DOCSLIB.ORG

The Use of Systemic and Topical Fluoroquinolones Mary Anne Jackson, MD, FAAP, Gordon E

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Use of Systemic and Topical Fluoroquinolones Mary Anne Jackson, MD, FAAP, Gordon E CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care The Use of Systemic and Topical Fluoroquinolones Mary Anne Jackson, MD, FAAP, Gordon E. Schutze, MD, FAAP, COMMITTEE ON INFECTIOUS DISEASES Appropriate prescribing practices for fl uoroquinolones, as well as all abstract antimicrobial agents, are essential as evolving resistance patterns are considered, additional treatment indications are identifi ed, and the toxicity profi le of fl uoroquinolones in children has become better defi ned. Earlier recommendations for systemic therapy remain; expanded uses of fl uoroquinolones for the treatment of certain infections are outlined in this report. Prescribing clinicians should be aware of specifi c adverse reactions This document is copyrighted and is property of the American associated with fl uoroquinolones, and their use in children should continue Academy of Pediatrics and its Board of Directors. All authors have fi led confl ict of interest statements with the American Academy to be limited to the treatment of infections for which no safe and effective of Pediatrics. Any confl icts have been resolved through a process approved by the Board of Directors. The American Academy of alternative exists or in situations in which oral fl uoroquinolone treatment Pediatrics has neither solicited nor accepted any commercial represents a reasonable alternative to parenteral antimicrobial therapy. involvement in the development of the content of this publication. Clinical reports from the American Academy of Pediatrics benefi t from expertise and resources of liaisons and internal (AAP) and external reviewers. However, clinical reports from the American Academy of Pediatrics may not refl ect the views of the liaisons or the organizations OVERVIEW or government agencies that they represent. The guidance in this report does not indicate an exclusive course of Fluoroquinolones are highly active in vitro against both Gram-positive treatment or serve as a standard of medical care. Variations, taking and Gram-negative pathogens, with pharmacokinetic properties that are into account individual circumstances, may be appropriate. favorable for treating a wide array of infections. The prototype quinolone All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffi rmed, antibiotic agent, nalidixic acid, was first approved by the US Food and revised, or retired at or before that time. Drug Administration (FDA) for adults in 1964 and generally is considered to be the first generation of such agents. For more than 2 decades, DOI: 10.1542/peds.2016-2706 nalidixic acid represented the prototypic fluoroquinolone approved by PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). the FDA and was available for children 3 months and older, but it is no Copyright © 2016 by the American Academy of Pediatrics longer available. Subsequent chemical modifications resulted in a series FINANCIAL DISCLOSURE: The authors have indicated they of fluoroquinolone agents with an increased antimicrobial spectrum of have no fi nancial relationships relevant to this article to activity and better pharmacokinetic characteristics. disclose. Ciprofloxacin, norfloxacin, and ofloxacin have a greater Gram-negative FUNDING: No external funding. spectrum (with activity against Pseudomonas aeruginosa). In 2004, POTENTIAL CONFLICT OF INTEREST: The authors have ciprofloxacin became the first fluoroquinolone agent approved for use in indicated they have no potential confl icts of interest to children 1 through 17 years of age. disclose. Levofloxacin is often referred to as a respiratory fluoroquinolone because it has increased activity against many of the respiratory pathogens, To cite: Jackson MA, Schutze GE, AAP COMMITTEE ON such as Streptococcus pneumoniae, Mycoplasma pneumoniae, and INFECTIOUS DISEASES. The Use of Systemic and Topical Fluoroquinolones. Pediatrics. 2016;138(5):e20162706 Chlamydophila pneumoniae, while retaining activity against many of the Downloaded from www.aappublications.org/news by guest on September 27, 2021 PEDIATRICS Volume 138 , number 5 , November 2016 :e 20162706 FROM THE AMERICAN ACADEMY OF PEDIATRICS Gram-negative pathogens. A fourth- inhalational anthrax and plague. of arthrotoxicity was observed during generation agent, moxifloxacin, A randomized, prospective, a 14-day treatment course at 90 mg/kg displays increased activity against double-blind multicenter study per day but not at 30 mg/kg per anaerobes while maintaining Gram- of moxifloxacin for complicated day. 8, 9 Apparent joint tenderness at positive and Gram-negative activity intraabdominal infection in the higher exposure resolved 6 weeks and also has excellent activity children, in which patients were