Dental Disease Case No 1. Antibiotic Protocal.

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Dental Disease Case No 1. Antibiotic Protocal.

Antibiotics_protocol_in_Dental_procedure

রুবিনার দাতের চিকিৎসা করা দরকার- ডাক্তারের কাছে আসলো, ডাক্তার জানালেন, তার স্ক্যালিং করা লাগবে– স্ক্যালিং করা হলো– রুবিনার কোনো এন্টিবায়োটিক প্রোপাইলেক্সিস লাগবে কিনা?

রোমেনা ৫৫ বছর বয়স, দাতে ব্যাথা- ডাক্তার বললেন, দাত তুলে ফেলতে হবে, দাত তোলার আগে পরে কোন এন্টিবায়োটিক লাগবে কিনা?

প্রথম কথা-

পেশেন্টের থেকে জেনে নিন- তার কোনো কনজেনিটাল হার্ট ডিজিজ আছে কিনা যা রিপায়ার করা হয়েছে, অথবা কোন prosthetic heart valve আছে কিনা, মোট কথা structural কোন হার্ট ডিজিজ আছে কিনা,

যদি না থাকে, তাহলে কোনো dental procedure এ কোনো এন্টিবায়োটিক লাগবেনা –

American Dental Association (ADA) এর সর্বশেষ তথ্য অনুযায়ী কোনো healthy person এর যে কোনো dental procedure এ কোনো এন্টিবায়োটিক লাগবেনা-

তবে যদি dental procedure এর সময় Mucosal injury হয়, কিংবা gingiva manipulation করা হয়, তথা মাড়ির ভিতরে কোনো কাজ করা হয়, তখন ইনফেকশনের ঝুঁকি থাকে- এমন পরিস্থিতিতে প্রসিডিওর শুরু করার ১ ঘন্টা আগে single dose of antibiotics দেওয়া হবে– পরে আর দেওয়ার দরকার নাই–পেশেন্ট নিয়মিত এন্টি সেপটিক মাউথ ওয়াশ দিয়ে ওরাল হাইজিন মেইনটেইন করবে- post procedure 3-5 দিনের এন্টিবায়োটিক এর কোনো দরকার হবেনা–

স্ক্যালিং এর পর কোনো এন্টিবায়োটিক লাগবেনা-

Tooth extraction in healthy individual – কোন এন্টিবায়োটিক লাগবেনা-

এখন জেনে নিই-

Oral cavity te normal flora হিসাবে কোন কোন অর্গানিজম থাকে–

The five most common organisms in the oral cavity are:

1. **Streptococcus mutans** (Gram-positive) – Associated with dental caries.

2. **Streptococcus sanguinis** (Gram-positive) – Part of the healthy oral flora.

3. **Porphyromonas gingivalis** (Gram-negative, anaerobe) – Associated with periodontitis.

4. **Fusobacterium nucleatum** (Gram-negative, anaerobe) – Involved in periodontal disease.

5. **Actinomyces spp.** (Gram-positive) – Associated with both health and early-stage caries.

সহজ কথায় গ্রাম পজিটিভ, নেগেটিভ +Anaerobic organism থাকে–

তাই এন্টিবায়োটিক দেওয়ার সময় লক্ষ রাখবে, যেনো এইগুলির কাভারেজ থাকে-

Antibiotics protocol :

American dental Association এখন ডেন্টাল প্রসিডিওর এর ক্ষেত্রে clindamycin এর ব্যবহার নিষেধ করে থাকে- এটা আগে অনেক বেশি ব্যবহার হতো-

Current guideline :

পেশেন্ট যদি মুখে খেতে পারে- তাহলে প্রসিডিওর এর আগে Moxaclav 1 gm ২ টা দিয়ে দিবেন single dose

healthy individual এর ক্ষেত্রে কোনো prophylaxis লাগবেনা,

যাদের হার্ট এর স্ট্রাকচারাল ডিজিজ আছে, তাদের ক্ষেত্রে prophylaxis দিবে–

২.. Amoxicillin এ Hypersensitivity থাকলে Doxycycline 100 mg দিবে-

৩… Azithromycin + metronidazole দেওয়া যেতে পারে–

৪… Cefadroxil + Metro (Adora 1000 mg stat +Filmet 400 mg stat)

অর্থাৎ Penicillin এর মধ্যে Amoxicillin +Clavulanic

Cephalosporin এর মধ্যে First Generation Cephalosporin + Metronidazole –

Second generation or 3rd Generation should be avoided — so no cefixime, no cefuroxime.

