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Omnicef pneumonia: Cefdinir: a review of its use in the management of mild-to-moderate bacterial infections

Cefdinir: a review of its use in the management of mild-to-moderate bacterial infections

Cefdinir (Omnicef) is an oral third-generation cephalosporin with good in vitro activity against many pathogens commonly causative in community-acquired infections. The drug provides good coverage against Haemophilus influenzae, Moraxella catarrhalis and penicillin-susceptible Streptococcus pneumoniae, the most common respiratory tract pathogens. Cefdinir is stable to hydrolysis by commonly occurring plasmid-mediated beta-lactamases and retains good activity against beta-lactamase-producing strains of H. influenzae and M. catarrhalis. The drug distributes into various tissues (e.g. sinus and tonsil) and fluids (e.g. middle ear), and has a pharmacokinetic profile that allows for once- or twice-daily administration.Cefdinir, administered for 5 or 10 days, has shown good clinical and bacteriological efficacy in the treatment of a wide range of mild-to-moderate infections of the respiratory tract and skin in adults, adolescents and paediatric patients in randomised, controlled trials. In adults and adolescents, cefdinir is an effective treatment for both lower (acute bacterial exacerbations of chronic bronchitis [ABECB], community-acquired pneumonia) and upper (acute bacterial rhinosinusitis, streptococcal pharyngitis) respiratory tract infections, and uncomplicated skin infections. Its bacteriological and clinical efficacy in patients with lower respiratory tract infections was equivalent to that of comparator agents (cefprozil [bacteriological only], loracarbef, cefuroxime axetil and cefaclor). In one trial in patients with ABECB, cefdinir produced a higher rate of clinical cure than cefprozil (95% CIs indicated nonequivalence). Cefdinir also produced good clinical and bacteriological responses equivalent to responses with amoxicillin/clavulanic acid in patients with acute bacterial rhinosinusitis. In addition, it was at least as effective as penicillin V (phenoxymethylpenicillin) in streptococcal pharyngitis/tonsillitis and as effective as cefalexin in uncomplicated skin infections. In paediatric patients aged > or =6 months, cefdinir showed similar efficacy to that of amoxicillin/clavulanic acid or cefprozil in acute otitis media, and cefalexin in uncomplicated skin infections. Cefdinir given for 5 or 10 days was at least as effective as penicillin V for 10 days in patients with streptococcal pharyngitis/tonsillitis. Cefdinir is usually well tolerated. Diarrhoea was the most common adverse event in trials in all age groups. Although the incidence of diarrhoea in cefdinir recipients was generally higher than in adults and adolescents treated with comparators, discontinuation rates due to adverse events were generally similar for cefdinir and comparator groups. In conclusion, cefdinir is a third-generation cephalosporin with a broad spectrum of antibacterial activity encompassing pathogens that are commonly causative in infections of the respiratory tract or skin and skin structure. Depending on the infection being treated, cefdinir can be administered as a convenient once- or twice-daily 5- or 10-day regimen. Clinical evidence indicates that cefdinir is an effective and generally well tolerated drug with superior taste over comparator antibacterial agents and is therefore a good option for the treatment of adults, adolescents and paediatric patients with specific mild-to-moderate respiratory tract or skin infections, particularly in areas where beta-lactamase-mediated resistance among common community-acquired pathogens is a concern.

Cefdinir User Reviews for Pneumonia

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Cefdinir has an average rating of 5.6 out of 10 from a total of 14 ratings for the treatment of Pneumonia.
50% of those users who reviewed Cefdinir reported a positive effect, while 43% reported a negative effect.

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Cefdinir Rating Summary

5. 6/10 average rating

14 ratings from 11 user reviews.

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This information is NOT intended to endorse any particular medication. While these reviews might be helpful, they are not a substitute for the expertise, knowledge and judgement of healthcare practitioners.

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Atypical (Walking) Pneumonia: Treatment & Management



Overview

What is “walking” pneumonia?

“Walking” pneumonia is a mild form of pneumonia (an infection of the lungs). This non-medical term has become a popular description because you may feel well enough to be walking around, carrying out your daily tasks and not even realize you have pneumonia.

Most of the time, walking pneumonia is caused by an atypical bacteria called Mycoplasma pneumoniae, which can live and grow in the nose, throat, windpipe (trachea) and lungs (your respiratory tract). It can be treated with antibiotics.

Scientists call walking pneumonia caused by mycoplasma “atypical” because of the unique features of the bacteria itself. Several factors that make it atypical include:

  • Milder symptoms
  • Natural resistance to medicines that would normally treat bacterial infections
  • Often mistaken for a virus because they lack the typical cell structure of other bacteria

Are there other types of atypical pneumonias?

Yes. Other types of atypical pneumonia include:

How is walking pneumonia different from “regular” pneumonia?

Walking pneumonia differs from typical pneumonia in several ways, including:

  • Walking pneumonia is a milder form of pneumonia.
  • Walking pneumonia usually does not require bed rest or hospitalization.
  • Walking pneumonia is usually caused by Mycoplasma pneumoniae. Typical pneumonia is most commonly caused by _Streptococcus _pneumonia or influenza (flu) virus or rhinovirus.

How common is walking pneumonia?

Mycoplasma pneumoniae accounts for 10 to 40 percent of the cases of community-acquired pneumonia (pneumonia contracted outside a healthcare setting).

Walking pneumonia can occur at any time of the year although it occurs most often in the fall and winter.

Is walking pneumonia contagious? If so, how is it spread and who is most at risk?

Yes, walking pneumonia caused by Mycoplasma pneumoniae is contagious (spread through person-to-person contact). When an infected person coughs or sneezes, tiny droplets containing the bacteria become airborne and can be inhaled by others who are nearby.

The infection can be easily spread in crowded or shared living spaces such as homes, schools, dormitories and nursing homes. It tends to affect younger adults and school-aged children more than older adults.

The risk of getting more severe pneumonia is even higher among those who have existing respiratory conditions such as:

How long am I contagious with walking pneumonia?

If you have walking pneumonia caused by Mycoplasma pneumoniae, you can be considered contagious from two to up to four weeks before symptoms appear (called the incubation period). During this time, you will not realize you are contagious and spreading pneumonia. Once the symptoms start, you remain contagious until the symptoms end.



Symptoms and Causes

What causes walking pneumonia?

Walking pneumonia is most commonly caused by Mycoplasma pneumoniae bacteria.

What are the symptoms of walking pneumonia?

Symptoms of walking pneumonia include:

  • Sore throat (pharyngitis)
  • Feeling tired (fatigue)
  • Chest pain
  • Mild chills
  • Low-grade fever
  • Persistent cough that can be dry or produce mucus
  • Sneezing
  • Headache

The symptoms of walking pneumonia may come on slowly, beginning one to four weeks after exposure. During the later stages of the illness, symptoms may worsen, the fever may become higher, and coughing may bring up discolored phlegm (mucus).



Diagnosis and Tests

How is walking pneumonia diagnosed?

Your doctor will ask you about your symptoms, how long you’ve had them and if any other family members or people you regularly interact with are also ill with similar symptoms. He or she will listen to your lungs with a stethoscope to check for abnormal breath sounds. Your doctor may order chest X-rays to see if there is an infection in your lungs. Your blood or mucus might be tested to determine if your pneumonia is caused by Mycoplasma pneumoniae, another bacteria, virus or fungus.



Management and Treatment

How is walking pneumonia treated?

Walking pneumonia is usually mild, does not require hospitalization and is treated with antibiotics (if your doctor thinks bacteria is causing your symptoms). Several types of antibiotics are effective. Antibiotics that are used to treat walking pneumonia caused by Mycoplasma pneumoniae include:

  • Macrolide antibiotics: Macrolide drugs are the preferred treatment for children and adults. Macrolides include azithromycin (Zithromax®) and clarithromycin (Biaxin®). Over the past decade, some strains of Mycoplasma pneumoniae have become resistant to macrolide antibiotics, possibly due to the widespread use of azithromycin to treat various illnesses.
  • Fluoroquinolones: These drugs include ciprofloxacin (Cipro®) and levofloxacin (Levaquin®). Fluoroquinolones are not recommended for young children.
  • Tetracyclines: This group includes doxycycline and tetracycline. They are suitable for adults and older children.

Often, over-the-counter medications can also be taken to help relieve symptoms of nasal congestion, cough and loosen mucus buildup in the chest. If you have a fever:

  • Drink more fluids
  • Rest
  • Take medicine



Prevention

How can walking pneumonia be prevented?

Unfortunately, no vaccines are available to prevent walking pneumonia caused by Mycoplasma pneumoniae. Even if you have recovered from walking pneumonia, you will not become immune, so it is possible to become infected again in the future.

Tips for preventing walking pneumonia include:

  • Cover your nose and mouth with a tissue when you sneeze or cough. If a tissue isn’t available, sneeze or cough into the inside of your elbow or sleeve. Never sneeze or cough into your hands. Place used tissues into a waste basket.
  • Wash your hands often with warm water and soap for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
  • Wear a mask around sick people if you have respiratory conditions (such as asthma, bronchitis, emphysema) or other chronic health conditions (heart, liver or kidney diseases, or diabetes) that would make getting pneumonia even riskier for you.
  • Get your annual Influenza (flu) shot. Bacterial pneumonia can develop after a case of the flu.
  • Ask your doctor about the pneumococcal vaccine. Two types of vaccines are available, Prevnar 13® and Pneumovax 23®. Each vaccine is recommended for people at different age points or who are at increased risk for pneumococcal disease, including pneumonia.



Outlook / Prognosis

When will I start feeling better if I have walking pneumonia?

Most people with walking pneumonia will feel better after a few days on antibiotics. Your cough might continue for a few weeks.

Pneumonia Information | Mount Sinai

Diagnostic Challenges

Diagnostic Difficulties in CAP

It is important to determine whether the cause of CAP is a bacterium, atypical bacterium, or virus, because they require different treatments. In children, for example, S pneumoniae is the most common cause of pneumonia, but RSV may also cause the disease. Although symptoms may differ, they often overlap, which can make it difficult to identify the organism by symptoms alone. The cause of CAP is found in only about half of cases.

Nevertheless, in many cases of mild-to-moderate CAP, the physician is able to diagnose and treat pneumonia based solely on a medical history and physical examination.

Diagnostic Difficulties with Hospital-Acquired (Nosocomial) Pneumonia

Diagnosing pneumonia is particularly difficult in hospitalized patients for a number of reasons:

  • Many hospitalized patients have similar symptoms, including fever or abnormal x-rays.
  • In hospitalized patients, sputum or blood tests often show bacteria or other organisms, but such agents do not necessarily indicate pneumonia.

Medical and Personal History

The person’s history is an important part of making a pneumonia diagnosis. People should report any of the following:

  • Alcohol or drug abuse
  • Exposure to people with pneumonia or other respiratory illnesses (such as TB)
  • History of smoking
  • Occupational risks
  • Recent or chronic respiratory infection
  • Recent antibiotic therapy
  • Recent outpatient wound care
  • Home infusion therapy or dialysis
  • Recent travel
  • Exposure to birds, bats, or other animals
  • Compromised immune system

Physical Examination

Auscultation (Use of the Stethoscope) and Percussion

The stethoscope is the tool that the physician uses to listen to the body sounds, including chest sounds produced while breathing. Sounds that may indicate pneumonia include:

  • Rales, a bubbling or crackling sound. Rales often suggest pneumonia.
  • Rhonchi, abnormal rumblings indicating that there is sputum in the large airways.
  • A dull thud. The physician will use a test called percussion, in which the chest is tapped lightly. A dull thud, instead of a hollow drum-like sound, indicates certain conditions that suggest pneumonia. These conditions include consolidation (in which the lung becomes filled with fluid and pus) and pleural effusion (fluid build-up in the space between the lungs and the lining around it).

Pulse Oximetry

A pulse oximetry test can help determine if a person needs hospital care. A simple test using a device on the fingertip or earlobe, determines the amount of oxygen in the blood.

Laboratory Tests

Although current antibiotics can attack a wide spectrum of organisms, it is best to use an antibiotic that targets the specific one making a person sick. Unfortunately, people carry many bacteria, and sputum and blood tests are not always effective in distinguishing between harmless and harmful kinds. The Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) recommends diagnostic testing when it may impact the choice of antibiotic and in people with a high likelihood of accurate results (sicker patients). Many of these laboratory tests take 4 to 5 days or longer to complete, however, and therapy should be started before results are available.

Although viral pneumonia accounts for more than a third of CAP cases, it can sometimes be difficult to determine if the pneumonia is viral or bacterial in origin.

In severe cases, a doctor needs to use invasive diagnostic measures to identify the cause of the infection. These tests are not commonly performed in outpatients. Standard lab tests are used to help diagnose pneumonia.

Sputum Tests

A sputum sample may reveal the organism causing the infection.

The person coughs as deeply as possible to bring up mucus from the lungs, since a shallow cough produces a sample that usually only contains normal mouth bacteria. Some people may need to inhale a saline spray to produce an adequate sample. In some cases, a tube will be inserted through the nose into the lower respiratory tract to trigger a deeper cough.

The physician will check the sputum for:

  • Blood, which suggests an infection is present.
  • Color and consistency. If it is gray, green, or brown, an infection is likely.

The sputum sample is sent to the laboratory, where it is analyzed for the presence of bacteria and to determine whether the bacteria are Gram-negative or Gram-positive.

