Cefpodoxime is an oral, third-generation cephalosporin antibiotic. It is active against most Gram-positive and Gram-negative organisms. Notable exceptions include Pseudomonas aeruginosa, Enterococcus, and Bacteroides fragilis. Currently, it is only marketed as generic preparations in the USA, according to the FDA Orange Book. It is commonly used to treat acute otitis media, pharyngitis, sinusitis, and gonorrhea. It also finds use as oral continuation therapy when intravenous cephalosporins (such as ceftriaxone) are no longer necessary for continued treatment.

Zoetis markets cefpodoxime proxetil under the trade name Simplicef for veterinary use. The dose range in dogs is 5–10 mg/kg body weight, administered orally, once a day.

Finecure, India markets the products under trade name Cefpo.

Cefpodoxime inhibits cell wall synthesis by inhibiting the final transpeptidation step of peptidoglycan synthesis in cell walls. It has well established pharmacokinetic profile with absorption of 50%. It is indicated in community acquired pneumonia, uncomplicated skin and skin structure infections, and uncomplicated urinary tract infections.

Usual Adult Dose for Bronchitis

Acute bacterial exacerbation of chronic bronchitis: 200 mg orally every 12 hours for 10 days

Usual Adult Dose for Cystitis

100 mg orally every 12 hours for 7 days

Usual Adult Dose for Gonococcal Infection – Uncomplicated

Uncomplicated urethral, cervical, or female anorectal infections: 200 mg orally one time

Alternatively, the Centers for Disease Control and Prevention suggest 400 mg orally one time may be effective for both male and female patients as an oral alternative for the treatment of uncomplicated gonorrhea of the cervix, urethra, or rectum.

Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.

The patient’s sexual partner(s) should also be evaluated/treated.

Cefpodoxime is not indicated for pharyngeal N gonorrhoeae infections.

Usual Adult Dose for Gonococcal Infection – Disseminated

400 mg orally twice a day

Initial therapy for disseminated gonococcal infections requires parenteral therapy which should be continued for 24 to 48 hours after clinical improvement is observed. Oral therapy may then be administered to complete a total course of at least 1 week.

Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.

The patient’s sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Pneumonia

Community-acquired pneumonia: 200 mg orally every 12 hours for 14 days

Diarrhea, nausea/vomiting, or headache may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

In the United States, moxifloxacin is licensed for the treatment of acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, community acquired pneumonia, complicated and uncomplicated skin and skin structure infections, and complicated intra-abdominal infections. In the European Union, it is licensed for acute bacterial exacerbations of chronic bronchitis, non-severe community-acquired pneumonia, and acute bacterial sinusitis. Based on its investigation into reports of rare but severe cases of liver toxicity and skin reactions, the European Medicines Agency recommended in 2008 that the use of the oral (but not the IV) form of moxifloxacin be restricted to infections in which other antibacterial agents cannot be used or have failed. In the US, the marketing approval does not contain these restrictions, though the label contains prominent warnings against skin reactions.

Avelox (moxifloxacin) was launched in the United States in 1999 and is marketed in more than 80 countries worldwide. In the United States, Avelox is marketed by Bayer’s partner Merck.

Usual Adult Dose for Pneumonia

400 mg orally or IV every 24 hours for 7 to 14 days

Usual Adult Dose for Skin or Soft Tissue Infection

400 mg orally or IV every 24 hours

Duration of therapy:
-Complicated infections: 7 to 21 days
-Uncomplicated infections: 7 days

Usual Adult Dose for Skin and Structure Infection

400 mg orally or IV every 24 hours

Duration of therapy:
-Complicated infections: 7 to 21 days
-Uncomplicated infections: 7 days

Uses: For the treatment of complicated skin and skin structure infections due to susceptible isolates of methicillin-susceptible S aureus, Escherichia coli, K pneumoniae, or Enterobacter cloacae; for the treatment of uncomplicated skin and skin structure infections due to susceptible isolates of methicillin-susceptible S aureus or S pyogenes

Rare but serious adverse effects that may occur as a result of moxifloxacin therapy include irreversible peripheral neuropathy, spontaneous tendon rupture and tendonitis, hepatitis, psychiatric effects (hallucinations, depression), torsades de pointes, Stevens-Johnson syndrome and Clostridium difficile-associated disease, and photosensitivity/phototoxicity reactions.

Several reports suggest the use of moxifloxacin may lead to uveitis.

Itraconazole has a broader spectrum of activity than fluconazole (but not as broad as voriconazole or posaconazole). In particular, it is active against Aspergillus, which fluconazole is not. It is also licensed for use in blastomycosis, sporotrichosis, histoplasmosis, and onychomycosis. Itraconazole is over 99% protein-bound and has virtually no penetration into cerebrospinal fluid. Therefore, it should never be used to treat meningitis or other central nervous system infections. According to the Johns Hopkins Abx Guide, it has “negligible CSF penetration, however treatment has been successful for cryptococcal and coccidioidal meningitis”.

