Pathogen Case No 1. Diarrhoea Salmonella shigellae

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Pathogen Case No 1. Diarrhoea Salmonella shigellae

কোনো Patient ডায়রিয়া নিয়ে আসলে

Diarrhoea এর probable Diagnosis হতে পারে

1. Main viral gastroenteritis**

2. Bacterial gastroenteritis

(Salmonella,shigellae

Campylobacter))

3. Amebiasis & Giadiasis

ডায়রিয়া হলেই আমরা অনেকে Antiobiotics দিয়ে দেই,,ডায়রিয়া তে Antiobiotics না দিলে মনে হয়;কি যেনো মিস হয়ে গেলো!!!

Diarrhoea তে Antiobiotics কখনোই 1st line drug হতে পারে না!!!

ডায়রিয়ার মুলত Food poisoning, Responsible organism Staphylococcal Toxin এর জন্য হয়ে থাকে…..যতক্ষন Toxin থাকবে পেটের ভিতর ,ততক্ষন porjonto Diarrhoe হবেই,,

তাহলে Diarrhoea তে কখন Antiobiotics এর রোল আছে;আর কখন নেই;;চলুন যেনে নেয়া যাক

Diarrhoea কিভাবে বুজবো কোনটা Bacterial আর কোনটা Viral**

সহজে বলতে চাইলে;

Bloody diarrhoea হলে অথবা Mucous containing diarrhoea হলে অথবা foul smelling হলে যেখানে Water এর চেয়ে Stool এর পরিমান বেশি, তখন এইটাকে আমরা Bactrial cause হিসাবে ধরতে পারি–( Bloody Diarrhoea এর D/D হতে পারে Bacterial Gastroenteritis & IBD))

Acute Diarrhoea এবং সাথে বমি হলে আমরা Viral cause এর দিকে যাবে!

Viral Gastroenteritis ***এই রকম ডায়েরিয়া তে পানি যাবে ,এইখানে Antiobiotics এর রোল নেই বল্লেই চলে।

এই ডায়েরিয়া তে Dehydrated হয়ে যায় Patient বেশি…..

এছাড়া অনেকের ল্যাকটোজ সমস্যার জন্য Dairrhoea হয়ে থাকে**

ল্যাকটোজ হল দুধ এবং অন্যান্য দুগ্ধজাত দ্রব্যে পাওয়া এক ধরনের চিনি। যাদের ল্যাকটোজ হজম করতে অসুবিধা হয় তাদের দুগ্ধজাত খাবার খাওয়ার পর ডায়রিয়া হয়। বয়স বাড়ার সাথে সাথে এই সমস্যাটি বাড়তে পারে, কারণ যে এনজাইমটি ল্যাকটোজ হজম করতে সাহায্য করে বয়স বাড়ার সাথে সাথে তার মাত্রা কমতে থাকে।

Acute bloody diarrhoea হলে প্রথম দিন থেকেই Antibiotics দিতে পারবেন..

যদি unpusturized milk খাবার হিস্ট্রি থাকে৷ তাহলে Compylobacter

এই ক্ষেতে চিকিৎসা হবে — Macrolides,

In that case we can use as Macrolides

Azithromycin:-

Tablet 1:-Zimex 500 mg (AS A Azithromycin Dihydrate AS A Macrolides).

Indications

Zimax is indicated for infections (caused by susceptible organisms) in lower respiratory tract infections including bronchitis and pneumonia, in upper respiratory tract infections including sinusitis and pharyngitis/tonsillitis, in otitis media, and in skin and soft tissue infections. In sexually transmitted diseases in men and women, Zimax is indicated in the treatment of non-gonococcal urethritis and cervicitis due to Chlamydia trachomatis.

Pharmacology

Azithromycin is acid-stable and can therefore be taken orally with no need of protection from gastric acids. It is readily absorbed; its absorption is greater on an empty stomach. Time to peak concentration in adults is 2.1 to 3.2 hours for oral dosage forms. Due to the high concentration in phagocytes, azithromycin is actively transported to the site of infection. During active phagocytosis, large concentrations of azithromycin are released. The concentration of azithromycin in the tissues can be over 50 times higher than in plasma. This is due to ion trapping and the high lipid solubility.

