to reach the clouds

Oral Anticoagulants

Abnormal prolongation of prothrombin time (increased international normalized ratio ) has been reported in patients receiving amoxicillin and oral anticoagulants. buy augmentin Appropriate monitoring should be undertaken when anticoagulants are prescribed concurrently with AUGMENTIN. Adjustments in the dose of oral anticoagulants may be necessary to maintain the desired level of anticoagulation.

Selected Differences Among the Oral Cephalosporins

Kinetics allow once-daily or twice-daily dosing; convenience offset by significantly higher cost than other first-generation cephalosporins

Extensive clinical experience with its use; well tolerated; good pharmacokinetics

Similar properties as cephalexin, but not as widely used

Cefaclor (Ceclor, Ceclor CD)

May cause serum sickness–like syndrome; absorption decreased by food; of second-generation cephalosporins, has highest incidence of Haemophilus influenzae resistance

Absorption not affected by food

Cefuroxime axetil (Ceftin)

Parenteral form available (cefuroxime sodium [Zinacef]); absorption enhanced by food; only second-generation agent labeled for the treatment of urinary tract infections

Oral suspension better absorbed than tablets (therefore, less likely to cause diarrhea); single oral dose indicated for the treatment of uncomplicated gonorrhea

Cefpodoxime (Vantin) and cefdinir (Omnicef)

Of the third-generation agents, provide best coverage of penicillin-sensitive Pneumococcus and methicillin-sensitive Staphylococcus aureus

Poor efficacy against Streptococcus pneumoniae , which limits its clinical usefulness

Information from references 1 , 5 , 6, and 9 through 11.

Antibiotic Use During Pregnancy and Lactation

At any given time, more than 10 million women in the United States are pregnant or lactating, and exposing a fetus or newborn to antibiotics can pose a unique threat. Changes during pregnancy and lactation also can trigger pharmacokinetic and pharmacodynamic modifications that alter the effectiveness of antibiotics. Nahum and colleagues reviewed the literature on antibiotic use to provide updated, evidence-based information on antibiotic use in women who are pregnant or lactating.

The researchers examined published medical literature, sources on teratogenicity and prescribing for women who are lactating or pregnant, and they abstracted data from product labels for drugs approved by the U.S. Food and Drug Administration (FDA) for use during pregnancy. The authors identified 124 references that covered 11 commonly prescribed antibiotics, all of which cross the placenta and are excreted in human breast milk.

There was no teratogenic potential for penicillins G and V potassium (V-Cillink); unlikely potential for amoxicillin, chloramphenicol (Chloromycetin), ciprofloxacin (Cipro), doxycycline (Vibramycin), levofloxacin (Levaquin), and rifampin (Rifadin); and undetermined potential for clindamycin (Cleocin), vancomycin, and gentamicin (see accompanying table) . All agents were FDA Pregnancy Category B (amoxicillin, clindamycin, penicillin G, penicillin V potassium, and vancomycin) or C (chloramphenicol, ciprofloxacin, gentamicin, levofloxacin, and rifampin), except for doxycycline, which was category D.

Evidence suggested that increased maternal dose or shorter dosing intervals should be considered for amoxicillin, gentamicin, and penicillins G and V potassium. However, information on pharmacokinetics during pregnancy was inadequate for the other antibiotics. There were limited data on several other aspects of antibiotic use during pregnancy, but the authors stress that conducting studies in this area would be challenging.

Despite the lack of scientific evidence, the authors conclude that physicians should make balanced judgments about the well-being of the mother and her child before making decisions about antibiotic use during pregnancy and lactation.

Which Antibiotics Are Best for Skin and Soft Tissue Infections?

Background : Bacterial skin and soft tissue infections (SSTIs) have traditionally responded well to treatment with beta-lactam antibiotics (e.g., penicillin derivatives, first- or second-generation cephalosporins) or macro-lides. However, there has been concern whether they are still effective given the emerging resistance of Staphylococcus and Streptococcus species. Consequently, physicians have started using broader-spectrum beta-lactams (e.g., third-generation cephalosporins) or fluoroqui-nolones to treat SSTIs in the belief that they may be more effective, despite limited evidence to support this approach. Falagas and colleagues conducted a meta-analysis of studies comparing the beta-lactams with fluoro-quinolones in the empiric treatment of SSTIs.

The Study : The PubMed and Cochrane databases were used to identify relevant studies published between Janu-ary 1980 and February 2006. To be included, studies had to be randomized controlled trials that examined the clinical or microbiologic effectiveness of the medications. Studies using febrile neutropenic patients were excluded, as were those evaluating nonclinical markers of effectiveness (e.g., pharmacokinetic analysis). Trials also were excluded if they involved antibiotics that had been withdrawn from the market.

Results : Twenty studies involving 4,817 patients were reviewed. The beta-lactam agents included in the studies were extended-spectrum agents (amoxicillin/clavula-nate [Augmentin], ampicillin/sulbactam [Unasyn], and piperacillin/tazobactam [Zosyn]); first-generation ceph-alosporins (cephalexin [Keflex]); and third-generation cephalosporins (cefotaxime [Claforan] and ceftazidime [Fortaz]). Fluoroquinolones included were ofloxacin (Floxin), ciprofloxacin (Cipro), fleroxacin (not available in the U.S.), levofloxacin (Levaquin), and moxifloxacin (Avelox).

Overall, fluoroquinolones were more effective than beta-lactam antibiotics for empirically treating SSTIs, but the difference was small (90.4 versus 88.2 percent resolution). Fluoroquinolones also were more effective in treating mild to moderate SSTIs. However, both of these advantages disappeared when third-generation cephalosporins were excluded from the analysis. There also was no difference between the antibiotic classes in the treatment of moderate to severe infections.

