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Microsoft word - 06 antibiotics final.doc

BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines ANTIBIOTICS
6.01 AMINOGLYCOSIDES

GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Gentamicin Inj 80mg/2ml
(as sulphate)
Gentamicin Sulphate
Impregnated Collagen Fleece
(containing 467mg collagen,
58mg gentamicin sulphate
corresponding to 35mg
gentamicin, 175mg gentamicin
crobefate corresponding to
35mg gentamicin)
5 x 8 cm (Septocoll)


COMMENT/CAUTIONS:
• S/E: Dose-related, ototoxicity and nephrotoxicity; avoid concurrent use with
potential y ototoxic diuretics e.g. frusemide, cephalosporins and amphotericin. • If plasma level monitoring is available: first assay 24 hrs after starting, twice weekly, peak levels taken 1 hour after dosing (range 5-12mg/L), trough levels taken just before the next dose (range < 2mg/L). BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines 6.02 CEPHALOSPORINS

GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Cefaclor Tab 250mg & 500mg
(Distaclor)
Cefalexin Monohydrate Cap
250mg& 500mg; Suspension
child 25-50mg/kg/DAY (max
125mg/5ml & 250mg/5ml
(Ceporex) [Cephalexin]

Cefazolin Injection 1g vial
(Ancef/Kefzol)
Ceftazidime Inj 1g vial (Fortum)
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Ceftriaxone Sodium Inj 1g vial
(IM/IV) (Rocephin)
between 2-4 sites). Infant/child < 12 Cefuroxime Sodium Inj 750mg
MSL IM, slow IV or IV infusion, 750mg q6- (Zinacef)

COMMENT/CAUTIONS:
• 10% of patients with hypersensitivity to penicil in wil also be al ergic to BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines 6.03 CHLORAMPHENICOLS
GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
*Chloramphenicol Cap 250mg
in severe infections; infants < 2 wks COMMENT/CAUTIONS:
• Chloramphenicol is a potent, potential y toxic, broad-spectrum antibiotic,
monitor closely for side effects: may cause marrow depression (rarely idiosyncratic marrow aplasia that may be fatal, and dose related suppression reversible on stopping). Monitor blood counts regularly. 6.04 MACROLIDES
GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
*Clarithromycin Tab 250mg
(Klacid)
Erythromycin Stearate
Suspension 125mg/5ml
Erythromycin Ethyl Succinate
MSL 400mg q6h; max 4g/DAY given in Tab 400mg (EES)
Erythromycin Stearate Tab
MSL 250-500mg q 6 hourly; max 4g/DAY 250mg & 500mg

COMMENT/CAUTIONS:
• Clarithromycin Indications: Please use for the treatment of complicated
infection especial y respiratory tract infection, unresponsive to standard macrolides or in patients intolerant or al ergic to standard macrolides. • Macrolides S/E: nausea/vomiting, diarrhoea, and arrhythmias, avoid
concomitant use with astemizole, terfenadine, cisapride, disopyramide, amiodarone & other arrhythmogenic drugs. • Drug interactions: Macrolides are P450 enzyme inhibitors and may increase
levels of anticoagulants, antiepileptics, antipsychotics, anxiolytics/hypnotics, BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines 6.05 PENICILLINS

GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Amoxicillin 1g/ Clavulanate
200mg Inj
(Augmentin 1.2g)
[Co-Amoxiclav]
Amoxicillin 500mg/ Clavulanate
K 125mg Tab [Co-Amoxiclav]
(Augmentin 625mg)
Amoxicillin 250mg/ Clavulanate
K 125mg Tab [Co-Amoxiclav]
(Augmentin 375mg)
Amoxicillin 200mg/ Clavulanate
K 28mg Syrup [Co-Amoxiclav]
(Augmentin 228mg/5ml)
Amoxicillin Cap 250mg &
500mg, Suspension 125mg/5ml
(Amoxyl)
Cloxacillin Sodium Cap 500mg
& Suspension 125mg/5ml
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Cloxacillin Sodium Inj 500mg
[Na content: ~2mmol/g]
Penicillin G / Benzylpenicillin Inj MSL IM, slow IV or IV infusion, adult 0.3g
600mg [1 mega units/MU]
(Crystapen)
*Penicillin V /
Phenoxymethylpenicillin Tab
250mg & Suspension
125mg/5ml

COMMENT/CAUTIONS:
• Phenoxymethylpenicillin is poorly absorbed oral y; take on an empty
stomach. Large doses esp. benzylpenicillin may cause electrolyte
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines 6.06 QUINOLONES

GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Ciprofloxacin (as HCl) Tab
MSL Adult, 500-750mg q 12 hourly. 250mg & 500mg (Ciprobay)

COMMENT/CAUTIONS:
• Quinolones: Equivalent plasma concentrations when given oral y or IV, so
use oral route as soon as possible. Cautious use in pregnancy, children
and epilepsy. May cause tendon damage: at the first sign of unexplained pain or inflammation, advise patient to discontinue treatment and rest the affected limb until tendon symptoms have resolved. 6.07 SULPHONAMIDES

GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
*Trimethoprim 40mg +
Sulfamethoxazole 200mg /5ml
Susp [Co-trimoxazole]
(Bactrim 240mg/5ml)
*Trimethoprim 160mg +
MSL 960mg q12h, double dose in severe Sulfamethoxazole 800mg Tab
[Co-trimoxazole] (Bactrim
> 14 days. High dose for P. carini 960/tab)

COMMENT/CAUTIONS:
• Trimethoprim – Avoid in the first trimester of pregnancy.
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines 6.08 TETRACYCLINES

GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
*Doxycycline Cap 100mg
MSL Take with plenty of fluid, general (Vibramycin)
Malaria prophylaxis, adult & child >
COMMENT/CAUTIONS:
• Doxycycline Drug Interaction: Antacids and iron and zinc salts may reduce
• S/E: deposited in growing bone/teeth, may cause staining and occasional y
dental hypoplasia, do not give to children under 12 years or to pregnant/breast-feeding women. May cause photosensitivity - avoid skin exposure to direct sunlight or sun lamps. 6.09 OTHER ANTIBACTERIALS

GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
*Clindamycin HCl Hydrate Cap
300mg (Dalacin C)
30mg/kg/DAY given q6-8h.
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
*Metronidazole Inj 500mg/100ml
(Flagyl)
*Metronidazole Tab 200mg or
MSL Anaerobic, 400-500mg q8h; child 250mg & Suspension
200mg/5ml or 125mg/5ml
(Flagyl)
*Metronidazole Suppository
MSL Insert 1g suppository rectal y every 8 500mg & 1g (Flagyl)
*Rifampicin Cap 300mg
*Trimethoprim Tab 100mg
*Vancomycin (as HCl) Inj 1g
Specified indication only
(see Comment).
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines COMMENT/CAUTIONS:
• Clindamycin S/E: Discontinue immediately if diarrhoea develops.
• Metronidazole S/E: avoid alcohol, may cause a disulfiram-like reaction
(flushing, palpitations etc). Others: unpleasant taste, furred tongue, dizziness, headache, ataxia, dark urine, leucopoenia, rarely peripheral neuropathy. • Rifampicin Drug Interactions: potent hepatic enzyme inducer, may reduce
levels of other drugs, e.g. estrogens, corticosteroids, phenytoin, • Rifampicin S/E: transient increase in liver enzymes level (seek urgent
medical advice if nausea/vomiting or jaundice; monitor liver function); red discoloration – urine/sputum/tears/soft contact lenses. • Vancomycin indications: 1) Confirmed MRSA infection; 2) MRSA
prophylaxis in ICU; 3) septicaemia in IV drug users; 4) bone infections (haematogenous, adult/child/prosthetic joint); 5) gastroenteritis with clostridium difficile toxin & positive antibiotic associated colitis. • Vancomycin is not absorbed oral y, oral route is only for treating
• Vancomycin S/E: Monitor renal & auditory function in patients prescribed
concurrent drugs that are neurotoxic and/or nephrotoxic e.g. aminoglycosides, amphotericin B and frusemide. • Vancomycin Injection: Avoid rapid IV infusions, may lead to anaphylactoid
reactions. If plasma level monitoring is available: target peak level (1 hr after end of an infusion) 29-45mg/l, trough level (just before next dose) 5-10mg/l. 6.10 ANTIFUNGALS

GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
*Amphotericin B (as sodium
deoxycholate complex) Inj
50mg (Fungizone)
°Fridge Item
Clotrimazole Vaginal Tab
500mg (Canesten)
Griseofulvin Tab 500mg (Grivin)
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Itraconazole Cap 100mg
(Sporanox)
*Ketoconazole Tab 200mg
(Nizoral)
Nystatin Suspension 100,000
units/ml (Mycostatin)

