for 5–6 days. Bacterial vaginosis and acute ulcerative gingivitis, a single 2-g dose. Abdominal surgery prophylaxis, a single 2- g dose approximately 12 hours before surgery.

 

Quinolones

 

CIPROFLOXACIN:

Indications: active against both Gram-positive and Gram-negative bacteria. It is particularly active against Gram-negative bacteria, including salmonella, shigella, campylobacter, neisseria, and pseudomonas. Acute Gonococcal Cervicitis, Acute Gonococcal Urethritis, Acute Maxillary Haemophilus Influenzae Sinusitis, Acute Maxillary Moraxella Catarrhalis Sinusitis, Acute Maxillary Streptococcus Pneumoniae Sinusitis, Bacterial Pneumonia, Bacterial Urinary Tract Infection, Bone Infections, Bronchitis with Bacterial Exacerbations, Chancroid, Chronic Bacterial Prostatitis, Citrobacter Urinary Tract Infection, Complicated Bacteroides Peritonitis, Complicated E. Coli Peritonitis, Complicated Klebsiella Peritonitis, Complicated Proteus Peritonitis.

Contraindications: Achilles Tendinitis, Cardiac Transplantation, CNS Disorder, Congenital Long QT Syndrome, Depression, Epilepsy, Hallucinations,

Hypokalemia, Lower Seizure Threshold, Lung Transplantation, Prolonged QT Interval, Pseudomembranous Enterocolitis, Psychotic Disorder, Renal Transplant, Severe Cerebral Arteriosclerosis, Shoulder Tendonitis, Tendonitis, Torsades de Pointes, Tremors.

Dose and Administration: By mouth, respiratory-tract infections, 250–750 mg twice daily. Urinary-tract infections, 250–500 mg twice daily (100 mg twice daily for 3 days in acute uncomplicated cystitis in women). Chronic prostatitis, 500 mg twice daily for 28 days. Gonorrhoea, 500 mg as a single dose. Surgical prophylaxis, 750 mg 60–90 minutes before procedure. By intravenous infusion (over 30–60 minutes; 400 mg over 60 minutes), 200–400 mg twice daily. Child and adolescent not recommended.

 

LEVOFLOXACIN:

Indications: acute sinusitis, Exacerbation of chronic bronchitis, Community-acquired pneumonia, Urinary-tract infections, chronic prostatitis and Skin and soft tissue infections.

Contraindications: Bradycardia, Cardiac Transplantation, CNS Disorder, Congenital Long QT Syndrome, Depression, Drug-Induced Hepatitis, Epilepsy, Hallucinations, Hypokalemia, Intracranial Hypertension, Lower Seizure Threshold, Lung Transplantation, Peripheral Neuropathy, Prolonged QT Interval, Pseudomembranous Enterocolitis, Psychotic Disorder, Renal Transplant, Rhabdomyolysis.

Dose and Administration: By mouth, acute sinusitis, 500 mg daily for 10–14 days. Exacerbation of chronic bronchitis, 250–500 mg daily for 7–10 days. Community-acquired pneumonia, 500 mg once or twice daily for 7–14 days. Urinary-tract infections, 250 mg daily for 7–10 days (for 3 days in uncomplicated infection). Chronic prostatitis, 500 mg once daily for 28 days. Skin and soft tissue infections, 250 mg daily or 500 mg once or twice daily for 7–14 days. By intravenous infusion (over at least 60 minutes for 500 mg), community-acquired pneumonia, 500 mg once or twice daily. Complicated urinary-tract infections, 250 mg daily, increased in severe infections. Skin and soft tissue infections, 500 mg twice daily.

 

MOXIFLOXACIN:

Indications: Community-acquired pneumonia; exacerbation of chronic bronchitis; sinusitis.

Contraindications: severe hepatic impairment; history of QT-interval prolongation, bradycardia, history of symptomatic arrhythmias, heart failure with reduced left ventricular ejection fraction, electrolyte disturbances, concomitant use with other drugs known to prolong QT-interval.

Dose and Administration: 400 mg once daily for 10 days in community-acquired pneumonia, for 5–10 days in exacerbation of chronic bronchitis, for 7 days in sinusitis.

 

NORFLOXACIN:

Indications: Urinary-tract infections, chronic relapsing urinary-tract infections and chronic prostatitis.

Contraindications: Cardiac Transplantation, CNS Disorder, Congenital Long QT Syndrome, Epilepsy, Hallucinations, Hypokalemia, Intracranial Hypertension, Lung Transplantation, Peripheral Neuropathy, Prolonged QT Interval, Pseudomembranous Enterocolitis, Psychotic Disorder, Renal Transplant, Severe

Cerebral Arteriosclerosis, Tendonitis, Tendon Rupture, Torsades de Pointes, Tremors.

Dose and Administration: Urinary-tract infections, 400 mg twice daily for 7–10 days (for 3 days in uncomplicated lower urinary-tract infections). Chronic relapsing urinary-tract infections, 400 mg twice daily for up to 12 weeks; may be reduced to 400 mg once daily if adequate suppression within first 4 weeks.

GEMIFLOXACIN:

Indications: Acute Exacerbation of Obstructive Chronic Bronchitis by M. Catarrhalis, Acute Exacerbation of Obstructive Chronic Bronchitis by Streptococcus Pneumoniae, Acute Exacerbation of Obstructive Chronic Bronchitis due to H. Flu, Bacterial Pneumonia, Chlamydial Pneumonia, Chronic Bronchitis with Bacterial Exacerbation, Haemophilus Influenzae Pneumonia, Moraxella Catarrhalis Pneumonia, Mycoplasmal Pneumonia, Pneumococcal Pneumonia, Pneumonia due to Klebsiella Pneumoniae.

Contraindications: Congenital Long QT Syndrome, Prolonged QT Interval, Torsades de Pointes. Bradycardia, Cardiac Transplantation, CNS Disorder, Depression, Epilepsy, Hallucinations, Hypokalemia, Hypomagnesemia, Lung Transplantation, Paranoid Disorder, Peripheral Neuropathy, Pseudomembranous Enterocolitis, Psychotic Disorder, Renal Transplant, Tendonitis.

Dose and Administration: 1 tablet (320 mg) by oral route once daily for 5 to 7 days.

 

Urinary-tract infections

Urinary-tract infection is more common in women than in men. Escherichia coli is the most common cause of urinary-tract infection; Staphylococcus saprophyticus is also common in sexually active young women.

NITROFURANTOIN:

Indications: E. Coli Urinary Tract Infection, Enterobacter Cystitis, Enterococcus Urinary Tract Infection, Klebsiella Urinary Tract Infection, Staphylococcus Aureus Urinary Tract Infection.

Contraindications: Anuria, Deficiency of Glucose-6-Phosphate Dehydrogenase, Drug-Induced Hepatitis, Hemolytic Anemia from Pyruvate Kinase and G6PD Deficiencies, Oliguria, Renal Disease with Mild to Moderate Renal Function Impairment.

Dose and Administration: Acute uncomplicated infection, 50 mg every 6 hours with food for 7 days; child over 3 months, 3 mg/kg daily in 4 divided doses. Severe chronic recurrent infection, 100 mg every 6 hours with food for 7 days.