Blood Tests

The following blood tests may be performed:

  • White blood cell count (WBC). High levels indicate infection.
  • Blood cultures. Cultures are done to determine the specific organism causing the pneumonia, but they are accurate in only 10% to 30% of cases. Their use is generally limited to severe cases.
  • Detection of antibodies. Antibodies are immune factors that target specific foreign invaders. Antibodies that react with mycoplasma or chlamydia are not present early enough in the course of pneumonia to allow for prompt diagnosis by this method.
  • C-reactive protein or procalcitonin. Not generally recommended but may help identify which people with respiratory symptoms have pneumonia and need to be hospitalized. Procalcitonin may also help guide the clinician in the appropriate use of antibiotics.
  • Polymerase chain reaction (PCR). In some difficult cases, PCR may be performed. The test makes multiple copies of the genetic material (DNA) of a virus or bacteria to make it detectable. PCR is useful for identifying certain atypical bacteria strains, including mycoplasma and Chlamydia pneumonia. While expensive, a real-time PCR test may help quickly diagnose Pneumocystis pneumonia in HIV-positive patients.

Urine Tests

Urine antigen tests for Legionella pneumophila (Legionnaires disease) and S pneumoniae may be helpful in some people with severe CAP.

Invasive Tests

In critically-ill people with VAP, doctors have tried sampling fluid taken from the lungs or trachea. These techniques enabled the physicians to identify the pneumonia-causing bacteria and start the appropriate antibiotics. However, this made no difference in the length of stay in the ICU or hospital, and there was no significant difference in outcome.

Imaging Techniques

X-rays

A chest x-ray is nearly always taken on a patient admitted to the hospital to confirm a pneumonia diagnosis.

X-rays are a form of electromagnetic radiation (like light). They are of higher energy, however, and can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray depending on density. X-rays can provide information about obstructions, tumors, and other diseases, particularly when coupled with the use of barium and air contrast within the bowel.

A chest x-ray may reveal the following:

  • Complications of pneumonia, including pleural effusions and abscesses
  • White areas in the lung called infiltrates, which often indicate infection

Other Imaging Tests

Computed tomography (CT) scans or magnetic resonance imaging (MRI) scans may be useful in some circumstances, such as when:

  • A lung tumor is suspected
  • Complications occur
  • People do not respond to antibiotics
  • People have other serious health problems
  • Pulmonary embolism is suspected
  • X-ray results are unclear

Click the icon to see an image of a CT scan.

CT and MRI can help detect tissue damage, abscesses, and enlarged lymph nodes. They can also detect some tumors that block bronchial tubes. No imaging technique can determine the actual organism causing the infection. However, features on the CT scan of people with certain forms of pneumonia — for example that are caused by Legionella pneumophila — are usually different from features produced by other bacteria in the lungs.

Invasive Diagnostic Procedures

Invasive diagnostic procedures may be necessary when:

  • People have AIDS or other immune problems
  • People have life-threatening complications
  • Standard treatments have failed for unknown reasons

Thoracentesis

If a doctor detects pleural effusion during the physical exam or from an imaging procedure, and suspects that pus (empyema) is present, a thoracentesis is performed.

  • Fluid in the pleura is withdrawn using a long thin needle inserted between the ribs.
  • The fluid is then sent to the lab for multiple tests.

Complications of this procedure are rare, but they can include collapsed lung, bleeding, and infection.

Bronchoscopy

Bronchoscopy is an invasive test to examine respiratory secretions. It is not usually needed in people with CAP, but it may be appropriate for people with a severely compromised immune system who need immediate diagnosis, or in people whose condition has worsened during treatment. In patients who need a breathing machine to breathe (severely ill) this procedure can be done via the existing breathing tube.

A bronchoscopy is done in the following way:

  • The person is given a local anesthetic, oxygen, and sedatives.
  • The physician inserts a fiber optic tube into the lower respiratory tract through the nose or mouth.
  • The tube acts like a telescope into the body, allowing the physician to view the windpipe and major airways and look for pus, abnormal mucus, or other problems.
  • The doctor removes specimens for analysis and can also treat the person by removing any foreign bodies or infected tissue encountered during the process.

Click the icon to see an image of a bronchoscopy.

Bronchoalveolar lavage (BAL) may be done at the same time as bronchoscopy. This involves injecting high amounts of saline through the bronchoscope into the lung and then immediately sucking the fluid out. The fluid is then analyzed in the laboratory. BAL is an effective method for detecting specific infection-causing organisms.

The procedure is usually very safe, but complications can occur. They include:

  • Allergic reactions to the sedatives or anesthetics
  • Asthma attacks in susceptible people
  • Bleeding
  • Fever

Lung Biopsy

In very severe cases of pneumonia or when the diagnosis is unclear, particularly in people with a damaged immune system, a lung biopsy may be required. A lung biopsy involves taking some tissue from the lungs and examining it under a microscope.

Lung Tap

This procedure typically uses a needle inserted between the ribs to draw fluid out of the lung for analysis. It is known by a number of names, including:

  • Lung aspiration
  • Lung puncture
  • Thoracic puncture
  • Transthoracic needle aspiration
  • Percutaneous needle aspiration
  • Needle aspiration

This is a very old procedure that is not done often anymore because it is invasive and poses a slight risk for collapsed lung. Some experts argue, however, that a lung tap is more accurate than other methods for identifying bacteria, and the risk it poses is slight. Given the increase in resistant bacteria, they believe its use should be reconsidered in young people.

An infectious disease specialist may need to be consulted in severe or difficult cases.

Differential Diagnosis

Common Causes of Persistent Coughing

The four most common causes of persistent coughing are:

  • Asthma
  • Long-term (chronic) bronchitis
  • Gastroesophageal reflux disease (GERD)
  • Postnasal drip

Other common causes of long-term (chronic) cough include heavy smoking or the use of blood pressure drugs known as ACE inhibitors.

Acute Bronchitis

Acute bronchitis is an infection in the passages that carry air from the throat to the lung. The infection causes a cough that produces phlegm. Acute bronchitis is almost always caused by a virus and usually clears up on its own within a few days. In some cases, acute bronchitis caused by a cold can last for several weeks.

Chronic Bronchitis

Chronic bronchitis causes shortness of breath and is often accompanied by infection, mucus production, and coughing, but it is a long-term and irreversible condition. The same bacteria and viruses that cause pneumonia can cause an infection in people with chronic bronchitis. However, infections involve only the airways leading to the lungs, and not the lung tissue itself. The 2 disorders may share the same symptoms, such as:

  • Coughing
  • Fatigue
  • Fever
  • Sputum production

There are significant differences between chronic bronchitis and pneumonia:

  • People with bronchitis are more likely to have wheezing, but less likely to have chills, very high fevers, and other signs of severe illness.
  • Those with pneumonia often cough up heavy sputum, which may contain blood.
  • X-rays of people with pneumonia show inflammation and other changes in the lung tissue that are not seen in people with chronic bronchitis.

Asthma

In asthma, the cough is usually accompanied by wheezing and occurs mostly at night or during activity. Fever is rarely present (unless the person also has an infection). Asthma symptoms from occupational causes can lead to persistent coughing, which is usually worse during the workweek. Tests, like the methacholine inhalation challenge and pulmonary function studies, may be effective in diagnosing asthma. Chest X-ray can also help in ruling out pneumonia.

Other Disorders that Affect the Lung

Many conditions mimic pneumonia, particularly in hospitalized patients. They include:

  • ARDS
  • Atelectasis, a partial collapse of lung tissue
  • Bronchiectasis, an irreversible widening of the airways that is usually associated with birth defects, chronic sinus or bronchial infection, or blockage
  • Heart failure (if it affects the left side of the heart, fluid build-up can occur in the lungs and cause persistent cough, shortness of breath, and wheezing)
  • Interstitial pulmonary fibrosis, a non-infectious inflammation of the lung that causes damage and scarring
  • Lung cancer
  • Severe allergic reactions, such as reactions to drugs
  • Tuberculosis

Ruling Out Causes in Children

Important causes of coughing in children at different ages include:

  • Asthma
  • Sinusitis in children 18 months to 6 years

Pediatric Guidelines: Respiratory Infections – Community-Acquired Pneumonia

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Community-acquired pneumonia, 3 months-5 years old, outpatient therapy

Majority: respiratory viruses

Streptococcus pneumoniae

Haemophilus influenzae

Antimicrobial therapy is not routinely indicated unless suspected bacterial etiology

If suspected typical bacterial etiology:

Amoxicillin 45mg/kg/dose PO BID (max 1000mg/dose)*

Note: Atypical pneumonia is rare in this age group

Non-severe penicillin allergy:

Cefdinir 7mg/kg/dose PO BID (max 600mg/day)

 

Duration for beta lactam therapy (not Azithromycin):

7 days

*Click here for guidance on Amoxicillin maximum dosing and formulations

Click here for further CAP management guidelines from the UCSF Northern California Pediatric Hospital Medicine Consortium

Severe penicillin allergy:

Azithromycin 10mg/kg/dose PO x 1 on day 1 then 5mg/kg/dose PO daily on days 2-5

Community-acquired pneumonia, > 5 years old, outpatient therapy

Typical, lobar:

Streptococcus pneumoniae

Atypical, bilateral interstitial infiltrates:

Respiratory viruses

Mycoplasma pneumoniae

If typical bacterial etiology suspected:

Amoxicillin 45mg/kg/dose PO BID (max 1000mg/dose)*

Non-severe penicillin allergy:

Replace Amoxicillin with Cefdinir 7mg/kg/dose PO BID (max 600mg/day)

Duration for beta lactam therapy (not Azithromycin):

7 days

Blood cultures are not usually indicated for outpatients with community-acquired pneumonia

*Click here for guidance on Amoxicillin maximum dosing and formulations

Click here for further CAP management guidelines from the UCSF Northern California Pediatric Hospital Medicine Consortium

If atypical bacterial etiology suspected: 

Azithromycin 10mg/kg/dose PO on day 1 (max 500mg/dose) then 5mg/kg/dose PO daily on days 2-5 (max 250mg/dose)

Severe penicillin allergy:

Replace Amoxicillin with Azithromycin 10mg/kg/dose PO on day 1 (max 500mg/dose) then 5mg/kg/dose PO daily on days 2-5 (max 250mg/dose)

Community-acquired pneumonia, < 3 months old

Streptococcus pneumoniae

Haemophilus influenzae

Respiratory viruses

 

Also consider: 

Bordetella pertussis

Chlamydia trachomatis

Ceftriaxone 50mg/kg/dose IV q24h if corrected gestational age > 44 weeks

Corrected gestational age < 44 weeks:

Use Cefotaxime per Neonatal Dosing Guideline in place of Ceftriaxone

Initial inpatient therapy is recommended 

Blood culture is recommended

Consider evaluation and empiric therapy for Pertussis especially for infants with apnea, significant post-tussive emesis, lymphocytosis or older contacts with prolonged cough

Community-acquired pneumonia, > 3 months old and up, inpatient therapy but not complicated (empyema, necrotizing pneumonia) Similar to outpatient etiologies

Suspected typical bacterial etiology:

Ampicillin 50mg/kg/dose IV q6h (max 2g/dose)

Non-severe penicillin allergy:

Replace Ampicillin with Ceftriaxone 50mg/kg/dose IV q24h (max 2g/dose)

Duration for beta lactam therapy (not Azithromycin or Levofloxacin):

Mild: 7 days

Moderate: 10 days

Consider blood culture for patients with moderate to severe illness, young age, incomplete vaccines, or immunocompromised

Consider therapy for Influenza if patient admitted during active Influenza season. 

Click here for further CAP management guidelines from the UCSF Northern California Pediatric Hospital Medicine Consortium

Strong suspicion for atypical etiology:

Azithromycin 10mg/kg/dose PO on day 1 (max 500mg/dose) then 5mg/kg/dose PO daily on days 2-5 (max 250mg/dose)

Note: Atypical pneumonia is rare in children < 5 years old

Severe beta lactam allergy:

Levofloxacin 10mg/kg/dose IV q24h if >= 5 years old, q12h if < 5 years old (max 750mg/day) (provides both typical and atypical bacterial activity)

OR 

Azithromycin 10mg/kg/dose PO on day 1 (max 500mg/dose) then 5mg/kg/dose PO daily on days 2-5 (max 250mg/dose) if strong suspicion for atypical etiology with low suspicion for typical bacterial etiology

If no distinguishing features for typical vs. atypical bacterial etiology and especially if > 5 years old:

Consider combination of Ampicillin + Azithromycin (doses as above)

Community-acquired pneumonia, complicated (empyema, necrotizing pneumonia)

Streptococcus pneumoniae

Staphylococcus aureus

Ceftriaxone 50mg/kg/dose IV q24h (max 2g/dose)

AND

One of the following agents with MRSA activity:

Clindamycin 10mg/kg/dose IV q8h (max 900mg/dose) for clinically stable patients

OR 

Vancomycin for critically ill/clinically unstable patients:

Age 3mo-<12yo: 17.5mg/kg/dose IV q6h (initial max 1g/dose)

Age >=12 yo: 15mg/kg/dose IV q6h (initial max 1g/dose)  

Severe beta lactam allergy:

Replace Ceftriaxone with Levofloxacin 10mg/kg/dose IV q24h if >= 5 years old, q12h if < 5 years old (max 750mg/day)

ID consult recommended

Blood cultures are recommended for patients with complicated pneumonia

Consider therapy for Influenza if patient admitted during active Influenza season

Reference: Bradley, JS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011;53:e25-e76.

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).

