Urology Case No 13.Urethritis

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Urology Case No 13.Urethritis

একটা পুরুষ মানুষ প্রস্রাবের সময় painful milky discharge নিয়ে আসলে অথবা urethral discharge নিয়ে আসলে অবশ্যই অবশ্যই তার থেকে Exposure এর হিস্ট্রি নিবেন-

সাথে Urine R/E

C/S of urethral discharge ( also Gram staining of urethral discharge..)

Most common Dx .. Gono coccal urethritis /Due to Nisseria Gonorrhea (কালচার পজিটিভ আসবে)

Culture Negative আসলে Dx.. Chlamydial urthraitis.

সিনারিও—

রায়হানের প্রস্রাবের সময় ১৫ দিন থেকে অনেক টন টন ব্যথা করে..

বয়স ২৩ বছর, আরো কমপ্লেইন করলো, প্রস্রাবের রাস্তা দিয়ে সাদা পুজ এর মত কিছু বের হয়…

অর্থাৎ – Dysuria and Urethral discharge যাচ্ছে, কোনো জ্বর নাই, কাঁপুনি নাই…

এইটা সিনারিও শুনে মনে হচ্ছে../Urethritis,

আমি জিজ্ঞেস করলাম, কি করেন,

বললো, কিছু করেনা, ভার্সিটি শেষ করেছে, Exposure এর হিস্ট্রি নিলাম কিছু কৌশলে, আর ভয় দেখিয়ে…

কক্সবাজার ট্যুর + এক্সপোসার এর হিস্ট্রি দিলো অনেকক্ষণ পরে

এইসব পেশেন্ট থেকে Exposure এর হিস্ট্রি নিতে হবে, এরা সত্য বলবেনা, তবে আপনাকে সত্যটা আদায় করে নিতে হবে,,, আর Uretheral swab For C/S দিতে হবে…

এই পেশেন্ট এর C/S positive আসছে for Nisseria Gonorrhea

.চিকিৎসা – Treatment Management :-

1.. Ceftriaxone 1 gm I/M single dose.

পেশেন্ট ইনজেকশন নিতে ভয় পায়, তাই তাকে আর ইনজেকশন দিলাম না…

তার জন্য দিয়েছি ওরাল ম্যানেজমেন্ট.

According to NICE Guideline..

Oral Rx–

Cefixime 400 mg Stat.

Capsule 1.Cef-3 DS 400 mg (AS A Cefixime Trihydrate AS A 3^RD Generation Cephalosporins)

Indications of Capsule 1.Cef-3 DS 400 mg (AS A Cefixime Trihydrate AS A 3^RD Generation Cephalosporins)

Cef-3 DS is an orally active cephalosporin antibiotic which has marked in-vitro bactericidal activity against a wide variety of Gram-positive and Gram-negative organism. It is indicated for the treatment of the following acute infections when caused by susceptible microorganisms.

Upper Respiratory Tract Infections (URTI): e.g. otitis media; and other URTI where the causative organism is known or suspected to be resistant to other commonly used antibiotics, or where treatment failure may carry significant risk. Lower Respiratory Tract Infections-e.g. bronchitis.

Urinary Tract Infections: e.g. cystitis, cystourethritis, pyelonephritis. Clinical efficacy has been demonstrated in infections caused by commonly occurring pathogens including Streptococcus pneumonia, Streptococcus pyogenes, Escherichia coli, Proteus mirabilis, Klebsiella species, Haemophilus influenzae (beta-lactamase positive and negative), Moraxella catarrhalis (beta-lactamase positive and negative) and Enterobacter species. Cef-3 DS is highly stable in the presence of beta-lactamase enzymes.

Pharmacology of Capsule 1.Cef-3 DS 400 mg (AS A Cefixime Trihydrate AS A 3^RD Generation Cephalosporins)

Cefixime is a third generation semisynthetic cephalosporin antibiotic for oral administration. It is bactericidal against a broad spectrum of gram positive and gram negative bacteria at easily achievable plasma concentrations. It kills bacteria by interfering in the synthesis of bacterial cell wall. It is highly stable in the presence of Beta-lactamase enzyme. As a result, many organisms resistant to penicillins and some cephalsporins due to the presence of beta-lactamases, may be susceptible to Cefixime. Absorption of it is about 40% to 50% whether administered with or without food.

