ANTI-INFECTIVES - ORAL (Page 1 of 2) Antibiotic /Pregnancy code Strength / Formulation Flavour Generic / TRADE g=generic (in mg or mg/5ml) PENICILLINS B Prepared by: Loren Regier, Brent Jensen © www.RxFiles.ca Ped. Dose Dosing Usual Dose:1{10kg child~1yr mg/kg/day Interval Max/d 2 Adult } COST $ /10d Oct 08 Comments (see page 31 - EDS criteria abbreviation key) ←Pregnancy category Amoxicillin AMOXIL 125 & 250mg 125mg/5ml 250mg/5ml 250 & 500mg 125F & 250F /5ml (4:1) cherry ChewT strawberry Susp Susp ☺banana/other Cap rasp-orange Q8H 40-50 1.5g 80-90mg/kg/d in kids at ↑risk of resistant S. pneumo up to 1.5-3g/day. eg. recent previous antibiotic use, daycare, not given Prevnar 1.5g amox 500-875mg q12h option 500mg Q8H per Sanford’s 25 13 15 17 (amox/clavulanate ratio varies) -dose listed=amoxicillin component 250(2:1), 500(4:1), 875mg (7:1) Q8-12H (range 20-80) Q12H Susp Tab Caution preterm: neonatal enterocolitis Q8-12H Penicillin V (Benzathine) 300mg/5ml Susp fruity 25-50 Q6-12H 3g {150mg Q8h ac} 13 D/C 125 & 300mgW/5ml 300mg (=500,000 I.U.s) Soln Tab fruity 25-50 Q6-12H 3g {125mg Q6H ac} 20 10 Amox/Clavulanate CLAVULIN 200 & 400 /5ml 70ml(7:1) Susp 45 {125-250mg Q8H} (may give q12h Sanford’s) {125mg Q8H cc} {200mg Q12H cc} 21 24 37 great middle ear penetration & drug of choice for initial Tx of acute otitis media. [Watch & wait may be a tx option. Antibiotics more useful in kids<2yr with bilateral AOM or if AOM & otorrhoea.] Novamoxin has sugar reduced susp,(Amoxil Susp. is bubble-gum flavoured but NOT usually stocked) WEDS -a,c,d,e,g,i,m,pbites,q ↑absorb. with food(cc) ↑activity vs resistant H. flu but not PRSP; ↑LFT’s rare diarrhea ~25% with q8h regimen; less frequent (~10%) with higher ratio formulation given q12h 875mg Q12H cc Combination of {Amoxicillin 40mg/kg/d + Amox/Clavulanate 40mg/kg/d} sometimes recommended to provide high-dose of amoxicillin for pen-resistant S. pneumoniae and regular dose amox/clavulanate for excellent H. influenzae & M. catarrhalis coverage without excessive clavulanate, which may cause excessive diarrhea & increased cost (i.e. option in resistant/recurrent OM). recommend amox (better absorption; q8h; less {250mg Q6H ac} 22 Ampicillin 250 & 500mg Cap 50-100 Q6H 2g 500mg Q6H cc 35 rash/diarrhea)unless shigella/citrobacter/enterobacter cherry 125 mg/5ml primarily for Staph. aureus; also strep coverage Susp {125-250mg Q6H ac} 50-100 Q6H 4g Cloxacillin 25 liquid poor tasting; consider cephalexin as alternative 250 & 500mg Cap 500mg Q6H ac 25 PEN-VEE Penicillin V (Potassium) PEN-VK 300mg Q8H ac/600mg bid D/C by company 2006 Drug of choice for adult pharyngitis (esp. when Strep. confirmed by C&S); q12h dosing appears effective. CEPHALOSPORINS (generation) B Cephalosporins lack coverage for atypicals & Enterococcus. Between 1-10% of adult pts with penicillin allergy will develop cephalosporin allergy.Med Let Sep/03; side chain esp. important Pichichero'05 41 serum sickness <1% Susp ☺strawberry {125mg Q8H} 20-40 Q6-8H 2g Cefaclor (2nd) 125,250 & 375mg/5ml 25 W CECLOR 250 & 500mg Cap 500mg Q8H Q8H 70 Delisted from Sask. formulary 2003 rd Susp ☺strawberry {80mg Q24H} 8mg Q24H 400mg Cefixime (~3 ) 100mg/5ml 24 W EDS -b,c,v & uncomplicated gonorrhea diarrhea ~15% SUPRAX 400mg Tab 400mg Q24H 49 W nd ☺ bubblegum 125 & 250mg/5ml Susp {150mg Q12H} EDS -a,b,c,d,e,i diarrhea only ~3% room temp 24hrs 