after the last dose of ciprofloxacin. against Mycobacterium tuberculosis; randomly assigned to receive either Histopathologic evidence of cartilage however, there are limited safety and moxifloxacin plus comparator drug injury was noted in virtually all dosing data available in children. placebo or comparator drug plus animals given 90 mg/kg per day Animal toxicology data available moxifloxacin placebo, was completed of ciprofloxacin. At this exposure with the first quinolone compounds in July 2015, but no data are available level, the observed clinical signs all revealed their propensity to create at this time. Systemic quinolones occurred during and shortly after inflammation and subsequent licensed in the United States will be treatment but resolved by 2 months destruction of weight-bearing discussed in this report. In addition, after cessation, with no recurrent joints in canine puppies. 1, 2 This this review will contain no discussion signs noted during the 5-month observation effectively sidelined of the use of fluoroquinolones in follow-up period. Histopathologic further development or large-scale infants younger than 6 months. evidence of cartilage injury was also evaluation of this class of antibiotic observed at 30 mg/kg per day, the agents in children at that time. dose currently recommended for SAFETY children, and inflammation occurred A policy statement summarizing the in fewer than half the animals at this assessment of risks and benefits of Animal Models dose but persisted for 5 months after fluoroquinolones in pediatric patients The original toxicology studies with treatment, at full skeletal maturation. was published by the American quinolones documented cartilage The “no observed adverse event Academy of Pediatrics (AAP) in injury in weight-bearing joints in level” (NOAEL) was 10 mg/kg per 2006, and earlier recommendations canine puppies, with damage to day, a dose at which neither clinical remain, with updates as appropriate the joint cartilage proportional nor histopathologic evidence of 3 covered in this document. The to the degree of exposure. 1, 2 Each toxicity was present, but a dose too statement indicated that the quinolone has a different potential to low for therapeutic benefit. parenteral fluoroquinolones were cause cartilage toxicity, 5 but given a appropriate for the treatment of sufficiently high exposure, cartilage Similar data were developed before infections caused by multidrug- changes will occur in all animal FDA approval of levofloxacin for resistant pathogens for which models with all quinolones. adults, documenting a NOAEL at no alternative safe and effective 3 mg/kg per day for IV dosing for Although initial reports focused parenteral agent existed. However, 14 days (approximately one-quarter on articular cartilage, subsequent for outpatient management, oral the current FDA-approved dose of studies suggested the possibility of fluoroquinolones were only indicated 16 mg/kg per day for children who epiphyseal plate cartilage injury, 6 when other options were intravenous weigh less than 50 kg). Levofloxacin leading to fluoroquinolone clinical (IV) treatment with other classes has virtually 100% bioavailability, study designs lasting several years to of antibiotic agents. In 2011, the with total drug exposure being assess growth potential. Data suggest AAP published an updated clinical equivalent between IV and oral that quinolone toxicity occurs as a report because of the increased formulations at the same milligram result of concentrations present in ophthalmologic and topical use of per kilogram dose. 10 fluoroquinolones as well as data cartilage that are sufficiently high to form chelate complexes with divalent on lack of toxicity when used in Data from a lamb model, with 4 cations, particularly magnesium, children. growth rates and activity more resulting in the impairment of Quinolones that are currently closely mirroring humans than integrin function and cartilage matrix approved for pediatric patients by juvenile beagle dogs or rats, have integrity in the weight-bearing joints, the FDA and available in an IV and been reported. Gross examination of which undergo chronic trauma oral suspension formulation are articular cartilage and microscopic during routine use. 7 ciprofloxacin for the indications examination of epiphyseal cartilage of inhalational anthrax, plague, In studies of ciprofloxacin exposure did not reveal abnormalities complicated urinary tract infections to very young beagle puppies (one of consistent with cartilage injury or (UTIs), and pyelonephritis and the most sensitive animal models for inflammation after a 14-day drug levofloxacin for the indications of quinolone toxicity), clinical evidence exposure to either gatifloxacin or Downloaded from www.aappublications.org/news
Load more

Recommended publications
  • Antibiotic Resistance in the European Union Associated with Therapeutic Use of Veterinary Medicines