Dosage & Administration of Capsule 1.Cef-3 DS 400 mg (AS A Cefixime Trihydrate AS A 3^RD Generation Cephalosporins)

Absorption of Cefixime is not significantly modified by the presence of food. The usual course of treatment is 7 days. This may be continued for up to 14 days if required.

Adults and children over 10 years: The recommended adult dosage is 200-400 mg daily according to the severity of the infection, given either as a single dose or in two divided doses.

Elderly: Elderly patients may be given the same dose as recommended for adults. Renal function should be assessed and dosage should be adjusted in severe renal impairment.

Children: The recommended dosage for children is 8 mg/kg/day administered as a single dose or in two divided doses. As a general guide for prescribing in children the following daily doses in terms of volume of suspension are suggested:

6 months up to 1 year: 3.75 ml daily
Children 1-4 years: 5 ml daily
Children 5-10 years: 10 ml daily

In typhoid: the recommended children dose is 5 mg/kg body weight twice daily for 10-14 days.

Children weighing more than 50 kg or older than 10 years: Should be treated with the recommended adult dose 200-400 mg daily depending on the severity of infection.

Children aged less than 6 months: The safety and efficacy of Cefixime has not been established in children aged less than 6 months.

Dosage in Renal Impairment: Cefixime may be administered in the presence of impaired renal function. Normal dose and schedule may be given in patients with creatinine clearances of 20 ml/min or greater. In patients whose creatinine clearance is less than 20 ml/min, it is recommended that a dose of 200 mg once daily should not be exceeded. The dose and regimen for patients who are maintained on chronic ambulatory peritoneal dialysis or haemodialysis should follow the same recommendation as that for patients with creatinine clearances of less than 20 ml/min.

Interaction

In common with other cephalosporins, increases in prothrombin times have been noted in a few patients. Care should therefore be taken in patients receiving anticoagulant therapy.

Contraindications

Patients with known hypersensitivity to cephalosporin antibiotics.

Side Effects of Capsule 1.Cef-3 DS 400 mg (AS A Cefixime Trihydrate AS A 3^RD Generation Cephalosporins)

Cef-3 DS is generally well tolerated. The majority of adverse reactions observed in clinical trials were mild and self limiting in nature. Gastrointestinal disturbances: The most frequent side-effects seen with Cef-3 DS are diarrhoea and stool changes; diarrhoea has been more commonly associated with higher doses. Other gastrointestinal side-effects seen less frequently are nausea, abdominal pain, dyspepsia, vomiting and flatulence. Pseudomembraneous colitis has been reported. Central nervous system: headache and dizziness. Hypersensitivity reactions: allergies in the form of rash, pruritis, urticaria, drug fever and arthralgia have been observed. These reactions usually subsided upon discontinuation of therapy. Hematological and clinical chemistry: thrombocytopenia, leukopenia and eosinophilia have been reported. These reactions were infrequent and reversible. Mild transient change in liver and renal function tests have been observed. Miscellaneous: other possible reactions include genital pruritis and vaginitis.

Pregnancy & Lactation of Capsule 1.Cef-3 DS 400 mg (AS A Cefixime Trihydrate AS A 3^RD Generation Cephalosporins)

There are, however, 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. It is not known that Cefixime is excreted in human milk. So, caution should be exercised when Cefixime is administered to a nursing woman.

Precautions & Warnings of Capsule 1.Cef-3 DS 400 mg (AS A Cefixime Trihydrate AS A 3^RD Generation Cephalosporins)

Cef-3 DS should be given with caution to patients who have shown hypersensitivity to other drugs. Cephalosporin should be given with caution to penicillin-sensitive patients, as there is some evidence of partial cross-allergenicity between the penicillins and the cephalosporins. Patients have had severe reactions (including anaphylaxis) to both classes of drugs. If an allergic effect occurs with Cef-3 DS, the drug should be discontinued and the patient treated with appropriate agents if necessary. Cef-3 DS should be administered with caution in patients with markedly impaired renal function. Treatment with broad spectrum antibiotics alters the normal flora of the colon and may permit overgrowth of clostridia. Studies indicate that a toxin produced by Clostridium difficile is a primary cause of antibiotic-associated diarrhoea. Use in pregnancy and lactation: There are no adequate and well-controlled studies in pregnant women. Cef-3 DS should therefore not be used in pregnancy or in nursing mothers unless considered essential by the physician.

