Strep Throat And Cephalexin: What You Should Know

Content

• Overview
• What is strep throat?
• Symptoms of strep throat
• Risk factors for strep throat
• Diagnosing strep throat
• Complications of strep throat
• Treating strep throat
• How to use cephalexin
• Side effects of cephalexin
• Cephalexin interactions
• Cephalexin vs. amoxicillin: Which is more effective?
• How to prevent the spread of strep throat
• When to see a doctor
• The lowdown

Sore throat is a common ailment among people of all ages. Usually, it brings about discomfort but is not a cause for concern as it’s easy to treat with home remedies and over-the-counter drugs. However, if your scratchy or painful throat is accompanied by other symptoms, you may have strep throat.

Fortunately, medical professionals are well-equipped to diagnose¹ strep throat and provide the necessary treatments to help you feel better. In this article, we’ll detail everything you need to know about strep throat and whether cephalexin is an effective treatment option.

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Strep throat also referred to as streptococcal pharyngitis, is an infection of the tonsils and throat caused by a group of bacteria known as Streptococcus pyogenes or group A streptococcus (group A strep). These bacteria live in the throat and nose and can easily pass to others through coughing, talking, sneezing, or touching shared surfaces or infected skin sores.

Once exposed to group A strep, it takes two to five days to become ill. It is vital to note that not every person infected with strep throat experiences symptoms or feels unwell. However, those who exhibit symptoms are more likely to infect others than those who don’t feel sick.

Symptoms can vary, but the most common signs of strep throat include:

• Swollen and inflamed lymph nodes

• Tiny red spots on the roof of the mouth

• Headache

• Rash

• Fever

• A painful throat that develops quickly

• Significant pain when swallowing

• Inflamed tonsils with white pus

• Body aches

• Vomiting or nausea, especially in young children

Most sore throats are caused by viruses, not bacteria. If you have a sore throat with a cough, pink eye, voice hoarseness, or a runny nose, your sore throat is most likely viral and not caused by strep. Even so, it’s best to consult a doctor just in case, as strep is highly contagious. 

Strep throat can infect anyone, but school-aged children are affected more often than adults. The condition is very rare among children under three years. When it comes to adults, those who are most likely to get strep throat are:

The most common mode of infection is through contact with someone infected with strep throat. Like other bacterial infections, strep throat spreads quickly in large crowds, including daycare facilities, schools, or military training grounds. 

Your doctor will need to see you in person to diagnose you with strep throat. They’ll ask about your symptoms and then proceed to a physical exam, which may include a throat swab (rapid strep test) or a throat culture. 

A rapid throat test involves taking a swab of the throat and conducting tests on the swab to determine whether group A strep is the cause of the condition. The entire process is carried out on the spot, and you won’t need to wait for results from a lab. If the rapid test is positive, the doctor will prescribe antibiotics. Alternatively, if it’s negative and the healthcare provider still suspects strep throat, they’ll collect a throat culture, where a swab is sent to a lab to check for strep bacteria. Results from a throat culture can take up to two days, but the results are more accurate than a rapid test.

A throat culture is usually conducted on children and teens because strep throat can develop into rheumatic fever² if left untreated.

If you suspect you have strep throat, see your doctor promptly to start treatment and reduce your risk of complications. If it’s not appropriately treated, strep throat can lead to:  

• Kidney problems

• Presence of pus pockets in the neck or around the tonsils

• Sinusitis (sinus infection)

• Rheumatic fever, which can cause heart problems

• Swollen lymph nodes around the neck region

• Meningitis (inflammation of the fluid surrounding the brain and spinal cord)

• PANDAS (pediatric autoimmune neuropsychiatric disorders)

Oral antibiotics, like amoxicillin or penicillin, are the most common and effective treatment for strep throat. Not only do they decrease the severity and duration of the symptoms, but antibiotics also reduce the risk of spreading to others and prevent complications. Most people start to feel better a day or two³ after starting antibiotics. However, you should only take antibiotics if your healthcare provider advises it. If your strep test was negative and your sore throat is caused by a virus, antibiotics won’t help, and they can cause unwanted side effects. 

Antibiotics for strep throat

Antibiotic prescriptions vary depending on weight and age. A medical professional will prescribe a tailored dose that aligns with the following CDC guidelines:⁴

Penicillin V (oral)

Amoxicillin (oral)

Benzathine penicillin G (injection)

• People weighing less than 27kg: A single 600,000-unit dose

• People weighing 27kg or more: A single 1,200,000-unit dose

Alternatives may be prescribed for people with a penicillin allergy. 

Non-antibiotic options for strep throat

If you suspect you have strep throat, your doctor will decide if you need antibiotics. Antibiotics are effective in slowing or stopping bacterial growth, and you should take them as prescribed by your doctor. However, it’s essential to note that antibiotics aren’t the only treatment to help you feel better while you have strep throat. In addition to antibiotics, there are steps you can take to get back to normal even sooner: 

Taking over-the-counter painkillers

It’s unlikely your doctor will prescribe pain medications to relieve your strep throat. However, if you’re exceptionally uncomfortable, over-the-counter pain medications can help. Some painkillers aren’t suitable for children, people taking certain medications, or those with specific health issues. If you’re not sure which over-the-counter treatments are right for you, ask your healthcare provider to recommend one.

Resting

Adequate sleep is crucial for recovery. If you test positive for strep, you should stay home and rest. Keep in mind that strep is contagious, so while it’s essential to rest so your body can recover, it’s also necessary to reduce the risk of spreading strep to others. Ask your doctor when you can return to school, work, or social activities. 

Staying hydrated

Drinking enough water ensures your throat is well-lubricated and moist to ease swallowing.  

Gargling warm salt water

Adults and children who are old enough to gargle without swallowing can gargle and swish a mixture of approximately one-quarter teaspoon of salt with eight ounces of warm water. Remember to spit it out when you’re done.

Eating foods that are easy to swallow

One of the symptoms of strep throat is pain while swallowing. You may find it easier to eat soft and soothing foods, including soups, mashed potatoes, broths, applesauce, yogurt, soft-cooked eggs, soft fruits, and cooked cereals. Warm (not hot) foods can alleviate throat soreness, and likewise, cold and frozen foods can offer temporary relief. Avoid spicy and acidic foods.