Cefdinir Capsules (cefdinir) dose, indications, adverse effects, interactions… from PDR.net

CLASSES

3rd Generation Cephalosporin Antibiotics

DESCRIPTION

Oral extended-spectrum, semisynthetic, third generation cephalosporin. It is not active against methicillin-resistant staphylococci or Pseudomonas aeruginosa. Cefdinir is used for skin infections and a variety of upper respiratory infections.

HOW SUPPLIED

Cefdinir/Omnicef Oral Cap: 300mg
Cefdinir/Omnicef Oral Pwd F/Recon: 5mL, 125mg, 250mg

DOSAGE & INDICATIONS

For the treatment of acute bacterial otitis media.

Oral dosage (oral suspension)

Infants and Children 6 months and older

7 mg/kg/dose PO every 12 hours (Max: 300 mg/dose) for 5 to 10 days or 14 mg/kg/dose PO every 24 hours (Max: 600 mg/dose) for 10 days. Cefdinir is recommended by the American Academy of Pediatrics (AAP) as an alternative treatment to high-dose amoxicillin or high-dose amoxicillin; clavulanate. AAP recommends a 10-day course for any child with severe disease and for all patients younger than 2 years of age, regardless of severity. For children 2 to 5 years with mild to moderate disease, a 7-day course is acceptable. For children at least 6 years old with mild to moderate disease, 5 to 7 days is acceptable.

Infants 2 to 5 months†

7 mg/kg/dose PO every 12 hours or 14 mg/kg/dose PO every 24 hours for 10 days was recommended in previous clinical practice guidelines. In general, cefdinir is recommended by the AAP as an alternative treatment to amoxicillin for penicillin-allergic patients.

For the treatment of acute exacerbations of chronic bronchitis.

Oral dosage (capsules)

Adults and Adolescents

300 mg PO every 12 hours for 5 to 10 days or 600 mg PO every 24 hours for 10 days.

For the treatment of acute maxillary sinusitis.

Oral dosage

Adults and Adolescents

300 mg PO every 12 hours or 600 mg PO every 24 hours for 10 days. Third-generation oral cephalosporins, such as cefdinir, are not recommended by the Infectious Disease Society of America (IDSA) for empiric monotherapy of acute bacterial sinusitis due to variable rates of S. pneumoniae resistance.

Infants >= 6 months and Children

7 mg/kg/dose PO every 12 hours (Max: 300 mg/dose) or 14 mg/kg/dose PO every 24 hours (Max: 600 mg/dose) for 10 days is recommended by the manufacturer. Third-generation oral cephalosporins, such as cefdinir, are not recommended by the Infectious Disease Society of America (IDSA) for empiric monotherapy of acute bacterial sinusitis due to variable rates of S. pneumoniae resistance.

For the treatment of community-acquired pneumonia (CAP).

Oral dosage

Adults

300 mg PO every 12 hours for 10 days.

Adolescents

300 mg PO every 12 hours for 10 days. Guidelines recommend cefdinir as an alternative to amoxicillin or amoxicillin; clavulanate for infections due to H. influenzae.[46963]

Infants and Children 4 months to 12 years†

7 mg/kg/dose (Max: 300 mg/dose) PO every 12 hours for 10 days. Guidelines recommend cefdinir as an alternative to amoxicillin or amoxicillin; clavulanate for infections due to H. influenzae.[46963] [60318]

For the treatment of pharyngitis or tonsillitis.

Oral dosage

Adults

300 mg PO every 12 hours for 5 to 10 days or 600 mg PO every 24 hours for 10 days. Guidelines do not recommend cefdinir for Group A Streptococcal pharyngitis to prevent rheumatic fever.

Adolescents

300 mg PO every 12 hours for 5 to 10 days or 600 mg PO every 24 hours for 10 days. Guidelines do not recommend cefdinir for Group A Streptococcal pharyngitis to prevent rheumatic fever.

Infants 6 months and older and Children

7 mg/kg/dose PO every 12 hours (Max: 300 mg/dose) for 5 to 10 days or 14 mg/kg/dose PO every 24 hours (Max: 600 mg/dose) for 10 days. Guidelines do not recommend cefdinir Group A Streptococcal pharyngitis to prevent rheumatic fever.

For the treatment of uncomplicated skin and skin structure infections.

Oral dosage (capsules)

Adults and Adolescents

300 mg PO every 12 hours for 10 days.

Oral dosage (oral suspension)

Infants and Children 6 months and older

7 mg/kg/dose PO every 12 hours (Max: 300 mg/dose) for 10 days.

For the treatment of urinary tract infection (UTI)†.

Oral dosage

Adults

300 mg PO every 12 hours for 10 days. A 3- to 7-day course of cefidinir may be an alternative in patients with uncomplicated cystitis when other recommended agents cannot be used. Cefdinir has been shown to be statistically equivalent to cefaclor for microbiologic response rates and clinical cure rates in adults with uncomplicated urinary tract infection (UTI). Additionally, in a retrospective in vitro antimicrobial susceptibility study (n = 456 urine samples from 30 medical sites), cefdinir was comparable or superior to other oral beta-lactams (i.e., cefpodoxime, cefprozil, cefuroxime, amoxicillin; clavulanate) for the treatment of UTI.

Infants, Children, and Adolescents

7 mg/kg/dose PO every 12 hours or 14 mg/kg/dose PO every 24 hours. A treatment course of 7 to 14 days is recommended by the American Academy of Pediatrics (AAP) for the treatment of initial UTI in febrile infants and young children 2 to 24 months of age. Shorter courses (2 to 4 days) may be used in older children with uncomplicated cystitis. In a retrospective in vitro antimicrobial susceptibility study in children, 95.6% of isolates (n = 412 of 431) recovered from the urine were susceptible to cefdinir. This rate was comparable or superior to rates for other antibiotics (i.e., ampicillin, nitrofurantoin; trimethoprim; sulfamethoxazole).

†Indicates off-label use

MAXIMUM DOSAGE

Adults

600 mg/day PO.

Geriatric

600 mg/day PO.

Adolescents

600 mg/day PO.

Children

14 mg/kg/day PO (Max: 600 mg/day).

Infants

6 months and older: 14 mg/kg/day PO.
1 to 5 months: Safety and efficacy have not been established; however, 14 mg/kg/day PO has been used off-label.

Neonates

Safety and efficacy have not been established.

DOSING CONSIDERATIONS

Hepatic Impairment

Dosage adjustment is not necessary.

Renal Impairment

CrCl >=30 mL/min: No dosage adjustment needed.
CrCl < 30 mL/min: For adults, the dose of cefdinir should be 300 mg PO once daily. For pediatric patients, if the CrCl < 30 mL/min/1.73 m2, the dose should be 7 mg/kg (up to 300 mg) PO once daily.
 
Intermittent hemodialysis
Hemodialysis removes cefdinir from the body. In patients maintained on chronic hemodialysis, the recommended initial dosage regimen is a 300 mg (adults) or 7 mg/kg (pediatrics) PO every other day. At the conclusion of each hemodialysis session, 300 mg (or 7 mg/kg) should be given. Subsequent doses (300 mg or 7 mg/kg) are then administered every other day.

ADMINISTRATION

Oral Administration

If antacids or iron supplements are necessary during cefdinir therapy, cefdinir should be given at least 2 hours before or after the antacid or iron supplement. Iron-fortified infant formulas do not significantly alter the absorption of cefdinir.

Oral Solid Formulations

Cefdinir capsules may be administered without regard to meals.

Oral Liquid Formulations

Cefdinir oral suspension may be administered without regard to meals.
Shake well prior to each use.
For accurate dosage, measure using a calibrated oral syringe, spoon or cup.
 
Suspension Reconstitution:
Tap the bottle to loosen the powder. The water will be added in 2 portions; shake well after each aliquot.
See manufacturer’s specific instructions regarding reconstitution volumes needed. Each manufacturer will have different instructions regarding the amount of water needed to obtain either the 125 mg/5 mL or 250 mg/mL concentrations.
After mixing, the suspension can be stored at controlled room temperature. The container should be kept tightly closed when not in use. Shake well prior to each use. The suspension may be used for 10 days, after which any unused portion must be discarded.

STORAGE

Omnicef:
– Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F

CONTRAINDICATIONS / PRECAUTIONS

General Information

A false-positive reaction for glucose in the urine has been observed in patients receiving cephalosporins, such as cefdinir, and using Benedict’s solution, Fehling’s solution, or Clinitest tablets for urine glucose testing. However, this reaction has not been observed with glucose oxidase tests (e.g., Tes-tape, Clinistix, Diastix). Patients with diabetes mellitus who test their urine for glucose should use glucose tests based on enzymatic glucose oxidase reactions while on cefdinir treatment.
 
A positive direct Coombs test may develop in some patients. In hematologic studies or in transfusion cross-matching procedures when antiglobulin tests are performed on the minor side or in Coombs test of newborns whose mothers received cefdinir before delivery, clinicians should keep in mind that a positive Coombs test may be due to the drug.

Antimicrobial resistance, viral infection

Cefdinir does not treat viral infection (e.g., common cold). Prescribing in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria (antimicrobial resistance). Patients should be told to complete the full course of treatment, even if they feel better earlier.

Cephalosporin hypersensitivity, penicillin hypersensitivity

Cefdinir is contraindicated in patients with a known history of cephalosporin hypersensitivity or cephamycin hypersensitivity. Cefdinir should be used cautiously in patients with hypersensitivity to penicillin. The structural similarity between cefdinir and penicillin means cross-reactivity can occur. Penicillins can cause a variety of hypersensitivity reactions ranging from mild rash to fatal anaphylaxis. Patients who have experienced severe penicillin hypersensitivity should not receive cefdinir. The incidence of cephalosporin hypersensitivity is approximately 3—7% among patients with a documented history of penicillin hypersensitivity. Cefdinir should be used with caution in patients who have had a delayed-type reaction to penicillin or related drugs. Serum sickness-like reactions have occurred following a second course of therapy.

Dialysis, renal failure, renal impairment

In patients with transient or persistent renal impairment (creatinine clearance <30 mL/min) or renal failure, the total daily dose of cefdinir should be reduced because high and prolonged plasma concentrations of cefdinir can result following recommended doses. Because hemodialysis removes cefdinir from the body, additional dosage adjustments are needed to ensure therapeutic effect if a patient receives dialysis.

Colitis, diarrhea, GI disease, inflammatory bowel disease, pseudomembranous colitis, ulcerative colitis

Almost all antibacterial agents have been associated with pseudomembranous colitis (antibiotic-associated colitis) which may range in severity from mild to life-threatening. In the colon, overgrowth of Clostridia may exist when normal flora is altered subsequent to antibacterial administration. The toxin produced by Clostridium difficile is a primary cause of pseudomembranous colitis. It is known that systemic use of antibiotics predisposes patients to development of pseudomembranous colitis. Consideration should be given to the diagnosis of pseudomembranous colitis in patients presenting with diarrhea following antibacterial administration. Systemic antibiotics should be prescribed with caution to patients with inflammatory bowel disease such as ulcerative colitis or other GI disease. If diarrhea develops during therapy, the drug should be discontinued. Following diagnosis of pseudomembranous colitis, therapeutic measures should be instituted. In milder cases, the colitis may respond to discontinuation of the offending agent. In moderate to severe cases, fluids and electrolytes, protein supplementation, and treatment with an antibacterial effective against Clostridium difficile may be warranted. Products inhibiting peristalsis are contraindicated in this clinical situation. Practitioners should be aware that antibiotic-associated colitis has been observed to occur over two months or more following discontinuation of systemic antibiotic therapy; a careful medical history should be taken.

Coagulopathy, vitamin K deficiency

All cephalosporins, including cefdinir, can rarely cause hypoprothrombinemia and have the potential to cause bleeding. Cephalosporins, which contain the methylthiotetrazole (MTT) side chain (e.g., cefoperazone, cefamandole, cefotetan), have been associated with an increased risk for bleeding. Cephalosporins should be used cautiously in patients with a preexisting coagulopathy (e.g., vitamin K deficiency) because these patients are at a higher risk for developing bleeding complications.

Diabetes mellitus

In patients with diabetes mellitus, it should be noted that cefdinir oral suspension contains sucrose (1.37 to 2.94 g per teaspoon depending on manufacturer), which may be a concern in patients whose blood glucose is very sensitive to carbohydrate intake.

Infants, neonates

Safety and efficacy of cefdinir in neonates and infants less than 6 months of age have not been established.

Pregnancy

Cefdinir is classified in FDA pregnancy risk category B. Animal data show that there are no teratogenic effects of cefdinir in rats. There are, however, no adequate and well-controlled studies in pregnant women, Because animal reproduction studies are not always predictive of human response, cefdinir should be used during pregnancy only if clearly needed.

Breast-feeding

Cefdinir may be administered to breast-feeding women. Cefdinir was not detected in human breast milk following single 600-mg oral doses.

Geriatric

Dose adjustment of cefdinir is not necessary in the geriatric patient unless renal function is markedly compromised. Clinical trial data and clinical experience suggests similar efficacy toin geriatric and younger adult patients. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents (geriatric adults) of long-term care facilities. According to OBRA, use of antibiotics should be limited to confirmed or suspected bacterial infections. Antibiotics are non-selective and may result in the eradication of beneficial microorganisms while promoting the emergence of undesired ones, causing secondary infections such as oral thrush, colitis, or vaginitis. Any antibiotic may cause diarrhea, nausea, vomiting, anorexia, and hypersensitivity reactions.