    The European Agency for the Evaluation of Medicinal Products Veterinary Medicines Evaluation Unit EMEA/CVMP/342/99-Final Antibiotic Resistance in the European Union Associated with Therapeutic use of Veterinary Medicines Report and Qualitative Risk Assessment by the Committee for Veterinary Medicinal Products 14 July 1999 Public 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Switchboard: (+44-171) 418 8400 Fax: (+44-171) 418 8447 E_Mail: [email protected] http://www.eudra.org/emea.html ãEMEA 1999 Reproduction and/or distribution of this document is authorised for non commercial purposes only provided the EMEA is acknowledged TABLE OF CONTENTS Page 1. INTRODUCTION 1 1.1 DEFINITION OF ANTIBIOTICS 1 1.1.1 Natural antibiotics 1 1.1.2 Semi-synthetic antibiotics 1 1.1.3 Synthetic antibiotics 1 1.1.4 Mechanisms of Action 1 1.2 BACKGROUND AND HISTORY 3 1.2.1 Recent developments 3 1.2.2 Authorisation of Antibiotics in the EU 4 1.3 ANTIBIOTIC RESISTANCE 6 1.3.1 Microbiological resistance 6 1.3.2 Clinical resistance 6 1.3.3 Resistance distribution in bacterial populations 6 1.4 GENETICS OF RESISTANCE 7 1.4.1 Chromosomal resistance 8 1.4.2 Transferable resistance 8 1.4.2.1 Plasmids 8 1.4.2.2 Transposons 9 1.4.2.3 Integrons and gene cassettes 9 1.4.3 Mechanisms for inter-bacterial transfer of resistance 10 1.5 METHODS OF DETERMINATION OF RESISTANCE 11 1.5.1 Agar/Broth Dilution Methods 11 1.5.2 Interpretative criteria (breakpoints) 11 1.5.3 Agar Diffusion Method 11 1.5.4 Other Tests 12 1.5.5 Molecular techniques 12 1.6 MULTIPLE-DRUG RESISTANCE
    [Show full text]
  • Fluoroquinolone Mechanisms of Action and Resistance
    Downloaded from http://perspectivesinmedicine.cshlp.org/ on October 1, 2021 - Published by Cold Spring Harbor Laboratory Press Topoisomerase Inhibitors: Fluoroquinolone Mechanisms of Action and Resistance David C. Hooper1 and George A. Jacoby2 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts 02114 2Lahey Hospital and Medical Center, Burlington, Massachusetts 01805 Correspondence: [email protected] Quinolone antimicrobials are widely used in clinical medicine and are the only current class of agents that directly inhibit bacterial DNA synthesis. Quinolones dually target DNA gyrase and topoisomerase IV binding to specific domains and conformations so as to block DNA strand passage catalysis and stabilize DNA–enzyme complexes that block the DNA repli- cation apparatus and generate double breaks in DNA that underlie their bactericidal activity. Resistance has emerged with clinical use of these agents and is common in some bacterial pathogens. Mechanisms of resistance include mutational alterations in drug target affinity and efflux pump expression and acquisition of resistance-conferring genes. Resistance mu- tations in one or both of the two drug target enzymes are commonly in a localized domain of the GyrA and ParC subunits of gyrase and topoisomerase IV, respectively, and reduce drug binding to the enzyme–DNA complex. Other resistance mutations occur in regulatory genes that control the expression of native efflux pumps localized in the bacterial membrane(s). These pumps have broad substrate profiles that include other antimicrobials as well as quin- olones. Mutations of both types can accumulate with selection pressure and produce highly resistant strains. Resistance genes acquired on plasmids confer low-level resistance that promotes the selection of mutational high-level resistance.
    [Show full text]
  • PACKAGE LEAFLET: INFORMATION for the USER Levofloxacin 5 Mg
    PACKAGE LEAFLET: INFORMATION FOR THE USER Levofloxacin 5 mg/ml solution for infusion Levofloxacin Read all of this leaflet carefully before you are given this medicine because it contains important information for you • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor, pharmacist or nurse. • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. • If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4. What is in this leaflet 1. What Levofloxacin solution for infusion is and what it is used for 2. What you need to know before you are given Levofloxacin solution for infusion 3. How Levofloxacin solution for infusion is given 4. Possible side effects 5. How to store Levofloxacin solution for infusion 6. Contents of the pack and other information 1. What Levofloxacin solution for infusion is and what it is used for The name of your medicine is Levofloxacin solution for infusion. Levofloxacin solution for infusion contains a medicine called levofloxacin. This belongs to a group of medicines called antibiotics. Levofloxacin is a ’quinolone’ antibiotic. It works by killing the bacteria that cause infections in your body. Levofloxacin solution for infusion can be used to treat infections of the: • Lungs, in people with pneumonia • Urinary tract, including your kidneys or bladder • Prostate gland, where you have a long lasting infection • Skin and underneath the skin, including muscles.
