Antibiotics

Question 1

Penicillin

Answer 1

Pen-VK 300mg tabs Q6H
food impairs absorption

Question 2

Amoxicillin

Answer 2

250mg, 500mg tabs or 250mg/5ml, 125mg/5ml susp Q8H
dose with food, shake well and refrigerate suspension

Question 3

Cloxacillin

Answer 3

250mg, 500mg tablets, 125mg/5ml susp Q6H
dose 1-2h before food, refrigerate suspension

Question 4

Amoxicillin/Clavulanate

Answer 4

Clavulin 250/125mg, 500/125mg 875/125mg tabs Q8-12H or 125/31.25mg, 200/28.5mg, 250/62.5mg, 400/57mg suspension
dose with or without food (better absorption of clavulanate without, less GI upset with)
shake well and refrigerate suspension

Question 5

Difference between Clavulin F and Clavulin suspensions?

Answer 5

the difference is in how many days it can be stored refrigerated:
for Clavulin 125F & 250F its 10 days
for Clavulin 200 & 400 its 7 days

Question 6

Which preparations have 4:1 Amoxicillin/Clavulanate ratio?

Answer 6

Clavulin 125F, Clavulin 250F suspensions
Clavulin 500F tablets

Question 7

Which preparations have 7:1 Amoxicillin/Clavulanate ratio?

Answer 7

Clavulin 200, Clavulin 400 suspensions
Clavulin 875 tablets

Question 8

Which preparations have 2:1 Amoxicillin/Clavulanate ratio?

Answer 8

Clavulin 250 tablets

Question 9

Cephalexin

Answer 9

Keflex 250mg, 500mg tabs and caps, 125mg/5ml, 250mg/5ml suspension Q6H
shake well and refrigerate suspension, 10% better absorption without food

Question 10

Cefuroxime

Answer 10

Ceftin 250mg, 500mg tab, 125mg/5ml susp
Shake well and refrigerate. Take with food.

Question 11

PO Beta Lactams include

Answer 11

penicillin, amoxicillin, cloxacillin, amoxi/clav, cephalexin, cefuroxime

Question 12

PO Beta Lactams side effects counselling

Answer 12

watch for allergic reactions like rashes, swelling, difficulty breathing
may cause stomach upset like nausea, vomiting, diarrhea, heartburn

Question 13

Ciprofloxacin

Answer 13

Cipro 250, 500, 750, 1000 mg tabs, 500mg/5ml susp
Ok to take with meals involving dairy but ideally separate 2h before or 6h after any calcium supplements or fortified drinks. Otherwise can take with or without food.
Shake well & refrigerate suspension.

Question 14

Moxifloxacin

Answer 14

400mg tabs once daily with or without food

Question 15

Levofloxacin

Answer 15

250, 500, 750mg tabs once daily with or without food. Seperate 2h from calcium supplements.

Question 16

Fluoroquinolone side effects

Answer 16

Cipro, Levo, Moxi
-avoid in pregnancy/breastfeeding
-C. diff diarrhea
-hypersensitivity - discontinue if rash
-photosensitivity - avoid UV exposure
-tendonitis in shoulder, hand or heel - if pain discontinue and rest and contact MD
-CNS: dizziness, suicidality in patients with depression, lower seizure threshold, neuropathy
-vision changes - discontinue and see ophthalmologist
-hypoglycemia - monitor and discontinue if low and contact MD
-QT prolongation - risk factors: antiarrhythmics, hypokalemia, bradycardia, heart disease

Question 17

Fluoroquinolone counselling

Answer 17

Cipro, Levo, Moxi
Any heart conditions? diabetes? depression? pregnancy? breastfeeding?
Avoid sun exposure. Most common (approx 3%) side effects are nausea, headache, diarrhea, insomnia, dizziness. Avoid taking with antacids, calcium or iron supplements. (Moxi ok with calcium)
Monitor and discontinue if any unusual side effects like joint pain, rash, vision changes, chest pain.

Question 18

Clarithromycin

Answer 18

Biaxin BID 250, 500 mg tabs, 125mg/5ml 250mg/5ml susp
XL extended release must be taken with food, otherwise may be with or without food.
Suspension: Shake well. DO NOT refrigerate.