Eating healthy foods

No matter your ailment, eating well can help improve your condition and accelerate recovery. Skip the hard healthy foods that may aggravate your irritated throat. 

Drinking warm water or tea with honey

Due to its antibacterial properties,⁵ honey has been used to treat a variety of conditions since ancient times. For strep throat, stir two tablespoons of honey in tea or warm water until dissolved. You can sip on the mixture as needed for relief throughout the day; however, this remedy is not suitable for children under one as they’re at risk for botulism, which can be severe or fatal. 

Using a humidifier

Use a cool-mist humidifier to add moisture to the air and ease discomfort and dryness in your throat. You can also use saline nasal sprays to moisten the inner linings of your nose and mouth and clear up sinus airways. Clean your humidifier regularly, as the moist environment is well-suited for mold and bacteria growth.

Avoiding irritants

Cigarette smoke, paint fumes, cleaning chemicals, and other strong smells and substances can cause or worsen throat irritation. 

Taking supplements

Some supplements have antibacterial properties. Others reduce inflammation and soothe irritation. Common supplements for strep throat include echinacea, elderberry, vitamin C, and vitamin D.  If you have any other health conditions or you’re taking medications, ask your doctor about possible interactions before adding supplements to your routine. 

Using essential oils

Ingesting essential oils like peppermint oil, naturally-occurring menthol, thyme oil, and lemon can help decrease swelling in your throat. Simply add one or two drops of your preferred essential oils to your herbal tea or water. Remember, not all essential oils are food-grade. Some are intended for external use only. Check the bottle before adding essential oils to your drink. If you’re unsure, try a prepared mint, thyme, or lemon tea, instead. You may also add some drops of essential oil to your bath water to alleviate body aches. 

Sipping chamomile tea

Many herbal teas have health-boosting properties. A warm cup of herbal tea can have immense benefits for your sore throat.

Specifically, chamomile tea has antioxidant and anti-inflammatory properties⁶ that can help improve a sore throat. Drink a cup of chamomile tea to relieve the symptoms associated with strep. You can likely enhance the effects by sweetening your tea with honey. Although chamomile tea is unlikely to harm you while you recover from strep throat, more research is needed to establish the benefits of chamomile for treating strep, in particular. 

When is cephalexin used to treat strep throat?

Amoxicillin and penicillin are the most common antibiotics prescribed to treat strep throat. Research⁷ indicates that group A strep has not yet shown resistance to penicillin. On the other hand, there is evidence the bacteria have developed resistance to both clarithromycin and amoxicillin.

People with penicillin allergies can use cephalexin for strep throat. Cephalexin works by preventing the cell walls of bacteria from growing and subsequently preventing them from replicating. Cephalexin is also effective in fighting the bacteria that cause:

• Sinus infections

• Respiratory tract infections

• Soft tissue and skin infections

• Middle ear infections

• Urinary tract infections

Cephalexin is available in the form of tablets, liquid, and capsules, all taken orally. If you take the liquid alternative, ensure you store it in a cool place and always shake it before use. Likewise, tablets and capsules should be stored in a cool and dry place. Tablets and capsules should be taken whole with water. Always keep all medications out of children’s reach.

Per the CDC guidelines cited above, a doctor will prescribe cephalexin at a dose of 20mg/kg of body weight (up to 500mg) twice daily for a maximum of ten days. If you forget to take a dose of cephalexin, take it as soon as possible or at the next dosing window. Don’t double your dosage to make up for a missed dose. 

Like all medications, cephalexin carries a risk of side effects. Common side effects include:

• Dizziness

• Diarrhea

• Fatigue

• Stomach aches

• Headaches

• Vomiting

• Nausea

• Joint and abdominal pain

• Vaginal discharge or itchiness

• Red or purple rashes and itchy, yellow skin

• Easy swelling

• Shortness of breath or lightheadedness

• Dark-colored urine

• Fever

If you experience side effects that don’t improve with time or affect your daily functioning, reach out to your healthcare provider for guidance. Note that you should not use cephalexin for strep throat if you have any of the following conditions:

• Liver disease

• Kidney disease

• Colitis

• Seizure disorders

People undergoing dialysis treatments and those who are pregnant should inform their doctor of their condition before seeking a prescription for cephalexin or other antibiotics. 

People taking cephalexin should exercise caution when considering taking other medications and supplements. Compared to other antibiotics, cephalexin for strep throat has limited interactions with other medicines. Nevertheless, people taking cephalexin should avoid:

Metformin

Metformin is among the most prescribed drugs in the United States. It is most frequently used to regulate blood sugar levels in people with type 2 diabetes. Cephalexin may increase metformin levels in the body by slowing elimination through the kidneys. This interaction is noted in the cephalexin labeling; however, few additional details are provided.

Note that metformin seldom causes low blood sugar (hypoglycemia) on its own. However, when combined with other medications, including cephalexin, the risk is significantly higher. Therefore, while using metformin alongside cephalexin, your doctor may advise you to check your blood sugar levels more often.

Warfarin

Warfarin is a blood thinner commonly prescribed to prevent and treat blood clots. When taking warfarin, many medications and foods can cause an increase in the risk of bleeding by boosting the blood thinning effect of warfarin. In contrast, other drugs can make warfarin less efficient, increasing the risk of blood clots. 

Cephalexin is one of the drugs that increase the risk of bleeding when taken with warfarin, so your doctor will perform frequent blood tests and encourage you to watch for signs of excessive blood thinning, including bruising or bleeding.

Probenecid

Probenecid is an effective drug used to treat gout. Probenecid can boost cephalexin levels in the body, which increases the risks of side effects. Further, high cephalexin levels can increase stress on the kidneys, especially in people with underlying kidney conditions. Many doctors advise against taking the two drugs simultaneously.

