Chloramphenicol
Capsules, 250mg
Suspension, oral (palmitate), 125mg/5ml; 60ml.
Indications: -for the treatment of acute typhoid fever, and also typhus when tetracycline is contraindicated.
Cautions: - it should not be used for the treatment of minor and undefined infections, or as a prophylaxis. Caution in patients with hepatic function impairment, blood disorder, in neonates and infants, in pregnant women, particularly those near term or in labour, and in nursing women.
Drug interactions: phenobarbital, oral contraceptives (estrogen containing), tolbutamide, chlorpropamide, penicillines, or streptomycin.
Side effects: - nausea, vomiting diarrhoea, and bone-marrow depression may occur.
Contraindications: known hypersensitivity and/or toxic reactions to chloramphenicol.
Dose and administration: -
Note: A high initial dosage should not be given in the treatment of typhoid fever as sensitivity like reaction occurs. Reduce dose in hepatic and/or renal impairment.
Typhoid Fever - Adults: 500mg every 6 hours daily for 14 days. Children: 11-30kg, 250mg every 6 hours daily for 14 days. 6-10kg, 125mg every 8 hours daily for 14 days.
Typhus -Adult: 500mg every 6 hours for 10 days. Children: 50 - 75 mg/kg of body weight daily in divided doses every 6 hours for 10 days.
Storage: at room temperature, in a tight container.
Tetracycline
Capsules, 250mg.
Indications: -exacerbations of chronic bronchitis; brucellosis, chlamydia, mycoplasma, and rickettsia; acne vulgaris, rosacea, typhus, gonorrhea, chancroid, syphilis, and cholera.
Cautions: -caution in patients with renal function impairment.
Drug interactions: - aluminium and/or magnesium containing antacids, laxatives, calcium (e.g. milk or other dairy products, eggs) and/or iron supplements, penicillines, or streptomycin.
Side effects: -nausea, vomiting, epigastric burning and distress, flatulence and diarrhoea occur most frequently due to gastric irritation. Rarely photosensitivity, skin discoloration, blood dyscrasias may occur.
Contraindications: -pregnant or nursing women, infants and children under 8 years of age (it may also depress bone growth and cause permanent discolouration of the teeth).
Dose and Administration: -orally, given 1 hour before or 2 hours after meals and/or milk with adequate amounts of fluid.
Reduce dosage in renal and hepatic function impairment.
Adults:
Rickettsial infection (e.g. typhus) -1-2g daily in 2-4 divided doses for 7-10 days.
Gonorrhea (uncomplicated or disseminated) in penicillin allergies - 500mg every 6 hours daily for at least 7 days.
Chancroid- 1-2g daily in 2-4 divided doses for 7 days.
Syphilis (in penicillin allergies)-
Early syphilis (of not more than 2 years duration) and Late syphilis (2 years and more)--500mg every 6 hours daily for 15 days.
Cholera- 1-2g daily in 2-4 divided doses for 48 - 72 hours.
Children (8 years and over): usually, oral, 25 -50mg/ml of body weight daily in 2-4 divided doses.
Relapsing fever-
Adults: 500mg - 1g every twelve hours.
Children(8 years and over); 6.25 -12.5mg/kg of body weight every six hours.
Storage: -at room temperature, in a tight, light-resistant container.
Note: outdated and decomposed tetracycline are toxic and may cause nephrotoxicity and skin lesion.
Doxycycline
Tablet, 100mg
Capsule, 100mg
Indications: - respiratory-tract infections, including pneumonia and chronic bronchitis; urinary-tract infections; syphilis; chlamydia, mycoplasma, and rickettsia; prostatitis; lymphogranuloma venereum; pelvic inflammatory disease (with metronidazole); Lyme disease; brucellosis (with rifampicin); leptospirosis, scrub typhus and travellers' diarrhoea; psittacosis; cholera; melioidosis; plague; anthrax; Q fever; malaria.
Cautions: - hepatic function impairment.
Drug interactions: - cyclosporin, oral contraceptives, warfarin.
Side effects: - nausea, vomiting, diarrhoea, erythema, headache, visual disturbance, hepatotoxicity, pancreatitis, pseudomembrane colitis, discolouration of infants and children’s teeth, photosensitivity.
Contraindications: - pregnancy, and breast-feeding, in infants and children up to 8 years of age.
