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Antibiotics in primary care setting
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.
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Antibiotics in primary care setting
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- 3. Doxycyclinum 100 mg capsules forchildren older then 12 years and adults 8/19/2017 Antibiotics 3
- 4. Indications: • acute exacerbationof chronic bronchitis and sinusitis • urinary tract infections (UTI) caused with E. coli, Klebsiella spp., Enterobacter spp., Streptoccocus faecalis 8/19/2017 Antibiotics 4
- 5. Indications: Sexually transmitted diseases (STD): •urethritis caused with Chlamydia trachomatis, Ureaplasma urealyticum • simple gonococcal infections • prostatitis • syphilis • lymphogranuloma venereum 8/19/2017 Antibiotics 5
- 6. Indications: • inclusion (chlamydial) conjunctivitis,trachoma • psittacosis • acne, acne rosacea • anthrax • actinomycosis • boreliosis (Laymes disease) 8/19/2017 Antibiotics 6
- 7. Indications: • rickettsiosis • shigellosis •cholera • amebiasis • tularemia • melidiosis • brucellosis • nocardiosis • leptospirosis • Wipple´s disease • tropical sprue 8/19/2017 Antibiotics 7
- 8. Dose • First dayof 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. 8/19/2017 Antibiotics 8
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- 10. Contraindications: • hypersensitivity Children underthe age of 12 years: • permanent teeth discoloration • bone development disorders • tooth enamel hypoplasia 8/19/2017 Antibiotics 10 OralAnswers.com
- 11. Precautions: • liver damage •kidney damage • severe skin reactions • photosensitivity • Clostridium difficile diarrhoea • esophagitis 8/19/2017 Antibiotics 11
- 12. Precautions: • benign intracranial hypertension •porphyria • Myasthenia gravis • systemic erythematous lupus • lactosis intolerance 8/19/2017 Antibiotics 12
- 13. Interactions: Warfarin! Increases the risk ofbleeding. 8/19/2017 Antibiotics 13
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- 15. Side effects: • anemia, thrombocytopenia, neutropenia... •headaches, benign intracranial hypertension • tinnitus • gastrointenstinal problems 8/19/2017 Antibiotics 15
- 16. Side effects: • ureablood levels elevation • hypersensitivity reactions • liver and kidney damage rarely 8/19/2017 Antibiotics 16
- 17. BETA LACTAM ANTIBIOTICS II. 8/19/2017Antibiotics 17
- 18. EXTENDED SPECTRUM BETA LACTAMANTIBIOTICS A) 8/19/2017 Antibiotics 18
- 19. Amoxicillinum • Almacin a500 mg • Amoksicilin a 1000 mg • ... 8/19/2017 Antibiotics 19
- 20. Indications: • otitis media •acute exacerbation of chronic bronchitis • bronchopneumonia • cystitis • urethritis • pyelonephritis 8/19/2017 Antibiotics 20
- 21. Indications: • bacteriuria inpregnancy • puerperal sepsis • gonorrhoea • skin and soft tissues infections • bacterial endocarditis • abdominal tifus • Helycobacter pylori 8/19/2017 Antibiotics 21
- 22. Dose: Adults: • 250 mgper 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 8/19/2017 Antibiotics 22
- 23. Precautions: • hypersensitivity • kidneydamage • neonatal period • lactosis intolerance 8/19/2017 Antibiotics 23
- 24. Interactions: Warfarin! Increases the risk ofbleeding. 8/19/2017 Antibiotics 24
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- 26. Common side effects: • nausea •vomiting • urticaria • pruritus 8/19/2017 Antibiotics 26
- 27. Amoxicillinum For children withbody 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 8/19/2017 Antibiotics 27
- 28. Example • Child: 30kg, 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 8/19/2017 Antibiotics 28
- 29. PENICILLIN SENSITIVE ON BETALACTAMASE B) 8/19/2017 Antibiotics 29
- 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. 8/19/2017 Antibiotics 30
- 31. PENICILLIN RESISTENT ON BETALACTAMASE C) 8/19/2017 Antibiotics 31
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- 33. COMBINATIONS WITH BETA LACTAMASEINHIBITORS D) 8/19/2017 Antibiotics 33
- 34. Combinations amoxicillinum and acidum clavulanicum (co-amoxiclav) piperacillinumand tazobactamum (for parenteral application) 8/19/2017 Antibiotics 34
- 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 8/19/2017 Antibiotics 35
- 36. Indications: • acute bacterialsinusitis • acute otitis media • acute exacerbations of chronic bronchitis • community acquired pneumonia • cystitis • pyelonephritis 8/19/2017 Antibiotics 36
- 37. Indications: • skin andsoft tissues infections, cellulitis • tooth abscess with cellulitis • bones and joints infections • osteomyelitis 8/19/2017 Antibiotics 37
- 38. Dose for adults: •500 mg/125 mg per os three times a day OR • 875 mg/125 mg per os twice a day 8/19/2017 Antibiotics 38
- 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 8/19/2017 Antibiotics 39
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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 8/19/2017 Antibiotics 43 The best activity on GRAM POSITIVE BACTERIA!