Azithromycin’s half-life allows a large single dose to be administered and yet maintain bacteriostatic levels in the infected tissue for several days. Following a single 500 mg dose, plasma concentrations of azithromycin declined in a polyphasic pattern with a mean apparent plasma clearance of 630 mL/min and a terminal elimination half life of 68 hours. The prolonged terminal half-life is thought to be due to extensive uptake and subsequent release of drug from tissues. Biliary excretion of azithromycin, predominantly unchanged, is a major route of elimination. Over the course of a week, approximately 6% of the administered dose appears as unchanged drug in urine.

Microbiology: Azithromycin acts by binding to the 50S ribosomal subunit of susceptible microorganisms and, thus, interfering with microbial protein synthesis. Nucleic acid synthesis is not affected. Azithromycin has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections:

Aerobic and facultative gram-positive microorganisms: Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pneumoniae, Streptococcus pyogenes
Aerobic and facultative gram-negative microorganisms: Haemophilus ducreyi, Haemophilus influenzae, Moraxella catarrhalis, Neisseria gonorrhoeae
Other microorganisms: Chlamydia pneumoniae, Chlamydia trachomatis , Mycoplasma pneumoniae , Betalactamase production should have no effect on azithromycin activity.
Aerobic and facultative gram-positive microorganisms: Streptococci (Groups C,F,G), Viridans group streptococci
Aerobic and facultative gram-negative microorganisms: Bordetella pertussis, Legionella pneumophila
Anaerobic microorganisms: Peptostreptococcus species, Prevotella bivia

Dosage

Oral–
Adult: 500 mg once daily orally for 3 days or 500 mg once on day 1, then 250 mg once on days 2-5 for 4 days. For sexually transmitted diseases caused by Chlamydia trachomatis in adults, the dose is 1 gm given as a single dose or 500 mg once on day 1, followed by 250 mg once daily for next 2 days may also be given.

Children:

10 mg/kg body weight once daily for 3 days for child over 6 months
200 mg (1 teaspoonful) for 3 days if body weight is 15-25 kg
300 mg (1½ teaspoonfuls) for 3 days if body weight is 26-35 kg; 400 mg (2 teaspoonfuls) for 3 days if body weight is 36-45 kg.
In typhoid fever, 500 mg (2½ teaspoonfuls) once daily for 7-10 days is given.

Azithromycin Injection (For IV Infusion only): The recommended dose of Azithromycin for injection for the treatment of adult patients with community-acquired pneumonia due to the indicated organisms is:

500 mg as a single daily dose by the intravenous route for at least two days. Intravenous therapy should be followed by Azithromycin by the oral route at a single, daily dose of 500 mg, administered as two 250-mg tablets to complete a 7 to 10-day course of therapy. The timing of the switch to oral therapy should be done at the discretion of the physician and in accordance with clinical response.
The recommended dose of Azithromycin for the treatment of adult patients with pelvic inflammatory disease due to the indicated organisms is: 500 mg as a single daily dose by the intravenous route for one or two days. Intravenous therapy should be followed by Azithromycin by the oral route at a single, daily dose of 250 mg to complete a 7-day course of therapy. The timing of the switch to oral therapy should be done at the discretion of the physician and in accordance with clinical response. If anaerobic microorganisms are suspected of contributing to the infection, an antimicrobial agent with anaerobic activity should be administered in combination with Azithromycin.
Safety and effectiveness of azithromycin for injection in children or adolescents under 16 years have not been established.

Side Effects

Zimax is well tolerated with a low incidence of side-effects. Most side-effects observed were mild to moderate in severity. The majority of side-effects were gastrointestinal in origin with nauseas, abdominal discomfort (pain/cramps), vomiting, flatulence, diarrhoea and loose stools being occasionally observed. Allergic reactions such as rash or photosensitivity have occurred and there have also been rare reports of serious hypersensitivity reactions. Reversible elevations in liver transaminases have been seen with a frequency similar to the comparative macrolides and penicillins used in clinical trials. Rarely, cases of cholestatic jaundice have been observed. Transient mild reductions in neutrofil counts have occasionally been observed in clinical trials, although a causal relationship to azithromycin has not been established. Hearing impairment: In investigational studies where higher doses were used for prolonged periods of time, reversible hearing impairment was seen in some patients.