Fluoroquinolones were no more effective than beta-lactam antibiotics in the treatment of abscesses and wound infections, nor were they more effective in treating patients hospitalized for SSTIs. Microbiologically, eradication rates of S. aureus and streptococci infections were the same for the two groups of medications. However, fluoroquinolones were more effective where gram-negative or anaerobic infections were identified.

No difference in mortality rates was found between the groups. Although most medication-related adverse events were mild and involved the gastrointestinal tract, fluoroquinolones were associated with a significantly higher rate of adverse events compared with beta-lactam antibiotics (19.2 and 15.2 percent, respectively).

Conclusion : The authors concluded that although fluo-roquinolones were slightly more effective in treating SSTIs compared with beta-lactam antibiotics, this difference disappeared when third-generation cephalosporins were excluded. When the greater adverse effect profile of fluoroquinolones was also considered, there was no substantial advantage to using them over beta-lactam agents for the empiric treatment of SSTIs. Although third-generation cephalosporins often are used to treat SSTIs, they appear to be less effective than extended-spectrum penicillins and first-generation cephalosporins.


Antibiotics for UTI are effective. The number of antibiotic-resistant UTIs is increasing (1), due mostly to people who do not finish the full course of treatment. That said, the overall success rate for antibiotics is still impressive. Few are the uncomplicated UTIs that cannot be effectively treated with some form of antibiotic.

Antibiotics for UTI are convenient. Many prescription drugs come with lists of conditions that need to be met while taking them. Not so with antibiotics for UTIs. With antibiotics, you typically take one or two capsules once or twice per day with water. The process is fast, convenient, and does not interfere with a busy lifestyle.

Antibiotics for UTI work fast. In the vast majority of cases, antibiotics will start providing relief from UTIs in one or two days. Within just a few days most UTI symptoms will be gone. It is at that point that people frequently stop taking their antibiotics. But this is a huge mistake. Stopping just because symptoms have receded is only going to increase the chances of a recurrence. And one that will be harder to deal with.

Antibiotics for UTI are affordable. When you consider the untold pain, discomfort, and long term suffering they prevent antibiotics represent an incredible healthcare value. When compared to other popular medications, antibiotics seem like a leftover from a bygone age when you did not have to go broke to fill a prescription. And with the rise of single dose antibiotics (2), that value proposition is becoming even more apparent.

Antibiotics for UTI are easy to take. Antibiotics are by far the most prescribed type of medication worldwide. And the vast majority of antibiotics are capsules people take at home with a glass of water. It is one of the simplest and easiest treatments available for potentially life-threatening conditions.

Antibiotics for UTI are safe for the vast majority of people. It is exceedingly rare for someone to have an actual allergic reaction to antibiotics. In some cases, people who report an allergic reaction are misinterpreting a normal (but no doubt unpleasant) side effect as a sign they are allergic. The fact is that for most people, antibiotics present little or no health threat when taken as directed. That said, if you have any concerns, discuss them with your doctor.

Antibiotics for UTI can help you get back to normal quickly. The early days of a UTI can be extremely unpleasant. You may have abdominal pain and pain when urinating. You may be driven to the bathroom to urinate repeatedly. You may even lose control of your bladder from time to time. Once you start your antibiotic treatment, however, you should return to a more or less normal state in just a few days.

Antibiotics for UTI are generally low in side effects. Most antibiotics (with the notable exception of the new class of fluoroquinolones) produce very mild or no side effects in most people. Compare that to cholesterol-lowering drugs that can cause liver damage (3), or even common NSAIDs that can cause kidney problems, stomach bleeding, and an increased risk of stroke (4).

Antibiotics for UTI are available as single dose treatments. Single dose antibiotics are becoming increasingly popular to deal with uncomplicated urinary tract infections (5). A single dose antibiotic is exactly what it sounds like. The patient is prescribed a single dose of a particular antibiotic – typically fosfomycin (6) – which they mix with water and drink. This further simplifies antibiotic treatment, which was already pretty simple to begin with.

Single dose antibiotics for UTI increase compliance. The biggest issue with antibiotics is a lack of compliance. That is, people often stop taking them once they start feeling better. By failing to finish the entire course, they help to create antibiotic-resistant bacteria that will be far more difficult to defeat. Single dose antibiotics have a compliance rate of close to 100%, which is helping to reduce the propagation of antibiotic-resistant bacteria.

Single dose antibiotics for UTIs reduce the chance of recurrence. Recurring urinary tract infections are an all-too-familiar phenomenon for many women (7). Single dose antibiotics, however, have proven to be effective in breaking the cycle of recurrence and are increasingly being prescribed for women with recurring UTIs.

Antibiotics for UTI may be covered by Medicare. If you are treated for a UTI while in the hospital, or you are administered intravenous antibiotics in a clinical setting, Medicare may cover the cost. If you have a Medicare Advantage Plan, it may cover the cost of antibiotics as well.

Antibiotics for UTI pose virtually no overdose threat. Many types of prescription medicine can be dangerous or downright deadly if you take too much. Fortunately, antibiotics pose virtually no overdose threat, even to children (8). This is just one of the many aspects of antibiotics that separate them from other classes of medication.

Antibiotics for UTI can save lives. Most common urinary tract infections manifest in the urethra or bladder. These can be quickly and effectively treated with antibiotics. However, if a UTI is left untreated, it can migrate to the kidneys and become a life-threatening (9). By preventing infections of the urethra or bladder (or both) from becoming kidney infections, antibiotics very literally save lives.