Impact of piperacillin resistance on the outcome of Pseudomonas ventilator-associated pneumonia.
Sept 7, 2006
Combes A,
Luyt CE,
Fagon JY,
Wolff M,
Trouillet JL,
Chastre J.
Groupe Hospitalier Pitie-Salpetriere, Assistance Publique, Hopitaux de Paris Universite Pierre et Marie Curie, Paris 6, Service de Reanimation Medicale, Institut de Cardiologie, 47, boulevard de l'Hopital, 75651, Paris Cedex 13, France, alain.combes@psl.aphp.fr.
BACKGROUND:
The impact of antibiotic resistance on the outcome of infections due to Gram-negative bacilli, especially Pseudomonas, remains highly controversial.
STUDY OBJECTIVE, DESIGN, AND PATIENTS:
We evaluated the impact of piperacillin resistance on the outcomes of Pseudomonas aeruginosa ventilator-associated pneumonia (VAP) for patients who had received appropriate empiric antibiotics before enrollment in the PNEUMA trial, a multicenter randomized study comparing 8 vs 15[Symbol: see text]days of antibiotics.
RESULTS:
Despite similar characteristics at intensive care unit (ICU) admission, patients infected with piperacillin-resistant Pseudomonas strains were more acutely ill at VAP onset and had a higher 28-day mortality rate (37 vs 19%; P[Symbol: see text]=[Symbol: see text]0.04) than those with piperacillin-susceptible Pseudomonas VAP. Factors associated with 28-day mortality retained by multivariable analysis were: age (OR: 1.07; 95% CI: 1.03-1.12); female gender (OR: 4.00; 95% CI: 1.41-11.11); severe underlying comorbidities (OR: 2.73; 95% CI: 1.02-7.33); and SOFA score (OR: 1.17; 95% CI: 1.03-1.32), but piperacillin resistance did not reach statistical significance (OR: 2.00; 95% CI: 0.72-5.61). The VAP recurrence rates, either superinfection or relapse, and durations of mechanical ventilation and ICU stay did not differ as a function of Pseudomonas-resistance status.
CONCLUSIONS:
For patients with Pseudomonas VAP benefiting from appropriate empiric antibiotics, piperacillin resistance was associated with increased disease severity at VAP onset and higher 28-day crude mortality; however, after controlling for confounders, piperacillin-resistance was no longer significantly associated with 28-day mortality. The VAP recurrence rates and durations of ICU stay and mechanical ventilation did not differ for susceptible and resistant strains.
PMID: 16957901 [PubMed - as supplied by publisher]
Friday, September 08, 2006
Friday, September 01, 2006
Antibiotics and Severe pseudomonal infections.
Antibiotics and Severe pseudomonal infections.
Curr Opin Crit Care. 2006 Oct;12(5):458-63.
Mutlu GM,
Wunderink RG.
Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
PURPOSE OF REVIEW:
To review the most recent data on severe Pseudomonas aeruginosa infections. The focus will be on clinical studies with an emphasis on the critically ill.
RECENT FINDINGS:
The frequency of P. aeruginosa as the etiologic agent of infections associated with high morbidity and mortality in hospitalized patients continues to increase. Unfortunately, pan-resistant isolates are now emerging as a significant clinical problem. Highly or pan-resistant isolates are associated with more frequent inappropriate initial therapy and increased mortality. Prevention relies on limitation of antibiotic pressure. Unfortunately, antibiotic class rotation has not resulted in persistent decreases in resistant isolates and the increased use of treatment protocols may actually increase selection.
SUMMARY:
Because of the frequency of antibiotic resistance in clinical isolates of P. aeruginosa and the high associated mortality, combination, broad-spectrum antibiotic therapy should be used for empiric coverage of suspected P. aeruginosa infections. Accurate diagnostic testing can help to discontinue unnecessary antibiotics and decrease the overall selective pressure. Increasing resistance without new antibiotic classes on the horizon suggests the need for better use of available antibiotics and an emphasis on innovative treatment strategies in the future.
PMID: 16943726 [PubMed - in process]
Curr Opin Crit Care. 2006 Oct;12(5):458-63.
Mutlu GM,
Wunderink RG.
Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
PURPOSE OF REVIEW:
To review the most recent data on severe Pseudomonas aeruginosa infections. The focus will be on clinical studies with an emphasis on the critically ill.
RECENT FINDINGS:
The frequency of P. aeruginosa as the etiologic agent of infections associated with high morbidity and mortality in hospitalized patients continues to increase. Unfortunately, pan-resistant isolates are now emerging as a significant clinical problem. Highly or pan-resistant isolates are associated with more frequent inappropriate initial therapy and increased mortality. Prevention relies on limitation of antibiotic pressure. Unfortunately, antibiotic class rotation has not resulted in persistent decreases in resistant isolates and the increased use of treatment protocols may actually increase selection.
SUMMARY:
Because of the frequency of antibiotic resistance in clinical isolates of P. aeruginosa and the high associated mortality, combination, broad-spectrum antibiotic therapy should be used for empiric coverage of suspected P. aeruginosa infections. Accurate diagnostic testing can help to discontinue unnecessary antibiotics and decrease the overall selective pressure. Increasing resistance without new antibiotic classes on the horizon suggests the need for better use of available antibiotics and an emphasis on innovative treatment strategies in the future.
PMID: 16943726 [PubMed - in process]
Saturday, August 26, 2006
Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections.
Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections.
Li J,
Nation RL,
Turnidge JD,
Milne RW,
Coulthard K,
Rayner CR,
Paterson DL.
Facility for Anti-infective Drug Development and Innovation, Victorian College of Pharmacy, Monash University, Parkville, Victoria, Australia.
Increasing multidrug resistance in Gram-negative bacteria, in particular Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, presents a critical problem. Limited therapeutic options have forced infectious disease clinicians and microbiologists to reappraise the clinical application of colistin, a polymyxin antibiotic discovered more than 50 years ago.
We summarise recent progress in understanding the complex chemistry, pharmacokinetics, and pharmacodynamics of colistin, the interplay between these three aspects, and their effect on the clinical use of this important antibiotic. Recent clinical findings are reviewed, focusing on evaluation of efficacy, emerging resistance, potential toxicities, and combination therapy.
In the battle against rapidly emerging bacterial resistance we can no longer rely entirely on the discovery of new antibiotics; we must also pursue rational approaches to the use of older antibiotics such as colistin.
PMID: 16931410 [PubMed - in process]
Related Articles
Evaluation of colistin as an agent against multi-resistant Gram-negative bacteria.
Li J,
Nation RL,
Turnidge JD,
Milne RW,
Coulthard K,
Rayner CR,
Paterson DL.
Facility for Anti-infective Drug Development and Innovation, Victorian College of Pharmacy, Monash University, Parkville, Victoria, Australia.
Increasing multidrug resistance in Gram-negative bacteria, in particular Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, presents a critical problem. Limited therapeutic options have forced infectious disease clinicians and microbiologists to reappraise the clinical application of colistin, a polymyxin antibiotic discovered more than 50 years ago.
We summarise recent progress in understanding the complex chemistry, pharmacokinetics, and pharmacodynamics of colistin, the interplay between these three aspects, and their effect on the clinical use of this important antibiotic. Recent clinical findings are reviewed, focusing on evaluation of efficacy, emerging resistance, potential toxicities, and combination therapy.
In the battle against rapidly emerging bacterial resistance we can no longer rely entirely on the discovery of new antibiotics; we must also pursue rational approaches to the use of older antibiotics such as colistin.
PMID: 16931410 [PubMed - in process]
Related Articles
Evaluation of colistin as an agent against multi-resistant Gram-negative bacteria.
Sunday, August 20, 2006
Efficacy and safety of Sultamicillin and Amoxicillin/Clavulanic Acid in the treatment of upper respiratory tract infections
[Efficacy and safety of Sultamicillin (Ampicillin/Sulbactan) and Amoxicillin/Clavulanic Acid in the treatment of upper respiratory tract infections in adults: an open-label, multicentric, randomized trial.]
Feb 2006
Ferreira JB,
Rapoport PB,
Sakano E,
Kos AO,
Piltcher OB,
Pignatari SS,
Pinheiro SD,
Mocellin M.
Servico de Otorrinolaringologia, Depto. de Cirurgia, Faculdade de Medicina, UFG.
Upper respiratory tract infections are the most common causes of medical visits in children and adults, demanding massive use of antibiotics. Bacterial resistance caused by beta-lactamase is one of the most serious problems in this matter. Sultamicillin, a double pro-drug of Ampicillin/Sulbactan, is a potent beta-lactamase inhibitor which can face this challenge. AIM: evaluate efficacy, safety and tolerability of Ampicillin/Sulbactan compared to Amoxicillin/Clavulanate in upper respiratory tract infections in adults.
METHODS:
102 patients were enrolled and randomized to receive Ampicillin/Sulbactan or Amoxicillin/Clavulanate during 10 days. They were evaluated 10 and 30 days after treatment to learn about the therapeutic response.
RESULTS:
There were no differences between the two groups respecting cure at the end of treatment (visit 2) or at the end of the study (visit 3). Cure ratio was 61.7% and 93.2% (visits 2 and 3) in the Amoxicillin/Clavulanate group compared to 64.4% and 97.4%, respectively, in Ampicillin/Sulbactan group. The adverse events ratio for the two groups was the same (p=0.940). The number of patients with diarrhea was greater in the group of patients receiving Amoxicillin/Clavulanate (70.6%) than in the group receiving Ampicillin/Sulbactan (29.4%) (p=0.0164).
CONCLUSIONS:
Ampicillin/Sulbactan is as safe and efficient as Amoxicillin/Clavulanate in the empiric treatment of upper respiratory infections in adults. The low occurrence of diarrhea in the group receiving Ampicillin/Sulbactan needs confirmation in other studies.
PMID: 16917560 [PubMed - in process]
Monday, August 14, 2006
Antibiotics / anti-inflammatories for reducing acute inflammatory episodes in lymphoedema of the limbs.
