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Antibiotics
What should a physician, pharmacist, nurse, antibiotics pharmaceutical manufacturer, and administrators in the state and outside the state know about antibiotics?
What is the difference between a physician, pharmacist, nurse, antibiotics pharmaceutical manufacturer and an administrator/guide in the state and outside the state?
What is an antibiotic?
What are the types or categories of antibiotics?
How does one choose an antibiotic?
Questions relevant to specific antibiotics
What is the exact name of the antibiotic?
Questions for the local pharmacy.
What types of oral antibiotics are available?
What types of intravenous antibiotics are available?
When can home intravenous antibiotics be given?
How do you do home intravenous antibiotics treatment?
Manufacture of antibiotics
How are antibiotics manufactured?
At what locations in the world are antibiotics manufactured?
How does the state regulate antibiotic manufacture?
How do you verify that intravenous antibiotics that have been manufactured are effective before circulating them in various communities?
Questions relevant to the patient.
Antibiotics


What should a physician, pharmacist, nurse, antibiotics pharmaceutical manufacturer, and administrators in the state and outside the state know about antibiotics?
Annotation or definition
Antibiotics and patient care
Antibiotics antagonism
Classes, types or categories
Drug-drug interactions
History
Medical uses
Medicinal chemistry
Other alternatives
Pharmacodynamics
Production
Questions relevant to a specific antibiotic.
Questions for local pharmacy.
Questions relevant to patient.
Questions relevant to medical conditions that require antibiotics.
References.
Resistance.
Route of administration.
Verification of effectiveness.
Side-effects.
Status of new antibiotics development.


What is the difference between a physician, pharmacist, nurse, antibiotics pharmaceutical manufacturer and an administrator/guide in the state and outside the state?
A physician has the ability to reach a correct diagnosis and treatment in various healthcare settings.
A physician takes decides if medication is required.
A nurse gives the patient oral or injectable medicines in cases where a physician has asked her/him to do so.
A pharmacist dispenses the medication (from pharmacy store to nurse).
A pharmaceutical manufacturer produces medicines, including antibiotics, in coordination with others.
An administrator in the state and outside the state should be able to guide at least 811 professions to be recognized as an administrator.
An administrator/guide in the state and outside the state should have at least basic abilities of teacher, lawyer, engineer, or physician.

What is an antibiotic?
With advances in medicinal chemistry, most modern antibacterials are semisynthetic modifications of various natural compounds.

An antibiotic is an agent that either kills or inhibits the growth of a microorganism.

Antibiotics, also known as antibacterials, are types of medications that destroy or slow down the growth of bacteria. The Greek word anti means "against", and the Greek word bios means "life" (bacteria are life forms).

Antibiotics are used to treat infections caused by bacteria. Bacteria are microscopic organisms, some of which may cause illness. The word bacteria is the plural of bacterium.

Before bacteria can multiply and cause symptoms, the body's immune system can usually destroy them. We have special white blood cells that attack harmful bacteria. Even if symptoms do occur, our immune system can usually cope and fight off the infection. There are occasions, however, when it is all too much and some help is needed.....from antibiotics.

The first antibiotic was penicillin. Such penicillin-related antibiotics as ampicillin, amoxicillin and benzylpenicilllin are widely used today to treat a variety of infections - these antibiotics have been around for a long time.

Antibiotics have saved millions of lives since they were first introduced in the 1940s and 1950s.

What are the types or categories of antibiotics?
Aminoglycosides such as gentamicin (Garamycin) and tobramycin (Tobrex)
Cephalosporins such as cephalexin (Keflex).
Fluoroquinolones such as ciprofloxacin (Cipro), levofloxacin (Levaquin), and ofloxacin (Floxin).
Macrolides such as erythromycin (E-Mycin), clarithromycin (Biaxin), and azithromycin (Zithromax).
Penicillins such as penicillin and amoxicillin.
Sulfonamides such as co-trimoxazole (Bactrim) and trimethoprim (Proloprim).
Tetracyclines such as tetracycline (Sumycin, Panmycin) and doxycycline (Vibramycin).