- 44. Dose for adults 500mg twice a day (every 12 hours) 8/19/2017 Antibiotics 44
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- 46. Precautions: • pseudomembranous colitis • kidneydamage • false positive direct Coomb´s test 8/19/2017 Antibiotics 46
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- 48. Side effects: • headache •agitation • halucinations • pseudomembranous colitis • pain in abdomen • anal pruritus • interstitial nephritis 8/19/2017 Antibiotics 48
- 49. Cefalexinum for children: • 250mg/5 mL powder for oral suspension • Dose is 25-50 mg/kg/day up to maximum 100 mg/kg/day. 8/19/2017 Antibiotics 49 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 otitismedia: • 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 8/19/2017 Antibiotics 50
- 51. SECOND GENERATION: ACTIVITY ONBOTH POSITIVE AND NEGATIVE GRAM BACTERIA B) 8/19/2017 Antibiotics 51
- 52. Cefuroximum • acute streptococcal tonsillitisand pharyngitis • acute bacterial sinusitis • acute otitis media • acute exacerbations of chronic bronchitis • cystitis • pyelonephritis 8/19/2017 Antibiotics 52
- 53. Cefuroximum • simple skinand soft tissues infections • Laymes disease early stage 8/19/2017 Antibiotics 53
- 54. Dose (adults andchildren >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 8/19/2017 Antibiotics 54
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- 56. Precautions • hypersensitivity • Jarisch-Herxheimer´s reaction •Candida albicans growth • pseudomembranous colitis 8/19/2017 Antibiotics 56
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- 58. Side effects: • Candidaalbicans growth • eosinophilia • headache • dizziness • liver enzimes elevation 8/19/2017 Antibiotics 58
- 59. Cefuroximum for children: Zinnat 125 mg/5mL granules for oral suspension 8/19/2017 Antibiotics 59
- 60. Cefuroximum for children (<40kg) 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 8/19/2017 Antibiotics 60
- 61. THIRD GENERATION: ACTIVITY MOREON GRAM NEGATIVE BACTERIA C) 8/19/2017 Antibiotics 61
- 62. Ceftibutenum • pharyngitis, tonsilitis •scarlatina (adults, children) • acute sinusitis (adults) • otitis media (children) • acute exacerbation of chronic bronchitis • community-acquired pneumonia 8/19/2017 Antibiotics 62
- 63. Ceftibutenum • complicated and simpleUTI in adults and children 8/19/2017 Antibiotics 63
- 64. Dose (adults, children >40kg) • 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). 8/19/2017 Antibiotics 64
- 65. Precautions: • hypersensitivity • kidneydamage • chronic gastrointestinal diseases (chronic colitis) • pseudomembranous colitis 8/19/2017 Antibiotics 65
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- 67. Side effects: • vomiting •diarrhea • headache • ... 8/19/2017 Antibiotics 67
- 68. Ceftibutenum for children: • Cedax180 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 8/19/2017 Antibiotics 68
- 69. Cefiximum Dose for adultsis 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 8/19/2017 Antibiotics 69
- 70. Cefiximum for children <40kg Cefexin 100 mg/5 mL powder for oral suspension: • 8 mg/kg/day at once or divided in two doses 8/19/2017 Antibiotics 70 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/200mg) 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 8/19/2017 Antibiotics 71
- 72. Cefpodoximum for children <40kg: Rexocef 40 mg/5 mL powder for oral suspension: • 8 mg/kg/day twice a day (every 12 hours) 8/19/2017 Antibiotics 72
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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 8/19/2017 Antibiotics 74