Pregnancy & Lactation

Pregnancy Category of Azithromycin Dihydrate is B. Animal reproduction studies have demonstrated that Azithromycin has no evidence of harm to the fetus. There are no adequate and well controlled studies in pregnant women. Since animal reproduction studies are not always predictive of human response, Azithromycin should be used during pregnancy only if adequate alternatives are not available. It is not known whether Azithromycin is secreted in breast milk. So, caution should be exercised when Azithromycin is administered to nursing women

Common Questions about Zimax 500 mg Tablet

What is Zimax 500 mg Tablet?

Zimax 500 mg Tablet performs its action by preventing the synthesis of essential proteins required by bacteria to carry out vital functions.

What are the uses of Zimax 500 mg Tablet?

Zimax 500 mg Tablet is used for the treatment and prevention of community-acquired pneumonia, pharyngitis/tonsillitis, and skin and soft tissue infections.

What are the Side Effects of Zimax 500 mg Tablet?

Side effects include diarrhea, dry or scaly skin, abdominal pain, difficult or painful urination, vomiting, fever, acid or sour stomach, aggression or anger, excessive air or gas in the stomach, and heartburn.

What are the instructions for storage and disposal Zimax 500 mg Tablet?

Zimax 500 mg Tablet should be kept in a cool dry place and its original packaging. Make sure this medication remains unreachable to children and pets. The patient should consult a doctor for its further uses.

Can the use of Zimax 500 mg Tablet cause diarrhea?

Yes, the use of Zimax 500 mg Tablet can cause diarrhea. It is an antibiotic that kills harmful bacteria. However, it also affects the helpful bacteria in your stomach or intestine and causes diarrhea. If you are experiencing severe diarrhea, consult your doctor immediately.

Is Zimax 500 mg Tablet safe?

Zimax 500 mg Tablet is safe if used at prescribed doses as advised by your doctor.

Is Zimax 500 mg Tablet an antibiotic?

Yes, Zimax 500 mg Tablet is an antibiotic that belongs to a class of antibiotics known as macrolides.

What if I don’t get better even after taking Zimax 500 mg Tablet?

You should inform your doctor if you do not notice any improvement in your symptoms after 3 days of taking Zimax 500 mg Tablet and if your symptoms get worse.

Quick Tips

Do not skip any doses of Zimax 500 mg Tablet and finish the full course of treatment even if you feel better. Stopping it early may make the infection to come back and harder to treat.
Take Zimax 500 mg Tablet 1 hour before or two hours after food.
Do not take antacids 2 hours before or after taking Zimax 500 mg Tablet.
Diarrhea may occur as a side effect but should stop when your course is complete. Inform your doctor if it doesn’t stop or if you find blood in your stools.
Stop taking Zimax 500 mg Tablet and inform your doctor immediately if you develop an itchy rash, swelling of the face, throat or tongue or breathing difficulties while taking it.

Rx…..Clarithromycin drug of choice, Azithromycin ও দেওয়া যেতে পারে*

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

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

Remac 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:-Remac 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:-Remac 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:-Remac 500 mg (AS A Clarithromycin AS A Macrolides).

Drug interaction with medication: Remac 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 Remac.

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

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

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

Remac should be discontinued if severe acute hypersensitivity reactions occur. Remac 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 Remac 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 Remac therapy.

Use in Special Populations Tablet 2:-Remac 500 mg (AS A Clarithromycin AS A Macrolides).

Use in children and adolescents: The safety and effectiveness of Remac 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 Remac 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 Remac has not been studied in MAC patients under the age of 20 months. Safety and effectiveness of Remac in pediatric patients under 6 months of age have not been established.

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

Reports indicate that the ingestion of large amounts of Remac can be expected to produce gastro-intestinal symptoms. One patient who had a history of bipolar disorder ingested 8 grams of Remac 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, Remac serum levels are not expected to be appreciably affected by haemodialysis or peritoneal dialysis.

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

Macrolides

আর যদি Abdominal cramp + bloody diarrhoea থাকে, তাহলে shigella,

তখন Rx…Ciprofloxacin দিলেই হবে

In that case we will use Ciprofloxacin AS Follwing the critaria

Tablet 3.Beuflox 500mg (AS A Ciprofloxacin AS A 4-Quinolone preparations, Anti-diarrhoeal Antimicrobial drugs).

Ciprofloxacin is a synthetic quinolone anti-infective agent. Ciprofloxacion has broad spectrum of activity. It is active against most gram negative aerobic bacteria

Indications of Tablet 3.Beuflox 500mg (AS A Ciprofloxacin AS A 4-Quinolone preparations, Anti-diarrhoeal Antimicrobial drugs).

