What are the common side effects of amoxicillin. How can patients manage potential risks associated with this antibiotic. What precautions should be taken when using amoxicillin for bacterial infections. When should patients seek medical attention for amoxicillin side effects.

Understanding Amoxicillin: A Powerful Antibiotic for Bacterial Infections

Amoxicillin is a widely prescribed antibiotic belonging to the penicillin family. It effectively treats various bacterial infections by inhibiting the formation and repair of bacterial cell walls. Healthcare providers commonly prescribe amoxicillin for conditions such as:

• Upper respiratory tract infections (e.g., sinusitis)
• Lung infections (bronchitis, pneumonia)
• Skin infections
• Middle ear infections
• Urinary tract infections
• H. pylori stomach infections

While amoxicillin proves highly effective against many bacterial infections, it’s crucial for patients to be aware of potential side effects and take necessary precautions to ensure safe usage.

Common Side Effects of Amoxicillin: What to Expect

Most patients tolerate amoxicillin well, but some may experience minor side effects. These common side effects are typically temporary and manageable:

• Rash
• Diarrhea
• Headache
• Nausea and vomiting
• Stomach pain
• Tongue discoloration
• Yeast infections
• Elevated liver enzymes
• High white blood cell counts (eosinophilia)

Are these side effects a cause for concern? In most cases, these common side effects do not require medical intervention and resolve on their own. However, patients should inform their healthcare provider if these symptoms persist or worsen.

Serious Side Effects: When to Seek Medical Attention

While less common, amoxicillin can cause serious side effects that require immediate medical attention. These include:

• Superinfections
• Clostridium difficile-associated diarrhea
• Liver problems (hepatitis, cholestatic jaundice)
• Blood disorders (hemolytic anemia, low platelets, agranulocytosis)
• Severe allergic reactions (anaphylaxis)

How can patients recognize these serious side effects? Symptoms may include severe diarrhea, yellowing of the skin or eyes, unusual bleeding or bruising, and signs of a severe allergic reaction such as difficulty breathing, swelling of the face or throat, and hives. If any of these symptoms occur, patients should seek immediate medical care.

Hypersensitivity Reactions: Understanding Amoxicillin Allergies

Allergic reactions to amoxicillin can range from mild to severe. Patients with a known penicillin allergy should inform their healthcare provider before taking amoxicillin, as cross-reactivity can occur.

Types of Hypersensitivity Reactions

1. Immediate reactions: Occur within hours of taking the medication
2. Delayed reactions: Develop days after starting the antibiotic course
3. Severe reactions: Anaphylaxis, which can be life-threatening

Can amoxicillin allergies develop over time? Yes, it’s possible for patients to develop an allergy to amoxicillin even if they’ve tolerated it well in the past. Any new or unusual symptoms should be reported to a healthcare provider promptly.

Superinfections: A Potential Consequence of Antibiotic Use

Superinfections occur when antibiotics like amoxicillin disrupt the natural balance of bacteria in the body, allowing opportunistic pathogens to overgrow. Common superinfections associated with amoxicillin use include:

• Oral thrush (yeast infection in the mouth)
• Vaginal yeast infections
• Antibiotic-associated diarrhea

How can patients reduce the risk of superinfections? Maintaining good hygiene, taking probiotics (as recommended by a healthcare provider), and completing the full course of antibiotics as prescribed can help minimize the risk of superinfections.

Clostridium Difficile: A Serious Concern in Antibiotic Therapy

Clostridium difficile (C. diff) infection is a potentially severe complication of antibiotic use, including amoxicillin. This bacterium can cause a range of symptoms, from mild diarrhea to life-threatening colitis.

Risk Factors for C. diff Infection

• Prolonged antibiotic use
• Advanced age
• Recent hospitalization
• Weakened immune system

What should patients do if they suspect C. diff infection? Persistent, severe, or bloody diarrhea during or after amoxicillin treatment warrants immediate medical evaluation. Early diagnosis and treatment are crucial for managing C. diff infections effectively.

Duration of Side Effects: What to Expect After Treatment

The duration of amoxicillin side effects can vary depending on the individual and the specific side effect. Most common side effects resolve within a few days to weeks after completing the antibiotic course.

Timeframes for Common Side Effects

• Gastrointestinal symptoms: Usually subside within 1-2 days after stopping the medication
• Rash: May persist for several days to a week after discontinuing amoxicillin
• Yeast infections: Can take 3-7 days to clear with appropriate treatment

When should patients be concerned about prolonged side effects? If side effects persist for more than two weeks after completing the amoxicillin course, patients should consult their healthcare provider for further evaluation.

Warnings and Precautions: Ensuring Safe Use of Amoxicillin

To minimize the risk of adverse effects and ensure optimal treatment outcomes, patients should be aware of the following warnings and precautions:

• Inform healthcare providers of all allergies, especially to penicillin or cephalosporin antibiotics
• Disclose all current medications, including over-the-counter drugs and supplements
• Notify healthcare providers of any pre-existing medical conditions, particularly kidney or liver disease
• Follow the prescribed dosage and duration of treatment precisely
• Complete the entire course of antibiotics, even if symptoms improve before finishing

How can patients ensure they’re taking amoxicillin safely? Open communication with healthcare providers, careful adherence to prescribed regimens, and prompt reporting of any concerning symptoms are key to safe and effective amoxicillin use.

Drug Interactions: Medications to Avoid While Taking Amoxicillin

Amoxicillin can interact with various medications, potentially altering their effectiveness or increasing the risk of side effects. Some notable interactions include:

• Oral contraceptives: Amoxicillin may reduce their effectiveness
• Anticoagulants: Increased risk of bleeding
• Probenecid: Can increase amoxicillin levels in the blood
• Allopurinol: May increase the risk of skin rashes
• Methotrexate: Amoxicillin can increase its toxicity

Why is it crucial to inform healthcare providers about all medications? Comprehensive knowledge of a patient’s medication regimen allows healthcare providers to anticipate and prevent potential drug interactions, ensuring safe and effective treatment.

Strategies for Minimizing Amoxicillin Side Effects

While some side effects may be unavoidable, patients can take steps to minimize their occurrence and severity:

1. Take amoxicillin with food to reduce gastrointestinal upset
2. Stay well-hydrated to help prevent diarrhea and support kidney function
3. Use probiotics as recommended by a healthcare provider to maintain gut health
4. Avoid alcohol consumption during treatment to reduce liver stress
5. Apply moisturizer to alleviate mild skin rashes
6. Follow proper hygiene practices to prevent yeast infections

How can patients actively participate in managing potential side effects? By following these strategies and maintaining open communication with their healthcare providers, patients can play an active role in minimizing side effects and ensuring a successful treatment outcome.

Alternative Antibiotic Options: When Amoxicillin Isn’t Suitable

For patients who cannot tolerate amoxicillin or have contraindications to its use, several alternative antibiotics may be considered:

• Cephalosporins (e.g., cephalexin, cefuroxime)
• Macrolides (e.g., azithromycin, clarithromycin)
• Fluoroquinolones (e.g., ciprofloxacin, levofloxacin)
• Tetracyclines (e.g., doxycycline, minocycline)

How do healthcare providers determine the most appropriate alternative? The choice of alternative antibiotic depends on factors such as the specific infection, local resistance patterns, patient allergies, and individual risk factors. A thorough discussion with a healthcare provider is essential to determine the best alternative treatment option.

Long-term Consequences: Balancing Benefits and Risks of Antibiotic Use

While antibiotics like amoxicillin are crucial for treating bacterial infections, their use can have long-term consequences that patients should be aware of:

• Antibiotic resistance: Overuse or misuse of antibiotics can lead to the development of resistant bacteria
• Microbiome disruption: Antibiotics can alter the balance of beneficial bacteria in the gut, potentially affecting overall health
• Increased susceptibility to certain infections: Changes in the microbiome may increase vulnerability to specific pathogens
• Potential impact on immune system function: Emerging research suggests that antibiotic use may influence immune responses

How can patients contribute to responsible antibiotic use? By using antibiotics only when necessary, completing prescribed courses, and practicing good hygiene to prevent infections, patients can help mitigate the long-term risks associated with antibiotic use while still benefiting from their life-saving properties when needed.

Patient Education: Empowering Informed Decision-Making

Educating patients about amoxicillin and its potential side effects is crucial for promoting safe and effective antibiotic use. Key points for patient education include:

• Understanding the importance of completing the full course of antibiotics
• Recognizing common side effects and knowing when to seek medical attention
• Being aware of potential drug interactions and the need to disclose all medications
• Understanding the role of antibiotics in treating bacterial infections only, not viral illnesses
• Learning about antibiotic resistance and the importance of responsible antibiotic use

How can healthcare providers effectively educate patients about amoxicillin? Clear communication, written materials, and follow-up discussions can help ensure patients fully understand the benefits, risks, and proper use of amoxicillin, leading to better treatment outcomes and reduced risk of adverse effects.

Oral Antibiotics for Ear Infections

When you need them—and when you don’t

Antibiotics are strong medicines that can kill bacteria. For ear infections, doctors often prescribe oral antibiotics that you swallow in pill or liquid form.

However, eardrops can sometimes be safer and more effective than oral medicines. Here’s why:

Oral antibiotics have risks.

• Oral antibiotics are more likely to cause resistant bacteria outside the ear. When that happens, these medicines will not work as well in the future. Illnesses will be harder to cure and more costly to treat.

• Antibiotic eardrops kill the bacteria faster and more completely than oral antibiotics. Drops don’t go into the bloodstream, so more medicine reaches the infection.

Oral antibiotics have more side effects.

Oral antibiotics can cause more side effects than antibiotic eardrops. Side effects include diarrhea, nausea and vomiting, stomach pain, rash, headache, and dangerous allergic reactions.

Who should use antibiotic eardrops?

Antibiotic eardrops can be more effective and safer for:

• People with Swimmer’s Ear, an infection caused by water in the ear.
• Children who have tubes in their ears. The tubes prevent most infections behind the eardrum—an area known as the middle ear. If there is an infection, antibiotic eardrops can be given right through the tube.

What about over-the-counter eardrops?

Over-the-counter eardrops can often be effective for Swimmer’s Ear.

People who have a hole or tube in the eardrum should check with their doctor before using any kind of eardrops. The drops may cause pain, infection, or even damage hearing. For bacterial infections, the only eardrops they should use are the antibiotics ofloxacin (Floxin Otic and generic) or the more pricey combination drug ciprofloxacin-dexamethasone (Ciprodex).

Antibiotics can lead to more costs.

Most oral antibiotics don’t cost much. But if they don’t work well, you may need extra doctor visits, a hospital stay, and costly drugs. You may also miss work. Treatment of a severe infection that is antibiotic-resistant can cost more than $25,000.

Who should take oral antibiotics for ear 

infections?

• Children without ear tubes should take oral antibiotics for middle-ear infections, especially when they have severe ear pain or high fever.
• Children with ear tubes should take oral antibiotics if:
  • They are very ill.
  • They have another reason to be on an antibiotic.
  • The infection doesn’t go away with eardrops.

