Medicines & You

= Chemical Compound
= Indications
= Dosage
= Contraindication
= Special Precautions
= Adverse Reactions
= Drug-Drug Interaction

Antibiotics

a) Aminoglycosides

Amikacin sulfate.
UTI, resp tract, bones & joints, skin & soft tissue, intra-abdominal (including peritonitis), burns & post-op infections, bacteraemia, septicaemia including neonatal sepsis & CNS infections (including meningitis).
Hypersensitivity.
Myasthenia gravis. Renal impairment. Pregnancy & lactation.
Ototoxicity & nephrotoxicity. Rarely, skin rash, fever, paresthesia, arthralgia, anaemia, hypotension.
Potentiation of toxicity in combination w/ loop diuretics, cefalothin, vancomycin, cyclosporine. Prolongs action of neuromuscular blockers. Increased risk of resp depression w/ ether, halothane, methoxyflurane & neuromuscular blockers.

b) Cephalosporins

Ceftibuten dihydrate.
Acute bacterial sinusitis, acute bronchitis, acute exacerbations of chronic bronchitis, complicated or uncomplicated, community-acquired pneumonia, pharyngitis w/ or w/o tonsillitis, acute otitis media w/ effusion, complicated or uncomplicated UTI, acute bacterial enteritis.
Hypersensitivity to cephalosporins.
Penicillin-allergic patients; impaired renal function, history of complicated GI disease, particularly chronic colitis, infants < 6 mth.
Nausea, diarrhoea. Rarely, dyspepsia, gastritis, vomiting, abdominal pain & dizziness.

Cefoperazone Na.
Resp tract infections, UTI, peritonitis, cholecystitis, cholangitis & other intra-abdominal infections, septicemia, meningitis, skin & soft tissue infection, infections of bones & joints, pelvic inflammatory disease, endometritis, gonorrhea, & other infections of the genital tract. Prophylaxis of post-op infection in patients undergoing abdominal & gynaecological surgery, cardiovascular & orthopaedic surgery.
Previous hypersensitivity to cephalosporin.
Penicillin-sensitive patients. Severe biliary obstruction. Severe hepatic disease or coexistent renal dysfunction.
Hypersensitivity reactions eg rash, urticaria, fever; neutropenia (reversible), hypoprothrombinaemia (occasional); GI effects & local reactions; vit K deficiency (rare).

Cephalexin.
Resp tract, GIT, skin & soft tissue, ENT, O&G infection, gonorrhoea & syphilis.
Hypersensitivity to cephalosporins.
Hypersensitivity to penicillins. Renal impairment. Superinfection.
GI disturbances; overgrowth of non-susceptible organisms; hypersensitivity reactions. Rarely, reversible neutropenia.
Concurrent treatment w/ high doses of cephalosporins & aminoglycosides or potent diuretics may adversely affect renal function. Probenecid may increase or prolong plasma level & toxicity of cephalosporins.

Cefaclor.
Distaclor, bronchitis & pneumonia, sinusitis, acute gonococcal urethritis, bronchitis & pneumonia, more serious infections, otitis media, distaclor MR, pharyngitis, tonsillitis, skin & soft tissue infections, bronchitis, pneumonia, lower UTI.
Hypersensitivity to cephalosporins.
Penicillin-sensitive patients. Superinfection. History of GI disease. Impaired renal function. Pregnancy, lactation.
Allergic reactions, GI side effects. Rarely, Stevens-Johnson syndrome, thrombocytopenia, eosinophillia, pseudomembranous colitis (reversible on discontinuation).
Probenecid. Bacteriostatic antibiotics may reduce cephalosporin effectiveness. Oral anticoagulants.

