Supply:250mg/F.C.Tab(SUPEROCINR), 100mg/50ml/Bot(CIPROXINR)
Use:Ciprofloxacin is effective in multi-resistant strains. Ciprofloxacin is active in vitro against most gram-negative aerobic bacteria, including Enterobacteriaceae and Psudomonas aeruginosa, and many gram-positive aerobic bacteria: penicillinase producing, nonpenicillinase producing, methicillin-resistant Staphylococci. It has indicated in skin and bone infections due to gram-negative organisms, gastrointestinal infections in patients with multiple-resistant organisms, complicated urinary tract infections, gram-negative nosocomial pneumonia, sexually transmitted diseases, febrile neutropenia, gram-negative meningitis, and hepatobiliary infections.
Place in therapy: Ciprofloxacin should not be used as empiric therapy due to the increasing development of resistance. It should be reserved for targeted indications where there is culture and sensitivity data guiding appropriate therapy. Resistance has been observed in numerous reports, especially to strains of Pseudomonas aeruginosa especially when the drug is used as a single agent.
Contraindication:Hypersensitivity to the drug or patients with known hypersensitivity to nalidixic acid, oxolinic acid, cinoxacin, or other quinolone antibiotics. Ciprofloxacin can cause arthropathy in immature animals, the manufacturer states that the drug should not be used in children or adolescents ( younger than 16-18 years of age).
Adverse effect:The main adverse effects of PO doses are gastrointestinal disturbances; CNS side effects, including seizures, have occurred with ciprofloxacin therapy. Several studies have documented increase in transaminases associated with ciprofloxacin and in some cases severe and fatal hepatitis have developed. Additionally, hematuria and anaphylactic reactions have been described.
Usual dosage:200-400mg IV Q12H; 250-750mg PO Q12H, usual duration: 7-14 days, bone and joint infection: 4-6 weeks or longer. Oral dosage is used after injection form only in our hospital.
Dosage adjustment : according to CrCl (ml/min)
> 30
200-400 mg
Q12H
5 - 29
200-400 mg
Q18-24H
Special precautions:Renal dysfunctio
NORFLOXACIN C
Supply:200mg/F.C.Tab(N.F.S.R)
Use:Treatment of complicated urinary tract infections caused by susceptible Citrobacter freundii, Enterobacter cloacae, E. coli, Klebsiella pneumoniae, Morganella morganii, Proteus mirabilis, P. vulgaris, Providencia rettgeri or Pseudomonas aeruginosa and also for the treatment of gonorrhea.
Contraindication:Patients with a history of hypersensitive to the drugs or to other quinolone anti-infective agents.
Adverse effect:Nausea, abdominal pain, diarrhea, vomiting, anorexia, dyspepsia, dysphagia, headache, dizziness, eosinophilia.
Usual dosage:PO, should be given 1 hour before or 2 hours after a meal. Usual dosage 400mg BID for 7-10 days in the uncomplicated UTI and 10-21 days for complicated UTI. Maximum dose: 1.2g/day
Special precautions:Renal failure. Patients with CNS damage.
OFLOXACIN C
Supply:100mg, 200mg/F.C.Tab(OXACINR)
Use:Ofloxacin is a broad spectrum oral fluoroquinolone antibiotics. It has been successful in treating: urinary and respiratory tract infections, gonorrhea, nongonococcal urethritis (Chlamydia), otitis media, and sinusitis. Ofloxacin and other quinolones will not replace beta lactam as drug of choice. It is useful for pyelonephritis, nosocomial UTIs, and hospital acquired gram-negative pneumonias.
Contraindication:Hypersensitivity to the drug or to other members of quinolone group: nalidixic acid, oxalinic acid, norfloxacin, and ciprofloxacin
Adverse effect:Nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, insomnia, hallucinations, skin reaction, blood dyscrasias, hypersensitivity, photoonycholysis. It should be avoided in prepubertal children since animal studies have demonstrated erosions of the cartilage and weight bearing joints.