কোথাও first Generation পাওয়া না গেলে second generation দিবেন, তবে Not 3rd Generation cefixime.

Moxaclav এ ডায়েরিয়ার সম্ভাবনা থাকে- তাই Adora + Metro একটা ভালো অপশন —

যদি কারো ক্ষেত্রে Mucosal injury or deep perforation or Gingiva manipulation কর হয়, অথবা পেশেন্ট এর ডায়াবেটিস আছে, কিংবা Gum infection আছে- সেই ক্ষেত্রে অনেক ফিজিশিয়ান post procedure ৫ দিনের জন্য এন্টিবায়োটিক প্রোফাইলেক্সিস দিয়ে থাকেন–

post Procedural antibiotics protocol :

1.. Tab- Moxaclav 625 mg.

1+1+1 (5 days)

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

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

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

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

Composition

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

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

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

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

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

Adults and children over 12 years:

Tablet:

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

Suspension:

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

Forte suspension:

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

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

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

Serious infections:

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

IV Injection

Adults-

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

Children-

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

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

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

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

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

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

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

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

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

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

Pregnancy & Lactation

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

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

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

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

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

Adult:

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

Children:

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

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

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

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

Moxaclav দিলে আলাদা করে আর anaerobic coverage এর জন্য Metronidazole দেওয়া লাগেনা—অথবা

Cefadroxil:-1st Generation Cephalosporins

2.. Tab- Adora 500 mg (AS A Cefadroxil Monohydrate First generation Cephalosporins).

1+0+1 (5 days)

Or adora 1000 mg once Daily –

Indications of Tab- Adora 500 mg (AS A Cefadroxil Monohydrate First generation Cephalosporins).

Adora 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 Tab- Adora 500 mg (AS A Cefadroxil Monohydrate 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 Tab- Adora 500 mg (AS A Cefadroxil Monohydrate 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 Tab- Adora 500 mg (AS A Cefadroxil Monohydrate First generation Cephalosporins).

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

Contraindications of Tab- Adora 500 mg (AS A Cefadroxil Monohydrate 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 Tab- Adora 500 mg (AS A Cefadroxil Monohydrate 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 Tab- Adora 500 mg (AS A Cefadroxil Monohydrate 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 Tab- Adora 500 mg (AS A Cefadroxil Monohydrate First generation Cephalosporins).

Adora 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 of Tab- Adora 500 mg (AS A Cefadroxil Monohydrate First generation Cephalosporins).

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 Tab- Adora 500 mg (AS A Cefadroxil Monohydrate First generation Cephalosporins).

First generation Cephalosporins

Tablet 3.Filmet 400 mg (AS A Metrondazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

1+1+1 (5 days)

Indications of Tablet:-Filmet 400 mg (AS A Metrondazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

1+1+1 (5 days)

Filmet is indicated in the treatment of following diseases:

The prevention of post-operative infections due to anaerobic bacteria (particularly species of bacteroides and anaerobic streptococci).
The treatment of septicaemia, bacteraemia, peritonitis, brain abscess, pelvic abscess, pelvic cellulitis and post-operative wound infections caused by anaerobes.
In the treatment of urogenital trichomoniasis.
Bacterial vaginosis (also known as non-specific vaginitis).
All forms of amoebiasis (intestinal, extra-intestinal disease and that of symptomless cyst passers).
Giardiasis.
Acute ulcerative gingivitis.
Anaerobically infected leg ulcers and pressure sores.
Acute dental infections due to anaerobic organisms.
Antibiotic associated pseudomembranus colitis.

Pharmacology of Tablet:-Filmet 400 mg (AS A Metrondazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Metronidazole is a member of the imidazole class of antibacterial drug and is classified therapeutically as an antiprotozoal agent. The 5-nitro group of Metronidazole is reduced by anaerobes metabolically. Studies have demonstrated that the reduced form of this drug interacts with DNA and gives bactericidal action of Metronidazole.

