Dosage of Albendazole for Nematode/Roundworm Infections (Baylisascariasis, Enterobiasis, Filariasis, Hookworm Infections, Toxocariasis, Strongyloidiasis, Trichinellosis, Trichostrongyliasis, Trichuriasis, Trematode, Giardiasis, Microsporidiosis)
Nematode (Roundworm) Infections
Ascariasis. For the treatment of ascariasis caused by Ascaris lumbricoides, adult and pediatric patients should receive a single 400-mg dose of albendazole.
Baylisascariasis. In an attempt to prevent clinical disease by killing larvae before they enter the CNS, the US Centers for Disease Control and Prevention (CDC) recommends early (with 1-3 days of possible infection) albendazole therapy at a dosage of 25-50 mg/kg daily for 10 days. Some clinicians recommend a 20-day course of albendazole therapy. Immediate treatment is recommended if infection is probable; treatment should not be delayed until the emergence of symptoms.
Enterobiasis. For the treatment of enterobiasis caused by Enterobius vermicularis (pinworm), some clinicians recommend that adult and pediatric patients receive an initial 400-mg dose of albendazole and a second 400-mg dose given 2 weeks later. Some clinicians recommend that all household contacts of patients with enterobiasis receive treatment, especially in situations in which multiple or repeated symptomatic infections occur, since such contacts commonly also are infected.
Filariasis. For the treatment of filariasis caused by Mansonella perstans, some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 400 mg twice daily for 10 days.
Hookworm Infections. For the treatment of cutaneous larva migrans (creeping eruption) caused by dog or cat hookworms, some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 400 mg once daily for 3 days.
For the treatment of intestinal hookworm infections caused by Ancylostoma duodenale or Necator americanus, some clinicians recommend that adult and pediatric patients receive a single 400-mg dose of albendazole. A repeat stool examination (using a concentration technique) for eggs of A. duodenale or N. americanus should be performed 2 weeks after treatment and the regimen should be repeated if results are positive.
For the treatment of eosinophilic enterocolitis caused by Ancylostoma caninum (dog hookworm), some clinicians recommend that adult and pediatric patients receive a single 400 mg dose of albendazole.
Toxocariasis (Visceral Larva Migrans). For the treatment of treatment of toxocariasis (visceral larva migrans) caused by dog and cat roundworms, some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 400 mg twice daily for 5 days. However, optimum duration of therapy is not known and some clinicians recommend that treatment be continued for up to 20 days.
Strongyloidiasis. For the treatment of strongyloidiasis caused by Strongyloides stercoralis (threadworm), some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 400 mg twice daily for 2 days. It may be necessary to repeat or prolong therapy or use other agents in immunocompromised individuals or those with disseminated disease.
Trichinellosis. The recommended dosage of albendazole for the treatment of trichinellosis (trichinosis) caused by Trichinella spiralis in adults and pediatric patients is 400 mg twice daily for 8-14 days.
Trichostrongyliasis. For the treatment of infections caused by Trichostrongylus, adults and pediatric patients should receive a single 400-mg dose of albendazole.
Trichuriasis. Adults and pediatric patients with trichuriasis caused by Trichuris trichiura (whipworm) should receive albendazole in a dosage of 400 mg once daily for 3 days.
Other Nematode Infections. For the treatment of capillariasis caused by Capillaria philippinensis, some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 400 mg once daily for 10 days.
Adults and pediatric patients with gnathostomiasis caused by Gnathostoma spinigerum should receive albendazole in a dosage of 400 mg twice daily for 21 days.
For the treatment of gongylonemiasis caused by Gongylonema, adults and pediatric patients should receive albendazole in a dosage of 10 mg/kg daily for 3 days.
Trematode (Fluke) Infections
For the treatment of infections caused by Clonorchis sinensis (Chinese liver fluke), some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 10 mg/kg daily given for 7 days.
Giardiasis
For the treatment of giardiasis caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis) in adults and pediatric patients, albendazole has been given in a dosage of 400 mg daily for 5 days (alone or in conjunction with metronidazole).
Microsporidiosis
For the treatment of ocular or disseminated microsporidiosis, some clinicians recommend that adults receive albendazole in a dosage of 400 mg twice daily. For the treatment of intestinal microsporidiosis caused by Encephalitozoon intestinalis, some clinicians recommend that adults receive albendazole in a dosage of 400 mg twice daily for 21 days.
Minggu, 27 Juli 2014
Dosage of Albendazole for Neurocysticercosis and Hydatid Disease.
Dosage of Albendazole for Neurocysticercosis and Hydatid Disease.
Cestode (Tapeworm) Infections
Neurocysticercosis. Because of its activity against the pork tapeworm (T. solium), albendazole therapy for the treatment of neurocysticercosis resulting from active lesions caused by Cysticercus cellulosae (the larval form of T. solium) has been associated with adverse CNS effects (e.g., seizures and/or hydrocephalus) resulting from inflammatory reactions to damaged intracerebral cysts. Therefore, patients receiving albendazole for the treatment of neurocysticercosis should receive appropriate corticosteroid and anticonvulsant therapy as required. Oral or IV corticosteroid therapy should be considered during the first week of albendazole treatment to prevent cerebral hypertension.
Although retinal cysticercosis is rare, patients with neurocysticercosis may have retinal lesions, and destruction of cysticercal lesions by albendazole may cause retinal damage. Therefore, patients should be examined for retinal lesions, and, if any are present, the need for treatment of patients with neurocysticercosis should be weighed against the possibility of retinal damage resulting from albendazole use.
For the treatment of neurocysticercosis in adults and children 6 years of age and older and weighing 60 kg or more, the usual dosage of albendazole is 400 mg given twice daily with meals for 8-30 days. For the treatment of neurocysticercosis in patients weighing less than 60 kg, the usual daily dosage of albendazole is 15 mg/kg daily (not to exceed 800 mg daily), administered as 2 equally divided doses with meals, for 8-30 days. Courses of therapy may be repeated as necessary.
Hydatid Disease. Surgery is considered the treatment of choice for hydatid disease, when medically feasible, and albendazole is administered either before or after surgery. When albendazole is used for the adjunctive perioperative treatment of hydatid disease, optimal killing of cyst contents is achieved by administering the drug in three 28-day courses of therapy, separated by two 14-day albendazole-free intervals.
For the treatment of cystic hydatid disease of the liver, lung, or peritoneum caused by the larval form of the dog tapeworm (Echinococcus granulosus) in adults or children 6 years of age and older and weighing 60 kg or more, the usual dosage of albendazole is 400 mg twice daily given with meals for 28 days, followed by a 14-day albendazole-free interval for a total of 3 dosage cycles. For patients weighing less than 60 kg, the usual dosage is 15 mg/kg daily (not to exceed 800 mg daily), administered in 2 equally divided doses with meals for 28 days, followed by a 14-day albendazole-free interval for a total of 3 dosage cycles. Some clinicians recommend that adults receive 400 mg of albendazole twice daily and that pediatric patients receive 15 mg/kg daily (not to exceed 800 mg daily) for 1-6 months for the treatment of hydatid cyst disease.
Cestode (Tapeworm) Infections
Neurocysticercosis. Because of its activity against the pork tapeworm (T. solium), albendazole therapy for the treatment of neurocysticercosis resulting from active lesions caused by Cysticercus cellulosae (the larval form of T. solium) has been associated with adverse CNS effects (e.g., seizures and/or hydrocephalus) resulting from inflammatory reactions to damaged intracerebral cysts. Therefore, patients receiving albendazole for the treatment of neurocysticercosis should receive appropriate corticosteroid and anticonvulsant therapy as required. Oral or IV corticosteroid therapy should be considered during the first week of albendazole treatment to prevent cerebral hypertension.
Although retinal cysticercosis is rare, patients with neurocysticercosis may have retinal lesions, and destruction of cysticercal lesions by albendazole may cause retinal damage. Therefore, patients should be examined for retinal lesions, and, if any are present, the need for treatment of patients with neurocysticercosis should be weighed against the possibility of retinal damage resulting from albendazole use.
For the treatment of neurocysticercosis in adults and children 6 years of age and older and weighing 60 kg or more, the usual dosage of albendazole is 400 mg given twice daily with meals for 8-30 days. For the treatment of neurocysticercosis in patients weighing less than 60 kg, the usual daily dosage of albendazole is 15 mg/kg daily (not to exceed 800 mg daily), administered as 2 equally divided doses with meals, for 8-30 days. Courses of therapy may be repeated as necessary.
Hydatid Disease. Surgery is considered the treatment of choice for hydatid disease, when medically feasible, and albendazole is administered either before or after surgery. When albendazole is used for the adjunctive perioperative treatment of hydatid disease, optimal killing of cyst contents is achieved by administering the drug in three 28-day courses of therapy, separated by two 14-day albendazole-free intervals.
For the treatment of cystic hydatid disease of the liver, lung, or peritoneum caused by the larval form of the dog tapeworm (Echinococcus granulosus) in adults or children 6 years of age and older and weighing 60 kg or more, the usual dosage of albendazole is 400 mg twice daily given with meals for 28 days, followed by a 14-day albendazole-free interval for a total of 3 dosage cycles. For patients weighing less than 60 kg, the usual dosage is 15 mg/kg daily (not to exceed 800 mg daily), administered in 2 equally divided doses with meals for 28 days, followed by a 14-day albendazole-free interval for a total of 3 dosage cycles. Some clinicians recommend that adults receive 400 mg of albendazole twice daily and that pediatric patients receive 15 mg/kg daily (not to exceed 800 mg daily) for 1-6 months for the treatment of hydatid cyst disease.
Drug Administration of Albendazole
Drug Administration of Albendazole
Albendazole is administered orally with food. Oral bioavailability of albendazole appears to be increased when the drug is administered with a fatty meal; when the drug is administered with meals containing about 40 g of fat, plasma concentrations of albendazole sulfoxide are up to 5 times higher than those observed when the drug is administered to fasting patients.
In patients who have difficulty swallowing tablets whole (particularly young children), albendazole tablets may be crushed or chewed and swallowed with a drink of water.
Albendazole may cause harm to the fetus and should be used during pregnancy only if the benefits justify the risk to the fetus and only when no alternative management is appropriate. Women of childbearing age should begin treatment only after a negative pregnancy test, and should be cautioned against becoming pregnant while receiving albendazole or within 1 month of completing treatment with the drug.
Because albendazole has been associated with mild to moderate increases of hepatic enzymes in about 16% of patients receiving the drug in clinical trials, and may cause hepatotoxicity, liver function tests should be performed prior to each course of albendazole therapy and at least every 2 weeks during treatment with the drug. If hepatic enzyme concentrations exceed twice the upper limit of normal, consideration should be given to discontinuance of the drug based on the individual patient circumstance. Decisions to reinstitute albendazole when hepatic enzymes return to pretreatment levels should be individualized taking into account the risks and benefits of further albendazole treatment. If the drug is reinstituted, laboratory tests should be performed frequently.
Leukopenia has occurred in less than 1% of patients receiving albendazole, and rarely, granulocytopenia, pancytopenia, agranulocytosis, or thrombocytopenia has been reported. Therefore, blood counts should be performed at the start of, and every 2 weeks during, each 28-day treatment cycle. Albendazole should be discontinued if clinically important decreases in blood cell counts occur.
Albendazole is administered orally with food. Oral bioavailability of albendazole appears to be increased when the drug is administered with a fatty meal; when the drug is administered with meals containing about 40 g of fat, plasma concentrations of albendazole sulfoxide are up to 5 times higher than those observed when the drug is administered to fasting patients.
In patients who have difficulty swallowing tablets whole (particularly young children), albendazole tablets may be crushed or chewed and swallowed with a drink of water.
Albendazole may cause harm to the fetus and should be used during pregnancy only if the benefits justify the risk to the fetus and only when no alternative management is appropriate. Women of childbearing age should begin treatment only after a negative pregnancy test, and should be cautioned against becoming pregnant while receiving albendazole or within 1 month of completing treatment with the drug.
Because albendazole has been associated with mild to moderate increases of hepatic enzymes in about 16% of patients receiving the drug in clinical trials, and may cause hepatotoxicity, liver function tests should be performed prior to each course of albendazole therapy and at least every 2 weeks during treatment with the drug. If hepatic enzyme concentrations exceed twice the upper limit of normal, consideration should be given to discontinuance of the drug based on the individual patient circumstance. Decisions to reinstitute albendazole when hepatic enzymes return to pretreatment levels should be individualized taking into account the risks and benefits of further albendazole treatment. If the drug is reinstituted, laboratory tests should be performed frequently.
Leukopenia has occurred in less than 1% of patients receiving albendazole, and rarely, granulocytopenia, pancytopenia, agranulocytosis, or thrombocytopenia has been reported. Therefore, blood counts should be performed at the start of, and every 2 weeks during, each 28-day treatment cycle. Albendazole should be discontinued if clinically important decreases in blood cell counts occur.