It is also prescribed for systemic infections, such as aspergillosis, candidiasis, and cryptococcosis, where other antifungal drugs are inappropriate or ineffective.

Itraconazole has also recently been explored as an anticancer agent for patients with basal cell carcinoma, non-small cell lung cancer, and prostate cancer. For example, in a phase II study involving men with advanced prostate cancer, high-dose itraconazole (600 mg/day) was associated with significant PSA responses and a delay in tumor progression. Itraconazole also showed activity in a phase II trial in men with non-small cell lung cancer when it was combined with the chemotherapy agent, pemetrexed.

Usual Adult Dose for Blastomycosis

Loading dose: 200 mg orally 3 times a day for the first 3 days of therapy
Maintenance dose: 200 mg orally once or twice a day
Duration of therapy: At least 3 months and until clinical parameters and laboratory tests indicate the active fungal infection has subsided

Comments:
-Capsule formulation
-A loading dose should be used in life-threatening situations.
-If no obvious improvement or if evidence of progressive fungal disease at 200 mg/day, the dose should be increased in 100 mg increments to a maximum of 400 mg/day.

Usual Adult Dose for Histoplasmosis

Loading dose: 200 mg orally 3 times a day for the first 3 days of therapy
Maintenance dose: 200 mg orally once or twice a day
Duration of therapy: At least 3 months and until clinical parameters and laboratory tests indicate the active fungal infection has subsided

Comments:
-Capsule formulation
-A loading dose should be used in life-threatening situations.
-If no obvious improvement or if evidence of progressive fungal disease at 200 mg/day, the dose should be increased in 100 mg increments to a maximum of 400 mg/day.

Usual Adult Dose for Aspergillosis – Aspergilloma

Loading dose: 200 mg orally 3 times a day for the first 3 days of therapy
Maintenance dose: 200 mg orally once or twice a day
Duration of therapy: At least 3 months and until clinical parameters and laboratory tests indicate the active fungal infection has subsided

Comments:
-Capsule formulation
-A loading dose should be used in life-threatening situations.

Commonly reported side effects of itraconazole include: nausea. Other side effects include: vomiting. See below for a comprehensive list of adverse effects.

Minocycline is a tetracycline antibiotic that fights bacteria in the body.

Minocycline is used to treat many different bacterial infections, such as urinary tract infections, respiratory infections, skin infections, severe acne, gonorrhea, tick fever, chlamydia, and others.

Minocycline is a broad-spectrum tetracycline antibiotic, and has a broader spectrum than the other members of the group. It is a bacteriostatic antibiotic, classified as a long-acting type. As a result of its long half-life it generally has serum levels 2–4 times that of the simple water-soluble tetracyclines.

Minocycline is the most lipid-soluble of the tetracycline-class antibiotics, giving it the greatest penetration into the prostate and brain, but also the greatest amount of central nervous system (CNS)-related side effects, such as vertigo. A common side effect is diarrhea. Uncommon side effects (with prolonged therapy) include skin discolouration and autoimmune disorders that are not seen with other drugs in the class.

Minocycline is a relatively poor tetracycline-class antibiotic choice for urinary pathogens sensitive to this antibiotic class, as its solubility in water and levels in the urine are less than all other tetracyclines. Minocycline is metabolized by the liver and has poor urinary excretion.

Minocycline was patented in 1961 and came into commercial use in 1971. is not a naturally occurring antibiotic, but was synthesized semi-synthetically from natural tetracycline antibiotics by Lederle Laboratories in 1966, and marketed by them under the brand name Minocin.

Minocycline and doxycycline are frequently used for the treatment of acne vulgaris. Both of these closely related antibiotics have similar levels of efficacy, although doxycycline has a slightly lower risk of adverse side effects. Historically, minocycline has been a very effective treatment for acne vulgaris. However, acne that is caused by antibiotic resistant bacteria is a growing problem in many countries. In Europe and North America, a significant number of acne patients no longer respond well to treatment with tetracycline family antibiotics (e.g. tetracycline, doxycycline and minocycline) because their acne symptoms are caused by bacteria (primarily Propionibacterium acnes) that are resistant to these antibiotics. 

Minocycline is also used for other skin infections such as MRSA as well as Lyme disease, as the one pill twice daily 100 mg dosage is far easier for patients than the four times a day required with tetracycline or oxytetracycline. Its activity against Lyme disease is enhanced by its superior ability to cross the blood-brain barrier.

Although minocycline’s broader spectrum of activity, compared with other members of the group, includes activity against Neisseria meningitidis,^[12] its use as a prophylaxis is no longer recommended because of side effects (dizziness and vertigo).