Overdose Effects of Capsule 1.Cef-3 DS 400 mg (AS A Cefixime Trihydrate AS A 3^RD Generation Cephalosporins)

Gastric Lavage may be indicated; otherwise, no specific antidote exists. Cef-3 DS is not removed in significant quantities from the circulation by hemodialysis or peritoneal dialysis. Adverse reactions in small numbers of healthy adult volunteers receiving single doses up to 2 g of Cef-3 DS did not differ from the profile seen in patients treated at the recommended doses.

Therapeutic Class of Capsule 1.Cef-3 DS 400 mg (AS A Cefixime Trihydrate AS A 3^RD Generation Cephalosporins)

Third generation Cephalosporins

Plus

Azithromycin 2 gm stat.

Tablet 2:-Zimex 500 mg (AS A Azithromycin Dihydrate AS A Macrolides).

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

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

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

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

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

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

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

Azithromycin Dihydrate is contraindicated in patients hypersensitive to Azithromycin or any other macrolide antibiotic. Co-administration of ergot derivatives and Azithromycin is contraindicated. Azithromycin is contraindicated in patients with hepatic diseases

Pregnancy & Lactation of Tablet :-Zimex 500 mg (AS A Azithromycin Dihydrate AS A Macrolides).

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—

Cef-400 mg

1+0+0

Cap- Zimax 500 mg

4 cap stat.

Gonococcal urethritis এর ক্ষেত্রে ceftriaxone/ iv penicillin কোনটা বেশি ভালো?

Answer is:-ceftriaxone is best treatment.

Ceftriaxone:-

Injection 3:-Ceftron IM/Injection 1gm/vial (AS A Ceftriaxone Sodium AS A Third generation Cephalosporins).

Indications of Injection 3:-Ceftron IM/Injection 1gm/vial (AS A Ceftriaxone Sodium AS A Third generation Cephalosporins).

Ceftron injection is indicated for the treatment of the following major infections:

Lower respiratory tract infections
Acute Bacterial Otitis Media
Skin and skin structure infections
Urinary tract infections
Gonorrhea
Bacterial Septicemia
Bone and joint infections
Meningitis
Prevention of postoperative infections
Perioperative prophylaxis of infections associated with surgery

Pharmacology of Injection 3:-Ceftron IM/Injection 1gm/vial (AS A Ceftriaxone Sodium AS A Third generation Cephalosporins).

Ceftriaxone is a 3rd generation broad-spectrum parenteral cephalosporin antibiotic. It has potent bactericidal activity against a wide range of Gram-positive and Gram-negative organisms. Like other cephalosporins and penicillins, Ceftriaxone kills bacteria by interfering with the synthesis of the bacterial cell wall. Ceftriaxone has a high degree of stability in the presence of beta lactamases. A remarkable feature of Ceftriaxone is its relatively long plasma elimination half-life of about 6 to 9 hours, which makes single or once-daily dosage of the drug appropriate for most patients. Ceftriaxone is not metabolized in the body. About 40-65% of a dose of Ceftriaxone is excreted unchanged in the urine; the remainder is excreted in the bile and ultimately found in the feces as unchanged drug and microbiologically inactive compound. The drug is highly protein bound (95%).

Dosage of Injection 3:-Ceftron IM/Injection 1gm/vial (AS A Ceftriaxone Sodium AS A Third generation Cephalosporins).

Adult: The usual dose is 1 to 2 gm by intravenous or intramuscular administration once a day (or in equally divided doses twice a day).

Pneumonia, Bronchitis, Acute bacterial otitis media, Skin and skin structure infection, Urinary tract infections, Bacterial Septicemia, Bone and joint infections, Meningitis: 1 to 2 g IV or IM once a day (or in equally divided doses twice a day); Maximum dose: 4 gm/day
Uncomplicated gonococcal infections: 250 mg IM as a single dose
Surgical prophylaxis: 1 g IV as a single dose 30 to 120 minutes before surgery

Infants and Children (01 month or older): The usual dose is 50 to 75 mg/kg intravenous or intramuscular administration once a day (or in equally divided doses twice a day).

Pneumonia, Bronchitis, Skin and skin structure infection, Urinary tract infections, Bacterial Septicemia, Bone and joint infections: 50 to 75 mg/kg IV or IM once a day (or in equally divided doses twice a day); Maximum dose: 2 gm/day
Acute bacterial otitis media: 50 mg/kg IM in single dose; Maximum dose: 1 gm/day
Meningitis: 100 mg/kg IV or IM in single daily dose or (or in equally divided doses twice a day); Maximum dose: 4 gm/day

Duration of therapy: Continue for more than 2 days after signs and symptoms of infection have disappeared. Usual duration is 4 to 14 days; in complicated infections, longer therapy may be required.

