Antibiotics in primary care setting Domina Petric MD

Antibiotics in primary care setting Domina Petric, MD

I. TETRACYCLINES 2/19/2021 Antibiotics 2

Doxycyclinum 100 mg capsules for children older then 12 years and adults 2/19/2021 Antibiotics 3

Indications: • acute exacerbation of chronic bronchitis and sinusitis • urinary tract infections (UTI) caused with E. coli, Klebsiella spp. , Enterobacter spp. , Streptoccocus faecalis 2/19/2021 Antibiotics 4

Indications: Sexually transmitted diseases (STD): • urethritis caused with Chlamydia trachomatis, Ureaplasma urealyticum • simple gonococcal infections • prostatitis • syphilis • lymphogranuloma venereum 2/19/2021 Antibiotics 5

Indications: • inclusion (chlamydial) conjunctivitis, trachoma • psittacosis • acne, acne rosacea • anthrax • actinomycosis • boreliosis (Laymes disease) 2/19/2021 Antibiotics 6

Indications: • • 2/19/2021 rickettsiosis shigellosis cholera amebiasis tularemia melidiosis brucellosis • • • nocardiosis leptospirosis Wipple´s disease • tropical sprue Antibiotics 7

Dose • First day of infection dose is 200 mg per os (at once or 100 mg twice a day). • Other days dose is 100 mg. • If it is severe infection, dose is always 200 mg. • Maximum dose is 300 mg. • Treatment duration is 24 -48 hours after symptoms withdrawal. 2/19/2021 Antibiotics 8

2/19/2021 Antibiotics 9

Contraindications: • hypersensitivity Children under the age of 12 years: • permanent teeth discoloration • bone development disorders • tooth enamel hypoplasia 2/19/2021 Antibiotics Oral. Answers. com 10

Precautions: • • • liver damage kidney damage severe skin reactions photosensitivity Clostridium difficile diarrhoea • esophagitis 2/19/2021 Antibiotics 11

Precautions: • benign intracranial hypertension • porphyria • Myasthenia gravis • systemic erythematous lupus • lactosis intolerance 2/19/2021 Antibiotics 12

Interactions: Warfarin! Increases the risk of bleeding. 2/19/2021 Antibiotics 13

Not recommended in pregnancy and lactation! 2/19/2021 Antibiotics 14

Side effects: • anemia, thrombocytopenia, neutropenia. . . • headaches, benign intracranial hypertension • tinnitus • gastrointenstinal problems 2/19/2021 Antibiotics 15

Side effects: • urea blood levels elevation • hypersensitivity reactions • liver and kidney damage rarely 2/19/2021 Antibiotics 16

II. BETA LACTAM ANTIBIOTICS 2/19/2021 Antibiotics 17

A) EXTENDED SPECTRUM BETA LACTAM ANTIBIOTICS 2/19/2021 Antibiotics 18

Amoxicillinum • • • Almacin a 500 mg Amoksicilin a 1000 mg. . . 2/19/2021 Antibiotics 19

Indications: • otitis media • acute exacerbation of chronic bronchitis • bronchopneumonia • cystitis • urethritis • pyelonephritis 2/19/2021 Antibiotics 20

Indications: • • bacteriuria in pregnancy puerperal sepsis gonorrhoea skin and soft tissues infections bacterial endocarditis abdominal tifus Helycobacter pylori 2/19/2021 Antibiotics 21

Dose: Adults: • 250 mg per os three times a day • in more severe infections, 500 mg three times a day • very difficult infections of respiratory tract, 3 g twice a day • urinary tract infections, two doses of 3 g • gonorrhea one dose of 3 g 2/19/2021 Antibiotics 22

Precautions: • • 2/19/2021 hypersensitivity kidney damage neonatal period lactosis intolerance Antibiotics 23

Interactions: Warfarin! Increases the risk of bleeding. 2/19/2021 Antibiotics 24

It can be used during pregnancy and lactation! 2/19/2021 Antibiotics 25

Common side effects: • • 2/19/2021 nausea vomiting urticaria pruritus Antibiotics 26