ADVERSE REACTIONS

Severe

anaphylactoid reactions / Rapid / 0-1.0
exfoliative dermatitis / Delayed / 0-1.0
vasculitis / Delayed / 0-1.0
erythema multiforme / Delayed / 0-1.0
Stevens-Johnson syndrome / Delayed / 0-1.0
angioedema / Rapid / 0-1.0
laryngeal edema / Rapid / 0-1.0
anaphylactic shock / Rapid / 0-1.0
toxic epidermal necrolysis / Delayed / 0-1.0
erythema nodosum / Delayed / 0-1.0
serum sickness / Delayed / 0-1.0
peptic ulcer / Delayed / 0-1.0
ileus / Delayed / 0-1.0
seizures / Delayed / 0-1.0
hemolytic anemia / Delayed / 0-1.0
agranulocytosis / Delayed / 0-1.0
aplastic anemia / Delayed / 0-1.0
thrombotic thrombocytopenic purpura (TTP) / Delayed / 0-1.0
pancytopenia / Delayed / 0-1.0
GI bleeding / Delayed / 0-1.0
disseminated intravascular coagulation (DIC) / Delayed / 0-1.0
hepatic failure / Delayed / 0-1.0
rhabdomyolysis / Delayed / 0-1.0
azotemia / Delayed / 0-1.0
renal failure (unspecified) / Delayed / 0-1.0
hyperkalemia / Delayed / 0-1.0
eosinophilic pneumonia / Delayed / 0-1.0
respiratory arrest / Rapid / 0-1.0
heart failure / Delayed / 0-1.0
myocardial infarction / Delayed / 0-1.0

Moderate

superinfection / Delayed / 1.0-10.0
candidiasis / Delayed / 0.2-4.0
proteinuria / Delayed / 1.0-2.0
melena / Delayed / 0-1.0
colitis / Delayed / 0-1.0
stomatitis / Delayed / 0-1.0
pseudomembranous colitis / Delayed / 0-1.0
vaginitis / Delayed / 0.3-1.0
thrombocytopenia / Delayed / 0-1.0
neutropenia / Delayed / 0-1.0
eosinophilia / Delayed / 0-1.0
bleeding / Early / 0-1.0
leukopenia / Delayed / 0-1.0
cholestasis / Delayed / 0-1.0
hyperbilirubinemia / Delayed / 0-1.0
jaundice / Delayed / 0-1.0
hepatitis / Delayed / 0-1.0
elevated hepatic enzymes / Delayed / 0-1.0
involuntary movements / Delayed / 0-1.0
hematuria / Delayed / 1.0-1.0
glycosuria / Early / 0-1.0
hyperglycemia / Delayed / 0-1.0
hyperphosphatemia / Delayed / 0-1.0
hypophosphatemia / Delayed / 0-1.0
hypocalcemia / Delayed / 0-1.0
hyperamylasemia / Delayed / 0-1.0
conjunctivitis / Delayed / 0-1.0
hypertension / Early / 0-1.0
chest pain (unspecified) / Early / 0-1.0
constipation / Delayed / 0.3-0.3

Mild

diarrhea / Early / 8.0-15.0
rash / Early / 0.9-3.0
nausea / Early / 0.2-3.0
headache / Early / 2.0-2.0
maculopapular rash / Early / 0-1.0
abdominal pain / Early / 0.8-1.0
vomiting / Early / 0.7-1.0
fever / Early / 0-1.0
dyspepsia / Early / 0.2-0.7
flatulence / Early / 0.7-0.7
xerostomia / Early / 0.3-0.3
anorexia / Delayed / 0.3-0.3
dizziness / Early / 0.3-0.3
pruritus / Rapid / 0.2-0.2
insomnia / Early / 0.2-0.2
drowsiness / Early / 0.2-0.2
asthenia / Delayed / 0.2-0.2
hyperkinesis / Delayed / 0.2-0.2
leukorrhea / Delayed / 0.2-0.2
stool discoloration / Delayed / Incidence not known

DRUG INTERACTIONS

Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: (Major) Antacids containing magnesium can interfere with the absorption of cefdinir. If magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid. Other orally administered magnesium salts may also interfere with the absorption of cefdinir.
Antacids: (Major) Antacids containing magnesium or aluminum can interfere with the absorption of cefdinir. If aluminum or magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid.
Calcium Carbonate: (Major) Antacids containing magnesium or aluminum can interfere with the absorption of cefdinir. If aluminum or magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid.
Calcium Carbonate; Magnesium Hydroxide: (Major) Antacids containing magnesium or aluminum can interfere with the absorption of cefdinir. If aluminum or magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid.
Calcium Carbonate; Risedronate: (Major) Antacids containing magnesium or aluminum can interfere with the absorption of cefdinir. If aluminum or magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid.
Calcium Carbonate; Simethicone: (Major) Antacids containing magnesium or aluminum can interfere with the absorption of cefdinir. If aluminum or magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid.
Choline Salicylate; Magnesium Salicylate: (Major) Antacids containing magnesium can interfere with the absorption of cefdinir. If magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid. Other orally administered magnesium salts may also interfere with the absorption of cefdinir.
Dienogest; Estradiol valerate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Ethinyl Estradiol; Levomefolate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Estradiol; Levonorgestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Estradiol; Norethindrone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Estradiol; Norgestimate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Desogestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Ethynodiol Diacetate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Etonogestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Levonorgestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norelgestromin: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norethindrone Acetate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate: (Moderate) If oral iron supplements are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or 2 hours after the iron supplement. Concomitant administration of cefdinir with therapeutic iron supplements containing 60 mg of elemental iron or vitamins supplemented with 10 mg of elemental iron reduced extent of cefdinir absorption by 80% and 31%, respectively. The effect highly iron-fortified food (primarily iron-fortified breakfast cereals) on cefdinir absorption has not been studied. Further, concomitantly administered iron-fortified infant formula (2.2 mg elemental iron/6 oz) has no significant effect on cefdinir pharmacokinetics; therefore, cefdinir oral suspension can be administered with iron-fortified infant formula. However, several case reports describe nonbloody, reddish stool discoloration in infants being treated with cefdinir who were also receiving iron-fortified infant formulas. This reddish color may occur as a result of the formation of a nonabsorbable complex between ferric ions and cefdinir or one of its metabolites. Parents of infants receiving cefdinir should be counseled about this potential interaction. (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norethindrone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norethindrone; Ferrous fumarate: (Moderate) If oral iron supplements are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or 2 hours after the iron supplement. Concomitant administration of cefdinir with therapeutic iron supplements containing 60 mg of elemental iron or vitamins supplemented with 10 mg of elemental iron reduced extent of cefdinir absorption by 80% and 31%, respectively. The effect highly iron-fortified food (primarily iron-fortified breakfast cereals) on cefdinir absorption has not been studied. Further, concomitantly administered iron-fortified infant formula (2.2 mg elemental iron/6 oz) has no significant effect on cefdinir pharmacokinetics; therefore, cefdinir oral suspension can be administered with iron-fortified infant formula. However, several case reports describe nonbloody, reddish stool discoloration in infants being treated with cefdinir who were also receiving iron-fortified infant formulas. This reddish color may occur as a result of the formation of a nonabsorbable complex between ferric ions and cefdinir or one of its metabolites. Parents of infants receiving cefdinir should be counseled about this potential interaction. (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norgestimate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norgestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Iron Salts: (Moderate) If oral iron supplements are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or 2 hours after the iron supplement. Concomitant administration of cefdinir with therapeutic iron supplements containing 60 mg of elemental iron or vitamins supplemented with 10 mg of elemental iron reduced extent of cefdinir absorption by 80% and 31%, respectively. The effect highly iron-fortified food (primarily iron-fortified breakfast cereals) on cefdinir absorption has not been studied. Further, concomitantly administered iron-fortified infant formula (2.2 mg elemental iron/6 oz) has no significant effect on cefdinir pharmacokinetics; therefore, cefdinir oral suspension can be administered with iron-fortified infant formula. However, several case reports describe nonbloody, reddish stool discoloration in infants being treated with cefdinir who were also receiving iron-fortified infant formulas. This reddish color may occur as a result of the formation of a nonabsorbable complex between ferric ions and cefdinir or one of its metabolites. Parents of infants receiving cefdinir should be counseled about this potential interaction.
Iron: (Moderate) If oral iron supplements are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or 2 hours after the iron supplement. Concomitant administration of cefdinir with therapeutic iron supplements containing 60 mg of elemental iron or vitamins supplemented with 10 mg of elemental iron reduced extent of cefdinir absorption by 80% and 31%, respectively. The effect highly iron-fortified food (primarily iron-fortified breakfast cereals) on cefdinir absorption has not been studied. Further, concomitantly administered iron-fortified infant formula (2.2 mg elemental iron/6 oz) has no significant effect on cefdinir pharmacokinetics; therefore, cefdinir oral suspension can be administered with iron-fortified infant formula. However, several case reports describe nonbloody, reddish stool discoloration in infants being treated with cefdinir who were also receiving iron-fortified infant formulas. This reddish color may occur as a result of the formation of a nonabsorbable complex between ferric ions and cefdinir or one of its metabolites. Parents of infants receiving cefdinir should be counseled about this potential interaction.
Lanthanum Carbonate: (Major) To limit absorption problems, cefdinir should not be taken within 2 hours of dosing with lanthanum carbonate. Oral drugs known to interact with cationic antacids, like cefdinir, may also be bound by lanthanum carbonate. Separate the times of administration appropriately. Monitor the patient to ensure the appropriate response to cefdinir is obtained.
Leuprolide; Norethindrone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Levonorgestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Loop diuretics: (Minor) Nephrotoxicity associated with cephalosporins may be potentiated by concomitant therapy with loop diuretics. Clinicians should be aware that this may occur even in patients with minor or transient renal impairment.
Magnesium Salicylate: (Major) Antacids containing magnesium can interfere with the absorption of cefdinir. If magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid. Other orally administered magnesium salts may also interfere with the absorption of cefdinir.
Magnesium Salts: (Major) Antacids containing magnesium can interfere with the absorption of cefdinir. If magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid. Other orally administered magnesium salts may also interfere with the absorption of cefdinir.
Mestranol; Norethindrone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norethindrone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norgestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Oral Contraceptives: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Polysaccharide-Iron Complex: (Moderate) If oral iron supplements are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or 2 hours after the iron supplement. Concomitant administration of cefdinir with therapeutic iron supplements containing 60 mg of elemental iron or vitamins supplemented with 10 mg of elemental iron reduced extent of cefdinir absorption by 80% and 31%, respectively. The effect highly iron-fortified food (primarily iron-fortified breakfast cereals) on cefdinir absorption has not been studied. Further, concomitantly administered iron-fortified infant formula (2.2 mg elemental iron/6 oz) has no significant effect on cefdinir pharmacokinetics; therefore, cefdinir oral suspension can be administered with iron-fortified infant formula. However, several case reports describe nonbloody, reddish stool discoloration in infants being treated with cefdinir who were also receiving iron-fortified infant formulas. This reddish color may occur as a result of the formation of a nonabsorbable complex between ferric ions and cefdinir or one of its metabolites. Parents of infants receiving cefdinir should be counseled about this potential interaction.
Segesterone Acetate; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate: (Moderate) If oral iron supplements are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or 2 hours after the iron supplement. Concomitant administration of cefdinir with therapeutic iron supplements containing 60 mg of elemental iron or vitamins supplemented with 10 mg of elemental iron reduced extent of cefdinir absorption by 80% and 31%, respectively. The effect highly iron-fortified food (primarily iron-fortified breakfast cereals) on cefdinir absorption has not been studied. Further, concomitantly administered iron-fortified infant formula (2.2 mg elemental iron/6 oz) has no significant effect on cefdinir pharmacokinetics; therefore, cefdinir oral suspension can be administered with iron-fortified infant formula. However, several case reports describe nonbloody, reddish stool discoloration in infants being treated with cefdinir who were also receiving iron-fortified infant formulas. This reddish color may occur as a result of the formation of a nonabsorbable complex between ferric ions and cefdinir or one of its metabolites. Parents of infants receiving cefdinir should be counseled about this potential interaction.
Sodium picosulfate; Magnesium oxide; Anhydrous citric acid: (Major) Prior or concomitant use of antibiotics with sodium picosulfate; magnesium oxide; anhydrous citric acid may reduce efficacy of the bowel preparation as conversion of sodium picosulfate to its active metabolite bis-(p-hydroxy-phenyl)-pyridyl-2-methane (BHPM) is mediated by colonic bacteria. If possible, avoid coadministration. Certain antibiotics (i.e., tetracyclines and quinolones) may chelate with the magnesium in sodium picosulfate; magnesium oxide; anhydrous citric acid solution. Therefore, these antibiotics should be taken at least 2 hours before and not less than 6 hours after the administration of sodium picosulfate; magnesium oxide; anhydrous citric acid solution.
Warfarin: (Moderate) The concomitant use of warfarin with many classes of antibiotics, including cephalosporins, may increase the INR thereby potentiating the risk for bleeding. Inhibition of vitamin K synthesis due to alterations in the intestinal flora may be a mechanism; however, concurrent infection is also a potential risk factor for elevated INR. Additionally, certain cephalosporins (cefotetan, cefoperazone, cefamandole) are associated with prolongation of the prothrombin time due to the methylthiotetrazole (MTT) side chain at the R2 position, which disturbs the synthesis of vitamin K-dependent clotting factors in the liver. Monitor patients for signs and symptoms of bleeding. Additionally, increased monitoring of the INR, especially during initiation and upon discontinuation of the antibiotic, may be necessary.