Cefadroxil.
Uncomplicated UTI. All other UTI, skin/skin structure infection, Pharyngitis / Tonsillitis, impetigo and other skin & skin structure infections. Treatment of ß-haemolytic strept infections.
Hypersensitivity to cephalosporins.
Hypersensitivity to penicillins. Histories of allergy & GI disease (colitis). Renal impairment. Superinfection.
Symptoms of pseudomembranous colitis. Rarely, nausea, vomiting, diarrhoea. Hypersensitivity reactions. Genital pruritus, genital moniliasis, vaginitis, moderate transient neutropenia & minor elevations in serum transaminase.
Concomitant use w/ potent diuretics, aminoglycosides & probenecid. Bacteriostatic antibiotics may reduce cephalosporin effectiveness.

Ceftazidime pentahydrate.
Severe infections of the resp tract, urinary tract & GIT, skin & soft tissue infections, bone & joint infections & infections associated w/ dialysis.
Hypersensitivity to cephalosporins.
Hypersensitivity to penicillins. Renal impairment.
GI upsets, CNS effects, phlebitis or thrombophlebitis at IV inj site, pain &/or inflammation after IM inj, very rarely, hypersensitivity reactions. Transient hematological changes.
Concomitant administration of nephrotoxic drugs.

Cefalexin monohydrate.
Bacterial infection of resp tract & GUT, skin & soft tissues. Pharyngitis, skin & skin-structure infections; uncomplicated cystitis in patients > 15 yr, serious infection.
Hypersensitivity to cephalosporins.
Allergic reactions. Marked renal impairment. Hypersensitivity to penicillins.
GI disturbances. Superinfection. Hypersensitivity. Genital & anal pruritus. Rarely, neutropenia, thrombocytopenia, eosinophilia, erythema multiforme, pseudomembranous colitis, anaphylaxis.

Cefprozil.
Upper resp tract infections, uncomplicated UTI, sinusitis, lower resp tract infections, skin & skin structure infections, uncomplicated skin & skin structure infections. Otitis media, upper resp infections, pharyngitis, tonsillitis, sinusitis.
Hypersensitivity.
Penicillin-sensitive patients; renal impairment; history of GI disease esp colitis; superinfection; pregnancy, lactation.
GI disorders, hypersensitivity, CNS reactions.
Potent diuretics; probenecid; aminoglycosides.

Cefuroxime Na.
resp, ENT, GUT, soft tissue, O & G, bone & joint infections, gonorrhea, septicemia, gonorrhea, septicemia, meningitis. Surgical prophylaxis.
Hypersensitivity to cephalosporins.
Anaphylactic reaction to penicillins; concurrent treatment w/ potent diuretics. Renal impairment.
Hypersensitivity, GI disturbances including vary rarely pseudomembranous colitis. Haematological changes. Superinfection. Transient pain at IM inj site. Occasionally, thrombophlebitis (IV inj).

Cefuroxime exetil.
Bronchitis, pneumonia, upper resp tract, GUT, skin & soft tissue infection, pyelonephritis, UTI, uncomplicated gonorrhoea.
Hypersensitivity to cephalosporins.
Anaphylactic reaction to penicillins.
GI disturbances, occasionally pseudomembranous colitis; hypersensitivity reactions. Eosinophilia. Headache. Superinfection.

c) Macrolides

Erythromycin ethylsuccinate.
Resp tract, skin & soft tissue infection, non-specific urethritis & primary syphilis in patients allergic to penicillins.
Hypersensitivity.
Hepatic impairment, myasthenia gravis.
Abdominal discomfort; mild allergic reaction; liver dysfunction w/ or w/o jaundice; reversible hearing loss.
Can increase plasma conc of warfarin, theophylline, carbamazepine, cyclosporine, possibly phenytoin. Combination w/ ergotamine increases risk of peripheral ischemia. Caution when taken w/ terfenadine or astemizole.