Oral antibiotics help treat Swimmer’s Ear when:

• Infection spreads beyond the ear.
• The person has other conditions, such as diabetes, that increase the risk of complications.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2017 Consumer Reports. Developed in cooperation with the American Academy of Otolaryngology-Head And Neck Surgery.

10/2013

Amoxicillin side effects and how to avoid them

People taking amoxicillin can experience minor side effects, but serious side effects, and drug interactions with existing medical conditions, are also possible

Amoxicillin side effects | Hypersensitivity | Superinfections | Clostridium difficile | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Amoxicillin is a generic antibiotic that treats a wide range of bacterial infections: upper respiratory tract infections such as sinusitis, lung infections such as bronchitis or pneumonia, skin infections, middle ear infections, urinary tract infections, as well as H. pylori stomach infections. 

Also prescribed under the brand names Amoxil and Augmentin (amoxicillin/clavulanate), amoxicillin is a penicillin antibiotic that kills bacteria by blocking their ability to make and repair their protective cell walls. For most infections, amoxicillin will only be given for a few days. Many people taking amoxicillin will experience minor side effects, but serious side effects, and drug interactions with existing medical conditions are also possible.

RELATED: What is amoxicillin?

Common side effects of amoxicillin

The most common side effects of amoxicillin are temporary and manageable. These include:

• Rash
• Diarrhea
• Headache
• Nausea
• Vomiting
• Stomach pain
• Tongue discoloration
• Yeast infection
• Elevated liver enzymes
• High white blood cell counts (eosinophilia)

Serious side effects of amoxicillin

Serious but less common side effects of amoxicillin include:

• Superinfections
• Clostridium difficile-associated diarrhea
• Liver problems such as swelling (hepatitis) and obstructive jaundice (cholestatic jaundice)
• Blood disorders such as hemolytic anemia (rapid red blood cell death), low platelets, or agranulocytosis (low counts of a certain type of white blood cell)
• Seizures 
• Swelling of the brain and spinal cord membranes (aseptic meningitis)
• Severe allergic reactions

Amoxicillin and hypersensitivity

Allergies to penicillin antibiotics such as amoxicillin and ampicillin are very common and potentially hazardous. About one in 10 people report a penicillin allergy. However, many people mistake drug side effects such as GI upset for an allergy. And even among patients with an actual hypersensitivity reaction, most are mild reactions, usually a delayed skin rash. These symptoms are less concerning than the immediate, life-threatening symptoms of anaphylaxis. Only 0.02% to 0.04% of the population experience a true allergy to amoxicillin that results in anaphylaxis. 

At one time, any person reporting an allergic reaction to penicillins or similar drugs such as cephalosporin antibiotics would not be given amoxicillin. Healthcare providers are still cautious about giving amoxicillin or any other penicillin drug to any person who has had a past reaction to amoxicillin or similar drugs. However, healthcare professionals now know that at least 90% of people who report penicillin allergy do not have a true allergy. In addition, people who have had a true allergic reaction tend to lose their sensitivity over time.  

As a result, people with a history of low-level reactions to penicillins may be administered a skin test to determine the exact nature of the allergy. Some of these patients can be given amoxicillin safely, but the treatment will require monitoring. However, amoxicillin will not be given to any person with a history of a serious hypersensitivity reaction to penicillins such as anaphylaxis.

Amoxicillin and superinfections

Bacteria normally limit the growth of other microorganisms in the body. Nearly all antibiotics, however, kill off native bacteria colonies, allowing other microorganisms to grow out of control, called superinfections. For amoxicillin, the most common superinfections are fungal infections of the mouth or vagina and overgrowth of Clostridium difficile in the colon. The incidence of C. difficile overgrowth is unknown, but about 2% of people taking amoxicillin will experience a yeast infection. 

Amoxicillin and Clostridium difficile

Nearly all antibiotics alter the microorganism environment of the colon, allowing an overgrowth of C. difficile bacteria colonies that are normally kept low by other bacteria in the colon. C. difficile-associated diarrhea, or CDAD, is a common and potentially serious side effect of amoxicillin therapy, occurring in 5% of people taking drugs like amoxicillin. In mild cases, CDAD can cause little more than mild diarrhea. In severe cases, bacterial overgrowth can lead to potentially fatal swelling of the colon. 

As a side effect, C. difficile-associated diarrhea can occur during amoxicillin treatment or as much as two months after treatment has ended. If diarrhea occurs during or after any antibiotic treatment, talk to a doctor or other healthcare professional. If the diarrhea is watery or bloody, get immediate medical attention. 

How long do Amoxicillin side effects last?

Amoxicillin is only given for a few days. Most side effects are temporary and will fade when treatment ends. Some amoxicillin side effects, however, are delayed and may take longer to resolve, such as allergic reactions and blood disorders. Clostridium difficile infection can be delayed for up to two months after amoxicillin treatment has stopped. Some side effects may require medical treatment such as yeast infections, allergic reactions, blood problems, superinfections, or C. difficile infection.

Amoxicillin contraindications & warnings

Amoxicillin won’t be given to everyone. Some people will not be able to take amoxicillin at all, while others may require dose adjustments or monitoring.

Abuse and dependence

Amoxicillin and similar antibiotics are not commonly abused or used recreationally. They are prescribed for only a short duration, and do not cause physical dependence or withdrawal symptoms.

Overdose

Amoxicillin should only be taken as prescribed for the duration prescribed. Taking too much amoxicillin can result in unpleasant side effects such as upset stomach and diarrhea, but usually does not cause serious problems. However, in rare cases, an amoxicillin overdose can damage the kidneys or result in renal failure. If an amoxicillin overdose is suspected, immediately call a poison control center.

Restrictions

Although amoxicillin is widely used, some people may not be able to take the drug. Others may require lower doses or careful monitoring.

People who have a history of severe anaphylactic allergic reactions to penicillins or similar drugs—called beta-lactam antibiotics—will not be given amoxicillin. Amoxicillin may, however, be given to people with a history of very mild allergies to beta lactams, but they will need to take a skin test first. If the doctor determines that they can safely take amoxicillin, they will be monitored carefully for allergic reactions. People with multiple allergies or asthma will also need to be tested and monitored. An allergic reaction (drug rash) is also possible when amoxicillin is given to people with mononucleosis, so healthcare providers will most likely use another antibiotic.

Most antibacterial drugs increase the risk of pseudomembranous colitis, so any patient with colitis, inflammatory bowel disease (IBD), or diarrhea will require monitoring while on amoxicillin therapy. Other medical conditions that also require heightened monitoring or dose adjustment include kidney disease, HIV infection, acute lymphocytic leukemia, and epilepsy. 

Pregnancy and nursing

There is no evidence that amoxicillin will harm a fetus, but healthcare providers are not certain amoxicillin is safe to take during pregnancy. Women should talk to a doctor or other healthcare professional about possible risks before taking amoxicillin.

Amoxicillin and similar drugs are present in breast milk. While there is no evidence that amoxicillin will harm a breastfeeding baby, healthcare providers are cautious. Because the infant may develop allergies to the drug, a healthcare provider may choose a different antibiotic or encourage the mother to temporarily stop nursing the infant.

Children

The Food and Drug Administration (FDA) has approved the use of amoxicillin in children as young as newborns. Doses will be reduced in infants younger than 12 weeks old.

Seniors

Amoxicillin is routinely prescribed to people older than the age of 65, and there is no evidence that its use is less effective or less safe than in younger people. Doses may be reduced if a healthcare provider has worries about the person’s kidney function.

Amoxicillin interactions

While Amoxicillin has several minor drug interactions, a few prescription drugs will cause problems when combined with amoxicillin. 

• Oral contraceptives. Amoxicillin may reduce the effectiveness of oral contraceptives, though there is some disagreement in the research. Still, women on birth control are advised to use backup birth control when taking amoxicillin.
• Tetracyclines. Antibiotics such as doxycycline are generally avoided in combination with penicillins. These drugs, called tetracyclines, reduce the effectiveness of amoxicillin.
• Live vaccines. Live, weakened bacteria vaccines such as BCG or typhoid vaccine are less effective when given to a person taking amoxicillin. The bacteria are killed off before they can elicit a strong antibody response. 
• Warfarin. Close monitoring is required when combining amoxicillin with warfarin. Many types of antibiotics, including amoxicillin, reduce the body’s ability to form blood clots when combined with warfarin, a blood-thinning drug. Other blood thinners, however, are safe to take with amoxicillin.
• Allopurinol. Anallergic reaction to amoxicillin is more likely when it is combined with the gout medication, allopurinol. In some cases, allopurinol has even precipitated severe allergic reactions to amoxicillin.

Some amoxicillin drug interactions are beneficial. The gout medication, probenecid, increases the effectiveness of amoxicillin. Some people without gout may be prescribed both drugs to treat certain types of infections. The effectiveness of amoxicillin is also enhanced by aminoglycoside antibiotics.

How to avoid lisinopril side effects

Side effects are common when taking amoxicillin or any other penicillin antibiotic. A few tips can help minimize side effects or ensure the maximum benefit from the drug.

1. Tell the doctor about all medical conditions and medications

Start by informing the healthcare provider prescribing amoxicillin about all past and present medical conditions, especially:

• Kidney problems
• Drug allergies or reactions to antibiotics
• Mononucleosis
• Any history of diarrhea when taking antibiotics
• Gastrointestinal problems

Some problems may arise when amoxicillin is combined with other drugs, but these drug interactions are uncommon. Always give the healthcare provider a complete list of all prescription and nonprescription medications being taken, especially birth control pills, antibiotics, or drugs that require precise dose adjustments such as methotrexate, or warfarin.

2. Take amoxicillin as directed

Take this drug as directed. Don’t miss a dose. If you do miss a dose, take it as soon as you remember, unless it is almost time for your next dose. Don’t take extra medicine to make up for a missed dose. Above all, take the medicine for the full duration of the prescription. Even if symptoms go away, it’s important to take the medication for the entire duration to ensure the bacterial infection is wiped out. If you have any questions about when or how to take your medicine, call your local pharmacy.

3. Do not use amoxicillin for other infections

Amoxicillin is effective against some bacterial infections, but will not help eradicate other bacterial or viral infections. To avoid unnecessary side effects, only take amoxicillin for the bacterial infection indicated. If any medicine is left over, don’t save it. Ask a pharmacist how to safely dispose of unused amoxicillin.

4. Take amoxicillin as scheduled

To successfully eradicate a bacterial infection, amoxicillin is intended to be taken frequently so that its concentration in the body stays high. The goal is to continually kill bacteria without any let-up. Late or missed doses allow the bacteria to start growing again and increase the risk of the infection evolving into a drug-resistant form. Make sure that each dose is taken on time. Amoxicillin may also be prescribed with other drugs such as clarithromycin or lansoprazole for certain infections. It is important to take all prescribed drugs on schedule. If there’s a problem with late or missed doses, a pharmacist can suggest alarms, apps, and other tools to make sure doses are remembered on time. 

