Respiratory Disease Case No.2 Pneumonia

Hello I'm Raiyyan Tahsan

Brand Model and Executive

Respiratory Disease Case No.2 Pneumonia

সহজ নিউমনিয়া চিকিৎসা –

(Presenting Complaint)

যদি কোন রোগী তীব্র জ্বর ( high fever ), কাশি সাথে বুকে ব্যাথা (Pleuritic chest pain)

প্রথমে ৪ টা জিনিস দেখবো অথবা হিস্টোরি নিবো (Risk Factor)

বিড়ি খায় কিনা ,

বৃদ্ধ কিনা,

এলকোহল বা স্টেরয়েড নেয় কিনা,

রিজেন্ট কোন ইনফ্লুয়েন্জায় আক্রান্ত হয়েছে কিনা ,

এবার কি করবো ?

এবার

৪ টা জিনিস (Differential Diagnosis)মাথায় ঘুরতে হবে,

Pneumonia

Pulmonary Tuberculosis

Malignancy

Pulmonary Infraction

এবার কি করবো ?

এবার ভাই রোগীর গায়ে একটু হাত দিবো

দেখবো High Fever পাবো ,

Inspection এ RR বেশি পাবো

বুকে Stethoscope লাগাবো আর Consolidation এর Sound তথা Bronchial Brest sound and Whispering pectoriloquy শুনবো

Others Parameters দেখবো

এরপর ??

এবার ধরলাম Probable Diagnosis is Pneumonia

তাহলে কনফার্ম কিভাবে করবো ।

৪ টা জিনিস আবার মাথায় ঘুরানো লাগবে,

1 – Types Of pneumonia (Hospital Acquired, Hospital Acquired, Abscess , Inhaled Cortico steroid)

2- CURB 65,

3- Best Guese Organism (Mycoplasma Pneumoniae, haemophillus influenza)

4- Antibiotics

এর পর নিচের বিষয়গুলো অবশ্যই খেয়াল করবো ,

1. Young aged patients সাথে pneumonia চোখ বন্ধ করে Mycoplasma pneumoniae(Viral infections are also recognised as important causes of CAP in children and their contribution to adult CAP is increasingly recognised.)

2. Older aged pt সাথে pneumonia,

think প্রথমে ভাববো Haemophilus influenzae.

3. Post influenza Pneumonia কিনা ? তাহলে Staphylococcus Aureus

4. Pneumonia with Herpes Labialis/ Rusty

Sputum (মরিচার মত থুথু)তাহলে Streptococcuspneumoniae

5. Pneumonia, যদি history থাকে post honeymoon/ travel with Cold shower /local outbreaks centred on contaminated cooling towers in hotels নিশ্চিত চিন্তা করতে পারেন Legionellapneumophila.

6. Alcoholic patient, pneumonia সাথে +_ Red Current jelly sputum তাহলে অবশ্যই Klebseilla.

7. Recent Foreign Travel.

A-MERS-coronavirus (middle East)

B. melioidisis caused by. Burkholderia pseudomalle ( South-east Asia and northern Australia) and

C.endemic fungal infection ( North , Central or South America)

8. Pneumonia with Lung Abscess তাহলে Staph, Klebseilla, Pseudomonas, TB.

9. pneumonia with Rapid onset High fever Pleuritic chest pain Herpes labialis- – – -> Streptococcus pneumonia

10. Pneumonia with Ear/CNS/skin/ anaemia ( haemolytic)/heart/ Renal/GIT complications …. ==> Mycoplasma

11. Pneumonia with 5L (Low Na, Low Pulse ( relative Bradycardia), Lymphopenic Leucocytosis, LFT derranged, # Low ALP,

Flu Like S/S Urine RME positive for Protein-Blood- myoglobin , অথবা GIT- ANVD(anorexia ,Nausea , Vomiting, Diarrhoe)=== > Legionella .