Dose and Administration -
Infections due to susceptible organisms, by mouth, ADULT and CHILD over 8 years, 200 mg on first day then 100 mg daily; in severe infections, 200 mg daily
Syphilis, by mouth, 200-300 mg daily in 1-2 divided doses
Uncomplicated genital chlamydia, non-gonococcal urethritis, by mouth, 100 mg twice daily
Louse and tick-borne relapsing fevers, by mouth, 100 mg or 200 mg as a single dose
Cholera, by mouth, ADULT 300 mg as a single dose; CHILD over 8 years, 100 mg as a single dose
PATIENT ADVICE. Capsules should be swallowed whole with plenty of fluid while sitting or standing to prevent oesophageal irritation. May be given with milk or food to counter gastric irritation
Storage: - at room temperature in a tight, light-resistant container.
Erythromycin
Tablet (stearate), 250mg, 500mg
Capsule, 250mg
Oral suspension, 125mg/5ml, 200mg/5ml, 250mg/5ml
Injection, 50mg/ml in 2ml ampoule
Indications: for treatment of conjunctivitis in newborns, genitourinary tract infection during pregnancy, pneumonia in infants, prophylaxis of bacterial endocarditis, gonorrhea, legionnaires disease, pharyngitis, sinusitis and for long term prophylaxis of rheumatic fever, syphilis.
Cautions: - pregnancy and breast-feeding, in patients with renal and hepatic function impairment, cardiac arrhythmias (prolongation of QT interval), porphyria.
Drug interactions: - alfentanil, carbamazepine, chloramphenicol, itraconazole, cyclosporins, terfenadin, warfarin, xanthines such as aminophylline, caffeine, oxtriphylline, and theophylline.
Side effects: - GIT disturbance (nausea, vomiting, diarrhoea, abdominal or stomach cramping and discomfort), reversible loss of hearing, recurrent fainting, sudden death (rare), hypersensitivity (skin rash, redness or itching), cholestatic jaundice (dark or amber urine, pale stools, stomach pains), inflammation or phlebitis at injection site (for parenteral erythromycin).
Dose and Administration: -
Adult:
Antibacterial (systemic) - oral, 250mg (base) every 6 hours, or 500mg every 12 hours if twice a day dosage is required. Maximum: - up to 4 grams (base) daily. IV infusion, 250-500mg (base) every 6 hours. Maximum - up to 4 grams.
Endocarditis (prophylaxis) - In patients with heart disease or rheumatic or other acquired valvular heart disease who undergo dental procedures or surgical procedure of the upper respiratory tract, oral, 1gm (base) one hour prior to the procedure, and 500mg 6 hours following the procedure.
Genitourinary tract infection, including chlamydial, oral, 500mg (base) every six hours for at least seven days. For patients unable to tolerate the higher dosage regimen, the dosage may be halved and given for at least fourteen days.
Legionnaires’ disease - oral, 500mg (base) to 1gm(base) every six hours.
Streptococcal (prophylaxis) - continuous prophylaxis of streptococcal infections in patients with a history of rheumatic heart disease - oral, 250mg (base) every twelve hours.
Child:
Antibacterial (systemic) - oral, 7.5to 12.5 (base) per kg of body weight every 6 hours, or 17 to 25mg per kg of body weight every 12 severe infection, 15 to 25mg (base) per kg of body weight every six hours.
Antibacterial (systemic) - IV infusion, 3.75 to 5mg (base) per kg of body weight every 6 hours.
Conjunctivitis, chlamydial - oral, 12.5mg (base) per kg of body weight every 6 hours for at least two week.
Endocarditis prophylaxis - in patients with heart disease are rheumatic or other acquired valvular heart disease who undergo dental procedures or surgical procedures of the upper respiratory tract - oral, 20mg (base) per kg of body weight one hour prior to the procedure, and 10mg per kg of body weight six hours following the procedure.
Pertusis - oral, 10 to 12.5mg (base) per kg of body weight every 6 hours for 14 days.
Pneumonia, chlamydial - oral, 12.5mg (base) per kg of body weight every 6 hours for two weeks.
Streptococcal pharyngitis - oral, 5-12.5mg (base) per kg of body weight every 6 hours for at least 10 days.
Storage: - at room temperature in tight container.
Gentamicin
Injection, 240mg/ml 2ml ampoule
Indications: -biliary tract infection, bone and joint infection, meningitis, ventriculitis, urinary tract infection including peritonitis, bacterial septicemia.
Cautions: -pregnancy and breast-feeding, in premature infants and neonates, elderly, patients with renal function impairment or dehydration, and in those with eighth-cranial nerve impairment. Prolonged use should be avoided.
