Antibiotic Therapy For Todays Ocular Infections 2011 - Michigan ...

More documents

Recommendations

Info

Antibiotic/Steroid Combinations • Steroid first, antibiotic second • Should have indication for steroid treatment • Dosage dependent on steroid requirements – Tobramycin/dexamethosone – Tobramycin/loteprednol – Sulfacetamide/prednisolone phosphate – Sulfacetamide/prednisolone acetate – Gentamicin/prednisolone acetate Oral Antibiotics • Penicillins ‐ Gram positive organisms, need efficacy against penicillinase producing Staphylococcus aureus, administer 1‐1.5 g/day in split doses – Amoxicillin/clavulanate potassium (Augmentin) – Dicloxacillin – Amoxicillin Fluoroquinolones • Broad spectrum antibacterial activity with greater potency than most other agents • Efficacy against both G+ & G‐ organisms • However, resistant strains are developing particularly to the earlier generation drugs Oral Antibiotic Agents • Oral Medications – Penicillins • Amoxicillin/clavulanic acid • Dicloxacillin • Amoxicillin – Cephalosporins • Cephalexin • Cefaclor • Cefadroxil – Fluoroquinolones • Levofloxacin • Moxifloxacin • Ciprofloxacin Oral Antibiotics • Cephalosporins ‐ may have broader spectrum of activity, need efficacy against penicillinase producing Staphylococcus aureus, administer 1‐1.5 g/day in split doses – Cefadroxil (Duricef) – Cephalexin (Keflex, KefTab) – Cefaclor (Ceclor) – Cefazolin (Ancef) –topical only as fortified agent – Ceftazidime (Ceptaz, Fortaz) –topical only as fortified agent – Ceftriaxone (Rocephin) – injectable, IV only Oral Antibiotics • Fluoroquinolones ‐ broad spectrum G+ & G‐ activity – Levofloxacin (Levaquin) typical dosage 500‐750 mg qd x 7 days – Moxifloxacin (Avelox) typical dosage 400mg qd x 7 days – Ciprofloxacin (Cipro) typical dosage 250‐500 mg bid x 7days
Fluoroquinolones • Fluoroquinolone agents usually not preferred over penicillins, cephalosporins or macrolides for routine cases. • However, may be needed if other agents have been ineffective or patient has risk factors, such as blood borne viral disease or being immunocompromised • Fluoroquinolone agents not usually preferred for pediatric infection due to risk of adverse reactions. • Not good choice for children ‐ cartilage damage, bone development issues, increased risk of tendon rupture (Achilles), can elevate theophylline levels Oral Antibiotics • Macrolides ‐ both G+ & G‐ activity with efficacy against Chlamydia trachomatis – Azithromycin (Zithromax) 500 mg first day, followed by 250 mg x 4 days • For Chlamydia trachomatis ‐ Initially 1,000 mg single dose • If not effective, give full course of drug or switch to doxycycline – Erythromycin EES 400 mg qid • Achieve equivalent of erythromycin 500 mg base Macrolides • Erythromycin may also be contraindicated if patient taking any of the following drugs. – Anticoagulant agents – Digoxin – Statin agents – Dilantin – Theophylline Oral Antibiotic Agents • Oral Medications – Macrolides • Azithromycin • Erythromycin – Tetracyclines • Doxycycline • Tetracycline • Minocycline – Folic acid inhibitor • Trimethoprim/Sulfamethoxazole Macrolides • Erythromycin is the antibiotic agent with the highest risk of interacting with other oral medications. If not certain, check PDR, PubMed, MedlinePlus, etc. prior to prescribing. • Example ‐ Fexofenadine taken concurrently with erythromycin may lead to a toxic reaction in susceptible patients. Oral Antibiotics • Tetracyclines ‐ anti‐inflammatory effects, collagenase inhibitor, metalloproteinase‐9 inhibitor – Tetracycline 250 mg qid – Doxycycline (Vibramycin) 50‐100 mg bid – Minocycline (Cleeravue‐M) 50‐100 mg bid
Page 1 and 2: Antibiotic Therapy for Today’s Oc
Page 3: Antibiotic Agents • Topical Agent

Antibiotic Therapy For Todays Ocular Infections 2011 - Michigan ...

Create successful ePaper yourself

Delete template?

Save as template?