Administration of Injection 3:-Ceftron IM/Injection 1gm/vial (AS A Ceftriaxone Sodium AS A Third generation Cephalosporins).

Preparation of Solutions for Intramuscular / Intravenous Injections:

For Intramuscular Injection: 250 mg or 500 mg Ceftriaxone should be dissolved in 2 ml Lidocaine HCI 1% injection or 1 g Ceftriaxone in 3.5 ml of Lidocaine HCI 1% injection.
For Intravenous Injection: 250 mg or 500 mg Ceftriaxone should be dissolved in 5 ml of Water for injection or 1 g Ceftriaxone in 10 ml of Water for injection USP or 2 g Ceftriaxone in 20 ml of Water for injection.

The injection should be administered over 2-4 minutes, by Intramuscular or Intravenous injection or by tubing infusion over a period of 30 minutes at concentration between 10 mg/mL and 40 mg/mL. Before starting treatment through Ceftriaxone injection, patient tolerance test should be checked by administration of a test dose. (The use of freshly reconstituted solution is recommended. However, it maintains potency for at least 6 hours at room temperature or 24 hours at 5°C).

Interaction of Injection 3:-Ceftron IM/Injection 1gm/vial (AS A Ceftriaxone Sodium AS A Third generation Cephalosporins).

No drug interactions have been reported.

Contraindications of Injection 3:-Ceftron IM/Injection 1gm/vial (AS A Ceftriaxone Sodium AS A Third generation Cephalosporins).

Ceftriaxone should not be given to patients with a history of hypersensitivity to cephalosporin antibiotics.

Side Effects of Injection 3:-Ceftron IM/Injection 1gm/vial (AS A Ceftriaxone Sodium AS A Third generation Cephalosporins).

Ceftron is generally well tolerated. A few side effects such as gastro-intestinal effects including diarrhea, nausea and vomiting, stomatitis and glossitis; cutaneous reactions including rash, pruritus, urticaria, edema and erythema multiforme; hematologic reactions including eosinophilia, thrombocytopenia, leucopenia, anemia and neutropenia; hepatic reactions including elevations of SGOT or SGPT, bilirubinemia; CNS reactions including nervousness, confusion, sleep disturbances, headache, hyperactivity, convulsion, hypertonia and dizziness were reported. Local phlebitis occurs rarely following intravenous administration but can be minimized by slow injections over 2-4 minutes.

Pregnancy & Lactation

Its safety in human pregnancy has not been established. Therefore, it should not be used in pregnancy unless absolutely indicated. Low concentrations of Ceftriaxone are excreted in human milk. Caution should be exercised when Ceftriaxone is administered to a lactating mother.

Precautions & Warnings of Injection 3:-Ceftron IM/Injection 1gm/vial (AS A Ceftriaxone Sodium AS A Third generation Cephalosporins).

As with other cephalosporins, anaphylactic shock cannot be ruled out even if a thorough patient history is taken. Anaphylactic shock requires immediate countermeasures such as intravenous epinephrine followed by a glucocorticoid. In rare cases, shadows suggesting sludge have been detected by sonograms of the gallbladder. This condition was reversible on discontinuation or completion of Ceftron therapy. Even if such findings are associated with pain, conservative, nonsurgical management is recommended. During prolonged treatment the blood picture should be checked at regular intervals.

Use in Special Populations

Ceftron must not be given to neonates if the neonates is premature and newborn (up to 28 days of age).

Overdose Effects

There is no specific antidote. Treatment of overdosage should be symptomatic.

Therapeutic Class of Injection 3:-Ceftron IM/Injection 1gm/vial (AS A Ceftriaxone Sodium AS A Third generation Cephalosporins).

Third generation Cephalosporins

Capsule 4. Doxicap 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Indications of Capsule:- Doxicap 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxicap 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 of Capsule:- Doxicap 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Doxicap 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. Doxicap is used as an alternate to penicillin in the treatment of gonorrhoea and syphilis. Doxicap has its main mechanism of action on protein synthesis. Inside the bacterial cell, it inhibits protein synthesis.