Beuflox is indicated for the treatment of single infection or mixed infections caused by two or more susceptible organisms. It can also be used for infections caused by organisms resistant to other antibiotics including Aminoglycosides, Penicillins and Cephalosporins.

As antibacterial concentrations of Beuflox are obtained in serum and body tissues as well as in the urine following administration by mouth, Beuflox has been suggested for use in the treatment of a wide range of infections caused by susceptible organisms including infections of the urinary, respiratory and gastrointestinal tracts, gonorrhoea and septicaemia. The extensive tissue penetration of Beuflox combined with its enhanced antibacterial activity (including antipseudomonal activity), enables Beuflox to be used alone (pending sensitivity results) or in combination with an Aminoglycoside or with beta lactam antibiotics for instance when severe neutropenia is present or with an antibiotic active against anaerobes where the presence of bacteroides fragilis is suspected. Beuflox is indicated for the treatment of the following infections caused by sensitive bacteria:

Severe systemic infections: e.g. septicaemia, bacteraemia, peritionitis, infections in immunosuppressed patients with haematological or solid tumors and in patients in intensive care unit with specific problems such as infected burns.
Respiratory tract infections: Lobar and bronchopneumonia, acute and chronic bronchitis, acute exacerbation of cystic fibrosis, bronchiectasis, empyema.
Urinary tract infections: Uncomplicated and complicated urethritis, cystitis, pyelonephritis, prostatitis, epididymitis.
Skin and soft tissue infections: e.g. infected ulcers, wound infections, abscesses, cellulitis, otitis externa, erysipelas, infected burns.
Gastro-intestinal infections: e.g. enteric fever, infective diarrhea.
Infection of the biliary tract: e.g. cholangitis, cholecystitis, empyema of the gall bladder.
Intra abdominal infections: e.g. peritonitis, intra abdominal abscesses.
Bone and joint infection: Osteomyelitis, septic arthritis.
Pelvic infections: e.g. salpingitis, endometritis, pelvic inflammatory diseases.
Eye, ear, nose and throat infections: e.g. otitis media, sinusitis, mastoiditis, tonsillitis.
Gonorrhoea: Including urethral, rectal and pharyngeal gonorrhoea caused by beta-lactamase producing organisms or organisms moderately sensitive to penicillin.

আর watery diarrhea হলে যদি Rice watery হয়, তাহলে v.cholerae চিন্তা করবেন

Rx….এক্ষেত্রে তখন Doxicap / Ciprofloxacin

Updated Treatment হিসেবে

The oral medications of choice for empiric ট্রিটমেন্ট হলো # Fluoroquinolones (eg-

-Ciprofloxacin 500 mg BD daily, or

–Ofloxacin 400 mg, or

–Levofloxacin 500 mg OD for 1-3 day

Or Azithromycin 1gm single dose star or 500 mg daily for 3 days).(Davidson)

Fluoroquinolones:-

Ciprofloxacin.
Delafloxacin.
Gemifloxacin.
Levofloxacin.
Moxifloxacin.
Norfloxacin.
Ofloxacin.

Uporer sob gula Antibiotic medicine ai Antibiotic Drug gulo ke amra Fluoroquinolones Boli.

Eder moddhe theke Ofloxacin And Levofloxacin er useas dekbo

Ofloxacin:

Tablet 1:Rutix 400mg (AS A Ofloxacin AS A 4-Quinolone preparations, Aural Anti-bacterial preparations).

Indications of Tablet 1:Rutix 400mg (AS A Ofloxacin AS A 4-Quinolone preparations, Aural Anti-bacterial preparations).

Rutix tablets are indicated for the treatment of adults with mild to moderate infections caused by susceptible strains.

Lower Respiratory Tract: Acute bacterial exacerbation of chronic bronchitis lung abscess, pneumonia.
Gastrointestinal Tract: Enteric fever, shigellosis.
Multi-drug-resistant Tuberculosis.
Skin and skin structures: Uncomplicated skin and skin structure infections.
Sexually Transmitted Diseases: Acute, Uncomplicated urethral and cervical gonorrhoea. Nongonococcal urethritis and cervicitis.
Mixed infections of the urethra and cervix.
Urinary tract: Uncomplicated Urinary Tract Infections, Complicated urinary tract infections.