Drug interactions: -avoid concurrent and/or sequential use of two or more aminoglycosides or aminoglycosides with capreomycin, antimysthenic, methoxyflurane or polymyxin, cephalosporins, ciclosporin, cisplatin, neostigmine, pyridostigmine, suxamethonium, vecuronium, furosemide, penicillines and indomethacin.
Side effects: - nephrotoxicity (greatly increased or decreased frequency of urination or amount of urine; increased thirst, loss of appetite, nausea or vomiting); neurotoxicity (muscle twitching, numbness, seizures, tingling); ototoxicity, auditory damage (loss of hearing, ringing or buzzing a feeling of fullness in the ears), vestibular damage (clumsiness, dizziness, nausea, vomiting, unsteadiness)
Contraindications: - pregnancy, myasthenia gravis, previous allergic reaction to one aminoglycoside.
Dosage and Administration: -
Adult: -
Antibacterial (systemic) - IM or IV infusion, 1-1.7mg (base) per kg of body weight every eight hours for seven to ten days or more.
Urinary tract infection (bacterial, uncomplicated) - IM or IV infusion -Adults (< 60kg body weight) - 3mg (base) per kg of body weight once a day, or 1.5mg per kg of body weight every 12 hours. Adults (>=60kg of body weight)- 160mg (base) once a day, or 80mg every 12 hours.
Usual adult prescribing limit - up to 8mg (base) per kg of body weight daily in severe, life threatening infections.
Child: -
Antibacterial (systemic) - IM or IV infusion - premature or full term neonates up to 1 week of age: 2.5mg (base) per kg of body weight every 12 or 24 hours for seven to ten days or more.
Older neonates and infants - 2.5mg (base) per kg of body weight every 8 to 16 hours for 7-10 days or more.
Children - 2 to 2.5mg (base) per kg of body weight every 8 hours for 7-10 days or more.
Storage: - at room temperature and protect from freezing.
Metronidazole
Tablet, 250mg
Intravenous infusion, 5mg/ml in 100ml
Indications: - treatment of anaerobic infection, bone and joint infection, meningitis, bacterial endocarditis, prophylaxis of perioperative infection during colorectal surgery, lower respiratory tract infection including pneumonia, emphysema and lung abscess, bacterial septicemia, skin and soft tissue infection, inflammatory bowel disease, antibiotic associated colitis, Helicobacter pylori associated duodenal ulcer; see also section 7.4.2.
Cautions: - disulfiram like reaction with alcohol; hepatic impairment and hepatic encephalopathy, pregnancy; breastfeeding; clinical and laboratory monitoring in courses lasting longer than 10 days; see also interactions.
Note: - Avoid Alcohol. The drug may cause dizziness.
Drug interactions: - phenytoin, cumarine or indandion derivative anticoagulant, warfarin, disulfiram, alcohol, cimetidine, fluorouracil, lithium, phenobarbitone.
Side effects: - nausea, vomiting, unpleasant metallic test, furred tongue and gastrointestinal disturbances; rarely headache, drowsiness, dizziness, ataxia, darkening of urine, erythema multiform, pruritus, urticaria, angioedema, and anaphylaxis; abnormal liver function tests, hepatitis, jaundice, thrombocytopenia, aplastic anaemia, myalgia, arthralgia, peripheral neuropathy, epileptiform seizures, leuxopenia, on prolonged or high dosage regimens
Contraindications: -chronic alcohol dependence
Dose and Administration-
Adult: -
Antibacterial (systemic), anaerobic infections, oral, 7.5mg (base) per kg of body weight up to a maximum of 1 gm, every 6 hours for 7 days or longer; IV-infusion, 15mg (base) per kg of body weight initially, then 7.5mg per kg of body weight up to a maximum of 1gm, every six hours for seven days or longer;
Inflammatory bowel disease - oral, 500mg (base) four times a day.
Antibiotic associated colitis - oral, 500mg (base) three or four times a day.
Helicobacter - pylori associated gastritis or duodenal ulcer, oral, 500mg (base) three times a day with amoxicilline for one to two weeks.
Perioperative infections, colonic (prophylaxis): - IV infusion, 15mg (base) per kg of body weight one hour prior to start of surgery and 7.5mg per kg of body weight six and twelve hours after the initial dose.
Child:-
Anaerobic infection - oral, 7.5mg (base) per kg of body weight every 6 hours, or 10mg per kg of body weight every 8 hours.