এবার কাগজে প্রমান করবো অর্থাৎ পরীক্ষার নিরীক্ষা করবো

Investigation-

Blood

1-CBC

2-Urea and electrolyte

3-Liver F T

4- Blood Culture ,

5-ABG

6-CRP

Sputum

1-Gram stain

Urine

Chest X-ray

Pleura fluid

মিনিমাম যে পরীক্ষা না করলেই নয়,

ABG, Chest X-ray , CBC

Treatment

Symptomatic

1-Paracetamol for fever

2-Oxygen in case of hypoxia

3- Fluid balance

4-physiotherapy

অবশ্যই অবশ্যই

৫- Antibiotics

Proper antibiotics then Proper Response

কিভাবে চয়েজ করবেন ,

যদি Streptococcus হয়, তাহলে Amoxicillin 500mg 3 times Daily

যদি pt Allergic to penicillin হয়,

Amoxicillin:-

In that case we can use

Tablet 1: -Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Indications of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Co-amoxiclav is indicated for short-term treatment of bacterial infections at the following sites:

Upper respiratory tract infections (including ENT) e.g.tonsillitis,sinusitis,otitis media.
Lower respiratory tract infections e.g.acute and chronic bronchitis, lobar and bronchopneumonia.
Genito-urinary tract infections e.g.cystitis,urethritis,pyelonephritis.
Skin and soft tissue infections.
Bone and joint infections e.g.osteomyelitis.
Other infections e.g.septic abortion,puerperal sepsis,intra-abdominal sepsis etc.

Composition

375 mg tablet: Each film coated tablet contains Amoxicillin 250 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 125 mg as Diluted Potassium Clavulanate BP.
625 mg tablet: Each film coated tablet contains Amoxicillin 500 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 125 mg as Diluted Potassium Clavulanate BP.
1 gm tablet: Each film coated tablet contains Amoxicillin 875 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 125 mg Diluted Potassium Clavulanate BP.
Powder for Suspension: Each 5 ml reconstituted suspension contains Amoxicillin 125 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 31.25 mg as Diluted Potassium Clavulanate BP.
Powder for Suspension (Forte): Each 5 ml reconstituted suspension contains Amoxicillin 400 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 57.5 mg as Diluted Potassium Clavulanate BP.
1.2 gm Injection: Each vial contains sterile mixture of Amoxicillin Sodium BP (equivalent to Amoxicillin 1 gm) and Clavulanate Potassium USP (equivalent to Clavulanic Acid 200 mg).
0.6 gm injection: Each vial contains sterile mixture of Amoxicillin Sodium BP (equivalent to Amoxicillin 500) and Clavulanate Potassium USP (equivalent to Clavulanic Acid 100 mg).

Pharmacology of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Pharmacodynamic properties: Co-amoxiclav is an antibacterial combination consisting of the antibiotic Amoxicillin and the (3-lactamase inhibitor Clavulanic Acid. Amoxicillin has a broad spectrum of bactericidal activity against many Gram-positive & Gram-negative microorganisms but it is susceptible to degradation by (3-lactamases and therefore the spectrum of activity does not include microorganisms, which produce these enzymes. Clavulanic acid possesses the ability to inactivate a wide range of beta-lactamase enzymes commonly found in microorganisms resistant to penicillins and cephalosporins. Thus Clavulanic acid in this preparation protects Amoxicillin from degradation by (3-lactamase enzymes and effectively extends the antibiotic spectrum to embrace a wide range of microorganisms.

Pharmacokinetic properties: The pharmacokinetics of the two components of Co-amoxiclav is closely matched. Peak serum levels of both occur about one hour after oral administration. Absorption of Co-amoxiclav is optimized at the start of a meal. Both clavulanate and Amoxicillin have low levels of serum binding; about 70% remains free in the serum. Doubling the dosage of Co-amoxiclav approximately doubles the serum levels achieved.

Dosage of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Adults and children over 12 years:

Tablet:

The usual adult dose is one 625 mg Tablet every 12 hours or one 375 mg Tablet every 8 hours.
For more severe infections and infections of the respiratory tract, the dose should be one 1 gm Tablet every 12 hours or one 625 mg Tablet every 8 hours.

Suspension:

Children 6-12 years: 2 teaspoonful every 8 hours.
Children 1-6years: 1 teaspoonful every 8 hours.
Children below 1 year: 25 mg/kg/day in divided doses every 8 hours, for example a 7.5 kg child would require 2 ml suspension t.i.d, Treatment should not be extended beyond 14 days without review.