Rutix Eye & Ear Drops is indicated in-

Eye: It is indicated for the treatment of external ocular infections such as acute & sub-acute conjunctivitis, keratitis, kerato-conjunctivitis, blepharo-conjunctivitis, blepharitis, corneal ulcer and pre-operative prophylaxis in ocular surgery.
Ear: It is indicated for the treatment of external ear infections (otitis externa) and certain middle ear infections (otitis media).

Pharmacology of Tablet 1:Rutix 400mg (AS A Ofloxacin AS A 4-Quinolone preparations, Aural Anti-bacterial preparations).

Ofloxacin containing ofloxacin is a synthetic 4-fluoroquinolone antibacterial agent with bactericidal activity against a wide range of Gram-negative and Gram-positive organisms. Ofloxacin is thought to exert bactericidal effect by inhibiting DNA gyrase, an essential enzyme that is a critical catalyst in the duplication, transcription and repair of bacterial DNA. Following oral administration ofloxacin is rapidly and well absorbed from G.I. tract. The bioavailability of ofloxacin in the tablet formulation is almost 100%. It is widely distributed into body tissues and fluid. The half-life is about 4.6 to 6.9 hours. Up to 80% of an oral dose of ofloxacin is eliminated in the urine as the parent compound within 48 hour.

Dosage & Administration of Tablet 1:Rutix 400mg (AS A Ofloxacin AS A 4-Quinolone preparations, Aural Anti-bacterial preparations).

General dosage recommendations: The dose of ofloxacin is determined by the type and severity of the infection. The dosage range for adults is 200 mg to 800 mg daily. Up to 400 mg may be given as a single dose, preferably in the morning, larger doses should be given as two divided doses. Ofloxacin tablets should be swallowed with liquid; they should not be taken within two hours of intake of magnesium/aluminium containing antacids or iron preparations since reduction of absorption of ofloxacin can occur.

Enteric fever: For adults 200 mg, every 12 hours, for 5 days. For children 15 mg/kg/day in 2 divided doses for 3 days.
Shigellosis: 400 mg single dose.
Multi-drug-resistant tuberculosis: 400 mg twice daily along with conventional anti-tuberculosis drugs.
Lower respiratory tract infection: 400 mg daily, increasing, if necessary, to 400 mg twice daily.
Uncomplicated Urinary Tract Infections: A single dose of 200/400 mg.
Uncomplicated urethral and cervical gonorrhoea: A single dose of 400 mg.
Non-gonococcal urethral and cervicitis: 400 mg daily in single or divided doses.
Complicated Urinary Tract Infection: 200/400 mg/day for 7 days.
Impaired liver function: The excretion of ofloxacin may be reduced inpatients with severe hepatic dysfunction.
Children: Ofloxacin is usually not indicated for use in children or growing adolescents.
Elderly: No adjustment of dosage is required in the elderly.

Ofloxacin Eye & Ear Drops-

Eye: Instill 1 drop in the affected eye(s) every 2 to 4 hours for the first two days and then 4 times daily. The length of treatment should not exceed ten days.
Ear: Instill 1-2 drops in the affected ear(s) twice daily or as needed.

Interaction of Tablet 1:Rutix 400mg (AS A Ofloxacin AS A 4-Quinolone preparations, Aural Anti-bacterial preparations).

Antacids containing magnesium, aluminium or calcium may decrease absorption of Rutix. Iron or Zinc may decrease oral absorption of Rutix.

Contraindications of Tablet 1:Rutix 400mg (AS A Ofloxacin AS A 4-Quinolone preparations, Aural Anti-bacterial preparations).

Ofloxacin should not be used in-patients with known hypersensitivity to 4-fluoroquinolone antibacterials. It is contraindicated in-patients with a history of epilepsy or with a lowered seizure threshold. Ofloxacin is usually contraindicated in children or growing adolescents and in pregnant or breast feeding women.

Side Effects of Tablet 1:Rutix 400mg (AS A Ofloxacin AS A 4-Quinolone preparations, Aural Anti-bacterial preparations).

Rutix tablet is generally well tolerated and clinical side-effects of Rutix has been quite low. Among the adverse effects gastrointestinal and central nervous systems’ reactions are common. Nausea, rash, vomiting, abdominal pain, diarrhoea and gastrointestinal distress are the gastrointestinal adverse effects. Common central nervous system reactions are headache, dizziness and insomnia.