Usual dosage:PO 200-400 mg BID, single dose ranging from 100-600 mg have been used to treat gonorrhea. Or 400 mg IV Q12H is usually used. It should be avoided in prepubertal child.
Special precautions:Renal dysfunction, convulsions, elderly
Antifungal drugs
CLOTRIMAZOLE B
Supply:10MG/GM 5GM/TUB(CANESTENR)
Use:Dermatomycoses, pityriasis versicolor, erythrasma, Candida vulvitis.
Adverse effect:Skin reaction (rare)
Usual dosage:Apply thinly bid-tid to the affected area
KETOCONAZOLE C
Supply:200MG/TAB(KETONAR)
Use:Treatment of superficial & deep mycoses, maintenance treatment to prevent recurrence in systemic mycotic infect & in chronic mucocutaneous candidosis.Vaginal candidosis. Onychomycoses.
Contraindication:Liver disease, recovery phase of hepatitis
Adverse effect:GI disturbances, pruritus, elevated liver function tests. Rarely, acute Allergic reactions, hepatitis, gynecomastia
Usual dosage:Adult 1 tab once daily. Child 3.3-6.6 mg/kg/day
MICONAZOLE
Supply:2%CREM/DAFRIN-H(DAFRIN-HR)
Use:Vag infections due to candida, vaginitis due to gm+ve bacterias.
Usual dosage:1 tabinserted deeply into vag nightly
TERBINAFINE B
Supply:250MG/TAB(LAMISILR)
Use:Oral terbinafine has been used for the treatment of onychomycosis and moccasin-type tinea pedis, cutaneous candidiasis.
Place in therapy: Terbinafine appears to be as effective as griseofulvin for the treatment of tinea crucis and corporis, but is more effective for onychomycosis, and moccasin-type tinea pedis.
Contraindication:Previous hypersensitivity to terbinafine or naftifine. For patients with pre-existing liver disease or renal impairment, the use of terbinafine is not recommended. Liver function tests are recommended in patients who have received terbinafine for more than 6 weeks.
Adverse effect:Fatigue, headache, dizziness, gastrointestinal disturbances, skin rash, pruritus, alopecia, and elevation of hepatic function tests .
Usual dosage:Superficial mycosis: 125 mg PO BID or 250 mg PO QD, Systemic mycosis: 250 - 500 mg PO QD; dose adjustments would appear indicated in those patients with renal insufficiency or liver dysfunction.>
Antituberculosis drugs
ETHAMBUTOL B
Supply:400MG/TAB(MYAMBUTOLR)
Use:Bacteriostatic and is active against organsims of Mycobacterium tuberculosis, M. bovis, M. marinum and some strains of M. kansasii, M. avium,M. fortuiturn and M. intracellulare.
Contraindication:Hypersensitivity, pregnancy, optic neuritis, ocular defects and patients with impaired renal functions.
Adverse effect:Decrease in visual acuity, hyperuricemia.
Usual dosage:Initial treatment: 15mg/kg/day in a single dose. (range 500mg-1.5g), continued treatment: 25mg/kg/day for 60 days then 15mg/kg/day.(range: 900mg-2.5g)
Patient information:Report any visual changes or rash to physician; may cause stomach upset, take with food; do not take within 2 hours of aluminum-containing antacids
*RIFATER C
Content:Rifampicin 120mg, INH 80 mg, pyrazinamide 250mg
Use:Initial intensive phase treatment (usually 2 mth) for short course chemotherapy of TB. When indicated other anti-TB drugs may be added. After the intensive phase treatment, therapy should be continue with Rifinah for a further 4 mth min
Contraindication:
Adverse effect:Staining of contact lenses, reddish coloration of urine, sputum & lachrymal fluid. Irregular dosing may result in immunological side effects eg 'flu syndrome'
Usual dosage:Single daily dose, 1 tab/10kg body wt, not exceeding 5 tab daily. Alternatively, patient>50kg 5 tab, 40-49kg 4 tab, 30-39kg 3 tab
RIFAMPICIN
Supply:450MG/CAP(RIFAMPICINR)
Use:Bactericidal and active against Mycobacterium tuberculosis, M. bovis, M. marinum, M. kansasii, and gram positive and negative bacteria including Neisseria, Staphylococcus aureus, Haemophilus influenzae, Legionella pneumophilia.