Forte suspension:

The usual recommended daily dosage: 25/3.6 mg/kg/day in mild to moderate infections (upper respiratory tract infections e.g. recurrent tonsilitis, lower respiratory infections, and skin and soft tissue infections)।
For serious infections: 45/6.4 mg/kg/day for the treatment of more serious infections (upper respiratory tract infections, e.g. otitis media and sinusitis, lower respiratory infections e.g. bronchopneumonia, and urinary tract infections).

Children of 2 to 12 years:
Mild to moderate infections:

25/3.6 mg/kg/day (Suspension)
2-6 years (13-21 kg) 2.5 ml suspension b.i.d
7-12years (22-40kg) 5 ml suspension b.i.d

Serious infections:

45/6.4 mg/kg/day (Forte Suspension)
2-6 years (13-21 kg) 5 ml suspension b.i.d
7-12 years (22-40 kg) 10 ml suspension b.i.d

IV Injection

Adults-

Usually, 1.2 gm every 8 hours
Increased in more serious infections to 1.2 gm every 6 hours
For surgical prophylaxis: The usual dose is 1.2 gm at induction, for high risk procedures (eg. colorectal surgery) up to 2-3 gm may be given every 8 hours.

Children-

0 to 3 months: 30 mg/kg every 8 hours. (every 12 hours in the perinatal period and in premature infants.
3 months to 12 years: Usually 30 mg/kg every 8 hours increased in more serious infection to 30 mg/kg every 6 hours.

Administration of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Oral dosage form: This may be taken without regard to meals; however, absorption of clavulanate potassium is enhanced when Amoxicillin and Clavulanic acid are administered at the start of a meal. To minimize the potential for gastrointestinal intolerance, Amoxicillin and Clavulanic acid should be taken at the start of the meal.

IV injection is not suitable for intramuscular or subcutaneous administration. The reconstituted vial can be administered intravenously by injection (over 2 minutes) or slow intravenous infusion (30 minutes). The contents of the content of the vial must be used within 20 minutes and thereafter any unused material should be discarded.

Interaction of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Prolongation of bleeding time and prothrombin time have been reported in some patients receiving Co-amoxiclav. In common with other broad-spectrum antibiotics, Co-amoxiclav may reduce the efficacy of oral contraceptives and patients should be warned accordingly. Concomitant use of allopurinol during treatment with amoxicillin can increase the likelihood of allergic skin reactions. There are no data on the concomitant use of Co-amoxiclav and allopurinol.

Contraindications of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

History of Penicillin hypersensitivity. Attention should be paid to possible cross-sensitivity with other beta-lactam antibiotics e.g. cephalosporins. Also contraindicated for patients with a previous history of Co-amoxiclav or Penicillin-associated cholestatic jaundice.

Side Effects of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Side effects, as with Amoxicillin, are uncommon and mainly of a mild and transitory nature. Diarrhoea, pseudomembranous colitis, indigestion, nausea, vomiting and candidiasis have been reported, if gastrointestinal side effects occur with oral therapy, that may be reduced by taking Co-amoxiclav at the start of meals. Hepatitis and cholestatic jaundice have been reported rarely but are usually reversible. Urticarial and erythematous rashes sometimes occur. Rarely erythema multiforme, Stevens-Johnson Syndrome and exfoliative dermatitis have been reported. In common with other beta-lactam antibiotics, angioedema and anaphylaxis have been reported.

Pregnancy & Lactation

Animal studies with orally and parenterally administered Co-amoxiclav have shown no teratogenic effect. The drug has been used orally in human pregnancy in a limited number of cases with no untoward effect; however, the use of Co-amoxiclav in pregnancy is not recommended unless considered essential by the physician. During lactation, trace quantities of Amoxicillin can be detected in breast milk.

Precautions & Warnings of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Co-amoxiclav should be used with care in patients on anticoagulation therapy or with severe hepatic dysfunction. In patients with moderate or severe renal impairment, dosage should be adjusted. During the administration of a high dose of Co-amoxiclav adequate fluid intake and urinary output should be maintained to minimize the possibility of crystalluria.