    [Show full text]
  • Disabling and Potentially Permanent Side Effects Lead to Suspension Or Restrictions of Quinolone and Fluoroquinolone Antibiotics
    16 November 2018 EMA/795349/2018 Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics EMA has reviewed serious, disabling and potentially permanent side effects with quinolone and fluoroquinolone antibiotics given by mouth, injection or inhalation. The review incorporated the views of patients, healthcare professionals and academics presented at EMA’s public hearing on fluoroquinolone and quinolone antibiotics in June 2018. EMA’s human medicines committee (CHMP) has endorsed the recommendations of EMA’s safety committee (PRAC) and concluded that the marketing authorisation of medicines containing cinoxacin, flumequine, nalidixic acid, and pipemidic acid should be suspended. The CHMP confirmed that the use of the remaining fluoroquinolone antibiotics should be restricted. In addition, the prescribing information for healthcare professionals and information for patients will describe the disabling and potentially permanent side effects and advise patients to stop treatment with a fluoroquinolone antibiotic at the first sign of a side effect involving muscles, tendons or joints and the nervous system. Restrictions on the use of fluoroquinolone antibiotics will mean that they should not be used: • to treat infections that might get better without treatment or are not severe (such as throat infections); • to treat non-bacterial infections, e.g. non-bacterial (chronic) prostatitis; • for preventing traveller’s diarrhoea or recurring lower urinary tract infections (urine infections that do not extend beyond the bladder); • to treat mild or moderate bacterial infections unless other antibacterial medicines commonly recommended for these infections cannot be used. Importantly, fluoroquinolones should generally be avoided in patients who have previously had serious side effects with a fluoroquinolone or quinolone antibiotic.
    [Show full text]
  • Pharmaceutical Services Division and the Clinical Research Centre Ministry of Health Malaysia
    A publication of the PHARMACEUTICAL SERVICES DIVISION AND THE CLINICAL RESEARCH CENTRE MINISTRY OF HEALTH MALAYSIA MALAYSIAN STATISTICS ON MEDICINES 2008 Edited by: Lian L.M., Kamarudin A., Siti Fauziah A., Nik Nor Aklima N.O., Norazida A.R. With contributions from: Hafizh A.A., Lim J.Y., Hoo L.P., Faridah Aryani M.Y., Sheamini S., Rosliza L., Fatimah A.R., Nour Hanah O., Rosaida M.S., Muhammad Radzi A.H., Raman M., Tee H.P., Ooi B.P., Shamsiah S., Tan H.P.M., Jayaram M., Masni M., Sri Wahyu T., Muhammad Yazid J., Norafidah I., Nurkhodrulnada M.L., Letchumanan G.R.R., Mastura I., Yong S.L., Mohamed Noor R., Daphne G., Kamarudin A., Chang K.M., Goh A.S., Sinari S., Bee P.C., Lim Y.S., Wong S.P., Chang K.M., Goh A.S., Sinari S., Bee P.C., Lim Y.S., Wong S.P., Omar I., Zoriah A., Fong Y.Y.A., Nusaibah A.R., Feisul Idzwan M., Ghazali A.K., Hooi L.S., Khoo E.M., Sunita B., Nurul Suhaida B.,Wan Azman W.A., Liew H.B., Kong S.H., Haarathi C., Nirmala J., Sim K.H., Azura M.A., Asmah J., Chan L.C., Choon S.E., Chang S.Y., Roshidah B., Ravindran J., Nik Mohd Nasri N.I., Ghazali I., Wan Abu Bakar Y., Wan Hamilton W.H., Ravichandran J., Zaridah S., Wan Zahanim W.Y., Kannappan P., Intan Shafina S., Tan A.L., Rohan Malek J., Selvalingam S., Lei C.M.C., Ching S.L., Zanariah H., Lim P.C., Hong Y.H.J., Tan T.B.A., Sim L.H.B, Long K.N., Sameerah S.A.R., Lai M.L.J., Rahela A.K., Azura D., Ibtisam M.N., Voon F.K., Nor Saleha I.T., Tajunisah M.E., Wan Nazuha W.R., Wong H.S., Rosnawati Y., Ong S.G., Syazzana D., Puteri Juanita Z., Mohd.