Contraindication:Hypersensitivity, pregnancy, lactation, liver disease.
Adverse effect:GI disturbances, hypersensitivity reaction, headache, drowsiness, fatigue, ataxia, visual disturbances, mental confusion.
Usual dosage:PO 1 hour before or 2 hour after meals. For treatment of tuberculosis, use in combination with at least one other antituberculosis agent, usual adult dose: 600mg/day as a single dose. Child > 5 years, 10-20mg/kg/day, daily dose should not exceed 600mg.
Patient information:May discolor urine, tears, sweat, or other body fluids to a red-orange color; take 1 hour befor or 2 hours after a meal on an empty stomach; soft contact lenses may be permanently stained; report to physician any sever or persistent flu-like symptoms, nausea, vomiting, dark urine or pale stools, or unusual bleeding or bruising; utilize an alternate form from oral/other systemic contraceptives during therapy; compliance and completion with course of therapy is very important; if you are a diabetic taking oral medications or if you regularly take oral anticoagulant therapy, your medication may need special and careful adjustment.
*RINA C
Content:Rifampicin 300mg, Isoniazide 150mg
Use:Pulmonary & extrapulmonary TB
Contraindication:Hypersensitivity. Janudice
Adverse effect:Skin reactions, GI intolerance; hepatitis; thrombocytopenia; flu syndrome; red discoloration of urine, sputum, tears, staining of contact lenses; polyneuritis.
Usual dosage:Adult 2 cap daily
Antiviral drugs
ACYCLOVIR C
Supply:200MG/TAB(ZOVIRAXR)
Use:Treatment of herpes simplex infections in immuno-compromised patients.
Contraindication:Hypersensitivity, use with caution in patients with abnormal renal function.
Adverse effect:Severe inflammation sometimes leading to ulceration has resulted from accidental infusion into the tissue extravascularly.
Usual dosage: PO 200 mg 5 times daily at approximately 4 hours intervals.
Five days treatment is usually adequate in acute infection.
INTERFERON ALFA-2B
Supply:3,000,000U/VIAL(INTRON AR)
Use:Interferon alfa-2b is indicated for the treatment of multiple myeloma, Kaposi's sarcoma in patients with acquired immune deficiency syndrome, malignant melanoma, hairy cell leukemia and laryngeal papillomatosis.
Place in therapy: Alfa-interferon is the most effective treatment currently available for the treatment of chronic hepatitis B and C; at best 50% of patients will have a good response of treatment.
Contraindication:It is contraindicated in patients with known hypersensitivity to the drug or any ingredients in the formulation.
Adverse effect:Neutropenia and thrombocytopenia occur frequently. Neutropenia is one of the most common reasons for discontinuation of therapy. Flu-like syndrome occurring 30 - 120 minutes after administration and persist for several hours is also common. Tolerance to these effects generally occurs within the first few weeks of therapy. Cardiovascular adverse effects occur in 15% of patients. Nausea, diarrhea, fatigue, headache, malaise, proteinuria are also common.
Usual dosage:Chronic hepatitis B: 5 million IU daily or 10 million IU 3 times/week, for 16 weeks, IM or SC; or low dose regimen: 3 million IU 3 times/week SC, for 4 months. Chronic hepatitis C: 3 million IU 3 times/week IM or SC, patient response with a decrease ALT levels, continue for 6 months; If no response is observed after 16 weeks, discontinue therapy.