Antibiotics / anti-inflammatories for reducing acute inflammatory episodes in lymphoedema of the limbs.
Badger C,
Seers K,
Preston N,
Mortimer P.
BACKGROUND: Lymphoedema is a chronic and progressive condition and current debate revolves around the best course of management for infective/inflammatory episodes.
OBJECTIVES: To determine whether antibiotic/anti-inflammatory drugs given prophylactically reduce the number and severity of infective/inflammatory episodes in patients with lymphoedema.
SEARCH STRATEGY: We searched the Cochrane Breast Cancer Group register in September 2003, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), CINAHL, MEDLINE, PASCAL, SIGLE, UnCover, reference lists produced by The British Lymphology Society, the National Research Register (NRR) and the International Society of Lymphology congress proceedings.
SELECTION CRITERIA: Types of studies considered for review were randomised controlled trials testing an antibiotic or anti-inflammatory drug against placebo (with or without physical therapies). DATA
COLLECTION AND ANALYSIS: Eligibility for inclusion was confirmed by two blinded reviewers who screened the papers independently using a checklist of criteria relating to the randomisation and blinding of a trial. Both reviewers extracted data from the eligible studies using a data extraction form.
MAIN RESULTS: Overall, four studies (364 randomised patients) were included. Two of these studied the effects of intensive physical treatment plus selenium or placebo in preventing AIE, and two studied the effects of Ivermectin, Diethylcarbamazine (DEC) (anti-filarial agents) and penicillin as prophylactic treatment for adeno lymphangitis(ADL) versus placebo.Both selenium trials reported no inflammatory episodes during the trial period in the treated group but one case of infection in the two placebo groups respectively during the first three weeks of each trial. Seven additional cases of infection in trial one and 14 cases in trial two required treatment in the three month follow up period.One anti filarial trial reported a total of 127 ADL episodes for all groups during the treatment year (compared with 684 episodes reported for the same participants during the pre-treatment year). Another 228 ADL episodes were reported during the trial follow-up year but no significant differences were found between the three groups. No apparent link was found between the grade of oedema and the frequency of ADL episodes. However, there was a significant link between increased episodes and the rainy season. In the penicillin group the mean number of inflammatory episodes was reduced from 4.6 to 0.5 after treatment and increased to 1.9 at the end of the follow-up year.
REVIEWERS' CONCLUSIONS: The effectiveness of selenium in preventing AIE in lymphoedema remains inconclusive in the absence of properly conducted randomised controlled trials. Anti-filarials (DEC and Ivermectin) do not appear to reduce ADL episodes in filarial lymphoedema. Foot care may be important in reducing ADL episodes, and penicillin appears to contribute to a significant reduction in ADL, when combined with foot-care. It seems reasonable to emphasise the importance of foot-care to patients and practitioners in preventing infection and this may also apply to care of the arm in women who develop lymphoedema following breast cancer treatment. However, properly conducted trials are needed to demonstrate any efficacy of these interventions.
PMID: 15106193 [PubMed - indexed for MEDLINE]
Badger C,
Seers K,
Preston N,
Mortimer P.
BACKGROUND: Lymphoedema is a chronic and progressive condition and current debate revolves around the best course of management for infective/inflammatory episodes.
OBJECTIVES: To determine whether antibiotic/anti-inflammatory drugs given prophylactically reduce the number and severity of infective/inflammatory episodes in patients with lymphoedema.
SEARCH STRATEGY: We searched the Cochrane Breast Cancer Group register in September 2003, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), CINAHL, MEDLINE, PASCAL, SIGLE, UnCover, reference lists produced by The British Lymphology Society, the National Research Register (NRR) and the International Society of Lymphology congress proceedings.
SELECTION CRITERIA: Types of studies considered for review were randomised controlled trials testing an antibiotic or anti-inflammatory drug against placebo (with or without physical therapies). DATA
COLLECTION AND ANALYSIS: Eligibility for inclusion was confirmed by two blinded reviewers who screened the papers independently using a checklist of criteria relating to the randomisation and blinding of a trial. Both reviewers extracted data from the eligible studies using a data extraction form.
MAIN RESULTS: Overall, four studies (364 randomised patients) were included. Two of these studied the effects of intensive physical treatment plus selenium or placebo in preventing AIE, and two studied the effects of Ivermectin, Diethylcarbamazine (DEC) (anti-filarial agents) and penicillin as prophylactic treatment for adeno lymphangitis(ADL) versus placebo.Both selenium trials reported no inflammatory episodes during the trial period in the treated group but one case of infection in the two placebo groups respectively during the first three weeks of each trial. Seven additional cases of infection in trial one and 14 cases in trial two required treatment in the three month follow up period.One anti filarial trial reported a total of 127 ADL episodes for all groups during the treatment year (compared with 684 episodes reported for the same participants during the pre-treatment year). Another 228 ADL episodes were reported during the trial follow-up year but no significant differences were found between the three groups. No apparent link was found between the grade of oedema and the frequency of ADL episodes. However, there was a significant link between increased episodes and the rainy season. In the penicillin group the mean number of inflammatory episodes was reduced from 4.6 to 0.5 after treatment and increased to 1.9 at the end of the follow-up year.
REVIEWERS' CONCLUSIONS: The effectiveness of selenium in preventing AIE in lymphoedema remains inconclusive in the absence of properly conducted randomised controlled trials. Anti-filarials (DEC and Ivermectin) do not appear to reduce ADL episodes in filarial lymphoedema. Foot care may be important in reducing ADL episodes, and penicillin appears to contribute to a significant reduction in ADL, when combined with foot-care. It seems reasonable to emphasise the importance of foot-care to patients and practitioners in preventing infection and this may also apply to care of the arm in women who develop lymphoedema following breast cancer treatment. However, properly conducted trials are needed to demonstrate any efficacy of these interventions.
PMID: 15106193 [PubMed - indexed for MEDLINE]
Thursday, August 10, 2006
WHO issues guidelines on use of cotrimoxazole prophylaxis
WHO issues guidelines on use of cotrimoxazole prophylaxis
Theo Smart, Thursday, August 10, 2006
Cotrimoxazole prophylaxis should be widely used by people with progressing HIV disease and by all HIV-infected or exposed infants (until it is clear that they are uninfected) according to guidelines issued this week by the World Health Organization (WHO).
In fact, where HIV prevalence is high, infectious diseases common and healthcare infrastructure is limited, governments may want to consider simply giving cotrimoxazole to everyone with HIV and to infants known or suspected of having been exposed to HIV, says WHO.
Background on cotrimoxazole prophylaxis Cotrimoxazole prophylaxis has long been part of the standard care for people living with advanced HIV disease in industrialised countries, where it is primarily used to prevent illnesses such as Pneumocystis jiroveci pneumonia (PCP) and toxoplasmosis. Studies have also shown that cotrimoxazole prophylaxis prevents infections and prolongs life in resource-limited settings. However, even though the treatment is simple, quite inexpensive and potentially life-saving, most countries have been slow to adopt or implement cotrimoxazole prophylaxis as a routine part of their HIV programmes for a number of reasons.
There were several reasons for this. Firstly, PCP and toxoplasmosis are not as common in resource-limited countries — where people with HIV usually first die from other illnesses. Also, there were concerns about fostering resistance to the drug (a widely used antibiotic) and cross-resistance to sulfadoxine/pyrimethamine (used to treat malaria). In fact, in some parts of Africa, there are already high levels of bacterial resistance to cotrimoxazole — until recently, there was little evidence to show that cotrimoxazole prophylaxis would be effective in such settings. Furthermore, clinical studies were needed to answer questions about the safety and practical aspects of using cotrimoxazole in infants or pregnant women.
Finally, although WHO had put out a provisional statement on the use of cotrimoxazole in 2000, it has never previously issued clear technical guidelines on the operational aspects of implementing cotrimoxazole prophylaxis, especially in the context of scaling up HIV care in resource-limited settings. However, over the last several years, the evidence base in support of cotrimoxazole prophylaxis has strengthened considerably. For instance, new studies have shown that PCP, which cotrimoxazole can prevent, is the leading cause of death in infants with HIV in all settings (and the incidence peaks during the first six months of life). Other new evidence has been drawn from recent clinical trials and observational cohort studies in a wide range of populations and settings, even in regions where malaria is endemic and background resistance to cotrimoxazole is common. Consistently, the studies have shown that cotrimoxazole prophylaxis reduces mortality and morbidity in adults, children and infants.
The new WHO guidelines review the clinical evidence as well as essential information needed to use cotrimoxazole safely; with annexes that summarise the criteria for recognising HIV-related clinical events used in the WHO staging system of HIV disease, as well as how to grade the seriousness of adverse events that may occur in persons taking cotrimoxazole.
Recommendations in infants and children It is especially important that infants with, or suspected of having, HIV receive cotrimoxazole during the first six months of their life. Cotrimoxazole prophylaxis is recommended for all HIV-exposed infants starting at 4–6 weeks of age (or at first encounter with the healthcare system) and should be continued until HIV infection can be excluded by HIV antibody testing (beyond 18 months of age) or virological testing (before 18 months of age) at least six weeks after complete cessation of breastfeeding.
Cotrimoxazole prophylaxis is recommended for all HIV-infected infants below one year of age regardless of symptoms or CD4 percentage. Treatment should continue until they are at least five years of age regardless of clinical symptoms or CD4 percentage or whether they have had a good immune response on antiretroviral therapy.
For children between one to four years old, cotrimoxazole prophylaxis is recommended for all children with WHO stage II, III or IV disease, or all children with a CD4 cell% <>
For children aged five or older, see adult recommendations in terms of starting or stopping cotrimoxazole prophylaxis. In settings with limited infrastructure and high child mortality and HIV prevalence — and where HIV screening may not be possible, WHO recommends a universal option: giving cotrimoxazole to all children born to mothers with or suspected of having HIV.
