Antibiotics Use in Primary Care Settings and Indications

1. Antibiotics in primary care setting Domina Petric, MD

2. I. Tetracyclines Antibiotics

3. Doxycyclinum Antibiotics

4. Indications: • acute exacerbation of chronic bronchitis and sinusitis • urinary tract infections (UTI) caused with E. coli, Klebsiella spp., Enterobacter spp., Streptoccocus faecalis Antibiotics

5. Indications: Sexually transmitted diseases (STD): • urethritis caused with Chlamydia trachomatis, Ureaplasma urealyticum • simple gonococcal infections • prostatitis • syphilis • lymphogranuloma venereum Antibiotics

6. Indications: • inclusion (chlamydial) conjunctivitis, trachoma • psittacosis • acne, acne rosacea • anthrax • actinomycosis • boreliosis (Laymes disease) Antibiotics

7. Indications: • rickettsiosis • shigellosis • cholera • amebiasis • tularemia • melidiosis • brucellosis • nocardiosis • leptospirosis • Wipple´s disease • tropical sprue Antibiotics

8. Dose • First day of infection dose is 200 mg per os (at once or 100 mg twice a day). • Other days dose is 100 mg. • If it is severe infection, dose is always 200 mg. • Maximum dose is 300 mg. • Treatment duration is 24-48 hours after symptoms withdrawal. Antibiotics

9. Treatment duration varies depending on specific infection. Antibiotics

10. Contraindications: • hypersensitivity Children under the age of 12 years: • permanent teeth discoloration • bone development disorders • tooth enamel hypoplasia OralAnswers.com Antibiotics

11. Precautions: • liver damage • kidney damage • severe skin reactions • photosensitivity • Clostridium difficile diarrhoea • esophagitis Antibiotics

12. Precautions: • benign intracranial hypertension • porphyria • Myasthenia gravis • systemic erythematous lupus • lactosis intolerance Antibiotics

13. Interactions: Antibiotics

14. Not recommended in pregnancy and lactation! Antibiotics

15. Side effects: • anemia, thrombocytopenia, neutropenia... • headaches, benign intracranial hypertension • tinnitus • gastrointenstinal problems Antibiotics

16. Side effects: • urea blood levels elevation • hypersensitivity reactions • liver and kidney damage rarely Antibiotics

17. II. beta lactam antibiotics Antibiotics

18. A) extended spectrum beta lactam ANtibiotics Antibiotics

19. Amoxicillinum • Almacin a 500 mg • Amoksicilin a 1000 mg • ... Antibiotics

20. Indications: • otitis media • acute exacerbation of chronic bronchitis • bronchopneumonia • cystitis • urethritis • pyelonephritis Antibiotics

21. Indications: • bacteriuria in pregnancy • puerperal sepsis • gonorrhoea • skin and soft tissues infections • bacterial endocarditis • abdominal tifus • Helycobacter pylori Antibiotics

22. Dose: Adults: • 250 mg per os three times a day • in more severe infections, 500 mg three times a day • very difficult infections of respiratory tract, 3 g twice a day • urinary tract infections, two doses of 3 g • gonorrhea one dose of 3 g Antibiotics

23. Precautions: • hypersensitivity • kidney damage • neonatal period • lactosis intolerance Antibiotics

24. Interactions: Antibiotics

25. It can be used during pregnancy and lactation! Antibiotics

26. Common side effects: • nausea • vomiting • urticaria • pruritus Antibiotics

27. Amoxicillinum For children with body weight less then 40 kg: • Almacin 250 mg/5 mL powder for oral suspension • one little spoon has 5 mL • dose is 40-90 mg/kg/day divided in two or three doses Antibiotics

28. Example • Child: 30 kg, mild infection Dose: • 50 mg x 30 kg=150 mg Result: 150 mg (3 mL) • 75 mg (1,5 mL) twice a day OR • 50 mg (1 mL) three times a day Antibiotics

29. B) penicillin sensitive on beta lactamase Antibiotics

30. Phenoxymethylpenicillinum kalicum per os • Silapen K 1 000 000 i.j. • Silapen K 1 500 000 i.j. • Silapen K powder for oral suspension • Ospen K 1 000 000 i.j. • Ospen K 1 500 000 i.j. Three or four doses every 6 to 8 hours. Antibiotics

31. C) penicillin resistent on beta lactamase Antibiotics

32. For parenteral application: Antibiotics

33. D) Combinations with beta lactamase inhibitors Antibiotics

34. Combinations Antibiotics

35. Co-amoxiclav For oral application, adults: • 500 mg/125 mg • 875 mg/125 mg For oral application, children (BW less then 40 kg) • 400 mg + 57 mg/5 mL powder for oral suspension Antibiotics

36. Indications: • acute bacterial sinusitis • acute otitis media • acute exacerbations of chronic bronchitis • community acquired pneumonia • cystitis • pyelonephritis Antibiotics

37. Indications: • skin and soft tissues infections, cellulitis • tooth abscess with cellulitis • bones and joints infections • osteomyelitis Antibiotics

38. Dose for adults: • 500 mg/125 mg per os three times a day OR • 875 mg/125 mg per os twice a day Antibiotics

39. Children (400 mg + 57 mg/5mL) Antibiotics

40. III. CEPhalosporins Antibiotics

41. A) First generation Antibiotics

42. First generation cephalosporins: Antibiotics

43. Cefalexinum (oral application) adults: • 250 mg OR 500 mg • respiratory tract infections • otitis media • skin and soft tissues infections • bones and joints infections • UTI (including prostatitis) • dental infections The best activity on GRAM POSITIVE BACTERIA! Antibiotics

44. Dose for adults Antibiotics

45. Contraindications: Antibiotics

46. Precautions: • pseudomembranous colitis • kidney damage • false positive direct Coomb´s test Antibiotics

47. Caution In pregnant women And lactation! Antibiotics

48. Side effects: • headache • agitation • halucinations • pseudomembranous colitis • pain in abdomen • anal pruritus • interstitial nephritis Antibiotics

49. Cefalexinum for children: • 250 mg/5 mL powder for oral suspension • Dose is 25-50 mg/kg/day up to maximum 100 mg/kg/day. Antibiotics

50. Cefalexinum for children: For otitis media: • 75-100 mg/kg/day divided in four doses! Example: otitis media, child 20 kg • 80 mg x 20 kg = 1600 mg • 400 mg (8 mL) every 6 hours Antibiotics