Hair cell leukemia, and Multiple myeloma: 2 million IU/m2, IM or SC 3 times a week, for 1-2 months. AIDS-related Kaposi's sarcoma: 50 million IU/m2 daily, IM or SC, for 5 day then escape 9 days before next 5-days regimen.
Miscellaneous
*CURAMR B
Content:Amoxicillin 500mg, Clavulanic acid 125mg
Use:Upper & lower resp tract infections, skin & soft tissue infections, genitourinary tract infections
Contraindication:Hypersenstivity to amoxicillin, clavulanic acid or penicillin; concomitant use of alcohol.
Adverse effect:Headache, rash, urticaria, nausea, vomiting pseudomembranous colitis, vaginal candidiasis, diarrhea (9%).
Usual dosage:Adults: PO 1 Tab Q8H; double amoxicillin dose in severe case; maximum dose: 2 g/day.
Child<40kg : 20 - 40 mg (amoxicillin component)/kg/day divided into 3 doses.
Dosage adjustment : according to CrCl (ml/min)
15 - 30
Q12- 18H
5 - 15
Q24- 36H
< 5
Q 48 H
Special precautions:Periodic monitoring of renal, hepatic & blood parameters. Pregnancy & lactation
*TIENAMR C
Content:Imipenem 500mg, Cilastatin 500gm
Use:Imipenem is indicated in treating severe infections due to multi-resistant organisms. Alone, or in combination with an aminoglycoside, it can be used for serious mixed infections including pulmonary, intra-abdominal and soft-tissue infections. Imipenem is more potent than third generation cephalosporins against Pseudomonas aeruginosa. Cilastatin reduces imipenem metabolism by inhibiting dehydropeptidase.
Contraindication:Use with caution in patients with a history of hypersensitivity reaction to penicillins.
Adverse effect:Increment in hepatic function tests occur commonly; but no reports of definite liver damage have been observed.
Usual dosage:Normal Dosage: 0.25 - 1 g Q6H or Q8H, maximum adult dosage: 50 mg/kg or 4 g/day.
Dosage adjustment : according to CrCl (ml/min)
> 70
500mg-1 g
Q6-8H
30 - 70
500 mg
Q6-8H
20 - 30
500 mg
Q8-12H
< 20
250-500 mg
Q12H
*TAZOCINR B
Supply:Per 2.25g vial Piperacillin 2 g, tazobactam 250mg
Use:Piperacillin/tazobactam is a combination of piperacillin, extended spectrum penicillin, and tazobactam, a b-lactamase inhibitor. Piperacillin sodium/tazobactam sodium has a wide spectrum of activity to against many gram-positive, -negative and anaerobic bacteria. In vitro studies, piperacillin sodium/tazobactam sodium dose not result in synergism against Pseudomonas aeruginosa and that the currently recommended dosage generally are too low to be effective in the treatment of Pseudomonas aeruginosa.
Place in therapy: It has been successfully used in the treatment of infections such as cellulitis, appendicitis, community-acquired pneumonia, and gynecologic infections. It is ineffective against MRSA and does not offer any major advantages in the treatment of gram positive organisms.
Contraindication:Patients with a prior history of hypersensitivity to beta-lactam antibiotics or to b-lactamase inhibitors.
Adverse effect:The most frequent adverse effects reported are GI effects (diarrhea, nausea, constipation, 11%), headache (7-8%), and dermatologic reactions (rash, pruritus, fever, 4%). In some cases, leukopenia and neutropenia occurred after 21 days of therapy.
Usual dosage:Adults: 12 g-15 g/day IV in divided doses of 3.375 grams Q6H. Dosage reduction is recommended in patients with renal failure:
CrCl(ml/min) Dosage
20-40
2.25 g
Q6H
<20
2.25 g
Q8H
*ANSULLINAR, *UNASYNR
Content:Per 750mg vial Sulbactam 250mg, Ampicillin 500mg
Use:Unasyn is an antibiotic combination, comprised of ampicillin and a beta-lactamase inhibitor-sulbactam. Besides the inhibition effects of ampicillin sensitive microorganisms, the resistant strains: S. aureus, S. epidermidis, H. influenzae, Moraxella catarrhalis, N. gonorrhea, Klebsiella spp. E coli, E aerogenes, Proteus spp, and Acinetobacter calcoaceticus are inhibited.