Third Generation Cephalosporins – GlobalRPH

INDICATIONS AND USAGE:
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Treatment
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Cefotaxime for Injection, USP is indicated for the treatment of patients with serious infections caused by susceptible strains of the designated microorganisms in the diseases listed below.

(1) Lower respiratory tract infections, including pneumonia, caused by Streptococcus pneumoniae (formerly Diplococcus pneumoniae), Streptococcus pyogenes* (Group A streptococci) and other streptococci (excluding enterococci, e.g., Enterococcus faecalis), Staphylococcus aureus (penicillinase and non-penicillinase producing), Escherichia coli, Klebsiella species, Haemophilus influenzae (including ampicillin resistant strains), Haemophilus parainfluenzae, Proteus mirabilis, Serratia marcescens*, Enterobacter species, indole positive Proteus and Pseudomonas species (including P. aeruginosa).

(2) Genitourinary infections. Urinary tract infections caused by Enterococcus species, Staphylococcus epidermidis, Staphylococcus aureus*, (penicillinase and non-penicillinase producing), Citrobacter species, Enterobacter species, Escherichia coli, Klebsiella species, Proteus mirabilis, Proteus vulgaris*, Providencia stuartii, Morganella morganii*, Providencia rettgeri*, Serratia marcescens and Pseudomonas species (including P. aeruginosa). Also, uncomplicated gonorrhea (cervical/urethral and rectal) caused by Neisseria gonorrhoeae, including penicillinase producing strains.

(3) Gynecologic infections, including pelvic inflammatory disease, endometritis and pelvic cellulitis caused by Staphylococcus epidermidis, Streptococcus species, Enterococcus species, Enterobacter species*, Klebsiella species*, Escherichia coli, Proteus mirabilis, Bacteroides species (including Bacteroides fragilis*), Clostridium species, and anaerobic cocci (including Peptostreptococcus species and Peptococcus species) and Fusobacterium species (including F. nucleatum*).
Cefotaxime for Injection, USP, like other cephalosporins, has no activity against Chlamydia trachomatis. Therefore, when cephalosporins are used in the treatment of patients with pelvic inflammatory disease and C. trachomatis is one of the suspected pathogens, appropriate anti-chlamydial coverage should be added.

(4) Bacteremia/Septicemia caused by Escherichia coli, Klebsiella species, and Serratia marcescens, Staphylococcus aureus and Streptococcus species (including S. pneumoniae).

(5) Skin and skin structure infections caused by Staphylococcus aureus (penicillinase and non-penicillinase producing), Staphylococcus epidermidis, Streptococcus pyogenes (Group A streptococci) and other streptococci, Enterococcus species, Acinetobacter species*, Escherichia coli, Citrobacter species (including C. freundii*), Enterobacter species, Klebsiella species, Proteus mirabilis, Proteus vulgaris*, Morganella morganii, Providencia rettgeri*, Pseudomonas species, Serratia marcescens, Bacteroides species, and anaerobic cocci (including Peptostreptococcus* species and Peptococcus species).

(6) Intra-abdominal infections including peritonitis caused by Streptococcus species*, Escherichia coli, Klebsiella species, Bacteroides species, and anaerobic cocci (including Peptostreptococcus* species and Peptococcus* species) Proteus mirabilis*, and Clostridium species*.

(7) Bone and/or joint infections caused by Staphylococcus aureus (penicillinase and non-penicillinase producing strains), Streptococcus species (including S. pyogenes*), Pseudomonas species (including P. aeruginosa*), and Proteus mirabilis*.

(8) Central nervous system infections, e.g., meningitis and ventriculitis, caused by Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Klebsiella pneumoniae* and Escherichia coli*.

(*) Efficacy for this organism, in this organ system, has been studied in fewer than 10 infections.

Although many strains of enterococci (e.g., S. faecalis) and Pseudomonas species are resistant to cefotaxime sodium in vitro, Cefotaxime for Injection, USP has been used successfully in treating patients with infections caused by susceptible organisms.

Specimens for bacteriologic culture should be obtained prior to therapy in order to isolate and identify causative organisms and to determine their susceptibilities to cefotaxime. Therapy may be instituted before results of susceptibility studies are known; however, once these results become available, the antibiotic treatment should be adjusted accordingly.

In certain cases of confirmed or suspected gram-positive or gram-negative sepsis or in patients with other serious infections in which the causative organism has not been identified, Cefotaxime for Injection, USP may be used concomitantly with an aminoglycoside. The dosage recommended in the labeling of both antibiotics may be given and depends on the severity of the infection and the patient’s condition. Renal function should be carefully monitored, especially if higher dosages of the aminoglycosides are to be administered or if therapy is prolonged, because of the potential nephrotoxicity and ototoxicity of aminoglycoside antibiotics. It is possible that nephrotoxicity may be potentiated if Cefotaxime for Injection, USP is used concomitantly with an aminoglycoside.

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Prevention
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The administration of Cefotaxime for Injection, USP preoperatively reduces the incidence of certain infections in patients undergoing surgical procedures (e.g., abdominal or vaginal hysterectomy, gastrointestinal and genitourinary tract surgery) that may be classified as contaminated or potentially contaminated.

In patients undergoing cesarean section, intraoperative (after clamping the umbilical cord) and postoperative use of Cefotaxime for Injection, USP may also reduce the incidence of certain postoperative infections. See DOSAGE AND ADMINISTRATION section.

Effective use for elective surgery depends on the time of administration. To achieve effective tissue levels, Cefotaxime for Injection, USP should be given 1/2 or 1 1/2 hours before surgery. See DOSAGE AND ADMINISTRATION section.

For patients undergoing gastrointestinal surgery, preoperative bowel preparation by mechanical cleansing as well as with a non-absorbable antibiotic (e.g., neomycin) is recommended.

If there are signs of infection, specimens for culture should be obtained for identification of the causative organism so that appropriate therapy may be instituted.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Cefotaxime for Injection, USP and other antibacterial drugs, Cefotaxime for Injection, USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

DOSAGE AND ADMINISTRATION:

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Adults:
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Dosage and route of administration should be determined by susceptibility of the causative organisms, severity of the infection, and the condition of the patient (see table for dosage guideline). Cefotaxime may be administered IM or IV after reconstitution. The maximum daily dosage should not exceed 12 grams.

GUIDELINES FOR DOSAGE OF CEFOTAXIME FOR INJECTION

Type of Infection Daily Dose (grams) Frequency and Route
Gonococcal urethritis/cervicitis in males and females 0.5 0.5 gram IM (single dose)
Rectal gonorrhea in females 0.5 0.5 gram IM (single dose)
Rectal gonorrhea in males 1 1 gram IM (single dose)
Uncomplicated infections 2 1 gram every 12 hours IM or IV
Moderate to severe infections 3-6 1-2 grams every 8 hours IM or IV
Infections commonly needing antibiotics in higher dosage (e.g., septicemia) 6-8 2 grams every 6-8 hours IV
Life-threatening infections up to 12 2 grams every 4 hours IV

If C. trachomatis is a suspected pathogen, appropriate anti-chlamydial coverage should be added, because cefotaxime sodium has no activity against this organism.

To prevent postoperative infection in contaminated or potentially contaminated surgery, the recommended dose is a single 1 gram IM or IV administered 30 to 90 minutes prior to start of surgery.

Cesarean Section Patients

The first dose of 1 gram is administered intravenously as soon as the umbilical cord is clamped. The second and third doses should be given as 1 gram intravenously or intramuscularly at 6 and 12 hours after the first dose.

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Neonates, Infants, and Children
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The following dosage schedule is recommended:

Neonates (birth to 1 month):
0-1 week of age 50 mg/kg per dose every 12 hours IV
1-4 weeks of age 50 mg/kg per dose every 8 hours IV

It is not necessary to differentiate between premature and normal-gestational age infants.

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Infants and Children (1 month to 12 years):
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For body weights less than 50 kg, the recommended daily dose is 50 to 180 mg/kg IM or IV body weight divided into four to six equal doses. The higher dosages should be used for more severe or serious infections, including meningitis. For body weights 50 kg or more, the usual adult dosage should be used; the maximum daily dosage should not exceed 12 grams.
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NOTE: As with antibiotic therapy in general, administration of cefotaxime should be continued for a minimum of 48 to 72 hours after the patient defervesces or after evidence of bacterial eradication has been obtained; a minimum of 10 days of treatment is recommended for infections caused by Group A beta-hemolytic streptococci in order to guard against the risk of rheumatic fever or glomerulonephritis; frequent bacteriologic and clinical appraisal is necessary during therapy of chronic urinary tract infection and may be required for several months after therapy has been completed; persistent infections may require treatment of several weeks and doses smaller than those indicated above should not be used.

Renal Dosing:
Although there is no clinical evidence supporting the necessity of changing the dosage of cefotaxime sodium in patients with even profound renal dysfunction, it is suggested that, until further data are obtained, the dose of cefotaxime sodium be halved in patients with estimated creatinine clearances of less than 20 mL/min/1.73 m2.

SOURCE:
Package insert data:

90,000 “Now they don’t get pneumonia, they get infected.” Doctor from Tver about the disease | HEALTH: Medicine | HEALTH

The coronavirus pandemic in the Tver region is declining. However, during it, doctors were faced with the fact that instead of classical pneumonia, they had to deal with a completely different disease affecting the patient’s lungs.

About what pneumonia was before the “war with COVID-19” and how the disease manifests itself now, AiF Tver told Chief Freelance Pulmonologist of the Ministry of Health of the Tver Region, Candidate of Medical Sciences, Associate Professor, Head of the Department of the Tver Regional Clinical Hospital Galina Trufanova …

Everything has changed

“AiF Tver”: Galina Yurievna, by what signs can one understand that a patient has classic pneumonia, and not a common cold?

Galina Trufanova: A respiratory viral infection, despite the fact that a huge number of viruses can cause it, has a certain specificity. For example, with an adenovirus infection, the patient will have a severe runny nose, as well as conjunctivitis. With respiratory syncytial virus, especially in children, there will be cough, obstructive bronchitis.The flu also has its own characteristics: there are few catarrhal manifestations, that is, there is no discharge from the nose and eyes, but high fever and intoxication.

As we say, “before the war,” that is, before the advent of the coronavirus, the classic picture of the development of pneumonia was the second wave of fever. If a patient falls ill with ARVI, then his temperature gradually decreases and suddenly rises sharply again – this is a cause for alarm. Evidence that a bacterium settled on a viral infection, and we most likely got bacterial pneumonia.

There are also cases when pneumonia manifests itself immediately, without prior ARVI. Usually this picture is given by severe pneumococcal pneumonia. They appear, as a rule, after hypothermia: a person drank a cold summer or got caught in the rain. Our lungs are generally well protected from viral infection by barriers of different levels. If we get sick, it means that something has destroyed these barriers.

– What has changed with the arrival of COVID-19?

– In the context of the coronavirus, things are different.Earlier, we even taught students that they do not get pneumonia, but get sick. Now everything is exactly the opposite. Almost all patients who come to us with pneumonia contracted it, and did not get sick as a result of hypothermia or previous ARVI.

Nobody, of course, has canceled the usual respiratory viral infections, after which classic pneumonia can develop. But in the epidemic period, there should be special vigilance towards them. Symptoms that cause anxiety are persistent high fever, increasing weakness, anosmia – loss of smell.With such signs of the disease, an urgent need to report this to the hospital. With coronavirus, not only the sense of smell is often lost, but also the taste and appetite. It is believed that this is the specificity of damage to the nervous system. And against the background of all this, the so-called “covid” pneumonia often develops.

It is impossible to divide common pneumonia and coronavirus into different hospitals. Therefore, today we do not have such departments where it would be possible to treat pneumonia as “maybe not coronavirus”.Indeed, even with an atypical picture of COVID-19, the next day it can become typical. Therefore, we consider any manifestations of the disease with special attention.

X-rays will not help

– Are pneumonia patients always hospitalized? Or can this disease be treated at home?

– If symptoms of prolonged fever persist, then now it is usually a question of conducting a computed tomography. A decision is made based on its results. The patient is left at home if he does not have extensive lung damage, there are no concomitant pathologies, and age allows.For example, with 20% lung damage, it is possible to be treated at home, but it is imperative to monitor the dynamics. Hospitalization should be performed in other cases if additional risk factors are present.

– Is CT imperative? Previously, after all, pneumonia was usually detected on x-rays?

– There used to be such an algorithm, or “gold standard”, of diagnostics: a clinical blood test was done, the doctor examined the patient, listened to the lungs, plus an X-ray was prescribed. And then, if there was a discrepancy between the clinical data and the standard X-ray picture, if there were any ambiguities and doubts, the patient could be sent for computed tomography.

What happened with the coronavirus? It turned out that because of him, the damage to the lungs received a certain specificity. The changes that occur in them are not visible on x-rays. Moreover, common pneumonia was often obvious even to an inexperienced specialist. It’s simple: I knocked (sound picture) and listened with my ear (certain side noises are heard). And with coronavirus, lung damage does not give sound symptoms. Therefore, today the main diagnostic method is CT.

B “inheritance” – fibrosis

– How do common, community-acquired, atypical pneumonia differ from each other?

– The term SARS does not exist in pulmonology. There are atypical pathogens. Pneumococcus usually causes pneumonia. And there are bacteria uncharacteristic of pneumonia. For example, mycoplasma, chlamydia. They have their own characteristics of the clinical picture and diagnosis (they are not excreted with sputum). Under them there is a choice of certain antibiotics.