Azithromycin dehydrate.
Lower resp tract infections including bronchitis & pneumonia; skin & soft tissue infection; otitis media; upper resp tract infections including sinusitis & pharyngitis/ tonsillitis. Uncomplicated genital infections due to Chlamydia trachomatis & non-multiresistant Neisseria gonorrhoea. Prophylaxis against Mycobacterium avium intracellulare complex (MAC) infection.
Known hypersensitivity to azithromycin or any of the macrolides.
Moderate or severe renal impairment, severe liver impairment; pregnancy & lactation.
Nausea, abdominal discomfort, vomiting, flatulence, diarrhea & loose stools. Hearing impairment, interstitial nephritis, acute renal failure, abnormal liver function, dizziness/ vertigo, convulsions, headache, somnolence.
Antacids, ergot derivatives. Monitor patients on concurrent warfarin, digoxin or cyclosporine.

d) Penicillins

Per 375 mg tab- Clavulanate K 125 mg, amoxixillin trihydrate 250 mg. Per 625 mg tab-Clavulanate K 125 mg, amoxicillin trihydrate 500 mg. Per 1 g tab - Clavulanate K 125 mg, amoxicillin trihydrate 875 mg.
Per 5 mL ‘156 mg’ syr- Clavulanate K 31.25 mg, amoxicillin trihydrate 125 mg. Per 5 mL ‘228 mg’ syr- Clavulanate K 28 mg, amoxicillin trihydrate 200 mg. Per 5 mL ‘312 mg’ syr- Clavulanate K 62 mg, amoxicillin trihydrate 250 mg. Per 600 mg vial - Clavulanate K 100 mg, amoxicillin Na 500 mg. Per 1.2 g vial Clavulanate K 200 mg, amoxicillin Na 1 g.
Resp tract skin, soft tissue, GUT infection, septicaemia, peritonitis, post-op infection & osteomyelitis, surgical prophylaxis.
Hypersensitivity to penicillins, possible cross sensitivity w/ other ß-lactam antibiotics. History of penicillin-associated cholestatic jaundice/hepatic dysfunction.
Diarrhoea, pseudomembranous colitis, indigestion, GI upsets, candidiasis, transient hepatitis, cholestatic jaundice. Rarely, urticaria & erythematous rashes, erthema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, transient leucopenia, thrombocytopenia, hemolytic anemia.
Aminoglycosides, anticoagulants, OC.

Sultamicillin.
Upper resp tract infections including sinusitis, otitis media & tonsillitis; lower resp tract infection including bacterial pneumonias & bronchitis, UTI & pyelonephritis; skin & soft tissue infection & gonococcal infection. Oral follow-up therapy to Unasyn IM/IV.
History of allergic reaction to any penicillins.
Overgrowth of non-susceptible organism. Check periodically for organ system dysfunction during prolonged therapy.
GI disturbances. Phlebitis, skin rashes, itching, blood disorders, anaphylaxis & superinfection.

e) Quinolones

Ciprofloxacin (Tab: HCI Infusion: lactate).
Infections of the resp tract, middle ear, sinuses, eyes, GUT, biliary tract, GI, skin & soft tissues, bones & joints due to sensitive organisms. Septicemia, peritonitis, infection in patients w/ reduced host defense & for selective gut decontamination.
Hypersensitivity to ciprofloxacin or other quinolones. Childn, adolescents, pregnancy & lactation.
Epilepsy, CNS damage.
Nausea, diarrhea, vomiting, dyspepsia, abdominal pain, flatulence, anorexia, dizziness, headache, tiredness, agitation, trembling. Very raely insomnia, peripheral paralgesia, sweating, unsteady gait, convulsions, increase in intracranial pressure, anxiety states, nightmares, confusion, depression, hallucinations, impaired taste & smell, visual disturbances, tinnitus, transitory impairment of hearing, esp at high frequencies, skin reactions.
Mineral-containing antacids reduce absorption of ciprofloxacin. May increase theophylline plasma levels. Concomitant intake w/ NSAIDs can lead to convulsion. Transients rise of serum creatinine w/ cyclosporine. Effects of warfarin are intensified.

