This document discusses various antibiotics used in primary care settings, including their indications, dosages, precautions and side effects. It covers tetracyclines like doxycycline, beta lactam antibiotics such as amoxicillin and co-amoxiclav, and several generations of cephalosporins including cefalexin, cefuroxime, ceftibuten and cefixime. It provides guidance on dosing antibiotics for both adult and pediatric patients for different types of infections. Precautions around interactions and side effects are also summarized.

1. Antibiotics in
primary care
setting
Domina Petric, MD

2. TETRACYCLINES
I.
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3. Doxycyclinum
100 mg capsules
for children older
then 12 years and
adults
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4. Indications:
• acute exacerbation of
chronic bronchitis and
sinusitis
• urinary tract infections
(UTI) caused with
E. coli, Klebsiella spp.,
Enterobacter spp.,
Streptoccocus faecalis
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5. Indications:
Sexually transmitted diseases
(STD):
• urethritis caused with
Chlamydia trachomatis,
Ureaplasma urealyticum
• simple gonococcal infections
• prostatitis
• syphilis
• lymphogranuloma venereum
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6. Indications:
• inclusion (chlamydial)
conjunctivitis, trachoma
• psittacosis
• acne, acne rosacea
• anthrax
• actinomycosis
• boreliosis (Laymes
disease)
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7. Indications:
• rickettsiosis
• shigellosis
• cholera
• amebiasis
• tularemia
• melidiosis
• brucellosis
• nocardiosis
• leptospirosis
• Wipple´s
disease
• tropical
sprue
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8. Dose
• First day of infection dose is
200 mg per os (at once or
100 mg twice a day).
• Other days dose is 100 mg.
• If it is severe infection, dose is
always 200 mg.
• Maximum dose is 300 mg.
• Treatment duration is 24-48
hours after symptoms
withdrawal.
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10. Contraindications:
• hypersensitivity
Children under the age of 12
years:
• permanent teeth
discoloration
• bone development
disorders
• tooth enamel hypoplasia
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11. Precautions:
• liver damage
• kidney damage
• severe skin reactions
• photosensitivity
• Clostridium difficile
diarrhoea
• esophagitis
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12. Precautions:
• benign intracranial
hypertension
• porphyria
• Myasthenia gravis
• systemic erythematous
lupus
• lactosis intolerance
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13. Interactions:
Warfarin!
Increases the
risk of bleeding.
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15. Side effects:
• anemia,
thrombocytopenia,
neutropenia...
• headaches, benign
intracranial hypertension
• tinnitus
• gastrointenstinal
problems
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16. Side effects:
• urea blood levels
elevation
• hypersensitivity reactions
• liver and kidney damage
rarely
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17. BETA LACTAM ANTIBIOTICS
II.
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18. EXTENDED SPECTRUM BETA
LACTAM ANTIBIOTICS
A)
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19. Amoxicillinum
• Almacin a 500 mg
• Amoksicilin a 1000 mg
• ...
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20. Indications:
• otitis media
• acute exacerbation of
chronic bronchitis
• bronchopneumonia
• cystitis
• urethritis
• pyelonephritis
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21. Indications:
• bacteriuria in pregnancy
• puerperal sepsis
• gonorrhoea
• skin and soft tissues
infections
• bacterial endocarditis
• abdominal tifus
• Helycobacter pylori