It may be used to treat certain strains of MRSA infection and a disease caused by drug resistant Acinetobacter.

Both minocycline and doxycycline have shown effectiveness in asthma due to immune suppressing effects.^[14] Minocycline as well as doxycycline have modest effectiveness in treating rheumatoid arthritis. It is recognized as a DMARD (Disease-Modifying Anti-Rheumatic Drug) by the American College of Rheumatology, which recommends its use as a treatment for rheumatoid arthritis.

A list of indications for which minocycline has been used include:

• Amoebic dysentery
• Anthrax
• Bubonic plague
• Cholera
• Ehrlichiosis
• Gonorrhea (when penicillin cannot be given)
• Gougerot-Carteaud syndrome (confluent and reticulated papillomatosis)
• Hidradenitis suppurativa
• HIV—for use as an adjuvant to HAART^[16]
• Periodontal disease
• Perioral dermatitis^[17]
• Respiratory infections such as pneumonia
• Rocky Mountain spotted fever
• Rosacea
• Syphilis (when penicillin cannot be given)
• Urinary tract infections, rectal infections, and infections of the cervix caused by certain microbes

Usual Adult Dose for Bacterial Infection

IV: 200 mg IV initially followed by 100 mg IV every 12 hours
Maximum dose: 400 mg/24 hours

Oral:
Most infections: 200 mg orally initially followed by 100 mg orally every 12 hours
-Alternative regimen (if more frequent dosing preferred): 100 to 200 mg orally initially followed by 50 mg orally 4 times a day

Uncomplicated urethral, endocervical, or rectal infections due to Chlamydia trachomatis or Ureaplasma urealyticum: 100 mg orally every 12 hours for at least 7 days

Comments:
-With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
-Coadministration with streptomycin recommended for bartonellosis.
-For syphilis, the duration of therapy is 10 to 15 days; close follow-up (including laboratory tests) recommended.

Uses:
-For the treatment of the following infections: Rocky Mountain spotted fever, typhus fever, typhus group, Q fever, rickettsialpox, tick fevers due to rickettsiae; respiratory tract infections due to Mycoplasma pneumoniae; lymphogranuloma venereum, trachoma, or inclusion conjunctivitis due to C trachomatis; psittacosis (ornithosis) due to Chlamydophila psittaci; nongonococcal urethritis, endocervical, or rectal infections due to U urealyticum or C trachomatis; relapsing fever due to Borrelia recurrentis; plague due to Yersinia pestis; tularemia due to Francisella tularensis; cholera due to Vibrio cholerae; Campylobacter fetus infections; brucellosis due to Brucella species; bartonellosis due to Bartonella bacilliformis; granuloma inguinale due to Klebsiella granulomatis
-For the treatment of infections due to the following bacteria when bacteriologic testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to Haemophilus influenzae; respiratory tract and urinary tract infections due to Klebsiella species; upper respiratory tract infections due to Streptococcus pneumoniae
-When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Syphilis due to Treponema pallidum subspecies pallidum; yaws due to T pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; anthrax due to Bacillus anthracis; Vincent’s infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; clostridial infections
-As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Acne

Extended-release formulations:
45 to 49 kg: 45 mg orally once a day
50 to 59 kg: 55 mg orally once a day
60 to 71 kg: 65 mg orally once a day
72 to 84 kg: 80 mg orally once a day
85 to 96 kg: 90 mg orally once a day
97 to 110 kg: 105 mg orally once a day
111 to 125 kg: 115 mg orally once a day
126 to 136 kg: 135 mg orally once a day

Duration of therapy: 12 weeks

Comments:
-Recommended dose is about 1 mg/kg once a day.
-This drug did not show any effect on non-inflammatory acne lesions.
-Safety not established beyond 12 weeks.

Use: To treat only inflammatory lesions of non-nodular moderate to severe acne vulgaris

American Academy of Dermatology (AAD) Recommendations:
Immediate-release formulations: 50 mg orally once to 3 times a day

Comments:
-Recommended as adjunctive treatment of moderate to severe inflammatory acne
-This drug should not be used as monotherapy.
-Use should be limited to the shortest duration possible; reevaluation recommended at 3 to 4 months to minimize resistant bacteria developing.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Meningitis – Meningococcal

200 mg IV initially followed by 100 mg IV every 12 hours
Maximum dose: 400 mg/24 hours

Use: When penicillin is contraindicated, as an alternative agent for the treatment of meningitis due to Neisseria meningitidis

Usual Adult Dose for Meningococcal Meningitis Prophylaxis

100 mg orally every 12 hours for 5 days

Comments:
-Diagnostic laboratory studies (including serotyping and susceptibility testing) are recommended to establish the carrier state and the appropriate therapy.
-Prophylactic use of this drug is only recommended when risk of meningococcal meningitis is high.