However, cotrimoxazole should not be given to young children who have (or have a history of) severe adverse reactions (grade 4 reactions) to cotrimoxazole or other sulfa-containing drugs and children with glucose-6-phosphate dehydrogenase (although WHO does not recommend routine screening for glucose-6-phosphate dehydrogenase deficiency in resource limited settings). If a child cannot take cotrimoxazole, dapsone 2 mg/kg once daily should be used. Recommendations in adolescents and adults Where CD4 cell counts are available, WHO recommends that everyone with CD4 cell counts below 350 should take cotrimoxazole prophylaxis whether they have symptoms or not. In addition, those with stage III and IV disease should take cotrimoxazole regardless of their CD4 cell count.
Where CD4 cell counts are not available, cotrimoxazole prophylaxis should be taken by everyone with mild, advanced or severe symptoms of HIV disease (WHO stage II, III or IV disease).
Where infrastructure is even more limited, and HIV prevalence is high, WHO says countries can consider offering cotrimoxazole to everyone who tests HIV-positive.
Cotrimoxazole is recommended to HIV-positive pregnant women, regardless of the stage of pregnancy and should continue while she is breastfeeding. Women with HIV who live in an area where there is malaria, should take cotrimoxazole rather than sulfadoxine/pyrimethamine–based intermittent presumptive therapy for malaria.
For people with HIV who qualify for antiretroviral therapy, WHO recommends that they start cotrimoxazole two weeks before their ART regimen — in case there is rash or any other adverse reaction.
In industrialised countries, it is considered safe to discontinue cotrimoxazole in response to effective antiretroviral treatment (that increases the CD4 cell count to over 200). However, in resource limited settings where the primary causes of mortality are malaria or bacterial infections that strike people down with much higher CD4 cell counts, WHO’s “general recommendation is to continue cotrimoxazole prophylaxis among adults living with HIV indefinitely.” Even so, the guidelines (perhaps prematurely considering the evidence base) discuss the alternatives, such as discontinuing cotrimoxazole once the CD4 cell count has been over 350 for at least six months. Recommended daily dosing: For infants below 6 months or <>30 kgs (800 mg/160 mg)
Cotrimoxazole suspension contains 200 mg/40 mg per 5 ml of syrup. Single strength tablets contain 400 mg/80 mg, double strength tablet twice that. It is possible to divide the tablets for children and infants.
Theo Smart, Thursday, August 10, 2006
Cotrimoxazole prophylaxis should be widely used by people with progressing HIV disease and by all HIV-infected or exposed infants (until it is clear that they are uninfected) according to guidelines issued this week by the World Health Organization (WHO).
In fact, where HIV prevalence is high, infectious diseases common and healthcare infrastructure is limited, governments may want to consider simply giving cotrimoxazole to everyone with HIV and to infants known or suspected of having been exposed to HIV, says WHO.
Background on cotrimoxazole prophylaxis Cotrimoxazole prophylaxis has long been part of the standard care for people living with advanced HIV disease in industrialised countries, where it is primarily used to prevent illnesses such as Pneumocystis jiroveci pneumonia (PCP) and toxoplasmosis. Studies have also shown that cotrimoxazole prophylaxis prevents infections and prolongs life in resource-limited settings. However, even though the treatment is simple, quite inexpensive and potentially life-saving, most countries have been slow to adopt or implement cotrimoxazole prophylaxis as a routine part of their HIV programmes for a number of reasons.
There were several reasons for this. Firstly, PCP and toxoplasmosis are not as common in resource-limited countries — where people with HIV usually first die from other illnesses. Also, there were concerns about fostering resistance to the drug (a widely used antibiotic) and cross-resistance to sulfadoxine/pyrimethamine (used to treat malaria). In fact, in some parts of Africa, there are already high levels of bacterial resistance to cotrimoxazole — until recently, there was little evidence to show that cotrimoxazole prophylaxis would be effective in such settings. Furthermore, clinical studies were needed to answer questions about the safety and practical aspects of using cotrimoxazole in infants or pregnant women.
Finally, although WHO had put out a provisional statement on the use of cotrimoxazole in 2000, it has never previously issued clear technical guidelines on the operational aspects of implementing cotrimoxazole prophylaxis, especially in the context of scaling up HIV care in resource-limited settings. However, over the last several years, the evidence base in support of cotrimoxazole prophylaxis has strengthened considerably. For instance, new studies have shown that PCP, which cotrimoxazole can prevent, is the leading cause of death in infants with HIV in all settings (and the incidence peaks during the first six months of life). Other new evidence has been drawn from recent clinical trials and observational cohort studies in a wide range of populations and settings, even in regions where malaria is endemic and background resistance to cotrimoxazole is common. Consistently, the studies have shown that cotrimoxazole prophylaxis reduces mortality and morbidity in adults, children and infants.
The new WHO guidelines review the clinical evidence as well as essential information needed to use cotrimoxazole safely; with annexes that summarise the criteria for recognising HIV-related clinical events used in the WHO staging system of HIV disease, as well as how to grade the seriousness of adverse events that may occur in persons taking cotrimoxazole.
Recommendations in infants and children It is especially important that infants with, or suspected of having, HIV receive cotrimoxazole during the first six months of their life. Cotrimoxazole prophylaxis is recommended for all HIV-exposed infants starting at 4–6 weeks of age (or at first encounter with the healthcare system) and should be continued until HIV infection can be excluded by HIV antibody testing (beyond 18 months of age) or virological testing (before 18 months of age) at least six weeks after complete cessation of breastfeeding.
Cotrimoxazole prophylaxis is recommended for all HIV-infected infants below one year of age regardless of symptoms or CD4 percentage. Treatment should continue until they are at least five years of age regardless of clinical symptoms or CD4 percentage or whether they have had a good immune response on antiretroviral therapy.
For children between one to four years old, cotrimoxazole prophylaxis is recommended for all children with WHO stage II, III or IV disease, or all children with a CD4 cell% <>
For children aged five or older, see adult recommendations in terms of starting or stopping cotrimoxazole prophylaxis. In settings with limited infrastructure and high child mortality and HIV prevalence — and where HIV screening may not be possible, WHO recommends a universal option: giving cotrimoxazole to all children born to mothers with or suspected of having HIV.
However, cotrimoxazole should not be given to young children who have (or have a history of) severe adverse reactions (grade 4 reactions) to cotrimoxazole or other sulfa-containing drugs and children with glucose-6-phosphate dehydrogenase (although WHO does not recommend routine screening for glucose-6-phosphate dehydrogenase deficiency in resource limited settings). If a child cannot take cotrimoxazole, dapsone 2 mg/kg once daily should be used. Recommendations in adolescents and adults Where CD4 cell counts are available, WHO recommends that everyone with CD4 cell counts below 350 should take cotrimoxazole prophylaxis whether they have symptoms or not. In addition, those with stage III and IV disease should take cotrimoxazole regardless of their CD4 cell count.
Where CD4 cell counts are not available, cotrimoxazole prophylaxis should be taken by everyone with mild, advanced or severe symptoms of HIV disease (WHO stage II, III or IV disease).
Where infrastructure is even more limited, and HIV prevalence is high, WHO says countries can consider offering cotrimoxazole to everyone who tests HIV-positive.
Cotrimoxazole is recommended to HIV-positive pregnant women, regardless of the stage of pregnancy and should continue while she is breastfeeding. Women with HIV who live in an area where there is malaria, should take cotrimoxazole rather than sulfadoxine/pyrimethamine–based intermittent presumptive therapy for malaria.
For people with HIV who qualify for antiretroviral therapy, WHO recommends that they start cotrimoxazole two weeks before their ART regimen — in case there is rash or any other adverse reaction.
In industrialised countries, it is considered safe to discontinue cotrimoxazole in response to effective antiretroviral treatment (that increases the CD4 cell count to over 200). However, in resource limited settings where the primary causes of mortality are malaria or bacterial infections that strike people down with much higher CD4 cell counts, WHO’s “general recommendation is to continue cotrimoxazole prophylaxis among adults living with HIV indefinitely.” Even so, the guidelines (perhaps prematurely considering the evidence base) discuss the alternatives, such as discontinuing cotrimoxazole once the CD4 cell count has been over 350 for at least six months. Recommended daily dosing: For infants below 6 months or <>30 kgs (800 mg/160 mg)
Cotrimoxazole suspension contains 200 mg/40 mg per 5 ml of syrup. Single strength tablets contain 400 mg/80 mg, double strength tablet twice that. It is possible to divide the tablets for children and infants.
Sunday, August 06, 2006
Carbapenems
Carbapenems
Carbapenems are a class of beta-lactam antibiotics.
The following drugs belong to the carbapenem class:
Imipenem (often given as part of Imipenem/cilastatin)
Meropenem
Ertapenem
Faropenem
Doripenem
External Links
Structure Activity Relationships "Antibacterial Agents; Structure Activity Relationships," André Bryskier MD; beginning at pp131
Carbapenems
* * * * *
Carbapenems
Imipenem/Cilastatin(Primaxin)
Mechanism of action
Inhibits bacterial cell wall synthesis. Cilastatin blocks metabolism of imipenem.
Spectrum of activity
Gram-negative (including P aeruginosa); Gram-positive (including some enterococci); not MRSA; Anaerobes including Bacteroides fragilis
Half-life
1 h
Metabolism
In kidney by dehydropeptidase. Blocked by cilastatin
Excretion
70% unchanged in urine
Clinical Side effects
GI, phlebitis, neurologic (seizures <>
Laboratory abnormalities
Increased LFTs, other rare events
Mechanism of drug interactions
No CYP-450 interactions. Probenecid increases levels
Other considerations
Significant dosage adjustment in renal insufficincy
Approved indications
Intra-abdominal infection, lower respiratory tract infection, UTI, gynecologic infection, bacterial septicemia, bone, joint, and skin infections, endocarditis, polymicrobic infections
Usual Dose
500 mg q6h, adjusted for renal function
----------
Meropenem(Merrem)
Mechanism of action
Ertapenem(Invanz)
Mechanism of action
Carbapenems are a class of beta-lactam antibiotics.