These are the main classes or categories of antibiotics.

How does one choose an antibiotic?

Questions to be answered.

What is the cause of infection?
How did you verify the cause of infection?
How good is the quality and accuracy of the laboratory?
Do the symptoms and signs correlate with infection?
Is the individual allergic to any medication or antibiotic?
What is most likely cause of the infection?
Is the medication available?
Will the medication have any side effects?
Should the patient receive oral or intravenous antibiotics?
When are intravenous antibiotics required?
What should be the dosage of oral antibiotics?
What should be the dosage of intravenous antibiotics?
How do you compare oral and intravenous antibiotics?
What should you know about Intravenous cephalosporins?


Questions relevant to specific antibiotics

We will mainly take the cephalosporins category, for example intravenous cephalosporins, and the fluoroquinolones category, for example intravenous ciprofloxacin, for further details.

What is the exact name of the antibiotic?
Cephalosporins are one category of antibiotics.
There has to be specific name for the antibiotic.

Questions for the local pharmacy.

What types of oral antibiotics are available?
What types of intravenous antibiotics are available?

When can home intravenous antibiotics be given?

Intravenous antibiotics at home have to be done under the supervision of a local experienced physician.

How do you do home intravenous antibiotics treatment?

Place an IV catheter in the vein of the patient’s forearm.

Liquid antibiotics are delivered through a tube connected to the IV line.



Manufacture of antibiotics

How are antibiotics manufactured?
At what locations in the world are antibiotics manufactured?
How does the state regulate antibiotic manufacture?
How do you verify that intravenous antibiotics that have been manufactured are effective before circulating them in various communities?
Here are further guidelines.

Questions relevant to the patient.


What is the name and date of birth of the patient?
Where is the patient now?
Does the patient have a fever?
What was the last known temperature?

Is the patient taking oral antibiotics or IV antibiotics?
What medications has the patient been taking for the past week?
Who is the treating doctor?
When did the treating doctor last see the patient?

When are intravenous antibiotics required?

Intravenous antibiotics are usually required only to treat more serious bacterial infections, such as:
Any specific focus of human body infection that causes fever and does not get treated with oral antibiotics.
Abscess along with fever.
Bacterial meningitis.
Septicaemia (blood poisoning).
Infection of the outer layer of the heart (endocarditis).
Lower respiratory tract infection.
An infection that develops inside a bone (osteomyelitis).

Antibiotics to prevent infection before specific medical procedures Antibiotic prophylaxis is necessary for people who have had their spleen removed.

What are the vital signs on the date and time of diagnosis and treatment?
Date:
Location:
Time:
Consciousness:
Pulse:
Blood pressure:
Respiratory rate:
Temperature:

How do you categorize the condition of the patient?
Undetermined
Good
Fair
Serious
Critical

What are further plans relevant to the individual?
Treatment at home.
Treatment in a hospital.
Treatment in a critical care unit.
Medication details.

What is the treatment?
Use oxygen through a nebulizer at home until the patient stabilizes. Use intravenous antibiotics until the temperature is normal.

What are various reference materials for antibiotics?
This resource is one of the reference materials for antibiotics.
What are antibiotics?
How do antibiotics work?
What are antibiotics for?
What are the side-effects of antibiotics?
How do you choose antibiotic treatment?
How to use antibiotics
How do antibiotics work?
Although there are a number of different types of antibiotic they all work in one of two ways:
A bactericidal antibiotic kills the bacteria. Penicillin is a bactericidal. A bactericidal usually either interferes with the formation of the bacterium's cell wall or its cell contents.

A bacteriostatic stops bacteria from multiplying.

What are antibiotics for?
An antibiotic is given for the treatment of an infection caused by bacteria. Antibiotics target microorganisms such as bacteria, fungi and parasites. However, they are not effective against viruses.