Some vaccines

Antibiotics, including cephalexin, can render the bacille Calmette-Guerin (BCG) tuberculosis vaccine, and those against typhoid and cholera, less effective. If you’re taking antibiotics, your body is less likely to build a robust immune response to fight the associated diseases. Speak with your doctor if you’re planning to get a vaccine and are currently taking (or have recently taken) antibiotics. They’ll advise if you need to wait and for how long. 

Alcohol

Drinking alcohol while taking cephalexin can worsen the drug’s side effects, which include low blood pressure, facial flushing, swelling in the mouth and face, vomiting, and nausea. Therefore, it’s best to avoid alcohol while taking this antibiotic.

Zinc supplements

Although supplements can help relieve sore throat symptoms, you should avoid taking zinc supplements as they decrease cephalexin absorption within the body. As a result, cephalexin may be less efficient in fighting infections. Take zinc supplements at least three hours after cephalexin to ensure maximum antibiotic function.

Antibiotics are effective in treating bacterial infections. A beta-lactam antibiotic,⁸ penicillin damages the cell walls of bacteria and prevents them from reproducing so the body can clear itself of the illness. 

There are many other classes of antibiotics. Cephalexin belongs to another group of beta-lactam antibiotics called cephalosporins. 

Amoxicillin and cephalexin are among the most popular antibiotics prescribed to patients. While they’re both beta-lactam antibiotics (amoxicillin belongs to the penicillin class), the drugs target different types of bacteria. When it comes to strep throat, cephalexin is more effective than amoxicillin. Even so, Amoxicillin remains the recommended first-line treatment option for strep throat, and cephalexin is the choice for a patient with a penicillin allergy..  

Getting strep throat once doesn’t prevent you from getting it again. So, even if you’ve had strep, you should take the appropriate precautions to avoid getting it again. If you have strep, you can prevent your close contacts, friends, and family from getting the infection by:

• Using soap and water to wash hands often for a minimum of twenty seconds

• Coughing and sneezing into your elbow, upper sleeve, tissue, or handkerchief instead of your hand

• Using an alcohol-based sanitizer when it’s not practical to wash your hands

• Avoiding sharing food, utensils, drinks, pillowcases, clothes, and towels with infected persons

If you suspect either you or your child has strep throat, make an appointment with your healthcare provider. Some symptoms, including difficulty swallowing or breathing, a fever above 101 degrees Fahrenheit, a headache, or a red or purple rash, require urgent medical attention. 

When using cephalexin for strep throat, it is vital to understand how and when to take it for optimal results. You should always take antibiotics exactly as prescribed to avoid complications. If you suspect that you or your child has strep throat, don’t hesitate to seek medical attention. While strep can improve without antibiotics, the drugs reduce the risk of complications and will help you feel better sooner.

Appropriate use of cephalosporins – BPJ Issue 41

There are very few indications for the use of cephalosporins as first-line antibiotic treatment. Ceftriaxone is used for the treatment of gonorrhoea, pelvic inflammatory disease and epididymo-orchitis. It is also an alternative to benzylpenicillin in patients with suspected meningitis. Cefaclor may be considered as a second-line treatment for infections such as otitis media, sinusitis, cellulitis, diabetic foot infection and mastitis. Cephalexin is a third-line treatment for urinary tract infection in pregnant women.

• Understanding cephalosporins
• Indications for the use of cephalosporins
• Issues associated with cephalosporins
• References

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Understanding cephalosporins

Cephalosporins are broad spectrum antibiotics similar to penicillins. They have a beta-lactam ring which interferes
with bacterial cell wall synthesis by binding to penicillin-binding proteins, eventually leading to cell lysis and death.¹ Like
amoxicillin clavulanate, cephalosporins should be avoided when a narrower spectrum antibiotic would be effective because
they increase the risk of Clostridium difficile, MRSA and other resistant infections.

Cephalosporins mainly used in general practice are; cefaclor, cephalexin and ceftriaxone (injection). Other cephalosporins
available on the Pharmaceutical Schedule are; cefazolin, cefoxitin and cefuroxime – these medicines are usually
prescribed for patients undergoing dialysis and for patients with cystic fibrosis.

The recommended dose for ceftriaxone has changed for many of the
conditions below. For more information, see “Correspondence: Ceftriaxone; Prostate cancer; Glandular fever”, BPJ 48 (November, 2012), and the latest edition of our handbook, “Antibiotics: Choices for common infections”, bpac^nz.

Cephalosporins are grouped based on their antibacterial properties and when they were introduced:²

• First generation cephalosporins include cephalexin and cefazolin. They have good activity against a wide spectrum
  of Gram-positive bacteria including penicillinase-producing staphylococci. However, they are not active against methicillin-resistant
  staphylococci (MRSA). Enterococci are resistant.²
• Second generation cephalosporins include cefaclor, cefuroxime and cefoxitin. They are more stable to hydrolysis by
  beta-lactamases produced by Gram-negative bacteria and therefore have enhanced activity against many of the Enterobacteriaceae,
  e.g. Escherichia coli, Salmonella.²
• Ceftriaxone is a third generation cephalosporin. They have the widest spectrum of activity compared to other generations
  of cephalosporins and are active against Gram-negative organisms, including many of the significant Enterobacteriaceae.
  They are also very active against streptococci.²

Key Concepts

• There are few infections where cephalosporins are the antibiotics of first choice and their use should be avoided
  when other more narrow spectrum antibiotics remain effective
• Ceftriaxone is an appropriate first line treatment for gonorrhoea, pelvic inflammatory disease and epididymo-orchitis
• Ceftriaxone may also be used for suspected meningitis in patients allergic to penicillin (benzylpenicillin is first-line)
• Cefaclor may be considered as a second-line treatment for otitis media, sinusitis, cellulitis, diabetic foot infection
  and mastitis
• Cephalexin is a third-line alternative for the treatment of urinary tract infection in pregnant women (after nitrofurantoin
  and trimethoprim)

Indications for the use of cephalosporins

There are few infections where cephalosporins are the antibiotics of first choice (Table 1). Ceftriaxone may be used
first-line for some genital tract infections such as gonorrhoea, pelvic inflammatory disease (PID) and epididymo-orchitis
(if sexually transmitted pathogens are suspected). Ceftriaxone is also appropriate empiric treatment for suspected meningitis
in people allergic to penicillin.