The following drugs belong to the carbapenem class:
Imipenem (often given as part of Imipenem/cilastatin)
Meropenem
Ertapenem
Faropenem
Doripenem
External Links
Structure Activity Relationships "Antibacterial Agents; Structure Activity Relationships," André Bryskier MD; beginning at pp131
Carbapenems
* * * * *
Carbapenems
Imipenem/Cilastatin(Primaxin)
Mechanism of action
Inhibits bacterial cell wall synthesis. Cilastatin blocks metabolism of imipenem.
Spectrum of activity
Gram-negative (including P aeruginosa); Gram-positive (including some enterococci); not MRSA; Anaerobes including Bacteroides fragilis
Half-life
1 h
Metabolism
In kidney by dehydropeptidase. Blocked by cilastatin
Excretion
70% unchanged in urine
Clinical Side effects
GI, phlebitis, neurologic (seizures <>
Laboratory abnormalities
Increased LFTs, other rare events
Mechanism of drug interactions
No CYP-450 interactions. Probenecid increases levels
Other considerations
Significant dosage adjustment in renal insufficincy
Approved indications
Intra-abdominal infection, lower respiratory tract infection, UTI, gynecologic infection, bacterial septicemia, bone, joint, and skin infections, endocarditis, polymicrobic infections
Usual Dose
500 mg q6h, adjusted for renal function
----------
Meropenem(Merrem)
Mechanism of action
Inhibits bacterial cell wall synthesis
Spectrum of activity
Gram-negative (including P aeruginosa); Gram-positive (including some enterococci); not MRSA; Anaerobes including Bacteriodes fragilis
Half-life
1-1.5 h
Metabolism
Minor hepatic to inactive metabolite
Excretion
75% unchanged in urine
Clinical Side effects
Headache, rash, GI, phlebitis, hypotension
Laboratory abnormalities
Increased LFTs, other rare events
Mechanism of drug interactions
No CYP-450 interactions. Probenecid increases levels
Other considerations
Dose adjustment necessary in renal insufficiency
Approved indications
Intra-abdominal infection, bacterial meningitis
Usual Dose
1 g q8h, adjusted for renal function
----------------Ertapenem(Invanz)
Mechanism of action
Inhibits bacterial cell wall synthesis
Spectrum of activityGram-negative—not P aeruginosa;Gram-positive, not enterococci, not MRSA; Anaerobes including Bacteriodes fragilis
Half-life
4h
Metabolism
Minor hepatic to inactive metabolite
Excretion
38% unchanged in urine; 37% inactive metabolite; 10% feces
Clinical Side effects
Headache, rash, GI, phlebitis, hypotension
Laboratory abnormalities
Increased LFTs, other rare events
Mechanism of drug interactions
No CYP-450 interactions. Probenecid increases levels.
Other considerations
Minor dose adjustment necessary in renal insufficiency
Approved indications
Intra-abdominal infection, skin and skin structure, community-acquired pneumonia, UTI, pelvic infections
Usual Dose
Sunday, July 30, 2006
Norfloxacin
Norfloxacin
Why is this medication prescribed?
Norfloxacin is an antibiotic used to treat certain infections caused by bacteria, such as gonorrhea, prostate, and urinary tract infections. Antibiotics will not work for colds, flu, or other viral infections.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
How should this medicine be used?
Norfloxacin comes as a tablet to take by mouth. It is usually taken every 12 hours (twice a day) for 7-28 days.
To treat gonorrhea, a single dose is taken. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take norfloxacin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
The tablets should be taken with a full glass of water.
Continue to take norfloxacin even if you feel well. Do not stop taking norfloxacin without talking to your doctor.
Other uses for this medicine
Norfloxacin is also used sometimes to treat stomach infections. Talk to your doctor about the possible risks of using this drug for your condition.
What special precautions should I follow?
Before taking norfloxacin,
tell your doctor and pharmacist if you are allergic to norfloxacin, ciprofloxacin (Cipro), enoxacin (Penetrex), levofloxacin (Levaquin), lomefloxacin (Maxaquin), ofloxacin (Floxin), sparfloxacin (Zagam), cinoxacin (Cinobac), nalidixic acid (NegGram), or any other drugs.
tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially other antibiotics, anticoagulants ('blood thinners') such as warfarin (Coumadin), cancer chemotherapy agents, cimetidine (Tagamet), cyclosporine (Neoral, Sandimmune), medications with caffeine (NoDoz, Vivarin), nitrofurantoin (Macrodantin), probenecid (Benemid), sucralfate (Carafate), theophylline (Theo-Dur), and vitamins.
do not take with antacids (Mylanta, Maalox), didanosine (Videx) chewable/buffered tablets or oral solution, iron or zinc supplements, or vitamins that contain iron or zinc. Take them 2 hours before or after norfloxacin.
tell your doctor if you have or have ever had kidney or liver disease, epilepsy, colitis, stomach problems, vision problems, heart disease, myasthenia gravis, or history of stroke.
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking norfloxacin, call your doctor immediately.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking norfloxacin.
you should know that this drug may cause dizziness, lightheadedness, and tiredness. Do not drive a car or work on dangerous machines until you know how norfloxacin will affect you.
plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Norfloxacin may make your skin sensitive to sunlight.
What special dietary instructions should I follow?
Take norfloxacin at least 1 hour before or 2 hours after meals or drinking or eating milk or dairy products. Take with a full glass of water. Drink at least eight full glasses of water or other liquid every day. Do not drink or eat a lot of caffeine-containing products as coffee, tea, cola, or chocolate. Norfloxacin increases nervousness, sleeplessness, heart pounding, and anxiety caused by caffeine.
What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
Although side effects from norfloxacin are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:
upset stomach
diarrhea
vomiting
stomach pain
headache
restlessness
If you experience any of the following symptoms, call your doctor immediately:
skin rash
itching
hives
difficulty breathing or swallowing
swelling of the face or throat
yellowing of the skin or eyes
dark urine
pale or dark stools
blood in urine
unusual tiredness
sunburn or blistering
seizures or convulsions
vaginal infection
vision changes
pain, swelling, or rupture of a tendon in the shoulder, hand, or heel
What storage conditions are needed for this medicine?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Keep away from light. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to norfloxacin.
Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms of infection after you finish the norfloxacin, call your doctor.
Brand names
Noroxin®
Medline Plus
* * * * * *
Norfloxacin (Ophthalmic)
Why is this medication prescribed?
Norfloxacin is an antibiotic used to treat certain infections caused by bacteria, such as gonorrhea, prostate, and urinary tract infections. Antibiotics will not work for colds, flu, or other viral infections.
This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
How should this medicine be used?
Norfloxacin comes as a tablet to take by mouth. It is usually taken every 12 hours (twice a day) for 7-28 days.
To treat gonorrhea, a single dose is taken. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take norfloxacin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
The tablets should be taken with a full glass of water.
Continue to take norfloxacin even if you feel well. Do not stop taking norfloxacin without talking to your doctor.
Other uses for this medicine
Norfloxacin is also used sometimes to treat stomach infections. Talk to your doctor about the possible risks of using this drug for your condition.
What special precautions should I follow?
Before taking norfloxacin,
tell your doctor and pharmacist if you are allergic to norfloxacin, ciprofloxacin (Cipro), enoxacin (Penetrex), levofloxacin (Levaquin), lomefloxacin (Maxaquin), ofloxacin (Floxin), sparfloxacin (Zagam), cinoxacin (Cinobac), nalidixic acid (NegGram), or any other drugs.
tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially other antibiotics, anticoagulants ('blood thinners') such as warfarin (Coumadin), cancer chemotherapy agents, cimetidine (Tagamet), cyclosporine (Neoral, Sandimmune), medications with caffeine (NoDoz, Vivarin), nitrofurantoin (Macrodantin), probenecid (Benemid), sucralfate (Carafate), theophylline (Theo-Dur), and vitamins.
do not take with antacids (Mylanta, Maalox), didanosine (Videx) chewable/buffered tablets or oral solution, iron or zinc supplements, or vitamins that contain iron or zinc. Take them 2 hours before or after norfloxacin.
tell your doctor if you have or have ever had kidney or liver disease, epilepsy, colitis, stomach problems, vision problems, heart disease, myasthenia gravis, or history of stroke.
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking norfloxacin, call your doctor immediately.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking norfloxacin.
you should know that this drug may cause dizziness, lightheadedness, and tiredness. Do not drive a car or work on dangerous machines until you know how norfloxacin will affect you.
plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Norfloxacin may make your skin sensitive to sunlight.
What special dietary instructions should I follow?
Take norfloxacin at least 1 hour before or 2 hours after meals or drinking or eating milk or dairy products. Take with a full glass of water. Drink at least eight full glasses of water or other liquid every day. Do not drink or eat a lot of caffeine-containing products as coffee, tea, cola, or chocolate. Norfloxacin increases nervousness, sleeplessness, heart pounding, and anxiety caused by caffeine.
What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
Although side effects from norfloxacin are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:
upset stomach
diarrhea
vomiting
stomach pain
headache
restlessness
If you experience any of the following symptoms, call your doctor immediately:
skin rash
itching
hives
difficulty breathing or swallowing
swelling of the face or throat
yellowing of the skin or eyes
dark urine
pale or dark stools
blood in urine
unusual tiredness
sunburn or blistering
seizures or convulsions
vaginal infection
vision changes
pain, swelling, or rupture of a tendon in the shoulder, hand, or heel
What storage conditions are needed for this medicine?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Keep away from light. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to norfloxacin.
Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms of infection after you finish the norfloxacin, call your doctor.
Brand names
Noroxin®
Medline Plus
* * * * * *
Norfloxacin (Ophthalmic)
Description
Norfloxacin (nor-FLOX-a-sin) is an antibiotic. The ophthalmic preparation is used to treat infections of the eye.
Norfloxacin is available only with your doctor's prescription, in the following dosage form:
Ophthalmic
Ophthalmic solution (eye drops) (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do.
