Antibiotic Case No 5.Skin Infection

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Antibiotic Case No 5.Skin Infection

একটা পেশেন্ট Emergency তে আসলো RTA নিয়ে., তাকে stitch দিয়ে cefixime (Cef-3) ৭ দিনের জন্য দিলেন- সাথে fluclox দিলেন– এইটা সঠিক না, কোনো স্কিন ইনফেকশনে cefixime দেওয়ার কোনো নিয়ম নাই

cefixime একটা 3rd Generation cephalosporin, যা মূলত গ্রাম নেগেটিভ অর্গানিজম এর বিরুদ্ধে কার্যকর

Skin infection হয় সাধারণত গ্রাম পজিটিভ অরগানিজম দিয়ে,

তাই এমন এন্টিবায়োটিক দিবে, যার গ্রাম পজিটিভ কাভারেজ সবচেয়ে বেশি

আমরা যদি দেখি,

Flucloxacillin (পেনিসিলিন শ্রেণির) একটা Drug, যাকে Anti-staphylococcal penicillin বলা হয়,

এইটা গ্রাম পজিটিভ এর বিরুদ্ধে খুবই কার্যকর,

গ্রাম পজিটিভ ব্যাকটেরিয়ার বিরুদ্ধে এমন কার্যকর অন্য ড্রাগ হচ্ছে

1st Generation cephalosporin.

1st Generation cephalosporin

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

Second generation:–Cefoxitin, Cefuroxim, Cefaclor, Cefprozil, and Cefmetazole are classed as second-generation cephems.

Third generation:-Ceftazidime,Ceftriaxone,and Cefotaxime

are classed as third-generation cephalosporins.Flomoxef and latamoxef are in a new, related class called Oxacephems.

Fourth generation

Drugs included in this group are cefepime and Fourth generation

Drugs included in this group are cefepime and cefpirome.

তাই স্কিন ইনফেকশন এর পেশেন্ট কে আপনি Flucloxacillin দিবেন, অথবা 1st Generation cephalosporin দিবেন,

সাধারণত Flucloxacillin দেওয়া হয়

Flucloxacillin ৬ ঘন্টা পরপর দৈনিক ৪ বার দেওয়া লাগে,

আবার 1st Generation cephalosporin এর মধ্যে Cephradine, Cephalexin ইত্যাদির ডোজ ও দৈনিক ৪ বার,

তবে Cefadroxil এর ডোজ দৈনিক ২ বার,

সিনারিও–

একটা পেশেন্ট Cut injury নিয়ে ইমার্জেন্সি তে আসলো, আপনি ভালোভাবে stitch দিয়ে এন্টিবায়োটিক লিখবেন,

কোন এন্টিবায়োটিক লিখবেন?

সাধারণত Capsule 1.Fluclox 500 mg

1+1+1+1 (7 days)

Capsule 1. 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

But patient বললো, সে দৈনিক ৪ বার ঔষধ খেতে পারবেনা, কিংবা পেশেন্ট রোজা রাখতেছে,

তাহলে Fluclox ২ বার দিবেন?

নাকি Fluclox এর মত গ্রাম পজিটিভ এর বিরুদ্ধে কার্যকর কোনো ঔষধ দিবেন?

হা, অবশ্যই Fluclox এর alternative একটা দিবে,

সেটা হচ্ছে 1st Generation cephalosporin – Cefadroxil

Capsule 2:- Arocef 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

Indications of Capsule :- Arocef 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

Arocef is indicated in the treatment of the following infections.

Streptococcal pharyngitis and tonsillitis
Bronchopneumonia, bacterial pneumonia
Uncomplicated urinary tract infections: pyelonephritis, cystitis
Skin and soft tissue infections: abscesses, furunculosis, impetigo, erysipelas, pyoderma, lymphadenitis.

Pharmacology of Capsule :- Arocef 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

Cefadroxil inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

Dosage & Administration of Capsule :- Arocef 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

The dosage of Cefadroxil depends on the susceptibility of the pathogens, the severity of the disease and on the clinical status of the patient (renal and hepatic function).