Albendazole anthelmintic for Cestode/Tapeworm Infections (Neurocysticercosis, Hydatid Disease)
Albendazole anthelmintic for Cestode/Tapeworm Infections (Neurocysticercosis, Hydatid Disease)
Albendazole ( C12H15N3O2S ) is used in the treatment of tissue infections caused by the larval forms of certain cestodes (tapeworms) including neurocysticercosis caused by ysticercus cellulosae, the larval form of Taenia solium (pork tapeworm). Albendazole also is used for the treatment of hydatid disease caused by the larval form of Echinococcus granulosus (dog tapeworm). Other anthelmintics (usually praziquantel or nitazoxanide) are used for the treatment of intestinal infections caused by adult forms of cestodes.
Neurocysticercosis
Albendazole is used for the treatment of parenchymal neurocysticercosis resulting from active lesions caused by Cysticercus cellulosae, the larval form of Taenia solium (pork tapeworm), preferably in combination with corticosteroids. Symptoms commonly associated with neurocysticercosis include headaches, seizures, or other CNS effects thought to result from expanding active cysticercal lesions or edema surrounding individual degenerating cysts in brain parenchyma. Therefore, important measures of response to antineurocysticercal therapy include resolution of CNS symptoms and radiologic response.
The manufacturer states that safety and efficacy of albendazole in patients with neurocysticercosis caused by T. solium was demonstrated by analysis of 3 sets of data, including a compilation of data from published reports of albendazole use in neurocysticercosis, data from US compassionate use patients, and data from one limited clinical study. In studies of patients with susceptible neurocysticercal lesions (i.e., nonenhancing cysts with no surrounding edema on contrast-enhanced computerized tomography) receiving albendazole, the number of cysts was reduced by 74-88%, and resolution of all active cysts occurred in 40-70% of patients. Combining two of the data sets (the report compilation and the US compassionate use data), the manufacturer states that about 41% of patients experienced a cure (no symptoms of neurocysticercosis), about 50% of patients were considered to be improved, and 9% experienced no change. Corticosteroids are used concomitantly to reduce the frequency and severity of adverse nervous system effects (CSF reaction syndrome), associated with albendazole therapy for neurocysticercosis. Anticonvulsant therapy also may be necessary.
Use of anthelmintics (albendazole or praziquantel) in the treatment of cysticercosis is controversial since efficacy has not been proven in controlled studies. Initial treatment of parenchymal disease with seizures should focus on symptomatic treatment with anticonvulsants. Obstructive hydrocephalus is treated with surgical removal of the obstructing cyst or CSF diversion and prednisone; arachnoiditis, vasculitis, or cerebral edema is treated with corticosteroids (prednisone or dexamethasone) used in conjunction with albendazole or praziquantel. Even when corticosteroids are used, any cysticercocidal drug may cause irreparable damage when used to treat ocular or spinal cysts, and ophthalmic exams should be performed before treatment to rule out intraocular cysts
Hydatid Disease
Albendazole is used for the treatment of cystic hydatid disease (unilocular hydatid disease) of the liver, lung, and peritoneum, caused by the larval form of the dog tapeworm (Echinococcus granulosus). Surgery is considered to be the treatment of choice for hydatid disease, when medically feasible, but perioperative administration of an anthelmintic drug (e.g., albendazole, mebendazole, praziquantel) may be indicated in patients undergoing surgical removal of cysts to minimize the risk of intraoperative dissemination of daughter cysts. Percutaneous drainage with ultrasound guidance plus albendazole therapy has been effective for the management of hepatic hydatid cyst disease.
Albendazole is absorbed to a greater extent, and achieves higher plasma concentrations (as its active metabolite) than mebendazole, and some clinicians consider albendazole to be a drug of choice for treatment of hydatid cyst disease caused by E. granulosus. Risks associated with surgery include operative morbidity, cyst recurrence, and anaphylaxis or dissemination of infection resulting from spillage of fluid from the cysts. Preoperative administration of albendazole may inactivate protoscolices and minimize the possibility of recurring cysts, and postoperative treatment with the drug may prevent secondary dissemination of the cestode that can occur after spontaneous or operative rupture and spillage of cyst contents. Optimal cysticidal effect of albendazole is achieved preoperatively or postoperatively when the drug is administered in three 28-day courses of therapy. Also, some clinicians have recommended administration of albendazole in patients with inoperable, widespread, or numerous E. granulosus cysts, or in patients with complex medical problems who are not eligible for surgery.
The manufacturer states that because of the low incidence of hydatid disease, safety and efficacy of albendazole in patients with hydatid disease caused by E. granulosus was demonstrated by combining data from accumulated clinical reports in small series of patients. Four sets of data were considered, including data from European compassionate use patients, an analysis of data from published studies, data from Australian compassionate use patients (not evaluable), and data from US compassionate use patients. About 80-90% of patients receiving albendazole in three 28-day cycles had noninfectious cyst contents. About 30-31% of evaluable patients with hydatid disease receiving albendazole experienced a clinical cure (i.e., disappearance of cysts), and improvement (i.e., a reduction in cyst diameter of at least 25%) was observed in about 40-42% of evaluable patients. About 24% of patients receiving albendazole experienced no change or were considered to be worse.
Although albendazole has been used to treat alveolar hydatid disease, another form of hydatid cyst disease caused by Echinococcus multilocularis, surgical excision of the larval mass is the recommended and only reliable treatment for this infection. Continuous albendazole or mebendazole therapy reportedly has been associated with clinical improvement in nonresectable cases, but the manufacturer states that efficacy of albendazole in the treatment of alveolar hydatid disease caused by E. multilocularis has not been clearly demonstrated in clinical studies.
Albendazole ( C12H15N3O2S ) is used in the treatment of tissue infections caused by the larval forms of certain cestodes (tapeworms) including neurocysticercosis caused by ysticercus cellulosae, the larval form of Taenia solium (pork tapeworm). Albendazole also is used for the treatment of hydatid disease caused by the larval form of Echinococcus granulosus (dog tapeworm). Other anthelmintics (usually praziquantel or nitazoxanide) are used for the treatment of intestinal infections caused by adult forms of cestodes.
Neurocysticercosis
Albendazole is used for the treatment of parenchymal neurocysticercosis resulting from active lesions caused by Cysticercus cellulosae, the larval form of Taenia solium (pork tapeworm), preferably in combination with corticosteroids. Symptoms commonly associated with neurocysticercosis include headaches, seizures, or other CNS effects thought to result from expanding active cysticercal lesions or edema surrounding individual degenerating cysts in brain parenchyma. Therefore, important measures of response to antineurocysticercal therapy include resolution of CNS symptoms and radiologic response.
The manufacturer states that safety and efficacy of albendazole in patients with neurocysticercosis caused by T. solium was demonstrated by analysis of 3 sets of data, including a compilation of data from published reports of albendazole use in neurocysticercosis, data from US compassionate use patients, and data from one limited clinical study. In studies of patients with susceptible neurocysticercal lesions (i.e., nonenhancing cysts with no surrounding edema on contrast-enhanced computerized tomography) receiving albendazole, the number of cysts was reduced by 74-88%, and resolution of all active cysts occurred in 40-70% of patients. Combining two of the data sets (the report compilation and the US compassionate use data), the manufacturer states that about 41% of patients experienced a cure (no symptoms of neurocysticercosis), about 50% of patients were considered to be improved, and 9% experienced no change. Corticosteroids are used concomitantly to reduce the frequency and severity of adverse nervous system effects (CSF reaction syndrome), associated with albendazole therapy for neurocysticercosis. Anticonvulsant therapy also may be necessary.
Use of anthelmintics (albendazole or praziquantel) in the treatment of cysticercosis is controversial since efficacy has not been proven in controlled studies. Initial treatment of parenchymal disease with seizures should focus on symptomatic treatment with anticonvulsants. Obstructive hydrocephalus is treated with surgical removal of the obstructing cyst or CSF diversion and prednisone; arachnoiditis, vasculitis, or cerebral edema is treated with corticosteroids (prednisone or dexamethasone) used in conjunction with albendazole or praziquantel. Even when corticosteroids are used, any cysticercocidal drug may cause irreparable damage when used to treat ocular or spinal cysts, and ophthalmic exams should be performed before treatment to rule out intraocular cysts
Hydatid Disease
Albendazole is used for the treatment of cystic hydatid disease (unilocular hydatid disease) of the liver, lung, and peritoneum, caused by the larval form of the dog tapeworm (Echinococcus granulosus). Surgery is considered to be the treatment of choice for hydatid disease, when medically feasible, but perioperative administration of an anthelmintic drug (e.g., albendazole, mebendazole, praziquantel) may be indicated in patients undergoing surgical removal of cysts to minimize the risk of intraoperative dissemination of daughter cysts. Percutaneous drainage with ultrasound guidance plus albendazole therapy has been effective for the management of hepatic hydatid cyst disease.
Albendazole is absorbed to a greater extent, and achieves higher plasma concentrations (as its active metabolite) than mebendazole, and some clinicians consider albendazole to be a drug of choice for treatment of hydatid cyst disease caused by E. granulosus. Risks associated with surgery include operative morbidity, cyst recurrence, and anaphylaxis or dissemination of infection resulting from spillage of fluid from the cysts. Preoperative administration of albendazole may inactivate protoscolices and minimize the possibility of recurring cysts, and postoperative treatment with the drug may prevent secondary dissemination of the cestode that can occur after spontaneous or operative rupture and spillage of cyst contents. Optimal cysticidal effect of albendazole is achieved preoperatively or postoperatively when the drug is administered in three 28-day courses of therapy. Also, some clinicians have recommended administration of albendazole in patients with inoperable, widespread, or numerous E. granulosus cysts, or in patients with complex medical problems who are not eligible for surgery.
The manufacturer states that because of the low incidence of hydatid disease, safety and efficacy of albendazole in patients with hydatid disease caused by E. granulosus was demonstrated by combining data from accumulated clinical reports in small series of patients. Four sets of data were considered, including data from European compassionate use patients, an analysis of data from published studies, data from Australian compassionate use patients (not evaluable), and data from US compassionate use patients. About 80-90% of patients receiving albendazole in three 28-day cycles had noninfectious cyst contents. About 30-31% of evaluable patients with hydatid disease receiving albendazole experienced a clinical cure (i.e., disappearance of cysts), and improvement (i.e., a reduction in cyst diameter of at least 25%) was observed in about 40-42% of evaluable patients. About 24% of patients receiving albendazole experienced no change or were considered to be worse.
Although albendazole has been used to treat alveolar hydatid disease, another form of hydatid cyst disease caused by Echinococcus multilocularis, surgical excision of the larval mass is the recommended and only reliable treatment for this infection. Continuous albendazole or mebendazole therapy reportedly has been associated with clinical improvement in nonresectable cases, but the manufacturer states that efficacy of albendazole in the treatment of alveolar hydatid disease caused by E. multilocularis has not been clearly demonstrated in clinical studies.
Albendazole, anthelmintic for nematode/roundworm infections (Intestinal Hookworm, Toxocariasis, Strongyloidiasis, Trichinellosis, Trichostrongyliasis, Trichuriasis,Trematode, Giardiasis, Microsporidiosis)
Albendazole, anthelmintic for nematode/roundworm infections (Intestinal Hookworm, Toxocariasis, Strongyloidiasis, Trichinellosis, Trichostrongyliasis, Trichuriasis,Trematode, Giardiasis, Microsporidiosis)
Intestinal Hookworm Infections. Albendazole is used for the treatment of intestinal hookworm infections caused by Ancylostoma duodenale or Necator americanus, and albendazole, mebendazole, or pyrantel pamoate are considered the drugs of choice for intestinal hookworm infections.
Albendazole, mebendazole, pyrantel pamoate, or endoscopic removal of worms is recommended for the treatment of eosinophilic enterocolitis caused by Ancylostoma caninum (dog hookworm).
Toxocariasis (Visceral Larva Migrans)
Albendazole is used for the treatment of toxocariasis (visceral larva migrans) caused by Toxocara canis or T. cati (dog and cat roundworms), and albendazole or mebendazole are considered the drugs of choice for these infections. In severe cases with cardiac, ocular, or CNS involvement, corticosteroids also may be indicated. Treatment may not be effective in ocular larva migrans; inflammation may be reduced by corticosteroid injections and surgery may be necessary for secondary damage.
Strongyloidiasis
Albendazole is used for the treatment of strongyloidiasiscaused by Strongyloides stercoralis (threadworm). Some clinicians consider ivermectin the drug of choice and albendazole and thiabendazole alternatives for the treatment of strongyloidiasis.
Trichinellosis
Albendazole is used for the treatment of trichinellosis (trichinosis) caused by Trichinella spiralis. Although some clinicians state that albendazole and mebendazole are equally effective for the treatment of trichinellosis, other clinicians consider mebendazole the drug of choice and albendazole the alternative agent. Use of corticosteroids in addition to the anthelmintic usually is recommended, especially when symptoms are severe. Corticosteroids alleviate symptoms of the inflammatory reaction and can be lifesaving when cardiac or CNS systems are involved.
Trichostrongyliasis
Albendazole is used in the treatment of trichostrongyliasis. Pyrantel pamoate is considered the drug of choice for the treatment of Trichostrongylus infections and albendazole and mebendazole are alternatives.
Trichuriasis
Albendazole is used as an alternative for the treatment of trichuriasis caused by Trichuris trichiura (whipworm). Mebendazole is considered the drug of choice and albendazole and ivermectin are alternatives for the treatment of trichuriasis.