Dosage & Administration

Tablet and Suspension:

Trichomoniasis (Adults & Children over 10 yrs)-

200 mg tid or 400 mg bid for 7 days
800 mg in the morning and 1-2 gm at night for 2 days
2 gm as a single dose for 1 days

Trichomoniasis (Children)-

Children 7-10 yrs: 100 mg tid
Children 3-7 yrs: 100 mg bid
Children 1-3 yrs: 50 mg tid

Intestinal amoebiasis (Adults & Children over 10 yrs)-

800 mg tid for 5 days

Intestinal amoebiasis (Children)-

Children 7-10 yrs: 400 mg tid
Children 3-7 yrs: 200 mg qid
Children 1-3 yrs: 200 mg tid

Extra-intestinal & Asymptomatic amoebiasis (Adults & Children over 10 yrs)-

400-800 mg tid for 5-10 days

Extra-intestinal & Asymptomatic amoebiasis (Children)-

Children 7-10 yrs: 200-400 mg tid
Children 3-7 yrs: 100-200 mg qid
Children 1-3 yrs: 100-200 mg tid

Giardiasis (Adults & Children over 10 yrs)-

2 gm once daily for 3 days

Giardiasis (Children)-

Children 7-10 yrs: 1 gm once daily
Children 3-7 yrs: 600-800 mg once daily
Children 1-3 yrs: 500 mg once daily

Acute ulcerative gingivitis (Adults & Children over 10 yrs)-

200 mg tid for 3 days

Acute ulcerative gingivitis (Children)-

Children 7-10 yrs: 100 mg tid
Children 3-7 yrs: 100 mg bid
Children 1-3 yrs: 50 mg tid

Acute dental infections (Adults & Children over 10 yrs)-

200 mg tid for 3-7 days

Bacterial Vaginosis (Adults & Children over 10 yrs)-

400 mg bid for 7 days
2 gm as a single dose for 1 days

Leg ulcers and pressure sores (Adults & Children over 10 yrs)-

400 mg tid for 7 days

Anaerobic infections (Adults & Children over 10 yrs)-

800 mg initially and then 400 mg tid for 7 days

Anaerobic infections (Children)-

Children 1-10 yrs: 7.5 mg/kg tid

Surgical prophylaxis (Adults & Children over 10 yrs)-

400 mg tid started 24 hours before surgery for 1 days

Surgical prophylaxis (Children)-

Children 1-10 yrs: 7.5 mg/kg tid

Vaginal Gel:

The recommended dose is one applicator full of Metronidazole gel (approximately 5 grams containing approximately 37.5 mg of Metronidazole) intravaginally once or twice a day for 5 days. For once a day dosing, Metronidazole gel should be administered at bedtime.

Suppository:

Anaerobic Infections-

Adults: 1 g every 8 hours for 3 days, then 1 g every 12 hours.
Children: 5-10 years: 500 mg every 8 hours for 3 days, then every 12 hours, Over 10 years adult dose.

Surgical Prophylaxis-

Adults: 1 g 2 hours before surgery; up to 3 further doses of 1 g may be given every 8 hours for high risk procedures.
Children: 5-10 years: 500 mg 2 hours before surgery; up to 3 further doses of 500 mg may be given every 8 hours for high risk procedures.

IV Infusion:

Metronidazole intravenous infusion requires no dilution and should not be mixed with any other drugs prior to administration.

Adults and children over 12 years: Infuse 500 mg 8 hourly at a rate of 5 ml/minute and a maximum of 4 g should not be exceeded during a 24-hour period. Treatment for 7 days is sufficient for most patients, but treatment can be extended, especially for cases where reinfection is likely. For surgical prophylaxis, administration shortly before surgery should be followed by 8-hourly doses for the next 24 hours.
Children under 12 years: 7.5 mg/kg body weight/day every 8 hours at a rate of 5 ml/minute.