15-30mg Q12H 1g 24 Cefprozil-new generic (2 ) 60g 500mg od = $43 –adequate for some indications CEFZIL 250 & 500mg Tab 500mg Q12H 83 W 250mg⊗ nd tutti-fruiti 125 mg /5 ml; sachet Susp {125mg Q12H cc} EDS -a,b,c,d,e,i Susp-bitter tasting; 20-30mg Q12H 1g 27 Cefuroxime axetil (2 ) absorption concerns: may ↑absorption with food 250 & 500mg CEFTIN Tab 500mg Q12H cc 55 st bubblegum, cherry, 125 & 250mg poor mid-ear penetration; no coverage of H. flu or Susp {125mg Q6H} 25-100mg Q6H 4g 19 Cephalexin (1 ) orange, banana ☺ atypical ∴not for empiric Tx of OM/CAP 250 & 500mg Tab/cap KEFLEX 500mg Q6H 25 avoid calcium x48hr Ceftriaxone -ROCEPHIN 50mg/kg IM X1 (Max2g) effective for acute OM incl. areas with high PRSP rates (X3 if recurrent OM) ; Cost 500mg < $30 ; inj. painful ∴often mixed with lidocaine ; rare SE: biliary sludge safety in <18yr not established DI:chelation with cations (eg. Al++,Ca++, Fe++) C concern for articular damage in kids; rare: photosensitivity, tendon rupture esp. elderly on steroids, transplants,seizure,allergy FQ’s removed from market: trovafloxacin (hepatic SE), grepafloxacin (cardiac SE), gatifloxacin TEQUIN 2006 (↑diabetes). Not for MRSA, & ↑ resistance to N. gonorrhoeae in USA >10% CDC MMWR April 2007 FLUOROQUINOLONES FQ’s likely absorbed in the duodenum, therefore less drug may be absorbed when administering via a jejunostomy tube Ciprofloxacin CIPRO ⊗ 500mg & 1g XL tabs, 500mg/5ml 250,500 & 750mg Susp Tab Levofloxacin Moxifloxacin Norfloxacin LEVAQUIN AVELOX NOROXIN 250, 500 & 750mg 400mg 400mg Tab Tab Tab Gemifloxacin Telithromycin FACTIVE 320mg Tab strawberry (20-30mg) Q12H 1.5g na na Q24H Q24H Q12H 500mg 400mg 800mg na Q24H 320mg coverage incl. PRSP, atypicals, & gm –ves, (not pseudomonas) rare QT prolongation< 3 / million; na ↑/↓ glucose changes< 300 / million but more common in elderly diabetics (Gatifloxacin the worst offender) Clostridium difficile: ↑ incidence & severity possible with fluoroquinolones 40 W EDS-b≥2 ABX,c C & S resistance,h,j,l,m prolonged,o,r & gonorrhea antipseudomonal (rarely in peds-cystic fibrosis) DIs 500mg Q12H;1g XL od 45;42 Travelers’ diarrhea: FQ good choice unless in Asia Campylobacter. 250mg Q12H (for UTI) 500-750mg Q24H 400mg po Q24H 400mg po Q12H before meals 320mg po Q24H 71-118 EDS-c resistant,d,e,j, PID.Generic was avail., rare ↑LFTs 74 EDS-c resistant,d,e,j covers anaerobes, rare ↑LFT 40 W EDS-b,c,l for genitourinary tract inf's 85 ⊗; Few DI’s; approved for CAP,AECB; rash 2.8% only & gonoccoccal urethritis/cervicitis ⊗ ↑DI 5: disopyramide,ergots, pimozide...; Rare:↑↑LFT’s, 85 800mg po Q24H (only for pneumonia FDA/CND) TEN & myasthenia gravis. SE: GI, vision blurry. Cover resistant strep ☺ tastes good =Exception Drug Status in Sask =prior approval required for NIHB coverage W covered by NIHB ⊗ not covered by NIHB ABX=antibiotic(s) CAP=community acquired pneumonia ChewT=chewable tab COST $=total cost to consumer for 10 day therapy GI = gastrointestinal inf=infection na=not applicable OM=otitis media Ped=pediatric PMC=pseudomembraneous colitis PRSP=penicillin resistant Strep. pneumoniae pts=patients Susp=suspension TEN=toxic epidermal necrolysis Tx=treatment. Ped. Dose : dosages in the higher end of the range should generally be used for treatment of OM References: (Ped Inf Dis 1999;18-5:403-9. Sanford's 2002:p7) Probiotics:i,ii Probiotics (Saccharomyces