Other Nematode Infections
Albendazole has been used in the treatment of capillariasis caused by Capillaria philippinensis. Mebendazole is considered the drug of choice for the treatment of capillariasis and albendazole is an alternative.
For the treatment of gnathostomiasis caused by Gnathostoma spinigerum, use of albendazole or ivermectin (with or without surgical removal) is recommended.
For the treatment of gongylonemiasis caused by Gongylonema, surgical removal or use of albendazole is recommended.
Albendazole or pyrantel pamoate may be effective for the treatment of oesophagostomiasis caused by Oesophagostomum bifurcum.
Trematode (Fluke) Infections
For the treatment of infections caused by Clonorchis sinensis (Chinese liver fluke), albendazole or praziquantel are recommended as the drugs of choice. Other anthelmintics (usually praziquantel) are recommended for all other fluke infections.
Giardiasis
Although metronidazole, tinidazole, or nitazoxanide generally are considered the drugs of choice for the treatment of giardiasis caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis), albendazole therapy alone or used in conjunction with metronidazole may be effective for the treatment of giardiasis. Albendazole may be as effective as metronidazole for treating giardiasis in pediatric patients and has fewer adverse effects.
Microsporidiosis
Albendazole has been used in the treatment of microsporidiosis. Microsporidia can cause ocular infections (Encephalitozoon hellem, E. cuniculi, Vittaforma corneae), intestinal infections (Enterocytozoon bieneusi, Encephalitozoon intestinalis), and disseminated infections (E. hellem, E. cuniculi, E. intestinalis, Pleistophora, Trachipleistophora, Brachiola vesicularum). Intestinal infections are most common in immunocompromised patients, and are being reported with increasing frequency in patients with human immunodeficiency virus (HIV) infection. Some clinicians recommend use of albendazole in conjunction with fumagillin (not commercially available in the US) for the topical treatment of ocular microsporidiosis and also consider albendazole the drug of choice for intestinal infections caused by E. intestinalis and for disseminated microsporidiosis. Although some patients with intestinal microsporidiosis caused by E. intestinalis may respond to albendazole, the organism is not eradicated in all patients and recurrence of diarrhea is common after therapy is stopped. Patients with E. bieneusi infections generally do not respond to albendazole. Topical fumagillin therapy generally is not effective for ocular lesions caused by V. corneae, and keratoplasty may be necessary.
Intestinal Hookworm Infections. Albendazole is used for the treatment of intestinal hookworm infections caused by Ancylostoma duodenale or Necator americanus, and albendazole, mebendazole, or pyrantel pamoate are considered the drugs of choice for intestinal hookworm infections.
Albendazole, mebendazole, pyrantel pamoate, or endoscopic removal of worms is recommended for the treatment of eosinophilic enterocolitis caused by Ancylostoma caninum (dog hookworm).
Toxocariasis (Visceral Larva Migrans)
Albendazole is used for the treatment of toxocariasis (visceral larva migrans) caused by Toxocara canis or T. cati (dog and cat roundworms), and albendazole or mebendazole are considered the drugs of choice for these infections. In severe cases with cardiac, ocular, or CNS involvement, corticosteroids also may be indicated. Treatment may not be effective in ocular larva migrans; inflammation may be reduced by corticosteroid injections and surgery may be necessary for secondary damage.
Strongyloidiasis
Albendazole is used for the treatment of strongyloidiasiscaused by Strongyloides stercoralis (threadworm). Some clinicians consider ivermectin the drug of choice and albendazole and thiabendazole alternatives for the treatment of strongyloidiasis.
Trichinellosis
Albendazole is used for the treatment of trichinellosis (trichinosis) caused by Trichinella spiralis. Although some clinicians state that albendazole and mebendazole are equally effective for the treatment of trichinellosis, other clinicians consider mebendazole the drug of choice and albendazole the alternative agent. Use of corticosteroids in addition to the anthelmintic usually is recommended, especially when symptoms are severe. Corticosteroids alleviate symptoms of the inflammatory reaction and can be lifesaving when cardiac or CNS systems are involved.
Trichostrongyliasis
Albendazole is used in the treatment of trichostrongyliasis. Pyrantel pamoate is considered the drug of choice for the treatment of Trichostrongylus infections and albendazole and mebendazole are alternatives.
Trichuriasis
Albendazole is used as an alternative for the treatment of trichuriasis caused by Trichuris trichiura (whipworm). Mebendazole is considered the drug of choice and albendazole and ivermectin are alternatives for the treatment of trichuriasis.
Other Nematode Infections
Albendazole has been used in the treatment of capillariasis caused by Capillaria philippinensis. Mebendazole is considered the drug of choice for the treatment of capillariasis and albendazole is an alternative.
For the treatment of gnathostomiasis caused by Gnathostoma spinigerum, use of albendazole or ivermectin (with or without surgical removal) is recommended.
For the treatment of gongylonemiasis caused by Gongylonema, surgical removal or use of albendazole is recommended.
Albendazole or pyrantel pamoate may be effective for the treatment of oesophagostomiasis caused by Oesophagostomum bifurcum.
Trematode (Fluke) Infections
For the treatment of infections caused by Clonorchis sinensis (Chinese liver fluke), albendazole or praziquantel are recommended as the drugs of choice. Other anthelmintics (usually praziquantel) are recommended for all other fluke infections.
Giardiasis
Although metronidazole, tinidazole, or nitazoxanide generally are considered the drugs of choice for the treatment of giardiasis caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis), albendazole therapy alone or used in conjunction with metronidazole may be effective for the treatment of giardiasis. Albendazole may be as effective as metronidazole for treating giardiasis in pediatric patients and has fewer adverse effects.
Microsporidiosis
Albendazole has been used in the treatment of microsporidiosis. Microsporidia can cause ocular infections (Encephalitozoon hellem, E. cuniculi, Vittaforma corneae), intestinal infections (Enterocytozoon bieneusi, Encephalitozoon intestinalis), and disseminated infections (E. hellem, E. cuniculi, E. intestinalis, Pleistophora, Trachipleistophora, Brachiola vesicularum). Intestinal infections are most common in immunocompromised patients, and are being reported with increasing frequency in patients with human immunodeficiency virus (HIV) infection. Some clinicians recommend use of albendazole in conjunction with fumagillin (not commercially available in the US) for the topical treatment of ocular microsporidiosis and also consider albendazole the drug of choice for intestinal infections caused by E. intestinalis and for disseminated microsporidiosis. Although some patients with intestinal microsporidiosis caused by E. intestinalis may respond to albendazole, the organism is not eradicated in all patients and recurrence of diarrhea is common after therapy is stopped. Patients with E. bieneusi infections generally do not respond to albendazole. Topical fumagillin therapy generally is not effective for ocular lesions caused by V. corneae, and keratoplasty may be necessary.
Albendazole, anthelmintic for Nematode/Roundworm Infections (Ascariasis, Baylisascariasis, Enterobiasis, Filariasis, Hookworm Infections)
Albendazole, anthelmintic for Nematode/Roundworm Infections (Ascariasis, Baylisascariasis, Enterobiasis, Filariasis, Hookworm Infections)
Ascariasis
Albendazole is used for the treatment of ascariasis caused by Ascaris lumbricoides. Albendazole, ivermectin, and mebendazole are considered the drugs of choice for the treatment of ascariasis.
Baylisascariasis
Albendazole has been used in a limited number of patients for the treatment of baylisascariasis caused by Baylisascaris procyonis; however, no drug has been demonstrated to be effective for the treatment of this infection. B. procyonis, a common roundworm found in the small intestine of raccoons, can cause severe or fatal encephalitis (neural larva migrans) in birds and mammals (including humans) and also can cause ocular and visceral larva migrans in humans. Since 1981, there have been at least 12 cases of severe or fatal encephalitis caused by this roundworm in the US (CA, IL, MI, MN, NY, OR, PA) and 10 of these cases occurred in children 9 months to 6 years of age; cases of B. procyonis ocular larva migrans also have been reported in the US. Humans become infected by ingesting B. procyonis eggs after contact with infected raccoon feces. Because CNS damage can occur before symptom onset, treatment of symptomatic patients with anthelmintic or anti-inflammatory agents often will not improve outcome. However, the CDC and other clinicians state that use of an anthelmintic agent (i.e., albendazole 25-50 mg/kg daily for 10-20 days) started within 1-3 days of possible infection might prevent clinical disease by killing larvae before they enter the CNS. Therefore, immediate treatment is recommended in cases of probable infection, including known exposures such as ingestion of raccoon stool or contaminated soil. Some clinicians suggest that ivermectin, mebendazole, thiabendazole, or levamisole (not commercially available in the US) could be tried if albendazole is not available. Corticosteroid therapy also may be helpful, especially in ocular and CNS infections; ocular baylisascariasis has been treated successfully using laser photocoagulation therapy to destroy the intraretinal larvae.
Enterobiasis
Albendazole is used for the treatment of enterobiasis caused by Enterobius vermicularis (pinworm). Albendazole, mebendazole, and pyrantel pamoate are considered the drugs of choice for the treatment of enterobiasis.
Filariasis
Mansonella perstans Infections. Albendazole and mebendazole are recommended as the drugs of choice for the treatment of filariasis caused by Mansonella perstans Use of antihistamines or corticosteroids may be indicated to decrease allergic reactions secondary to disintegration of microfilariae following treatment of filarial infections.
Wuchereria and Brugia Infections. Although diethylcarbamazine (available in the US from the CDC) is considered the drug of choice for the treatment of filariasis caused by Wuchereria bancrofti or Brugia malayi ivermectin has been used (with or without albendazole) for the treatment of these infections. There is some evidence that a combined regimen of a single dose of albendazole with a single dose of diethylcarbamazine or ivermectin is more effective than any one drug alone for suppression of microfilaremia caused by W. bancrofti or B. malayi. A regimen of albendazole and ivermectin has been used effectively in patients co-infected with W. bancrofti and O. volvulus.
Loiasis. Albendazole has been used to reduce microfilaremia in the treatment of loiasis caused by Loa loa Diethylcarbamazine (available in the US from the CDC) usually is considered the drug of choice for Loa loa infections. Albendazole may be useful for treatment of loiasis when diethylcarbamazine is ineffective or cannot be used, but repeated courses may be necessary. Because rapid killing of microfilariae may provoke encephalopathy, albendazole may be the preferred alternative (rather than ivermectin) because of its slower onset of action.
Hookworm Infections
Cutaneous Larva Migrans. Albendazole is used for the treatment of cutaneous larva migrans (creeping eruption) caused by dog and cat hookworms. Although cutaneous larva migrans usually is self-limited with spontaneous cure after several weeks or months, albendazole, ivermectin, or topical thiabendazole are considered the drugs of choice when treatment is indicated.
Ascariasis
Albendazole is used for the treatment of ascariasis caused by Ascaris lumbricoides. Albendazole, ivermectin, and mebendazole are considered the drugs of choice for the treatment of ascariasis.
Baylisascariasis
Albendazole has been used in a limited number of patients for the treatment of baylisascariasis caused by Baylisascaris procyonis; however, no drug has been demonstrated to be effective for the treatment of this infection. B. procyonis, a common roundworm found in the small intestine of raccoons, can cause severe or fatal encephalitis (neural larva migrans) in birds and mammals (including humans) and also can cause ocular and visceral larva migrans in humans. Since 1981, there have been at least 12 cases of severe or fatal encephalitis caused by this roundworm in the US (CA, IL, MI, MN, NY, OR, PA) and 10 of these cases occurred in children 9 months to 6 years of age; cases of B. procyonis ocular larva migrans also have been reported in the US. Humans become infected by ingesting B. procyonis eggs after contact with infected raccoon feces. Because CNS damage can occur before symptom onset, treatment of symptomatic patients with anthelmintic or anti-inflammatory agents often will not improve outcome. However, the CDC and other clinicians state that use of an anthelmintic agent (i.e., albendazole 25-50 mg/kg daily for 10-20 days) started within 1-3 days of possible infection might prevent clinical disease by killing larvae before they enter the CNS. Therefore, immediate treatment is recommended in cases of probable infection, including known exposures such as ingestion of raccoon stool or contaminated soil. Some clinicians suggest that ivermectin, mebendazole, thiabendazole, or levamisole (not commercially available in the US) could be tried if albendazole is not available. Corticosteroid therapy also may be helpful, especially in ocular and CNS infections; ocular baylisascariasis has been treated successfully using laser photocoagulation therapy to destroy the intraretinal larvae.
Enterobiasis
Albendazole is used for the treatment of enterobiasis caused by Enterobius vermicularis (pinworm). Albendazole, mebendazole, and pyrantel pamoate are considered the drugs of choice for the treatment of enterobiasis.
Filariasis
Mansonella perstans Infections. Albendazole and mebendazole are recommended as the drugs of choice for the treatment of filariasis caused by Mansonella perstans Use of antihistamines or corticosteroids may be indicated to decrease allergic reactions secondary to disintegration of microfilariae following treatment of filarial infections.
Wuchereria and Brugia Infections. Although diethylcarbamazine (available in the US from the CDC) is considered the drug of choice for the treatment of filariasis caused by Wuchereria bancrofti or Brugia malayi ivermectin has been used (with or without albendazole) for the treatment of these infections. There is some evidence that a combined regimen of a single dose of albendazole with a single dose of diethylcarbamazine or ivermectin is more effective than any one drug alone for suppression of microfilaremia caused by W. bancrofti or B. malayi. A regimen of albendazole and ivermectin has been used effectively in patients co-infected with W. bancrofti and O. volvulus.