Table 1: First and second-line indications for cephalosporins

Norfloxacin is now used in place of cephalexin for third-line treatment of UTIs in pregnancy;
cephalexin is also now recommended in place of cefaclor. For more information on this and other conditions treated with cephalosporins, see the latest edition of our handbook, “Antibiotics: Choices for common infections”, bpac^nz.

First line indications for cephalosporins

Gonorrhoea

A single dose of ceftriaxone 250 mg given intramuscularly is the treatment of choice for gonorrhoea. N.B.
Ceftriaxone is subsidised if prescribed for the treatment of confirmed ciprofloxacin-resistant gonorrhoea, and the prescription
or MPSO is endorsed accordingly.

Research shows that ceftriaxone attains the optimal concentrations to prevent the development of step-wise mutations
and resistance in Neisseria gonorrhoea.³ Standard treatment with ceftriaxone has been shown to be greater than
95% effective.⁴ Therefore a repeat test to ensure cure is not usually required as long as the patient is asymptomatic
after treatment. Azithromycin (oral) is also routinely given when treating gonorrhoea, because co-infection with chlamydia
is common.

Ciprofloxacin (500 g stat) is an alternative to ceftriaxone if cephalosporins are contraindicated (most often due to
a documented allergy to beta-lactam antibiotics) or if the isolate is known to be sensitive to ciprofloxacin.Ciprofloxacin
resistance is becoming increasingly common, with a prevalence of approximately 30% across New Zealand, varying by location.⁵

Pelvic inflammatory disease

Broad-spectrum treatment is justified in pelvic inflammatory disease (PID) because the consequences of untreated
infection can be serious, e.g. infertility, ectopic pregnancy. The recommended treatment which covers N. gonorrhoea,
Chlamydia trachomatis and anaerobes is ceftriaxone 250 mg IM stat and doxycycline 100 mg, twice daily, and metronidazole
400 mg, twice daily, for two weeks.

Ceftriaxone is included in the regimen primarily to cover N. gonorrhoeae. Patients should be advised to inform sexual
partners that they need to be screened and treated if positive for gonorrhoea and chlamydia.

Epididymo-orchitis if STI pathogens are suspected

Ceftriaxone 250 mg IM stat in combination with doxycycline 100 mg, twice daily, for two weeks is recommended
for epididymo-orchitis if sexually transmitted infections (mostly chlamydia or gonorrhoea) are the suspected cause. Most
guidelines recommend this regimen in men aged less than 35 years.⁶ Other risk factors for sexually transmitted
infection include urethral discharge and more than one sexual partner in the last 12 months.⁷

Ceftriaxone is an alternative to benzylpenicillin for suspected meningitis

Any patients with suspected meningitis should be immediately transferred to hospital. IV or IM benzylpenicillin
should be given while transfer to hospital is being arranged. Ceftriaxone is an alternative to benzylpenicillin for people
with suspected meningitis who have a history of immediate allergic reaction to penicillin. Although there is some cross-reactivity
between penicillin and cephalosporin allergy, it is appropriate to use ceftriaxone given the seriousness of the infection
(See below).

Second-line indications for cephalosporins

Cefaclor is used as a second-line alternative for some respiratory tract infections

Cefaclor is a second-line alternative to amoxicillin for suspected acute bacterial sinusitis. Other second-line
alternatives are doxycycline or co-trimoxazole. However, in most cases antibiotics are not necessary at all. Eighty percent
of sinusitis cases resolve in 14 days without antibiotics. In addition, antibiotics only offer marginal benefit after
seven days.⁸ Analgesics (e.g. paracetamol or NSAIDs) are the primary treatment for sinusitis.⁹ Other
treatments that may increase drainage of exudate and improve symptoms include: intranasal corticosteroids, sodium chloride
0.9% sprays and drops, steam inhalations and decongestants. ¹ Purulent nasal discharge persisting for more
than seven days, facial pain or maxillary tooth ache, unilateral sinus tenderness or fever suggest that bacterial infection
is more likely and antibiotics may be appropriate in people with these symptoms and signs.

Cefaclor is also a second-line alternative (as are erythromycin or co-trimoxazole) to amoxicillin for acute otitis media,
however, again antibiotic treatment is usually unnecessary. Most cases of acute otitis media can be treated symptomatically
(e.g. with paracetamol) and arrangements for a follow-up appointment and antibiotic prescription can be made if no improvement
occurs in the next 24 hours. Antibiotics can be considered earlier for those with systemic symptoms, children aged under
six months or children under aged two years with severe or bilateral disease.

Cephalexin is appropriate as a third-line option for UTI in pregnant women

Norfloxacin is now used in place of cephalexin for third-line treatment of UTIs in pregnancy. For more information on this and other conditions treated with cephalosporins, see the latest edition of our handbook, “Antibiotics: Choices for common infections”, bpac^nz.

Cephalosporins are not associated with an increased risk of congenital malformations when used in pregnancy and are
therefore considered safe to use.¹ However, it is recommended that cephalexin is reserved as a third-line option
after nitrofurantoin (avoid at 36+ weeks) and trimethoprim (avoid during first trimester) for the treatment of UTI in
pregnant women because it is a broad spectrum antibiotic and increases the risk of C. difficile. C. difficile infection
can be life-threatening in pregnant women, with case reports of both maternal deaths and stillborn infants.¹⁰

Cefaclor may be used as a second-line option for mastitis, cellulitis and diabetic foot infections

Cephalexin is now recommended over cefaclor for many conditions. For more information, see the latest edition of our handbook, “Antibiotics: Choices for common infections”, bpac^nz.

Cefaclor has good activity against a wide spectrum of Gram-positive bacteria and also has activity against Gram-negative
bacteria, particularly Haemophilus influenzae. This makes it suitable as a second-line option for treating mastitis (first-line
flucloxacillin, other second-line option erythromycin) and cellulitis (first-line flucloxacillin, other second-line options
erythromycin, roxithromycin or co-trimoxazole). It may also be used as a second-line alternative to amoxicillin clavulanate
to treat diabetic foot infections (in combination with metronidazole). Co-trimoxazole plus metronidazole is another second-line
option.