Anaerobic infection - for preterm infants - IV infusion, 15mg per kg of body weight (base) as an initial dose, then 7.5mg per kg of body weight every 12 hours starting 48 hours after the initial dose. Term infants, IV infusion, 15mg (base) per kg of body weight as an initial dose, then 7.5mg per kg of body weight every 12 hours starting 24 hours after the initial dose. Infants greater than 7 days of age and children - IV infusion, 15mg (base) per kg of body weight as an initial dose, then 7.5 mg per kg of body weight every 6 hours.
Storage - at room temperature, in a well closed, light resistant container. Protect from freezing
Nitrofurantoin
Tablet, 50mg, 100mg
Capsule (macrocrystal), 50mg, 100mg
Oral suspension, 0.5%
Indications: -prophylaxis and treatment of urinary tract infection.
Cautions: - hypersensitive to nitrofurantioin, diabetes mellitus, electrolyte imbalance, vitamin B and folate deficiency, pulmonary disease, hepatic impairment, peripheral neuropathy.
Drug interactions: - hemolytic, neurotoxic medication, probenecid, sulfinpyrazone.
Side effects: - pneumonitis (chills, chest pain, cough, fever, troubled breathing, abdominal or stomach pain or upset, diarrhoea, loss of appetite, nausea, vomiting), hematology reactions, specifically granulocytopenia (sore throat and fever) or megaloblastic anemia (unusual tiredness or weakness), neurotoxicity (dizziness, drowsiness, headache, unusual tiredness or weakness), polyneuropathy (numbness or tingling, or burning of face or mouth, unusual muscle weakness, haemolytic anaemia (pale skin, unusual tiredness or weakness), hepatitis (yellow eyes or skin), hypersensitivities (skin rash, itching, arthralgia, fever, chills), rust yellow to brown discoloration of urine.
Contraindications: - pregnancy, in infants up to 1 month of age, during breastfeeding. And also in patients with renal function impairment, glucose 6 phosphate dehydrogenase (G6PD) deficiency, and in those with porphyria.
Dose and Administration -
Adult: - Oral, 50 to 100mg every 6 hours. Maximum up to 600mg daily, or up to 10mg per kg of body weight daily.
Note: - Prophylaxis - oral, 50 to 100mg once a day at bedtime.
Child: - infants and children 1 month of age and over, Oral, 0.75 to 1.75mg per kg of body weight every 6 hours.
Note: - Prophylaxis - oral, 1mg per kg of body weight once a day at bedtime. Continue medicine for full time of treatment.
Storage - at room temperature in a tight, light resistant container.
Sulphamethoxazole + Trimethoprim
Tablet (pediatric), 100mg + 20mg; (adult), 400mg + 80mg, 800mg+160mg
Mixture, 200mg + 40mg in each 5ml
Injection, 400mg + 80mg in each 5ml ampoule
Indications: - acute exacerbation of chronic bronchitis, otitis media (children), primary agent for pneumocystis carinii pneumonia (PCP) in immunocompromised patients including AIDS patients, urinary tract infection, biliary tract infection, bone and joint infection, chancroid, gonorrhea, meningitis, bacterial septicemia, skin and soft tissue infection.
Note: - It is not indicated for prophylaxis or prolonged therapy for otitis media.
Cautions: - elderly, renal and hepatic function impairment, photosensitivity, Glucose-6-phosphate dehydrogenase (G6PD) deficiency. During treatment maintain adequate fluid intake.
Drug interactions: - cumarin or indandione derivative anticoagulant, hydantoin, oral hypoglycemics, hemolytics, hepatotoxic medication, methenamine, methotrexate, folate antagonists.
Contraindications: - pregnancy, renal and hepatic function failure, jaundice, blood disorders, megaloblastic anemia, porphyria. Breast-feeding, infants up to two months of age, in patients who are allergy to sulfonamide, furosemide, thiazide diuretics, sulfonylureas, carbonic anhydrase inhibitors or trimethoprim.
Side effects: - hypersensitivity (fever, itching, skin rash), photosensitivity (increased sensitivity of skin to sunlight), blood disorder (sore throat, fever, pale skin), unusual bleeding or bruising, unusual tiredness or weakness), hepatitis (yellow eyes or skin), Steven’s Johnson syndrome, aching joints and muscles, redness, blistering, peeling, or loosening of the skin, unusual tiredness or weakness, toxic epidermal necrosis (difficulty in swallowing, redness, blistering, peeling, loosening of the skin), dizziness, headache, GIT disturbance, loss of appetite, nausea or vomiting).