If you have an infection it is important to know whether it is caused by bacteria or a virus. Most upper respiratory tract infections, such as the common cold and sore throats are generally caused by viruses - antibiotics do not work against these viruses.

If antibiotics are overused or used incorrectly there is a risk that the bacteria will become resistant - the antibiotic becomes less effective against that type of bacterium.

A broad-spectrum antibiotic can be used to treat a wide range of infections. A narrow-spectrum antibiotic is only effective against a few types of bacteria. There are antibiotics that attack aerobic bacteria, while others work against anaerobic bacteria. Aerobic bacteria need oxygen, while anaerobic bacteria don't.

Antibiotics may be given beforehand, to prevent infection, as might be the case before surgery. This is called 'prophylactic' use of antibiotics. They are commonly used before bowel and orthopedic surgery.

How to use antibiotics

Antibiotics are usually taken by mouth (orally); however, they can also be administered by injection, or applied directly to the affected part of the body.

Most antibiotics start having an effect on an infection within a few hours. It is important to remember to complete the whole course of the medication to prevent the infection from coming back.

If you do not complete the course, there is a higher chance the bacteria may become resistant to future treatments - because the ones that survive when you did not complete the course have had some exposure to the antibiotic and may consequently have built up a resistance to it. Even if you are feeling better, you still need to complete the course.

Some antibiotics should not be consumed with certain foods and drinks. Others should not be taken with food in your stomach - these would normally be taken about an hour before meals, or two hours after. It is crucial that you follow the instructions correctly if you want the medication to be effective. If you are taking metronidazole do not consume alcohol.

Dairy products should not be consumed if you are taking tetracyclines, as they might affect the absorption of the medication.

Antibiotics
Ciprofloxacin

Antihistamines
Diphenhydramine Hydrochloride
What are antihistamines?

Antibiotics

Ciprofloxacin

* Why is this medication prescribed?
* How should this medicine be used?
* What special precautions should I follow?
* What special dietary instructions should I follow?
* What should I do if I forget a dose?
* What side effects can this medication cause?
* What storage conditions are needed for this medicine?
* What other information should I know?

Types of Antibiotics

Although there are well over 100 antibiotics, the majority come from only a few types of drugs. These are the main classes of antibiotics.

* Penicillins such as penicillin and amoxicillin

* Cephalosporins such as cephalexin (Keflex)

* Macrolides such as erythromycin (E-Mycin), clarithromycin (Biaxin), and azithromycin (Zithromax)

* Fluoroquinolones such as ciprofloxacin (Cipro), levofloxacin (Levaquin), and ofloxacin (Floxin)

* Sulfonamides such as co-trimoxazole (Bactrim) and trimethoprim (Proloprim)

* Tetracyclines such as tetracycline (Sumycin, Panmycin) and doxycycline (Vibramycin)

* Aminoglycosides such as gentamicin (Garamycin) and tobramycin (Tobrex)

Why is this medication prescribed?

Ciprofloxacin is used to treat or prevent certain infections caused by bacteria. Ciprofloxacin is also used to treat or prevent anthrax (a serious infection that may be spread on purpose as part of a bioterror attack) in people who may have been exposed to anthrax germs in the air. Ciprofloxacin extended-release (long-acting) tablets are used only to treat certain types of urinary tract infections. Ciprofloxacin is in a class of antibiotics called fluoroquinolones. It works by killing bacteria that cause infections. Antibiotics will not work for colds, flu, or other viral infections.

How should this medicine be used?

Ciprofloxacin comes as a tablet, a suspension (liquid), and an extended-release tablet to take by mouth. The tablet and suspension are usually taken twice a day, in the morning and evening, with or without food. The extended-release tablets are usually taken once a day. Cipro XR brand extended-release tablets may be taken with or without food. Proquin XR brand extended-release tablets should be taken with a main meal of the day, preferably the evening meal. Take ciprofloxacin at around the same time(s) every day. The length of your treatment depends on the type of infection you have. Your doctor will tell you how long to take ciprofloxacin. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ciprofloxacin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

One brand or type of ciprofloxacin cannot be substituted for another. Be sure that you receive only the brand or type of ciprofloxacin that was prescribed by your doctor. Ask your pharmacist if you have any questions about the type of ciprofloxacin you were given.