Use: In the treatment of asymptomatic carriers of N meningitidis to eliminate meningococci from the nasopharynx

Usual Adult Dose for Skin or Soft Tissue Infection

IV: 200 mg IV initially followed by 100 mg IV every 12 hours
Maximum dose: 400 mg/24 hours

Oral:
Infection due to Staphylococcus aureus: 200 mg orally initially followed by 100 mg orally every 12 hours
-Alternative regimen (if more frequent dosing preferred): 100 to 200 mg orally initially followed by 50 mg orally 4 times a day

Infection due to Mycobacterium marinum: 100 mg orally every 12 hours for 6 to 8 weeks

Comments:
-Not the drug of choice for any type of staphylococcal infection
-The optimal dose has not been established to treat M marinum infections; the recommended dose has been successful in limited cases.

Uses: For the treatment of skin and skin structure infections due to S aureus when bacteriologic testing shows suitable susceptibility to this drug; for the treatment of infections due to M marinum

Infectious Diseases Society of America (IDSA) Recommendations: 100 mg orally twice a day

Comments:
-Recommended for skin and soft tissue infections due to methicillin-susceptible and methicillin-resistant S aureus
-After an initial dose of 200 mg, recommended for purulent cellulitis (cellulitis associated with purulent drainage/exudate without a drainable abscess) due to methicillin-resistant S aureus
-Current guidelines should be consulted for additional information.

Minocycline may cause upset stomach, diarrhea, dizziness, unsteadiness, drowsiness, mouth sores, headache and vomiting. Minocycline increases sensitivity to sunlight. Minocycline may affect quality of sleep and rarely cause sleep disorders. It has also been linked to cases of lupus. Prolonged use of minocycline over an extended period of time can lead to blue-gray skin, fingernails and staining of scar tissue. This staining is not permanent but can take a very long time for the skin color to return to normal; on the other hand a muddy brown skin color in sun exposed areas is usually a permanent skin discolouration. Permanent blue discoloration of gums or teeth discoloration may also occur. Rare but serious side effects include fever, yellowing of the eyes or skin, stomach pain, sore throat, vision changes, and mental changes, including depersonalization.

Cefalexin, also spelled cephalexin, is an antibiotic that can treat a number of bacterial infections. It kills gram-positive and some gram-negative bacteria by disrupting the growth of the bacterial cell wall. Cefalexin is a beta-lactam antibiotic within the class of first-generation cephalosporins. It works similarly to other agents within this class, including intravenous cefazolin, but can be taken by mouth.

Cefalexin can treat certain bacterial infections, including those of the middle ear, bone and joint, skin, and urinary tract. It may also be used for certain types of pneumonia, strep throat, and to prevent bacterial endocarditis. Cefalexin is not effective against infections caused by methicillin-resistant Staphylococcus aureus (MRSA), Enterococcus, or Pseudomonas. Like other antibiotics, cefalexin cannot treat viral infections, such as the flu, common cold or acute bronchitis. Cefalexin can be used in those who have mild or moderate allergies to penicillin. However, it is not recommended in those with severe penicillin allergies.

Common side effects include stomach upset and diarrhea. An allergic reaction and infection with Clostridium difficile, a type of diarrhea, is also possible. To date, no evidence of harm to the baby has been found when used during pregnancy or breast feeding. It can be used in children and those over 65 years of age. Those with kidney problems may require a decrease in dose.

In 2012, cefalexin was one of the top 100 most prescribed medications in the United States. In Canada, it was the 5th most common antibiotic used in 2013. In Australia, it is one of the top 15 most prescribed medications. Cefalexin was developed in 1967. It was first marketed in 1969 and 1970 under the names Keflex and Ceporex, among others. Generic drug versions are available under several other trade names and are inexpensive. Cefalexin is on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

2 g orally as a single dose one hour before the procedure

Usual Adult Dose for Cystitis

250 mg orally every 6 hours or 500 mg orally every 12 hours for 7 to 14 days

Usual Adult Dose for Otitis Media

500 mg orally every 6 hours for 10 to 14 days

Usual Adult Dose for Pharyngitis

250 mg orally every 6 hours or 500 mg orally every 12 hours

Usual Adult Dose for Skin or Soft Tissue Infection

250 mg orally every 6 hours or 500 mg orally every 12 hours

Usual Adult Dose for Osteomyelitis

500 mg orally every 6 hours
Therapy should be continued for approximately 4 to 6 weeks, depending on the nature and severity of the infection. Chronic osteomyelitis may require an additional one to two months of antibiotic therapy and may benefit from surgical debridement.

Usual Adult Dose for Prostatitis

500 mg orally every 6 hours for 14 days

Usual Adult Dose for Pyelonephritis

500 mg orally every 6 hours for 14 days

Usual Adult Dose for Upper Respiratory Tract Infection

250 to 500 mg orally every 6 hours for 7 to 10 days

Usual Adult Dose for Bacterial Infection

250 to 500 mg orally every 6 hours
Therapy should be continued for approximately 7 to 21 days, depending on the nature and severity of the infection.