Eye: Transient ocular irritation, burning, stinging, redness, itching or photophobia have been reported.

Ear: Mild irritation or mild discomfort in the ear may occur. Symptoms of an allergic reaction include rash, itching, swelling or trouble breathing.

Pregnancy & Lactation of Tablet 1:Rutix 400mg (AS A Ofloxacin AS A 4-Quinolone preparations, Aural Anti-bacterial preparations).

The safety of ofloxacin during pregnancy has not been established. Ofloxacin may enter breast milk but data are not available.

Precautions & Warnings of Tablet 1:Rutix 400mg (AS A Ofloxacin AS A 4-Quinolone preparations, Aural Anti-bacterial preparations).

Patients being treated with Rutix should not expose themselves unnecessarily to strong sunlight and should avoid UV rays. Caution is recommended if the drug is to be used in psychotic patients or in-patients with a history of psychiatric disease.

Prolonged use of eye drops & ear drops may result in overgrowth of non-susceptible organisms and secondary infection respectively.

Therapeutic Class of Tablet 1:Rutix 400mg (AS A Ofloxacin AS A 4-Quinolone preparations, Aural Anti-bacterial preparations).

4-Quinolone preparations, Aural Anti-bacterial preparations

Levofloxacin:-

Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

Indications of Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

Levoxin is indicated for the treatment of mild, moderate and severe infections caused by susceptible strains of the designated micro-organisms in the condition listed below:

Acute maxillary sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
Acute bacterial exacerbation of chronic bronchitis due to Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
Community-acquired pneumonia due to Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydia pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae.
Uncomplicated & complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.
Acute pyelonephritis caused by Escherichia coli.
Uncomplicated & complicated skin and soft tissue infections including abscesses, cellulitis, furuncles, impetigo, pyoderma, wound infections, due to Staphylococcus aureus, Streptococcus pyogenes, Proteus mirabilis or Enterococcus faecalis.
Enteric infections caused by Enterobacter sp., Escherichia coli, Campylobacter sp., Vibrio cholerae, Shigella sp., Salmonella sp.

Description of Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

Levoxin is a synthetic, broad-spectrum, third-generation fluoroquinolone derivative antibacterial agent for oral administration. Chemically levofloxacin is a chiral fluorinated carboxyquinolone.

Pharmacology of Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

Levofloxacin is a synthetic, broad-spectrum, third generation fluoroquinolone antibiotic. Chemically, Levofloxacin is a chiral fluorinated carboxyquinolone. Levofloxacin exerts antibacterial action by inhibiting bacterial topoisomerase IV and DNA gyrase, the enzymes required for DNA replication, transcription repair and recombination. It has in vitro activity against a wide range of gm-ve and gm+ve microorganisms.

Dosage of Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

The usual dose of Levofloxacin Tablets is 250 mg or 500 mg or 750 mg administered orally every 24 hours. Levofloxacin tablets can be administered without regard to food. Levofloxacin oral solution should be taken 1 hour before, or 2 hours after eating.

Levofloxacin injection should only be administered by intravenous infusion. It is not for intramuscular, intrathecal, intraperitoneal, or subcutaneous administration. The usual dose of Levofloxacin injection is 250 mg or 500 mg administered by slow infusion over 60 minutes every 24 hours or 750 mg administered by slow infusion over 90 minutes every 24 hours. Since the Levofloxacin injections are for single-use only, any unused portion should be discarded. Additives or other medications should not be added to Levofloxacin Injection or infused simultaneously through the same intravenous line.

Adults:

Acute sinusitis: 500 mg once daily for 10-14 days, or 750 mg once daily for 5 days
Exacerbation of chronic bronchitis: 500 mg once daily for 7 days, or 750 mg once daily for 3 days (Uncomplicated), 750 mg once daily for 5 days (Complicated)
Community-acquired pneumonia: 500 mg once daily for 7-14 days, or 750 mg once daily for 5 days
Uncomplicated urinary-tract infections: 250 mg once daily for 3 days
Complicated urinary-tract infections and acute pyelonephritis: 250 mg once daily for 7-10 days
Uncomplicated skin and soft-tissue infections: 500 mg once daily for 7-10 days.
Complicated skin and soft-tissue infections: 750 mg once daily for 7-14 days.
Enteric fever: 500 mg once daily for 7-14 days.
Diarrhea, cholera, shigellosis & enteritis: Mild to moderate case: 500 mg (single dose). Moderate to sever case: 500 mg once daily for 3 days

Children:

Children 6 months to <5 years: 10 mg/kg every 12 hours.
Children >5 years: 10 mg/kg every 24 hours

In each case, sequential therapy (intravenous to oral) may be instituted at the discretion of the physician.