5. Take amoxicillin with food

Amoxicillin usually can be taken with a meal or on an empty stomach. Unless instructed otherwise, take amoxicillin with food to avoid side effects such as nausea, vomiting, stomach cramps, and abdominal pain.

6. Watch for signs of an allergic reaction

Allergic reactions are among the most common side effects of amoxicillin and other penicillin antibiotics. Most are mild reactions, but they should be taken seriously. Watch for signs of an allergic reaction such as:

Get medical advice if any allergic reaction is noticeable. Get emergency medical help at any sign of trouble breathing, wheezing, lightheadedness, clammy skin, confusion, fever, sore throat, skin pain, or blistering.

7. Watch for diarrhea

Diarrhea is another common side effect of amoxicillin. This is usually okay and can be treated with over-the-counter anti-diarrheal medications. Diarrhea may, however, be a sign of a more serious problem if the diarrhea is watery or bloody. If this happens, immediately see a healthcare provider rather than treat the diarrhea on your own.

Related resources for amoxicillin side effects:

• Amoxicillin, Epocrates
• Amoxicillin, StatPearls
• Amoxicillin capsules, oral suspension, chewable tablets prescribing information, U.S. National Library of Medicine
• Amoxicillin drug summary, Prescriber’s Digital Reference
• Clostridium difficile-associated diarrhea in patients with community-acquired lower respiratory infection being treated with levofloxacin compared with beta-lactam-based therapy, Clinical Trial
• Hypersensitivity to amoxicillin after drug rash with eosinophilia and systemic symptoms (DRESS) to carbamazepine and allopurinol: a possible co-sensitization, British Journal of Clinical Pharmacology
• Penicillin allergy, StatPearls
• Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population, Allergy and Asthma
• Probenecid, LiverTox

Oral or intravenous antibiotics?

Some conditions, such as bone and joint infections and endocarditis, are managed with prolonged courses of intravenous antibiotics. There is little evidence to guide the duration of intravenous therapy and whether oral antibiotics can be used.

The Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA) trial was conducted at multiple centres across the UK.¹⁶ It compared early switching (within one week) from intravenous to oral therapy to continuing intravenous antibiotics for at least six weeks. It included all adults with suspected bone and joint infections, irrespective of surgical intervention or antibiotic choice, who were planned to receive at least six weeks of antibiotic therapy. Comparing the outcomes at one year suggested that appropriately selected oral therapy is non-inferior to intravenous therapy. However, there are several important caveats:

• the trial was not powered to evaluate the outcome between different types of infection
• Gram-negative infections were under-represented
• most patients had surgical management of the infection
• rifampicin was used as a treatment option in approximately one-third of the cohort
• the clinicians managing the patients were specialist-led teams.

Although the events were not necessarily related to the antibiotics, one in four patients experienced a serious adverse event. This shows that ongoing monitoring is still required even with an oral antibiotic regimen.^16,17 Further studies are required to look more closely at the different types of infection and the varying antibiotic regimens. Ideally these trials should be performed in the Australian healthcare system.

The Partial Oral Treatment of Endocarditis (POET) trial was a study of left-sided endocarditis caused by streptococci, Enterococcus faecalis, Staphylococcus aureus or coagulase-negative staphylococci. The patients were randomised to either receive intravenous drugs for the full course of therapy, or for a minimum of 10 days followed by oral therapy. Patients were clinically stable before the switch and required transoesophageal echocardiography to confirm the response to treatment. Oral antibiotic regimens were designed to include at least two drugs with different mechanisms of action and were based on pharmacokinetic–pharmacodynamic analyses to enhance synergy and decrease the risk of resistance. ¹⁸

There was no difference in a composite end point of all-cause mortality, unplanned cardiac surgery, embolic events or relapse of bacteraemia from the primary pathogen. A subsequent analysis at 3.5 years showed similar results.^18,19

Important caveats on these results included the heterogeneity in the bacterial pathogens being treated and the antibiotic combinations used and the lack of infections with multiresistant organisms. Few patients had cardiac devices or were injecting drug users. The study was also led by physicians in specialist centres.²⁰

FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects

[ 7-26-2016 ] The U.S. Food and Drug Administration (FDA) approved changes to the labels of fluoroquinolone antibacterial drugs for systemic use (i.e., taken by mouth or by injection). These medicines are associated with disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system that can occur together in the same patient. As a result, we revised the Boxed Warning, FDA’s strongest warning, to address these serious safety issues. We also added a new warning and updated other parts of the drug label, including the patient Medication Guide.

We have determined that fluoroquinolones should be reserved for use in patients who have no other treatment options for acute bacterial sinusitis, (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTI) because the risk of these serious side effects generally outweighs the benefits in these patients. For some serious bacterial infections the benefits of fluoroquinolones outweigh the risks, and it is appropriate for them to remain available as a therapeutic option.

Patients must contact your health care professional immediately if you experience any serious side effects while taking your fluoroquinolone medicine. Some signs and symptoms of serious side effects include unusual joint or tendon pain, muscle weakness, a “pins and needles” tingling or pricking sensation, numbness in the arms or legs, confusion, and hallucinations. Talk with your health care professional if you have any questions or concerns (see List of Serious Side Effects from Fluoroquinolones).

Health care professionals should not prescribe systemic fluoroquinolones to patients who have other treatment options for acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTI) because the risks outweigh the benefits in these patients. Stop fluoroquinolone treatment immediately if a patient reports serious side effects, and switch to a non-fluoroquinolone antibacterial drug to complete the patient’s treatment course (see List of Currently Available FDA-approved Fluoroquinolones for Systemic Use).

Fluoroquinolones are antibiotic medicines that work by killing or stopping the growth of bacteria that can cause illness. They are FDA-approved to prevent or treat certain serious bacterial infections.

The labels of fluoroquinolone medicines already have a Boxed Warning for tendinitis, tendon rupture, and worsening of myasthenia gravis. The labels also include warnings about the risks of peripheral neuropathy and central nervous system effects. Other serious risks associated with fluoroquinolones are described in the labels, such as cardiac, dermatologic, and hypersensitivity reactions. After FDA’s 2013 review that led to the additional warning that peripheral neuropathy may be irreversible, FDA evaluated post-marketing reports* of apparently healthy patients who experienced disabling and potentially permanent side effects involving two or more body systems after being treated with a systemic fluoroquinolone (see Data Summary). We evaluated only reports submitted to FDA, so there are likely additional cases of which we are unaware. The side effects occurred within hours to weeks after starting the fluoroquinolone, and at the time we received the reports, the side effects had continued for an average of 14 months to as long as 9 years after stopping the medicines. Several cases reported that some side effects stopped or improved after discontinuation of the medicine; others reported the side effects worsened or continued.

We previously communicated about these safety issues associated with fluoroquinolones in May 2016. Additional communications about related safety issues associated with fluoroquinolones occurred in August 2013 (peripheral neuropathy) and July 2008 (tendinitis and tendon rupture). The safety issues described in this Drug Safety Communication were also discussed at an FDA Advisory Committee meeting in November 2015.

In addition to updating information in the Boxed Warning, we are also including information about these safety issues in the Warnings and Precautions section of the label. The Indications and Usage section contains new limitation-of-use statements to reserve fluoroquinolones for patients who do not have other available treatment options for acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTI). The patient Medication Guide that is required to be given to the patient with each fluoroquinolone prescription describes the safety issues associated with these medicines. We are continuing to assess safety issues with fluoroquinolones as part of FDA’s usual ongoing review of drugs and will update the public if additional actions are needed.

We urge health care professionals and patients to report side effects involving fluoroquinolone antibacterials and other drugs to the FDA MedWatch program, using the information in the “Contact FDA” box at the bottom of the page.

*The cases were reported to the FDA Adverse Event Reporting System (FAERS).

Antibiotics | Cystic Fibrosis Foundation

The buildup of thick, sticky mucus in the lungs makes people with cystic fibrosis more likely to develop bacterial infections that can last for short periods of time (known as acute infections or exacerbations) or for many years.

The good news is that many of these infections can be treated. To keep them in check, antibiotics are taken by people with cystic fibrosis as part of regular daily treatment. For lung exacerbations, people with CF may receive intravenous (IV) antibiotics — that is, directly into the veins — in addition to the inhaled or oral antibiotics.

See how inhaled antibiotics work to help control bacteria in your lungs.

Inhaled antibiotics should be taken last, after bronchodilators (if you take them), mucus thinners, and airway clearance techniques, so your lungs will be as clear of mucus as possible. This allows the antibiotics to reach deep into your lungs to treat the bacteria that cause infection.

The tables below list bacteria common among people with CF, the antibiotics that are commonly prescribed to treat them, and how they are taken.

Staphylococcus aureus (Staph)

Pseudomonas (P. aeruginosa)

Learn more about P. aeruginosa.

Macrolides
Type and Kinds	How Taken
Azithromycin (may help reduce inflammation from P. aeruginosa)	Oral, IV

Methicillin-Resistant Staphylococcus aureus (MRSA)

Learn more about MRSA.

Nontuberculous mycobacteria (NTM)

Learn more about NTM.

Mycobacterium abscessus (M. abscessus)

Intensive Phase

Consolidation Phase

Mycobacterium avium complex (MAC)

Burkholderia cepacia (B. cepacia)

Learn more about B. cepacia.

Stenotrophomonas maltophilia

Haemophilus influenzae

Achromobacter xylosoxidans

CF and Antibiotic Resistance

It is particularly important to take antibiotics exactly as they’ve been prescribed by your doctor, even if you no longer feel the symptoms of an infection. Not doing so can allow the remaining bacteria in your system to become resistant to the antibiotic, which will make it more difficult to treat.

Antibiotic-resistant infections are a real concern among people with CF and over time, can lead to fewer treatment options. Your CF care team will watch for signs of resistance and help you understand how to prevent or decrease the risk of developing infections from resistant bacteria.

Talk to your care team if you have questions about how to take the antibiotic, including the sequence for taking the drug in relation to your other treatments, what you should expect and do if you experience side effects, and what to do if you miss a dose or cannot complete the full course.

Alcohol interferes with the effectiveness of many antibiotics. It is a good rule to avoid consuming alcohol while taking antibiotics. Antibiotics also can decrease the effectiveness of oral contraceptives in women.

What Should I Expect After Taking Them?

Antibiotics typically begin working 48 to 72 hours after you begin taking them. It may take a day or so before you start to feel better. As the antibiotics work to break up the mucus, coughing may increase, which is why some people feel worse before they feel better.

You may experience side effects when you take any medication, including antibiotics. When discussing any new medications or changes in dosages for medications you are already taking, be sure to ask your care team about:

• Any potential side effects
• Which side effects might be more serious than others
• How long they might last
• When to talk to your care team if side effects don’t go away or if they interfere with your quality of life

Let your care team know if you feel any side effect that bothers you or makes it hard for you to continue taking this medication as prescribed. Your care team can work with you to help you manage side effects or to adjust your treatment plan.