The most common adverse effects of cefalexin, like other oral cephalosporins, are gastrointestinal (stomach area) disturbances and hypersensitivity reactions. Gastrointestinal disturbances include nausea, vomiting, and diarrhea, diarrhea being most common. Hypersensitivity reactions include skin rashes, urticaria, fever, and anaphylaxis. Pseudomembranous colitis and Clostridium difficile have been reported with use of cefalexin.

Signs and symptoms of an allergic reaction include rash, itching, swelling, trouble breathing, or red, blistered, swollen, or peeling skin. Overall, cefalexin allergy occurs in less than 0.1% of patients, but it is seen in 1% to 10% of patients with a penicillin allergy.

Cefdinir is a third-generation oral cephalosporin antibiotic sold under the brand names Cefzon and Omnicef.

As of 2008, cefdinir, as Omnicef, was the highest-selling cephalosporin antibiotic in the United States, with more than US$585 million in retail sales of its generic versions alone. Cephalosporin is structurally similar to cefixime.

Cefdinir is used to treat certain infections caused by bacteria such as bronchitis (infection of the airway tubes leading to the lungs); pneumonia; and infections of the skin, ears, sinuses, throat, and tonsils.. Cefdinir is in a class of medications called cephalosporin antibiotics. It works by killing bacteria.

Antibiotics such as cefdinir will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

Cefdinir comes as a capsule and suspension (liquid) to take by mouth. It is usually taken with or without food every 12 or 24 hours for 5 to 10 days, depending on the condition being treated. Take cefdinir at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take cefdinir exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Side effects include diarrhea, vaginal infections or inflammation, nausea, headache, and abdominal pain

The main use of linezolid is the treatment of severe infections caused by Gram-positive bacteria that are resistant to other antibiotics; it should not be used against bacteria that are sensitive to drugs with a narrower spectrum of activity, such as penicillins and cephalosporins. In both the popular press and the scientific literature, linezolid has been called a “reserve antibiotic”—one that should be used sparingly so that it will remain effective as a drug of last resort against potentially intractable infections.

In the United States, the indications for linezolid use approved by the U.S. Food and Drug Administration (FDA) are the treatment of vancomycin-resistant Enterococcus faeciuminfections, with or without bacterial invasion of the bloodstream; nosocomial pneumonia (hospital-acquired) and community-acquired pneumonia caused by S. aureus or S. pneumoniae; complicated skin and skin structure infections (cSSSI) caused by susceptible bacteria, including diabetic foot infection, unless complicated by osteomyelitis (infection of the bone and bone marrow); and uncomplicated skin and soft tissue infections caused by S. pyogenes or S. aureus. The manufacturer advises against the use of linezolid for community-acquired pneumonia or uncomplicated skin and soft tissue infections caused by MRSA. In the United Kingdom, pneumonia and cSSSIs are the only indications noted in the product labeling. 

Linezolid appears to be as safe and effective for use in children and newborns as it is in adults.

Usual Adult Dose for Bacteremia

600 mg IV or orally every 12 hours

Duration of therapy:
-Pneumonia: 10 to 14 consecutive days
-Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days

Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Usual Adult Dose for Pneumonia

600 mg IV or orally every 12 hours

Duration of therapy:
-Pneumonia: 10 to 14 consecutive days
-Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days

Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Usual Adult Dose for Bacterial Infection

600 mg IV or orally every 12 hours

Duration of therapy:
-Pneumonia: 10 to 14 consecutive days
-Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days

Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Diarrhea, headache, nausea, vomiting, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Сlarithromycin, sold under the brand name Biaxin, is an antibiotic used to treat various bacterial infections. This includes strep throat, pneumonia, skin infections, H. pylori infection, and Lyme disease, among others. Clarithromycin can be taken by mouth as a pill or liquid.

Clarithromycin is primarily used to treat a number of bacterial infections including: pneumonia, Helicobacter pylori and as an alternative to penicillin in strep throat. Other uses include: cat scratch disease and other infections due to bartonella, cryptosporidiosis, as a second line agent in Lyme disease and toxoplasmosis. It may also be used to prevent bacterial endocarditis in those who cannot take penicillin. It is effective against upper and lower respiratory tract infections, skin and soft tissue infections and helicobacter pylori infections associated with duodenal ulcers.

Clarithromycin was developed in 1980. It is on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system. Clarithromycin is available as a generic medication. 

Usual Adult Dose for Tonsillitis/Pharyngitis

Immediate-release: 250 mg orally every 12 hours for 10 days

Comments:
-The drug of choice for treatment and prevention of streptococcal infections and prophylaxis of rheumatic fever is IM or oral penicillin.
-In general, this drug effectively eradicates Streptococcus pyogenes from the nasopharynx; efficacy in the subsequent prevention of rheumatic fever has not been established.