Contraindication:Severe hypersensitivity to penicillin.
Adverse effect:Similar to those seen with ampicillin alone, the most common of which are diarrhea and maculopapular rash.
Usual dosage:Adults: 1.5-12 g/day, in divided Q6-8H. Child: 150 mg/kg/day, in divided Q6-8H
Special precautions:Overgrowth of non-susceptible organism. Check periodically for organ system dysfunction during prolonged therapy.
CLINDAMYCIN B
Supply:150mg, 300mg/Cap(CLINDAMYCINR), 300mg/2ml/Vial(EUDAMYCINR, B.B.R)
Use:Antimicrobial spectrum similar to lincomycin but activity is greater.
Contraindication:Hypersensitivity, diarrheal states
Adverse effect:Diarrhea, Pseudomembranous colitis, hyper-sensitivity reactions, agranulocytosis, thrombocytopenia.
Usual dosage:Adults: 150-300mg Q6H PO, severe infection: 450mg Q6H PO, 0.6-2.7g/day in divided doses IM or slow IV. Child: 8-16mg/kg/day in 4 divided dose up to 20 mg/kg/day PO, 15-40 mg/kg/day in divided doses IM or slow IV, maximum dose: 2.7-4.8g/day
COLISTIN
Supply:1,000,000Unit/Cap(COLISTINR)
Use:Gm-ve infections
Adverse effect:Dizziness, ataxia, sensory disturbances, paresthesia, neuromuscular blockade, nephrotoxicity, ototoxicity.
Usual dosage:Adult 1-2 MU bid or qid. Child 75,000-150,000 u/kg/day.
Special precautions:Impaired renal function. Myasthenia gravis.
LINCOMYCIN
Supply:300mg/ml 10ml/Vial(LINCOCINR)
Use:Resp tract, skin & soft tissue, bone & joint infection, septicemia & endocarditis, bacillary dysentery.
Contraindication:Hypersensitivity to lincomycin or clindamycin
Adverse effect:GI disturbances, hematopoietic effects, pruritus, skin rashes, liver jaundice, renal dysfunction
Usual dosage:IMAdult 600mg 24hrly or 12 hrly. Child 10mg/kg 24 hrly or 12 hrly. IV Adult 600 mg-1g 8-12 hrly. Child 10-20 mg/kg/day in 2-3 doses at 8-12 hrly
Special precautions:GI disease esp colitis
MEROPENEM B
Supply:250mg/Vial(MEPEMR)
Use:Meropenem has demonstrated efficacy comparable to that of imipenem/cilastatin in intraabdominal and soft tissue infections; it has also shown usefulness in febrile neutropenia, urinary tract infections, and Pseudomonas meningitis.
Place in therapy: In vitro, meropenem is more active than imipenem against many gram-negative pathogens; it has shown activity against strains of Enterobacteriaceae and Pseudomonas aeruginosa resistant to imipenem, aminoglycosides, quinolones, and third-generation cephalosporins. the primary indications for meropenem will be for the treatment of mixed infections usually requiring antibiotic combinations (eg, intraabdominal infections, pulmonary infections) and infections caused by multidrug-resistant gram-negative pathogens, including Pseudomonas aeruginosa.
Contraindication:Hypersensitivity to meropenem; use with caution to patient with renal impairment or epileptic patients and patients with neurological disorders or liver dysfunction (possible hepatotoxic effects)
Adverse effect:Headache, nausea, abdominal pain, diarrhea, and liver function test abnormalities have been reported with meropenem; there is some evidence that meropenem may be less likely than imipenem to induce seizures.