Amoxicillinum For children with body weight less then 40 kg: • Almacin 250 mg/5 m. L powder for oral suspension • one little spoon has 5 m. L • dose is 40 -90 mg/kg/day divided in two or three doses 2/19/2021 Antibiotics 27

Example • Child: 30 kg, mild infection Dose: • 50 mg x 30 kg=150 mg Result: 150 mg (3 m. L) • 75 mg (1, 5 m. L) twice a day OR • 50 mg (1 m. L) three times a day 2/19/2021 Antibiotics 28

B) PENICILLIN SENSITIVE ON BETA LACTAMASE 2/19/2021 Antibiotics 29

Phenoxymethylpenicillinum kalicum per os • • • Silapen K 1 000 i. j. Silapen K 1 500 000 i. j. Silapen K powder for oral suspension • Ospen K 1 000 i. j. • Ospen K 1 500 000 i. j. Three or four doses every 6 to 8 hours. 2/19/2021 Antibiotics 30

C) PENICILLIN RESISTENT ON BETA LACTAMASE 2/19/2021 Antibiotics 31

For parenteral application: cloxacillinum flucloxacillinum 2/19/2021 Antibiotics 32

D) COMBINATIONS WITH BETA LACTAMASE INHIBITORS 2/19/2021 Antibiotics 33

Combinations amoxicillinum and acidum clavulanicum (co-amoxiclav) piperacillinum and tazobactamum (for parenteral application) 2/19/2021 Antibiotics 34

Co-amoxiclav For oral application, adults: • 500 mg/125 mg • 875 mg/125 mg For oral application, children (BW less then 40 kg) • 400 mg + 57 mg/5 m. L powder for oral suspension 2/19/2021 Antibiotics 35

Indications: • • • acute bacterial sinusitis acute otitis media acute exacerbations of chronic bronchitis community acquired pneumonia cystitis pyelonephritis 2/19/2021 Antibiotics 36

Indications: • skin and soft tissues infections, cellulitis • tooth abscess with cellulitis • bones and joints infections • osteomyelitis 2/19/2021 Antibiotics 37

Dose for adults: • 500 mg/125 mg per os three times a day OR • 875 mg/125 mg per os twice a day 2/19/2021 Antibiotics 38

Children (400 mg + 57 mg/5 m. L) Age 2 months 2 years 2 -6 years (13 -21 kg) 7 -12 years (22 -40 kg) 2/19/2021 Moderate infections 0, 15 m. L/kg twice a day 2, 5 m. L twice a day Severe infections 0, 3 m. L/kg twice a day 5 m. L twice a day 10 m. L twice a day Antibiotics 39

III. CEPHALOSPORINS 2/19/2021 Antibiotics 40

A) FIRST GENERATION 2/19/2021 Antibiotics 41

First generation cephalosporins: cefazolinum (parenteral application) cefalexinum 2/19/2021 Antibiotics 42

Cefalexinum (oral application) adults: • • 250 mg OR 500 mg respiratory tract infections otitis media skin and soft tissues infections bones and joints infections UTI (including prostatitis) dental infections 2/19/2021 Antibiotics The best activity on GRAM POSITIVE BACTERIA! 43

Dose for adults 500 mg twice a day (every 12 hours) 2/19/2021 Antibiotics 44

Contraindications: hypersensitivity on cephalosporins or penicillin 2/19/2021 Antibiotics 45

Precautions: • pseudomembranous colitis • kidney damage • false positive direct Coomb´s test 2/19/2021 Antibiotics 46

2/19/2021 Antibiotics 47

Side effects: • • headache agitation halucinations pseudomembranous colitis pain in abdomen anal pruritus interstitial nephritis 2/19/2021 Antibiotics 48

Cefalexinum for children: • 250 mg/5 m. L powder for oral suspension • Dose is 25 -50 mg/kg/day up to maximum 100 mg/kg/day. For most infections: Children <5 years old 125 mg (2, 5 m. L) every 8 hours (three times a day) Children >5 years old 250 mg (5 m. L) every 8 hours (three times a day) In difficult infections dose can be double! 2/19/2021 Antibiotics 49