Norfloxacin.
UT uncomplicated & complicated cystitis & pyelonephritis. Gonorrhoea: uncomplicated gonorrhoea, including urethral & rectal gonorrhoea. GI infections: bacterial gastroenteritis & prophylaxis of diarrhea in travelers to countries w/ high risk of GI infections.
Hypersensitivity to quinolones. Severe renal insufficiency.
Pregnancy & lactation. Prepubertal childn.
GI disturbances, neurological disturbances; fatigue, rash, depression, somnolence, heartburn, fever, dyspepsia, insomnia.
Antacids may impair absorption. May increase thephylline plasma levels.

Lomefloxacin.
Treatment of uncomplicated UTI, complicated including recurrent UTI, acute exacerbation of chronic bronchitis. Prevention of post-op UTI in patients undergoing transurethral surgery.
Hypersensitivity. Childn < 18 yr. Pregnancy, lactation.
Patients w/ known or suspected CNS disorders. Reduced renal function.
Headache, nausea, photosensitivity, dizziness, diarrhea, vomiting, abdominal pain, allergic & anaphylactoid reactions, anorexia, arthralgia, CNS stimulation, hallucination, phlebitis, pruritus, psedomembtanous colitis, rash, renal disorders, Steven-Johnson syndrome, tachycardia, hematological changes.
Sucralfate, antacids containing Mg or Al, probenecid

Ofloxacin.
Resp; GUT, ophth, skin & soft tissue, biliary tract, GI & ENT infections. Cholecystitis & cholangitis. Bacillary dysentery & enteritis.
Hypersensitivity. Childn. Pregnancy & lactation.
Patient w/ severe nephropathy, convulsions, elderly.
Shock, anaphylactoid symptom, Lyell’s syndrome, rhabdomyolysis, tendon disorders, agranulocytosis, interstitial pneumonia, pseudomembranous colitis, anemia, GI distress, headache, dizziness, sleep disturbances, hepatic & hematological disorders.
Antacids may reduce absorption.

f) Tetracyclines

Minocycline HCI.
Infections caused by tetracycline-sensitive organisms, including nongonococcal urethritis, acne vulgaris.
Hypersensitivity. Last half of pregnancy, infants, childn < 8 yr.
Overgrowth of susceptible organisms, VD, renal impairment. Use in conjunction w/ penicillins.
GI disorders. Maculopapular & erythematous rashes, photosensitivity, tooth discoloration, hypersensitivity reactions.
Oral absorption is impaired by antacids containing Al, Mg.

Doxycycline hyclate.
Resp, GUT & soft tissue infection.
Hypersensitivity to tetracycline. Last ½ of pregnancy & childn < 8 yr.
Organ system damage. Lactation.
Enamel hypoplasia, superinfection. GI disturbances; maculopapular & erythematous rashes; photosensitivity; hypersensitivity reactions.
Absorption impaired by antacids, colloidal bismuth & Fe prep.

g) Antifungals

Fluconazole.
Vag candidiasis, oropharyngeal candidiasis, atrophic oral candidiasis associated w/ dentures, other candidal infections of mucosa, candidaemia, disseminated candidiasis & other invasive condidal infections, cryptococcal infections at other sites, prevention of relapse of cryptococcal meningitis in patients w/ AIDS, prevention of fungal infections in immunocompromised patients considered at risk as a consequence of HIV infections or neutropenia following cytotoxic chemotherapy, radiotherapy or bone marrow transplant.
Pregnancy, lactation.
Nausea, abdominal pain, diarrhea, flatulence; rash.
Warfarin, oral sulfonylureas, phenytoin, rifampicin, cyclosporine, theophylline.

Griseofulvin.
Fungal infections of the skin, hair & nails.
Established porphyria; hepatocellular failure; SLE & related conditions; pregnancy.
Ability to drive & operate machinery may be impaired. Lactation. May damage sperm cells – male should not father childn w/ in 6 mth of treatment.
Urticarial reactions; rashes; headache, GI disturbances; dizziness, fatigue, granulocytopenia, leucopenia; photosensitivity; rarely, precipitation of SLE & related conditions, erythema multiforme, toxic epidermal necrolysis & related conditions, peripheral neuropathy, confusion w/ impaired co-ordination; oral candidiasis.
Absorption reduced by barbiturates. Effectiveness reduced by liver enzyme inducing drugs. Decreases anticoagulant effect of warfarin. Reduces effectiveness of OC. Enhancement of effects of alcohol.