Usual dosage:Adults: 0.5-1 g IV Q8H; for meningitis 2 g IV Q8H
Child: IV 20 mg/kg Q8H intra-abdominal infections; 40 mg/kg Q8H for meningitis.
SODIUM FUSIDATE
Supply:250mg/Tab(FUCIDINR)
Use:Treatment of infections caused by susceptible organisms esp Staph eg osteomyelitis, septicaemia, endocarditis, pneumonia, cutaneous infections, surgical & traumatic wound infections. Also other Staph infections including MRSA.
Adverse effect:GI disturbances
Usual dosage:Adult 2 tab tid. Skin & soft tissue infection 1-2 tab bid
Special precautions:Hepatic insufficiency. Pregnancy & lactation
SPECTINOMYCIN DIHCL.
Supply:2gm/Vial(TOGAMYCINR)
Use:Acute gonorrheal urethritis/cervicitis & proctitis in male& femalw.
Contraindication:
Adverse effect:Local pain, urticaria, dizziness, nausea, chills, fever, reduction in urine output; rarely, anaphylaxis.
Usual dosage:2 g as a single dose IM
Special precautions:Serologic test for syphilis before & after treatment
TEICOPLANIN
Supply:200mg/Vial(TARGOCIDR)
Use:Teicoplanin is a glycopeptide antibiotic, similar to vancomycin. It is used in the treatment of serious gram-positive infections. It has been used empirically in neutropenic patients.
Place in therapy: Compared to vancomycin, teicoplanin possesses an extended elimination half-life and can be dosed once daily. Additionally, the severe pain and necrosis that is associated with intramuscular injections of vancomycin have not been reported with teicoplanin. Teicoplanin should be a suitable alternative to vancomycin for gram-positive infections.
Contraindication:Patient has hypersnsitivity to this drug.
Adverse effect:Pain on injection, thrombophlebitis, neutropenia, rash, bronchospasm, eosinophilia, and rare cases of ototoxicity.
Usual dosage:Adults: loading dose of 400 to 800mg , maintenance doses of 200 to 600mg QD; IM as maintenance doses of 200 to 600mg following an intravenous loading dose.
Child: 3-6mg/kg/day.
Teicoplanin dose in patients with renal insufficiency has been proposed:
Creatinine Clearance
>80 mL/min
30-80 mL/min
<10 mL/min
Constant Interval
400 mg Q24H
200 mg Q24H
133 mg Q24H
Constant Dose
400 mg Q24H
400 mg Q48H
400 mg Q72H
Special precautions:Serologic test for syphilis befor & after treatment
VANCOMYCIN C
Supply:500mg/Vial(VANCOR)
Use:Treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (ß-lactamase-resistant) Staphylococci. Oral form of vancomycin for treatment of antibiotic associated pseudomembranous colitis produced by Clostridium difficile.
Contraindication:Patients with known hypersensitivity to the drug.
Adverse effect:Ototoxicity, nephrotoxicity, rapid infusion may develop anaphylactoid reactions, including red man syndrome, hypotension, urticaria, reversible neutropenia.
Usual dosage:Normal Dosage: Adults IV 2g/day divided either as 500mg every 6 hours or 1g every 12 hours. Each gram should be administered over a period of at least 60 minutes. The usual child daily IV dosage is 40mg/kg, can be divided and incorporated into the child's 24 hour fluid requirement. In neonates and infants, an initial dose of 15mg/kg is suggested followed by 10mg/kg every 12 hours for neonates in the first week of life and every 8 hours thereafter up to the age of one month. Treatment of antibiotic-associated pseudomembranous colitis, the usual adult daily dosage is 500mg to 2g given in 3 or 4 divided doses for 7 to 10 days, the total daily dosage should not exceeded 2g.
Dosage adjustment : according to CrCl (ml/min)
> 60 : 1 gm Q12H or 500 mg Q6H
< 60 : may lengthen interval to keep trough < 10
Now: 