Use: For the treatment of pharyngitis/tonsillitis due to S pyogenes

Usual Adult Dose for Sinusitis

Immediate-release: 500 mg orally every 12 hours for 14 days
Extended-release: 1000 mg orally every 24 hours for 14 days

Uses: For the treatment of acute maxillary sinusitis due to Haemophilus influenzae, Moraxella catarrhalis, or S pneumoniae

Usual Adult Dose for Bronchitis

Immediate-release:
-Due to H influenzae: 500 mg orally every 12 hours for 7 to 14 days
-Due to H parainfluenzae: 500 mg orally every 12 hours for 7 days
-Due to M catarrhalis or S pneumoniae: 250 mg orally every 12 hours for 7 to 14 days

Extended-release: 1000 mg orally every 24 hours for 7 days

Uses: For the treatment of acute bacterial exacerbation of chronic bronchitis due to H influenzae, H parainfluenzae, M catarrhalis, or S pneumoniae

Usual Adult Dose for Pneumonia

Immediate-release:
-Due to H influenzae: 250 mg orally every 12 hours for 7 days
-Due to S pneumoniae or Chlamydophila pneumoniae: 250 mg orally every 12 hours for 7 to 14 days

Extended-release: 1000 mg orally every 24 hours for 7 days

Uses: For the treatment of community-acquired pneumonia due to:
-Immediate-release: H influenzae, S pneumoniae, or C pneumoniae (TWAR)
-Extended-release: H influenzae, H parainfluenzae, M catarrhalis, S pneumoniae, C pneumoniae (TWAR)

Usual Adult Dose for Mycoplasma Pneumonia

Immediate-release: 250 mg orally every 12 hours for 7 to 14 days
Extended-release: 1000 mg orally every 24 hours for 7 days

Use: For the treatment of community-acquired pneumonia due to Mycoplasma pneumoniae

Usual Adult Dose for Skin and Structure Infection

Immediate-release: 250 mg orally every 12 hours for 7 to 14 days

Comments:
-Abscesses usually require surgical drainage.

Uses: For the treatment of uncomplicated skin and skin structure infections due to Staphylococcus aureus or S pyogenes

Usual Adult Dose for Helicobacter pylori Infection

Immediate-release:
Triple therapy:
-In combination with lansoprazole and amoxicillin: Clarithromycin 500 mg orally every 12 hours for 10 to 14 days
-In combination with omeprazole and amoxicillin: Clarithromycin 500 mg orally every 12 hours for 10 days

Dual therapy:
-In combination with omeprazole: Clarithromycin 500 mg orally every 8 hours for 14 days
-In combination with ranitidine bismuth citrate: Clarithromycin 500 mg orally every 8 to 12 hours for 14 days

Comments:
-Helicobacter pylori eradication shown to reduce the risk of duodenal ulcer recurrence
-Regimens with this drug as the only antimicrobial agent are more likely to be associated with clarithromycin resistance in patients who fail therapy.
-Regimens containing this drug should not be used in patients with known or suspected clarithromycin-resistant isolates; efficacy of therapy is reduced.
-Susceptibility testing is recommended in patients who fail therapy; if resistance to this drug is established, a non-clarithromycin-containing regimen is recommended.
-The manufacturer product information for the other drugs indicated in combination with clarithromycin should be consulted.

Uses:
-Triple therapy: In combination with amoxicillin and (lansoprazole or omeprazole), for the treatment of patients with H pylori infection and duodenal ulcer disease (active or 5-year history of duodenal ulcer) to eradicate H pylori
-Dual therapy: In combination with omeprazole or ranitidine bismuth citrate, for the treatment of patients with active duodenal ulcer associated with H pylori infection

Usual Adult Dose for Mycobacterium avium-intracellulare – Prophylaxis

Immediate-release: 500 mg orally twice a day

Use: For the prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection

US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA) Recommendations for HIV-infected Patients:
-Primary prevention of disseminated MAC disease: 500 mg orally twice a day
-Chronic maintenance therapy (secondary prophylaxis) for disseminated MAC disease: 500 mg orally twice a day

Comments:
-Primary prophylaxis against disseminated MAC disease recommended for patients with CD4 count less than 50 cells/mm3 (after active disseminated MAC disease has been ruled out based on clinical assessment).
-This drug is a preferred prophylactic agent for primary prevention of disseminated MAC disease (except during pregnancy).
-The combination of this drug and rifabutin should not be used for primary MAC prophylaxis; not more effective than this drug alone.
-Primary MAC prophylaxis should be discontinued in patients responding to antiretroviral therapy (ART) with increase in CD4 count to greater than 100 cells/mm3 for at least 3 months; should restart if CD4 count declines to less than 50 cells/mm3.
-This drug should be used with ethambutol for chronic maintenance therapy; same regimen as for treatment.
-Patients with disseminated MAC disease should continue chronic maintenance therapy (secondary prophylaxis) unless immune reconstitution occurs due to ART.
-Chronic maintenance therapy may be stopped in patients at low risk of MAC recurrence; such patients have completed at least 12 months of MAC therapy, have no signs/symptoms of MAC disease, and have an increase in CD4 count to greater than 100 cells/mm3 for more than 6 months in response to ART; should restart if CD4 count declines to less than 100 cells/mm3.