- 75. Co-trimoxazol for adults: Two tablets400 mg/80 mg twice a day (every 12 hours) • OR One tablet 800 mg/160 mg twice a day every 12 hours 8/19/2017 Antibiotics 75
- 76. Indications: • prevention and treatmentof Pneumocystis jiroveci pneumonia • prevention and treatment of toxoplasmosis • nocardiosis 8/19/2017 Antibiotics 76
- 77. Indications if thereis sensitivity of bacteria on Co-trimoxazol and resistency on other antibiotics: • acute UTI • acute otitis media • acute exacerbation of chronic bronchitis 8/19/2017 Antibiotics 77
- 78. For children <40kg: • Sinersul 200 mg + 40 mg/5 mL syrup 8/19/2017 Antibiotics 78 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 to7 days: 24-48 hours after symptoms withdrawal! 8/19/2017 Antibiotics 79
- 80. Contraindications: • hypersensitivity • severeliver damage • severe kidney damage • severe haematological disorders • megaloblastic anemia (folic acid deficiency) • preterm babies and all babies younger then 6 weeks 8/19/2017 Antibiotics 80
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- 82. Side effects: • headache •rash • fungi overgrowth • hypersensitivity • ... 8/19/2017 Antibiotics 82
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- 84. Azithromycinum For adults: • Sumamed500 mg tbl. • Sumamed 250 mg tbl. For children: • Sumamed 100 mg/5 mL • Sumamed Forte 200 mg/5mL 8/19/2017 Antibiotics 84
- 85. Indications and dose foradults: Upper and lower respiratory tract infections: • 500 mg per os once a day for three days (1500 mg) 8/19/2017 Antibiotics 85
- 86. Indications and dose foradults: Acne vulgaris: • 500 mg per os once a day during three days • 500 mg once a day during nine weeks 8/19/2017 Antibiotics 86
- 87. Indications and dose foradults: 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 8/19/2017 Antibiotics 87
- 88. Indications and dose foradults: Erysipelas, impetigo, pyoderma: • 500 mg per os once a day during three days 8/19/2017 Antibiotics 88
- 89. Indications and dose foradults: Chlamydia trachomatis urethritis, cervicitis: • 1 g once (2 x 500 mg) per os 8/19/2017 Antibiotics 89
- 90. Indications: • Helicobacter pylori infections •C. trachomatis chronic prostatitis 8/19/2017 Antibiotics 90
- 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) 8/19/2017 Antibiotics 91 Treatment duration: three days!
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- 93. Side effects: • headache •pain in stomach • vomiting • nausea • lymphopenia • eosinophilia • diarrhoea • ... 8/19/2017 Antibiotics 93
- 94. Erythromycinum • Eritromicin 250mg tbl. • For children age more then 8 years and adults: 8/19/2017 Antibiotics 94 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 andchildren 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 8/19/2017 Antibiotics 95
- 96. Clarithromycinum Mycobacterium avium complex: • 500mg per os every 12 hours • therapy is usually long 8/19/2017 Antibiotics 96
- 97. Clarithromycinum • For children<40 kg: Fromilid 125 mg/5 mL granules 8/19/2017 Antibiotics 97 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
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- 99. Ciprofloxacinum (for adults) Most infectionsof 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 8/19/2017 Antibiotics 99
- 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 8/19/2017 Antibiotics 100
- 101. Ciprofloxacinum (for adults) • Skinand 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. 8/19/2017 Antibiotics 101
- 102. Ciprofloxacinum (for adults) Intraabdominal and intestinalinfections (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 8/19/2017 Antibiotics 102
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