    [Show full text]
  • On the Extraction of Antibiotics from Shrimps Prior to Chromatographic Analysis
    separations Review On the Extraction of Antibiotics from Shrimps Prior to Chromatographic Analysis Victoria Samanidou *, Dimitrios Bitas, Stamatia Charitonos and Ioannis Papadoyannis Laboratory of Analytical Chemistry, University of Thessaloniki, GR 54124 Thessaloniki, Greece; [email protected] (D.B.); [email protected] (S.C.); [email protected] (I.P.) * Correspondence: [email protected]; Tel.: +30-2310-997698; Fax: +30-2310-997719 Academic Editor: Frank L. Dorman Received: 2 February 2016; Accepted: 26 February 2016; Published: 4 March 2016 Abstract: The widespread use of antibiotics in veterinary practice and aquaculture has led to the increase of antimicrobial resistance in food-borne pathogens that may be transferred to humans. Global concern is reflected in the regulations from different agencies that have set maximum permitted residue limits on antibiotics in different food matrices of animal origin. Sensitive and selective methods are required to monitor residue levels in aquaculture species for routine regulatory analysis. Since sample preparation is the most important step, several extraction methods have been developed. In this review, we aim to summarize the trends in extraction of several antibiotics classes from shrimps and give a comparison of performance characteristics in the different approaches. Keywords: sample preparation; extraction; aquaculture; shrimps; chromatography; antibiotics 1. Introduction According to FAO (CWP Handbook of Fishery Statistical Standards, Section J: AQUACULTURE), “aquaculture is the farming of aquatic organisms: fish, mollusks, crustaceans, aquatic plants, crocodiles, alligators, turtles, and amphibians. Farming implies some form of intervention in the rearing process to enhance production, such as regular stocking, feeding, protection from predators, etc.”[1]. Since 1960, aquaculture practice and production has increased as a result of the improved conditions in the aquaculture facilities.
    [Show full text]
  • LEVAQUIN (Levofloxacin) Tablets Are Supplied As 250, 500, and 750 Mg Capsule-Shaped, Coated Tablets
    LEVAQUIN (levofloxacin) TABLETS LEVAQUIN (levofloxacin) ORAL SOLUTION LEVAQUIN (levofloxacin) INJECTION LEVAQUIN (levofloxacin in 5% dextrose) INJECTION To reduce the development of drug-resistant bacteria and maintain the effectiveness of LEVAQUIN (levofloxacin) and other antibacterial drugs, LEVAQUIN should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria. DESCRIPTION LEVAQUIN (levofloxacin) is a synthetic broad spectrum antibacterial agent for oral and intravenous administration. Chemically, levofloxacin, a chiral fluorinated carboxyquinolone, is the pure (-)-(S)-enantiomer of the racemic drug substance ofloxacin. The chemical name is (-)-(S)-9-fluoro-2,3-dihydro-3-methyl-10-(4-methyl- 1-piperazinyl)-7-oxo-7H-pyrido[1,2,3-de]-1,4-benzoxazine-6-carboxylic acid hemihydrate. O F COOH 1/2 H2O N N N O CH3 H3C The chemical structure is: H Its empirical formula is C18H20FN3O4 • ½ H2O and its molecular weight is 370.38. Levofloxacin is a light yellowish-white to yellow-white crystal or crystalline powder. The molecule exists as a zwitterion at the pH conditions in the small intestine. The data demonstrate that from pH 0.6 to 5.8, the solubility of levofloxacin is essentially constant (approximately 100 mg/mL). Levofloxacin is considered soluble to freely soluble in this pH range, as defined by USP nomenclature. Above pH 5.8, the solubility increases rapidly to its maximum at pH 6.7 (272 mg/mL) and is considered freely soluble in this range. Above pH 6.7, the solubility decreases and reaches a minimum value (about 50 mg/mL) at a pH of approximately 6.9.