In general, to distinguish between different types of pneumonia, to be interested in the conditions in which the disease developed, it is necessary just in order to choose the right antibiotic. Because the hospital and the home are completely different stories. The pneumonia that developed in the hospital has its own set of pathogens. Out-of-hospital patients have their own.

What happens in the lungs with coronavirus is pneumonitis, that is, an inflammatory process involving the immune system, with vascular lesions – vasculitis.Moreover, the disease often affects not only the lungs, but also the nervous system, intestines, and other organs.

– How long does the treatment take?

– It all depends on the massiveness of the lung lesion. The guideline that the patient has recovered will be a normal temperature for a long time and the absence of inflammatory changes in the blood. But we are in no hurry to write out anyone, because we need to see a steady positive trend. Usually, the patient spends at least 10 days in the hospital, on average, from 14 to 21 days.And after that, it still takes time to fully recover the ability to work.

– Do the patients have any consequences as a result of the disease?

– After lung damage, fibrosis can be observed for a very long time. How do I explain to patients what it is? For example, if you cut yourself or burn yourself, this wound will either leave a scar or nothing. Fibrosis is an analogy for such a “scar”. What fibrosis will be – breathing or not breathing, and which specific parts of the lung can be turned off from gas exchange, is determined much later.The general condition of the patient will also depend on this. However, if part of the lung falls out of gas exchange, then the rest of the lung tissue has great reserve capabilities.

Reference

Vasculitis, or angiitis, arteritis is a group of diseases based on immunopathological inflammation of blood vessels – arteries, capillaries, veins, etc. Typically, these diseases alter the structures and functions of the organs that supply blood to the inflamed vessels. Vasculitis is divided into primary, caused by inflammation of the vessels themselves, and secondary, in which the vessel becomes inflamed as a reaction to another disease.

90,000 Scientists have explained how covid pneumonia differs from the usual

Scientists from Northwestern University (USA) have studied the characteristics of the course of pneumonia caused by bacteria or viruses for many years. The systematic analysis compiled a large file of fluid samples from the lungs of patients with pneumonia, and when scientists realized that the course of COVID-19 pneumonia was different from anything they had seen before, the team decided to compare samples to find unique patterns of coronavirus pneumonia.

Scientists first saw that SARS-CoV-2 was deposited in many small areas of the lung instead of rapidly infecting large areas of the organ, as is usually the case with pneumonia caused by a virus or bacteria. This probably also explains another phenomenon discovered by scientists. It turned out that the mortality rate of patients with COVID-19 on mechanical ventilation was lower than with conventional pneumonia on mechanical ventilation.

SARS-CoV-2 then captures the immune cells of the lungs and uses them to spread through the tissue for days and even weeks.This can be compared to small fires in a forest that gradually spread over a large area, the authors explain.

As the infection slowly spreads in the lungs, it keeps the body developing fever, lowering blood pressure, and damaging the kidneys, brain, heart, and many other organs.

In other words, the more serious complications of COVID-19, when compared to other pneumonias, are caused by the long course of the disease, and not by its severity, the researchers said.

Their work is the first to analyze immune cells in pneumonia caused by various pathogens. Biomaterial samples for covid pneumonia were obtained from 89 patients.

Scientists have also identified important new targets for the treatment of severe COVID-19 pneumonia. They are currently studying how macrophages and T cells can reduce inflammation. One of the experimental drugs is planned to be tested in clinical trials in the first half of 2021.

In another study, scientists from Spain also tried to find out the causes of the more severe form of COVID-19. Their observations show that the severity of the disease depends on the length of telomeres – the main indicators of the body’s aging.

90,000 11 myths about pneumonia: injections, control X-rays and compulsory hospitalization

90,073 According to statistics, every minute in the world two children under the age of five die from pneumonia, and every year 4 million people die from pneumonia and lower respiratory tract infections 25 September – World Lung Day.We decided to debunk the main myths about this dangerous disease together with the pulmonologist Vasily Shtabnitsky.

1. Is it true that pneumonia is always a high temperature?

V.Sh .: No, of course this is not true. In most cases of pneumonia, there is indeed a high temperature, but there is a certain number of pneumonias, the so-called atypical ones, for which a high temperature is not typical.It can be subfebrile and not rise above 38 degrees.

2. Is it true that pneumonia is most often a consequence, complication of ARVI?

V.Sh .: Rather a myth. Most cases of pneumonia develop against a background of absolute health. Although, of course, there is always some predisposing factor. But ARVI is by no means in the first place. Prolonged ARVI does not lead to pneumonia. That is, we can say that there is no connection between ARVI and pneumonia as such.

3. Is it true that cough syrups and antibiotics “for every fireman” during ARVI will protect against pneumonia?

V.Sh .: Will not protect. Unfortunately, antibiotics do not work prophylactically. And they work only after the fact. Syrups, of course, are different. But in general, these are all symptomatic agents that change the properties of sputum and cannot protect against pneumonia. Except in rare cases, when, for example, a patient with cystic fibrosis drinks mucolytics, since sputum-thinning therapy is indicated for him, and yes, it can reduce the risk of pneumonia.But this is an exceptional and very rare case.

4. Is it true that pneumonia can be missed?

V.Sh .: Unfortunately, this is true. This is the imperfection of the auscultation method (lat. Auscultatio – “listening” – a physical method of medical diagnostics, which consists in listening to sounds generated during the functioning of internal organs – ed.). Some minor pneumonias, especially those that are not located on the side of the lungs, but inside, closer to the heart, are really very difficult to hear even for a good experienced doctor.

5. Is it true that pneumonia must be treated with antibiotics?

V.Sh .: It’s difficult here. According to Russian recommendations, we should treat classical bacterial pneumonia with antibiotics. In the West, the view is slowly gaining popularity that the mildest pneumonia, which is not accompanied by an increase in the protein responsible for inflammation, can not be treated with antibiotics. And research confirms that the recovery time for these patients is shortened because they are not receiving antibiotics, and the harm from the side effects of antibiotic use is reduced.That is, it does not worsen the prognosis, but, on the contrary, accelerates recovery, and the patient leaves the hospital faster. But this is only true for the mildest pneumonia!

The indication for parenteral administration of antibiotics, and this is by the way not injections, but only intravenous administration, is only the inability to swallow the suspension.

6. Is it true that antibiotics for pneumonia are necessary exclusively in injections?

V.Sh .: The bioavailability of antibiotics does not differ between the oral (syrups, suspensions, tablets) form and the parenteral (injection) form.And accordingly, the indication for parenteral administration of antibiotics, and this is by the way not injections, but only intravenous administration, is only the inability to swallow a suspension, a tablet or something else, or the absence of an oral form of an antibiotic. Indeed, there are such antibiotics, but there are very few of them. And so, many antibiotics are presented in all forms for administration.

If a patient is shown conditional ceftriaxone, which is commonly used in hospitals, the patient is admitted to a hospital with severe or moderate pneumonia.With this course of the disease, one of the options for therapy is cephalosporins, and they really are mostly administered only intravenously. But not intramuscularly! That is, we cannot talk about any injections.

Mild pneumonia can be easily treated on an outpatient basis.

7. Is it true that pneumonia is treated only in a hospital setting?

V.Sh .: No. Again, it depends on its shape. Mild pneumonia can be safely treated on an outpatient basis, and in turn, it is the mild form of pneumonia that still dominates the prevalence of the disease.If there is no pronounced intoxication, pneumonia proceeds without any severe symptoms, good health remains, then hospitalization is not required.

Feasibility of hospitalization for pneumonia:

  • blood oxygen level below 90%
  • dehydration
  • severe intoxication
  • moderate or severe respiratory failure
  • no effect from the therapy carried out within 48-72 hours
  • concomitant diseases
  • Complications of pneumonia
  • Suspected virulent strain of infection (e.g. Staphylococcus aureus)

8.Is it true that the severity of pneumonia depends on what pathogen it is caused by?

V.Sh .: This is true. The bacterial agent that caused the pneumonia does matter, though not decisive. Mycoplasma and chlamydial pneumonia are often mild. But legionella – in a heavy one. Streptococcal – 50 to 50. It happens that it costs a mild form, and it happens that it develops into a severe one.

9. Is it true that there is no vaccine against pneumonia?

V.S .: Vaccination against pneumonia exists. Or rather, even a few. Pneumococcal vaccination, either 13-valent or 23-valent, which are included in the National Vaccination Schedule. The flu shot indirectly protects against pneumonia, as pneumonia can be a complication of the disease. And haemophilus influenza vaccination protects against haemophilus influenzae, which can also cause pneumonia.

5 tips for parents on how to protect their child from pneumonia:

Vaccination Prevenar for all children, according to the National Vaccination Schedule, up to one year.And after a year, too, you can.

Treatment of comorbid conditions that seem like nonsense, such as vitamin D deficiency or iron deficiency.

Frequent hand washing, especially during the season of viral infections.

Sports, walks and good food.

Oral hygiene.

10. Is it true that in case of pneumonia it is not necessary to identify the causative agent of the infection?

V.Sh .: This is so. There is an express diagnosis that allows you to isolate a bacterium at the patient’s bedside, but this is only necessary for moderate and severe pneumonia.Mild pneumonia does not require identification of the pathogen. Diagnostics can be carried out, but it is advisable only in some cases.

A good doctor can prescribe treatment simply after examining and identifying the entire clinical picture of the disease. That is, for the treatment of pneumonia, we, in fact, do not need anything other than confirmation of the very fact of the presence of pneumonia. In the case of severe to moderate pneumonia, we can take care of choosing an antibiotic more specifically. Conduct a streptococcal test for the determination of streptococcal antigen in the urine, and a similar test for the determination of legionella in the urine.These two tests allow you to confirm or exclude two serious infections and, accordingly, to understand in which direction to go.

X-ray recovery is delayed from clinical recovery.

11. Is it true that you definitely need a control X-ray?

V.Sh .: In the classical form of pneumonia in outpatient treatment, an X-ray is not needed. Moreover, as a rule, the X-ray recovery is delayed from the clinical one.Sometimes X-ray infiltration can last a month. Therefore, a repeated x-ray performed after a week, or two, three, may reveal an infiltration, which is likely to force the doctor to prescribe another antibiotic. And thus, the patient will receive an extra course of antibiotics, which in turn can adversely affect his health.

A control X-ray is needed only if something goes wrong with us. If the patient does not recover, we do not see positive dynamics or we do not like the course of the disease, then we take an X-ray.

Red flags indicating the possibility of pneumonia:

  • second episode of temperature rise, above 38 in a short time
  • prolonged rise in febrile temperature, more than one week
  • excessive weakness
  • very poor health
  • excessive sweating
  • chest pain
  • coughing up sputum with blood
  • Shortness of breath and signs of shortness of breath

Parents should not independently suspect pneumonia in a child. There is a doctor for this.Pneumonia is a medical diagnosis. And only a doctor can deliver, confirm and prescribe the appropriate treatment.

***

Lyudmila Chirkova

90,000 Human Universe. The main achievements and predictions of Stephen Hawking

A person continues to live as long as his memory is alive. In this sense, we can confidently say that British physicist Stephen Hawking, who died at the age of 77, conquered time and gained immortality.His main achievements are in the material of the portal Moscow 24.

Photo: TASS / FA Bobo / PIXSELL / PA Images / Joe Giddens

Popularization of science

Long ago only representatives of the elite could learn to read and write: ordinary people simply did not have chances of acquiring these skills. Today, the same could be said about the science of the origin of the universe if Stephen William Hawking had not been born in Oxford on January 8, 1942.

Hawking devoted most of his scientific life to the popularization of science, trying to make it accessible to everyone.2. In addition, Hawking expressed his views on many contemporary issues such as social inequality, ecology and global warming.

For the smallest

Stephen Hawking with Daughter Lucy. Photo: TASS / FA Bobo / PIXSELL / PA Images / Matt Crossick

Hawking did everything possible not only to make science accessible to adults, but also to help children understand it.

In 2007 Hawking, together with his daughter Lucy, wrote the children’s story “George’s Secret Key to the Universe.”It tells the story of the life of a boy who, despite the attempts of his parents to protect him from modern technology, meets a physicist neighbor who has an incredibly powerful computer that can open portals to distant points of the Universe.

Two more years later, a sequel to the book entitled “George’s Space Treasure Hunt” was published.

As soon as Hawking was in his third decade, he was diagnosed with amyotrophic lateral sclerosis. Subsequently, the disease led to paralysis, and the scientist was forever confined to a wheelchair.

And in 1985 Hawking suffered severe pneumonia and, as a result of a series of operations, lost the ability to speak. So that Stephen could communicate with others, friends gave him an electronic speech synthesizer. Towards the end of his life, he controlled the only movable muscle – the facial muscle of the cheek.

Independence Day

Photo: TASS / Zuma / Dennis Van Tine

Hawking had his own theory about how a personal meeting of people with representatives of alien civilizations could end.It should be noted right away that the scientist did not feel any optimism about this.

Recognizing even a purely mathematical possibility of the existence of other living organisms in the Universe, Hawking assumed that in the event of a meeting, the level of technology development would play a decisive role.

In other words, the scientist believed that if the technologies of aliens surpass those of the Earth, the same will happen as after Columbus discovered America: the aliens would build their own colony and use the local population as slaves.

In addition, Hawking assumed that in the next millennium, humanity will perish if it does not find a way to start colonizing other planets. As for the scenarios, the scientist believed that everything would end in either a nuclear war or the creation of a genetic virus.