Use in Special Populations of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

The dose should be adjusted in case of patients with renal impairment

Adult:

Mild impairment (Creatinine clearance> 30ml/minute): No changein dosage.
Moderate impairment (Creatinine clearance 10-30 ml/minute): One 375 Tablet or one 625 Tablet 12 hourly or 1.2 gm IV followed by 0.6 gm IV 12 hourly.
Severe impairment (Creatinine clearance <10 ml/minute): Not more than one 375 mg tablet 12 hourly or 1.2 gm IV followed by 0.6 gm IV 24 hourly. Dialysis decreases serum concentrations of Moxaclav and an additional 0.6 gm IV dose may need to be given during dialysis and at the end of dialysis.

Children:

A similar reduction in dosage should be made for children.
Administration hepatic impairment: Dose with caution; monitor hepatic function at regular intervals.

Overdose Effects of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Problems of overdose with Co-amoxiclav are unlikely to occur, if encountered gastrointestinal symptoms and disturbance of the fluid and electrolyte balances may be evident. Co-amoxiclav may be removed from the circulation by haemodialysis.

Therapeutic Class of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

OR:-

Clarithromycin 500mg twice daily

Tablet 2:-Klarix 500 mg (AS A Clarithromycin AS A Macrolides).

Indications of Tablet 2:-Klarix 500 mg (AS A Clarithromycin AS A Macrolides).

Klarix is indicated for the treatment of-

Acute bacterial exacerbation of chronic bronchitis in adults
Acute maxillary sinusitis
Community-acquired pneumonia
Pharyngitis or tonsillitis
Uncomplicated skin and skin structure infections
Acute otitis media in pediatric patients
Treatment and prophylaxis of disseminated mycobacterial infections
Helicobacter pylori infection and duodenal ulcer disease in adults

Pharmacology Tablet 2:-Klarix 500 mg (AS A Clarithromycin AS A Macrolides).

Clarithromycin acts by inhibiting microsomal protein synthesis in susceptible organisms mainly by binding to the donor site on the 50S subunit of the bacterial ribosome and preventing translocation to that site. Clarithromycin is active against most Gram-positive bacteria and Chlamydia, some Gram-negative bacteria and Mycoplasmas. Clarithromycin’s activity is the same as, or greater than, that of Erythromycin in vitro against most Gram-positive bacteria. Clarithromycin is more acid-stable than Erythromycin and therefore, is better tolerated. Clarithromycin has twice the activity of Erythromycin against H. influenzae. Most species of Gram-negative bacteria are resistant to Clarithromycin because of failure to penetrate the target.

Dosage & Administration Tablet 2:-Klarix 500 mg (AS A Clarithromycin AS A Macrolides).

Adults:

Acute bacterial exacerbation of chronic bronchitis: 250 mg to 500 mg every 12 hours for 7 to 14 days.
Acute maxillary sinusitis: 500 mg every 12 hours for 14 days.
Community-acquired pneumonia: 250 mg every 12 hours for 7 to 14 days.
Pharyngitis or tonsillitis: 250 mg every 12 hours for 10 days.
Uncomplicated skin and skin structure infections: 250 mg every 12 hours for 7 to 14 days.
Treatment and prophylaxis of disseminated Mycobacterium avium disease: 500 mg every 12 hours until the patient is considered at low risk of disseminated infection.

Combination dosing regimens for H. pylori infection:

Triple therapy: Clarithromvcin/lansoprazole/amoxicillin: The recommended adult dosage is 500 mg clarithromycin, 30 mg lansoprazole and 1 g amoxicillin, all given every 12 hours for 10 or 14 days.

Triple therapy: Clarithromycin/omeprazole/amoxicillin: The recommended adult dosage is 500 mg clarithromycin, 20 mg omeprazole and 1 g amoxicillin; all given every 12 hours for 10 or 14 days. In patients with an ulcer present at the time of initiation of therapy, an additional 14 or 18 days of omeprazole 20 mg once daily is recommended for ulcer healing and symptom relief.

Dual therapy: Clarithromycin/omeprazole: The recommended adult dosage is 500 mg clarithromycin given every 8 hours and 40 mg omeprazole given once every morning for 14 days. An additional 14 days of omeprazole 20 mg once daily is recommended for ulcer healing and symptom relief.