Pharmacology of Capsule:- Doxicap 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 of Capsule:- Doxicap 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 of Capsule:- Doxicap 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 standing.

Interaction of Capsule:- Doxicap 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 of Capsule:- Doxicap 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 of Capsule:- Doxicap 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

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

Pregnancy & Lactation of Capsule:- Doxicap 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 of Capsule:- Doxicap 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

The 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 of Capsule:- Doxicap 100mg (AS A Doxycycline Hydrochloride AS A Tetracycline group of drugs).

Tetracycline group of drugs

পেশেন মেডিসিন নিলো..

৫ দিন পর দেখা করতে বলেছি.

সে ৭ দিন পরে আসছে, পরিপূর্ণ সুস্থ.

তবে এইসব পেশেন্ট কে এত সহজে চিকিৎসা না দিয়ে কিছু নেগেটিভ কাউন্সেলিং করে দিবেন, যেন, এইসব কাজ ২য় বার না করে.

আর যদি কালচার নেগেটিভ হয়, তাহলে চিকিৎসা হবে

doxicap 100 mg BD (10 days)

তারপরও রোগী যদি ইনফেকশন থাকে বা গনোরিয়া থাকে white discharge thake

গনোরিয়া (Gonorrhea) এর ক্ষেত্রে সঠিক চিকিৎসা প্রদান একটি চ্যালেঞ্জ হতে পারে, বিশেষ করে যদি সঠিক চিকিৎসা দিয়ে রোগীর সমস্যা পুরোপুরি সমাধান না হয়। কিছুক্ষেত্রে গনোরিয়া-র সাথে কো-ইনফেকশন বা এন্টিবায়োটিক রেজিস্ট্যান্সও থাকতে পারে, যেটি উপযুক্ত চিকিৎসা নির্ধারণে প্রভাব ফেলে।

যদি Ceftriaxone এবং Cefixime এর প্রাথমিক ব্যবহারের পরেও রোগী পুনরায় (whitish discharge) অভিযোগ নিয়ে আসে, তাহলে নিম্নলিখিত ব্যবস্থা গ্রহণ করা যেতে পারে:

1. এন্টিবায়োটিক রেজিস্ট্যান্স টেস্ট:

C/S of discharge sample

2. সচরাচর রেজিস্ট্যান্সের ক্ষেত্রে চিকিৎসা :

-Ceftriaxone 500 mg IM (single dose) এবং Azithromycin 1 gm PO (single dose) এর সমন্বিত ব্যবহার

এটি ব্যবহার করে রেজিস্ট্যান্স রোধের ক্ষেত্রে ভালো ফল পাওয়া যায়।

3. Reinfection অথবা Mixed Infection

– যদি রোগী পুনরায় একই অভিযোগ নিয়ে আসে, তাকে reinfection বা mixed infection-এর জন্য পরীক্ষা করতে হবে, যেমন Chlamydia trachomatis বা অন্যান্য STI এর জন্য।

সেইক্ষেত্রে প্রথমবার ই চিকিৎসার সময়

১০ দিনের জন্য Doxycycline দিয়ে দিবেন,

doxicap 100 mg BD.

সাথে ceftriaxone single dose I/M + Azithromycin

Benzyl penicillin:

গনোরিয়া জন্য বর্তমানে বিশ্ব স্বাস্থ্য সংস্থা (WHO) বা CDC গাইডলাইনে Benzyl Penicillin ব্যবহার করার প্রস্তাবনা নেই, কারণ গনোরিয়ার জন্য এটি তেমন কার্যকরী নয়। Penicillin-resistant Neisseria gonorrhoeae রেজিস্ট্যান্সের কারণে এই এন্টিবায়োটিক আর ব্যবহৃত হয় না।

এছাড়া, রোগীর সঙ্গীকে (partners) পরীক্ষা এবং চিকিৎসা করাও খুব গুরুত্বপূর্ণ যাতে পুনরায় সংক্রমণ রোধ করা যায়।

ধন্যবাদ

এই রোগ থেকে রক্ষার জন্য ইসলামের অনুশাসন পর্দা মেনে চলার বিকল্প নাই– আল্লাহ পাক আমাদের সবাইকে বুঝার তাওফিক দান করুন–

Raiyyan Tahsan Date:-27-01-2025 Monday Time:2-10-33 PM

Raiyyan Tahsan

Raiyyan Tahsan