The scientist also warned against the invention of artificial intelligence: according to Hawking, before starting to flirt with various types of robots, humanity needs to make sure that its goals and the goals of machines coincide. However, he was not the only one who liked to dream up on this topic: a huge number of feature films were shot about the war between man and machines, including The Terminator, The Matrix, I, Robot and others.

Einstein was right

Photo: TASS / PA Images / Anthony Devlin

Among other things, one of Hawking’s main achievements is that he confirmed the General Theory of Relativity, formulated by Albert Einstein back in 1915.

Einstein argued that the existence of gravitational effects is due to the deformation of space-time associated with the presence of mass-energy, and not due to the interaction of forces and fields.

In turn, Hawking noted that if this theory is not taken into account in the development of satellite navigation systems, then the error in their operation will accumulate at a speed of about 10 kilometers per day.This is due to the fact that time in the earth’s orbit and on the earth’s surface flows differently, which means that the on-board clocks of spacecraft will work at a different speed.

For his popularization of science, Stephen Hawking has earned a place of honor among the heroes of popular culture. The scientist has appeared in Family Guy, The Simpsons and even Futurama, where he voiced himself.

Two biographical films were also made about him: Hawking, in which the scientist was played by the famous British actor Benedict Cumberbatch, and Stephen Hawking’s Universe, the central link of which is the love story of Hawking and Jane Wilde.

She will not see the end

Photo: TASS / PA Photos / Andrew Matthews

Together with Jim Hartle in 1983, Hawking created the theory that our Universe has no boundaries.

To explain this in simpler terms, Hawking proposes to imagine movement on the surface of the globe: not a single person has yet managed to reach its edge. At the same time, there is a difference between the earth’s surface and the Universe: the first exists in two dimensions, the second in four.

In his explanation, Hawking added that the concept of space-time is similar to the earth’s lines of latitude, which first expand towards the equator, and then, conversely, narrow.Based on this, the scientist concluded that a collapse would one day occur with the Universe. However, this will not happen earlier than in 20 billion years.

Hawking radiation

In 1973 Stephen came to Moscow and talked with Yakov Zeldovich and Alexander Starobinsky. Soviet scientists showed Hawking that, in accordance with the laws of quantum mechanics, black holes should not only absorb, but also produce particles.

A year later, Hawking presented his modified theory that black holes lose mass over time, since they give rise to particle-antiparticle pairs, and in the case when the total energy of the antiparticle is negative, and the energy of the particle is positive, the first falls into the black hole, decreasing its energy and mass, and the second, on the contrary, flies away to infinity.This effect is called Hawking radiation.

Fight for the rights of fish

Once Hawking compared humanity with fish that live in a spherical aquarium. Thus, the scientist tried to explain that not being able to get out of his aquarium, a person believes that he knows everything about the structure of the world around him, but in fact he sees only a distorted image.

It so happened that the authorities of the Italian city of Monz took his words too literally and rushed to introduce a law prohibiting breeding fish in spherical aquariums.However, the city authorities forgot that the water itself, in which the fish live, has its own refractive index of light and distorts the image even in a cubic aquarium.

Community-acquired pneumonia


“If your health is bad, think about something else” Edward Benson

DEFINITION

Pneumonia is an infectious inflammation of the pulmonary parenchyma.


Etiology

Jain S, et al. N Engl J Med.2015; 373: 415-27.


ETIOLOGY OF PNEUMONIA

Respiratory viruses : SARS-CoV-2 coronavirus, rhinovirus, human metapneumovirus, respiratory syncytial virus, influenza A and B, parainfluenza, adenovirus.

Bacteria : Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Mycoplasma pneumoniae, Chlamidia pneumoniae, Legionella pneumophila, Enterobacteriacae.


Streptococcus pneumoniae

Electronic photograph of Streptococcus pneumoniae.Janice Haney Carr.


DEFINITION OF THE EXCITER

Gram stain and culture of sputum, culture of blood.

• Severe community-acquired pneumonia.

• Empirical treatment for MRSA or P. aeruginosa.

• Previous infection (especially respiratory) with MRSA or P. aeruginosa.

• Hospitalization and treatment with parenteral antibiotics in the last 90 days.


Adenoviruses in nasopharyngeal cells

Yellow immunofluorescence indicates adenovirus antigens.Hibbert K, et al. N Engl J Med. 2018; 378: 182–90.


CLINICAL DIAGNOSTICS

• Cough with phlegm.

• Fever.

• Dullness of percussion sound.

• Locally fine bubbling, crepitant rales.

• Scales: diagnosis of pneumonia (GRACE consortium), severity (CRB-65, SMART-COP).


Reports for Mycoplasma pneumoniae UK

Public Health England.


LABORATORY DIAGNOSTICS

• General blood analysis.
• Pulse Oximetry.

• Radiography: straight, lateral. When symptoms resolve in 5–7 days, control is not required (1% of cancer in 90 days).

• Computed tomography: for non-informative radiographs.

• Ultrasound, pleural puncture.


Chest X-ray

Disseminated pulmonary blastomycosis. 6 days before hospitalization (A), 5 days after (B). Mansour M, et al. New Engl J Med. 2015; 373: 1554–64.


COMPLICATIONS OF PNEUMONIA

• Pleural effusion (uncomplicated and complicated).
• Empyema of the pleura.

• Destruction / abscess formation of lung tissue.

• Acute respiratory distress syndrome.

• Acute respiratory failure.

• Sepsis, septic shock (50% of all causes [ATS]).

• Secondary bacteremia, sepsis, hematogenous foci of dropout.

• Pericarditis, myocarditis.

• Jade.


Ultrasound examination of the lungs

Arrow – pleurisy, asterisk – seal. Schenck E, Rajwani K.Curr Opin Infect Dis. 2016; 29: 223-8.


CLASSIFICATION OF PNEUMONIA

Conditions : community-acquired, hospitalized (> 48 hours after hospitalization).

Localization : segment, lobe, lung.

Severity : heavy, not heavy.

Etiology : Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamidia pneumoniae, Pneumocystis jiroveci …

Special forms : interstitial (± with autoimmune signs [ESC]), eosinophilic.


STATEMENT OF DIAGNOSIS

□ Community-acquired pneumonia (Str. Pneumoniae), in the lower right lobe, not severe. [J13]

□ Community-acquired pneumonia of the upper lobe on the left, severe. [J18.1]

□ Community-acquired pneumonia, bilateral, caused by coronavirus (COVID-19), severe. [U07.2]


Dynamics of hospital mortality from pneumonia in Irkutsk

IrkutskStat, 2019.


INDICATIONS FOR HOSPITALIZATION (ERS / ESCMID)

• Suspected severe pneumonia (stunnedness, tachypnea> 30, tachycardia> 100, hypotension <90/60 mm Hg.Art.).
• No effect on antibiotics.

• Elderly with an increased risk of complications (comorbidity: diabetes, heart failure, moderate / severe COPD, liver disease, kidney disease, malignant neoplasms).

• Suspected pulmonary embolism.

• Suspected malignant neoplasm.


Time of initiation of antibiotics and mortality from community-acquired pneumonia

Daniel P, et al. Thorax. 2016; 71: 568–70.


CRITERIA FOR SEVERE PNEUMONIA (IDSA / ATS)

Large criteria

• Septic shock with the need for vasopressors (> 4 h).
• The need for mechanical ventilation.

Small criteria

• Respiratory rate ≥30 / min.

• PaO 2 / FiO 2 ≤250.

• Lesion> 2 lobes in R.

• Stunned / disoriented.

• Uremia with urea nitrogen> 20 mg / dL.

• Leukopenia <4 • 10 9 / l.

• Thrombocytopenia <100 • 10 12 / l.

• Hypothermia <36 ° C.
• Hypotension requiring aggressive infusion.

Transfer to PIT: 1 large or 3 small criteria.


Corticosteroids in patients hospitalized with community-acquired pneumonia

Reduction of mortality by 3%, the need for mechanical ventilation by 5%, the duration of treatment by 1 day. Siemieniuk R, et al. Ann Intern Med. 2015; 163: 519-28.


TREATMENT OF PNEUMONIA

• Antibiotics.

• Corticosteroids for refractory septic shock (ATS / IDSA).

• Prescription of antitussives, expectorants, mucolytics, antihistamines and bronchodilators, physiotherapy is impractical (ERS / ESCMID).


ANTIBACTERIAL TREATMENT (IDSA / ATS, 2019)

Outpatient, no comorbidity, risk of MRSA or P. aeruginosa

• Azithromycin 500 mg and then 250 mg once.

• Clarithromycin 500 mg twice or 1000 mg extended once.

• Doxycycline 100 mg twice.

• Amoxicillin 1 g 3 times.

Outpatient, there are concomitant diseases

• Beta-lactam: amoxicillin / clavulanate 500/125 mg 3 times, 875/125 mg twice, cefuroxime 500 mg twice + macrolide.
• Respiratory fluoroquinolone: ​​levofloxacin 750 mg, moxifloxacin 400 mg, gemifloxacin 320 mg once.

Stationary, light

• Ampicillin-sulbactam 1.5-3 g after 6 hours, cefotaxime 1-2 g after 8 hours, ceftriaxone 1-2 g + azithromycin 500 mg once or clarithromycin 500 mg twice.

• Levofloxacin 750 mg, moxifloxacin 400 mg once.

Stationary, heavy

• Beta-lactam + macolid.

• Beta-lactam + respiratory fluoroquinolone.
• MRSA: vancomycin 15 mg / kg, linezolid 600 mg after 12 hours.

• P. aeruginosa: piperacillin-tazobactam 4.5 g, imipenem 500 mg after 6 hours; meropenem 1 g, cefepime 2 g, ceftazidime 2 g, aztreones 2 g after 8 hours.


Frequency of general and arrhythmogenic death during antibiotic treatment

Rao G, et al. Ann Fam Med. 2014; 12: 121-7.


TREATMENT DURATION

• At least 5 days.

• MRSA or P. aeruginosa 7 days.

• No fever (≤37.8 ° C) for 48 h.


Frequency of pneumonia after vaccination initiation

Griffin M, et al. NEJM. 2013; 369: 155–63.


INDICATIONS FOR ANTI-Pneumococcal Vaccination (PPSV23, PCV13)

• Immunocompetent elderly> 65 years of age.

• <65 years of age with chronic illness.
• Splenectomy.

90,000 Chinese scientists have solved the secret of COVID-19? Analyzing the news with an expert

COVID-19 causes not pneumonia, but hypoxia, scientists at Sichuan University of Science and Technology and Yibin University are sure.The conclusion suggests itself: we were treating the wrong disease and the wrong drugs. But is it?

SARS-CoV-2 steals iron?

According to the theory of Chinese scientists, Wenzhong Liu from Sichuan University of Science and Technology and Hualang Li from Yibin University, the SARS-CoV-2 virus attacks not the pulmonary alveoli, but human blood cells. Penetrating inside the erythrocytes, it binds to hemoglobin molecules, and “rips off” iron ions from them.Because of this, red blood cells can no longer carry out a full transport of oxygen through the bloodstream. This leads to the development of:

  • hypoxemia (decreased oxygen content in the blood)

  • hypoxia (multiple organ oxygen deficiency)

  • ARDS (acute respiratory distress symptom)

Which increases, among other things, foci of inflammation in the lungs.Therefore, on a computed tomography of the chest, doctors see the effect of “ground glass”, which corresponds to the picture of pneumonia.

What does this mean?

If Wenzhong and Hualang are right, and SARS-CoV-2 disrupts oxygen transport and makes all organs and tissues in the human body “suffocate”, then it is necessary to fight not with pneumonia, but with hypoxia. And this radically changes the tactics of treating coronavirus infection.

Such stunning conclusions from an article by Chinese scientists produced the effect of a bomb exploding in the world.Not only in scientific and medical circles, but in general in society. Surprisingly, the study itself has not even been published anywhere yet. The article by scientists is posted in the archive of ChemRxiv preprints and is awaiting review.

Does such attention to the work of Chinese scientists mean that they have actually figured out the pathogenesis of the COVID-19 disease? Will we finally get a truly effective treatment and the pandemic is about to end?

The situation around the sensational scientific theory for RBC was commented on by Ancha Baranova, Doctor of Biological Sciences, Professor at the School of Systems Biology at George Mason University (Virginia, USA) and Scientific Director of the Atlas Biomedical Holding.


How accurate is the “hemoglobin” hypothesis?

If I were a scientific reviewer of this scientific article, I would say, guys, it’s great that you made a bioinformatics article, but you have such far-reaching hypotheses, why don’t you test them? In vitro at least? And they would have written to me in response: we are bioinformatics, except for a computer and a server, we have nothing, we cannot test the hypothesis by other methods. This should be done by other experimental scientists.And as a reviewer, then I would say: well, accepted. Because this is a standard situation: bioinformatics cannot conduct experiments, this is not their scientific task. I myself write such bioinformatics articles in large numbers.

But what happened now? Instead of this article remaining in the information field of bioinformatics, as an interesting, unorthodox hypothesis that needs to be further tested, it immediately jumped into the mass consciousness. And people concluded that the problem with COVID-19 was solved, hurray! But in reality, computer models were just made.They only exist in a computer: the drawn viral protein interacts with the drawn iron ion and another protein, hemoglobin, to which this iron ion is attached. And so the energy of this interaction was calculated and it was concluded that this viral protein can “tear” the iron ion from the hemoglobin molecule.

More disadvantages?