Dose and Administration: -
Usual Adult and Adolescent dose:
- Antibacterial (systemic)
- Oral, 160mg of trimethoprim and 800mg of sulphamethoxazole every 12 hours.
- IV infusion 2-2.5mg of trimethoprim and 10-12.5mg sulphamethoxazole per kg of body weight every six hours; 2.7 to 3.3mg of trimethoprim and 13.3-16.7mg sulphamethoxazole per kg of body weight every 8 hours, or 4-5mg of trimethoprim and 20-25mg of sulphamethoxazole per kg of body weight every 12 hours.
Pneumocystis carinii pneumonia
Treatment - oral, 3.75 - 5mg of trimethoprim and 18.75-25mg sulphamethoxazole per kg of body weight every 6 hours.
Prophylaxis - oral, 160mg of trimethoprim and 800mg of sulphamethoxazole once daily.
- IV infusion - pneumocystis carinii pneumonia - IV infusion 3.75-5mg of Trimethoprim and 18.75-25mg sulphamethoxazole per kg of body weight every 6 hours or 5.0-6.7mg of Trimethoprim and 25-33.3mg sulphamethoxazole per kg of body weight every 8 hours.
Usual child dose -
Antibacterial (systemic)
Infants 2months of age and over up to 40kg of body weight - oral, 4-6mg trimethoprim and 20-30mg sulphamethoxazole per kg of body weight every 12 hours.
Pneumocystis Carinii pneumonia
Treatment - oral, 3.75 - 5mg of trimethoprim and 18.75-25mg sulphamethoxazole per kg of body weight every 6 hours.
Prophylaxis - children 2 months of age and over: oral, 75mg trimethoprim and 375 of sulphamethoxazole per meter square two times a day, 3 times a week on consecutive days (e.g. Monday, Tuesday, Wednesday). IV - infusion for pneumocystis carinii pneumonia is same as adult’s.
Note: - For oral, continue medicine for full time of treatment, avoid too much sun or use of sun lamp. Avoid IM administration.
Storage: -at room temperature, in a tight, light-resistant container, protect from freezing.
Quinolones
Nalidixic acid and Norfloxacin are effective in uncomplicated urinary - tract infections and, in the treatment of shigella in areas where it remains susceptible.
Ciprofloxacin is active against both Gram-Positive and Gram-Negative bacteria..
Cautions - Quinolones should be used with caution in patients with a history of epilepsy or conditions predisposing to seizures; convulsions may be induced in patients with or without a history of convulsions; also, use with caution in G6PD deficiency, pregnancy or breast feeding; use in children or adolescents is generally not recommended (quinolones cause arthropathy in weight - bearing joints in young animals), although in some specific circumstances, shorter use may be justified. Exposure to sunlight should be avoided (discontinue if photosensitivity occurs).
Side effects - Adverse effects of quinolones include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, and rarely antibiotic associated colitis; headache, dizziness, sleep disorders, rash (rarely stevens - Johnson Syndrom and toxic epidermal necrolysis), and pruritus; less commonly, anorexia, transient disturbances in liver enzymes and bilirubin and increases in blood urea and creatinine; drowsiness, restlessness, depression, confusion, hallucinations, convulsions, paraesthesia; photosensitivity; hypersensitivity reactions including fever, urticaria, angioedema, arthralgia, myalgia, and anaphylaxis, blood disorders, disturbances in vision, taste, hearing, and smell; isolated reports of tendon inflammation and damage; if psychiatric, neurological, or hypersensitivity reactions occur -discontinue the drug.
Drug interactions - Quinolones may interact with the various compounds including analgesics, anticoagulants, ciclosporin (increased risk of nephrotoxicity) and theophylline.
Nalidixic acid
Tablet, 500 mg
Oral susepnsion300 mg/vial
Indications: - urinary - tract infections
Cautions: - see notes above: avoid in porphyria; liver disease; renal impairment; false positive urinary glucose (if tested for reducing substances); monitor blood counts, renal and liver function if treatment exceeds 2 weeks.
Drug interactions: see notes above
Side effects: see notes above; also reported toxic psychosis, weakness, increased intracranial pressure, cranial nerve palsy, and metabolic acidosis.
Dose and Administration
1g every 6 hours for 7 days reduced in chronic infections to 500 mg every 6 hours; Child over 3 months max. 50 mg/kg daily in divided doses; reduced in prolonged therapy to 30 mg/kg daily.
Storage: - at room temperature (up to 25°C) in a tight container. Protect from freezing.