Loiasis. Albendazole has been used to reduce microfilaremia in the treatment of loiasis caused by Loa loa Diethylcarbamazine (available in the US from the CDC) usually is considered the drug of choice for Loa loa infections. Albendazole may be useful for treatment of loiasis when diethylcarbamazine is ineffective or cannot be used, but repeated courses may be necessary. Because rapid killing of microfilariae may provoke encephalopathy, albendazole may be the preferred alternative (rather than ivermectin) because of its slower onset of action.
Hookworm Infections
Cutaneous Larva Migrans. Albendazole is used for the treatment of cutaneous larva migrans (creeping eruption) caused by dog and cat hookworms. Although cutaneous larva migrans usually is self-limited with spontaneous cure after several weeks or months, albendazole, ivermectin, or topical thiabendazole are considered the drugs of choice when treatment is indicated.
Amoxicillin : Precautions, Contraindications, pregnancy, lactation
Amoxicillin : Precautions, Contraindications, pregnancy, lactation
Amoxicillin shares the toxic potentials of the penicillins, including the risk of hypersensitivity reactions, and the usual precautions of penicillin therapy should be observed. Prior to initiation of therapy with amoxicillin, careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens. There is clinical and laboratory evidence of partial cross-allergenicity among penicillins and other -lactam antibiotics including cephalosporins and cephamycins. Amoxicillin is contraindicated in patients who are hypersensitive to any penicillin.
Because a high percentage of patients with infectious mononucleosis have developed rash during therapy with aminopenicillins, amoxicillin probably should not be used in patients with the disease.
Individuals with phenylketonuria (i.e., homozygous genetic deficiency of phenylalanine hydroxylase) and other individuals who must restrict their intake of phenylalanine should be warned that the amoxicillin 200- and 400-mg chewable tablets contain aspartame which is metabolized in the GI tract to provide 1.82 or 3.64 mg of phenylalanine, respectively, following oral administration. Amoxicillin powder for oral suspension does not contain aspartame.
Renal, hepatic, and hematologic systems should be evaluated periodically during prolonged therapy with amoxicillin.
Pregnancy
Safe use of amoxicillin during pregnancy has not been definitely established. There are no adequate or controlled studies using aminopenicillins in pregnant women, and amoxicillin should be used during pregnancy only when clearly needed. However, amoxicillin has been administered to pregnant women without evidence of adverse effects to the fetus. In addition, use of the drug is currently included in the US Centers For Disease Control and Prevention (CDC) recommendations for the treatment of chlamydial infections during pregnancy and CDC recommendations for the treatment of cutaneous anthrax or for postexposure prophylaxis following exposure to Bacillus anthracis spores.
Lactation
Because amoxicillin is distributed into milk and may lead to sensitization of infants, the drug should be used with caution in nursing women. Because of its general safety in infants, the CDC states that amoxicillin is an option for anti-infective prophylaxis in breast-feeding women when B. anthracis is known to be penicillin susceptible and there is no contraindication to maternal amoxicillin use.
Amoxicillin shares the toxic potentials of the penicillins, including the risk of hypersensitivity reactions, and the usual precautions of penicillin therapy should be observed. Prior to initiation of therapy with amoxicillin, careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens. There is clinical and laboratory evidence of partial cross-allergenicity among penicillins and other -lactam antibiotics including cephalosporins and cephamycins. Amoxicillin is contraindicated in patients who are hypersensitive to any penicillin.
Because a high percentage of patients with infectious mononucleosis have developed rash during therapy with aminopenicillins, amoxicillin probably should not be used in patients with the disease.
Individuals with phenylketonuria (i.e., homozygous genetic deficiency of phenylalanine hydroxylase) and other individuals who must restrict their intake of phenylalanine should be warned that the amoxicillin 200- and 400-mg chewable tablets contain aspartame which is metabolized in the GI tract to provide 1.82 or 3.64 mg of phenylalanine, respectively, following oral administration. Amoxicillin powder for oral suspension does not contain aspartame.
Renal, hepatic, and hematologic systems should be evaluated periodically during prolonged therapy with amoxicillin.
Pregnancy
Safe use of amoxicillin during pregnancy has not been definitely established. There are no adequate or controlled studies using aminopenicillins in pregnant women, and amoxicillin should be used during pregnancy only when clearly needed. However, amoxicillin has been administered to pregnant women without evidence of adverse effects to the fetus. In addition, use of the drug is currently included in the US Centers For Disease Control and Prevention (CDC) recommendations for the treatment of chlamydial infections during pregnancy and CDC recommendations for the treatment of cutaneous anthrax or for postexposure prophylaxis following exposure to Bacillus anthracis spores.
Lactation
Because amoxicillin is distributed into milk and may lead to sensitization of infants, the drug should be used with caution in nursing women. Because of its general safety in infants, the CDC states that amoxicillin is an option for anti-infective prophylaxis in breast-feeding women when B. anthracis is known to be penicillin susceptible and there is no contraindication to maternal amoxicillin use.
Spectrum, absorbtion, chemistry, and stability of amoxicillin
Spectrum, absorbtion, chemistry, and stability of amoxicillin
Spectrum
Based on its spectrum of activity, amoxicillin is classified as an aminopenicillin. amoxicillin are active in vitro against most gram-positive and gram-negative aerobic cocci (except penicillinase-producing strains), some gram-positive aerobic and anaerobic bacilli, and some spirochetes. The drugs are also active in vitro against some gram-negative aerobic and anaerobic bacilli. amoxicillin are inactive against Mycoplasma, Rickettsia, fungi, and viruses.
Amoxicillin generally has the same spectrum of activity and the same level of activity against susceptible organisms as ampicillin; however, amoxicillin is more active in vitro on a weight basis than ampicillin against enterococci and Salmonella but less active than ampicillin against Shigella and Enterobacter.
Absorption
Amoxicillin is generally stable in the presence of acidic gastric secretions, and 74-92% of a single oral dose of the drug is absorbed from the GI tract. Amoxicillin is more completely absorbed from the GI tract than is ampicillin, and peak serum concentrations of amoxicillin are generally 2-2.5 times higher than those attained with an equivalent oral dose of ampicillin. As oral dosage of amoxicillin is increased, the fraction of the dose absorbed from the GI tract decreases only slightly and peak serum concentrations and areas under the serum concentration-time curves (AUCs) increase linearly with increasing dosage.
Peak serum concentrations are usually reached 1-2 hours after oral administration of amoxicillin capsules, film-coated tablets, chewable tablets, or oral suspension in fasting and nonfasting adults. Following oral administration of a single 250- or 500-mg dose of amoxicillin, peak serum concentrations range from 3.5-5 or 5.5-11 mcg/mL, respectively. In one study in healthy, fasting adults who received a single 500-mg oral dose of amoxicillin, serum concentrations of the drug averaged 3.3, 6.7, 9.3, 5.8, and 0.6 mcg/mL at 30 minutes, 1 hour, 2 hours, 3 hours, and 4 hours, respectively, after the dose. The manufacturer states that serum concentrations attained following administration of 125- or 250-mg chewable tablets are similar to those attained when the same dose is given as the oral suspension containing 125 or 250 mg of the drug per 5 mL. In healthy adults who received a single 400-mg dose of amoxicillin given as a 400-mg chewable tablet or the oral suspension containing 400 mg of the drug per 5 mL (dose given at the start of a light meal), peak serum concentrations were attained approximately 1 hour after the dose and averaged 5.18 or 5.92 mcg/mL, respectively, and AUC averaged 17.9 or 17.1 mcg•hr/mL, respectively.
In one study in children 4-45 months of age receiving amoxicillin oral suspension in a dosage of 15 mg/kg daily, serum amoxicillin concentrations ranged from 2.4-8.5, 1.9-11.3, 1.7-6.4, 0.17-1.9, and 0.14-3.3 mcg/mL at 30 minutes, 1 hour, 2 hours, 4 hours, and 6 hours, respectively, after a dose.
Although presence of food in the GI tract reportedly results in lower and delayed peak serum concentrations of amoxicillin, the total amount of drug absorbed does not appear to be affected.
Chemistry
Amoxicillin is an aminopenicillin which differs structurally from ampicillin only in the addition of an hydroxyl group on the phenyl ring.
Amoxicillin is commercially available as the trihydrate. Potency of amoxicillin trihydrate is calculated on the anhydrous basis. Amoxicillin occurs as a white, practically odorless, crystalline powder and is sparingly soluble in water. When reconstituted as directed, amoxicillin oral suspensions have a pH of 5-7.5.
Amoxicillin is commercially available for oral administration as capsules, film-coated tablets, chewable tablets, or powder for oral suspension. Amoxicillin also is commercially available for oral administration in fixed-ratio combinations with clavulanate potassium.
Each 125-, 200-, 250-, or 400-mg amoxicillin chewable tablet contains 0.0019 mEq (0.044 mg), 0.0005 mEq (0.0107 mg), 0.0037 mEq (0.085 mg), or 0.0009 mEq (0.0215 mg) of sodium, respectively. The 200- and 400-mg chewable tablets contain aspartame which is metabolized in the GI tract to provide 1.82 or 3.64 mg of phenylalanine, respectively, following oral administration.
Stability
Amoxicillin capsules, 125- and 250-mg chewable tablets, and powder for oral suspension should be stored in tight containers at 20C or lower; amoxicillin 200- and 400-mg chewable tablets and amoxicillin film-coated tablets should be stored in tight containers at 25C or lower.
Following reconstitution, amoxicillin oral suspensions should preferably be refrigerated at 2-8C, but refrigeration is not necessary and the suspensions are stable for 14 days at room temperature or 2-8C.
Spectrum
Based on its spectrum of activity, amoxicillin is classified as an aminopenicillin. amoxicillin are active in vitro against most gram-positive and gram-negative aerobic cocci (except penicillinase-producing strains), some gram-positive aerobic and anaerobic bacilli, and some spirochetes. The drugs are also active in vitro against some gram-negative aerobic and anaerobic bacilli. amoxicillin are inactive against Mycoplasma, Rickettsia, fungi, and viruses.
Amoxicillin generally has the same spectrum of activity and the same level of activity against susceptible organisms as ampicillin; however, amoxicillin is more active in vitro on a weight basis than ampicillin against enterococci and Salmonella but less active than ampicillin against Shigella and Enterobacter.
Absorption
Amoxicillin is generally stable in the presence of acidic gastric secretions, and 74-92% of a single oral dose of the drug is absorbed from the GI tract. Amoxicillin is more completely absorbed from the GI tract than is ampicillin, and peak serum concentrations of amoxicillin are generally 2-2.5 times higher than those attained with an equivalent oral dose of ampicillin. As oral dosage of amoxicillin is increased, the fraction of the dose absorbed from the GI tract decreases only slightly and peak serum concentrations and areas under the serum concentration-time curves (AUCs) increase linearly with increasing dosage.
Peak serum concentrations are usually reached 1-2 hours after oral administration of amoxicillin capsules, film-coated tablets, chewable tablets, or oral suspension in fasting and nonfasting adults. Following oral administration of a single 250- or 500-mg dose of amoxicillin, peak serum concentrations range from 3.5-5 or 5.5-11 mcg/mL, respectively. In one study in healthy, fasting adults who received a single 500-mg oral dose of amoxicillin, serum concentrations of the drug averaged 3.3, 6.7, 9.3, 5.8, and 0.6 mcg/mL at 30 minutes, 1 hour, 2 hours, 3 hours, and 4 hours, respectively, after the dose. The manufacturer states that serum concentrations attained following administration of 125- or 250-mg chewable tablets are similar to those attained when the same dose is given as the oral suspension containing 125 or 250 mg of the drug per 5 mL. In healthy adults who received a single 400-mg dose of amoxicillin given as a 400-mg chewable tablet or the oral suspension containing 400 mg of the drug per 5 mL (dose given at the start of a light meal), peak serum concentrations were attained approximately 1 hour after the dose and averaged 5.18 or 5.92 mcg/mL, respectively, and AUC averaged 17.9 or 17.1 mcg•hr/mL, respectively.
In one study in children 4-45 months of age receiving amoxicillin oral suspension in a dosage of 15 mg/kg daily, serum amoxicillin concentrations ranged from 2.4-8.5, 1.9-11.3, 1.7-6.4, 0.17-1.9, and 0.14-3.3 mcg/mL at 30 minutes, 1 hour, 2 hours, 4 hours, and 6 hours, respectively, after a dose.
Although presence of food in the GI tract reportedly results in lower and delayed peak serum concentrations of amoxicillin, the total amount of drug absorbed does not appear to be affected.
Chemistry
Amoxicillin is an aminopenicillin which differs structurally from ampicillin only in the addition of an hydroxyl group on the phenyl ring.
Amoxicillin is commercially available as the trihydrate. Potency of amoxicillin trihydrate is calculated on the anhydrous basis. Amoxicillin occurs as a white, practically odorless, crystalline powder and is sparingly soluble in water. When reconstituted as directed, amoxicillin oral suspensions have a pH of 5-7.5.