Issues associated with cephalosporins

Cross-reactivity with penicillin allergy is often over-estimated

Penicillin allergy is reported by up to 10% of people, however, many do not have a true (IgE mediated) allergy. True
allergy is recognisable by clinical features such as urticaria, laryngeal oedema, bronchospasm, hypotension or local swelling
within 72 hours of administration or a pruritic rash, developing even after 72 hours. ¹¹

Cross-reactivity between penicillins and cephalosporins of 10% is widely quoted, however, this is now believed to be
an overestimate. This estimation was largely based on reviews in the 1970s which included the following limitations:¹¹

• Up until 1982, compounds relating to penicillin had been produced commercially using the cephalosporin mould and the
  cephalosporins used in these reviews were contaminated with penicillin
• The fact that people with penicillin allergy are three times more likely to have adverse reactions to other drugs
  was not accounted for
• The definition of allergy was imprecise and differed between studies

A more recent review suggests that the cross-reactivity between first generation cephalosporins and penicillins is closer
to 0.5% than 10% and that second and third generation cephalosporins (e.g. ceftriaxone) are unlikely to be associated
with cross-reactivity as they have different side chains to penicillin. ¹¹

It is still considered appropriate to avoid cephalosporins in patients who have a history of an immediate hypersensitivity
(Type I allergy) to penicillins for mild to moderate infections when a suitable alternative antibiotic exists. However,
in life-threatening cases (e.g. suspected meningitis) where a cephalosporin is essential because a suitable alternative
is not available then a second or third generation cephalosporin (such as ceftriaxone, but excluding cefaclor) can be
used with caution.¹²

Gonorrhoea shows potential signs of resistance to cephalosporins

Cephalosporins are now widely used for the treatment of gonorrhoea, following the development of resistance to fluoroquinolones.
In New Zealand the recommended treatment is IM ceftriaxone which is the same advice given by the United States Centres
for Disease Control and Prevention (CDC). United States data is now showing that the percentage of isolates with elevated
mean inhibitory concentrations (the lowest concentration that will inhibit the growth of a microorganism) to cephalosporins
(cefixime and ceftriaxone) has increased during the last ten years. These trends are concerning because the emergence
of resistance to fluoroquinolones followed a similar pattern in the United States as what is now being seen with ceftriaxone.
Cephalosporin treatment failures have also been reported in Europe and Asia.¹³

Although cephalosporins are still effective, the CDC is advising health-care providers to be vigilant for gonorrhoea
treatment failures after using a cephalosporin (shown by persistent symptoms or a positive follow-up test despite treatment).¹³

Extended-spectrum beta lactamases

Extended spectrum beta lactamases (ESBLs) are produced by some bacteria and confer resistance to all penicillins and
cephalosporins, including the extended spectrum cephalosporins (e.g. ceftriaxone, cefuroxime) that were originally designed
to resist the action of older beta-lactamases. Many of these organisms producing ESBLs may also be resistant to other
antibiotic classes, e. g., aminoglycosides, sulphonamides and fluoroquinolones, limiting treatment options for patients
infected with ESBL-producing organisms.¹⁴ ESBLs are most common in Escherichia coli and Klebsiella pneumoniae.
The most typical type of infection they cause is urinary tract infections, however, they can cause serious infections
in the blood stream, in which case they are likely to be resistant to many of the empirical antibiotics used for these
infections.

Infections with ESBL-producers are most common amongst elderly people or those who have recently been in hospital, received
antibiotic treatment or travelled overseas. The incidence of these infections has been increasing in New Zealand and globally
and is of concern because these organisms are resistant to many commonly used antibiotics. As with other types of antibiotic
resistance, minimising the spread of resistant organisms relies in part on only using antibiotics when necessary and at
appropriate doses for the correct duration in both the community and inpatient settings. ¹⁴

Acknowledgement

Thank you to Dr Rosemary Ikram, Clinical Microbiologist, Medlab South, Christchurch for expert guidance
in developing this article.

References

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12. British National Formulary (BNF) 62. London: Pharmaceutical Press, 2011.
13. Centres for Disease Control and Prevention (CDC). Cephalosporin susceptibility among Neisseria gonorrhoeae isolates
    – United States, 2000-2010. Morbidity and Mortality Weekly Report 2011;60(26):873-7.
14. Drug and Therapeutics Bulletin. Risks of extended-spectrum beta-lactamases. Drug and Therapeutics Bulletin 2008;46(3):21-4.

Antibiotics for sinusitis

Sinusitis is a serious disease, the development of which is based on inflammation of the paranasal (maxillary) sinuses. In most cases, the cause of the development of pathology are pathogenic microorganisms. Predisposing factors include low immunity protection, anatomical features of the nasal passages, paranasal cavities, as well as post-traumatic changes in this area that disrupt ventilation in the sinuses and narrow the nasal passages.

Untimely initiation of therapy can lead to the development of severe complications, namely, infection of the ear cavity, meninges of the brain. You can suspect sinusitis based on the following symptoms:

• nasal discharge that gradually becomes purulent and bothers for more than a week;
• nasal congestion due to swelling of the tissues, hypersecretion, which forces the person to breathe through the mouth;
• lack of smell;
• change in taste;
• fever above 39 degrees;
• pain in the paranasal region, which extends to the forehead, eye sockets, teeth, and is aggravated by tilting, turning the head;
• malaise;
• drowsiness;
• decreased motor activity.

In order to diagnose the disease in time, it is necessary to undergo an examination by a doctor at the stage of the appearance of the first clinical signs of pathology. You can consult with a qualified otolaryngologist at the Health of the capital medical center. Experienced specialists of various profiles work here, which allows us to provide medical care to adults and children.

Treatment of sinusitis is based on taking antibacterial agents. They can be used topically or systemically. Depending on the severity of the disease, the patient’s state of health, drugs can be administered orally or by injection (intramuscularly, intravenously).