Administration of Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

Instructions for the Use of Levofloxacin Infusion-

Check the container for minute leaks by squeezing the inner bag firmly. If leaks are found, or if the seal is not intact, discard the solution.
Do not use if the solution is cloudy or a precipitate is present.
Do not use flexible containers in series connections.
Close flow control clamp of administration set.
Remove cover from port at bottom of container.
Insert piercing pin of administration set into port with a twisting motion until the pin is firmly seated.
Suspend container from hanger.
Squeeze and release drip chamber to establish proper fluid level in chamber during infusion of Levoxin Injection.
Open flow control clamp to expel air from set. Close clamp.
Regulate rate of administration with flow control clamp.

Interaction of Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

No quinolone should be co-administered with any solution containing multivalent cations, e.g., magnesium, through the same intravenous line. Antacids, Iron and Adsorbents reduce absorption of Levoxin. NSAID may increase the risk of CNS stimulation. Warfarin may increase the risk of bleeding.

Contraindications of Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

Levofloxacin is contraindicated in patients with a history of hypersensitivity to levofloxacin, quinolone antimicrobial agents, or any other components of this product.

Side Effects of Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

Levoxin is generally well tolerated. However, a few side-effects can usually be seen. There is a risk of retinal detachment. Other side-effects include: nausea, vomiting, diarrhea, abdominal pain, flatulence and rare occurrence of phototoxicity (0.1%). Side-effects that may be seen very rarely include tremors, depression, anxiety, confusion etc.

Pregnancy & Lactation of Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

Levofloxacin is not recommended for use during pregnancy or nursing, as the effects on the unborn child or nursing infant are unknown.

Precautions & Warnings

The following measures should be taken during administration of Levoxin:

Levoxin Injection should only be administered by slow intravenous infusion over a period of 60 or 90 minutes depending on the dosage.
While administrating Levoxin, adequate amount of water should be taken to avoid concentrated form of urine.
Dose adjustment should be exercised during Levoxin administration in presence of renal insufficiency.

Overdose Effects

Levoxin exhibits a low potential for acute toxicity. However, in the events of an acute overdosage, the stomach should be emptied. The patients should be kept under observation and appropriate hydration should be maintained.

Therapeutic Class of Tablet 2:-Levoxin 500mg (AS A Levofloxacin Hemihydrate AS A 4-Quinolone preparations).

4-Quinolone preparations

Travelers Diarrhoea এর Coz mainly Enterotoxigenic Escherichia coli (ETEC)

তাই প্রবাবল ড্রাগ অফ চয়েজ হতে পারে –Azithromycin & Ciprofloxacin

Acute Watery ডায়রিয়া তে Antiobiotics না দিয়ে Patient কে কাউন্সিলিং এর মাধ্যমে বুজিয়ে ORS খেতে বলুন২৪ hour এর মধেই পেশেন্ট ভালো হয়ে যায় মেইনলি

Diarrhoea তে অনেক সময় abdominal bloating হয়, এইটা গ্যাসের জন্য কিংবা acidity এর জন্য না

এইটা Transient Hypokalemic change এর জন্য,

যা ডাবের পানি খেলেই ঠিক হয়ে যাবে

Quesition:-renal function না দেখে কি শুরুতেই cholera saline start করবো? নাকি প্রথমে Normal saline, then renal function normal থাকলে Cholera saline?

Answer is :-not significant

Amni te Cholera salin o dite prbn.

Quesition :-Metronidazole er use ki???

Incomplete course e Resistance er chance ase ki???

Answer Is:-Metro resistance hoy na*Irrational use korle resistance hote pare..

5 days er jonno diye diben dite chaile* remember the things prolong diarrhoea te

Antibiotics associated diarrhoea te

Metronizazole use kora jete pare.

NB:-ডায়রিয়া তে Choice of fluid হবে cholera saline** Raiyyan Tahsan. Date:26-01-2025 Sunday Time:6-42-55 PM

Raiyyan Tahsan

Raiyyan Tahsan