boulardii, Lactobacillus rhamnosus GG, & probiotic mixes) ↓ antibiotic-associated diarrhea (AAD) but separate 2hrs from abx. Only S. boulardii 1g od effective for C. difficile diarrhea caution if immunocompromised, pancreatitis. KETEK C 400mg (a KETOLIDE) Tab na Q24H 800mg 46 ANTI-INFECTIVES - ORAL (Continued) - Page 2 © www.RxFiles.ca Oct 08 Antibiotic /Pregnancy code Strength/Formulation Flavour Ped. Dose Comments Dosing Usual Dose:1{10kg child~1yr } COST (in mg or mg/5ml) $ /10d Generic / TRADE mg/kg/day Interval Max/d 2 Adult MACROLIDES: Erythro- & clarithro-mycin can ↑ the QT intervaliii & more drug interactions CYP 3A4,↑ level of other drugs incl. digoxin than azithromycin. Rare ototoxicity. covers atypical organisms; not for MRSA W ☺ cherry;but Day 1: 10mg 100 & 200mg/5ml 15ml Susp generic Q24H 500mg {D1: 100mg; D2-5: 50mg} Azithromycin 21 EDS -a,b,f,k,s,t,u & chlamydia trachomatis PMS poor taste B 5days ≅10days therapy; also 1&3day regimens Day 2-5: 5mg ZITHROMAX, generic 250mg D1: 500mg; D2-5: 250mg Tab 30 Travelers’ diarrhea: option in Asia, kids or in pregnancy. Z-PAK= 6x 250mg tabs 600mg Tab W for disseminated MAC in pts with HIV 1200mg weekly fruity 125& 250mg/5ml 105ml Susp {75mg Q12H} Clarithromycin 15mg Q12H 1g 26 W EDS -a,b,f,k,s,u,w, MAC prophylaxis in HIV C @ BIAXIN, generic10day tx ~↓$5 than XL Q12-24H 250&500mg; 500mg XL Tab 500-1000mg XL OD cc 37-67 pts, & 1wk for H. pylori tx; susp room temp;DI colchicine W Base 250mg Q6H Erythro, ERYC 16i,30ii ↑absorption on empty stomach, but with food Erythromycin B i) 250mg, 500mg Q6-8H 2g EC Cap 333mg Q8H ERYC ↓GI upset.Kids:ERYC→sprinkled on food useful i)Base Tab ii) ERYC Non ii) 250 & 333mg 26 D/C by Company D/C PCE Estolate form preferred in kids as most acid iii) PCE iii) 333mg EC Tab 333mg Q8H Q8H 2g 25 estolate stable; not recommended in adults Susp ☺ orange/cher {125mg Q8H cc} 30-40mg Q6-8H 2g Eryth. Estolate ILOSONE 125 & 250mg/5ml 15 Coverage for H. influenzae poor with erythro (better 200 & 400mg/5ml Susp strawb/bana {100mg Q6H}after meals 30-40mg Q6-8H 2g Eryth. Ethylsuc. EES 15 with newer macrolides); there is some PRSP crossTab 250mg Q6H Q6-8H 2g Eryth.Stearate ERYTHROCIN 250mg 17 resistance Option in acute gastroparesis DI colchicine SULFA COMBINATIONS43 C ,but near term D -Trimethoprim has antifolate effect.. Rare SE: Stevens Johnson Syndrome & Toxic epidermal necrolysis cherry Susp 6-12mg TMP Q12H 320mg {(200/40) 5ml Q12H} Cotrimoxazole (SMX/TMP) 200/40 /5ml (10ml=1 tab) 10 of TMP BACTRIM/SEPTRA 100/20 Pediatric Tab {ii tab Q12h} 12 (Sulfamethoxazole/Trimethoprim) 400/80 & 800/160 (DS) Tab 10 (800/160) i tab Q12H contraindicated in infants <2months old UTI prophylaxis: Adult 40-80mg as TMP daily or 3X/wk DS="double strength" (PCP:20mg/kg/d TMP);?use for MRSA esp CA Eryth/Sulfisoxazole D/C by Company 200mg/600mg /5ml disadvantage: ↑'d resistance & ↑SEe.g. GI/allergy-rash b/c of 2 drugs refrigerate& best after meals PEDIAZOLE TETRACYCLINES D Susp strawberrybanana 40-50mg Eyrth. Q6-8H TCN & doxycycline not recommended in kids <8yr (minocycline <13yr) Doxycycline VIBRAMYCIN 100mg 50 & 100mg Minocycline MINOCIN 250mg Tetracycline Tab/Cap √ atypical RTIs 2-5mg {(160/480) 4ml Q8H} 24 D/C Q12-24H 200mg 100mg Q12H x1d, Q24H Q12H Q6H 200mg 2g 200mg X1, 100mg Q12H 250mg Q6H ac 10-30mg Q6-8H Q6-12H 1.8g {100mg Q8H} 300mg Q6H 34 54 25mg store suspension at