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22. Dose:
Adults:
• 250 mg per os three times a
day
• in more severe infections,
500 mg three times a day
• very difficult infections of
respiratory tract, 3 g twice a
day
• urinary tract infections, two
doses of 3 g
• gonorrhea one dose of 3 g
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23. Precautions:
• hypersensitivity
• kidney damage
• neonatal period
• lactosis intolerance
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24. Interactions:
Warfarin!
Increases the
risk of bleeding.
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26. Common side
effects:
• nausea
• vomiting
• urticaria
• pruritus
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27. Amoxicillinum
For children with body
weight less then 40 kg:
• Almacin 250 mg/5 mL
powder for oral
suspension
• one little spoon has 5 mL
• dose is 40-90 mg/kg/day
divided in two or three
doses
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28. Example
• Child: 30 kg, mild infection
Dose:
• 50 mg x 30 kg=150 mg
Result: 150 mg (3 mL)
• 75 mg (1,5 mL) twice a day
OR
• 50 mg (1 mL) three times a
day
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29. PENICILLIN SENSITIVE ON
BETA LACTAMASE
B)
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30. Phenoxymethylpenicillinum
kalicum per os
• Silapen K 1 000 000 i.j.
• Silapen K 1 500 000 i.j.
• Silapen K powder for oral
suspension
• Ospen K 1 000 000 i.j.
• Ospen K 1 500 000 i.j.
Three or four doses every 6
to 8 hours.
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31. PENICILLIN RESISTENT ON
BETA LACTAMASE
C)
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32. For parenteral
application:
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33. COMBINATIONS WITH BETA
LACTAMASE INHIBITORS
D)
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34. Combinations
amoxicillinum and
acidum clavulanicum
(co-amoxiclav)
piperacillinum and
tazobactamum (for
parenteral application)
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35. Co-amoxiclav
For oral application, adults:
• 500 mg/125 mg
• 875 mg/125 mg
For oral application, children
(BW less then 40 kg)
• 400 mg + 57 mg/5 mL
powder for oral
suspension
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36. Indications:
• acute bacterial sinusitis
• acute otitis media
• acute exacerbations of
chronic bronchitis
• community acquired
pneumonia
• cystitis
• pyelonephritis
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37. Indications:
• skin and soft tissues
infections, cellulitis
• tooth abscess with
cellulitis
• bones and joints
infections
• osteomyelitis
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38. Dose for adults:
• 500 mg/125 mg per os
three times a day
OR
• 875 mg/125 mg per os
twice a day
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39. Children (400 mg +
57 mg/5mL)
Age Moderate
infections
Severe
infections
2 months-
2 years
0,15 mL/kg
twice a day
0,3 mL/kg
twice a day
2-6 years
(13-21 kg)
2,5 mL
twice a day
5 mL twice
a day
7-12 years
(22-40 kg)
5 mL twice
a day
10 mL twice
a day
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40. CEPHALOSPORINS
III.
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41. FIRST GENERATION
A)
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42. First generation
cephalosporins:
cefazolinum
(parenteral
application)
cefalexinum
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43. Cefalexinum (oral
application) adults:
• 250 mg OR 500 mg
• respiratory tract infections
• otitis media
• skin and soft tissues
infections
• bones and joints infections
• UTI (including prostatitis)
• dental infections
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The best activity
on GRAM POSITIVE
BACTERIA!