This is a decision you and your doctor will make. For ophthalmic norfloxacin, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to norfloxacin or to any related medicines, such as cinoxacin (e.g., Cinobac), ciprofloxacin (e.g., Cipro or Ciloxan), enoxacin (e.g., Penetrax), lomefloxacin (e.g., Maxaquin), nalidixic acid (e.g., NegGram), or ofloxacin (e.g., Floxin or Ocuflox). Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy—Studies have not been done in humans. However, norfloxacin taken by mouth can cause bone problems in young animals. Since it is not known whether ophthalmic norfloxacin can cause bone problems in infants, use is not recommended during pregnancy.
Breast-feeding—It is not known whether ophthalmic norfloxacin passes into the breast milk. Low doses of norfloxacin taken by mouth do not pass into breast milk, but other related medicines do. Also, norfloxacin taken by mouth can cause bone problems in young animals. Since it is not known whether ophthalmic norfloxacin can cause bone problems in infants, use is not recommended in nursing mothers.
Children—Use is not recommended in infants and children up to 1 year of age. Norfloxacin taken by mouth has been shown to cause bone problems in young animals. It is not known whether ophthalmic norfloxacin can cause bone problems in infants. In children 1 year of age and older, this medicine is not expected to cause different side effects or problems than it does in adults.
Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of ophthalmic norfloxacin in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking or using any prescription or nonprescription (over -the-counter [OTC]) medicine.
Proper Use of This Medicine
To use:
First, wash your hands. Tilt the head back and with the index finger of one hand, press gently on the skin just beneath the lower eyelid and pull the lower eyelid away from the eye to make a space. Drop the medicine into this space. Let go of the eyelid and gently close the eyes. Do not blink. Keep the eyes closed for 1 or 2 minutes, to allow the medicine to come into contact with the infection.
If you think you did not get the drop of medicine into your eye properly, use another drop.
To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed.
Dosing—
The dose of ophthalmic norfloxacin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of ophthalmic norfloxacin. If your dose is different, do not change it unless your doctor tells you to do so:
For infants and children up to 1 year of age: Use is not recommended.
For adults and children 1 year of age and over: Place 1 drop in each eye four times a day for 7 days.
To help clear up your infection completely, keep using this medicine for the full time of treatment, even if your symptoms begin to clear up after a few days. If you stop using this medicine too soon, your symptoms may return. Do not miss any doses.
Missed dose—
If you do miss a dose of this medicine, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.
Storage—
To store this medicine:
Keep out of the reach of children.
Store away from heat and direct light.
Keep the medicine from freezing.
Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
If your symptoms do not improve within a few days, or if they become worse, check with your doctor.
This medicine may cause your eyes to become more sensitive to light than they are normally. Wearing sunglasses and avoiding too much exposure to bright light may help lessen the discomfort.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Skin rash or other sign of allergic reaction
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
More common
Burning or other eye discomfort
Less common
Bitter taste following use in the eye; increased sensitivity of eye to light; redness of the lining of the eyelids; swelling of the membrane covering the white part of the eye
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
Brand Names
In the U.S.—
Chibroxin
Antibacterial, ophthalmic
Saturday, July 22, 2006
Antibiotics not advised for treating runny nose
Antibiotics not advised for treating runny nose
LONDON (Reuters) - Children suffering from a common cold and persistent runny noise should not be treated initially with antibiotics, researchers said on Friday.
They suggested antibiotics, which can sometimes cause side effects such as vomiting, diarrhea and abdominal pain, should only be prescribed if the youngsters do not improve.
"Most patients will get better without antibiotics," Bruce Arroll of the University of Auckland in New Zealand said in a report in the British Medical Journal.
The overuse of antibiotics has lead to concerns about the emergence of so-called superbugs that are resistant to the most powerful antibiotics.
Arroll and his colleague Tim Kenealy reviewed seven studies that looked at the effectiveness or harm of treating acute purulent rhinitis, a runny nose with a colored discharge, with antibiotics.
Although the drugs are probably effective for the problem, they found that for each patient that will benefit from the drugs six others will not.
"Our summation would be to suggest initial management by non-antibiotic treatments or "watchful waiting" and that antibiotics should be used only when symptoms have persisted for long enough to concern parents or patients," they said in the report.
The researchers said their findings support current "no antibiotic as first line" advice.
Rueters
LONDON (Reuters) - Children suffering from a common cold and persistent runny noise should not be treated initially with antibiotics, researchers said on Friday.
They suggested antibiotics, which can sometimes cause side effects such as vomiting, diarrhea and abdominal pain, should only be prescribed if the youngsters do not improve.
"Most patients will get better without antibiotics," Bruce Arroll of the University of Auckland in New Zealand said in a report in the British Medical Journal.
The overuse of antibiotics has lead to concerns about the emergence of so-called superbugs that are resistant to the most powerful antibiotics.
Arroll and his colleague Tim Kenealy reviewed seven studies that looked at the effectiveness or harm of treating acute purulent rhinitis, a runny nose with a colored discharge, with antibiotics.
Although the drugs are probably effective for the problem, they found that for each patient that will benefit from the drugs six others will not.
"Our summation would be to suggest initial management by non-antibiotic treatments or "watchful waiting" and that antibiotics should be used only when symptoms have persisted for long enough to concern parents or patients," they said in the report.
The researchers said their findings support current "no antibiotic as first line" advice.
Rueters
Tygacil now available in the UK
Broad Spectrum Antibiotic Available for Antibiotic Resistant Bacteria
22 Jul 2006
Tygacil (tigecycline)is a new, expanded broad-spectrum IV antibiotic that can be used for the treatment of a wide range of infections including those caused by antibiotic resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).
It will be available in the UK from today. Availability of this new antibiotic comes at a time when the need for effective new treatments is greater than ever and clinicians are running out of options.
"Difficult to treat, antibiotic-resistant and often life-threatening infections are a growing problem in the UK, costing the NHS an estimated additional £1 billion annually," says Dr Robert Masterton, Executive Medical Director and Consultant Microbiologist, NHS Ayrshire & Arran, "Even more worrying has been the emergence of the organisms commonly called 'superbugs' – those very worrying bacteria that have become resistant to a large number and in some cases all available antibiotics.
Add to this the diminishing development of new antibiotics in the last 20 years and we could soon see a return to the Florence Nightingale era where infections caused more death than bullets because there were no effective drugs to treat these diseases. The introduction of tigecycline in the UK comes at absolutely the right time and will provide a vital new weapon in the fight against infection."
Source
22 Jul 2006
Tygacil (tigecycline)is a new, expanded broad-spectrum IV antibiotic that can be used for the treatment of a wide range of infections including those caused by antibiotic resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).
It will be available in the UK from today. Availability of this new antibiotic comes at a time when the need for effective new treatments is greater than ever and clinicians are running out of options.
"Difficult to treat, antibiotic-resistant and often life-threatening infections are a growing problem in the UK, costing the NHS an estimated additional £1 billion annually," says Dr Robert Masterton, Executive Medical Director and Consultant Microbiologist, NHS Ayrshire & Arran, "Even more worrying has been the emergence of the organisms commonly called 'superbugs' – those very worrying bacteria that have become resistant to a large number and in some cases all available antibiotics.
Add to this the diminishing development of new antibiotics in the last 20 years and we could soon see a return to the Florence Nightingale era where infections caused more death than bullets because there were no effective drugs to treat these diseases. The introduction of tigecycline in the UK comes at absolutely the right time and will provide a vital new weapon in the fight against infection."
Source
Antibiotic-resistant E. coli likely started in poultry
Drug-resistant E. coli likely started in poultry
Reuters HealthMonday, July 10, 2006
NEW YORK (Reuters Health) - The food-contaminating bug E. coli -- which can cause diarrhea, urinary tract infections and more severe illness in humans -- appears to be developing resistance to antibiotics called fluoroquinolones in chickens, a study shows.
The problem is arising largely because of antibiotic treatment of the animals, which forces the microbes to mutate and become resistant. Food-borne resistant E. coli can then be transmitted to humans.
Action to interrupt the transmission of resistant bacteria from animals to humans may become necessary, the researchers say. Such measures could include "limiting antimicrobial use in food animals, adopting more hygienic food-processing and distribution practices, irradiating food, and improving kitchen hygiene."
In the late 1990s, Dr. James R. Johnson of the University of Minnesota in Minneapolis and colleagues obtained E. coli from 35 blood samples and 33 fecal samples from patients with food poisoning seen at a hospital in Barcelona. The investigators also evaluated 49 fecal specimens from chickens at three slaughterhouses in the area.
They found that 30 of the human specimens and 30 of the chicken specimens were resistant to Cipro, a type of fluoroquinolone antibiotic, according to their report in The Journal of Infectious Diseases.
Resistant human isolates resembled the resistant chicken isolates in terms of virulence and their DNA sequence.
"These data provide the strongest molecular evidence available to date for a food (specifically chicken) source for potentially pathogenic fluoroquinolone-resistant E. coli in humans," Johnson and his team write.
They emphasize that even though the resistant organisms from humans and chickens were less virulent than antibiotic-susceptible human E. coli isolates, "they are not benign." The resistant isolates are still capable of causing blood poisoning and acute urinary tract infections in humans.
Once these findings are confirmed in other studies, the researchers conclude, they will "provide a compelling rationale for efforts to eliminate such organisms from the food supply."
SOURCE: Journal of Infectious Diseases, July 1, 2006.
Sunday, July 16, 2006
Bactericidal activity of orally available agents against methicillin-resistant Staphylococcus aureus.
Bactericidal activity of orally available agents against methicillin-resistant Staphylococcus aureus.
Kaka AS, Rueda AM, Shelburne SA 3rd, Hulten K, Hamill RJ, Musher DM.
Section of Infectious Diseases, Michael E. Debakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Background:
The recent proliferation of community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) has led to a marked increase in the need for outpatient treatment of MRSA infections. Many oral agents active against MRSA have been available for years, and a paucity of literature compares them, leaving physicians with little guidance for choosing among them. The purpose of the present study was to compare the bactericidal effects of orally available antibiotics against MRSA and to determine whether there were differences in antimicrobial killing activity against CA-MRSA and hospital-acquired (HA) MRSA isolates.