Interaction of Tablet:-Filmet 400 mg (AS A Metrondazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Disulfiram: Psychotic reactions have been reported in patients who were using Filmet and disulfiram concurrently.
Alcohol: Alcoholic beverages and drugs containing alcohol should not be consumed during therapy and for at least one day afterwards because of the possibility of a disulfiram-like (antabuse effect) reaction (flushing, vomiting, tachycardia). Oral anticoagulant therapy (warfarin type): Potentiation of the anticoagulant effect and increased hemorrhagic risk caused by decreased hepatic catabolism. In case of co-administration, prothrombin time should be more frequently monitored and anticoagulant therapy adjusted during treatment with Filmet.
Lithium: Plasma levels of lithium may be increased by Filmet.
Cyclosporin: Serum cyclosporin and serum creatinine should be closely monitored when co-administration is necessary.
Phenytoin or phenobarbital: increased elimination of Filmet resulting in reduced plasma levels.
5-Fluorouracil: Reduced clearance of 5-fluorouracil resulting in increased toxicity of 5-fluorouracil.
Busulfan: Plasma levels of busulfan may be increased by Filmet, which may lead to severe busulfan toxicity.

Contraindications of Tablet:-Filmet 400 mg (AS A Metrondazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Metronidazole is contraindicated in patients with a history of hypersensitivity to Metronidazole or other Nitroimidazole derivatives.

Side Effects of Tablet:-Filmet 400 mg (AS A Metrondazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Metallic taste, nausea, vomiting, diarrhoea, drowsiness, rashes may be observed during treatment.

Pregnancy & Lactation of Tablet:-Filmet 400 mg (AS A Metrondazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

US FDA Pregnancy Category of Metronidazole is B. 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. Metronidazole have been shown to be excreted in human milk. So, caution should be exercised when Metronidazole is administered to a nursing woman.

Precautions & Warnings

If for compelling reasons, Filmet must be administered longer than the usually recommended duration, it is recommended that hematological tests, especially leucocyte count should be carried out regularly and that patients should be monitored for adverse reactions such as peripheral or central neuropathy (such as paresthesia, ataxia, dizziness, convulsive seizures).
Filmet should be administered with caution to patients with hepatic encephalopathy.
Patients should be warned that Filmet may darken urine.

Use in Special Populations

Hepatic impairment: Filmet is mainly metabolised by hepatic oxidation. Substantial impairment of Filmet clearance may occur in the presence of advanced hepatic insufficiency. Significant cumulation may occur in patients with hepatic encephalopathy and the resulting high plasma concentrations of Filmet may contribute to the symptoms of the encephalopathy. Filmet should therefore, be administered with caution to patients with hepatic encephalopathy. The daily dosage should be reduced to one third and may be administered once daily. Patients should be warned that Filmet may darken urine.

Renal impairment: The elimination half-life of Filmet remains unchanged in the presence of renal failure. The dosage of Filmet therefore needs no reduction. Such patients however retain the metabolites of Filmet. The clinical significance of this is not known at present. In patients undergoing haemodialysis Filmet and metabolites are efficiently removed during an eight hour period of dialysis. Filmet should therefore be re-administered immediately after haemodialysis. No routine adjustment in the dosage of Filmet need be made in patients with renal failure undergoing intermittent peritoneal dialysis (IDP) or continuous ambulatory peritoneal dialysis (CAPD).

Overdose Effects of Tablet:-Filmet 400 mg (AS A Metrondazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Single oral doses of Filmet, up to 12 g have been reported in suicide attempts and accidental overdoses. Symptoms were limited to vomiting, ataxia and slight disorientation. There is no specific antidote for Filmet overdosages. In case of suspected massive overdosages, a symptomatic and supportive treatment should be instituted.

Therapeutic Class of Tablet:-Filmet 400 mg (AS A Metrondazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal).

Amoebicides, Anti-diarrhoeal Antiprotozoal

অথবা

3.. Azithromycin 500 mg

0+0+1 (5 days)

Tablet 3:-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

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.

Filmet 400 mg.

1+1+1 (5 days)

যদি Penicillin /cephalosporin এ hypersensitivity থাকে- তাহলে

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

1+0+1 (5 days)

Doxicap দিলেও metro lagbena.. কারণ এইটার গ্রাম পজিটিভ + নেগেটিভ +অ্যানারবিক কাভারেজ আছে-

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

Tetracycline group of drugs

Ref: (ADA guideline) Raiyyan Tahsan Date:27-01-2025 Monday Time:3-03-58PM

Raiyyan Tahsan

Raiyyan Tahsan