Amoxicillin is commercially available for oral administration as capsules, film-coated tablets, chewable tablets, or powder for oral suspension. Amoxicillin also is commercially available for oral administration in fixed-ratio combinations with clavulanate potassium.
Each 125-, 200-, 250-, or 400-mg amoxicillin chewable tablet contains 0.0019 mEq (0.044 mg), 0.0005 mEq (0.0107 mg), 0.0037 mEq (0.085 mg), or 0.0009 mEq (0.0215 mg) of sodium, respectively. The 200- and 400-mg chewable tablets contain aspartame which is metabolized in the GI tract to provide 1.82 or 3.64 mg of phenylalanine, respectively, following oral administration.
Stability
Amoxicillin capsules, 125- and 250-mg chewable tablets, and powder for oral suspension should be stored in tight containers at 20C or lower; amoxicillin 200- and 400-mg chewable tablets and amoxicillin film-coated tablets should be stored in tight containers at 25C or lower.
Following reconstitution, amoxicillin oral suspensions should preferably be refrigerated at 2-8C, but refrigeration is not necessary and the suspensions are stable for 14 days at room temperature or 2-8C.
Special dosage of amoxicillin for acute otitis media, gonorrhea, lyme disease, H.pylori
Special dosage of amoxicillin for acute otitis media, gonorrhea, lyme disease, H.pylori
Acute Otitis Media
For the treatment of uncomplicated acute otitis media (AOM), the recommended dosage of amoxicillin is 80-90 mg/kg daily given in 2 or 3 divided doses. The drug usually is given for 10 days, but the optimal duration of therapy is uncertain.2550 The American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) recommend that a 10-day regimen be used for treatment of AOM in children younger than 6 years of age and in those with severe disease, but that a duration of 5-7 days may be appropriate in those 6 years of age or older with mild to moderate AOM.
Although amoxicillin has been given in a dosage of 40-45 mg/kg daily for 10 days for the treatment of AOM, the AAP, AAFP, US Centers for Disease Control and Prevention (CDC), and others recommend use of the higher amoxicillin dosage. The higher amoxicillin dosage (80-90 mg/kg daily) is especially important in patients with AOM known or suspected of being caused by Streptococcus pneumoniae with reduced susceptibility to penicillins and in patients with a history of anti-infective treatment of AOM within the previous few months.
Gonorrhea and Associated Infections
Some manufacturers state that adults and children weighing 40 kg or more may receive a single 3-g oral dose of amoxicillin for the treatment of acute, uncomplicated gonorrhea caused by susceptible nonpenicillinase-producing N. gonorrhoeae. and that children weighing less than 40 kg who are 2 years of age or older may receive a single 50-mg/kg (maximum 3 g) dose of oral amoxicillin given with a single 25-mg/kg (up to 1 g) oral dose of probenecid. However, penicillins are no longer included in CDC recommendations for the treatment of gonorrhea.
Lyme Disease
The Infectious Diseases Society of America (IDSA), AAP, and other clinicians consider amoxicillin a drug of choice for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of neurologic involvement or third-degree atrioventricular (AV) heart block. Amoxicillin is preferred for the treatment of early Lyme disease in pregnant or lactating women and in children younger than 8 years of age.
For the treatment of mild Lyme carditis manifested by first- or second-degree AV heart block, amoxicillin 500 mg 3 times daily for 14-21 days is recommended in adults; children younger than 8 years of age should receive amoxicillin 50 mg/kg daily in 3 divided doses (maximum dose: 500 mg).
For the treatment of Lyme arthritis without associated neurologic disease, amoxicillin 500 mg 3 times daily for 28 days is recommended in adults; children should receive amoxicillin 50 mg/kg daily (maximum: 1.5 g daily). For the treatment of early localized or early disseminated Lyme disease associated with erythema migrans in adults, amoxicillin 500 mg 3 times daily for 14-21 days is recommended; children younger than 8 years of age should receive amoxicillin 50 mg/kg daily (maximum: 1.5 g daily) in 3 divided doses.
Helicobacter pylori Infection
For the treatment of Helicobacter pylori (formerly Campylobacter pylori or C. pyloridis) infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer) in adults, the recommended dosage of amoxicillin is 1 g twice daily in combination with clarithromycin (500 mg twice daily) and lansoprazole (30 mg twice daily) for 14 days (triple therapy). When used in combination with clarithromycin (500 mg twice daily) and omeprazole (20 mg twice daily) for the treatment of H. pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer), the recommended dosage of amoxicillin is 1 g twice daily for 10 days (triple therapy). An additional 18 days of omeprazole monotherapy is recommended for ulcer healing and symptom relief in patients with an active duodenal ulcer at the time therapy is initiated.
For the treatment of H. pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer) in adults who are either allergic to or intolerant of clarithromycin or in whom resistance to clarithromycin is known or suspected, the recommended dosage of amoxicillin is 1 g 3 times daily in combination with lansoprazole 30 mg 3 times daily for 14 days (dual therapy).
When amoxicillin has been used in other multiple-drug regimens for the treatment of H. pylori infection and peptic ulcer disease in combination with at least one other agent that has activity against H. pylori, oral dosages of 500 mg 3 or 4 times daily (or 1 g 2 or 3 times daily) generally have been used; higher dosages of amoxicillin in such regimens reportedly have not been associated with improved results. Studies in which H. pylori was eradicated successfully generally have employed regimens consisting of a bismuth salt (e.g., bismuth subsalicylate), a nitroimidazole anti-infective (e.g., metronidazole), and another anti-infective agent (e.g., amoxicillin, tetracycline) or combined therapy with a proton-pump inhibitor (e.g., lansoprazole, omeprazole) and 1 or 2 anti-infective agents (e.g., clarithromycin, amoxicillin).
In a limited number of children with H. pylori-associated peptic ulcer disease (e.g., gastritis, duodenitis/ duodenal ulcer), oral amoxicillin 25-50 mg/kg daily in divided doses (e.g., 250-500 mg 3 times daily) has been administered as part of multiple-drug regimens that included a nitroimidazole anti-infective (e.g., metronidazole) and/or a bismuth salt (e.g., bismuth subsalicylate). Further study is needed to establish an optimal drug regimen for treatment of H. pylori infection in children.
Acute Otitis Media
For the treatment of uncomplicated acute otitis media (AOM), the recommended dosage of amoxicillin is 80-90 mg/kg daily given in 2 or 3 divided doses. The drug usually is given for 10 days, but the optimal duration of therapy is uncertain.2550 The American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) recommend that a 10-day regimen be used for treatment of AOM in children younger than 6 years of age and in those with severe disease, but that a duration of 5-7 days may be appropriate in those 6 years of age or older with mild to moderate AOM.
Although amoxicillin has been given in a dosage of 40-45 mg/kg daily for 10 days for the treatment of AOM, the AAP, AAFP, US Centers for Disease Control and Prevention (CDC), and others recommend use of the higher amoxicillin dosage. The higher amoxicillin dosage (80-90 mg/kg daily) is especially important in patients with AOM known or suspected of being caused by Streptococcus pneumoniae with reduced susceptibility to penicillins and in patients with a history of anti-infective treatment of AOM within the previous few months.
Gonorrhea and Associated Infections
Some manufacturers state that adults and children weighing 40 kg or more may receive a single 3-g oral dose of amoxicillin for the treatment of acute, uncomplicated gonorrhea caused by susceptible nonpenicillinase-producing N. gonorrhoeae. and that children weighing less than 40 kg who are 2 years of age or older may receive a single 50-mg/kg (maximum 3 g) dose of oral amoxicillin given with a single 25-mg/kg (up to 1 g) oral dose of probenecid. However, penicillins are no longer included in CDC recommendations for the treatment of gonorrhea.
Lyme Disease
The Infectious Diseases Society of America (IDSA), AAP, and other clinicians consider amoxicillin a drug of choice for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of neurologic involvement or third-degree atrioventricular (AV) heart block. Amoxicillin is preferred for the treatment of early Lyme disease in pregnant or lactating women and in children younger than 8 years of age.
For the treatment of mild Lyme carditis manifested by first- or second-degree AV heart block, amoxicillin 500 mg 3 times daily for 14-21 days is recommended in adults; children younger than 8 years of age should receive amoxicillin 50 mg/kg daily in 3 divided doses (maximum dose: 500 mg).
For the treatment of Lyme arthritis without associated neurologic disease, amoxicillin 500 mg 3 times daily for 28 days is recommended in adults; children should receive amoxicillin 50 mg/kg daily (maximum: 1.5 g daily). For the treatment of early localized or early disseminated Lyme disease associated with erythema migrans in adults, amoxicillin 500 mg 3 times daily for 14-21 days is recommended; children younger than 8 years of age should receive amoxicillin 50 mg/kg daily (maximum: 1.5 g daily) in 3 divided doses.
Helicobacter pylori Infection
For the treatment of Helicobacter pylori (formerly Campylobacter pylori or C. pyloridis) infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer) in adults, the recommended dosage of amoxicillin is 1 g twice daily in combination with clarithromycin (500 mg twice daily) and lansoprazole (30 mg twice daily) for 14 days (triple therapy). When used in combination with clarithromycin (500 mg twice daily) and omeprazole (20 mg twice daily) for the treatment of H. pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer), the recommended dosage of amoxicillin is 1 g twice daily for 10 days (triple therapy). An additional 18 days of omeprazole monotherapy is recommended for ulcer healing and symptom relief in patients with an active duodenal ulcer at the time therapy is initiated.
For the treatment of H. pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer) in adults who are either allergic to or intolerant of clarithromycin or in whom resistance to clarithromycin is known or suspected, the recommended dosage of amoxicillin is 1 g 3 times daily in combination with lansoprazole 30 mg 3 times daily for 14 days (dual therapy).
When amoxicillin has been used in other multiple-drug regimens for the treatment of H. pylori infection and peptic ulcer disease in combination with at least one other agent that has activity against H. pylori, oral dosages of 500 mg 3 or 4 times daily (or 1 g 2 or 3 times daily) generally have been used; higher dosages of amoxicillin in such regimens reportedly have not been associated with improved results. Studies in which H. pylori was eradicated successfully generally have employed regimens consisting of a bismuth salt (e.g., bismuth subsalicylate), a nitroimidazole anti-infective (e.g., metronidazole), and another anti-infective agent (e.g., amoxicillin, tetracycline) or combined therapy with a proton-pump inhibitor (e.g., lansoprazole, omeprazole) and 1 or 2 anti-infective agents (e.g., clarithromycin, amoxicillin).
In a limited number of children with H. pylori-associated peptic ulcer disease (e.g., gastritis, duodenitis/ duodenal ulcer), oral amoxicillin 25-50 mg/kg daily in divided doses (e.g., 250-500 mg 3 times daily) has been administered as part of multiple-drug regimens that included a nitroimidazole anti-infective (e.g., metronidazole) and/or a bismuth salt (e.g., bismuth subsalicylate). Further study is needed to establish an optimal drug regimen for treatment of H. pylori infection in children.
Special dosage of amoxicillin for endocarditis, anthrax, and chlamydial infections
Special dosage of amoxicillin for endocarditis, anthrax, and chlamydial infections
Prevention of Bacterial Endocarditis
When selecting anti-infectives for the prevention of bacterial endocarditis, the current recommendations published by the American Heart Association (AHA) should be consulted.
When an oral regimen is used for prevention of bacterial endocarditis in patients at high or moderate risk undergoing certain dental procedures or minor upper respiratory tract surgery or instrumentation the AHA, American Dental Association (ADA), and others currently recommend that adults receive a single 2-g dose of oral amoxicillin and children receive a single 50-mg/kg dose of oral amoxicillin given 1 hour prior to the procedure. Pediatric dosage should not exceed adult dosage. Previous recommendations for prophylaxis of bacterial endocarditis in patients undergoing dental or minor upper respiratory tract procedures included use of a 2-dose regimen of amoxicillin (3 g given 1 hour prior to the procedure and 1.5 g given 6 hours later). However, because recent comparisons of these dosing schedules indicate that a single 2-g dose of amoxicillin results in adequate serum concentrations for several hours and causes fewer adverse GI effects than the previously recommended regimen, recommended dosage was lowered and the second dose is no longer considered necessary.
For prevention of enterococcal endocarditis in patients at high or moderate risk undergoing certain GI, biliary tract, or genitourinary tract surgery or instrumentation use of a 2-dose parenteral regimen is recommended for most patients; however, the AHA and others state that a single-dose regimen of parenteral ampicillin or oral amoxicillin can be considered for those with cardiac conditions that put them only at moderate risk of enterococcal endocarditis. If the single-dose amoxicillin regimen is used for prophylaxis of enterococcal endocarditis in patients at moderate risk, the AHA and others recommend that adults receive a single 2-g dose of oral amoxicillin and children receive a single 50-mg/kg dose of oral amoxicillin given 1 hour prior to the procedure. When a 2-dose regimen is used for prophylaxis of enterococcal endocarditis in patients at high or moderate risk, the first dose should consist of IM or IV ampicillin (2 g in adults or 50 mg/kg in children) given in conjunction with IM or IV gentamicin (1.5 mg/kg) and administered within 30 minutes of starting the procedure; the second dose administered 6 hours later can consist of IM or IV ampicillin (1 g in adults or 25 mg/kg in children) or, alternatively, oral amoxicillin (1 g in adults or 25 mg/kg in children). Pediatric dosage should not exceed adult dosage.