Streptococcal pharyngitis and tonsillitis–

Adult and adolescents >40 kg with normal renal function: 1000 mg once a day over at least 10 days. Dosage may be decreased.
Children <40 kg with normal renal function: 30 mg/kg/day once a day over at least 10 days.

Bronchopneumonia, bacterial pneumonia, Urinary tract infections, Skin & soft tissue infections–

Adult and adolescents >40 kg with normal renal function: 1000 mg twice a day.
Children <40 kg with normal renal function: 30-35 mg/kg/day divided into two daily doses.

Children may benefit of increased posology up to 100 mg/kg/day. Depending on the severity of the infection, adults may require increased posology. The dosage maximum is 4 g per day. Chronic urinary tract infection may require a prolonged and intensive treatment with continued testing of susceptibility and clinical monitoring. Cefadroxil 500 mg is not recommended for infants and children under 6 years. For younger children and children with a body weight <40 kg, liquid dosage oral form is recommended.

Renal impairment patients: In patients with renal impairment, the dose should be adjusted according to creatinine clearance rates to prevent accumulation of cefadroxil. In patients with creatinine clearance of 50 ml/min or less, the following reduced dosage schedule is recommended as a guideline.

Creatinine clearance 50-25 ml/min/1.73 m2: 500 mg-1000 mg every 12 hours
Creatinine clearance 25-10 ml/min/1.73 m2: 500 mg-1000 mg every 24 hours
Creatinine clearance 10-0 ml/min/1.73 m2: 500 mg-1000 mg every 36 hours
Children (<40 kg) with renal impairment: Cefadroxil is not indicated in children suffering from renal insufficiency and children requiring haemodialysis.
Dosage for haemodialysis patients: Haemodialysis eliminates 63% of 1000 mg of cephalosporin after 6 to 8 hours of haemodialysis. Elimination half-time of cephalosporin is about 3 hours during dialysis. Patients with haemodialysis receive one additional dose ofcefadroxil 500 mg-1000 mg at the end of the haemodialysis.

Hepatic impairment: No adjustment of posology is necessary.

Elderly: As cefadroxil is excreted by renal route, the dosage should be adjusted if necessary as described under impaired renal function.

Mode of administration: Bioavailability is not affected by food and cefadroxil may be taken with meals or on an empty stomach. In case of gastro-intestinal disturbances, it may be administered with food.

Duration of therapy: Treatment should be applied for 2 to 3 further days after regression of the acute clinical symptoms or evidence of bacterial eradication has been obtained. In infections caused by Streptococcus pyogenes up to 10 days treatment may be considered.

Interaction of Capsule :- Arocef 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

Prothrombin time will be prolonged; bleeding may occur when taken with anticoagulants. Decreased elimination with Probenecid is also reported.

Contraindications of Capsule :- Arocef 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

Cefadroxil is contraindicated in patients with a history of hypersensitivity to any of the Cephalosporins. It is also contraindicated in patients with a history of severe reactions to penicillins or to any other beta lactam drugs.Cefadroxil should not be combined with bacteriostatic antibiotics (e.g. tetracycline, erythromycin, sulfonamides, chloramphenicol) since an antagonistic effect is possible.Treatment with cefadroxil in combination with aminoglycoside antibiotics, polymyxin B, colistin or high-dose loop diuretics should be avoided since such combinations can potentiate nephrotoxic effects.