You can learn more about antibiotics at DailyMed, which is a service from the National Library of Medicine that provides information about drugs, including dosages and possible side effects. You can learn more about specific antibiotics by searching for the medication from the main DailyMed page.

Where Are These Medications Available?

For IV antibiotics given in the hospital, clinic, or hospital, staff work with the appropriate individuals to provide the therapy. For IV antibiotics that will be administered at home, clinic, or hospital, staff work with home care agencies to arrange delivery and therapy. Oral antibiotics are typically available at retail pharmacies and mail-order pharmacies. Inhaled antibiotics are available through specialty pharmacies that are contracted with specific insurance plans. Medications from specialty pharmacies often need to be handled and stored specially and delivered quickly.

Insurance plan coverage for some antibiotics can vary. For antibiotics that are specifically indicated for CF treatment, most insurance providers should provide coverage. For antibiotics that are not specifically indicated for CF treatment, insurance coverage may be more difficult to arrange. For example, although the antibiotic colistimethate (Colistin®) is often prescribed as an inhaled treatment for P. aeruginosa, it is considered an injectable antibiotic. Because it is not specifically indicated to be used in that way, coverage may be declined by insurers. Check with your insurance provider to ensure that the antibiotic is covered and confirm what your out-of-pocket expenses may be. 

You can also contact the Cystic Fibrosis Foundation Compass, a free, personalized service that can help you with insurance, financial, legal, and other issues. Dedicated Compass case managers can assist in coordinating benefits or providing information about benefits offered under your plans. Contact Compass at: 

844-COMPASS (844-266-7277) 
Monday – Friday, 9 a.m. – 7 p.m. ET
[email protected]

Antibiotics for acne | DermNet NZ

Author: Updated and reviewed by Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand; Vanessa Ngan, Staff Writer; Clare Morrison, Copy Editor, April 2014.

Antibiotics are commonly used to treat acne. They are available as topical preparations for mild acne, and as tablets, capsules and elixirs for oral use in moderate and severe acne.

A doctor’s prescription is required to obtain antibiotics. The antibiotics listed on this page were available in New Zealand in April 2014. Other antibiotics or brand names are available on prescription in other countries.

Mechanism of action of antibiotics in acne

Antibiotics have two main effects in acne:

• They reduce the number of bacteria on the skin surface and in the follicles, including Cutibacterium acnes (also known as Propionibacterium acnes)
• They have an anti-inflammatory action.

Topical antibiotics in acne

Topical antibiotics require a prescription in New Zealand.

Side effects and risks of topical antibiotics

• Dryness of the treated area is usually mild but is a common side effect of topical antibiotics. If the skin is visibly scaly, apply a light non-oily moisturiser.
• Skin irritation from topical antibiotics is rarely severe. Occasionally, irritation means that the patient should stop using the product. Lotions are less likely to cause irritation than solutions or gels.
• Contact dermatitis (red, dry, itchy skin) can be due to irritancy or allergy. It can be treated with a topical corticosteroid such as hydrocortisone cream (available at a NZ pharmacy without prescription).
• Bacterial resistance to antibiotics most frequently arises with intermittent use of topical antibiotics. To reduce the chance of bacterial resistance, apply topical antibiotics liberally twice daily and also use benzoyl peroxide and/or a topical retinoid.

Oral antibiotics in acne

The oral antibiotics most commonly prescribed in New Zealand for acne include:

• Tetracyclines – doxycycline (Doxine®, Doxy®), limecycline (Tetralysal®), minocycline (Mino-tabs®, Minomycin®). These are not suitable for children younger than 10 years old because they may stain teeth yellow
• Erythromycin – E-mycin®, ERA®
• Trimethroprim – TMP®
• Cotrimoxazole – Trisul®, Deprim®

Side effects and risks of oral antibiotics (see also, DermNet’s page on tetracycline)

• Allergy – oral antibiotics can cause a variety of rashes in those susceptible. These can be mild or life-threateningly severe. Allergy to a tetracycline or to erythromycin is very uncommon, but more than 2% of those on trimethoprim or cotrimoxazole become allergic to it. Tell your doctor if you have ever reacted badly to an antibiotic.
• Photosensitivity may be a problem for those taking doxycycline. Taking the medicine after the evening meal reduces the risk of sunburn. Dress up and protect your skin from exposure to the sun.
• Gastrointestinal disturbance affects about 5% of patients and includes nausea, colicky pain and diarrhoea.
• Thrush (Candida albicans infection) affects 5% of treated women and most often affects the vagina. Thrush can also affect the oral mucosa or body folds (intertrigo), particularly in diabetics or in obesity. Thrush is less likely with erythromycin than with tetracycline.
• Bacterial resistance may occur but is less common with the use of oral antibiotics than with topical antibiotics.
• Acne antibiotics are unlikely to result in failure of the oral contraceptive pill but if you are concerned, add a barrier method and talk to your doctor about your risks.

Controversies in use of antibiotics for acne

Antibiotics are moderately effective for acne and are frequently used for acne treatment. They are often prescribed for months or years, because acne is a chronic skin condition. However, many physicians are concerned about the use of antibiotics for acne, mainly because of reports of increasing rates of bacterial resistance to antibiotics.

Bacterial resistance and serious infections including cellulitis, pneumonia, tuberculosis and diarrhoeal illnesses are a global threat. New, more expensive antibiotics are often less well tolerated than older agents and are unavailable in many countries. Very few new antibiotics are being discovered or brought to market.

Note:

• Acne is an inflammatory disease and is not an infection. See DermNet NZ’s Causes of acne page.
• Topical antibiotics are more likely to induce bacterial resistance than oral antibiotics.
• P. acnes bacterial resistance is common in people treated with antibiotics for acne, and the resistance can spread to their family members and neighbours.
• Resistance genes can spread from P. acnes to other types of bacteria such as Staphylococcus epidermidis and S. aureus.
• The prevalence of bacteria with multidrug resistance is increasing worldwide.
• Topical antibiotics alone are no more effective in acne than topical retinoids or benzoyl peroxide.
• Topical or systemic antibiotics should always be used in combination with benzoyl peroxide, a topical retinoid or azelaic acid. In women, they may also be used in combination with antiandrogen therapy or oral contraceptive pill.
• There have been no reports of bacterial resistance being caused by benzoyl peroxide. Benzoyl peroxide has been shown to reduce the prevalence of resistant strains of P. acnes.
• Topical antibiotics should not be used at the same time as oral antibiotics.
• The optimum dose and duration of treatment with oral antibiotics that can be given without inducing bacterial resistance is unknown.
• However, low-dose doxycycline (50 mg daily) is probably less likely to induce resistance than standard-dose doxycycline (100–200 mg daily) and may be as effective in controlling the acne.
• Oral antibiotics are known to act by reducing bacterial colonisation and inflammation in the affected follicles, but they do not cure acne.
• There is no benefit to switching antibiotics to improve efficacy in acne treatment. Switching may increase the risk of bacterial resistance.
• It may be necessary to change antibiotics in the case of adverse effects.
• Side effects from antibiotics are occasionally serious and may be long lasting. Serious adverse effects are more likely from minocycline than from doxycycline.

If you are prescribed antibiotics for acne, discuss these concerns with your doctor. Make sure your acne treatment is reviewed regularly. It’s best to limit a course of antibiotics to 3 months, if possible. Apply topical benzoyl peroxide and/or a topical retinoid to areas affected by acne while on antibiotics and after they have been stopped. Find out if other, non-antibiotic treatment might be suitable for you.

References

• Muhammad M, Rosen T. A controversial proposal: no more antibiotics for acne! Skin Therapy Lett. 2013 Jul-Aug;18(5):1-4. PubMed PMID: 24305661.
• Humphrey S. Antibiotic resistance in acne treatment. Skin Therapy Lett. 2012 Oct;17(9):1-3. Review. PubMed PMID: 23032935.
• Narahari S, Gustafson CJ, Feldman SR. What’s new in antibiotics in the management of acne? G Ital Dermatol Venereol. 2012 Jun;147(3):227-38. Review. PubMed PMID: 22648324.
• Garner SE, Eady A, Bennett C, Newton JN, Thomas K, Popescu CM. Minocycline for acne vulgaris: efficacy and safety. Cochrane Database Syst Rev. 2012 Aug 15;8:CD002086. doi: 10.1002/14651858.CD002086.pub2. Review. PubMed PMID: 22895927.
• Chon SY, Doan HQ, Mays RM, Singh SM, Gordon RA, Tyring SK. Antibiotic overuse and resistance in dermatology. Dermatol Ther. 2012 Jan-Feb;25(1):55-69. doi: 10.1111/j.1529-8019.2012.01520.x. Review. PubMed PMID: 22591499.

On DermNet NZ

Other websites

• Medsafe — consumer information about medicines and data sheets 

Books about skin diseases

Diagnosis and Treatment of Impetigo

CHARLES COLE, M.D., and JOHN GAZEWOOD, M.D., M.S.P.H., University of Virginia School of Medicine, Charlottesville, Virginia

Am Fam Physician.  2007 Mar 15;75(6):859-864.

 
Patient information: See related handout on impetigo, written by the authors of this article.

Impetigo is a highly contagious, superficial skin infection that most commonly affects children two to five years of age. The two types of impetigo are nonbullous impetigo (i.e., impetigo contagiosa) and bullous impetigo. The diagnosis usually is made clinically, but rarely a culture may be useful. Although impetigo usually heals spontaneously within two weeks without scarring, treatment helps relieve the discomfort, improve cosmetic appearance, and prevent the spread of an organism that may cause other illnesses (e.g., glomerulonephritis). There is no standard treatment for impetigo, and many options are available. The topical antibiotics mupirocin and fusidic acid are effective and may be superior to oral antibiotics. Oral antibiotics should be considered for patients with extensive disease. Oral penicillin V is seldom effective; otherwise there is no clear preference among antistaphylococcal penicillins, amoxicillin/clavulanate, cephalosporins, and macrolides, although resistance rates to erythromycin are rising. Topical disinfectants are not useful in the treatment of impetigo.