Children: The recommended daily dosage is 15 mg/kg/day divided every 12 hours for 10 days. For treatment and prophylaxis of mycobacterial infections in pediatric patients, the recommended dose is 7.5 mg/kg every 12 hours up to 500 mg every 12 hours.

Renal and hepatic impairment: Clarithromycin is principally excreted via the liver and kidney. Clarithromycin may be administered without dosage adjustment to patients with hepatic impairment and normal renal function. However, in the presence of severe renal impairment with or without coexisting hepatic impairment, decreased dosaqe or prolonqed dosinq intervals may be appropriate.

Interaction Tablet 2:-Klarix 500 mg (AS A Clarithromycin AS A Macrolides).

Drug interaction with medication: Klarix is contraindicated when co-administration with HMG-CoA reductase inhibitors (e.g., lovastatin and simvastatin), gastroprokinetic agents (e.g., cisapride), ergot alkaloids (e.g., ergotamine and dihydroergotamine), antipsychotics (e.g., pimozide and quetiapine) and anti-gout agents (e.g., colchicine). Antiarrhythmics drugs (e.g., disopyramide, quinidine, dofetilide, amiodarone, sotalol and procainamide) are not recommended to use with Klarix.

Contraindications Tablet 2:-Klarix 500 mg (AS A Clarithromycin AS A Macrolides).

Clarithromycin is contraindicated in patients with known hypersensitivity to clarithromycin, erythromycin, any of the macrolide antibacterial drugs or any other components of this product. It is also contraindicated in patients with a history of cholestatic jaundice or hepatic dysfunction associated with prior use of clarithromycin.

Side Effects Tablet 2:-Klarix 500 mg (AS A Clarithromycin AS A Macrolides).

Klarix is generally well tolerated. Side effects include nausea, vomiting, diarrhoea and abdominal pain. Stomatitis and glossitis have also been reported. Other side effects include headache, allergic reactions ranging from urticaria and mild skin reactions to anaphylaxis. Taste perversion may occur. There have been reports of transient central nervous system side effects including anxiety, dizziness, insomnia and hallucination.

Pregnancy & Lactation

The drug may be used in neonates and children in appropriate doses. Breast milk from mothers receiving Clarithromycin should not be given to infants until treatment is completed. There is as yet little experience in the treatment of pregnant patients and Clarithromycin is not recommended.

Precautions & Warnings

Klarix should be discontinued if severe acute hypersensitivity reactions occur. Klarix should be avoided in patients with known QT prolongation or receiving drugs known to prolong the QT interval, ventricular arrhythmia, hypokalemia or hypomagnesemia, significant bradycardia or taking Class IA or III antiarrhythmics. It should be discontinued if signs and symptoms of hepatitis occur. There is an increased risk of all-cause mortality one year or more after the end of treatment in patients with coronary artery disease. Balancing this potential risk with the treatment benefits should be considered when prescribing Klarix in these patients. If diarrhea occurs, the patient should be evaluated for Clostridium difficile associated diarrhea (CDAD). Exacerbation of myasthenia gravis has been reported in patients receiving Klarix therapy.

Use in Special Populations

Use in children and adolescents: The safety and effectiveness of Klarix have been established for the treatment of pharyngitis or tonsillitis, community-acquired pneumonia, acute maxillary sinusitis, acute otitis media, uncomplicated skin and skin structure infections in pediatric patients 6 months and older. The safety and effectiveness of Klarix have been established for the prevention of disseminated Mycobacterium avium complex (MAC) disease in pediatric patients 20 months and older with advanced HIV infection. The safety of Klarix has not been studied in MAC patients under the age of 20 months. Safety and effectiveness of Klarix in pediatric patients under 6 months of age have not been established.

Overdose Effects Tablet 2:-Klarix 500 mg (AS A Clarithromycin AS A Macrolides).

Reports indicate that the ingestion of large amounts of Klarix can be expected to produce gastro-intestinal symptoms. One patient who had a history of bipolar disorder ingested 8 grams of Klarix and showed altered mental status, paranoid behaviour, hypokalemia and hypoxemia. Adverse reactions accompanying overdosage should be treated by the prompt elimination of unabsorbed drug and supportive measures. As with other macrolides, Klarix serum levels are not expected to be appreciably affected by haemodialysis or peritoneal dialysis.

