Antibiotics Case No 20. Doxycycline uses in Pregnency

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Antibiotics Case No 20. Doxycycline uses in Pregnency

সিনারিও-৫৫ (Lab interpretation)

নিলা ২২ বছর বয়স, ১৪ সপ্তাহের প্রেগন্যান্ট, ১১ দিন থেকে জ্বর, আর শরীরে র‍্যাশ, history of ticks bite আছে, Blood C/S নেগেটিভ,

Widal test নেগেটিভ, কোন UTI এর উপসর্গ নাই, empirically Ceftriaxone দেওয়া হলো, কোন উন্নতি নাই, Rickettsia febrile antigen test করা হলো, Rickettsi Ab positive. , ক্লিনিক্যাল উপসর্গ ও ল্যাব ইনভেস্টিগেশন বিবেচনায় Ricketssia Dx হলো, চিকিৎসা কি?

Rickettsia একটা obligatory intracellular organism, এইটা কালচারে Growth হয়না, তাই কালচার নেগেটিভ আসে, Rickettsial ফিভারে পেশেন্ট এর low grade fever থাকে, র‍্যাশ থাকে,

এই রোগে টিপিকাল এন্টিবায়োটিক গুলি কোনো কাজ করে না, যেমন ceftriaxone, amoxicillin ইত্যাদি।

Rickettsial fever এ এন্টিবায়োটিক চয়েজ হবে Doxycycline, এখন এই পেশেন্ট প্রেগন্যান্ট, তার ক্ষেত্রে করনীয় কি?

pregnancy with Rickettsia হলে প্রথমে Azithromycin 500 mg once daily ৫ দিনের জন্য দিবে, এতে যদি রেস্পন্স না করে তাহলে Doxycycline দেওয়া হবে,

doxicap 100 mg BD for 7 days (Ref:CDC)

এখন প্রশ্ন হতে পারে, এইটা তো pregnancy category -D, তাই এইটা কেন দেওয়া হবে? তার উত্তর হচ্ছে,

যখন পেশেন্টের চিকিৎসার জন্য অন্য কোন অল্টারনেটিভ এজেন্ট না থাকে, এবং চিকিৎসা করাটাও

গুরুত্বপূর্ণ হয়, সেই ক্ষেত্রে ক্যাটাগরি -D এর ড্রাগ ব্যবহার করা যাবে, Risk benefit ratio হিসাব করে।

এখন একজন প্রেগন্যান্ট মহিলার Rickettsia চিকিৎসা না করালে fatality rate 1-40% বলা হয়েছে, আর Doxycycline দিয়ে চিকিৎসা করালে pregnancy এর প্রথম ১৮ সপ্তাহের মধ্যে মেজর কোন ক্ষতি নাই,

এর পরে করলে কিছু কিছু ক্ষেত্রে Bone growth delay হতে পারে, কিংবা teeth staining হতে পারে, কিন্ত এখানে রিস্কের চেয়ে বেনেফিট বেশি, সেইজন্য রিস্ক বেনেফিট রেশিও হিসাবে করে Doxycycline দিয়ে চিকিৎসা শুরু করতে হবে।

চলবে-

Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Indications of Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxacil is indicated in the following infections caused by susceptible microorganisms:

Respiratory tract infections: Pneumonia, influenza, sinusitis, bronchitis, tonsillitis, tracheitis.
Gastrointestinal tract infections: Cholera, traveler’s diarrhea, shigella dysentery, acute intestinal amebiasis.
Chlamydial infections: Lympho-granuloma venereum, psittacosis, trachoma.
Sexually transmitted diseases: Non gonococcal urethritis, acute pelvic inflammatory disease, uncomplicated urethral and endocervical or rectal infections, gonorrhoea, syphilis, pyelonephritis, cystitis.
Other infections: Impetigo, furunculosis, inclusion conjunctivitis, brucellosis, tularemia, cellulitis, acne and Q-fever.

Description Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxacil is a highly active broad-spectrum antibiotic of tetracycline group. It is effective against a wide range of Gram-positive and Gram-negative bacteria, spirochete, mycoplasma, rickettsia and mycobacteria. Doxacil is used as an alternate to penicillin in the treatment of gonorrhoea and syphilis. Doxacil has its main mechanism of action on protein synthesis. Inside the bacterial cell, it inhibits protein synthesis.

Pharmacology Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxycycline Hydrochloride is a semisynthetic tetracycline antibiotic with broad spectrum activity. It is primarily a bacteriostatic antibiotic. It has a similar spectrum of activity to other tetracyclines but in particular is more active against Staphylococcus aureus and Nocardia. The drug is often active against penicillin-resistant strains of Staphylococcus aureus and against strains of those organisms that are resistant to other Tetracyclines. Certain Gram-negative strains of E. coli, Proteus mirabilis and Klebsiella, which are often resistant to Tetracycline, may be sensitive to Doxycycline. In addition, 70-90% of the various anaerobes are sensitive to Doxycycline and Bacteroides fragilis is more likely to be sensitive to Doxycycline than to other tetracyclines.

Doxycycline is active against most strains of Haemophilus influenzaeand is particularly useful for infections with H. ducreyi, Actinomyces, Brucella and Vibrio cholerae. It is also active against Nocardia, Chlamydia, Mycoplasma and a wide range of Rickettsiae. Doxycycline is active against spirochetes such as Borellia recurrentis, Treponema pallidum and Treponema pertenue. It is also active against Plasmodium falciparum.

Dosage Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Usual dose: 200 mg on first day, then 100 mg daily for 7-10 days.
Severe infections (including refractory urinary tract infections): 200 mg daily for 10 days.
Acne: 100 mg daily.
Uncomplicated genital chlamydia, non-gonococcal urethritis: 100 mg twice daily for 7-21 days (14-21 days in pelvic inflammatory disease).

Administration Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Capsules should be swallowed whole with plenty of fluid during meals while sitting or standin

Interaction Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Absorption of tetracyclines is impaired by antacid containing aluminium, calcium or magnesium, and iron containing preparation. Absorption of tetracyclines is also impaired by bismuth salicylate. Barbiturates, carbamazepine and phenytoin decrease half-life of doxycycline. Concurrent use of tetracyclines may render oral contraceptive less effective. Patients who are on anticoagulant therapy may require downward adjustment of their anticoagulant dosages. It is advisable to avoid giving tetracyclines in conjunction with penicillin.

Contraindications Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxycycline is contraindicated to the patients who have shown hypersensitivity to any of the tetracyclines. Doxycycline is contraindicated to the children under 8 years of age. It is also contraindicated to pregnant women and to the lactating mothers.

Side Effects Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Nausea, vomiting, diarrhoea, skin rashes, hemolytic anaemia, eosinophilia may be reported.

Pregnancy & Lactation Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxycycline should be avoided in pregnant women, because of the risk of both staining and effect on bone growth in the foetus. Doxycyclines enter breast milk, and mothers taking these drugs should not breastfeed their child.

Precautions & Warnings Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

use of drugs of the tetracycline class during tooth development (last half of pregnancy, infancy and childhood to the age of 8 years) may cause permanent discoloration of teeth. Tetracyclines drugs, therefore should not be used in this age group.

Therapeutic Class Capsule 1.Doxacil 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Tetracycline group of drugs

Raiyyan Tahsan. Date:-4-02-2025 Tuesday Time:-11-47-35 Pm

Raiyyan Tahsan

Raiyyan Tahsan