Impetigo is a highly contagious infection of the superficial epidermis that most often affects children two to five years of age, although it can occur in any age group. Among children, impetigo is the most common bacterial skin infection and the third most common skin disease overall, behind dermatitis and viral warts.1,2 Impetigo is more common in children receiving dialysis.1 The infection usually heals without scarring, even without treatment. Staphylococcus aureus is the most important causative organism. Streptococcus pyogenes (i.e., group A beta-hemolytic streptococcus) causes fewer cases, either alone or in combination with S. aureus.3

View/Print Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

SORT: KEY RECOMMENDATIONS FOR PRACTICE

There are two types of impetigo: nonbullous (i.e., impetigo contagiosa) and bullous. Nonbullous impetigo represents a host response to the infection, whereas a staphylococcal toxin causes bullous impetigo and no host response is required to manifest clinical illness.3 The diagnosis usually is made clinically and can be confirmed by Gram stain and culture, although this is not usually necessary. Culture may be useful to identify patients with nephritogenic strains of S. pyogenes during outbreaks of poststreptococcal glomerulonephritis or those in whom methicillin-resistant S. aureus is suspected.3

Epidemiology

Impetigo usually is transmitted through direct contact. In a study in the United Kingdom, the annual incidence of impetigo was 2.8 percent in children up to four years of age and 1.6 percent among children five to 15 years of age.4 Nonbullous impetigo accounts for approximately 70 percent of cases. Patients can further spread the infection to themselves or others after excoriating an infected area. Infections often spread rapidly through schools and day care centers. Although children are infected most often through contact with other infected children, fomites also are important in the spread of impetigo. The incidence is greatest in the summer months, and the infection often occurs in areas with poor hygiene and in crowded living conditions.1,3

Diagnosis

NONBULLOUS IMPETIGO

Nonbullous impetigo begins as a single red macule or papule that quickly becomes a vesicle. The vesicle ruptures easily to form an erosion, and the contents dry to form characteristic honey-colored crusts that may be pruritic (Figures 1 and 2). Impetigo often is spread to surrounding areas by autoinoculation. This infection tends to affect areas subject to environmental trauma, such as the extremities or the face. Spontaneous resolution without scarring typically occurs in several weeks if the infection is left untreated.5

Figure 1.

Nonbullous impetigo on the face.

Figure 2.

Nonbullous impetigo in the groin.

A subtype of nonbullous impetigo is common (or impetiginous) impetigo, also called secondary impetigo. This can complicate systemic diseases, including diabetes mellitus and acquired immunodeficiency syndrome. Insect bites, varicella, herpes simplex virus, and other conditions that involve breaks in the skin predispose patients to the formation of common impetigo. The presentation is similar to that of primary nonbullous impetigo. 1 Table 1 provides a selected differential diagnosis of nonbullous impetigo.1

View/Print Table

TABLE 1

Selected Differential Diagnosis of Nonbullous Impetigo

TABLE 1

Selected Differential Diagnosis of Nonbullous Impetigo

BULLOUS IMPETIGO

Bullous impetigo most commonly affects neonates but also can occur in older children and adults. It is caused by toxin-producing S. aureus and is a localized form of staphylococcal scalded skin syndrome.5,6 Superficial vesicles progress to rapidly enlarging, flaccid bullae with sharp margins and no surrounding erythema (Figures 3 and 4). When the bullae rupture, yellow crusts with oozing result.

Figure 3.

Bullous impetigo.

Figure 4.

Bullous impetigo.

A pathognomonic finding is a “collarette” of scale surrounding the blister roof at the periphery of ruptured lesions.5 Bullous impetigo favors moist, intertriginous areas, such as the diaper area, axillae, and neck folds. Systemic symptoms are not common but may include weakness, fever, and diarrhea. Most cases are self-limited and resolve without scarring in several weeks. Bullous impetigo appears to be less contagious than nonbullous impetigo, and cases usually are sporadic.3 Bullous impetigo can be mistaken for cigarette burns when localized, or for scald injuries when more extensive infection is present, and the condition may mimic child abuse.7 Table 21 provides a selected differential diagnosis of bullous impetigo.

View/Print Table

TABLE 2

Selected Differential Diagnosis of Bullous Impetigo

TABLE 2

Selected Differential Diagnosis of Bullous Impetigo

Prognosis and Complications

No high-quality prognostic studies of impetigo are available. According to two recent nonsystematic reviews, impetigo usually resolves without sequelae within two weeks if left untreated.2,5 Only five placebo-controlled randomized trials have been conducted. Seven-day cure rates in these trials ranged from 0 to 42 percent.8 Adults seem to have a higher risk of complications.2,5

Acute poststreptococcal glomerulonephritis is a serious complication that affects between 1 and 5 percent of patients with nonbullous impetigo.1,4 Treatment with antibiotics is not thought to have any effect on the risk of poststreptococcal glomerulo-nephritis. Rheumatic fever does not appear to be a potential complication of impetigo. In patients with chronic renal failure, especially those on dialysis and transplant recipients, impetigo can complicate the condition.

Other rare potential complications include sepsis, osteomyelitis, arthritis, endocarditis, pneumonia, cellulitis, lymphangitis or lymphadenitis, guttate psoriasis, toxic shock syndrome, and staphylococcal scalded skin syndrome.5

Treatment

The aims of treatment include relieving the discomfort and improving cosmetic appearance of the lesions, preventing further spread of the infection within the patient and to others, and preventing recurrence. Treatments ideally should be effective, inexpensive, and have limited side effects. Topical antibiotics have the advantage of being applied only where needed, which minimizes systemic side effects. However, some topical antibiotics may cause skin sensitization in susceptible persons.

A Cochrane review of interventions for impetigo identified only 12 good-quality studies of impetigo treatment.8 In a 2003 meta-analysis that included 16 studies, 12 received a good-quality score.4 Most of the studies addressed nonbullous impetigo, although the limited data for bullous and common impetigo suggest that similar conclusions may be drawn regarding treatment.

TOPICAL ANTIBIOTICS VERSUS PLACEBO

Three studies found that topical antibiotics are clearly more effective than placebo for the treatment of impetigo.4,8 Most patients with localized disease should receive mupirocin (Bactroban) or fusidic acid (not available in the United States) because they are effective and well tolerated. Data from four trials show that they are equally effective.4,8 Data on other topical antibiotics were limited, but bacitracin and bacitracin/neomycin were less effective. Adverse effects from topical antibiotics were uncommon and, when present, were mild.8

ORAL ANTIBIOTICS

Oral penicillin V was no more effective than placebo in a single study of patients with impetigo; however, the study was too small (and therefore lacked adequate statistical power) to show a clinically meaningful difference between the treatment and placebo groups, if one existed.8 Data comparing other oral antibiotics with placebo are not available.

Numerous studies compared various oral antibiotics. Two systematic reviews showed that lactamase-resistant, narrow-spectrum penicillins; broad-spectrum penicillins; cephalosporins; and macrolides were, in general, equally effective. Penicillin V and amoxicillin were less effective than cephalosporins, cloxacillin, or amoxicillin/clavulanate (Augmentin).4,8 One study found cefuroxime (Ceftin) to be more effective than erythromycin, and erythromycin resistance rates appear to be rising.4,8

TOPICAL VERSUS ORAL ANTIBIOTICS

According to several systematic reviews, mupirocin was as effective as several oral antibiotics (dicloxacillin [Dynapen], cephalexin [Keflex], ampicillin). Oral antibiotics are recommended for patients who do not tolerate a topical antibiotic, and should be considered for those with more extensive or systemic disease. Basic prescribing information is summarized in Table 3. One study comparing fusidic acid and cefuroxime found no difference in effectiveness, and both mupirocin and fusidic acid were consistently more effective than oral erythromycin.4,7 Although patients with more extensive impetigo and those with systemic symptoms often are treated with oral antibiotics, there were no studies comparing oral and topical antibiotics in this subset of patients. Oral antibiotics can be used, however, based on expert opinion and traditional practice.8 Adverse effects, particularly nausea, are more common with oral antibiotics, especially erythromycin, than with topical antibiotics.8

View/Print Table

TABLE 3

Dosage, Duration, and Cost of Treatment Regimens for Impetigo

TABLE 3

Dosage, Duration, and Cost of Treatment Regimens for Impetigo

TOPICAL DISINFECTANTS

In a small, single study, topical disinfectants, such as hexachlorophene (Phisohex), were no better than placebo; and topical antibiotics were found to be superior to topical disinfectants in the treatment of impetigo.8 Comparison of oral penicillin V and hexachlorophene showed no differences in cure rates or improvement in symptoms. Adverse effects from topical disinfectants were rare and, when present, were mild; however, topical disinfectants are not recommended.8

Data Search: For this review we searched Ovid Evidence-Based Medicine using the search term “impetigo.” We also searched the National Guideline Clearinghouse, the TRIP database, and Clinical Evidence using the search term “impetigo.” We searched Medline (1996 to 2005) using the Clinical Evidence search strategy.

Figures provided by Kenneth Greer, M.D.

90,000 Oral antibiotics: “strong” and “weak”

Myths and scientific facts about the efficacy and safety of antibacterial drugs

Scientists argue that bacteria have existed on Earth for at least 3.8×10 ⁹ years, while antibiotics have been used in clinical practice only since the 40s of the last century [1]. But even this time was enough for the drugs of this group to be overgrown with many myths that interfere with effective antibiotic therapy.Despite the fact that treatment with antimicrobial agents is a priori impossible without the direct supervision of a physician, the modern “reasonable patient”, subject to the influence of pseudo-scientific data, makes its “invaluable contribution” to antibiotic resistance and other negative consequences of incorrect use of antibiotics. A competent pharmaceutical specialist who possesses correct information about antimicrobial agents and is ready to share it with the client can warn him against rash decisions.

Myth.Modern antibiotics are so “strong” that no bacteria can resist them

True. In fact, one of the most pressing problems of modern pharmacology and public health in general is the rapid development of resistant strains of bacteria that are resistant, among other things, to modern antibiotics of the latest generations. The emergence of resistance has been registered for each and every class of antimicrobial drugs. It can develop at any stage of achieving a therapeutic effect (and even at several at once).The main mechanisms for the development of sustainability [1, 2]:

• Initially resistant strains. For example, some gram-negative bacteria have outer cell membranes that protect their cells from the action of a number of penicillins and cephalosporins.
• Spontaneous mutations resulting in antibiotic-resistant organisms.
• The transfer of genes for antimicrobial resistance is the most common and important mechanism for the development of antibiotic resistance.

Antibiotic resistance is a global problem that can have unpredictable consequences for each of us. Alas, consumers themselves make a huge contribution to its existence. It is appropriate to remind buyers of this with prescriptions for antibiotics, stressing that the use of antimicrobial drugs only as prescribed by a doctor and strict adherence to the dose and regimen of antibiotic therapy can significantly reduce the risks of developing resistant strains.

Myth.To recover quickly, you need “strong” broad-spectrum antibiotics

True. All registered antibacterial drugs can be safely attributed to powerful, that is, “strong”, but the severity of their antimicrobial effect depends on many factors combined by the principles of antibiotic therapy [2]:

• Making the diagnosis as accurate as possible. Knowing the diagnosis allows the suspected pathogen to be identified.
• Determination of the pathogen, if possible.
• Making an informed decision about the need to prescribe antibiotics.
• Selection of the optimal antibiotic, taking into account the pharmacokinetics and spectrum of activity.
• Selection of the optimal dose and course of treatment (the latter for most acute infections should be at least 5-10 days).
• Monitoring the effectiveness of antibiotic therapy.