44. Dose for adults
500 mg twice
a day (every
12 hours)
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45. Contraindications:
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46. Precautions:
• pseudomembranous
colitis
• kidney damage
• false positive direct
Coomb´s test
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48. Side effects:
• headache
• agitation
• halucinations
• pseudomembranous
colitis
• pain in abdomen
• anal pruritus
• interstitial nephritis
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49. Cefalexinum for
children:
• 250 mg/5 mL powder for oral
suspension
• Dose is 25-50 mg/kg/day up to
maximum 100 mg/kg/day.
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For most infections:
Children <5 years old 125 mg (2,5 mL) every 8
hours (three times a
day)
Children >5 years old 250 mg (5 mL) every 8
hours (three times a
day)
In difficult infections dose can be double!

50. Cefalexinum for
children:
For otitis media:
• 75-100 mg/kg/day divided
in four doses!
Example: otitis media, child 20 kg
• 80 mg x 20 kg = 1600 mg
• 400 mg (8 mL) every 6 hours
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51. SECOND GENERATION: ACTIVITY
ON BOTH POSITIVE AND
NEGATIVE GRAM BACTERIA
B)
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52. Cefuroximum
• acute streptococcal
tonsillitis and pharyngitis
• acute bacterial sinusitis
• acute otitis media
• acute exacerbations of
chronic bronchitis
• cystitis
• pyelonephritis
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53. Cefuroximum
• simple skin and soft
tissues infections
• Laymes disease early
stage
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54. Dose (adults and children
>40 kg) per os:
Acute tonsillitis and
pharyngitis, bacterial
sinusitis
250 mg per os twice a
day (every 12 hours)
Acute otitis media 500 mg twice a day
Acute exacerbations
of chronic bronchitis
500 mg twice a day
Cystitis 250 mg twice a day
Pyelonephritis 250-500 mg twice a
day
Skin and soft tissues
infections
250 mg twice a day
Laymes disease 500 mg twice a day, 14
days
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56. Precautions
• hypersensitivity
• Jarisch-Herxheimer´s
reaction
• Candida albicans
growth
• pseudomembranous
colitis
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58. Side effects:
• Candida albicans
growth
• eosinophilia
• headache
• dizziness
• liver enzimes elevation
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59. Cefuroximum for
children:
Zinnat
125 mg/5 mL
granules for
oral
suspension
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60. Cefuroximum for children
(<40 kg) PER OS:
Disease Dose Maximum dose
Acute tonsillitis
and pharyngitis,
bacterial sinusitis
10 mg/kg twice a
day
125 mg twice a day
(5 mL) twice a day
Acute otitis
media (age>2 years)
15 mg/kg twice a
day
250 mg twice a day
(10 mL) twice a day
Cystitis 15 mg/kg twice a
day
250 mg twice a day
Pyelonephritis 15 mg/kg twice a
day
250 mg twice a day
during 10-14 days
Skin and soft
tissues infections
15 mg/kg twice a
day
250 mg twice a day
Laymes disease 15 mg/kg twice a
day
250 mg twice a day
during 10-21 days
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61. THIRD GENERATION:
ACTIVITY MORE ON GRAM
NEGATIVE BACTERIA
C)
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62. Ceftibutenum
• pharyngitis, tonsilitis
• scarlatina (adults,
children)
• acute sinusitis (adults)
• otitis media (children)
• acute exacerbation of
chronic bronchitis
• community-acquired
pneumonia
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63. Ceftibutenum
• complicated and
simple UTI in adults
and children
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64. Dose (adults,
children >40 kg)
• Dose is 400 mg per os
once a day in most of the
indications.
• In community acquired
pneumonia dose is 200 mg
per os twice a day (every
12 hours).
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65. Precautions:
• hypersensitivity
• kidney damage
• chronic
gastrointestinal
diseases (chronic
colitis)
• pseudomembranous
colitis
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67. Side effects:
• vomiting
• diarrhea
• headache
• ...
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68. Ceftibutenum for
children:
• Cedax 180 mg/5 mL
powder for oral
suspension.
• Dose is 9 mg/kg/day per os
once a day (maximum
400 mg/day) in acute otitis
media, UTI and tonsilitis,
pharyngitis.
Child: 20 kg, UTI
• 20 kg x 9 mg = 180 mg (5 mL) once a day
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69. Cefiximum
Dose for adults is
200-400 mg per os a day (at
once or in two doses) for:
• respiratory tract infections
with resistent bacteria
• bronchitis, pneumonia
• UTI
• cervical/urethral
gonorrhoea
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70. Cefiximum for
children <40 kg
Cefexin 100 mg/5 mL
powder for oral suspension:
• 8 mg/kg/day at once or
divided in two doses
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Age of the child Dose
6 months to 1 year 3,75 mL a day (75 mg)
1 year to 4 years 5 mL a day (100 mg)
5 years to 10 years 10 mL a day (200 mg)

71. Cefpodoximum (Rexocef
100 mg/200 mg) per os:
Disease Dose
Sinusitis 200 mg twice a day
(every 12 hours)
Tonsillitis, pharyngitis 100 mg twice a day
Acute bronchitis,
pneumonia
100-200 mg twice a
day
Lower UTI 100 mg twice a day
Upper UTI 200 mg twice a day
Gonococcal urethritis 200 mg once
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72. Cefpodoximum for
children <40 kg:
Rexocef 40 mg/5 mL
powder for oral
suspension:
• 8 mg/kg/day twice a
day (every 12 hours)
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73. TRIMETOPRIM
SULFAMETOXAZOL
(CO-TRIMOXAZOL)
IV.
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74. For adults and
children >40 kg:
• Sinersul 400 mg +
80 mg per os
• Sinersul Forte
800 mg + 160 mg
per os
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75. Co-trimoxazol for
adults:
Two tablets 400 mg/80 mg
twice a day (every 12 hours)
• OR
One tablet 800 mg/160 mg
twice a day every 12 hours
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76. Indications:
• prevention and
treatment of
Pneumocystis jiroveci
pneumonia
• prevention and
treatment of
toxoplasmosis
• nocardiosis
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77. Indications if there is
sensitivity of bacteria on
Co-trimoxazol and
resistency on other
antibiotics:
• acute UTI
• acute otitis media
• acute exacerbation of
chronic bronchitis
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78. For children <40 kg:
• Sinersul 200 mg +
40 mg/5 mL syrup
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Age of the child Dose
6 weeks to 5
months
2,5 mL every 12
hours
6 months to 5 years 5 mL every 12
hours
6 years to 12 years 10 mL every 12
hours