Cefalexinum for children: For otitis media: • 75 -100 mg/kg/day divided in four doses! Example: otitis media, child 20 kg • 80 mg x 20 kg = 1600 mg • 400 mg (8 m. L) every 6 hours 2/19/2021 Antibiotics 50

B) SECOND GENERATION: ACTIVITY ON BOTH POSITIVE AND NEGATIVE GRAM BACTERIA 2/19/2021 Antibiotics 51

Cefuroximum • acute streptococcal tonsillitis and pharyngitis • acute bacterial sinusitis • acute otitis media • acute exacerbations of chronic bronchitis • cystitis • pyelonephritis 2/19/2021 Antibiotics 52

Cefuroximum • simple skin and soft tissues infections • Laymes disease early stage 2/19/2021 Antibiotics 53

Dose (adults and children >40 kg) per os: Acute tonsillitis and pharyngitis, bacterial sinusitis 250 mg per os twice a day (every 12 hours) Acute otitis media 500 mg twice a day Acute exacerbations of chronic bronchitis 500 mg twice a day Cystitis 250 mg twice a day Pyelonephritis 250 -500 mg twice a day Skin and soft tissues infections 250 mg twice a day Laymes disease 500 mg twice a day, 14 days 2/19/2021 Antibiotics 54

2/19/2021 Antibiotics 55

Precautions • hypersensitivity • Jarisch-Herxheimer´s reaction • Candida albicans growth • pseudomembranous colitis 2/19/2021 Antibiotics 56

Can be used in pregnancy and lactation only if necessary. 2/19/2021 Antibiotics 57

Side effects: • Candida albicans growth • eosinophilia • headache • dizziness • liver enzimes elevation 2/19/2021 Antibiotics 58

Cefuroximum for children: Zinnat 125 mg/5 m. L granules for oral suspension 2/19/2021 Antibiotics 59

Cefuroximum for children (<40 kg) PER OS: Disease Dose Maximum dose Acute tonsillitis and pharyngitis, bacterial sinusitis 10 mg/kg twice a day 125 mg twice a day (5 m. L) twice a day Acute otitis media 15 mg/kg twice a 250 mg twice a day (10 m. L) twice a day (age>2 years) day Cystitis 15 mg/kg twice a day 250 mg twice a day Pyelonephritis 15 mg/kg twice a day 250 mg twice a day during 10 -14 days Skin and soft tissues infections 15 mg/kg twice a day 250 mg twice a day Laymes disease 15 mg/kg twice a day 250 mg twice a day during 10 -21 days 2/19/2021 Antibiotics 60

C) THIRD GENERATION: ACTIVITY MORE ON GRAM NEGATIVE BACTERIA 2/19/2021 Antibiotics 61

Ceftibutenum • pharyngitis, tonsilitis • scarlatina (adults, children) • acute sinusitis (adults) • otitis media (children) • acute exacerbation of chronic bronchitis • community-acquired pneumonia 2/19/2021 Antibiotics 62

Ceftibutenum • complicated and simple UTI in adults and children 2/19/2021 Antibiotics 63

Dose (adults, children >40 kg) • Dose is 400 mg per os once a day in most of the indications. • In community acquired pneumonia dose is 200 mg per os twice a day (every 12 hours). 2/19/2021 Antibiotics 64

Precautions: • • • hypersensitivity kidney damage chronic gastrointestinal diseases (chronic colitis) • pseudomembranous colitis 2/19/2021 Antibiotics 65

Interactions with warfarin. Check INR! No data for pregnant women. 2/19/2021 Antibiotics 66

Side effects: • vomiting • diarrhea • headache • . . . 2/19/2021 Antibiotics 67

Ceftibutenum for children: • Cedax 180 mg/5 m. L powder for oral suspension. • Dose is 9 mg/kg/day per os once a day (maximum 400 mg/day) in acute otitis media, UTI and tonsilitis, pharyngitis. Child: 20 kg, UTI • 20 kg x 9 mg = 180 mg (5 m. L) once a day 2/19/2021 Antibiotics 68