METHODS:
A total of 12 unique patient MRSA isolates were studied. Six strains were CA, carrying the staphylococcal chromosomal cassette (SCCmec) type IVa, while six were HA and carried SCCmec type II. Time-kill methods were used to study the bactericidal activity of the orally available antimicrobials linezolid, rifampicin, trimethoprim/sulfamethoxazole, clindamycin, minocycline, and moxifloxacin alone and in combination in vitro.
RESULTS:
Trimethoprim/sulfamethoxazole was rapidly bactericidal resulting in >2 log10 cfu/mL decrease at 8 h and >3 log10 cfu/mL decrease at 24 h in vitro. No antibiotic combination exhibited better killing than trimethoprim/sulfamethoxazole alone. Adding rifampicin to trimethoprim/sulfamethoxazole showed a trend towards antagonism in vitro. There were no differences in the bactericidal activity of any antimicrobial or antimicrobial combination against MRSA isolates carrying SCCmec type IVa versus those carrying SCCmec type II.
CONCLUSION:
Trimethoprim/sulfamethoxazole is rapidly bactericidal against MRSA in vitro when compared with most other orally available antimicrobials. No differences in bactericidal activity were detected when activities against CA-MRSA and HA-MRSA were compared.
PMID: 16840428 [PubMed - as supplied by publisher]
Kaka AS, Rueda AM, Shelburne SA 3rd, Hulten K, Hamill RJ, Musher DM.
Section of Infectious Diseases, Michael E. Debakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Background:
The recent proliferation of community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) has led to a marked increase in the need for outpatient treatment of MRSA infections. Many oral agents active against MRSA have been available for years, and a paucity of literature compares them, leaving physicians with little guidance for choosing among them. The purpose of the present study was to compare the bactericidal effects of orally available antibiotics against MRSA and to determine whether there were differences in antimicrobial killing activity against CA-MRSA and hospital-acquired (HA) MRSA isolates.
METHODS:
A total of 12 unique patient MRSA isolates were studied. Six strains were CA, carrying the staphylococcal chromosomal cassette (SCCmec) type IVa, while six were HA and carried SCCmec type II. Time-kill methods were used to study the bactericidal activity of the orally available antimicrobials linezolid, rifampicin, trimethoprim/sulfamethoxazole, clindamycin, minocycline, and moxifloxacin alone and in combination in vitro.
RESULTS:
Trimethoprim/sulfamethoxazole was rapidly bactericidal resulting in >2 log10 cfu/mL decrease at 8 h and >3 log10 cfu/mL decrease at 24 h in vitro. No antibiotic combination exhibited better killing than trimethoprim/sulfamethoxazole alone. Adding rifampicin to trimethoprim/sulfamethoxazole showed a trend towards antagonism in vitro. There were no differences in the bactericidal activity of any antimicrobial or antimicrobial combination against MRSA isolates carrying SCCmec type IVa versus those carrying SCCmec type II.
CONCLUSION:
Trimethoprim/sulfamethoxazole is rapidly bactericidal against MRSA in vitro when compared with most other orally available antimicrobials. No differences in bactericidal activity were detected when activities against CA-MRSA and HA-MRSA were compared.
PMID: 16840428 [PubMed - as supplied by publisher]
Saturday, July 08, 2006
Factive
Factive
Generic Name: gemifloxacin (gem ih FLOCK sah sin)
Brand Names: Factive
What is the most important information I should know about gemifloxacin?
Take all of the gemifloxacin that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
Do not take gemifloxacin without first talking to your doctor if you or any member of your family have a heart condition known as prolongation of the QT interval. Also, do not take gemifloxacin if you are being treated for heart rhythm disturbances with drugs such as quinidine (Quinidex, Quinaglute, others), procainamide (Pronestyl, Procan SR, others), amiodarone (Cordarone, Pacerone, others), sotalol (Betapace), and others.
The following medicines should be taken at least 3 hours before or 2 hours after gemifloxacin: antacids that contain magnesium or aluminum (e.g. Rolaids, Maalox, others); vitamin or mineral supplements that contain zinc, magnesium or iron; didanosine chewable/ buffered tablets or pediatric powder for oral solution (ddI, Videx, Videx Pediatric, others). These medicines may decrease the effectiveness of gemifloxacin.
Gemifloxacin should be taken at least 2 hours before sucralfate (Carafate).
Avoid the use of sunlamps or tanning beds or prolonged exposure to sunlight while taking this medication. Gemifloxacin may increase the sensitivity of the skin to sunlight. Severe sunburn may result, even with minimal sun exposure. If exposure to the sun is unavoidable while taking gemifloxacin, wear protective clothing and use sunscreen. Call your doctor if you experience severe burning, redness, itching, rash, or swelling after exposure to the sun.
Use caution when driving, operating machinery, or performing other hazardous activities. Gemifloxacin may cause dizziness. If you experience dizziness, avoid these activities.
What is gemifloxacin?
Gemifloxacin is an antibiotic in the class of drugs called fluoroquinolones. It fights bacteria in the body.
Gemifloxacin is used to treat bacterial infections such as bronchitis and pneumonia.
Gemifloxacin may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking gemifloxacin?
Do not take gemifloxacin without first talking to your doctor if you or any member of your family have a heart condition known as prolongation of the QT interval. Also, do not take gemifloxacin if you are being treated for heart rhythm disturbances with drugs such as quinidine (Cardioquin, Quinidex, Quinaglute, others), procainamide (Pronestyl, Procan SR, others), amiodarone (Cordarone, Pacerone, others), sotalol (Betapace), and others.
Before taking gemifloxacin, tell your doctor if you have
a low level of potassium or magnesium in your blood;
a slow heart rate (bradycardia);
heart disease or recent heart attack;
kidney disease;
liver disease; or
epilepsy or another seizure disorder.
You may not be able to take gemifloxacin or you may require a dosage adjustment or special monitoring during your treatment.
Gemifloxacin is in the FDA pregnancy category C. This means that it is not known whether gemifloxacin will be harmful to an unborn baby. Do not take gemifloxacin without first talking to your doctor if you are pregnant or could become pregnant during treatment.
It is unknown whether gemifloxacin passes into breast milk. Do not take gemifloxacin without first talking to your doctor if you are breast feeding a baby.
If you are over 60 years of age, you may be more likely to experience side effects from gemifloxacin. Your doctor may prescribe a lower dose of this medication.
How should I take gemifloxacin?
Take gemifloxacin exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass (8 ounces) of water. Drink plenty of fluid while taking gemifloxacin.
Gemifloxacin can be taken with or without food.
Gemifloxacin is usually taken once a day. Take each dose at the same time every day. Follow your doctor's instructions.
Take all of the gemifloxacin that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
The following medicines should be taken at least 3 hours before or 2 hours after gemifloxacin: antacids that contain magnesium or aluminum (e.g. Rolaids, Maalox, others); vitamin or mineral supplements that contain zinc, magnesium or iron; didanosine chewable/ buffered tablets or pediatric powder for oral solution (ddI, Videx, Videx Pediatric, others). These medicines may decrease the effectiveness of gemifloxacin.
Gemifloxacin should be taken at least 2 hours before sucralfate (Carafate).
Store this medication at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a gemifloxacin overdose may include decreased activity, dizziness, tremors, and convulsions.
What should I avoid while taking gemifloxacin?
Avoid the use of sunlamps or tanning beds or prolonged exposure to sunlight while taking this medication. Gemifloxacin may increase the sensitivity of the skin to sunlight. Severe sunburn may result, even with minimal sun exposure. If exposure to the sun is unavoidable while taking gemifloxacin, wear protective clothing and use sunscreen. Call your doctor if you experience severe burning, redness, itching, rash, or swelling after exposure to the sun.
Use caution when driving, operating machinery, or performing other hazardous activities. Gemifloxacin may cause dizziness. If you experience dizziness, avoid these activities.
What are the possible side effects of gemifloxacin?
If you experience any of the following serious side effects, stop taking gemifloxacin and seek emergency medical attention or contact your doctor immediately:
an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
irregular or rapid heartbeats;
fainting;
seizures or tremors;
confusion or hallucinations (seeing or hearing things that are not there);
muscle or joint pain or swelling; or
a skin rash.
If you experience any of the following less serious side effects, continue taking gemifloxacin and talk to your doctor:
nausea, stomach pain, or diarrhea;
change in the way things taste in the mouth;
dizziness;
headache; or
increased sensitivity of the skin to sunlight.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect gemifloxacin?
The following medicines should be taken at least 3 hours before or 2 hours after gemifloxacin: antacids that contain magnesium or aluminum (e.g. Rolaids, Maalox, others); vitamin or mineral supplements that contain zinc, magnesium or iron; didanosine chewable/ buffered tablets or pediatric powder for oral solution (ddI, Videx, Videx Pediatric, others). These medicines may decrease the effectiveness of gemifloxacin.
Gemifloxacin should be taken at least 2 hours before sucralfate (Carafate).
Do not take gemifloxacin without first talking to your doctor if you are taking any of the following drugs:
the heart medicines quinidine (Cardioquin, Quinidex, Quinaglute, others), procainamide (Pronestyl, Procan SR, others), amiodarone (Cordarone, Pacerone, others), sotalol (Betapace), and others;
a tricyclic antidepressant including amitriptyline (Elavil, Endep), amoxapine (Asendin), imipramine (Tofranil), nortriptyline (Pamelor), doxepin (Sinequan), and others;
an antipsychotic medication such as chlorpromazine (Thorazine), fluphenazine (Prolixin), perphenazine (Trilafon), mesoridazine (Serentil), thioridazine (Mellaril), haloperidol (Haldol), and others; or
erythromycin (E-Mycin, Ery-Tab, E.E.S., others).