Usual Adult Dose for Mycobacterium avium-intracellulare – Treatment

Immediate-release: 500 mg orally twice a day

Comments:
-Recommended as the primary agent for the treatment of disseminated infection due to MAC
-This drug should be used in combination with other antimycobacterial agents that have shown in vitro activity against MAC or clinical benefit in MAC treatment.
-Therapy should continue if clinical response is observed; can discontinue this drug when patient considered at low risk of disseminated infection.

Uses: For the treatment of disseminated mycobacterial infections due to M avium or M intracellulare

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients:
-Treatment of disseminated MAC disease: 500 mg orally twice a day

Comments:
-This drug should be used with ethambutol.
-Combination therapy with at least 2 antimycobacterial drugs is recommended for initial treatment of MAC disease to prevent/delay resistance development.
-This drug is the preferred first agent (except during pregnancy); ethambutol is the recommended second agent.
-Addition of a third or fourth agent should be considered for patients with CD4 count less than 50 cells/mm3, high mycobacterial loads, or when effective ART is absent; some experts recommend rifabutin as a third agent.
-MAC isolates should be tested for susceptibility to this drug in all patients.
-Patients with disseminated MAC disease should continue chronic maintenance therapy (secondary prophylaxis) unless immune reconstitution occurs due to ART.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

American Heart Association (AHA) recommendations:
Immediate-release: 500 mg orally as a single dose 30 to 60 minutes before procedure

Comments:
-Recommended for patients allergic to penicillins

Usual Adult Dose for Legionella Pneumonia

Some experts recommend:
Immediate-release: 500 mg orally every 12 hours

Duration of therapy:
-For mild to moderate infections in immunocompetent patients: 10 days
-To prevent relapse, especially in patients with more severe infections or with underlying comorbidity or immunodeficiency: 3 weeks may be necessary

Comments:
-Recommended for Legionnaires’ disease

Usual Adult Dose for Pertussis Prophylaxis

US CDC recommendations:
Immediate-release: 500 mg orally every 12 hours for 7 days

Comments:
-Recommended for treatment and postexposure prophylaxis
-Macrolides are preferred agents for the treatment of pertussis.

Usual Adult Dose for Pertussis

US CDC recommendations:
Immediate-release: 500 mg orally every 12 hours for 7 days

Comments:
-Recommended for treatment and postexposure prophylaxis
-Macrolides are preferred agents for the treatment of pertussis.

Usual Pediatric Dose for Tonsillitis/Pharyngitis

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Uses: For the treatment of pharyngitis/tonsillitis due to S pyogenes

Usual Pediatric Dose for Sinusitis

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Uses: For the treatment of acute maxillary sinusitis due to H influenzae, M catarrhalis, or S pneumoniae

Usual Pediatric Dose for Mycoplasma Pneumonia

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Uses: For the treatment of community-acquired pneumonia due to M pneumoniae, S pneumoniae, or C pneumoniae (TWAR)

Usual Pediatric Dose for Pneumonia

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Uses: For the treatment of community-acquired pneumonia due to M pneumoniae, S pneumoniae, or C pneumoniae (TWAR)

Usual Pediatric Dose for Otitis Media

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Uses: For the treatment of acute otitis media due to H influenzae, M catarrhalis, or S pneumoniae

Usual Pediatric Dose for Skin and Structure Infection

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Comments:
-Abscesses usually require surgical drainage.

Uses: For the treatment of uncomplicated skin and skin structure infections due to S aureus or S pyogenes

Usual Pediatric Dose for Mycobacterium avium-intracellulare – Prophylaxis

Immediate-release:
20 months or older: 7.5 mg/kg orally twice a day
Maximum dose: 500 mg/dose

Use: For the prevention of disseminated MAC disease in patients with advanced HIV infection

US CDC, NIH, HIVMA/IDSA, Pediatric Infectious Diseases Society (PIDS), and American Academy of Pediatrics (AAP) Recommendations for HIV-exposed and HIV-infected Children:
-Primary prevention of MAC infections: 7.5 mg/kg orally twice a day
-Chronic suppressive therapy for MAC infections: 7.5 mg/kg orally twice a day

Maximum dose: 500 mg/dose

Common side effects include nausea, vomiting, headaches, and diarrhea. Severe allergic reactions are rare. Liver problems have been reported. It may cause harm if taken during pregnancy. It is in the macrolide class and works by decreasing protein production of some bacteria.