Note that the dose of drugs, the type of antibiotic and the duration of therapy are set exclusively by the doctor based on the results of instrumental, laboratory examinations. Self-administration of medications can not only not bring relief to the general condition, but also worsen the course of the disease, provoke the appearance of adverse reactions.

Next, consider the groups of antibacterial agents that are most often used in the treatment of sinusitis.

• Penicillin series. The drugs are available in combination with clavulanic acid. Representatives of this group of antibiotics include Flemoxin, Amoxiclav, Augmentin, Flemoxin. Medicines are widely used in the treatment of sinusitis in children. For them, preparations are sold in the form of a suspension with the addition of fruit fillers to give a pleasant taste.
• Cephalosporins such as Ceftriaxone, Cefuroxime, Zefthera. Preparations are divided into generations, depending on the spectrum of action against pathogenic microorganisms. The choice of medicine is carried out on the basis of the results of bakposev biological material.
• Macrolides (Clarithromycin, Sumamed, Fromilid, Macropen) – act on intracellular bacteria (chlamydia, mycoplasmas). They are prescribed when the above antibiotics cannot be used due to allergic reactions or their ineffectiveness.

Antibiotics from the aminoglycoside group are prescribed for topical therapy. They have a greater number of side effects compared to other drugs, so they are rarely prescribed for systemic administration.

Polydex drops are used for intranasal administration. In their composition, they have not only an antibiotic, but also a vasoconstrictor, hormonal component. Spray Isofra is also prescribed for local use. In addition to antibacterial drugs, saline solutions are prescribed for washing the nasal passages.

An integrated approach to therapy allows you to overcome infection, reduce inflammation, eliminate nasal congestion, restore nasal breathing, alleviate the general condition of a person, and also prevent the development of complications.

Which antibiotic is used to treat sinus infections in dogs?

Contents

Antibiotics such as: Cephalexin. Amoxicillin. Ciprofloxacin.

Which antibiotic is best for sinusitis?

Amoxicillin remains the drug of choice for acute uncomplicated bacterial sinusitis. Amoxicillin is most effective when administered frequently enough to maintain adequate levels in the infected tissue. While it is often given twice a day, it is even more effective when taken in 3 or 4 doses.

How do I clean my dog’s sinuses?

If your dog has mild nasal congestion, you can use natural home remedies to treat your pet.

1. Humidifier.
2. Pro Tip: For best results, keep your puppy in the same room as a humidifier for the most effective treatment.
3. Nasal aspirator.
4. Steaming.
5. ⚠️ Never put your dog directly in the shower while vaping.
6. Massage.

What causes a sinus infection in dogs?

Fungal rhinitis is an infection that affects the nose and sinuses (air spaces inside the skull). Fungal rhinitis in dogs is usually caused by a variant of the fungus Aspergillus fumigatus, and this general association has led to the term “aspergillosis” often being used as a synonym for “fungal rhinitis”.

Amoxicillin or azithromycin is better for sinusitis?

Conclusions. In adults with acute sinusitis, a 3-day course of azithromycin was as effective and well tolerated as a 10-day course of amoxicillin/clavulanic acid. The advantage of azithromycin was a much simpler dosing regimen and a faster clinical effect.

Does Zpack help with sinus infections?

When is it appropriate to use Z-Pak? While your Z-pak does not work against viruses such as the common cold, flu, or runny nose, or even some bacterial infections, including most cases of bronchitis, many sinus infections, and some ear infections, it does play a role in treating certain bacterial infections. infections.

How do I know if my dog ​​has sinusitis?

Dogs affected by rhinitis and sinusitis may experience many symptoms, including:

1. Sneezing.
2. Deformation of the face.
3. Loss of appetite (anorexia)
4. Nasal discharge (e.g. mucus)
5. Reduced airflow (nasal congestion) in one or both nasal passages.

Which decongestants are safe for dogs?

Unfortunately, there are not many safe dog decongestants available over the counter. Oxymetazoline is a good choice because it is not easily toxic. This active ingredient is used in nasal sprays from brands such as Afrin, Dimetapp, Vicks Sinex, Zicam, and Mucinex Sinus-Max Full Force.

How much amoxicillin should I give my dog?

Dosing Instructions

Amoxicillin is prescribed based on your dog’s body weight and what infection the veterinarian is trying to treat. The typical dosage used by many veterinarians is 5 to 10 mg per pound. This means that a 50 lb dog needs to take 500 mg twice a day. This usually takes 10 to 14 days.

Can dogs take amoxicillin?

Amoxicillin can be given in liquid or tablet form. The recommended dose for most dogs is 5 mg per pound. Most courses of amoxicillin are given up to two times a day for 5 to 7 days or within 48 hours of complete resolution of symptoms. For upset stomach, give amoxicillin with meals.

How to treat rhinitis and sinusitis in dogs?

Your veterinarian may prescribe antibiotics if a bacterial infection is present or suspected (antibiotics are not effective against viruses). Fungal rhinitis and sinusitis can be treated with antifungal therapy once the specific fungus has been identified.

How to treat an upper respiratory tract infection in a dog?

Treatment of upper respiratory tract infections in dogs and cats

1. Steam it. Increasing the humidity can help your dog or cat breathe easier, just like humans!
2. Feed the cold. When pets have a stuffy nose, their sense of smell is dulled.
3. Wipe your runny nose.
4. Keep your pet from dehydration.
5. Rest, rest and once again rest.
6. Tie them up.

Will doxycycline treat sinusitis?

Treatment for a suspected bacterial infection is with antibiotics such as amoxicillin/clavulanate or doxycycline for 5 to 7 days for acute sinusitis and up to 6 weeks for chronic sinusitis.

What is the difference between Zpack and amoxicillin?

Both drugs are used to treat bacterial infections in adults and children. Azithromycin belongs to the macrolide group, and amoxicillin belongs to the beta-lactam/penicillin group. They work differently and have some differences, for example, in indications and drug interactions.

What is the Zpack equivalent?

Amoxicillin is a common alternative to azithromycin. Amoxicillin can be given alone or as augmentin, which contains amoxicillin and clavulanate. Clavulanate is added to amoxicillin to prevent resistance.

Which drug to choose for sinusitis?