Cefiximum Dose for adults is 200 -400 mg per os a day (at once or in two doses) for: • respiratory tract infections with resistent bacteria • bronchitis, pneumonia • UTI • cervical/urethral gonorrhoea 2/19/2021 Antibiotics 69

Cefiximum for children <40 kg Cefexin 100 mg/5 m. L powder for oral suspension: • 8 mg/kg/day at once or divided in two doses Age of the child Dose 6 months to 1 year 3, 75 m. L a day (75 mg) 1 year to 4 years 5 m. L a day (100 mg) 5 years to 10 years 10 m. L a day (200 mg) 2/19/2021 Antibiotics 70

Cefpodoximum (Rexocef 100 mg/200 mg) per os: Disease Dose Sinusitis 200 mg twice a day (every 12 hours) Tonsillitis, pharyngitis 100 mg twice a day Acute bronchitis, pneumonia 100 -200 mg twice a day Lower UTI 100 mg twice a day Upper UTI 200 mg twice a day Gonococcal urethritis 200 mg once 2/19/2021 Antibiotics 71

Cefpodoximum for children <40 kg: Rexocef 40 mg/5 m. L powder for oral suspension: • 8 mg/kg/day twice a day (every 12 hours) 2/19/2021 Antibiotics 72

IV. TRIMETOPRIM SULFAMETOXAZOL (CO-TRIMOXAZOL) 2/19/2021 Antibiotics 73

For adults and children >40 kg: • Sinersul 400 mg + 80 mg per os • Sinersul Forte 800 mg + 160 mg per os 2/19/2021 Antibiotics 74

Co-trimoxazol for adults: Two tablets 400 mg/80 mg twice a day (every 12 hours) • OR One tablet 800 mg/160 mg twice a day every 12 hours 2/19/2021 Antibiotics 75

Indications: • prevention and treatment of Pneumocystis jiroveci pneumonia • prevention and treatment of toxoplasmosis • nocardiosis 2/19/2021 Antibiotics 76

Indications if there is sensitivity of bacteria on Co -trimoxazol and resistency on other antibiotics: • • • acute UTI acute otitis media acute exacerbation of chronic bronchitis 2/19/2021 Antibiotics 77

For children <40 kg: • Sinersul 200 mg + 40 mg/5 m. L syrup Age of the child 6 weeks to 5 months 6 months to 5 years 6 years to 12 years 2/19/2021 Dose 2, 5 m. L every 12 hours 10 m. L every 12 hours Antibiotics 78

Treatment: Usually 5 to 7 days: 24 -48 hours after symptoms withdrawal! 2/19/2021 Antibiotics 79

Contraindications: • • hypersensitivity severe liver damage severe kidney damage severe haematological disorders • megaloblastic anemia (folic acid deficiency) • preterm babies and all babies younger then 6 weeks 2/19/2021 Antibiotics 80

Interactions with warfarin. Check INR! Not recommended in pregnancy and lactation. 2/19/2021 Antibiotics 81

Side effects: • • • 2/19/2021 headache rash fungi overgrowth hypersensitivity. . . Antibiotics 82

V. MACROLIDE ANTIBIOTICS 2/19/2021 Antibiotics 83

Azithromycinum For adults: • Sumamed 500 mg tbl. • Sumamed 250 mg tbl. For children: • Sumamed 100 mg/5 m. L • Sumamed Forte 200 mg/5 m. L 2/19/2021 Antibiotics 84

Indications and dose for adults: Upper and lower respiratory tract infections: • 500 mg per os once a day for three days (1500 mg) 2/19/2021 Antibiotics 85

Indications and dose for adults: Acne vulgaris: • 500 mg per os once a day during three days • 500 mg once a day during nine weeks 2/19/2021 Antibiotics 86