    [Show full text]
  • The Grohe Method and Quinolone Antibiotics
    The Grohe method and quinolone antibiotics Antibiotics are medicines that are used to treat bacterial for modern fluoroquinolones. The Grohe process and the infections. They contain active ingredients belonging to var- synthesis of ciprofloxacin sparked Bayer AG’s extensive ious substance classes, with modern fluoroquinolones one research on fluoroquinolones and the global competition of the most important and an indispensable part of both that produced additional potent antibiotics. human and veterinary medicine. It is largely thanks to Klaus Grohe – the “father of Bayer quinolones” – that this entirely In chemical terms, the antibiotics referred to for simplicity synthetic class of antibiotics now plays such a vital role for as quinolones are derived from 1,4-dihydro-4-oxo-3-quin- medical practitioners. From 1965 to 1997, Grohe worked oline carboxylic acid (1) substituted in position 1. as a chemist, carrying out basic research at Bayer AG’s Fluoroquinolones possess a fluorine atom in position 6. In main research laboratory (WHL) in Leverkusen. During this addition, ciprofloxacin (2) has a cyclopropyl group in posi- period, in 1975, he developed the Grohe process – a new tion 1 and also a piperazine group in position 7 (Figure A). multi-stage synthesis method for quinolones. It was this This substituent pattern plays a key role in its excellent achievement that first enabled him to synthesize active an- antibacterial efficacy. tibacterial substances such as ciprofloxacin – the prototype O 5 O 4 3 6 COOH F COOH 7 2 N N N 8 1 H N R (1) (2) Figure A: Basic structure of quinolone (1) (R = various substituents) and ciprofloxacin (2) Quinolones owe their antibacterial efficacy to their inhibition This unique mode of action also makes fluoroquinolones of essential bacterial enzymes – DNA gyrase (topoisomer- highly effective against a large number of pathogenic ase II) and topoisomerase IV.
    [Show full text]
  • Therapeutic Class Overview Otic Fluoroquinolones
    Therapeutic Class Overview Otic Fluoroquinolones Therapeutic Class • Overview/Summary: This review will focus on the otic fluoroquinolone antibiotics.1-4 Topical corticosteroids help to aid in the resolution of the inflammatory response accompanying bacterial infections.3,4 Fluoroquinolones are broad-spectrum antimicrobial agents that directly inhibit bacterial deoxyribonucleic acid (DNA) synthesis by blocking the actions of DNA gyrase and topoisomerase IV, which leads to bacterial cell death.5 The otic antibacterials are approved for the treatment of otitis externa and otitis media. Otitis externa (also known as swimmer’s ear) is an inflammatory condition of the external ear canal auditory canal or auricle, usually from infection. Common infectious pathogens include S. aureus, S. epidermidis and P. aeruginosa; however, several other gram-positive, gram-negative and anaerobic infections along with polymicrobic infections occur frequently.6 Topical antibacterials (alone or in combination with a corticosteroid) are very effective and systemic therapy is generally not required.7 Acute otitis media is an inflammatory condition of the middle ear with middle ear effusion and symptoms include otalgia, hearing loss and vertigo.8 Common pathogens in children include S. pneumoniae and H. influenzae (and M. catarrhalis in children).8,9 Oral antibacterials are generally the initial treatment option for children and adults; however, topical antibacterials with or without corticosteroids may be used in patients with perforated tympanic membranes, tympanostomy
    [Show full text]
  • Commonly Used Antibiotics in the Outpatient Setting By
    Commonly Used Antibiotics in the Outpatient Setting By: Raymond Lengel, MSN, FNP, RN Purpose: This course will provide an overview of the antibiotics most commonly ordered by primary care providers for common conditions in the outpatient setting. Objectives: · List three major problems associated with the use of antibiotics · Discuss common allergic reactions to antibiotics · List three health conditions that are treated with each class of antibiotic discussed · List three side effects associated with each class of antibiotic discussed · Discuss the nurse’s role in the administration of oral antibiotics The course will look at 6 major classes of commonly used oral antibiotics, some miscellaneous antibiotics and topical antibiotics that health care providers prescribe in the outpatient setting. One injection medication that is commonly used in the primary care office will be discussed. Many people go to the doctor with false perceptions of the ideal antibiotic to treat their infection. One common example is the use of the Z-Pak. The Z-Pak is a formulation of the commonly used antibiotic azithromycin. It is a very good antibiotic, but it gets over used. The reason that this medication is overused is because it is a once a day antibiotic for five days (some infections can be treated with a three or even one day course). This is convenient for people and is often requested. While the Z-Pak is commonly a good choice to treat many infections, it is not always the ideal choice. There is currently a lot of resistance to this antibiotic, due to its overuse. The use of antibiotics is a major part of the primary care doctor’s practice as many visits are due to an infectious process.