Question 19

Erythromycin

Answer 19

Eryc 250mg Q6H and 333mg Q8H delayed release caps
Take 2h before or after food, on empty stomach

Question 20

Azithromycin

Answer 20

Zithromax 250mg, 600mg tabs, 100mg/5ml, 200mg/5ml susp
Take with or without food.
Suspension: Shake well and DO NOT refrigerate.

Question 21

Macrolides side effects & counselling

Answer 21

Clarithromycin, Erythromycin, Azithromycin
-common side effects occur in <5%: cramping, nausea, vomiting, diarrhea, taste perversion, headache
-monitor for allergic reactions: rash, swelling, breathing difficulty(<1%)
-caution in pts w hepatic impairment, history of cholestatic juandice (monitor for yellowing), myesthenia gravis, QT prolongation risk factors (monitor for palpitations), many DDI
-not recommended in pregnancy or breastfeeding
-may use in children 6 months and older

Question 22

Tetracycline

Answer 22

250mg tab QID
1h before or 2h after food

Question 23

Doxycycline

Answer 23

Periostat 20mg tab for peridontitis - BID at least 1h before breakfast and dinner
Aprillon 40mg MR tab for rosacea, acne - QAM on empty stomach at least 1h before food
Doxytab or Doxycin 100mg tab/caps for infections, acne - OD-BID with or after food, with full glass of water, don’t lie down for 1-2h after

Question 24

Minocycline

Answer 24

100mg, 200mg OD-BID
not significantly affected by food

Question 25

Tetracyclines side effects & counselling

Answer 25

Tetra, Mino, Doxycycline - iron, antacids, dairy may impair absorption - separate 2h
-common s/e: diarrhea, nausea, throat irritation, dizziness (7%), photosensitvity /hyperpigmentation (wear sunscreen)
-d/c if rash/swelling, difficulty/pain swallowing, visual changes with headache (pseudomotor cerebri- HTN in brain), watery diarrhea (C.Diff), yeast infection
-contraindicated in children <8 y, pregnancy and lactation (stains teeth

Question 26

Linezolid

Answer 26

Zyvoxam 600mg tab Q12H with or without food
-do not use with pseudoephedrine cold meds
-most common (10%) s/e: headache, nausea, diarrhea
-less common (1%) s/e: vomiting, taste disturbances, tongue discoloration, fungal infections (oral, vaginal)
-rare: hypertension, hypoglycemia/lactic acidosis, C Diff, myelosuppression (monitor if >2w duration), optic neuropathy (monitor for vision changes), serotonin syndrome (many DDI eg MAOI in past 2w)

Question 27

Vancomycin

Answer 27

Vancocin 125mg, 250mg cap
-common: nausea, chills, hypotension
-rare: ototoxicity , nephrotoxicity, red man syndrome, TEN, allergic reactions
-not recommended in pregnancy/lactation

Question 28

Clindamycin

Answer 28

Dalacin C 150mg, 300mg cap, 75mg/5ml susp
susp: shake well, do not refridgerate, stable for 14 days
-common (1-2%) s/e: diarrhea, rash, nausea, vomiting
-inform MD about any rash, diarrhea (high risk of C Diff)
-not recommended in pregnancy/lactation

Question 29

Metronidazole

Answer 29

Flagyl 250mg, 500mg caps
-CI in hypothyroidism, neurological disorders…
-avoid alcohol during and 1 day after tx (may cause disulfiram reaction: flushing, vomiting, tachycardia)
-nausea, vomiting, diarrhea, reddish brown urine darkening, taste disturbances,
-inform MD if severe confusion, dizziness, hallucinations, visual disturbances
-d/c if allergic reaction (rash, swelling), hepatotoxicity (jaundice/yellowing), neuropathy, convulsions or stiff neck, fever, pancreatitis (severe abdominal pain, nausea)
-avoid in 1st trimester and during lactation

Question 30

Rifampin

Answer 30

Rofact 150mg, 300mg caps
OD on empty stomach 1h before food
-common s/e: nausea, vomiting, diarrhea, orange discoloration of bodily fluids, headache, dizziness, difficulty concentrating, tiredness, menstrual changes
-d/c if C Diff (watery diarrhea), DRESS (rash), neuropathy, ataxia, thrombocytopenia (bruising), jaundice, anemia (SOB), leukopenia (fever)

Question 31

HP Pack

Answer 31

Take all meds together before breakfast and dinner
OR
Take PPI before and ABX after food

AE:
Bismuth -stool darkening
Tetracycline-sun sensitivity
Metronidazole-DDI Alcohol