In Russian realities, when control over the intake of antibiotics, frankly, is insufficient, the issue of incorrect selection of drugs is especially acute.It is known that it is carried out in two ways: etiotropic and empirical. In the first case, the antibiotic is applied purposefully against a specific, precisely identified pathogen. Without a doubt, this is rational and justified. However, identification of the microorganism that caused the infection takes time, usually several days. When the process is acute and the patient needs immediate help, isolating the pathogen is an unjustified luxury. In such a situation, empirical therapy is prescribed, selecting the drug taking into account the most likely pathogens [3].For example, the most common causative agent of pneumonia is pneumococcus, cystitis is E. coli, and so on.

If the antibiotic was selected correctly and all other principles of antibiotic therapy were followed, it will undoubtedly prove to be “strong”. But the same drug, used incorrectly (regardless of the stage at which the mistake was made), can show “weakness” and not have a therapeutic effect.

Myth. Although many sulfa drugs are almost a thing of the past, co-trimoxazole still retains its position among antimicrobial drugs

True. Sulfonamides became the first effective chemotherapeutic agents successfully used for the prevention and treatment of bacterial infections. And although the area of ​​their application narrowed significantly with the advent of penicillin, and later other antibiotics, some of their representatives for a long time occupied a niche in the range of antimicrobial drugs. First of all, we are talking about a synergistic combination of trimethoprim and sulfamethoxazole, known under the INN co-trimoxazole.

Co-trimoxazole is a potent selective inhibitor of microbial dihydrofolate reductase, an enzyme that reduces dihydrofolate to tetrahydrofolate.Blocking this reaction provides a violation of the formation of purine and pyrimidine bases, nucleic acids and thus inhibits the growth and reproduction of microorganisms [4]. However, in recent years, the number of strains of bacteria resistant to co-trimoxazole has increased dramatically, and the prevalence of resistance continues to grow rapidly.

It is assumed that microorganisms previously sensitive to the drug in the course of evolution acquired extrachromosomal DNA molecules (plasmids) that encode an altered dihydrofolate reductase.Thanks to them, resistance to co-trimoxazole is formed in almost every third isolate of E. coli in urine [4]. The situation with other strains of bacteria previously sensitive to the drug is not much better. In this regard, today the use of co-trimoxazole is sharply limited, and the drug has practically given way to more effective and safe antimicrobial drugs [5].

Myth. Oral cephalosporins are as strong as parenteral

Cephalosporins (Cs) are one of the broadest classes of antimicrobial drugs, available in both oral and parenteral form.In this case, the severity of the antibacterial effect is primarily determined by belonging to one of four generations. Antibiotics of the 1st generation cephalosporins – parenteral cefazolin and oral cephalexin – have the narrowest spectrum of activity, similar to the spectrum of aminopenicillins (ampicillin, amoxicillin) [3]. II generation cephalosporins (parenteral cefuroxime, oral cefaclor) are active against gram-negative bacteria, while their action on staphylococci and streptococci is close to their predecessors.Thus, the potency of the representatives of the first and second generation antibiotics is practically independent of the dosage form. But with cephalosporins of subsequent generations, things are not so simple.

It is known that antibiotics of the 3rd generation have a higher activity in relation to gram-negative bacteria, pneumococci and streptococci compared to CS-I and CS-II. However, their oral forms, cefixime and ceftibuten, certainly have a narrower spectrum of activity than parenteral ceftriaxone, ceftazidime and cefoperazone.In particular, oral preparations do not work against penicillin-resistant pneumococci, which is associated with their relatively low bioavailability. Thus, the bioavailability of cefixime is only 40–50%, while in parenteral forms it is close to 100% [3].

Nevertheless, cefixime is considered a powerful antibiotic, the use of which is justified for urinary tract infections, as well as otitis media and pharyngitis. Ceftibuten is used much less frequently: it is indicated only for the treatment of acute bacterial complications of chronic bronchitis, otitis media, pharyngitis and tonsillitis.A significant drawback of this drug is its low activity against Staphylococcus aureus [4]. At the same time, parenteral cephalosporins of the third generation are widely used to treat severe infections of the upper and lower respiratory tract, biliary tract, soft tissues, intestinal infections, sepsis, and others [3].

Myth. Chloramphenicol is a “strong” safe antibiotic for intestinal infections

True. On the one hand, chloramphenicol really has a wide spectrum of activity, including gram-positive and gram-negative cocci, gram-negative bacilli, including intestinal and hemophilic bacteria, as well as other pathogens of intestinal infections – salmonella, shigella, and so on.But, on the other hand, the drug is associated with an equally wide range of adverse reactions.

It is known that chloramphenicol inhibits hematopoiesis, causing thrombocytopenia, anemia and even fatal aplastic anemia (although only in 1 case per 10,000–40,000 patients) [3]. In addition, it has hepatotoxic, neurotoxic effects and other side effects. Due to its extremely unfavorable safety profile, chloramphenicol is considered a reserve antibiotic and is prescribed only in cases where the benefits of its use outweigh the risk of side effects.This happens, as a rule, if, for some reason, it is not possible to select another antibacterial drug [3, 5].

Myth. Tetracyclines are traditionally “weak” antibiotics, significantly less potent than penicillins

True. In fact, tetracyclines have a wide spectrum of antibacterial activity, and their modern representatives act against even more bacteria than their predecessors, including a number of pathogens that are resistant to other classes of antibiotics.Thus, tigecycline, which appeared on the market only in the mid-2000s, was developed as part of a program to combat the growing antibiotic resistance of such “complex” pathogens in this regard, such as Staphylococcus aureus and Escherichia coli [6].

Tetracyclines, including those used for decades, tetracycline and doxycycline, are able to penetrate into the cell, therefore they are still widely used to treat intracellular sexually transmitted infections (chlamydia, ureaplasmosis, mycoplasmosis).The indications for their appointment include Helicobacter pylori infection – as part of eradication therapy. Due to the effectiveness against Propionibacterium acne tetracyclines, along with macrolides, are used to treat acne. Minocycline, whose spectrum includes Neisseria meningitidis , is used to prevent meningococcal infection [2].

As a fly in the ointment, it should be mentioned that most tetracyclines (with the exception of modern representatives) are characterized by a high level of secondary resistance of many bacteria and, moreover, cross-resistance of microorganisms [3].And this, undoubtedly, in many cases reduces their relevance.

Myth. Fluoroquinolones are too “strong” antibacterial drugs, therefore they are not used to treat children

True. Fluoroquinolones – an extensive group of antimicrobial drugs, including representatives of four generations. Today, quinolones of the last three generations are used, with the most active antibiotics belonging to III (levofloxacin, sparfloxacin, gatifloxacin) and IV (moxifloxacin, clinafloxacin) generations.Their spectrum of activity includes pneumococci, including penicillin-resistant, atypical pathogens (chlamydia, mycoplasma), most gram-negative bacteria, streptococci, anaerobes and others. The undoubted advantages of modern quinolones include resistance to beta-lactamases, slow development of resistant strains, high bioavailability of oral forms of drugs, low toxicity, and duration of action, which allows many drugs to be prescribed once a day [7].

Fluoroquinolones are the drugs of choice for urinary, biliary and respiratory tract infections, sexually transmitted infections, gynecological diseases, and so on [7].But with all their advantages, fluoroquinolones also have a number of disadvantages, including the possibility of affecting the cartilaginous growth points of bones in children. However, this effect was revealed during toxicological studies on immature animals. According to clinical data, the total number of side effects of fluoroquinolones – both in quantity and quality – does not differ in children and adults [8]. Moreover, the practice of using antibacterials of this group in children is widespread throughout the world [9], although in Russia the age of up to 18 years is still a contraindication to their use.

Myth. Erythromycin is a “weak” macrolide, much inferior to modern representatives of this class of drugs

True. Erythromycin, like other macrolides, reversibly binds to the 50S ribosome subunit, disrupting the process of translocation and formation of peptide bonds between amino acid molecules and blocking the synthesis of proteins of sensitive bacteria. Despite the existence of modern representatives of the class – azithromycin, clarithromycin and others – erythromycin is still considered the drug of choice for the treatment of a number of infections, in particular, mycoplasma infection in children, legionellosis, diphtheria and whooping cough [2].

Along with high activity, erythromycin is not well tolerated. It is known that it causes dyspepsia in 30–35% of patients, and also has a number of other side effects [3]. In this regard, in practice, they often give preference to modern representatives of this group.

Myth. Amoxicillin is the same strong antibiotic as amoxicillin clavulanate – in fact, it is the same drug

True. Amoxicillin, along with ampicillin, belongs to extended spectrum aminopenicillins, acting against gram-positive and gram-negative bacteria.It is still considered the most active among all oral lactam antibiotics against penicillin-sensitive and penicillin-resistant pneumonia staphylococci [4]. However, it should be borne in mind that a number of bacteria have developed resistance to penicillins and aminopenicillins in particular. Thus, resistant strains of Haemophilus influenzae, pneumococcus, enterobacteria are widespread. A way out of this situation is the use of inhibitor-protected aminopenicillins, such as amoxicillin / clavulanate and ampicillin / sulbactam, resistant to the action of beta-lactamases and having, accordingly, a wider spectrum of activity [4].

Thus, the appointment of aminopenicillins is justified in mild and uncomplicated infections, while inhibitor-protected drugs are indicated in severe and recurrent forms. In this case, the route of administration (parenteral or oral) is chosen depending on the severity of the infection [3].

Sources of

1. Hamilton-Miller J. M. T. The emergence of antibiotic resistance: myths and facts in clinical practice // Intensive care medicine.1990; 16 (3): S206 – S211.
2. Peter N Bennett et al. Clinical pharmacology. 11th edition.
3. Clinical pharmacology and pharmacotherapy: textbook. – 3rd ed., Add. and revised / ed. V.G. Kukes, A.K. Starodubtseva. – M .: GEOTAR-Media, 2012 .– 832 p.
4. Goodman and Gilman’s The Pharmacological Basis of Therapeutics, Twelfth Edition.
5. Eliopoulos G. M., Huovinen P. Resistance to trimethoprim-sulfamethoxazole // Clinical infectious diseases.2001; 32 (11): 1608-1614.
6. Rose W. E., Rybak M. J. Tigecycline: first of a new class of antimicrobial agents // Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2006; 26 (8): 1099-1110.
7. Novikov V.E. Pharmacology of quinolones and fluoroquinolones // Reviews on clinical pharmacology and drug therapy, 2008. T. 6. No. 3.
8. Postnikov S.S. Tolerance of fluoroquinolones // Medicine, 2004. No. 2.
9. Kolbin A.S., Shabalov N.P., Karpov O.I. Efficiency and safety of the use of fluoroquinolones in pediatrics // Pediatrics. Journal named after GN Speransky, 2005. T. 84. No. 2.

Oral versus inhaled antibiotics for people with bronchiectasis

Review question

We would like to know if oral antibiotics (taken by mouth) or inhaled antibiotics are more effective in reducing the duration and frequency of bronchiectasis infections, hospitalizations and side effects, and in reducing the risk of chest infections not responding to antibiotic treatment.