    [Show full text]
  • Antimicrobial Use and Prevalence of Healthcare-Associated Infections in Acute and Long-Term Care Facilities December 2018
    . Europe’s journal on infectious disease epidemiology, prevention and control Special edition: Antimicrobial use and prevalence of healthcare-associated infections in acute and long-term care facilities December 2018 Featuring • Antimicrobial prescribing in long-term care facilities: a nationwide point- prevalence study, Slovenia, 2016 • Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long- term care facilities: results from two European point prevalence surveys, 2016 to 2017 • and more... www.eurosurveillance.org Editorial team Editorial advisors Based at the European Centre for Albania: Alban Ylli, Tirana Disease Prevention and Control (ECDC), Austria: Maria Paulke-Korinek, Vienna 169 73 Stockholm, Sweden Belgium: Koen de Schrijver, Antwerp; Tinne Lernout, Brussels Telephone number Bosnia and Herzegovina: Nina Rodić Vukmir, Banja Luka +46 (0)8 58 60 11 38 Bulgaria: Iva Christova, Sofia E-mail Croatia: Sanja Music Milanovic, Zagreb [email protected] Cyprus: Maria Koliou, Nicosia Czech Republic: Jan Kynčl, Prague Editor-in-chief Denmark: Peter Henrik Andersen, Copenhagen Dr Ines Steffens Estonia: Kuulo Kutsar, Tallinn Senior editor Finland: Outi Lyytikäinen, Helsinki Kathrin Hagmaier France: Judith Benrekassa, Paris Germany: Jamela Seedat, Berlin Scientific editors Greece: Rengina Vorou, Athens Janelle Sandberg Hungary: Ágnes Hajdu, Budapest Karen Wilson Iceland: Gudrun Sigmundsdottir, Reykjavík Assistant editors Ireland: Joan O
    [Show full text]
  • Download Full Article As
    Article Comparative screening of dose-dependent and strain- specific antimicrobial efficacy of berberine against a representative library of broad-spectrum antibiotics Stephanie Sun1, Andrew Su2, Simrun Sakhrani3, Bhavesh Ashok4, Sarah Su5, Sarada Rajamanickam4, and Edward Njoo6 1BASIS Independent Silicon Valley, San Jose, CA; 2Foothill High School, Pleasanton, CA; 3The College Preparatory School, Oakland, CA; 4Amador Valley High School, Pleasanton, CA; 5Los Altos High School, Los Altos, CA; 6Department of Chemistry, Biochemistry, & Physical Science, Aspiring Scholars Directed Research Program, Fremont, CA SUMMARY methodology behind systematic screening of drugs while Widespread use of antibiotics has resulted in the trying to find a drug to treat syphilis in 1904, and Flemming, emergence of antibiotic-resistant bacteria strains, who accidentally discovered penicillin in 1929. Since then, increasing the necessity in research towards the hundreds of antimicrobial agents have been developed and identification of novel antibiotic agents. Berberine, clinically screened, the majority of which are derived from a natural alkaloid that is extracted from the roots natural products (3). Current antibiotics lack diversity in and stems of plants in the genus Berberis, has been their targets, with almost all antibiotics inhibiting DNA, RNA, documented to have medicinal potential since 3000 protein synthesis, or cell wall synthesis. In fact, around half of BC, where it was used as an antibacterial agent in all antibiotics target the cell wall. Antibiotics also lack diversity ancient Chinese medicine. Since then, berberine and in scaffold design - the core structure of small molecules- with synthesized analogs have been studied for a wide most of the novel antibiotics within the past forty years coming range of medicinal properties, including antimicrobial activity.
    [Show full text]