Therapeutic Class Tablet 2:-Klarix 500 mg (AS A Clarithromycin AS A Macrolides).

Macrolides

যদি Staphylococcus হয় ,karon amra jani je Flucloxacillin (পেনিসিলিন শ্রেণির) একটা Drug, যাকে Anti-staphylococcal penicillin বলা হয়,

এইটা গ্রাম পজিটিভ এর বিরুদ্ধে খুবই কার্যকর,

Flucloxacillin:-

Tablet 3. Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

1+1+1+1——-5days

Indications of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Fluclox is indicated for the treatment of infections due to Gram-positive organisms, including infections caused by penicillinase producing staphylococci. These indications include:

Skin and soft tissue infections: Boils, abscess, carbuncles, infected skin conditions (e.g. ulcer, eczema, acne, furunculosis, cellulitis, infected wounds, infected burns, otitis media and externa, impetigo).
Respiratory tract infections: Pneumonia, lung abscess, empyema, sinusitis, pharyngitis, tonsillitis, quinsy.
It is also used for the treatment of other infections i.e. osteomyelitis, enteritis, endocarditis, urinary tract infection, meningitis, septicaemia caused by Fluclox-sensitive organisms.
As a prophylactic agent, it is used during major surgical procedures where appropriate; for example, cardiothoracic and orthopedic surgery.

Pharmacology of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Flucloxacillin is active against Gram-positive organisms including penicillinase producing strains. It has little activity against Gram-negative bacilli. Flucloxacillin acts by inhibiting the formation of cell wall of bacteria. Flucloxacillin is isoxazolyl penicillin which combined the properties of resistance to hydrolysis by penicillinase, gastric acid stability and activity against gram-positive bacteria. Flucloxacillin is a bactericidal antibiotic that is particularly useful against penicillinase-producing staphylococci. Flucloxacillin kills bacterial cellwall, thus interfering with peptidoglycan synthesis. Peptidoglycan is a heteropolymeric structure that provides the cell wall with its mechanical stability. The final stage of peptidoglycan synthesis involves the completion of the cross-linking with the terminal glycine residue of the pentaglycin bridge linking to the fourth residue of the pentapeptide (D-alanine). The transpeptidase enzyme that performs this step is inhibited by Flucloxacillin. As a result the bacterial cellwall is weakened, the cell swells and then ruptures. Flucloxacillin resists the action of bacterial penicillinase probably because of the steric hindrance induced by the acyl side chain which prevents the opening of the β- lactam ring.

Dosage of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Oral administration:

Adult: 250 mg four times daily. Dosage may be doubled in severe infections. In osteomyelitis and endocarditis, up to 8 gm daily is used in 6-8 hourly divided doses.
Children (2-10 years): 1/2 of adult dose.
Children (Under 2 years): 1/4 of adult dose.

Parenteral administration:
Adult or Elderly:

Intramuscular Injection: 250 mg four times daily.
Intravenous Injection: 250 mg-1 g four times daily by slow injection over 3 to 4 minutes or by intravenous infusion.
All systemic doses may be doubled in severe infections: doses up to 8 g daily have been suggested for endocarditis or osteomyelitis.

Children:

2-10 years: half of the adult dose.
Under 2 years: a quarter of the adult dose.

Administration of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Oral doses should be administered 1 hour before meal.

Interaction of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Concurrent use of Fluclox and may result in increased level of Fluclox in blood for prolonged period.

Contraindications of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Flucloxacillin is contraindicated in penicillin hypersensitive patients.

Side Effects of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

There have been some common side effects of gastrointestinal tract such as nausea, vomiting, diarrhoea, dyspepsia and other minor gastrointestinal disturbances. Besides these rashes, urticaria, purpura, fever, interstitial nephritis, hepatitis and cholestatic jaundice have been reported.

Pregnancy & Lactation of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

US FDA Pregnancy Category of Flucloxacillin is B. There are, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Flucloxacillin have been shown to be excreted in human milk. So, caution should be exercised when Flucloxacillin is administered to a lactating mother.

Therapeutic Class of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Penicillinase-resistant penicillins

গ্রাম পজিটিভ ব্যাকটেরিয়ার বিরুদ্ধে এমন কার্যকর অন্য ড্রাগ হচ্ছে

1st Generation cephalosporin.