room temp.; rare: thrombocytopenia 1hr before or 2hr after any Ca++ (dairy products) & Fe++ Concern: phototoxicity, GI irritating 14 33 11 4mg/kg X1, 2mg/kg Cap Cap 2g Eryt, 6g Sulf. better tolerated than TCN; useful Lyme dx/?CA-MRSA Tx: acne unresponsive to TCN. SE: lupus, vertigo… Gram +ve, anaerobic coverage & CA-MRSA store suspension at room temp (b/c ↑ thickness) take on empty stomach with water avoid if ↓renal fx OTHER Clindamycin cherry B 75mg/5ml 150 & 300mg Soln Cap Linezolid ZYVOXAM C 600mg (600mg IV ) tab 30mg BID 1.2g 600mg BID 1470 Methenamine mandelate C 500mg EC Tab 50-75mg Q6H 2g 1g Q12H 18 B 250mg (500mg capW) DALACIN C MANDELAMINE Metronidazole FLAGYL Fosfomycin MONUROL B 3g oral powder 50 & 100mg Nitrofurantoin ii) MACRODANTIN B/D ii)50mg macrocrystals iii) MACROBID iii)100mg macrocrystal {Avoid if CrCl <60ml/min} Probenecid BENURYL C 500mg Trimethoprim PROLOPRIM C 100 & 200mg Vancomycin VANCOCIN B 125 & 250mg Tab/ Cap sachet Tab Cap Cap 30mg (range 15-50) Q6-12H >1 yr 2g x1 5-7mg ped. formulation not avail. but recipe in CJHP Feb’06 or round to the nearest ¼ tab =12.5mg Tab Tab Cap 40mg vial sometimes used to make up oral solution {na} 40mg 4g x1 Q6H Q6H Q12H 3g 200400mg Q6H 2-3g Q12-24H 200mg Q6-8H 2g {75mg Q6H} 250-500mg Q8H 3g x1 empty stomach 50mg Q6H cc 50mg Q6H cc EDS-Gram +ve resistant/intolerant to vanco. weak MAOI & serotonin action; rare :thrombocytopenia requires acidified urine (pH <5.5)∴often given with ascorbic acid Susp. compounded-poor taste; Disulfiram Rx; DI: phenytoin, warfarin Tx: anaerobic, antiprotozoal & PMC inf's 100mg Q12H cc 11 31 14 23 23 1g OD or 500mg QID 30-45min prior to IV antibiotics 15 Action: ↑ levels of penicillin/cephalosporins. CI <2yrs. 200mg Q24H 125mg Q6H 12 340 Tx:PMC unresponsive to Metro.; Not Absorbed! EDS-b,c,x for UTIs only! D/C by Co 2007 for UTI only; avoid at term(36wks) in pregnancy UTI prophylaxis: Kid>1mo 1-2mg/kg/d (max 100mg/d); Adult 50-100mg po HS. Long term ↑SE & rarely causes pneumonitis, neuropathy & ↑LFTs Option: sulfa allergy QID dose in PCP May ↑Scr = ↓ dose for renal dysfunction a) Upper & lower RTI’s in pts NOT responding to 1st line ABX b) Pts ALLERGIC to alternative ABX c) Inf's known to be resistant or not responding to alternate ABX(s) d) RTIs in nursing home pts e) Pneumonia in pts in the community with comorbidity (ie. COPD, diabetes, renal insufficiency, heart failure, stroke) f) Pneumonia g) Pneumonia caused by aspiration h) Pts with bronchiectasis or cystic fibrosis i) Completion of Tx initiated in hospital j) Completion of ABX Tx initiated in hospital when alternatives are not appropriate k) Completion of ABX Tx initiated in hospital with macrolides or quinolones l) Pseudomonas aeruginosa inf’s m) Inf’s in pts with neutropenia n) Inf’s & prophylaxis in neutropenic pts o) UTI in pts allergic or not responding to alternate ABX p) For human, cat & dog BITES q) Diabetic foot inf’s r) Severe diabetic foot inf’s in combo with other ABX s) Non-tuberculous Mycobacterium inf’s & prophylaxis t) Chlamydia trachomatis inf’s u) Pts intolerant to erythromycin &/or other ABX v) Uncomplicated gonorrhea w) H. pylori -1 week when used in combo regimens for eradication x) Tx of UTI in pregnancy when first line agents inappropriate PMC =pseudomembraneous colitis (C. difficile) Abbreviation Key to EDS (Exception Drug Status) criteria in SK: 47