For most patients, we suggest initial empiric therapy with either amoxicillin or amoxicillin-clavulanate. We treat patients with risk factors for resistance with high doses of amoxicillin-clavulanate.

What is the strongest antibiotic for an upper respiratory infection?

Amoxicillin is the preferred treatment for patients with acute bacterial rhinosinusitis. A short course of antibiotic therapy (mean five days) is as effective as a longer course of treatment (mean 10 days) in patients with acute uncomplicated bacterial rhinosinusitis.

Can cephalexin treat sinusitis?

The susceptibility of these microorganisms allows cephalexin to be effective in the treatment of many common types of infections, including upper respiratory tract infections such as sinusitis, pharyngitis and tonsillitis.

Can dogs get sinus congestion?

YES! Although a stuffy nose seems like a human ailment, your dog can also develop a stuffy nose and suffer from the same ailments as his. People may think that dogs don’t get colds or can’t get hay fever, but your dog could very well have a stuffy nose.

Can I use Flonase on my dog?

Fluticasone should not be used in pets that are hypersensitive or allergic to it. It should not be used during acute bronchospasm (wheezing or difficulty breathing). Fluticasone should not be used in pregnant or breeding pets, but studies in cats and dogs are limited.

Why does my dog ​​have nasal mucus?

Infections. A number of different infections can cause a runny nose in dogs. So, if your dog’s nasal discharge is thick or green or yellow in color, it could indicate a bacterial, fungal, or viral infection as the cause of your dog’s runny nose.

Can I give my dog ​​Benadryl for nasal congestion?

Benadryl is an allergy medication that is also safe for dogs. It can be used to treat allergy symptoms such as sneezing, runny nose, swelling, itching, and more.

Is Claritin or Zyrtec better for dogs?

Benadryl (diphenhydramine) is the most popular antihistamine in humans and may be effective in dogs. Just be aware that Benadryl has sedative properties, so your dog can become very drowsy. Other safe antihistamines for dogs include Claritin (Loratadine) and Zyrtec (Cetirizine).

Can dogs get Benadryl Plus congestion?

No. Benadryl for sinusitis and allergies is not just diphenhydramine (an antihistamine that works well for dogs). It also contains acetaminophen (Tylenol), which has a very narrow safety margin for dogs and can be quite toxic, and phenylephrine (a decongestant).

What is the difference between dog amoxicillin and human amoxicillin?

“Amoxicillin and other drugs are generally the same antibiotics people use,” said Dr. Jana Leighton of Riverbrook Animal Hospital. This may seem like a way to buy up pennies. Eliminate the intermediary, in this case a doctor, and move on to the food history to self-prescribe antibiotics for the infection.

Can I give my dog ​​human amoxicillin 500 mg?

The dosage of amoxicillin 500 mg used in humans can be fatal in pets. For dogs and cats, the typical dose of amoxicillin is 5 to 12 mg per pound (10 to 25 mg/kg) two or three times a day.

Can I get antibiotics for my dog ​​without going to the vet?

Can I get antibiotics for my dog ​​without going to the vet? Yes, there are antibiotics available without a veterinarian prescription. Can you buy antibiotics at the pet store? Many pet stores, including online stores, sell antibiotics that are safe for dogs.

Can I give my dog ​​human AMOX CLAV 875 mg?

Amoxicillin/clavulanate is generally suitable for cats and dogs, but should not be given to small animals such as ferrets, rabbits, guinea pigs, chinchillas, or hamsters because the antibiotic nature of the drug affects normal bacteria in the gastrointestinal tract of small animals. tract, how can it…

How much amoxicillin do you give a 70 lb dog?

Amoxicillin Dose for Dogs

The recommended dose of amoxicillin for dogs is 5 mg per pound of body weight twice daily. Use should last 5 to 7 days or 48 hours after the disappearance of all symptoms.

Which human antibiotics can dogs take?

However, the following antibiotics are safe for both humans and dogs:

• Amoxicillin.
• Cephalexin.
• Ciprofloxacin.
• Clavamox.
• Otomax.
• Penicillin.
• Tetracycline.

Does your dog have an upper respiratory tract infection?

• Snorting, sneezing and other signs of breathing problems.
• Discharge from nose and eyes.
• Foam at mouth.
• Weight loss and loss of interest in food.
• Tired or lethargic.
• Fever.
• Cough (dry or productive), vomiting or vomiting.

How long does an upper respiratory tract infection last in a dog?

Infection is usually caused by a virus or bacteria and is comparable to a mild to severe cold in humans. A dog with a respiratory illness often gets better on its own within one to three weeks. Respiratory infections are highly contagious.

Is clavamox good for upper respiratory infections in dogs?

Amoxicillin and clavulanic acid are effective in bacterial pneumonia and respiratory tract infections (sinusitis and bronchitis). In addition, Clavamox is a first-line antibiotic for dogs with aspiration pneumonia.

Which is better for sinus infections Augmentin or doxycycline?

Recommended choice: Amoxicillin or amoxicillin/clavulanate potassium (Augmentin) for 5–10 days. Doxycycline is a good alternative for people allergic to penicillin, followed by levofloxacin or moxifloxacin.

How long does it take for doxycycline to work for a sinus infection?

Our sinuses are hard to reach, so it can take two or three days before antibiotic treatment starts to work. It is extremely important to continue the entire course of antibiotics, even if you start to feel better.

What is the difference between amoxicillin and doxycycline?

Amoxicillin and doxycycline belong to different classes of antibiotics. Amoxicillin is a penicillin antibiotic and doxycycline is a tetracycline antibiotic.

Which is better azithromycin or doxycycline?

Trials have shown that doxycycline is slightly more effective, but researchers are not entirely convinced of its superiority. The standard treatment for chlamydia is a single dose of azithromycin or a weekly course of doxycycline twice a day.

Does amoxicillin help with sinus infections?

Amoxicillin (Amoxil) is acceptable for uncomplicated acute sinus infections; however, many doctors prescribe amoxicillin-clavulanate (Augmentin) as a first-line antibiotic to treat a possible bacterial sinus infection. Amoxicillin is usually effective against most strains of bacteria.