COMMENT/CAUTIONS:
• Amphotericin lipid complex (Abelcet), liposomal (Ambisone) and col oidal
(Amphotec/Amphocil) formulations have different drug profiles compared to conventional Amphothericin B (Fungizone). Consult individual product • Amphotericin is toxic when given parenteral y. Reconstitute each 50mg vial
with 10ml WFI to produce a 5mg/ml solution, then dilute further in 490ml of D5 to a 100ug/ml (1mg/10ml) solution (pH of glucose must not be below 4.2); give initial test dose of 1mg in 10mls over 20-30 min, observe patient, if no adverse reaction after 30min infuse dose as required over 2-4 hours, protect from light, incompatible with saline solutions. Side effects include fever, chil s, hypotension, nausea, nephrotoxicity and thrombophlebitis. Monitor for hypokalaemia and weekly blood counts are advisable. Systemic corticosteroids may be needed. Avoid giving other nephrotoxic drugs • DRUG-INDUCED CANDIDIASIS: oral thrush and other stomatitis are sometimes induced by broad-spectrum antibiotics & cytotoxics (withdraw if possible) or inhaled corticosteroids (reduce by using spacer device, or rinsing/wiping mouth with water after inhalation). • Ketoconazole has been associated with fatal hepatotoxicity, monitor liver
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines 6.11 ANTIMALARIALS
[Note: Please refer to current local and national guidelines for drug and regimen of choice for malaria prophylaxis and treatment, advise on importance of GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Artemether 20mg +
NF Treatment, with food: adult & child > Lumefantrine 120mg Tab
[Co-Artemether]
Atovaqone 250mg + Proguanil
Treatment: Adult & child > 40 kg, 4 100mg Tab (Malarone)
NOTE: Limited stocks on board,
please prescribe for treatment
*Chloroquine Tab base 150mg
vivax, ovale & malariae) with [250mg phosphate salt = 150mg
Prophylaxis: adult & child > 13 yo (> BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines [Note: Please refer to current local and national guidelines for drug and regimen of choice for malaria prophylaxis and treatment, advise on importance of GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
*Chloroquine Suspension
10mg/ml (base)
*Doxycycline Cap 100mg
MSL Treatment of malignant malaria (P. (Vibramycin)
falciparum), with quinine, adult only, *Mefloquine Tab 250mg
(Lariam)
malignant malaria (P. falciparum), Prophylaxis: adult or > 13 yo (> 45 *Proguanil Tab 100mg
or > 13 yo (> 45 kg), 200mg (2 tabs) Quinine Sulphate Tab 300mg
Treatment of malignant malaria (P. falciparum), dose as salt, adult
[300mg salt = 250mg base]
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines [Note: Please refer to current local and national guidelines for drug and regimen of choice for malaria prophylaxis and treatment, advise on importance of
GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Quinine DiHCl Inj 600mg/2ml
seriously il patient (P. falciparum), dose as salt, adult, IV (in NS)
Sulfadoxine 500mg,
Pyrimethamine 25mg Tab
chloroquine for benign malaria (P. (Fansidar)
vivax, ovale & malariae) or with quinine for malignant malaria (P. falciparum), adult 3 tabs; child < 4 yo half a tablet; 4-8 yo 1 tab; > 8 yo 2
COMMENT/CAUTIONS:
• Chloroquine S/E: hepatic/renal impairment, avoid concurrent therapy with
hepatotoxic drugs. May cause reversible retinal damage (ophthalmic • Proguanil: If used in pregnancy for prophylaxis, give 5mg folic acid oral
• Mefloquine & chloroquine: Avoid in patients with a history of epilepsy.
• Return from malarial region: Advise to see doctor and mention possible
exposure to malaria if malaria symptoms develop, especial y within 3 months • See section 6.08 Tetracyclines on notes on Doxycycline dose & side effects.
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines 6.12 ANTHELMINTICS/ANTIPARASITICS

GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Albendazole Tab Chewable
Diethylcarbamazine Tab 50mg
(Hetrazan)
bancrofti and Brugia malayi: initial y Levamisole Tab 50mg
(Decaris, Ergamisol)
infections: adult & child > 2 mth Mebendazole Tab Chewable
MSL Threadworms/pinworms (Enterobius 100mg (Vermox)
vermicularis), adult & child > 2 yo, (Ascaris lumbricoides), adult & child Metronidazole Tab 200mg,
MSL Invasive intestinal amoebiasis: in 3-4 Suspension 200mg/5ml
Giardiasis (Giardia lamblia): 250mg BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Praziquantel Tab 600mg
(Cysticide)
haematobium or S. mansoni):
COMMENT/CAUTIONS:
• Anthelmintics should be combined with hygienic measures to break the autoinfection cycle – advise patients to wash hands and scrub fingernails before meals and after visits to the toilet and to bath/shower daily. If patient has normal bowel movements a purgative is not needed. Al members of the 6.13 ANTIVIRALS

GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Aciclovir Tab 200mg (Zovirax)
for 5 days or child < 2 yo 200mg 4 Aciclovir Cream 5% (Zovirax)
times daily) for 5 days. Cont. next page BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines GENERIC (TRADE) NAME
CAT. INDICATION/DOSE
Indinavir Cap 400mg (Crixivan)
Specified indication only.
Lamivudine Tab 150mg (Zeffix)
Specified indication only.
Zidovudine Cap 100mg
(Retrovir)
[Azidothymidine/AZT]
Specified indication only.

COMMENT/CAUTIONS:
• Aciclovir: higher doses may be required in immunocompromised patients. To
reduce risk of nephrotoxicity with IV route it is essential to give infusion over 60 minutes, maintaining adequate hydration and avoiding concurrent administration of other nephrotoxic drugs. • Post-Exposure Prophylaxis (PEP) – please refer to current guidelines.

Source: http://pharmacytech.org/library/Drug-Manual/06-Antibiotics.PDF