Indications and dose for adults: Erythema migrans (Laymes disease): • 1 g (2 x 500 mg) per os at once, then 500 mg per os once a day from second to fifth day of the treatment 2/19/2021 Antibiotics 87

Indications and dose for adults: Erysipelas, impetigo, pyoderma: • 500 mg per os once a day during three days 2/19/2021 Antibiotics 88

Indications and dose for adults: Chlamydia trachomatis urethritis, cervicitis: • 1 g once (2 x 500 mg) per os 2/19/2021 Antibiotics 89

Indications: • Helicobacter pylori infections • C. trachomatis chronic prostatitis 2/19/2021 Antibiotics 90

Dose in children (powder for oral suspension): Body weight in kilograms Sumamed 100 mg/5 m. L 5 2, 5 m. L (50 mg) 6 3 m. L (60 mg) 7 3, 5 m. L (70 mg) 8 4 m. L (80 mg) 9 4, 5 m. L (90 mg) 10 -14 5 m. L (100 mg) Sumamed Forte 200 mg/5 m. L 2, 5 m. L (100 mg) 15 -24 5 m. L (200 mg) 25 -34 7, 5 m. L (300 mg) 35 -44 10 m. L (400 mg) Treatment duration: three days! 2/19/2021 Antibiotics 91

2/19/2021 Antibiotics 92

Side effects: • • 2/19/2021 headache pain in stomach vomiting nausea lymphopenia eosinophilia diarrhoea. . . Antibiotics 93

Erythromycinum • Eritromicin 250 mg tbl. • For children age more then 8 years and adults: Mild to moderate infections 250 mg four times a day (1 g) Severe infections 1 g four times a day Bacterial endocarditis prophylaxis 1 g one hour before the procedure and 500 mg six hours later Rheumatic fever prophylaxis 250 mg every 12 hours Treatment duration can vary from 7 to 14 days depending on indication. 2/19/2021 Antibiotics 94

Clarithromycinum For adults and children age more the 12 years: • most infections of respiratory tract 250 mg per os every 12 hours • if Haemophilus influenzae, 500 mg per os every 12 hours • during 6 to 14 days 2/19/2021 Antibiotics 95

Clarithromycinum Mycobacterium avium complex: • 500 mg per os every 12 hours • therapy is usually long 2/19/2021 Antibiotics 96

Clarithromycinum • For children <40 kg: Fromilid 125 mg/5 m. L granules 2/19/2021 Body weight in kg 8 16 24 Dose 2, 5 m. L twice a day 7, 5 m. L twice a day 33 10 m. L twice a say Antibiotics 97

VI. QUINOLONE ANTIBIOTICS 2/19/2021 Antibiotics 98

Ciprofloxacinum (for adults) Most infections of upper and lower respiratory tract: • 500 -750 mg per os twice a day (every 12 hours) during 10 -14 days Severe external ear infection: • 750 mg per os twice a day during 28 days up to 3 months 2/19/2021 Antibiotics 99

Ciprofloxacinum (for adults) UTI: • cystitis: 500 mg per os twice a day during 3 days • pyelonephritis: 500 mg per os twice a day during 7 days up to 21 days • acute prostatitis: 500 mg twice a day for 2 -4 weeks • chronic prostatitis: 750 mg twice a day for 6 weeks 2/19/2021 Antibiotics 100

Ciprofloxacinum (for adults) • Skin and soft tissues infections: 500 mg per os twice a day during 7 -14 days. • Bones and joints infections: 500 mg per os twice a day during maximum three months. 2/19/2021 Antibiotics 101

Ciprofloxacinum (for adults) Intraabdominal and intestinal infections (cholera, shigella, typhus): • 500 mg twice a day during 3 to 14 days depending on the bacteria • if gram negative bacteria, 750 mg twice a day 2/19/2021 Antibiotics 102

Check INR if patient is on warfarin! Not recommended in pregnancy and during lactation. 2/19/2021 Antibiotics 103

fluoroquinolones 2/19/2021 Antibiotics 104

Literature: • Mediately. com • HALMED 2/19/2021 Antibiotics 105