Is there an OTC Zpack?

Azithromycin is not available over the counter (OTC) in the United States. Azithromycin is a prescription drug, which means your doctor must prescribe it for you. OTC medicines do not require a prescription.

Can you get Zpacks without a prescription?

Azithromycin belongs to a class of drugs known as macrolide antibiotics. It works by killing bacteria or preventing their growth. However, this medicine does not work for colds, flu, or other viral infections. This medicine is only available with a doctor’s prescription.

Is Doxycycline the same as Zithromax?

Brand names of azithromycin include Zithromax, Zithromax Tri-Pak, Zithromax Z-Pak and Zmax. Doxycycline and azithromycin are different antibiotics. Doxycycline belongs to the tetracycline antibiotics, and azithromycin belongs to the macrolide group.

Amoxicillin or azithromycin is better for sinusitis?

Conclusions. In adults with acute sinusitis, a 3-day course of azithromycin was as effective and well tolerated as a 10-day course of amoxicillin/clavulanic acid. The advantage of azithromycin was a much simpler dosing regimen and a faster clinical effect.

What is the strongest antibiotic for sinusitis?

Amoxicillin remains the drug of choice for acute uncomplicated bacterial sinusitis. Amoxicillin is most effective when administered frequently enough to maintain adequate levels in the infected tissue. While it is often given twice a day, it is even more effective when taken in 3 or 4 doses.

Does Zpack help with sinus infections?

When is it appropriate to use Z-Pak? While your Z-pak does not work against viruses such as the common cold, flu, or runny nose, or even some bacterial infections, including most cases of bronchitis, many sinus infections, and some ear infections, it does play a role in treating certain bacterial infections. infections.

Zpack for viruses or bacteria?

Z-pack is a prescription antibiotic (azithromycin) regimen for treating bacterial infections. Antibiotics, including Z-pack, do not treat the viruses that cause most colds and even bronchitis. Antibiotics, especially Z-pack, are usually over-prescribed when they are not needed.

What does Zpack treat?

Zithromax (azithromycin), also known as Z-Pak, is an antibiotic used to treat bacterial infections by inhibiting the growth of bacteria in the body. Z-Pak is usually taken for five days to treat infections such as bronchitis, pneumonia, and infections of the ears, lungs, and other organs.

How can I tell if an upper respiratory infection is viral or bacterial?

Bacterial infections

Symptoms persist longer than the expected 10-14 days, as the virus usually lasts. The fever is higher than you would normally expect from a virus. The fever worsens a few days after the onset of the illness, rather than improving.

What is cephalexin used for in dogs?

What is cephalexin? Cephalexin (brand names Rilexine®, Keflex®, Vetolexin®) is an oral antibiotic used to treat pyoderma and other bacterial skin infections in dogs and is used off-label or off-label in cats to treat pyoderma and certain other skin types. infections.

Is cephalexin safe for dogs?

In dogs and cats, cephalexin may be useful in the treatment of skin, respiratory and urinary tract infections. The FDA (US Food and Drug Administration) has approved this drug for use in humans and dogs, but is not formally approved for use in other animal species.

Penicillin, erythromycin (Suprax) and first-generation cephalosporins such as cephalexin (Keflex, Keftab) are not recommended for the treatment of acute sinusitis due to inadequate antimicrobial activity against major microorganisms.

How do I clean my dog’s sinuses?

If your dog has mild nasal congestion, you can use natural home remedies to treat your pet.

1. Humidifier.
2. Pro Tip: For best results, keep your puppy in the same room as a humidifier for the most effective treatment.
3. Nasal aspirator.
4. Steaming.
5. ⚠️ Never put your dog directly in the shower while vaping.
6. Massage.

How do I know if my dog ​​has sinusitis?

Many symptoms can be observed in dogs affected by rhinitis and sinusitis, including:

1. Sneezing.
2. Deformation of the face.
3. Loss of appetite (anorexia)
4. Nasal discharge (e.g. mucus)
5. Reduced airflow (nasal congestion) in one or both nasal passages.

How to treat nasal congestion in dogs?

Calm your dog and keep him calm. Cover the bleeding nostril with something absorbent. Apply a cold compress to the dog’s nose between the eyes and nostrils. Don’t tilt your dog’s head back to slow blood flow, and don’t put anything in your dog’s nostril.

What kind of decongestant can I give my dog?

Unfortunately, there are not many safe dog decongestants available over the counter. Oxymetazoline is a good choice because it is not easily toxic. This active ingredient is used in nasal sprays from brands such as Afrin, Dimetapp, Vicks Sinex, Zicam, and Mucinex Sinus-Max Full Force.

What is the best antihistamine for dogs?

Benadryl is an excellent remedy for dogs with mild to moderate allergies. Seasonal allergies, food allergies, environmental allergies, and allergic reactions to snake and insect bites are most likely to respond to Benadryl.

How much Mucinex can be given to a dog?

The manufacturer’s recommended dose is one tablet (50 mg/5 mg) every four hours for small dogs and cats and one tablet (100 mg/10 mg) every four hours for large dogs. Although this product is available without a prescription, a veterinarian should be consulted first.

Can dogs be given doxycycline?

Most dogs take antibiotics at least once in their lives, whether for an ongoing infection or as a preventive measure. One antibiotic commonly used in veterinary medicine is doxycycline.

Can dogs take Zyrtec?

Yes, you can give your dog Zyrtec. In fact, Zyrtec is one of the safest OTC drugs for dogs. It is an excellent choice for first aid and has a large margin of safety – it will not cause any problems even when taken in large doses.

Can I give my dog ​​a sinus pill?

Dogs can benefit from decongestants in the same way. However, you should never give your dog a decongestant or start any other treatment option without first consulting with your veterinarian. Some decongestants are actually combination medications that contain other potentially harmful drugs.

What can I give my dog ​​for an upper respiratory tract infection?

Treatment of upper respiratory tract infections in dogs and cats

• Steam it. Increasing the humidity can help your dog or cat breathe easier, just like humans!
• Feed the cold. When pets have a stuffy nose, their sense of smell is dulled.
• Wipe your runny nose.