Gemifloxacin and the drugs listed above may affect the rhythm of your heartbeats. You may not be able to take gemifloxacin, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Before taking gemifloxacin, tell your doctor if you are taking:
warfarin (Coumadin);
probenecid (Benemid and others);
a steroid medication taken by mouth or injection such as cortisone (Cortone), methylprednisolone (Medrol), prednisone (Deltasone, Orasone, others), and others; or
a diuretic (water pill) such as furosemide (Lasix) or hydrochlorothiazide (HCTZ, Microzide, Hydrodiuril, others).
You may not be able to take gemifloxacin, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with gemifloxacin. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines including vitamins, minerals, and herbal products.
Where can I get more information?
Your pharmacist has additional information about gemifloxacin written for health professionals that you may read.
Drugs.com
.......................
Antimicrobial treatment of lower respiratory tract infections in the hospital setting.
Antimicrobial treatment of lower respiratory tract infections in the hospital setting.
Grossman RF, Rotschafer JC, Tan JS.
University of Toronto, Toronto, Ontario, Canada.
Respiratory tract infections (RTIs) that may require hospitalization include acute exacerbations of chronic bronchitis (AECB), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP), which includes ventilator-associated pneumonia (VAP). Healthcare-associated pneumonia (HCAP) is treated similar to HAP and may be considered with HAP. For CAP requiring hospitalization, the current guidelines for the treatments of RTIs generally recommend either a beta-lactam and macrolide combination or a fluoroquinolone.
The respiratory fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin) are excellent antibiotics due to high levels of susceptibility among gram-negative, gram-positive, and atypical pathogens. The fluoroquinolones are active against > 98% of Streptococcus pneumoniae, including penicillin-resistant strains. Fluoroquinolones are also recommended for AECB requiring hospitalization. Evidence from clinical trials suggests that levofloxacin monotherapy is as efficacious as combination ceftriaxone-erythromycin therapy in the treatment of patients hospitalized with CAP. For early-onset HAP, VAP, and HCAP without the risk of multidrug resistance, ceftriaxone, ampicillin-sulbactam, ertapenem, or one of the fluoroquinolones is recommended.
High-dose, short-course therapy regimens may offer improved treatment due to higher drug concentrations, more rapid killing, increased adherence, and the potential to reduce development of resistance. Recent studies have shown that short-course therapy with levofloxacin, azithromycin, or telithromycin in patients with CAP was effective, safe, and tolerable and may control the rate of resistance.
Am J Medicine - July 2005
Generic Name: gemifloxacin (gem ih FLOCK sah sin)
Brand Names: Factive
What is the most important information I should know about gemifloxacin?
Take all of the gemifloxacin that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
Do not take gemifloxacin without first talking to your doctor if you or any member of your family have a heart condition known as prolongation of the QT interval. Also, do not take gemifloxacin if you are being treated for heart rhythm disturbances with drugs such as quinidine (Quinidex, Quinaglute, others), procainamide (Pronestyl, Procan SR, others), amiodarone (Cordarone, Pacerone, others), sotalol (Betapace), and others.
The following medicines should be taken at least 3 hours before or 2 hours after gemifloxacin: antacids that contain magnesium or aluminum (e.g. Rolaids, Maalox, others); vitamin or mineral supplements that contain zinc, magnesium or iron; didanosine chewable/ buffered tablets or pediatric powder for oral solution (ddI, Videx, Videx Pediatric, others). These medicines may decrease the effectiveness of gemifloxacin.
Gemifloxacin should be taken at least 2 hours before sucralfate (Carafate).
Avoid the use of sunlamps or tanning beds or prolonged exposure to sunlight while taking this medication. Gemifloxacin may increase the sensitivity of the skin to sunlight. Severe sunburn may result, even with minimal sun exposure. If exposure to the sun is unavoidable while taking gemifloxacin, wear protective clothing and use sunscreen. Call your doctor if you experience severe burning, redness, itching, rash, or swelling after exposure to the sun.
Use caution when driving, operating machinery, or performing other hazardous activities. Gemifloxacin may cause dizziness. If you experience dizziness, avoid these activities.
What is gemifloxacin?
Gemifloxacin is an antibiotic in the class of drugs called fluoroquinolones. It fights bacteria in the body.
Gemifloxacin is used to treat bacterial infections such as bronchitis and pneumonia.
Gemifloxacin may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking gemifloxacin?
Do not take gemifloxacin without first talking to your doctor if you or any member of your family have a heart condition known as prolongation of the QT interval. Also, do not take gemifloxacin if you are being treated for heart rhythm disturbances with drugs such as quinidine (Cardioquin, Quinidex, Quinaglute, others), procainamide (Pronestyl, Procan SR, others), amiodarone (Cordarone, Pacerone, others), sotalol (Betapace), and others.
Before taking gemifloxacin, tell your doctor if you have
a low level of potassium or magnesium in your blood;
a slow heart rate (bradycardia);
heart disease or recent heart attack;
kidney disease;
liver disease; or
epilepsy or another seizure disorder.
You may not be able to take gemifloxacin or you may require a dosage adjustment or special monitoring during your treatment.
Gemifloxacin is in the FDA pregnancy category C. This means that it is not known whether gemifloxacin will be harmful to an unborn baby. Do not take gemifloxacin without first talking to your doctor if you are pregnant or could become pregnant during treatment.
It is unknown whether gemifloxacin passes into breast milk. Do not take gemifloxacin without first talking to your doctor if you are breast feeding a baby.
If you are over 60 years of age, you may be more likely to experience side effects from gemifloxacin. Your doctor may prescribe a lower dose of this medication.
How should I take gemifloxacin?
Take gemifloxacin exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
Take each dose with a full glass (8 ounces) of water. Drink plenty of fluid while taking gemifloxacin.
Gemifloxacin can be taken with or without food.
Gemifloxacin is usually taken once a day. Take each dose at the same time every day. Follow your doctor's instructions.
Take all of the gemifloxacin that has been prescribed for you even if you begin to feel better. Your symptoms may start to improve before the infection is completely treated.
The following medicines should be taken at least 3 hours before or 2 hours after gemifloxacin: antacids that contain magnesium or aluminum (e.g. Rolaids, Maalox, others); vitamin or mineral supplements that contain zinc, magnesium or iron; didanosine chewable/ buffered tablets or pediatric powder for oral solution (ddI, Videx, Videx Pediatric, others). These medicines may decrease the effectiveness of gemifloxacin.
Gemifloxacin should be taken at least 2 hours before sucralfate (Carafate).
Store this medication at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.
What happens if I overdose?
Seek emergency medical attention.
Symptoms of a gemifloxacin overdose may include decreased activity, dizziness, tremors, and convulsions.
What should I avoid while taking gemifloxacin?
Avoid the use of sunlamps or tanning beds or prolonged exposure to sunlight while taking this medication. Gemifloxacin may increase the sensitivity of the skin to sunlight. Severe sunburn may result, even with minimal sun exposure. If exposure to the sun is unavoidable while taking gemifloxacin, wear protective clothing and use sunscreen. Call your doctor if you experience severe burning, redness, itching, rash, or swelling after exposure to the sun.
Use caution when driving, operating machinery, or performing other hazardous activities. Gemifloxacin may cause dizziness. If you experience dizziness, avoid these activities.
What are the possible side effects of gemifloxacin?
If you experience any of the following serious side effects, stop taking gemifloxacin and seek emergency medical attention or contact your doctor immediately:
an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
irregular or rapid heartbeats;
fainting;
seizures or tremors;
confusion or hallucinations (seeing or hearing things that are not there);
muscle or joint pain or swelling; or
a skin rash.
If you experience any of the following less serious side effects, continue taking gemifloxacin and talk to your doctor:
nausea, stomach pain, or diarrhea;
change in the way things taste in the mouth;
dizziness;
headache; or
increased sensitivity of the skin to sunlight.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
What other drugs will affect gemifloxacin?
The following medicines should be taken at least 3 hours before or 2 hours after gemifloxacin: antacids that contain magnesium or aluminum (e.g. Rolaids, Maalox, others); vitamin or mineral supplements that contain zinc, magnesium or iron; didanosine chewable/ buffered tablets or pediatric powder for oral solution (ddI, Videx, Videx Pediatric, others). These medicines may decrease the effectiveness of gemifloxacin.
Gemifloxacin should be taken at least 2 hours before sucralfate (Carafate).
Do not take gemifloxacin without first talking to your doctor if you are taking any of the following drugs:
the heart medicines quinidine (Cardioquin, Quinidex, Quinaglute, others), procainamide (Pronestyl, Procan SR, others), amiodarone (Cordarone, Pacerone, others), sotalol (Betapace), and others;
a tricyclic antidepressant including amitriptyline (Elavil, Endep), amoxapine (Asendin), imipramine (Tofranil), nortriptyline (Pamelor), doxepin (Sinequan), and others;
an antipsychotic medication such as chlorpromazine (Thorazine), fluphenazine (Prolixin), perphenazine (Trilafon), mesoridazine (Serentil), thioridazine (Mellaril), haloperidol (Haldol), and others; or
erythromycin (E-Mycin, Ery-Tab, E.E.S., others).
Gemifloxacin and the drugs listed above may affect the rhythm of your heartbeats. You may not be able to take gemifloxacin, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Before taking gemifloxacin, tell your doctor if you are taking:
warfarin (Coumadin);
probenecid (Benemid and others);
a steroid medication taken by mouth or injection such as cortisone (Cortone), methylprednisolone (Medrol), prednisone (Deltasone, Orasone, others), and others; or
a diuretic (water pill) such as furosemide (Lasix) or hydrochlorothiazide (HCTZ, Microzide, Hydrodiuril, others).
You may not be able to take gemifloxacin, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with gemifloxacin. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines including vitamins, minerals, and herbal products.
Where can I get more information?
Your pharmacist has additional information about gemifloxacin written for health professionals that you may read.
Drugs.com
.......................
Antimicrobial treatment of lower respiratory tract infections in the hospital setting.
Antimicrobial treatment of lower respiratory tract infections in the hospital setting.
Grossman RF, Rotschafer JC, Tan JS.
University of Toronto, Toronto, Ontario, Canada.