Anthrax
If oral amoxicillin is used as an alternative agent for postexposure prophylaxis following suspected or confirmed exposure to aerosolized anthrax spores (inhalational anthrax) or for the treatment of anthrax when a parenteral regimen is not available (e.g., when there are supply or logistic problems because large numbers of individuals require treatment in a mass casualty setting), the CDC and other experts (e.g., US Working Group on Civilian Biodefense) recommend that adults receive 500 mg 3 times daily and that children receive 80 mg/kg daily (maximum 1.5 mg daily) given in 3 divided doses at 8-hour intervals. Anti-infective postexposure prophylaxis should be continued until exposure to B. anthracis has been excluded. If exposure is confirmed, postexposure vaccination with anthrax vaccine (if available) may be indicated in conjunction with prophylaxis. Because of the possible persistence of anthrax spores in lung tissue following an aerosol exposure, the CDC and other experts recommend that postexposure prophylaxis be continued for 60 days.
If oral amoxicillin is used as an alternative for the treatment of mild, uncomplicated cutaneous anthrax caused by susceptible Bacillus anthracis, the CDC and other experts (e.g., US Working Group on Civilian Biodefense) recommend that adults receive 500 mg 3 times daily and that children receive 80 mg/kg daily (maximum 1.5 mg daily) given in 3 divided doses at 8-hour intervals. Cutaneous anthrax in infants and children younger than 2 years of age should be treated initially IV. Although 5-10 days of anti-infective therapy may be adequate for the treatment of mild, uncomplicated cutaneous anthrax that occurs as the result of natural or endemic exposures to anthrax, the CDC and other experts recommend that therapy be continued for 60 days if the cutaneous infection occurred as the result of exposure to aerosolized anthrax spores since the possibility of inhalational anthrax would also exist. Anti-infective therapy may limit the size of the cutaneous anthrax lesion and it usually becomes sterile within the first 24 hours of treatment, but the lesion will still progress through the black eschar stage despite effective treatment.
Chlamydial and Mycoplasmal Infections
For the treatment of chlamydial urogenital infections during pregnancy, the recommended dosage of oral amoxicillin is 500 mg 3 times daily for 7-10 days. Experience with oral amoxicillin therapy in this infection is limited and the drug may not be highly efficacious. Therefore, the CDC recommends that repeat testing (preferably by culture) should be performed 3 weeks after treatment is completed.
Prevention of Bacterial Endocarditis
When selecting anti-infectives for the prevention of bacterial endocarditis, the current recommendations published by the American Heart Association (AHA) should be consulted.
When an oral regimen is used for prevention of bacterial endocarditis in patients at high or moderate risk undergoing certain dental procedures or minor upper respiratory tract surgery or instrumentation the AHA, American Dental Association (ADA), and others currently recommend that adults receive a single 2-g dose of oral amoxicillin and children receive a single 50-mg/kg dose of oral amoxicillin given 1 hour prior to the procedure. Pediatric dosage should not exceed adult dosage. Previous recommendations for prophylaxis of bacterial endocarditis in patients undergoing dental or minor upper respiratory tract procedures included use of a 2-dose regimen of amoxicillin (3 g given 1 hour prior to the procedure and 1.5 g given 6 hours later). However, because recent comparisons of these dosing schedules indicate that a single 2-g dose of amoxicillin results in adequate serum concentrations for several hours and causes fewer adverse GI effects than the previously recommended regimen, recommended dosage was lowered and the second dose is no longer considered necessary.
For prevention of enterococcal endocarditis in patients at high or moderate risk undergoing certain GI, biliary tract, or genitourinary tract surgery or instrumentation use of a 2-dose parenteral regimen is recommended for most patients; however, the AHA and others state that a single-dose regimen of parenteral ampicillin or oral amoxicillin can be considered for those with cardiac conditions that put them only at moderate risk of enterococcal endocarditis. If the single-dose amoxicillin regimen is used for prophylaxis of enterococcal endocarditis in patients at moderate risk, the AHA and others recommend that adults receive a single 2-g dose of oral amoxicillin and children receive a single 50-mg/kg dose of oral amoxicillin given 1 hour prior to the procedure. When a 2-dose regimen is used for prophylaxis of enterococcal endocarditis in patients at high or moderate risk, the first dose should consist of IM or IV ampicillin (2 g in adults or 50 mg/kg in children) given in conjunction with IM or IV gentamicin (1.5 mg/kg) and administered within 30 minutes of starting the procedure; the second dose administered 6 hours later can consist of IM or IV ampicillin (1 g in adults or 25 mg/kg in children) or, alternatively, oral amoxicillin (1 g in adults or 25 mg/kg in children). Pediatric dosage should not exceed adult dosage.
Anthrax
If oral amoxicillin is used as an alternative agent for postexposure prophylaxis following suspected or confirmed exposure to aerosolized anthrax spores (inhalational anthrax) or for the treatment of anthrax when a parenteral regimen is not available (e.g., when there are supply or logistic problems because large numbers of individuals require treatment in a mass casualty setting), the CDC and other experts (e.g., US Working Group on Civilian Biodefense) recommend that adults receive 500 mg 3 times daily and that children receive 80 mg/kg daily (maximum 1.5 mg daily) given in 3 divided doses at 8-hour intervals. Anti-infective postexposure prophylaxis should be continued until exposure to B. anthracis has been excluded. If exposure is confirmed, postexposure vaccination with anthrax vaccine (if available) may be indicated in conjunction with prophylaxis. Because of the possible persistence of anthrax spores in lung tissue following an aerosol exposure, the CDC and other experts recommend that postexposure prophylaxis be continued for 60 days.
If oral amoxicillin is used as an alternative for the treatment of mild, uncomplicated cutaneous anthrax caused by susceptible Bacillus anthracis, the CDC and other experts (e.g., US Working Group on Civilian Biodefense) recommend that adults receive 500 mg 3 times daily and that children receive 80 mg/kg daily (maximum 1.5 mg daily) given in 3 divided doses at 8-hour intervals. Cutaneous anthrax in infants and children younger than 2 years of age should be treated initially IV. Although 5-10 days of anti-infective therapy may be adequate for the treatment of mild, uncomplicated cutaneous anthrax that occurs as the result of natural or endemic exposures to anthrax, the CDC and other experts recommend that therapy be continued for 60 days if the cutaneous infection occurred as the result of exposure to aerosolized anthrax spores since the possibility of inhalational anthrax would also exist. Anti-infective therapy may limit the size of the cutaneous anthrax lesion and it usually becomes sterile within the first 24 hours of treatment, but the lesion will still progress through the black eschar stage despite effective treatment.
Chlamydial and Mycoplasmal Infections
For the treatment of chlamydial urogenital infections during pregnancy, the recommended dosage of oral amoxicillin is 500 mg 3 times daily for 7-10 days. Experience with oral amoxicillin therapy in this infection is limited and the drug may not be highly efficacious. Therefore, the CDC recommends that repeat testing (preferably by culture) should be performed 3 weeks after treatment is completed.
Dosage and Duration Therapy of Amoxicillin
Dosage and Duration Therapy of Amoxicillin
The duration of amoxicillin therapy depends on the type and severity of infection and should be determined by the clinical and bacteriologic response of the patient. For most infections, except gonorrhea, therapy should be continued for at least 48-72 hours after the patient becomes asymptomatic or evidence of eradication of the infection has been obtained. Persistent infections may require several weeks of therapy. Amoxicillin usually is continued for 60 days for postexposure prophylaxis or treatment of inhalational or cutaneous anthrax in the context of biologic warfare or bioterrorism.
If amoxicillin is used in the treatment of infections caused by group A -hemolytic streptococci, therapy should be continued for at least 10 days to decrease the risk of rheumatic fever and glomerulonephritis.
If amoxicillin is used in the treatment of chronic urinary tract infections, frequent bacteriologic and clinical appraisal is necessary during therapy and may be required for several months after therapy.
In patients with renal impairment, doses and/or frequency of administration of amoxicillin should be modified in response to the degree of renal impairment, severity of the infection, and susceptibility of the causative organisms. The manufacturer states that adults with severe renal impairment and creatinine clearances less than 30 mL/minute should not receive the commercially available film-coated tablets containing 875 mg of amoxicillin. The recommended dosage of amoxicillin for adults with creatinine clearances of 10-30 mL/minute is 250 or 500 mg every 12 hours, depending on the severity of the infection, and the recommended dosage for adults with creatinine clearances less than 10 mL/minute is 250 or 500 mg every 24 hours, depending on the severity of the infection.
Patients undergoing hemodialysis should receive 250 or 500 mg of amoxicillin every 24 hours, depending on the severity of the infection, and should receive an additional dose of the drug during and after each dialysis period.
The manufacturer states that data are insufficient to recommend dosage for pediatric patients with renal impairment.
The duration of amoxicillin therapy depends on the type and severity of infection and should be determined by the clinical and bacteriologic response of the patient. For most infections, except gonorrhea, therapy should be continued for at least 48-72 hours after the patient becomes asymptomatic or evidence of eradication of the infection has been obtained. Persistent infections may require several weeks of therapy. Amoxicillin usually is continued for 60 days for postexposure prophylaxis or treatment of inhalational or cutaneous anthrax in the context of biologic warfare or bioterrorism.
If amoxicillin is used in the treatment of infections caused by group A -hemolytic streptococci, therapy should be continued for at least 10 days to decrease the risk of rheumatic fever and glomerulonephritis.
If amoxicillin is used in the treatment of chronic urinary tract infections, frequent bacteriologic and clinical appraisal is necessary during therapy and may be required for several months after therapy.
In patients with renal impairment, doses and/or frequency of administration of amoxicillin should be modified in response to the degree of renal impairment, severity of the infection, and susceptibility of the causative organisms. The manufacturer states that adults with severe renal impairment and creatinine clearances less than 30 mL/minute should not receive the commercially available film-coated tablets containing 875 mg of amoxicillin. The recommended dosage of amoxicillin for adults with creatinine clearances of 10-30 mL/minute is 250 or 500 mg every 12 hours, depending on the severity of the infection, and the recommended dosage for adults with creatinine clearances less than 10 mL/minute is 250 or 500 mg every 24 hours, depending on the severity of the infection.
Patients undergoing hemodialysis should receive 250 or 500 mg of amoxicillin every 24 hours, depending on the severity of the infection, and should receive an additional dose of the drug during and after each dialysis period.
The manufacturer states that data are insufficient to recommend dosage for pediatric patients with renal impairment.
amoxicillin,first drug choice for acute otitis media
amoxicillin,first drug choice for acute otitis media
Amoxicillin is used for the treatment of acute otitis media (AOM) caused by S. pneumoniae, H. influenzae, or M. catarrhalis. Amoxicillin usually is considered the drug of first choice for initial treatment of AOM, unless the patient has severe illness (moderate to severe otalgia or fever 39C or higher) or the infection is suspected of being caused by -lactamase-producing H. influenzae or M. catarrhalis, in which case amoxicillin and clavulanate potassium is recommended for initial treatment. The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), US Centers for Disease Control and Prevention (CDC), and others state that, despite the increasing prevalence of multidrug-resistant S. pneumoniae and presence of B-lactamase-producing H. influenzae or M catarrhalis in many communities, amoxicillin remains the anti-infective of first choice for treatment of uncomplicated AOM since it is highly effective, has a narrow spectrum of activity, is well distributed into middle ear fluid, is well tolerated, has an acceptable taste, and is inexpensive. Amoxicillin (when given in a dosage of 80-90 mg/kg daily) usually is effective in the treatment of AOM caused by S. pneumoniae, including infections involving strains with intermediate resistance to penicillins, and also usually is effective in the treatment of AOM caused by most strains of H. influenzae.
Alternatives for initial treatment of AOM in patients with a history of non-type I hypersensitivity reactions to penicillins include oral cephalosporins (cefdinir, cefpodoxime, cefuroxime axetil) or parenteral ceftriaxone. Alternatives for patients with type I penicillin hypersensitivity include oral macrolides (azithromycin, clarithromycin, fixed combination of erythromycin and sulfisoxazole), oral co-trimoxazole, or oral clindamycin (especially in those with infections known or presumed to be caused by penicillin-resistant S. pneumoniae).
AAP, AAFP, and others recommend that patients who fail to respond to an initial amoxicillin regimen (given in a dosage of 80-90 mg/kg daily) within 48-72 hours should be retreated using a regimen of amoxicillin and clavulanate potassium (90 mg/kg of amoxicillin and 6.4 mg/kg of clavulanate daily in 2 divided doses). Alternatively, a 3-day regimen of IM or IV ceftriaxone can be used for retreatment in those who fail to respond to an initial amoxicillin regimen, especially in those who have severe illness (moderate to severe otalgia or fever 39C or higher) and in those who are vomiting or cannot otherwise tolerate an oral regimen.