First generation Cephalosporins:-Cefalotin, Cefazolin, Cephalexin, Cefapirin, Cephradine, and cefadroxil are drugs belonging to this group.

Injection 1:Zolibac 1gm/vial (AS A Cefazolin Sodium AS A First generation Cephalosporins).

Capsule 2:-Cephaxin 500mg (AS A Cephalexin First generation Cephalosporins).

Capsule 3:Lebac 500mg AS A Cephradine (AS A Cephalexin First generation Cephalosporins).

Capsule 4.Arocef 500mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

Uporer je kono akta 1^st generation Cephalosporins used korlei hobe.

তাহলে IV Flcloxacillin 1-2 g daily সাথে Clarythromycin 500mg twice daily

যদি Mycoplasma অথবা legionella হয় ,

Clarythromycin 500mg twice daily মুখে অথবা IV ,

সাথে

Rifampicin 600mg

Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

Indications of Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

In the treatment of both tuberculosis and the meningococcal carrier state, the small number of resistant cells present within large populations of susceptible cells can rapidly become the predominant type. Bacteriologic cultures should be obtained before the start of therapy to confirm the susceptibility of the organism to rifampinand they should be repeated throughout therapy to monitor the response to treatment. Since resistance can emerge rapidly, susceptibility tests should be performed in the event of persistent positive cultures during the course of treatment. If test results show resistance to rifampin and the patient is not responding to therapy, the drug regimen should be modified.

Pharmacology Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

Rifampicin suppresses initiation of chain formation for RNA synthesis in susceptible bacteria by binding to the β subunit of DNA-dependent RNA polymerase, thus blocking RNA transcription.

Dosage Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

Rifampin can be administered by the oral route or by IV infusion. IV doses are the same as those for oral.

Tuberculosis:

Adults: 10 mg/kg, in a single daily administration, not to exceed 600 mg/day, oral or IV
Pediatric Patients: 10–20 mg/kg, not to exceed 600 mg/day, oral or IV

It is recommended that oral rifampin be administered once daily, either 1 hour before or 2 hours after a meal with a full glass of water.

Rifampin is indicated in the treatment of all forms of tuberculosis. A three-drug regimen consisting of rifampin, isoniazid, and pyrazinamide is recommended in the initial phase of shortcourse therapy which is usually continued for 2 months. The Advisory Council for the Elimination of Tuberculosis, the American Thoracic Society, and the Centers for Disease Control and Prevention recommend that either streptomycin or ethambutol be added as a fourth drug in a regimen containing isoniazid (INH), rifampin and pyrazinamide for initial treatment of tuberculosis unless the likelihood of INH resistance is very low. The need for a fourth drug should be reassessed when the results of susceptibility testing are known. If community rates of INH resistance are currently less than 4%, an initial treatment regimen with less than four drugs may be considered.

Following the initial phase, treatment should be continued with rifampin and isoniazid for at least 4 months. Treatment should be continued for longer if the patient is still sputum or culture positive, if resistant organisms are present, or if the patient is HIV positive.

Administration Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

Should be taken on an empty stomach. Best taken on an empty stomach 1 hr before or 2 hr after meals.

Interaction Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

May accelerate the metabolism and reduce the effect of drugs that are metabolised by CYP450 enzymes (e.g. quinidine, phenytoin, theophylline). Decreased concentrations of atovaquone and increased concentrations of Rifcin when taken concomitantly. Concurrent use of ketoconazole and Rifcin may result in decreased serum concentrations of both drugs. May decrease serum concentrations of enalaprilat. Reduced absorption by antacids. Increased risk of hepatotoxicity with halothane or isoniazid.

Contraindications Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

Rifampicin is contraindicated in patients with a history of hypersensitivity to rifampin or any of the components, or to any of the rifamycins. Rifampin is contraindicated in patients who are also receiving ritonavir-boosted saquinavir due to an increased risk of severe hepatocellular toxicity.

Rifampin is contraindicated in patients who are also receiving atazanavir, darunavir, fosamprenavir, saquinavir, or tipranavir due to the potential of rifampin to substantially decrease plasma concentrations of these antiviral drugs, which may result in loss of antiviral efficacy and/or development of viral resistance.

