Notes on I.V Antibiotics depending on BNF 73

1. REFERENCE: BNF 73 1
I. Amikacin & Gentamicin
* parenteral treatment shouldn’t exceed 7 days
* dehydration should be corrected before starting treatment
* vestibular function should be monitered during therapy
* ototoxicity & nephrotoxicity occur most commonly in eldrly
* used in caution in cases of muscle weakness, myasthenia gravis
* adminsteration with ototoxic diuretic should be seperated by long time
period as possible
* their principle excretion is renal so increase doses interval in cases of renal
impairments and decrease the dose in severe impairment
* in pregancy they are associated with risk of infant auditory/vestibular nerve
damage when used in 2nd & 3rd trimester (least with gentamicin)
* associated hypomagnesaemia, hypoclcaemia & hypokalaemia with
prolonged therpy
II. Amoxicillin
* maintain adequate hydration with high doses during parenteral therapy
* parenteral therapy asscoiated with crystalluria so require renal dosage
adjustment in severe impairment

2. REFERENCE: BNF 73 2
III. Ampicillin
* erythematous rash is commonin glandular fever, CMV infection, ALL/CLL
* rash is also common in renal impairment, dose reduction if GFR less than
10ml/min/1.73m2
* safe in pregnancy & apropriate to use in breast feeding
IV. Cefotaxime & Ceftazidime
* both associated for false positive urinary glucose test
* [cefotaxime] renal dosage adjustment if GFR less than 5ml/min/1.73m2
while [ceftazidime] dosage adjustment if GFR less than 50ml/min/1.73m2 &
caution in hepatic failure
* ceftazidime associated with taste disturbance
V. Ceftriaxone
* used in caution with history ofkidney stones, hypercalciuria, treatment with
I.V. calcium (precipitation occur in very young , dehydrated & immobilized
pt.)
* reducedosein renal impairment when GFR less than 10ml/min/1.73m2 (max
2g)
* in preganancy used when benefit outweight risks (harmful in animal studies)
* convulsion repoterted as side effect
VI. Meropenem
* caution in sensetivity to β-lactam allergy
* monitor LFTs in cases of hepatic impairment
* renal dosage adjustment if GFR 26-50ml/min/1.73m2 given every 12hr., if
GFR 10-25ml/min/1.73m2 give half dose every 12 hr, & in GFR less than
10ml/min/1.73m2 give half dose every 24hr

3. REFERENCE: BNF 73 3
VII. Metronidazole
* associated disulfiram-like reaction with alcohol
* associated with darkning ofurine, visual disturbance, neuropathy, arthralgia
& psychotic disorder-epileptiform seizures
* give 1
3⁄ of total daily dose& once in severe liver imairement, caution with
encephalopathy
* avoid high doses in pregnancy & breast feeding ( significant amount
secreted in milk)
VIII. Teicoplanin
* contraindicated in cases with vancomycin allergy
* LFTs, RFTs and auditory function monitoring is required during prolonged
treatment, in renal impairment & co-administeration with neuro- & nephro-
toxic drugs
* in renal failure use normal dose during 1st-4th day of tratment then give
maintenance dose every 48hr if GFR 30-80ml/min/1.73m2 & every 72hr if
GFR less than 30ml/min/1.73m2
* associated with rash, bronchospasm, dizziness, tinnitus & mild hearing loss
IX. Vancomycin
* avoid rapid infusion (risk of anapylactoid reaction, severe hypotension &
cardiac arrest, red man syndrom & muscle spasm of back - chest), rotate
infusion site, also associated with phlebitis
* avoid in elderly & cases with history of deafness (ototoxic)
* RFTs, bloodcount, urinalysis & dosereductionrequired in renal impairment
(nephrotoxic)
* used in caution with tiecoplanin sensitivity
* systemic absorption may follow oral administeration if given in multiple
doses or with inflammatory bowel disoreders
* associated with fetal toxicity