Amoxicillin is used for the treatment of acute otitis media (AOM) caused by S. pneumoniae, H. influenzae, or M. catarrhalis. Amoxicillin usually is considered the drug of first choice for initial treatment of AOM, unless the patient has severe illness (moderate to severe otalgia or fever 39C or higher) or the infection is suspected of being caused by -lactamase-producing H. influenzae or M. catarrhalis, in which case amoxicillin and clavulanate potassium is recommended for initial treatment. The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), US Centers for Disease Control and Prevention (CDC), and others state that, despite the increasing prevalence of multidrug-resistant S. pneumoniae and presence of B-lactamase-producing H. influenzae or M catarrhalis in many communities, amoxicillin remains the anti-infective of first choice for treatment of uncomplicated AOM since it is highly effective, has a narrow spectrum of activity, is well distributed into middle ear fluid, is well tolerated, has an acceptable taste, and is inexpensive. Amoxicillin (when given in a dosage of 80-90 mg/kg daily) usually is effective in the treatment of AOM caused by S. pneumoniae, including infections involving strains with intermediate resistance to penicillins, and also usually is effective in the treatment of AOM caused by most strains of H. influenzae.
Alternatives for initial treatment of AOM in patients with a history of non-type I hypersensitivity reactions to penicillins include oral cephalosporins (cefdinir, cefpodoxime, cefuroxime axetil) or parenteral ceftriaxone. Alternatives for patients with type I penicillin hypersensitivity include oral macrolides (azithromycin, clarithromycin, fixed combination of erythromycin and sulfisoxazole), oral co-trimoxazole, or oral clindamycin (especially in those with infections known or presumed to be caused by penicillin-resistant S. pneumoniae).
AAP, AAFP, and others recommend that patients who fail to respond to an initial amoxicillin regimen (given in a dosage of 80-90 mg/kg daily) within 48-72 hours should be retreated using a regimen of amoxicillin and clavulanate potassium (90 mg/kg of amoxicillin and 6.4 mg/kg of clavulanate daily in 2 divided doses). Alternatively, a 3-day regimen of IM or IV ceftriaxone can be used for retreatment in those who fail to respond to an initial amoxicillin regimen, especially in those who have severe illness (moderate to severe otalgia or fever 39C or higher) and in those who are vomiting or cannot otherwise tolerate an oral regimen.
Amoxicillin alternative agent for anthrax
Amoxicillin alternative agent for anthrax
Amoxicillin shares the uses of other aminopenicillins and is used principally for the treatment of infections caused by susceptible gram-negative bacteria (e.g., Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Salmonella). Amoxicillin also is used for the treatment of infections caused by susceptible gram-positive bacteria (e.g., Streptococcus pneumoniae, enterococci, nonpenicillinase-producing staphylococci, Listeria. However, like other aminopenicillins, amoxicillin generally should not be used for the treatment of streptococcal or staphylococcal infections when a natural penicillin would be effective.
Amoxicillin is used as an alternative agent for postexposure prophylaxis following exposure to Bacillus anthracis spores, for the treatment of anthrax when a parenteral regimen is not available (e.g., when there are supply or logistic problems because large numbers of individuals require treatment in a mass casualty setting), and for the treatment of cutaneous anthrax. Strains of B. anthracis with naturally occurring penicillin resistance have been reported rarely, and there are published reports of B. anthracis strains that have been engineered to have penicillin and tetracycline resistance as well as resistance to other anti-infectives (e.g., macrolides, chloramphenicol, rifampin). Therefore, it has been postulated that exposures to B. anthracis that occur in the context of biologic warfare or bioterrorism may involve bioengineered resistant strains and this concern should be considered when selecting initial therapy for the treatment of anthrax that occurs as the result of bioterrorism-related exposures or for postexposure prophylaxis following such exposures.
Postexposure Prophylaxis
Ciprofloxacin or doxycycline generally are considered the initial drugs of choice for postexposure prophylaxis following suspected or confirmed exposure to aerosolized B. anthracis spores that occurs in the context of biologic warfare or bioterrorism. If exposure is confirmed and results of in vitro testing indicate that the organism is susceptible to penicillin, then postexposure prophylaxis may be switched to a penicillin (e.g., oral amoxicillin, oral penicillin V). IM penicillin G procaine also has been recommended as an alternative for postexposure prophylaxis. Although monotherapy with a penicillin is not recommended for the treatment of clinically apparent inhalational anthrax when high concentrations of the organism are likely to be present, penicillins may be considered an option for anti-infective prophylaxis when ciprofloxacin and doxycycline are contraindicated, since the likelihood of -lactamase induction resulting in an increase in penicillin MICs is lower when only a small number of vegetative cells are present.
Although the CDC and other experts recommend that postexposure prophylaxis in children be initiated with ciprofloxacin or doxycycline, if exposure has been confirmed and in vitro tests indicate that the organism is susceptible to penicillin, the postexposure prophylaxis regimen in children may be switched to oral amoxicillin or oral penicillin V.
The possible benefits of postexposure prophylaxis against anthrax should be weighed against the possible risks to the fetus when choosing an anti-infective for postexposure prophylaxis in pregnant women. The CDC and other experts state that ciprofloxacin should be considered the drug of choice for initial postexposure prophylaxis in pregnant women exposed to B. anthracis spores and that, if in vitro studies indicate that the organism is susceptible to penicillin, then consideration can be given to changing the postexposure regimen to amoxicillin. Women who become pregnant while receiving anti-infective prophylaxis should continue the existing regimen and consult with a healthcare provider or public health official to discuss whether an alternative regimen might be more appropriate.
Cutaneous Anthrax
Although natural penicillins (e.g., oral penicillin V, IM penicillin G benzathine, IM penicillin G procaine) generally have been considered drugs of choice for the treatment of mild, uncomplicated cutaneous anthrax caused by susceptible strains of B. anthracis that occurs as the result of naturally occurring or endemic exposure to anthrax, the CDC recommends use of oral ciprofloxacin or oral doxycycline for the treatment of cutaneous anthrax that occurs following exposure to B. anthracis spores in the context of biologic warfare or bioterrorism.
Therapy may be changed to oral amoxicillin if results of in vitro susceptibility testing indicate that the organism is susceptible to the drug and the patient is improving. Use of a multiple-drug parenteral regimen is recommended for the initial treatment of cutaneous anthrax when there are signs of systemic involvement, extensive edema, or lesions on the head and neck.
For young children (i.e., younger than 2 years of age), initial therapy for cutaneous anthrax should be IV rather than oral, and combination anti-infective therapy should be considered since it currently is not known whether infants and young children are at increased risk of systemic dissemination of cutaneous anthrax.
Amoxicillin shares the uses of other aminopenicillins and is used principally for the treatment of infections caused by susceptible gram-negative bacteria (e.g., Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Salmonella). Amoxicillin also is used for the treatment of infections caused by susceptible gram-positive bacteria (e.g., Streptococcus pneumoniae, enterococci, nonpenicillinase-producing staphylococci, Listeria. However, like other aminopenicillins, amoxicillin generally should not be used for the treatment of streptococcal or staphylococcal infections when a natural penicillin would be effective.
Amoxicillin is used as an alternative agent for postexposure prophylaxis following exposure to Bacillus anthracis spores, for the treatment of anthrax when a parenteral regimen is not available (e.g., when there are supply or logistic problems because large numbers of individuals require treatment in a mass casualty setting), and for the treatment of cutaneous anthrax. Strains of B. anthracis with naturally occurring penicillin resistance have been reported rarely, and there are published reports of B. anthracis strains that have been engineered to have penicillin and tetracycline resistance as well as resistance to other anti-infectives (e.g., macrolides, chloramphenicol, rifampin). Therefore, it has been postulated that exposures to B. anthracis that occur in the context of biologic warfare or bioterrorism may involve bioengineered resistant strains and this concern should be considered when selecting initial therapy for the treatment of anthrax that occurs as the result of bioterrorism-related exposures or for postexposure prophylaxis following such exposures.
Postexposure Prophylaxis
Ciprofloxacin or doxycycline generally are considered the initial drugs of choice for postexposure prophylaxis following suspected or confirmed exposure to aerosolized B. anthracis spores that occurs in the context of biologic warfare or bioterrorism. If exposure is confirmed and results of in vitro testing indicate that the organism is susceptible to penicillin, then postexposure prophylaxis may be switched to a penicillin (e.g., oral amoxicillin, oral penicillin V). IM penicillin G procaine also has been recommended as an alternative for postexposure prophylaxis. Although monotherapy with a penicillin is not recommended for the treatment of clinically apparent inhalational anthrax when high concentrations of the organism are likely to be present, penicillins may be considered an option for anti-infective prophylaxis when ciprofloxacin and doxycycline are contraindicated, since the likelihood of -lactamase induction resulting in an increase in penicillin MICs is lower when only a small number of vegetative cells are present.
Although the CDC and other experts recommend that postexposure prophylaxis in children be initiated with ciprofloxacin or doxycycline, if exposure has been confirmed and in vitro tests indicate that the organism is susceptible to penicillin, the postexposure prophylaxis regimen in children may be switched to oral amoxicillin or oral penicillin V.
The possible benefits of postexposure prophylaxis against anthrax should be weighed against the possible risks to the fetus when choosing an anti-infective for postexposure prophylaxis in pregnant women. The CDC and other experts state that ciprofloxacin should be considered the drug of choice for initial postexposure prophylaxis in pregnant women exposed to B. anthracis spores and that, if in vitro studies indicate that the organism is susceptible to penicillin, then consideration can be given to changing the postexposure regimen to amoxicillin. Women who become pregnant while receiving anti-infective prophylaxis should continue the existing regimen and consult with a healthcare provider or public health official to discuss whether an alternative regimen might be more appropriate.
Cutaneous Anthrax
Although natural penicillins (e.g., oral penicillin V, IM penicillin G benzathine, IM penicillin G procaine) generally have been considered drugs of choice for the treatment of mild, uncomplicated cutaneous anthrax caused by susceptible strains of B. anthracis that occurs as the result of naturally occurring or endemic exposure to anthrax, the CDC recommends use of oral ciprofloxacin or oral doxycycline for the treatment of cutaneous anthrax that occurs following exposure to B. anthracis spores in the context of biologic warfare or bioterrorism.
Therapy may be changed to oral amoxicillin if results of in vitro susceptibility testing indicate that the organism is susceptible to the drug and the patient is improving. Use of a multiple-drug parenteral regimen is recommended for the initial treatment of cutaneous anthrax when there are signs of systemic involvement, extensive edema, or lesions on the head and neck.
For young children (i.e., younger than 2 years of age), initial therapy for cutaneous anthrax should be IV rather than oral, and combination anti-infective therapy should be considered since it currently is not known whether infants and young children are at increased risk of systemic dissemination of cutaneous anthrax.
Reconstitution, Administration, And General Dosage Of Amoxicillin
Reconstitution, Administration, And General Dosage Of Amoxicillin
Amoxicillin trihydrate is administered orally. Amoxicillin has also been given IV as the sodium salt, but a parenteral dosage form of amoxicillin is currently not available in the US.
Amoxicillin may be administered orally without regard to meals. However, in studies evaluating the film-coated tablet containing 875 mg of amoxicillin, the tablet was administered at the start of a light meal.
The required dose of reconstituted amoxicillin oral suspension should be placed directly on the child's tongue for swallowing. Alternatively, the required dose of oral suspension may be added to formula, milk, fruit juice, water, or ginger ale and then administered immediately.
Amoxicillin powder for oral suspension should be reconstituted at the time of dispensing by adding the amount of water specified on the bottle to provide a suspension containing 125, 200, 250, or 400 mg of amoxicillin per 5 mL or 50 mg of amoxicillin per mL. After tapping the bottle to thoroughly loosen the powder for oral suspension, the water should be added to the powder in 2 portions and the suspension agitated well after each addition. The suspension should be agitated well just prior to administration of each dose.
Dosage of amoxicillin, which is available for oral use as the trihydrate, is expressed in terms of anhydrous amoxicillin.
General Adult Dosage
The usual adult dosage of amoxicillin for the treatment of mild to moderate infections of the ear, nose, or throat; skin and skin structure; or genitourinary tract is 500 mg every 12 hours or 250 mg every 8 hours. A dosage of 875 mg every 12 hours or 500 mg every 8 hours should be used for the treatment of severe infections of the ear, nose, or throat; skin and skin structure; or genitourinary tract in adults. The usual adult dosage of amoxicillin for the treatment of mild, moderate, or severe lower respiratory tract infections is 875 mg every 12 hours or 500 mg every 8 hours.
A single 3-g oral dose of amoxicillin has been used effectively for the initial treatment of acute, uncomplicated urinary tract infections in nonpregnant women.
General Pediatric Dosage
The manufacturer states that for neonates and infants 12 weeks of age or younger, amoxicillin may be administered in a dosage of up to 30 mg/kg daily in divided doses every 12 hours.
The usual dosage of amoxicillin for pediatric patients 3 months of age or older for the treatment of mild to moderate infections of the ear, nose, throat, skin and skin structure, or genitourinary tract is 20 mg/kg daily in divided doses every 8 hours or 25 mg/kg daily in divided doses every 12 hours. The usual dosage of amoxicillin for pediatric patients 3 months of age or older for the treatment of mild, moderate, or severe lower respiratory tract infections or for the treatment of severe infections of the ear, nose, throat, skin and skin structure, or genitourinary tract is 40 mg/kg daily in divided doses every 8 hours or 45 mg/kg daily in divided doses every 12 hours.