Cefadroxil does not penetrate in the CSF and is not indicated for the treatment of meningitis. Penicillin is the first drug of choice for the treatment of the Streptococcus pyogenes and for the prevention of rheumatic fever. Data for cefadroxil are not Sufficiently substantial for prophylaxis therapy. Special caution should be exercised in patients with history of severe allergies or asthma. In patients with a history of non severehypersensitity to penicillins, or other non-cephalosporin beta-lactam drugs, cefadroxil should be used with special caution. Caution is necessary in patients with renal impairment; the dosage must be adjusted according to the grade of renal impairment. Cefadroxil should be used with caution in patients with a history of gastro-intestinal disturbances, particularly colitis. The occurrence of diarrhoea may impair the resorption of other medicaments and therefore lead to an impairment of their efficacy. Treatment must be discontinued at once if allergic reactions occur (urticaria, exanthema, pruritus, fall of blood pressure and increased heart rate, respiratory disturbances, collapse, etc.) and suitable countermeasures should be taken (sympathomimetics, corticosteroids and/or antihistaminics). Particularly on prolonged use frequent checks on the blood count and regular hepatic and renal function tests are advisable.Superinfections with fungi (e.g. candida) can occur on prolonged treatment with cefadroxil. In case of severe and persistent diarrhoea, an antibiotic-associated pseudomembranous colitis should be considered. In that case Cefadroxil must be discontinued immediately and a suitable therapy should be started. The result of the Coombs’ test can be transiently positive during or after treatment with cefadroxil. This also applies to Coombs’ tests carried out in newborns whose mothers received treatment with cephalosporins before delivery. Urinary sugar should be determined enzymatically (e.g. with test strips) during treatment with cefadroxil since reduction tests can furnish falsely elevated values.

Side Effects of Capsule :- Arocef 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

Infections and infestations: Uncommon side effects are Vaginal mycoses, thrush. Blood and lymphatic system disorders: Rare side effects are eosinophilia, thrombocytopenia, leucopenia, neutropenia, agranulocytosis and very rarely occurs haemolytic anemia.

Immune system disorders: Rarely occur serum sickness-like reactions, Very rarely occur immediate allergic reaction (anaphylactic shock).

Nervous system disorders: Very rare side effects are Headache, sleeplessness, dizziness, nervousness.

Gastrointestinal disorders: Common side effects are nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, glossitis and very rarely occurs Pseudomenbranous colitis.

Hepatobiliary disorders: Rarely occurs cholestase and idiosyncratic hepatic failure.

Skin and subcutaneous tissue disorders: Pruritus, rash, allergic exanthema, urticaria are common side effects. Very rarely occurs stevens Johnson syndrom and erythema multiforma.

Musculoskeletal and connective tissue disorders: Rarely occur arthralgia. Renal and urinary disorders: Rarely occurInterstitial nephritis.

General disorders: Fever is rare and fatigue is very rare.

Pregnancy & Lactation of Capsule :- Arocef 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

Although animal studies and clinical experience have not shown any evidence of teratogenicity, the safe use during pregnancy has not been established. Cefadroxil is present in low concentrations in breast milk; sensitization, diarrhoea or colonization of the infants’ mucosa with fungi are possible. The use of cefadroxil during pregnancy and in lactating mothers should therefore be handled very strictly.

Precautions & Warnings of Capsule :- Arocef 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

Arocef binds to cholestyramine which may lead to reduced bioavailability of cefadroxil. The concomitant administration of probenecid reduces the renal elimination of cefadroxil; therefore, plasma concentrations of cefadroxil may be increased when given in combination with probenecid.

Overdose Effects

No clinical reports are as yet available on cefadroxil in this respect. However in view of experience gained with other cephalosporins the following symptoms are possible: nausea, hallucinations, hyperreflexia, extrapyramidal symptoms, clouded consciousness, or even coma and renal functional impairment.

Therapeutic Class of Capsule :- Arocef 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins)

First generation Cephalosporins

1+0+1 (7 days)

এইটা দিনে ২ বার দিলে যে কাজ,

Fluclox ৪ বার দিলেও একই কাজ,

Fluclox ৪ টা = ৪০ টাকা

Arocef ২ টা =৩৬ টাকা

তার মানে দাম প্রায় কাছাকাছি।

চলবে–

Raiyyan Tahsan Date:25-01-2025 Thursday Time:8-55-45 PM

Raiyyan Tahsan

Raiyyan Tahsan