Side Effects Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

Facial flushing and itching, with or without a rash, flu-like syndrome characterised by episodes of fever, chills, headache, dizziness, bone pain, shortness of breath, and malaise; GI adverse effects (e.g. nausea, vomiting, anorexia, diarrhoea, epigastric distress), pseudomembranous colitis, eosinophilia, leucopenia, haemolytic anaemia; alterations in kidney function and renal failure, menstrual disturbances, oedema, myopathy, muscular weakness; orange-red discolouration of the urine, faeces, sweat, saliva, sputum, tears, and other body fluids; thrombophlebitis, local irritation and inflammation after prolonged IV infusion. Rarely, eye irritation and visual disturbances, anaphylaxis or shock.

Pregnancy & Lactation Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

Pregnancy: When administered during the last few weeks of pregnancy, rifampin can cause post natal hemorrhages in the mother and infant for which treatment with vitamin K may be indicated.

Nursing Mothers: Because of the potential for tumorigenicity shown for rifampin in animal studies, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Precautions & Warnings Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

Rifcin has been shown to produce liver dysfunction. Fatalities associated with jaundice have occurred in patients with liver disease and in patients taking rifampin with other hepatotoxic agents. Patients with impaired liver function should be given rifampin only in cases of necessity and then with caution and under strict medical supervision. In these patients, careful monitoring of liver function, especially SGPT/ALT and SGOT/AST should be carried out prior to therapy and then every 2 to 4 weeks during therapy. If signs of hepatocellular damage occur, rifampin should be withdrawn.

In some cases, hyperbilirubinemia resulting from competition between rifampin and bilirubin for excretory pathways of the liver at the cell level can occur in the early days of treatment. An isolated report showing a moderate rise in bilirubin and/or transaminase level is not in itself an indication for interrupting treatment; rather, the decision should be made after repeating the tests, noting trends in the levels, and considering them in conjunction with the patient’s clinical condition.

Rifampin has enzyme-inducing properties, including induction of delta amino levulinic acid synthetase. Isolated reports have associated porphyria exacerbation with rifampin administration.

Use in Special Populations

Geriatric Use: Clinical studies of Rifcin did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Caution should therefore be observed in using rifampin in elderly patients.

Overdose Effects

Nausea, vomiting, abdominal pain, pruritus, headache, and increasing lethargy will probably occur within a short time after ingestion; unconsciousness may occur when there is severe hepatic disease. Transient increases in liver enzymes and/or bilirubin may occur. Brownish-red or orange discoloration of the skin, urine, sweat, saliva, tears, and feces will occur, and its intensity is proportional to the amount ingested.

Liver enlargement, possibly with tenderness, can develop within a few hours after severe overdosage; bilirubin levels may increase and jaundice may develop rapidly. Hepatic involvement may be more marked in patients with prior impairment of hepatic function. Other physical findings remain essentially normal. A direct effect upon the hematopoietic system, electrolyte levels, or acid-base balance is unlikely.

Facial or periorbital edema has also been reported in pediatric patients. Hypotension, sinus tachycardia, ventricular arrhythmias, seizures and cardiac arrest were reported in some fatal cases.

Therapeutic Class Capsule 4:-Rifcin 150 mg (AS A Rifampicin AS A Anti-Tubercular Antibiotics).

Anti-Tubercular Antibiotics

পেশেন যদি সিভিয়ার থাকে

Clarythromycin 500mg twice daily IV

অথবা

Erythromycin 500mg দিনে ৪ বার করে আই ভি ,

সাথে Co amoxiclav, / Ceftriaxone / cefuroxime / Amoxicillin / Flucloxacillin (IV must )

এভাবে স্টেপকেয়ার চিকিৎসা দিল অবশ্যই পেশেন্ট রেসপন্স করবে ,

এবার ছুটির পালা –

ছুটিতে কি উপদেশ থাকা জরুরী

৬ সপ্তাহ পর বুকের এক্সরে সহ দেখা করবেন আর বিড়ি খাওয়ার অভ্যাস থাকলে তা ত্যাগ করবেন।

Raiyyan Tahsan Date:26-01-2025 Sunday Time:9-07-45 PM

Raiyyan Tahsan

Raiyyan Tahsan