Do not take ciprofloxacin with dairy products or calcium-fortified juices alone. However, you may take ciprofloxacin with a meal that includes these foods or drinks.

Swallow the tablets whole; do not split, crush, or chew them. If you cannot swallow tablets whole, tell your doctor.

If you are taking the suspension, shake the bottle very well for 15 seconds before each use to mix the medication evenly. Swallow the correct dose without chewing the granules in the suspension. Close the bottle completely after each use. Do not give the suspension to a patient through a feeding tube.

You should begin feeling better during the first few days of your treatment with ciprofloxacin. If your symptoms do not improve or if they get worse, call your doctor. If you are being treated for a urinary tract infection, call your doctor if you develop fever or back pain during or after your treatment. These symptoms may be signs that your infection is worsening.

Take ciprofloxacin until you finish the prescription, even if you feel better. Do not stop taking ciprofloxacin unless you experience the symptoms of tendinitis or tendon rupture described in the IMPORTANT WARNING section or the symptoms of allergic reaction described in the SIDE EFFECTS section. If you stop taking ciprofloxacin too soon or if you skip doses, your infection may not be completely treated and the bacteria may become resistant to antibiotics.

Other uses for this medicine

In the event of biological warfare, ciprofloxacin may be used to treat and prevent dangerous illnesses that are deliberately spread such as plague, tularemia, and anthrax of the skin or mouth. Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking ciprofloxacin,

* tell your doctor and pharmacist if you are allergic or have had a severe reaction to ciprofloxacin; any other quinolone or fluoroquinolone antibiotic such as gatifloxacin (Tequin) (not available in the US), gemifloxacin (Factive), levofloxacin (Levaquin), lomefloxacin (Maxaquin) (not available in the US), moxifloxacin (Avelox), nalidixic acid (NegGram), norfloxacin (Noroxin), ofloxacin (Floxin), and sparfloxacin (Zagam) (not available in the US); or any other medications, or if you are allergic to any of the ingredients in ciprofloxacin tablets or suspension. Ask your doctor or pharmacist for a list of the ingredients.

* tell your doctor if you are taking tizanidine (Zanaflex). Your doctor will probably tell you not to take ciprofloxacin while you are taking this medication.

* tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); certain antidepressants; antipsychotics (medications to treat mental illness); caffeine or medications that contain caffeine (Excedrin, NoDoz, Vivarin, others); clozapine (Clozaril, Fazaclo); cyclosporine (Gengraf, Neoral, Sandimmune); diuretics ('water pills'); glyburide (DiaBeta, in Glucovance, Micronase, others); certain medications for irregular heartbeat such as amiodarone (Cordarone), disopyramide (Norpace), procainamide (Procanbid), quinidine, and sotalol (Betapace, Betapace AF, Sorine); methotrexate (Rheumatrex, Trexall); metoclopramide (Reglan); certain nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Naprosyn, others); phenytoin (Dilantin, Phenytek); probenecid (in Col-Probenecid, Probalan); ropinirole (Requip); or theophylline (Elixophyllin, Theo-24, Uniphyl, others). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with ciprofloxacin, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.

* if you are taking antacids containing aluminum hydroxide or magnesium hydroxide (Maalox, Mylanta, Tums, others); didanosine (Videx); calcium, iron, zinc, or vitamin supplements; or sucralfate (Carafate), you will need to allow some time to pass between when you take a dose of any of these medications and when you take a dose of ciprofloxacin. Ask your doctor or pharmacist how many hours before or after you take ciprofloxacin you may take these medications.

* tell your doctor if you or anyone in your family has or has ever had a prolonged QT interval (a rare heart problem that may cause irregular heartbeat, fainting, or sudden death) or an irregular heartbeat, and if you have or have ever had nerve problems, a low level of potassium in your blood, cerebral arteriosclerosis (narrowing of blood vessels in or near the brain that can lead to stroke or mini-stroke), seizures, or liver disease.

* tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking ciprofloxacin, call your doctor.

* you should know that ciprofloxacin may cause confusion, dizziness, lightheadedness, and tiredness. Do not drive a car, operate machinery or participate in activities requiring alertness or coordination until you know how this medication affects you.

* plan to avoid unnecessary or prolonged exposure to sunlight or ultraviolet light (tanning beds and sunlamps) and to wear protective clothing, sunglasses, and sunscreen. Ciprofloxacin may make your skin sensitive to sunlight or ultraviolet light. If your skin becomes reddened, swollen, or blistered, like a bad sunburn, call your doctor.

What special dietary instructions should I follow?

Do not drink or eat a lot of caffeine-containing products such as coffee, tea, energy drinks, cola, or chocolate. Ciprofloxacin may increase nervousness, sleeplessness, heart pounding, and anxiety caused by caffeine.

Make sure you drink plenty of water or other fluids every day while you are taking ciprofloxacin.

What should I do if I forget a dose?

If you miss a dose of ciprofloxacin, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.Do not take more than 2 doses of the tablets or suspension or more than one dose of the extended-release tablets in one day.

What side effects can this medication cause?

Ciprofloxacin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

* nausea
* vomiting
* stomach pain
* heartburn
* diarrhea
* feeling an urgent need to urinate
* headache
* vaginal itching and/or discharge

Some side effects can be serious. If you experience any of these symptoms, or those mentioned in the IMPORTANT WARNING section, stop taking ciprofloxacin and call your doctor immediately:

* severe diarrhea (watery or bloody stools) that may occur with or without fever and stomach cramps (may occur up to 2 months or more after your treatment)
* rash or blisters
* hives
* itching
* tingling or swelling of the face, neck, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
* difficulty breathing or swallowing
* hoarseness or throat tightness
* wheezing
* rapid, irregular, or pounding heartbeat
* fainting
* fever
* joint or muscle pain
* unusual bruising or bleeding
* extreme tiredness
* lack of energy
* loss of appetite
* pain in the upper right part of the stomach
* yellowing of the skin or eyes
* dark urine
* flu-like symptoms
* seizures
* dizziness
* confusion
* nervousness
* restlessness
* anxiety
* difficulty falling asleep or staying asleep
* nightmares or abnormal dreams
* not trusting others or feeling that others want to hurt you * hallucinations (seeing things or hearing voices that do not exist)
* depression
* thoughts about dying or killing yourself
* uncontrollable shaking of a part of the body
* pain, burning, tingling, numbness, and/or weakness in a part of the body

Ciprofloxacin may cause problems with bones, joints, and tissues around joints in children. Ciprofloxacin should not normally be given to children younger than 18 years of age unless they have certain serious infections that cannot be treated with other antibiotics or they have been exposed to anthrax in the air. If your doctor prescribes ciprofloxacin for your child, be sure to tell the doctor if your child has or has ever had joint-related problems. Call your doctor if your child develops joint problems such as pain or swelling while taking ciprofloxacin or after treatment with ciprofloxacin. Talk to your child's doctor about the risks of giving ciprofloxacin to your child.

Ciprofloxacin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/index.html] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets and extended-release tablets at room temperature and away from excess heat and moisture (not in the bathroom). Store the suspension in the refrigerator or at room temperature, closed tightly, for up to 14 days. Do not freeze ciprofloxacin suspension. Throw away any suspension that is left over after 14 days and any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to ciprofloxacin.

Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms of infection after you finish taking ciprofloxacin, call your doctor.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Brand names

* Cipro®

* Cipro® XR

* Proquin® XR

Antihistamines
Diphenhydramine Hydrochloride

What are antihistamines?

Antihistamines are medicines that help stop allergy symptoms such as itchy eyes, sneezing and a runny nose. Sometimes, itchy rashes (especially hives) may also be helped by an antihistamine.