Terbinafine HCI.
Fungal infections of the skin & nails caused by dermatophytes. Treatment of ringworm & yeast infections of the skin caused by Candida where oral therapy is considered appropriate owing to the site, severity or extent of the infection. Onychomycosis.
Severe liver or renal dysfunction (creatinine clearance < 50 mL/min or serum creatinine of >300 µmol/L) should receive a lower dose. Pregnancy, lactation.
GI symptoms, skin reactions.

Nystatin.
Intestinal, oral or other monillial infections during broad-spectrum antibiotic therapy.
GI disturbances.

Itraconazole.
Vulvovag candidosis, Dermatomycosis including pityriasis versicolor, palmar tinea manus & plantar tinea pedis, oral candidosis, fingernail onychomycosis, toenail onychomycosis.
Pegnancy, hypersensitivity.
Lactation, history of liver or renal disease, childn, decreased gastric acidity.
GI disturbances, headache.
Rifampicin & phenytoin reduce oral bioavailability of itraconazole. Inhibits metabolism of warfarin, digoxin, terfenadine, cyclosporine A, astemizole, disaoride, oral midazolam & triazolam.

h) Antibacterial Combinations

Co-trimoxazole: Trimethoprim (TM) & sulfamethoxazole (SMZ). Adult tab TM 80 mg, SMZ 400 mg. DS tab TM 160 mg, SMZ 800mg. Per 5 mL paed susp TM 40mg, SMZ 200 mg. Per 5 mL infusion amp TM 80 mg, SMZ 400 mg.
Resp tract, renal, GUT, GIT skin infections. Bacterial infections caused by wide range of sensitive organisms.
Hypersensitivity; marked liver parenchymal damage; except in certain circumstances, should not be given to patients w/ serious haematological disorders. Severe renal insufficiency. Premature babies or full-term infants in the neonatal period.
Discontinue if a skin rash appears. Renal impairment. Pregnancy & lactation.
Nausea, vomiting, diarrhea, glossitis & skin rashes. Rarely: pseudomembranous colitis. Infrequently: Severe skin sensitivity reactions.
Warfarin, phenytoin, pyrimethamine, thiazides (elderly).

Per tab/10mL susp- Trimethoprim 90 mg, sulfadiazine 410 mg.
Upper & lower resp tract, urogenital tract, GIT, skin & soft tissue infections & against penicillinase-producing organisms.
Severe renal or hepatic failure. Hypersensitivity to sulfonamide. Blood dyscrasias. Pregnancy & lactation. Infants < 2 mth. Porphyria.
Patients w/ folic acid deficiency, poor nutritional status or G6PD deficiency. Elderly & others w/ reduced kidney function.
Nausea, vomiting & allergic reactions.
Effects reduced by PABA or its derivatives. Increased incidence of thrombocytopenia w/ thiazide diuretics in elderly. May potentiate effects of methotrexate, warfarin, sulfonylurea.

i) Other Antibiotics

Clindamycin HCI hydrate.
Resp tract, skin & soft tissue infections & other serious infections caused by susceptible organisms.
Hypersensitivity to clindamycin or lincomycin.
History of GI disease, severe renal or liver impairment.
Diarrhea occasionally w/ acute colitis (discontinue), abdominal pain, GI upsets, skin reactions, jaundice, hematopoietic changes.
Antagonism w/ erythromycin.