Decreasing the risk that hepatic encephalopathy (a serious liver problem) will occur again in patients who have already had it. It may be used for other conditions as determined by your doctor.

Rifaximin is an antibiotic. Exactly how it works to treat hepatic encephalopathy is not known. It is thought to have an effect on the bacteria in the stomach.

This medication is used to treat diarrhea caused by the common bacteria known as E. coli (“traveler’s diarrhea”). Rifaximin should not be used if you have a fever or bloody diarrhea. It works by stopping the growth of bacteria.

This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness.

Rifaximin is also used to treat irritable bowel syndrome with diarrhea. It is also used to prevent a brain problem caused by liver disease (hepatic encephalopathy). It may help you think more clearly.

Usual Adult Dose for Traveler’s Diarrhea

200 mg orally 3 times a day for 3 days

Comments:
-Should not use in patients with diarrhea complicated by fever and/or blood in the stool or diarrhea caused by pathogens other than Escherichia coli

Use: For the treatment of travelers’ diarrhea due to noninvasive strains of E coli

Usual Adult Dose for Hepatic Encephalopathy

550 mg orally twice a day

Comments:
-In trials, lactulose was used concomitantly in 91% of patients; differences in treatment effect of patients not using concomitant lactulose could not be assessed.

Use: For reduction in risk of overt hepatic encephalopathy recurrence

Usual Adult Dose for Irritable Bowel Syndrome

550 mg orally 3 times a day for 14 days

Comments:
-If symptoms recur, patients can be retreated up to 2 times with the same dose regimen.

Use: For the treatment of irritable bowel syndrome with diarrhea

Usual Pediatric Dose for Traveler’s Diarrhea

12 years or older: 200 mg orally 3 times a day for 3 days

Comments:
-Should not use in patients with diarrhea complicated by fever and/or blood in the stool or diarrhea caused by pathogens other than E coli

Use: For the treatment of travelers’ diarrhea due to noninvasive strains of E coli

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Mild or moderate liver dysfunction (Child-Pugh A or B): No adjustment recommended.
Severe liver dysfunction (Child-Pugh C): Caution is recommended.

Comments:
-This drug was not studied in hepatic encephalopathy patients with Model for End-stage Liver Disease (MELD) scores greater than 25; in the controlled trial, only 8.6% of patients had MELD scores over 19.
-Systemic exposure increased with more severe liver dysfunction.

Precautions

Travelers’ diarrhea: Safety and efficacy have not been established in patients younger than 12 years.
Hepatic encephalopathy, irritable bowel syndrome with diarrhea: Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Commonly reported side effects of rifaximin include: flatulence. Other side effects include: abdominal pain, bowel urgency, headache, nausea, and rectal tenesmus. See below for a comprehensive list of adverse effects.

Bupropion is a medication primarily used as an antidepressant and smoking cessation aid. It is marketed as Wellbutrin and Zyban among other trade names. It is one of the most frequently prescribed antidepressants in the United States and Canada,  although in many countries this is an off-label use. It is an effective antidepressant on its own, but is also popular as an add-on medication in cases of incomplete response to first-line SSRI antidepressants. Bupropion is taken in tablet form and is available only by prescription in most countries.

Bupropion is known to affect several different biological targets. It often is described as a norepinephrine-dopamine reuptake inhibitor (NDRI), and is also a nicotinic antagonist. However, bupropion does not appear to have significant dopaminergic actions in humans under normal clinical circumstances. Chemically, bupropion belongs to the class of aminoketones and is similar in structure to stimulants such as cathinone and amfepramone, and to phenethylamines in general.

Bupropion was first made by Nariman Mehta and patented by Burroughs Wellcome in 1969, which later became part of what is now GlaxoSmithKline. It was first approved for medical use in the United States in 1989. It was originally called by the generic name amfebutamone, before being renamed in 2000.

Sustained-release tablets (Wellbutrin SR (R)):
Initial dose: 150 mg orally once a day in the morning, increase if necessary after 3 days to 150 mg orally twice a day.
Maintenance dose: 150 mg orally twice a day
Maximum dose: 200 mg orally twice a day; maximum single dose should not exceed 200 mg

The most important side effect is an increase in risk for epileptic seizures, which caused the drug to be withdrawn from the market for some time and then caused the recommended dosage to be reduced.In comparison to many other antidepressants, it does not cause as much weight gain, sexual dysfunction, or sleepiness.

Bupropion acts as an norepinephrine-dopamine reuptake inhibitor (NDRI). It is an atypical antidepressant, different from most commonly prescribed antidepressants such as selective serotonin reuptake inhibitors (SSRIs).