79. Treatment:
Usually 5 to 7
days: 24-48
hours after
symptoms
withdrawal!
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80. Contraindications:
• hypersensitivity
• severe liver damage
• severe kidney damage
• severe haematological
disorders
• megaloblastic anemia (folic
acid deficiency)
• preterm babies and all babies
younger then 6 weeks
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82. Side effects:
• headache
• rash
• fungi overgrowth
• hypersensitivity
• ...
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83. MACROLIDE
ANTIBIOTICS
V.
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84. Azithromycinum
For adults:
• Sumamed 500 mg tbl.
• Sumamed 250 mg tbl.
For children:
• Sumamed 100 mg/5 mL
• Sumamed Forte
200 mg/5mL
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85. Indications and dose
for adults:
Upper and lower
respiratory tract
infections:
• 500 mg per os once a
day for three days
(1500 mg)
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86. Indications and dose
for adults:
Acne vulgaris:
• 500 mg per os once a
day during three
days
• 500 mg once a day
during nine weeks
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87. Indications and dose
for adults:
Erythema migrans
(Laymes disease):
• 1 g (2 x 500 mg) per os
at once, then 500 mg
per os once a day from
second to fifth day of
the treatment
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88. Indications and dose
for adults:
Erysipelas, impetigo,
pyoderma:
• 500 mg per os once
a day during three
days
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89. Indications and dose
for adults:
Chlamydia trachomatis
urethritis, cervicitis:
• 1 g once (2 x 500 mg)
per os
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90. Indications:
• Helicobacter pylori
infections
• C. trachomatis
chronic prostatitis
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91. Dose in children (powder
for oral suspension):
Body weight in
kilograms
Sumamed
100 mg/5 mL
Sumamed Forte
200 mg/5 mL
5 2,5 mL (50 mg)
6 3 mL (60 mg)
7 3,5 mL (70 mg)
8 4 mL (80 mg)
9 4,5 mL (90 mg)
10-14 5 mL (100 mg) 2,5 mL (100 mg)
15-24 5 mL (200 mg)
25-34 7,5 mL (300 mg)
35-44 10 mL (400 mg)
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Treatment duration: three days!

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93. Side effects:
• headache
• pain in stomach
• vomiting
• nausea
• lymphopenia
• eosinophilia
• diarrhoea
• ...
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94. Erythromycinum
• Eritromicin 250 mg tbl.
• For children age more then
8 years and adults:
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Mild to moderate
infections
250 mg four times a day
(1 g)
Severe infections 1 g four times a day
Bacterial endocarditis
prophylaxis
1 g one hour before the
procedure and 500 mg six
hours later
Rheumatic fever
prophylaxis
250 mg every 12 hours
Treatment duration can vary from 7 to 14 days
depending on indication.

95. Clarithromycinum
For adults and children age
more the 12 years:
• most infections of
respiratory tract 250 mg
per os every 12 hours
• if Haemophilus influenzae,
500 mg per os every 12
hours
• during 6 to 14 days
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96. Clarithromycinum
Mycobacterium avium
complex:
• 500 mg per os every
12 hours
• therapy is usually
long
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97. Clarithromycinum
• For children <40 kg:
Fromilid 125 mg/5 mL
granules
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Body weight in kg Dose
8 2,5 mL twice a day
16 5 mL twice a day
24 7,5 mL twice a day
33 10 mL twice a say

98. QUINOLONE
ANTIBIOTICS
VI.
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99. Ciprofloxacinum (for
adults)
Most infections of upper and
lower respiratory tract:
• 500-750 mg per os twice a day
(every 12 hours) during 10-14
days
Severe external ear infection:
• 750 mg per os twice a day
during 28 days up to 3 months
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100. Ciprofloxacinum (for
adults)
UTI:
• cystitis: 500 mg per os twice a
day during 3 days
• pyelonephritis: 500 mg per os
twice a day during 7 days up
to 21 days
• acute prostatitis: 500 mg
twice a day for 2-4 weeks
• chronic prostatitis: 750 mg
twice a day for 6 weeks
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101. Ciprofloxacinum (for
adults)
• Skin and soft tissues
infections: 500 mg per os
twice a day during 7-14
days.
• Bones and joints
infections: 500 mg per os
twice a day during
maximum three months.
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102. Ciprofloxacinum (for
adults)
Intraabdominal and
intestinal infections
(cholera, shigella, typhus):
• 500 mg twice a day during
3 to 14 days depending on
the bacteria
• if gram negative bacteria,
750 mg twice a day
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fluoroquinolones

105. Literature:
•Mediately.com
•HALMED
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