Metronidazole.
Prophylaxis against anaerobic infection, Treatment of established anaerobic infection, acute ulcerative gingivitis.
If administered for > 10 days, haematological tests are recommended. Re-administer immediately w/ active disease of CNS except for brain abscess or hepatic encephalopathy. Pregnancy & lactation.
Unpleasant taste in mouth, furry tongue, GIT disturbances. Urticaria, angioedema. Drowsiness, dizziness, headache, ataxia, skin rashes, pruritus, darkening of urine. Peripheral neuropathy or transient epileptiform seizures (prolonged therapy). Leucopenia. Rarely, anaphylaxis.
lcohol may cause disulfiram-like reaction. Potentiates anticoagulant effect of warfarin-type oral anticoagulants. Phenobarb increases the metabolism of metronidazole. Plasma levels of lithium may be increased.

Na fusidate.
Treatment of infections caused by susceptible organisms esp Staph eg osteomyelitis, septicaemia, endocarditis, pneumonia, cutaneous infections, surgical & traumatic wound infections. Also other Staph infections including MRSA.
Hepatic insufficiency. Pregnancy & lactation.
GI disturbances.

Loracarbef.
Secondary bacterial infection of acute bronchitis, acute bacterial exacerbation of chronic bronchitis, pneumonia, sinusitis, uncomplicated pyelonephritis, pharyngitis/ tonsillitis, uncomplicated skin & skin structure infections, uncomplicated cystitis, acute otitis media, pharyngitis/ tonsillitis, skin & skin structure infection.
Hypersensitivity to loracarbef or cephalosporins.
Allergic reactions. Renal impairment. History of colitis.
Gl disturbances. Hypersensitivity. Headache, somnolence, nervourness, insomnia, dizziness.

Rifampicin.
Combination w/ other antibiotic/ chemotherapy agents in all forms of TB & leprosy. Non-mycobacterial infection w/ tetracycline in brucellosis. Prevention of meningococcal meningitis.
Hypersensitivity, jaundice.
Liver disease, undernourishment. Pregnancy, premature & newborn infant.
Reddish brown discolouration of body fluids, Gl disturbances, hepatic toxicity, induction of porphyria, renal failure & blood dyscrasias.
Impairment of efficacy of many drugs, eg OC, oral anticoagulant, digitals, sulfonylureas.

Sulbactam 500 mg, Cefoperazone 500 mg.
Resp tract infection, UTI, peritonitis, cholecystitis, cholangitis & other intra-abdominal infection, septicaemia, meningitis, skin & soft tissue infection, bone & joint infection, pelvic inflammatory disease, endometritis, gonorrhoea & other infections of the genital tract.
Known allergy to penicillins or cephalosporins.
Hepatic dysfunction & concomitant renal impairment; ingestion of alcoholic beverages;overgrowth of nonsusceptible organisms.
Diarrhea, nausea, vomiting; maculopapular rash, urticaria; eosinophilia; drug fever.

Per imipenem 250mg/ cilastatin 250 mg vial Imipenem 250mg, cilastatin Na 250 mg. Per imipenem 500 mg/ cilastatin 500 mg vial imipenem 500 mg, cilastatin Na 500 mg.
Intra-abdominal, lower resp tract, gynecological, GUT, bone & joint, skin & soft tissue & mixed infections, endocarditis, septicemia. Can be used as empiric therapy or prophylaxis.
Dosage adjustment in patients w/ renal insufficiency. Partial cross allergenicity w/ other ß-lactam antibiotics. History of Gl disease. Caution in patients w/ CNS disorders &/or compromised renal function in whom accumulation of drug could occur. If CNS symptoms occur, dosage of Tienam should be decreased or discontinued. Usage during pregnancy, lactation & childn< 3 mth or paed patients w/ impaired renal function (serum Cr > 2 mg/dL).
Thrombophlebitis, pain, induration, erythema & tenderness following inj. Rash, urticaria, pruritus, Gl disturbances, pseudomembranous colitis, haematological disturbances, increased in liver enzymes, taste perversion. Myoclonic activity, seizures, psychic disturbances, confusional states.
Ganciclovir.