Respiratory tract infections (RTIs) that may require hospitalization include acute exacerbations of chronic bronchitis (AECB), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP), which includes ventilator-associated pneumonia (VAP). Healthcare-associated pneumonia (HCAP) is treated similar to HAP and may be considered with HAP. For CAP requiring hospitalization, the current guidelines for the treatments of RTIs generally recommend either a beta-lactam and macrolide combination or a fluoroquinolone.
The respiratory fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin) are excellent antibiotics due to high levels of susceptibility among gram-negative, gram-positive, and atypical pathogens. The fluoroquinolones are active against > 98% of Streptococcus pneumoniae, including penicillin-resistant strains. Fluoroquinolones are also recommended for AECB requiring hospitalization. Evidence from clinical trials suggests that levofloxacin monotherapy is as efficacious as combination ceftriaxone-erythromycin therapy in the treatment of patients hospitalized with CAP. For early-onset HAP, VAP, and HCAP without the risk of multidrug resistance, ceftriaxone, ampicillin-sulbactam, ertapenem, or one of the fluoroquinolones is recommended.
High-dose, short-course therapy regimens may offer improved treatment due to higher drug concentrations, more rapid killing, increased adherence, and the potential to reduce development of resistance. Recent studies have shown that short-course therapy with levofloxacin, azithromycin, or telithromycin in patients with CAP was effective, safe, and tolerable and may control the rate of resistance.
Am J Medicine - July 2005
Saturday, July 01, 2006
Gramicidin
Gramicidin/neomycin/polymyxin B ophthalmic Drug information
Generic Name: gramicidin/ neomycin/ polymyxin B ophthalmic (gram i SEE din/ nee oh MY sin/ paw lee MIX in)Brand Names: AK-Spore, Neocidin, Neocin PG, Neoptic, Neosporin Ophthalmic
What is the most important information I should know about gramicidin/ neomycin/ polymyxin B ophthalmic?
Contact your doctor if your symptoms begin to get worse or if you do not see any improvement in your condition after a few days.
Do not touch the dropper to any surface, including your eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in your eye.
Apply light pressure to the inside corner of your eye (near your nose) after each drop to prevent the liquid from draining down your tear duct.
What is gramicidin/ neomycin/ polymyxin B ophthalmic?
Gramicidin, neomycin, and polymyxin B are all antibiotics. They are used to treat bacterial infections.
The ophthalmic form of gramicidin/ neomycin/ polymyxin B is used to treat bacterial infections of the eyes.
Gramicidin/ neomycin/ polymyxin B ophthalmic may also be used for purposes other than those listed in this medication guide.
Who should not use gramicidin/ neomycin/ polymyxin B ophthalmic?
Do not use gramicidin/ neomycin/ polymyxin B ophthalmic if you have a viral or fungal infection in your eye. It is used to treat infections caused by bacteria only.
It is not known whether gramicidin/ neomycin/ polymyxin B ophthalmic will harm an unborn baby. Do not use this medication without first talking to your doctor if you are pregnant.
It is not known whether gramicidin/ neomycin/ polymyxin B ophthalmic passes into breast milk. Do not use this medication without first talking to your doctor if you are breast-feeding a baby.
How should I use gramicidin/ neomycin/ polymyxin B ophthalmic?
Use gramicidin/ neomycin/ polymyxin B eyedrops exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Wash your hands before and after using your eyedrops.
To apply the eyedrops:
Tilt your head back slightly and pull down on your lower eyelid. Position the dropper above your eye. Look up and away from the dropper. Squeeze out a drop and close your eye. Apply gentle pressure to the inside corner of your eye (near your nose) for about 1 minute to prevent the liquid from draining down your tear duct. If you are using more than one drop in the same eye or drops in both eyes, repeat the process with about 5 minutes between drops.
Do not touch the dropper to any surface, including your eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in your eye.
Do not use any eyedrop that is discolored or has particles in it.
Store gramicidin/ neomycin/ polymyxin B ophthalmic at room temperature away from moisture and heat. Keep the bottle properly capped.
What happens if I miss a dose?
Apply the missed dose as soon as you remember. However, if it is almost time for your next regularly scheduled dose, skip the missed dose and apply the next one as directed. Do not use a double dose of this medication.
What happens if I overdose?
An overdose of this medication is unlikely to occur. If you do suspect an overdose, wash the eye with water and call an emergency room or poison control left near you. If the drops have been ingested, drink plenty of fluid and call an emergency left for advice.
What should I avoid while using gramicidin/ neomycin/ polymyxin B ophthalmic?
Do not touch the dropper to any surface, including your eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in your eye.
Use caution when driving, operating machinery, or performing other hazardous activities. Gramicidin/ neomycin/ polymyxin B ophthalmic may cause blurred vision. If you experience blurred vision, avoid these activities.
Use caution with contact lenses. Wear them only if your doctor approves. After applying this medication, wait at least 15 minutes before inserting contact lenses.
Avoid other eye medications unless your doctor approves.
What are the possible side effects of gramicidin/ neomycin/ polymyxin B ophthalmic?
Serious side effects are not expected with this medication.
Commonly, some burning, stinging, irritation, itching, redness, blurred vision, eyelid itching, eyelid swelling or crusting, tearing, or sensitivity to light may occur. Continue to use gramicidin/ neomycin/ polymyxin B and talk to your doctor about any side effects you experience.
What other drugs will affect gramicidin/ neomycin/ polymyxin B ophthalmic?
Avoid other eye medications unless they are approved by your doctor.
Drugs other than those listed here may also interact with gramicidin/ neomycin/ polymyxin B ophthalmic. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Where can I get more information?
Your pharmacist has additional information about gramicidin/ neomycin/ polymyxin B written for health professionals that you may read.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/ or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2004 Cerner Multum, Inc. Version: 2.03. Revision Date: 1/ 23/ 04.
Generic Name: gramicidin/ neomycin/ polymyxin B ophthalmic (gram i SEE din/ nee oh MY sin/ paw lee MIX in)Brand Names: AK-Spore, Neocidin, Neocin PG, Neoptic, Neosporin Ophthalmic
What is the most important information I should know about gramicidin/ neomycin/ polymyxin B ophthalmic?
Contact your doctor if your symptoms begin to get worse or if you do not see any improvement in your condition after a few days.
Do not touch the dropper to any surface, including your eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in your eye.
Apply light pressure to the inside corner of your eye (near your nose) after each drop to prevent the liquid from draining down your tear duct.
What is gramicidin/ neomycin/ polymyxin B ophthalmic?
Gramicidin, neomycin, and polymyxin B are all antibiotics. They are used to treat bacterial infections.
The ophthalmic form of gramicidin/ neomycin/ polymyxin B is used to treat bacterial infections of the eyes.
Gramicidin/ neomycin/ polymyxin B ophthalmic may also be used for purposes other than those listed in this medication guide.
Who should not use gramicidin/ neomycin/ polymyxin B ophthalmic?
Do not use gramicidin/ neomycin/ polymyxin B ophthalmic if you have a viral or fungal infection in your eye. It is used to treat infections caused by bacteria only.
It is not known whether gramicidin/ neomycin/ polymyxin B ophthalmic will harm an unborn baby. Do not use this medication without first talking to your doctor if you are pregnant.
It is not known whether gramicidin/ neomycin/ polymyxin B ophthalmic passes into breast milk. Do not use this medication without first talking to your doctor if you are breast-feeding a baby.
How should I use gramicidin/ neomycin/ polymyxin B ophthalmic?
Use gramicidin/ neomycin/ polymyxin B eyedrops exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
Wash your hands before and after using your eyedrops.
To apply the eyedrops:
Tilt your head back slightly and pull down on your lower eyelid. Position the dropper above your eye. Look up and away from the dropper. Squeeze out a drop and close your eye. Apply gentle pressure to the inside corner of your eye (near your nose) for about 1 minute to prevent the liquid from draining down your tear duct. If you are using more than one drop in the same eye or drops in both eyes, repeat the process with about 5 minutes between drops.
Do not touch the dropper to any surface, including your eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in your eye.
Do not use any eyedrop that is discolored or has particles in it.
Store gramicidin/ neomycin/ polymyxin B ophthalmic at room temperature away from moisture and heat. Keep the bottle properly capped.
What happens if I miss a dose?
Apply the missed dose as soon as you remember. However, if it is almost time for your next regularly scheduled dose, skip the missed dose and apply the next one as directed. Do not use a double dose of this medication.
What happens if I overdose?
An overdose of this medication is unlikely to occur. If you do suspect an overdose, wash the eye with water and call an emergency room or poison control left near you. If the drops have been ingested, drink plenty of fluid and call an emergency left for advice.
What should I avoid while using gramicidin/ neomycin/ polymyxin B ophthalmic?
Do not touch the dropper to any surface, including your eyes or hands. The dropper is sterile. If it becomes contaminated, it could cause an infection in your eye.
Use caution when driving, operating machinery, or performing other hazardous activities. Gramicidin/ neomycin/ polymyxin B ophthalmic may cause blurred vision. If you experience blurred vision, avoid these activities.
Use caution with contact lenses. Wear them only if your doctor approves. After applying this medication, wait at least 15 minutes before inserting contact lenses.
Avoid other eye medications unless your doctor approves.
What are the possible side effects of gramicidin/ neomycin/ polymyxin B ophthalmic?
Serious side effects are not expected with this medication.
Commonly, some burning, stinging, irritation, itching, redness, blurred vision, eyelid itching, eyelid swelling or crusting, tearing, or sensitivity to light may occur. Continue to use gramicidin/ neomycin/ polymyxin B and talk to your doctor about any side effects you experience.
What other drugs will affect gramicidin/ neomycin/ polymyxin B ophthalmic?
Avoid other eye medications unless they are approved by your doctor.
Drugs other than those listed here may also interact with gramicidin/ neomycin/ polymyxin B ophthalmic. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
Where can I get more information?
Your pharmacist has additional information about gramicidin/ neomycin/ polymyxin B written for health professionals that you may read.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/ or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2004 Cerner Multum, Inc. Version: 2.03. Revision Date: 1/ 23/ 04.
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