They are. And this is not only my opinion. At least there is one scientific article that is also in preprint status – that is, it has not yet been published.In it, a whole team of scientists criticizes this bold “hemoglobin” hypothesis. Curiously, scientists usually do not respond to preprints, only to published articles. And here they answered. And what do the critics say? They admit that the thoughts of Chinese scientists are going in an interesting direction. The idea that viral proteins can penetrate red blood cells and displace iron from the porphyrin nuclei of the hemoglobin molecule, and, as a result, deprive red blood cells of the ability to transport oxygen does not seem unscientific.Nevertheless, opponents noticed that the Chinese made mistakes in their calculations, and there are many of them. At least one of them is very rude.

What is the error: Chinese bioinformatics described the complex, in which the interaction of viral proteins with hemoglobin molecules took place, as a complex with the highest energy. Considering that the greater the energy of the complex, the more stable it is. But in biology, more doesn’t mean better. Quite the opposite – the lower the energy of the complex, the more stable it is.Read more in the article by scientists.

This, of course, raises a reasonable question: how competent were Chinese scientists in general in making bold biological conclusions based on purely bioinformatics calculations? But this still does not mean that the authors of the “hemoglobin” hypothesis of COVID-19 are bad scientists. You definitely shouldn’t think so. They showed the flexibility of the mind, a new formulation of the problem. They looked where no one else had looked. Found tools that can solve the problem. But, yes, they made mistakes.And that’s okay too. Such scientific articles, where there is a new hypothesis, but the evidence for it is not entirely convincing – a million.

Can the Chinese hypothesis be tested?

Of course, and quite easy.

  • Experiment number one. Viral proteins have long been expressed separately. You can take each of these, in theory, iron-binding proteins, pour them into a test tube, add iron ions there and see if they bind to them or not? Such an experiment can be done in a day or two and it will be completely safe.
  • Experiment number two. It can no longer be carried out with iron ions, but with hemoglobin itself. That is, take hemoglobin molecules on which hemes with iron ions sit, and put viral proteins in the same test tube. It will become immediately clear: can they “tear off” the iron from the hemoglobin, because it is quite tightly “screwed” to it? Or do these viral proteins only bind free iron in solution?
  • Experiment number three. You can forget about in vitro and go straight to your patients.We have COVID-19 cases and some people, unfortunately, are dying of pneumonia. After they die, an autopsy is performed to understand what happened to the lungs. And here you can do an iron accumulation test. This is one of the simplest pathological tests, although not every pathologist would guess to do it. Yet the death of patients does not occur from hemochromatosis, but from a respiratory disease. But the main thing is that there are such tests. And, in principle, any pathologist can conduct it, and then close this issue once and for all.

But here’s the caveat: since quite a lot of people have died from COVID-19, and pathologists in different countries have already done a lot of work on studying the state of the lungs of the dead, it seems to me a little strange that none of them noticed such a strange thing as iron deposition in the lungs. But this is not so difficult to notice, as we found out. But for some reason no one has informed us about this yet. From which I still conclude that the authors of the sensational article really made too far-reaching conclusions.

Why did the “raw” work of the Chinese become a worldwide sensation?

At the same time, along with this theory, reports came from the cutting edge of practical medicine that people who are admitted to the hospital with a diagnosis of COVID-19, even if they suffocate, should not be immediately transferred to mechanical ventilation. It became clear to the doctors that this measure rarely leads to the recovery of patients. Even less frequently than with pulmonary edema arising for some other reason. According to US statistics, only 15-20% of people diagnosed with COVID-19 return to life after three days of mechanical ventilation.The rest, unfortunately, are dying.

Coronavirus

Russia Moscow World

0 (per day)

Recovered

0

0 (per day)

Infected

0

0 (per day)

died

0 (per day)

Recovered

0

0 (per day)

Infected

0

0 (per day)

died

0 (per day)

Recovered

0

0 (per day)

Infected

0

0 (per day)

died

Source: JHU,
federal and regional
headquarters for the fight against the virus

Source: JHU, Federal and Regional Virus Control Headquarters

There is also such a nuance: regardless of the reason for getting on a ventilator, many survivors then experience problems with memory, kidneys and more.Not all, of course, but those who were particularly unlucky. And this “unlucky” is determined again by the initial state of health. Much depends on the level of inflammation in the body, especially neuroinflammation. Why? It is already known that the SARS-CoV-2 virus is somewhat neurotoxic. Therefore, patients with severe COVID-19 have many neurological symptoms: anosmia (loss of smell), disorientation, headache. At the same time, many people also have shortness of breath in parallel. And, hence, hypoxia.An important clarification: this hypoxia may not be at all connected with the hemoglobin theory of the Chinese and the fact that viral proteins affect oxygen transport. But what does a person with shortness of breath and hypoxia need? Oxygen, of course. However, if it is immediately put on mechanical ventilation with this very hypoxia, then neuroinflammation in the body will only intensify. That is why many hospitals in the USA and Europe have decided to give these patients just pure oxygen as long as possible. Through special masks, or somehow, but to increase the oxygen content in the body.And most importantly, patients should breathe on their own. This decision, by the way, has even been fixed at the level of hospital guidelines.

Now back to the Chinese hemoglobin theory. The news of this publication simply coincided with reports from doctors who began to talk about the fact that patients need oxygen, not mechanical ventilation. Because of what, in the minds of the majority, the following picture has developed: oxygen is needed, because the virus disrupts its transport in the blood. Just a unique coincidence.Hence all the hype.

Haemoglobin fantasy will not help you understand the pathogenesis of COVID-19 disease?

In fact, the pathogenesis of COVID-19 is already clear. There is no mystery, in my opinion. We know how a virus gets into a person. It attaches to specific receptors in our cells – ACE2 receptors. They are found on many cells in our body. For example, the intestine has a very high concentration of ACE2 receptors.

The varied and unpredictable picture that we see after the infection has occurred is no longer associated with the virus itself.And with what each of us has a current immune status, what diseases in history, what lifestyle each of us leads. And, of course, our genetics plays a big role.

That is, we all initially differ in the predisposition to catch the virus, as well as in the predisposition – to react strongly to the virus or not strongly.

Apparently, we also differ in our individual ability to develop immunity to this virus. The SARS-Cov2 virus is a relative of the SARS-CoV virus.The SARS virus is generally called the SARS virus. That is, in principle, nothing strange happens in comparison with the infection with the first SARS. There we also had ambiguous pathogenicity or atypical pathogenicity. But now we understand that such pathogenicity is just typical for the family of viruses related to SARS-CoV. That is, we need to talk not about the mysterious pathogenesis of the disease, but simply about the new pathogenicity mechanism of the virus. Therefore, we need to quickly deal not with the virus itself, but with how our body reacts to it. To understand what exactly is the difference between the response of the organism, which copes with the infection easily, from the response of the organism, which carries the disease in a severe form? And what factors it depends on, besides age, current diseases, and so on.

In my opinion, the real mystery of this disease is only one – we still do not understand at all how the re-infection will take place. That is, in the case when a person was ill, and then his immunity to COVID-19 took and ended, because it was fragile.How will the disease be transferred in this situation? Lighter or more severe? Or maybe the same? Or will no one get sick at all?

Should we expect truly “iron” sensations about COVID-19?

I believe that the main thing that will happen soon is that we will understand what happens to people after they have suffered a coronavirus infection. And here I am not talking about immunity, but about the consequences of the disease. What signs indicate that a person’s health has returned to normal, and what – what has not returned.Moreover, we will have quantitative measures with the help of which we will learn to understand how badly or how well each particular person came out of this disease. And soon, soon we are waiting for the data on the cohorts of the recovered to understand all this.

Yes, we already have data for China and South Korea. Still, they cannot be extrapolated to the same Europe. And not because there are some errors in these data – it’s just that ethnicity is different. The healthcare system, the conditions in which everything is measured, are also different.What is normal for a Korean, not for a European, and vice versa. Therefore, we are waiting primarily for data from Europe and America – where we have a strong epidemic.

There is one more important thing that we are waiting for – information about how the health status of people with other diseases has changed as a result of quarantine. That is, those who did not get coronavirus infection, but those whose chronic diseases have changed their course: worsened or simply somehow changed under quarantine conditions. After all, these people, like many, may have changed their diet.We were under great stress. Couldn’t see a doctor. We didn’t get the medicines we needed. All this data is now being processed. In a word, now there is a huge experiment all over the world on all of us. And he is about how human physiology is changing in the face of a pandemic and quarantine. And it is definitely changing. The big question is how exactly?

Long-term prospects for the COVID-19 pandemic?

So far, I can say for sure about one thing – the level of biological literacy among people all over the world will increase enormously as a result of this story.And that’s great. I hope that many adolescents, and indeed young people in general, will be encouraged to take up science seriously. Because we will definitely need even more biology scientists in the future.


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90,000 Can viral pneumonia be cured at home?

The medical topic began to return to the information field again.And, of course, recommendations from “experts”, mailings in instant messengers and advice in the kitchen poured from everywhere on how to treat the viral pneumonia caused by the coronavirus, how to treat it and where to treat it. Many people diagnose themselves online and take serious antibiotics. Is it possible to cure pneumonia by self-medication at home? The correspondent of Azattyq Rýhy talks about this with Rafail Kipshakbaev, Ph.D.

– Raphael, is it possible to cure viral pneumonia at home?

– According to the classification, we have such a concept as “community-acquired pneumonia”. That is, it is understood that pneumonia can be treated outside the hospital. Here I will immediately make a reservation: there must be an important and fundamental condition: regardless of where it is being treated – at home or in a hospital, a doctor should prescribe any treatment. It has no options. I do not recommend using any mailing lists with treatment regimens, with the use of serious drugs, such as self-prescription and use of antibiotics, anticoagulants, hormonal drugs.Why? Because there is no universal scheme. Each patient has his own characteristics for dosages, for the selection of drugs, and so on. Even if the scheme from Whatsapp is correct and suitable for someone, it is not a fact that it is suitable for everyone.

Second, the severity of the pneumonia is important. That is, viral pneumonia, like bacterial, has its own severity. That is, you and I should be guided by our, Kazakhstani, diagnostic and treatment protocol. Treatment of mild pneumonia is possible at home, but again – as prescribed by a doctor.And here there should be constant monitoring of saturation, that is, filling the lungs with oxygen and the dynamics of the general condition. And moderate and severe forms of pneumonia should be treated in a hospital.

For medicinal products. Here it turns out: the main and fundamental difference between viral pneumonia and bacterial is that with viral pneumonia, microthrombosis develops in the vessels surrounding the alveoli, followed by general thrombosis. That is, the mechanism of development of viral pneumonia differs from bacterial and therefore it is difficult for a person to prescribe treatment himself.In particular, here the initiation of treatment is indicated with antibiotics. Here it is important to start using anticoagulants earlier – these are very serious and strong drugs, respectively, they are very effective in this type of pneumonia. But for a person without medical education, this is unlikely to help with an independent appointment. Therefore, I can say that mild forms of pneumonia can be treated on an outpatient basis. Treatment should be prescribed exclusively by a doctor.

– Can a doctor prescribe treatment remotely? Now the service of remote diagnosis and treatment of the disease has become popular.

– First, you need to measure the patient’s oxygen saturation. This can be done remotely. That is, a person does his own pulse oximetry and sends the results to the doctor. And, for example, to listen to a patient, if necessary, to do an x-ray or computed tomography – here I can hardly imagine how this can be done without a doctor. The doctor may issue a referral for X-ray or CT, but again, there are organizational difficulties. But on the other hand, what is happening now – distance medicine – is rather related to the level of development of the epidemic.This is not very good, but it is a necessary measure. If somewhere there is a lack of the same district doctors or primary care, then such cases of remote treatment are likely to occur. Ideally, this should not be the case. Telemedicine is, of course, promising. For example, somewhere in Alaska. American experience shows that a doctor consults patients through Internet communications. But in our conditions, I think, it is possible to meet with a doctor at least once in order to correctly diagnose, exclude self-medication and polyprognosis, for example, a person has banal bronchitis, but he clocked himself, came up with viral pneumonia and prescribed himself treatment.

– Should you buy drugs now to avoid the summer drug shortage collapse?

– In this case, we went through this during the first wave, when people rushed around, bought buckwheat, then toilet paper, then everyone ran together for medicines. Here the very first and most important rule – the treatment of any viral infections, be it influenza, ARVI, coronavirus – does not start with antibiotics. Secondly, not all antibiotics can be indicated.Thirdly, drugs have an expiration date and it can happen that when the drug is needed, it will pass the expiration date. Fourthly, by creating such a stir, buying up all the drugs, you yourself are helping to raise prices, because pharmacists are guided by the needs of the market and simply raise prices for what is in demand. In addition, those who really need this drug at the moment may be left without it. But the most important point is that the drug may not be indicated and, in general, the treatment of a viral infection does not begin with antibiotics.Therefore, there is no need to buy or run. We had the sad experience of the first wave, now the warehouses are full. We create panic ourselves when we run to pharmacies and start shopping. No health care system can withstand this onslaught of panic.

– What are the consequences of unauthorized use of antibiotics?

– There are consequences, say, short-term and long-term. As for the neighbors, firstly, an allergic reaction may develop. Second, the antibiotic may not be suitable due to the history.Let’s say a person was sick a month ago and used a stronger antibiotic. A person without medical education will not be able to figure out whether he has previously used a stronger or weaker antibiotic. That is, he may simply not help him. The next group is the most terrible, these are long-term, delayed consequences. This is the development of antibiotic resistance. In this case, it is worse than the epidemic itself, the coronavirus itself. This means that viruses, bacteria, microorganisms living in our body become immune to this antibiotic.