Amoxicillin trihydrate is administered orally. Amoxicillin has also been given IV as the sodium salt, but a parenteral dosage form of amoxicillin is currently not available in the US.
Amoxicillin may be administered orally without regard to meals. However, in studies evaluating the film-coated tablet containing 875 mg of amoxicillin, the tablet was administered at the start of a light meal.
The required dose of reconstituted amoxicillin oral suspension should be placed directly on the child's tongue for swallowing. Alternatively, the required dose of oral suspension may be added to formula, milk, fruit juice, water, or ginger ale and then administered immediately.
Amoxicillin powder for oral suspension should be reconstituted at the time of dispensing by adding the amount of water specified on the bottle to provide a suspension containing 125, 200, 250, or 400 mg of amoxicillin per 5 mL or 50 mg of amoxicillin per mL. After tapping the bottle to thoroughly loosen the powder for oral suspension, the water should be added to the powder in 2 portions and the suspension agitated well after each addition. The suspension should be agitated well just prior to administration of each dose.
Dosage of amoxicillin, which is available for oral use as the trihydrate, is expressed in terms of anhydrous amoxicillin.
General Adult Dosage
The usual adult dosage of amoxicillin for the treatment of mild to moderate infections of the ear, nose, or throat; skin and skin structure; or genitourinary tract is 500 mg every 12 hours or 250 mg every 8 hours. A dosage of 875 mg every 12 hours or 500 mg every 8 hours should be used for the treatment of severe infections of the ear, nose, or throat; skin and skin structure; or genitourinary tract in adults. The usual adult dosage of amoxicillin for the treatment of mild, moderate, or severe lower respiratory tract infections is 875 mg every 12 hours or 500 mg every 8 hours.
A single 3-g oral dose of amoxicillin has been used effectively for the initial treatment of acute, uncomplicated urinary tract infections in nonpregnant women.
General Pediatric Dosage
The manufacturer states that for neonates and infants 12 weeks of age or younger, amoxicillin may be administered in a dosage of up to 30 mg/kg daily in divided doses every 12 hours.
The usual dosage of amoxicillin for pediatric patients 3 months of age or older for the treatment of mild to moderate infections of the ear, nose, throat, skin and skin structure, or genitourinary tract is 20 mg/kg daily in divided doses every 8 hours or 25 mg/kg daily in divided doses every 12 hours. The usual dosage of amoxicillin for pediatric patients 3 months of age or older for the treatment of mild, moderate, or severe lower respiratory tract infections or for the treatment of severe infections of the ear, nose, throat, skin and skin structure, or genitourinary tract is 40 mg/kg daily in divided doses every 8 hours or 45 mg/kg daily in divided doses every 12 hours.
Senin, 14 Juli 2014
macam antibiotika
Pengertian Antibiotik adalah obat-obat yang digunakan untuk mengobati
berbagai penyakit, dan dalam beberapa kasus dapat mencegah infeksi
bakteri. Mekanisme kerja antibiotik atau kegunaan antibiotik dapat
digunakan untuk mengobati kondisi yang relatif ringan seperti jerawat
serta kondisi yang berpotensi mengancam jiwa seperti pneumonia (sejenis
infeksi paru-paru).
Bagaimana cara penggunaan antibiotik ?
Dosis antibiotik dapat diberikan dalam beberapa cara:
Jenis jenis antibiotik dan penggolongan antibiotik
Saat ini ada ratusan jenis obat antibiotik, tetapi kebanyakan dari jenis atau penggolongan antibiotik dapat secara luas diklasifikasikan menjadi enam kelompok. Akan dijelaskan di bawah ini.
Penisilin
Penisilin digunakan secara luas untuk mengobati infeksi tertentu seperti infeksi kulit, radang tenggorokan, infeksi dada dan infeksi saluran kemih.
Beberapa jenis penisilin banyak digunakan meliputi:
Antibiotik Sefalosporin
Obat Sefalosporin adalah anti biotik spektrum luas, yang berarti mereka efektif dalam mengobati berbagai jenis infeksi termasuk infeksi yang lebih serius, seperti:
Aminoglikosida
Aminoglikosida adalah jenis obat antibiotik yang digunakan secara luas diresepkan sampai ditemukan bahwa Aminoglikosida dapat menyebabkan kerusakan baik pendengaran maupun ginjal. Karena itu, Aminoglikosida cenderung sekarang digunakan hanya untuk mengobati penyakit yang sangat serius seperti meningitis. Aminoglikosida memecah dengan cepat di dalam sistem pencernaan sehingga mereka harus diberikan melalui suntikan atau tetes.
Obat tetrasiklin
Tetrasiklin adalah jenis lain dari obat antibiotik spektrum luas yang dapat digunakan untuk mengobati berbagai macam infeksi. Tetrasiklin umumnya juga merupakan salah satu obat antibiotik untuk jerawat yang digunakan untuk mengobati jerawat yang parah dan kondisi yang disebut rosacea, yang menyebabkan kemerahan pada kulit dan bintik-bintik.
Makrolida
Manfaat antibiotik Makrolida adalah jenis antibiotik yang berguna dalam mengobati infeksi paru-paru dan dada. Makrolida juga bisa menjadi pengobatan alternatif yang berguna bagi orang-orang dengan alergi penisilin atau untuk mencegah bakteri yang kebal obat penisilin.
Contoh golongan antibiotik makrolida termasuk:
Fluoroquinolones
Fluoroquinolones adalah tipe terbaru dari antibiotik. Fluoroquinolones merupakan obat antibiotik spektrum luas yang dapat digunakan untuk mengobati berbagai macam infeksi.
Contoh fluoroquinolones adalah:
Efek samping Antibiotik
Kebanyakan antibiotik diatas (kecuali aminoglikosida) tidak menimbulkan banyak masalah bagi orang-orang yang menggunakannya dan efek samping yang parah jarang terjadi. Efek samping antibiotik yang dilaporkan yang paling umum adalah:
Pertimbangan dan interaksi
Beberapa jenis antibiotik tidak cocok untuk orang dengan kondisi medis tertentu atau untuk ibu hamil dan menyusui. Anda sebaiknya menggunakan antibiotik yang telah diresepkan dokter untuk Anda, jangan meminjam dari anggota keluarga seorang teman. Beberapa antibiotik juga dapat bereaksi tak terduga dengan obat lain dan pil kontrasepsi oral. Oleh karena itu sangat penting untuk membaca pelaturan pemakaian yang telah ditetapkan dengan hati-hati.
Resistensi antibiotik
Organisasi kesehatan di seluruh dunia sedang mencoba untuk mengurangi penggunaan antibiotik, terutama untuk kondisi yang tidak serius. Hal ini untuk mencoba memerangi masalah resistensi antibiotik, yang ketika strain bakteri tidak lagi merespon terhadap pengobatan dengan satu atau beberapa jenis antibiotik. Resistensi antibiotik dapat terjadi dalam beberapa cara.
Strain bakteri dapat bermutasi (berubah) dan dari waktu ke waktu menjadi resisten (kebal) terhadap antibiotik tertentu. Kesempatan ini meningkat jika seseorang tidak mengetahui tentang antibiotik karena beberapa bakteri dapat dibiarkan untuk mengembangkan resistensi. Juga, antibiotik dapat menghancurkan banyak strain berbahaya dari bakteri yang hidup pada tubuh. Hal ini memungkinkan bakteri resisten untuk berkembang biak dengan cepat dan menggantinya. Penggunaan obat antibiotik yang berlebihan dalam beberapa tahun terakhir telah memainkan peranan utama dalam resistensi antibiotik. Ini termasuk menggunakan macam-macam antibiotik untuk mengobati kondisi kecil.
Hal ini telah menyebabkan munculnya strain bakteri yang sudah kebal terhadap berbagai jenis antibiotik. Mereka termasuk:
Bagaimana cara penggunaan antibiotik ?
Dosis antibiotik dapat diberikan dalam beberapa cara:
- Antibiotik oral - tablet, pil dan kapsul atau cairan yang dapat Anda minum
- Antibiotik topikal - krim, lotion, semprotan atau tetes
- Suntikan antibiotik - obat antibiotik dapat diberikan dengan suntikan, melalui infus, langsung ke dalam darah atau otot.
Jenis jenis antibiotik dan penggolongan antibiotik
Saat ini ada ratusan jenis obat antibiotik, tetapi kebanyakan dari jenis atau penggolongan antibiotik dapat secara luas diklasifikasikan menjadi enam kelompok. Akan dijelaskan di bawah ini.
Penisilin
Penisilin digunakan secara luas untuk mengobati infeksi tertentu seperti infeksi kulit, radang tenggorokan, infeksi dada dan infeksi saluran kemih.
Beberapa jenis penisilin banyak digunakan meliputi:
- Antibiotik Amoxicillin ( amoksisilin )
- Flukloksasilin
Antibiotik Sefalosporin
Obat Sefalosporin adalah anti biotik spektrum luas, yang berarti mereka efektif dalam mengobati berbagai jenis infeksi termasuk infeksi yang lebih serius, seperti:
- Septicemia - infeksi darah
- Pneumonia
- Meningitis - infeksi lapisan pelindung terluar dari otak dan sumsum tulang belakang
- Obat Cefalexin
- Obat Cefixime
Aminoglikosida
Aminoglikosida adalah jenis obat antibiotik yang digunakan secara luas diresepkan sampai ditemukan bahwa Aminoglikosida dapat menyebabkan kerusakan baik pendengaran maupun ginjal. Karena itu, Aminoglikosida cenderung sekarang digunakan hanya untuk mengobati penyakit yang sangat serius seperti meningitis. Aminoglikosida memecah dengan cepat di dalam sistem pencernaan sehingga mereka harus diberikan melalui suntikan atau tetes.
Obat tetrasiklin
Tetrasiklin adalah jenis lain dari obat antibiotik spektrum luas yang dapat digunakan untuk mengobati berbagai macam infeksi. Tetrasiklin umumnya juga merupakan salah satu obat antibiotik untuk jerawat yang digunakan untuk mengobati jerawat yang parah dan kondisi yang disebut rosacea, yang menyebabkan kemerahan pada kulit dan bintik-bintik.
Makrolida
Manfaat antibiotik Makrolida adalah jenis antibiotik yang berguna dalam mengobati infeksi paru-paru dan dada. Makrolida juga bisa menjadi pengobatan alternatif yang berguna bagi orang-orang dengan alergi penisilin atau untuk mencegah bakteri yang kebal obat penisilin.
Contoh golongan antibiotik makrolida termasuk:
- Eritromisin
- Spiramisin
Fluoroquinolones
Fluoroquinolones adalah tipe terbaru dari antibiotik. Fluoroquinolones merupakan obat antibiotik spektrum luas yang dapat digunakan untuk mengobati berbagai macam infeksi.
Contoh fluoroquinolones adalah:
- Obat Ciprofloxacin
- Obat Norfloksasin
Efek samping Antibiotik
Kebanyakan antibiotik diatas (kecuali aminoglikosida) tidak menimbulkan banyak masalah bagi orang-orang yang menggunakannya dan efek samping yang parah jarang terjadi. Efek samping antibiotik yang dilaporkan yang paling umum adalah:
- Sakit
- Gangguan pencernaan
- Diare
Pertimbangan dan interaksi
Beberapa jenis antibiotik tidak cocok untuk orang dengan kondisi medis tertentu atau untuk ibu hamil dan menyusui. Anda sebaiknya menggunakan antibiotik yang telah diresepkan dokter untuk Anda, jangan meminjam dari anggota keluarga seorang teman. Beberapa antibiotik juga dapat bereaksi tak terduga dengan obat lain dan pil kontrasepsi oral. Oleh karena itu sangat penting untuk membaca pelaturan pemakaian yang telah ditetapkan dengan hati-hati.
Resistensi antibiotik
Organisasi kesehatan di seluruh dunia sedang mencoba untuk mengurangi penggunaan antibiotik, terutama untuk kondisi yang tidak serius. Hal ini untuk mencoba memerangi masalah resistensi antibiotik, yang ketika strain bakteri tidak lagi merespon terhadap pengobatan dengan satu atau beberapa jenis antibiotik. Resistensi antibiotik dapat terjadi dalam beberapa cara.
Strain bakteri dapat bermutasi (berubah) dan dari waktu ke waktu menjadi resisten (kebal) terhadap antibiotik tertentu. Kesempatan ini meningkat jika seseorang tidak mengetahui tentang antibiotik karena beberapa bakteri dapat dibiarkan untuk mengembangkan resistensi. Juga, antibiotik dapat menghancurkan banyak strain berbahaya dari bakteri yang hidup pada tubuh. Hal ini memungkinkan bakteri resisten untuk berkembang biak dengan cepat dan menggantinya. Penggunaan obat antibiotik yang berlebihan dalam beberapa tahun terakhir telah memainkan peranan utama dalam resistensi antibiotik. Ini termasuk menggunakan macam-macam antibiotik untuk mengobati kondisi kecil.
Hal ini telah menyebabkan munculnya strain bakteri yang sudah kebal terhadap berbagai jenis antibiotik. Mereka termasuk:
- Meticillin resistant Staphylococcus aureus ( MRSA )
- Clostridium difficile ( C.diff )
- Bakteri yang menyebabkan tuberkulosis yang resistan terhadap obat ( MDR-TB )
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