Relevance

Bronchiectasis is a long-term, incurable condition in which people develop repeated bacterial chest infections, leading to frequent coughing, shortness of breath and mucus production. They often occur three or more times a year and require antibiotic treatment, either short-term if chest infection occurs, or long-term to prevent recurrent chest infections. It was once considered a rare condition, but recent data show that up to 5 people in every 1000 may have bronchiectasis, and the death rate for people with the condition can be more than double that of the general population.

Antibiotics are commonly used to treat chest infections in people with bronchiectasis, to kill the specific types of bacteria that cause the infection. Some antibiotics are more effective against specific types of bacteria than others, and these different types of bacteria can develop resistance to antibiotic treatment, making them less effective and reducing the choice of antibiotic later. Antibiotics can also be given to people in a variety of ways, such as by mouth as a pill or by inhalation (inhalation).

At this time, we do not know which method of administering antibiotics, oral or inhaled, is most effective in treating recurrent chest infections in terms of killing bacteria, reducing the chances of developing antibiotic resistance, and reducing bronchiectasis symptoms.

We searched for all published and unpublished evidence available, up to March 2018, comparing oral antibiotics to inhaled antibiotics.

Research characteristics

Although there have been several studies investigating the benefits of antibiotics for people with bronchiectasis, none have compared oral antibiotics to inhaled antibiotics.

Quality of evidence

There is no high quality evidence available to determine whether oral or inhaled antibiotics are more beneficial for people with bronchiectasis.More research is needed to evaluate the effectiveness of oral antibiotics versus inhaled antibiotics in reducing the incidence of chest infections and the chances of developing resistance to antibiotic therapy.

Antibiotic rules: no alcohol, orange juice and self-medication

The basic rule for taking antibiotics is to take antibiotics only when you cannot do without them.And only on the recommendation of a doctor.

With ARVI, many self-medicate, which can lead to excessive and unjustified use of drugs. But taking antibacterial drugs for infections that caused viruses can lead to an excessive drug load on the body. Few people know that only two drugs taken at the same time, which a person takes without consulting a doctor, can cause the development of negative consequences of drug interactions. ¹

Antibiotics should not be taken as a prophylaxis for certain diseases and in order to relieve ARVI symptoms. ² It can do more harm than good. To prescribe antibacterial drugs, you must consult a doctor who will make the correct diagnosis and, if necessary, will recommend laboratory tests to determine the pathogen. In the absence of indications, antibiotics should not be taken together with medications for the treatment of throat diseases.For common and most common viral diseases such as tonsillitis, pharyngitis and laryngitis, use symptomatic local therapy, ³ , which helps to fight discomfort in the throat.

If a course of treatment with antibiotics has already been prescribed, it is worth, according to the WHO advice, to adhere to the rational use of drugs – correct, appropriate and appropriate. ⁴ Let’s see what is included in these definitions.

Follow the instructions.Drink with water

Tea, coffee, orange, apple and any other juices, milk and dairy products – in most cases all this is not suitable for drinking antibiotics intended for oral administration. These drinks speed up the elimination of the drug and may reduce the effectiveness of the treatment. ⁵ Juices also contain various acids that can react with drugs and cause unwanted reactions. ⁶

It is most rational to use water when taking medications, unless otherwise indicated in the instructions.Be sure to study it before starting treatment. Tea and coffee are also undesirable because they contain caffeine, tannins and catechins, which can alter the absorption and pharmacological action of many drugs. ⁷

Before meals, during or after

It is necessary to take into account the type of antibiotic, the doctor’s recommendations and the information specified in the instructions. Some drugs should be taken exclusively on an empty stomach, while others should be taken with or after a meal.

It is unacceptable to take the medicine when you remember about it, not paying attention to the instructions for the medicine.

Stick to a strict admission schedule

Antibiotics are taken as many times a day as prescribed by the doctor. If it is recommended three times a day, this most often means that the drug must be taken in the morning, afternoon and evening at regular intervals.

When taken twice a day, the interval is 12 hours. Stick to the dose of the drug recommended by your doctor, do not increase or decrease it yourself.

Do not stop taking the medicine as soon as you feel better

Even if the symptoms of the disease have decreased and it seems to you that the treatment can be completed and it is not necessary to take the remaining drugs, this should not be done without consulting a doctor.Otherwise, the development of resistance of microorganisms to the drug is possible, when weakened bacteria that have already come under the influence of the drug and are still alive mutate and stop responding to the antibiotic. Thus, the drug taken may be useless the next time and recovery will be delayed for a long time. ⁸

Individual selection of combinations

Sometimes a combined intake of drugs is required, due to which synergism occurs – an increase in the pharmacological effect.The combination of drugs with each other, taking into account the dosage and type of action on the pathological process, allows you to increase the effectiveness of the treatment. At the same time, you can take both antibiotics of different types, and a combination of antibiotics with other drugs. But only a doctor selects a scheme and draws up a treatment plan.

Independent experiments “shouldn’t I also take this pill, it helped my friend” can lead to unpredictable consequences.

Antibiotics are incompatible with alcohol

Alcohol can reduce or even block the therapeutic effect of many antibiotics.It can also increase the side effects of antimicrobial drugs and lead to drowsiness, dizziness, nausea, vomiting, high blood pressure, heart palpitations, and severe headaches. ⁹

A cocktail of alcohol and antibiotics can lead to toxic damage to internal organs, primarily the liver and kidneys.

How to treat a sore throat?

You can try Strepsils® Intensive, lozenges [orange] containing flurbiprofen, an anti-inflammatory agent from the group of propionic acid derivatives that has an analgesic effect.

Strepsils® Intensive, lozenges [orange] helps to reduce swelling, relieve swallowing difficulties and fights pain, discomfort and irritation in the throat. It can be used for viral, bacterial and fungal diseases. ¹⁰

Method of application and dosage

¹⁰

Adults and children over 12 years of age: Slowly dissolve one tablet every 3-6 hours.

Maximum daily dose: 5 tablets.

The duration of the course of treatment is no more than 3 days. If, after taking the drug for 3 days, the symptoms persist or worsen, it is necessary to stop treatment and consult a doctor.

Read the instructions before using the drug.

You can also use Strepsils® Intensive spray for topical application dosed with flurbiprofen. The drug penetrates the throat tissue and acts on the cause of the pain – inflammation. Helps relieve sore throat.The interval between doses of the drug is up to 6 hours. It is recommended to take 1 dose of the drug every 3-6 hours, but no more than 5 doses within 24 hours. ¹¹

Method of application and dosage

¹¹

Adults and children over 12 years of age: spray 1 dose of the drug (3 presses on the dispenser) along the back wall of the oropharynx every 3-6 hours. Do not inhale when spraying.

Maximum daily dose: 5 doses (15 pressings on the dispenser).

Do not exceed the indicated dose.

The duration of the course of treatment is no more than 3 days. If, after taking the drug for 3 days, the symptoms persist or worsen, it is necessary to stop treatment and consult a doctor.

Read the instructions before using the drug.

FLEMOXIN SOLUTAB 1.0 N20 TABL DISPER

group

Hemocytes

Hemocytes

mirabilia

miraculous

Floron 10% oral solution

I. General

1. Trade name of the medicinal product: Floron ^® 10% (FLORON ^® 10%).

International non-proprietary name: florfenicol.

2. Dosage form; oral solution.

Floron ^® 10% as active ingredient contains florfenicol 100 mg / ml and an auxiliary substance – polyethylene glycol 200.

3. In appearance, the preparation is a clear viscous solution from light yellow to brownish yellow.

The shelf life of the medicinal product, subject to storage conditions, is 2 years from the date of manufacture. After opening the original packaging, the medicinal product is recommended to be stored in the manufacturer’s sealed packaging and used within 28 days.

It is forbidden to use the medicinal product after the expiration date.

4. Floron ^® 10% is produced in 1000 ml plastic bottles of appropriate capacity. Each package is supplied with instructions for use.

5. Store the medicinal product in the manufacturer’s packaging, separately from food and feed, in a place protected from direct sunlight, at a temperature from 5 ^o C to 25 ^o C.

6.Store the drug out of the reach of children.

7. The unused product is disposed of in accordance with legal requirements.

8. Available without a veterinarian’s prescription.

II. Pharmacological properties

9. Floron ^® 10% refers to antibacterial drugs of the fenicol group.

10. Florfenicol is a thiamphenicol derivative in which the hydroxyl group is replaced by a fluorine atom.Florfenicol has a bacteriostatic effect on sensitive microorganisms. In the protoplasm of a bacterial cell, it binds to the 70S ribosomal subunit, where it blocks the enzyme peptidyl transferase, which leads to inhibition of protein synthesis in sensitive bacteria at the ribosome level.

Florfenicol is active against bacteria that produce acetyltransferase and are resistant to chloramphenicol.

Florfenicol has a wide spectrum of antibacterial action, including against Actinobacillus pleuropneumoniae, Pasteurella multocida, Pasteurella haemolitica, Bordetella bronchiseptica, Haemophilus sp., Micoplasma hyopneumoniae, Micoplasma hyorhinis, Ornitobacterium rhinotracheale, E. coli, Salmonella sp., Staphilococcus aureus, Streptococcus sp., Shigella sp., Klebsiella sp., Proteus sp.

When administered orally, florfenicol is intensively absorbed from the intestinal tract and penetrates into all organs and tissues, but does not overcome the blood-tissue barriers. The bioavailability of florfenicol after oral administration is 88% in pigs and 55% in birds. The maximum concentration of the antibiotic in the blood is reached after 1 hour.The therapeutic concentration of the antibiotic remains in the organs and tissues of pigs and birds for 24 hours.

Florfenicol and its metabolites are excreted from the body of birds mainly with droppings; from the body of pigs, florfenicol and its metabolites are excreted from the body mainly in the urine and, to a lesser extent, in the faeces.

Floron ^® 10% in terms of the degree of exposure to the body refers to moderately hazardous substances (hazard class 3 according to GOST 12.1.007-76).

III.Application procedure

11. Floron ^® 10% is used for the treatment of pigs with respiratory diseases of bacterial etiology: pleuropneumonia caused by Actinobacillus pleuropneumoniae and / or Haemophilus parasuis, atrophic rhinitis caused by Pasteurella multocida, Bordetella bronchiseptica diseases, and other infectious etiology caused by microorganisms sensitive to florfenicol, and secondary bacterial infections.

Floron ^® 10% is used for the treatment of colibacillosis, pasteurellosis, respiratory diseases of bacterial etiology in birds, incl.including caused by Ornitobacterium rhinotracheale, staphylococcosis and other infectious diseases caused by microorganisms sensitive to florfenicol, as well as secondary bacterial infections.

12. A contraindication to the use of the preparation Floron ^® 10% is the increased individual sensitivity of the animal to the components of the preparation. The use of Floron ^® 10% for laying hens is prohibited due to the release of florfenicol with the egg.

13. When working with Floron ^® 10%, it is necessary to observe the general rules of personal hygiene and safety measures provided for when working with medicinal products.

14. It is prohibited to use Floron ^® 10% for the treatment of sows during pregnancy and lactation, as well as breeding boars.

