Cephalosporins: a class of oral and parenteral medications first synthesized from penicillin in the latter part of the 1940's in Italy. In the 1960's, Cephalexin, sold by Eli Lilly under the brand-name of "Keflex" became the most widely prescribed form of the medication (a similar medication, Keflin, was a close second). There have been five generations in the evolution and synthesis of this class of antibiotics, and are still a very useful adjunct in the treatment of infections in the world today. Cephtriaxone, (Rocephin, Roche Pharmaceuticals) is one of the most often prescribed intravenous antibiotics used in hospitals and in home-care today. Note: Because of the fact the drug is an analog of penicillin, there is the possibility of cross-allergency with this class of medication. Discuss this with your prescriber and pharmacist if you are penicillin allergic.
Ampicillin and amoxicillin, which are technically cephalosporins but not classified as such are often employed in the treatment of UTI's in children and adolescents (when susceptibility permits). When combined with potassium clavuante to form (Augmentin, GSK Pharmaceuticals), amoxicillin can be used in the treatment of more severe infections and susceptible sexually transmitted diseases.
Tetracyclines: The most frequently used antibiotic in this class is a second-generation medication known as doxycycline hyclate. It is a semi-synthetic antibiotic, the base material used in its synthesis being oxytetracycline, and was first synthesized by Pfizer Pharmaceuticals in the early 1960's. Common brand names are Vibramycin, Vibra-tabs, and Doryx (timed-release capsules). Doxycycline provides the benefit of once-daily dosing (in the 100 mg strength) for the treatment of uncomplicated urinary tract infection. Minocycline, (Minocin, Lederle) a somewhat "cousin" to Doxycycline, has also proven useful in the treatment of UTI's, and is usually prescribed twice daily. In 2009, the FDA added minocycline to its Adverse Event Reporting System; a list of medications under investigation by the FDA for potential safety issues. It is believed there is a correlation between minocycline and certain pediatric autoimmune disorders. Tetracycline hydrochloride, the parent of these second generation medications is now seldom used in the treatment of urinary tract infections because of bacterial resistance. It is still used in the treatment of chlamydia trachomatis.
Note: avoid sunlight when taking any of the tetracycline class antibiotics because of photosensitivity. Also, it is advisable to avoid taking any form of antacid containing aluminum or magnesium, or the consumption of milk within a few hours of taking the medication. Tetracyclines chelate, or bind to minerals very easily, reducing the availability of the medication in your system. Pediatric usage (under 12 years of age) is usually contraindicated because this class of medication can discolor teeth and have adverse effects on bone formation.
Nitrofurantoin: was specifically developed for use in the treatment of susceptible urinary tract infections. It was discovered in the late 1950's, and came into favor during the latter-part of the 1960's. Common brand names are Furadantin, Macrobid, and Macrodantin. It is generally a well tolerated medication, and is useful only in non-complicated UTI's. It is of little benefit in the treatment of bacterial prostatitis, or skin-structure infections.
Fluroquinolones: Ciprofloxacin (Cipro, Miles Pharmaceuticals) was the first widely available second generation fluroquinolone anti-infective marketed in the U.S., beginning in 1986. It is the most commonly prescribed of its class of medications, and seems to be the go-to drug for most practitioners (it is listed among the $4.00 generics at Wal*Mart). It was initially marketed for the treatment of both complicated and uncomplicated urinary tract infections and prostatitis, and is well-tolerated by most patients. That said, in the mid-1990's, a correlation between tendon rupture, tendinitis, and ciprofloxacin was discovered, and appropriate precautions were recommended for its prescribing and usage. Concomitant administration of antacids containing aluminum and magnesium within five hours of taking ciprofloxacin is contraindicated. Milk should be avoided when taking this medication.
Norfloxacin (Noroxin, Merck Pharmaceuticals) was the second widely available form of the second generation fluroquinolone class of anti-infectives approved in the United States. It was initially marketed for the treatment of both complicated and uncomplicated urinary tract infections and prostatitis, but has since fallen out of favor because of a myriad of adverse side-effects including tendinitis, tendon rupture, hypersensitivity, hepatic (liver) disorders - including hepatitis. It is rarely prescribed in the United States.
Levofloxacin (Levaquin, Janssen Pharmaceuticals) is the strongest commonly prescribed member of the fluroquinolone family. It comes complete with all of the side effects listed for the rest of this class of medications, and carries two FDA Black Box warnings regarding the danger of prescribing levofloxacin. At $29.00 US per 500 mg tablet, it is cost-prohibitive, and reserved for only the most serious of urinary tract infections. Moxifloxacin (Avalox, Merck Pharmaceuticals) is slightly less expensive than Levaquin, and carries similar side effect liability.
There have been a few misfires among this class of medication, the most notable being Trovafloxacin (Trovan, Pfizer Pharmaceuticals), which was restricted to use in hospitals and long term care facilities shortly after its introduction into the market in 1998. It was implicated in cases of severe liver failure in the U.S., and at least six deaths in Nigeria in the mid-1990's. Olfloxacin, (Floxin, Janssen Pharmaceuticals) was essentially withdraw from manufacture by Janssen in 2009, and is unavailable in the U.S. at this time. It, too had similar liabilities to the rest of the class of anti-infective medications.
Per: Moderator Tim
**Many thanks to my friend, Dr. R.S.H., D.P.M. for his contribution to the "antibiotics/anti-infectives" posts.
Per Dr. "Rob": IT IS IMPORTANT TO TAKE THE ANTIBIOTICS AS DIRECTED, WHEN DIRECTED, AND FOR THE LENGTH OF TIME DIRECTED BY THE PRESCRIBER. REPORT ANY ADVERSE EFFECTS TO THE PHYSICIAN IMMEDIATELY. IN THE EVENT OF SYMPTOMS OF ANAPHYLAXIS (HIVES, DIFFICULTY BREATHING, SWOLLEN THROAT, LOW BLOOD PRESSURE) SEEK IMMEDIATE EMERGENCY TREATMENT, ACTIVATE 911. FOR LESSER SIDE EFFECTS, CONTACT YOUR PHYSICIAN OR PHARMACIST.
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