15. Floron ^® 10% is administered to pigs orally with drinking water at a daily dose of 5 mg florfenicol per kg of animal live weight (which corresponds to 5 ml of the drug per 100 kg of animal weight) for 7 days.

Floron ^® 10% is administered to poultry orally with drinking water in a daily dose of 20 mg of florfenicol per 1 kg of animal weight, which corresponds to: chickens under 4 weeks of age – 100 ml of the drug per 100 l of water; other age categories of poultry – 200 ml of the drug per 100 liters of water for 3 days, and for salmonellosis – within 5 days.

During the treatment period, animals should receive only water containing the medicinal product. In the case when this is not possible, the daily dose is divided into 2 equal parts and set with an interval of 12 hours. The active ingredient Floron ^® 10% can precipitate if the concentration of florfenicol in water exceeds 1 g per 1 liter, which corresponds to 10 ml of 10% Floron per 1 liter of water.

16. Side effects of the medicinal product in poultry have not been identified.

When treated with Floron ^® 10%, pigs may develop perianal erythema and soft feces. These changes do not require treatment, they quickly pass by themselves and do not affect the physiological state of the animals.

17. In case of overdose, animals may experience diarrhea and anorexia.

18. The simultaneous use of Floron ^® 10% with thiamphenicol and chloramphenicol is not allowed. It is not recommended to mix Floron ^® 10% with other medicines.

19. The peculiarities of the action of the drug during its first use and cancellation have not been established.

20. Skipping the next dose of the drug should be avoided, as this can lead to a decrease in therapeutic efficacy. If one dose is missed, the use of the drug is resumed in the same dosage and according to the same scheme.

21. Slaughter of pigs is allowed no earlier than 6 days after the last application of Floron ^® 10%. Slaughter of poultry is allowed no earlier than 2 days after the last application of Floron ^® 10%.The meat of animals that were forcedly killed before the expiration of the specified period can be used as feed for fur animals or in the production of meat and bone meal.

Name and address of the manufacturing site of the drug manufacturer

JSC KRKA, dd, Novo Mesto / KRKA, d.d., Novo mesto, Smarjeska cesta 6, 8501 Novo mesto, Slovenija.

Name, address of the organization authorized by the owner or holder of the registration certificate of the medicinal product to accept claims from the consumer.

LLC “KRKA-RUS”, 25212, Moscow, Golovinskoe highway, building 5, building 1

Tel .: (495) 981-10-95, fax: (495) 981-10-91.

With the approval of these instructions for the use of Floron ^® 10%, the instructions for use approved by Rosselkhoznadzor approved by Rosselkhoznadzor on April 21, 2016

Registration certificate number: 705-3-30.12-3151№-3-3.7 / 02191

Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Acticlate; Avidoxy; Doryx; Doryx MPC; Doxy 100; Mondoxyne NL; Monodox [DSC]; Morgidox; Okebo [DSC]; Oracea; Soloxide [DSC]; TargaDOX; Vibramycin

Trade names: Canada

APO-Doxy; APO-Doxycycline MR; Apprilon; Doxycin; Doxytab; Periostat; PMS-Doxycycline [DSC]; TEVA-Doxycycline

What is this drug used for?

• Used to treat acne.
• It is used for the treatment and prevention of bacterial infections.
• Used to prevent malaria.
• It is used to treat periodontitis (inflammation of the tissues around the tooth). It is used for removing dental calculus and leveling the surface of the tooth roots.
• This medication is used to treat red acne.
• This medicinal product may be used for other indications. Check with your doctor.

What do I need to tell my doctor BEFORE taking this drug?

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
• If you are taking any of the following drugs: Acitretin, isotretinoin, or penicillin.

This list of drugs and diseases that may be adversely associated with the use of this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (prescription and over-the-counter, natural products and vitamins) and your health problems.You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while I am taking this drug?

• Tell all healthcare providers that you are taking this drug.These are doctors, nurses, pharmacists and dentists.
• With long-term use of the drug, a blood test must be performed. Talk to a healthcare professional.
• This drug may interfere with some laboratory tests. Tell all healthcare providers and lab staff that you are taking this drug.
• Do not use for longer than the prescribed time. A secondary infection is possible.
• In case of an individual allergic reaction to sulfites, it is necessary to consult a doctor.Some foods contain sulfites.
• You can easily get sunburn with this drug. Be careful if you are in the sun. If you get sunburn easily with this drug, talk to your doctor.
• Possible severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis). This can lead to serious and permanent health problems and sometimes death.Get immediate medical attention if you experience symptoms such as redness, skin swelling with blistering or scaling (with or without a high fever), eye redness or irritation, or ulceration in the mouth, throat, nose, or eyes.
• A serious reaction has occurred that can be fatal. In most cases, this reaction was accompanied by symptoms such as fever, rash, inflammation of the lymph nodes, and dysfunction of various organs such as the liver, kidneys, blood, heart, muscles, joints and lungs.If you have any questions, please consult your doctor.
• The effectiveness of birth control pills and other hormonal contraceptives may be reduced. Use a different type of birth control, such as a condom, while taking this drug.
• In children under 8 years of age, this drug may cause yellowish-brown or greyish-brown discoloration of teeth. The same effect is found in the fetus when the drug is used at certain points during pregnancy.This staining of the teeth is irreversible. Other dental abnormalities have been reported. The use of the drug can also lead to impaired bone growth in these age categories. If you have any questions, please consult your doctor.
• In most cases, this drug is not for use in children under 8 years of age. However, there may be times when these children are likely to need this drug. Check with your doctor.
• Teeth discoloration has also been reported in adults. It went away after stopping the drug and brushing the teeth at the dentist. Check with your doctor.
• If used during pregnancy, the drug may have a harmful effect on the fetus. If you are pregnant or become pregnant while taking this drug, call your doctor right away.
• Tell your doctor if you are breastfeeding. It is necessary to consult if the drug poses any risk to the child.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can cause serious and sometimes deadly side effects. Call your doctor or doctor right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction, such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Signs of liver problems such as dark urine, feeling tired, lack of appetite, nausea or abdominal pain, light stools, vomiting, yellowing of the skin and eyes.
• Signs of a problem with the pancreas (pancreatitis) such as severe abdominal pain, severe back pain, severe stomach upset and vomiting.
• Chest pain or pressure or a rapid heartbeat.
• Difficulty urinating or change in the amount of urine excreted.
• Fever, chills, sore throat; the appearance of bruising and bleeding for unexplained reasons; a pronounced feeling of tiredness or weakness.
• Sore throat.
• Difficulty swallowing.
• Joint or muscle pain.
• Rapid breathing.
• Hyperemia (blush).
• Severe dizziness or fainting.
• Skin discoloration.
• Swelling of the gland.
• Vaginal itching or discharge.
• Diarrhea is common with antibiotics. In rare cases, severe diarrhea caused by the bacteria Clostridium difficile (C. diff.) [CDAD] can occur. This sometimes leads to gut problems that end in death. CDAD can occur during or several months after taking antibiotics. If you have pain, abdominal cramps, or very loose, watery or bloody stools, see your doctor right away. Check with your doctor before treating diarrhea.
• Increased intracranial pressure has happened with this drug. Most of the time, your blood pressure will return to normal after you stop taking this drug. Loss of vision may sometimes occur and may persist even after you stop taking this drug. See your doctor right away if you have a headache or visual impairment, such as blurred vision, double vision, or loss of vision.

What are some other side effects of this drug?

Any medicine can have side effects.However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

• Diarrhea, indigestion or vomiting.
• Lack of feeling of hunger.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor.Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you.Follow all instructions strictly.

All oral preparations:

• Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.
• Some drugs must be taken with food and some must be taken on an empty stomach. There are medications that can be taken with food or on an empty stomach. Ask your pharmacist how to take this drug.
• It is recommended not to consume milk, dairy products and other foods rich in calcium along with this drug.Treatment with this drug may not be effective. If you have any questions, ask your doctor or pharmacist.
• Drink plenty of decaffeinated fluids, unless your doctor tells you to drink less fluids.
• Do not take bismuth (Pepto-Bismol ^® ), calcium, iron, magnesium, zinc, multivitamins with minerals, colestipol, cholestyramine, didanosine, or antiacids within 2 hours of taking this drug.

Tablets and capsules:

• Take this drug with a full glass of water.
• Do not lie down after taking this drug. This will help reduce the chances of irritation of the esophagus. Ask your pharmacist how long it takes before you can lie down after taking this drug.

Sustained-release tablets:

• Swallow whole. Do not chew or crush.
• The tablet may be broken with the permission of the doctor.
• You can pour the contents of the tablet into the applesauce.Crush the tablet with care to avoid crushing the pellets. Do not chew, crush or damage the contents of the tablet.
• Do not mix with applesauce.
• If taken mixed, swallow immediately. Do not store for future use.

All liquid preparations:

• Doses of liquid preparation should be measured with caution. Use the dispenser that comes with the medicine. If a dispenser is not included in the package, ask your pharmacist for the dosing product for this drug.

Liquid (suspension):

• Shake well before use.

Injection:

• This drug is administered by intravenous infusion continuously over a period of time.

What to do if a dose of a drug is missed?

All oral preparations:

• Take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal dose.
• Do not take 2 doses at the same time or an additional dose.

Injection:

• Call your doctor for further instructions.

How do I store and / or discard this drug?

All oral preparations:

• Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
• Do not use this drug after the expiration date.
• Do not take this medicinal product if it was stored in a different way from the instructions you received.

Solution (syrup):

• Throw away all unused portions of this medicine.

Liquid (suspension):

• Store liquid (suspension) at room temperature. Throw away any unused portion after 2 weeks.

Injection:

• If you need to store this drug at home, ask your doctor, nurse, or pharmacist for information about how it is stored.

All forms of issue:

• Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist.There may be drug recycling programs in your area.

General information on medicinal products

• If your health does not improve or even worsens, see your doctor.
• You should not give your medicine to anyone and take other people’s medicines.
• Some medicines may come with other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• Some medicines may come with other patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, unwanted effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug.Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

90,000 Pulmonologist declared the inadmissibility of antibiotics for the prevention of COVID – RBC

Taking such drugs is pointless and dangerous for future health.Earlier, the Ministry of Health has repeatedly urged Russians not to get carried away with antibiotics for coronavirus infection

Photo: Anton Vaganov / Reuters

It is unacceptable to take antibiotics to prevent coronavirus infection.This was told by the chief freelance pulmonologist of the Ministry of Health of Russia Sergey Avdeev, reports TASS.

“Antibiotics do not work on any viruses, including the new coronavirus. They are prescribed only in case of development of bacterial complications of a new coronavirus infection, ”the doctor said.

He recalled that uncontrolled intake of antibiotics without medical prescription can cause side reactions, as well as resistance to them in microorganisms. Side effects can range from life-threatening rashes or stool disturbances to anaphylactic shock.

Beglov asked not to buy antibiotics like buckwheat

The Ministry of Health has repeatedly warned that antibiotics cannot be used to prevent COVID-19.