17.07.2015
Amoxicillin back pain
National surveillance of antimicrobial resistance in Neisseria gonorrhoeae . Penicillin-induced seizures during cardiopulmonary bypass - a clinical and electroencephalographic study. Bactericidal activity of antimicrobials in the dynamic kill-curve model. Pediatr Clin North Amer 1983;30:161-76.  [PubMed] 211. The frequency of skin test reactions to side-chain penicillin determinants. J Allergy Clin Immunol 1993;91:694-701.  [PubMed] 212. Beta-lactam antibiotic-induced leukopenia in severe hepatic dysfunction: risk factors and implications for dosing in patients with liver disease. (eds.) Principles and Practice of Infectious Diseases. (eds.) Principles and Practice of Infectious Diseases. Conjugative transfer of staphylococcal  antibiotic resistance markers in the absence of detectable plasmid DNA. Antimicrob Agents Chemother 1986;30:161-9.  [PubMed] 217. Antimicrobial therapy of postpartum endomyometritis. Am J Obstet Gynecol 1981;141:246-51.  [PubMed] 218. Biochemical and genetical approaches to the mechanism of action of penicillin. Philos Trans R Soc Lond 1980;289:27-283.  [PubMed] 220. Stark BJ, Earl HS, Gross GN, Lumry WR, goodman EL, Sullivan TJ. Acute and chronic desensitization of penicillin-allergic patients using oral penicillin. J Allergy Clin Immunol 1987;79:523-32.  [PubMed] 221. Neurologic abnormalities of Lyme disease: Successful treatment with high-dose intravenous penicillin. Comparison of clindamycin, rifampin, tetracycline, metronidazole, and penicillin for efficacy in prevention of experimental gas gangrene due to Clostridium perfringens . The Eagle effect revisited: efficacy of clindamycin, erythromycin, and penicillin in the treatment of streptococcal myositis. Penicillin-binding protein expression at different growth stages determines penicillin efficacy in vitro  and in vivo : an explanation for the inoculum effect. Comparison of the bactericidal activity of ciprofloxacin alone and in combination with selected antipseudomonal beta-lactam agents against clinical isolates of Pseudomonas aeruginosa . Diag Microbiol Infect Dis 1988;11:41-52.  [PubMed] 226. Ticarcillin-induced hemorrhage in a patient with thrombocytosis. The β-lactamases of gram-negative bacteria and their role in resistance to β-lactam agents. J Antimicrob Chemother 1976;2:115-57.  [PubMed] 228. Susceptibility of anaerobic bacterial to 23 antimicrobial agents. Antimicrob Agents Chemother 1976;10:736-52.  [PubMed] 229. Tauber MG, Doroshow CA, Hackbarth CJ, Rusnak MG, Drake TA, Sande MA. Antibacterial activity of beta-lactam antibiotics in experimental meningitis due to Streptococcus pneumoniae . Oral antibiotic therapy for skeletal infections in children. Therapy of osteomyelitis and suppurative arthritis. Thauvin C, Eliopoulos GM, Willey S, Wennersten C, Moellering RC. Continuous-infusion ampicillin therapy of enterococcal endocarditis in rats. Antimicrob Agents Chemother 1987;31:139-43.  [PubMed] 232. Tjandramaga TB, Mullie A, Verbesselt R, De Schepper PJ, Verbist L. Piperacillin: human pharmacokinetics after intravenous and intramuscular administration. Antimicrob Agents Chemother 1978;14:829-37.  [PubMed] 233. Multiple anitbiotic resistance in a bacterium with suppressed autolytic system. The mechanism of the irreversible antimicrobial effects of penicillin: how the beta-lactam antibiotics kill and lyse bacteria. Ann Rev Microbiol 1979a;33:113-37.  [PubMed] 235. From penicillin-binding proteins to the lysis and death of bacteria: a 1979 view. Penicillin-binding proteins and the antibacterial effectiveness of the beta-lactam antibiotics. Rev Infect Dis 1986;8(Suppl 3):S260-78.  [PubMed] 237. Antibiotic resistance in Streptococcus pneumoniae . Clin Infect Dis 1997;24(Suppl 1):S85-8.  [PubMed] 238. Persistence of Treponema pallidum  following penicillin G therapy. Sudden death occurring during “massive-dose” potassium penicillin G therapy. Occurrence of a beta-lactam inducible penicillin-binding protein in methicillin-resistant staphylococci. Antimicrob Agents Chemother 1985;27:851-7.  [PubMed] 242. VanArsdel PP Jr, Martonick GJ, Johnson LE, Sprenger JD, Altman LC, Henderson WR Jr. The value of skin testing for penicillin allergy diagnosis. Van Esso D, Fontanals D, Uriz S, Morera MA, Juncosa T, Latorre C, Duran M. Neisseria meningitidis  with reduced susceptibility to penicillin. Van Etta LL, Kravitz GR, Russ TE, Fasching CE, Gerding DN, Peterson LR. Effect of method of administration on extravascular penetration of four antibiotics. Antimicrob Agents Chemother 1982;21:873-80.  [PubMed] 245. Comparison of the activities of the new ureidopenicillins piperacillin, mezlocillin, azlocillin, and Bay k 4999 against gram-negative organisms. Antimicrob Agents Chemother 1979;16:115-9.  [PubMed] 246. Visser LG, Arnouts P, van Furth R, Mattie H, van den Broek PJ. Clinical pharmacokinetics of continuous intravenous administration of penicillins. Vogelman B, Gudmundsson S, Leggett J, Turnidge J, Ebert S, Craig WA. Correlation of antimicrobial pharmacokinetic parameters with therapeutic efficacy in an animal model. Beta-lactam antibiotics: is continuous infusion the preferred method of administration? A hospital outbreak of high-level beta-lactam resistant Enterobacter  spp.: association more with ampicillin and cephalosporin therpay than with nosocomial transmission. Synergism with aminoglycosides of penicillin, ampicillin, and vancomycin against nonenterococcal group D streptococci and viridans streptococci. Watt G, Padre LP, Tuazon ML, Calubaquib C, Santiago E, Ranoa CP, Laughlin LW. Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis. On the mechanism of action of probenecid on renal tubular secretion. Bull Johns Hopkins Hosp 1960;106:333-46.  [PubMed] 253. Wenger JD, Hightower AW, Facklam RR, Gaventa S, Broome CV, Bacterial Meningitis Study Group. Bacterial meningitis in the United States 1986: report of a multistate surveillance study. Influence of ampicillin elimination half-life on in vitro  bactericidal effect. J Antimicrob Chemother 1985;15(Suppl A):257-60.  [PubMed] 255. White GW, Malow JB, Zimelis VM, Pahlavanzadeh H, Panwalker AP, Jackson GG. Comparative in vitro  activity of azlocillin, ampicillin, mezlocillin, piperacillin, and ticarcillin, alone and in combination with an aminoglycoside. Antimicrob Agents Chemother 1979;15:540-3.  [PubMed] 256. Whitney CG, Farley MM, Hadler J, Harrison LH, Lexau C, Reingold A, Lefkowitz L, Cieslak PR, Cetron M, Zell ER, Jorgensen JH, Schuchat A; Active Bacterial Core Surveillance Program of the Emerging Infections Program Network. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae  in the United States. Antibiotic susceptibility of clinical isolates of Listeria monocytogenes . Antimicrob Agents Chemother 1978;13:854-60.  [PubMed] 258. Williams TW Jr, Lawson SA, Brook MI, Ory EM, Morgen RO. Effect of hemodialysis on dicloxacillin concentration in plasma. Antimicrob Agents Chemother 1967;7:767-9.  [PubMed] 259. Wilson WR, Geraci JE, Wilkowske CJ, Washington JA 2d. Short-term intramuscular therapy with procaine penicillin plus streptomycin for infective endocarditis due to viridans streptococci. Wilson WR, Thompson RL, Wilkowske CJ, Washington JA 2d, Giuliani ER, Geraci JE. Short-term therapy for streptococcal infective endocarditis: combined intramuscular administration of penicillin and streptomycin. Activity of azlocillin and mezlocillin against gram-negative organisms: comparison to other penicillins. Antimicrob Agents Chemother 1978;13:559-65.  [PubMed] 262. Clin Neuropharmacol 1987;10:483-510.  [PubMed] 263. Woods CR, Smith AL, Wasilauskas BL, Campos J, Givner LB. Invasive disease caused by Neisseria meningitidis  relatively resistant to penicillin in North Carolina. Antibiotic cost savings from formulary resitrictions and physician monitoring in a medical-school affiliated hospital. Yamamoto M, Jimbo M, Ide M, Tanaka N, Umebara Y, Hagiwara S. Penetration of intravenous antibiotics into brain abscesses. Diffusion of β-lactam antibiotics through the porin channels of Escherichia coli K-12. Antimicrob Agents Chemother 1985;27:84-92.  [PubMed] 268. Studies on the pathogenesis of the Jarisch-Herxheimer reaction. Yu VL, Chiou CC, Feldman C, Ortqvist A, Rello J, Morris AJ, Baddour LM, Luna CM, Snydman DR, Ip M, Ko WC, Chedid MB, Andremont A, Klugman KP; International Pneumococcal Study Group. An international prospective study of pneumococcal bacteremia: correlation with in vitro  resistance antibiotics administered and clinical outcome. Cefuroxime by continuous infusion: a new standard of care? Rev Infect Dis 1990;Suppl 6:590-609.  [PubMed] 272. Effect of dose and schedule on cefoperazone pharmacodynamics in an in vitro  model of infection in a neutropenic host. Am J Med 1988;85(Suppl 1A):56-8.  [PubMed] Tables. Class and compounds  Trade names 1      Availability Natural penicillins  penicillin G potassium Pfizerpen Parenteral: 5, 20 mu vials phenoxymethyl penicillin various generics Tablets: 250, 500mg Solution: 125mg/5 mL, 250mg/5 mL penicillin G procaine Wycillin  Parenteral: 600,000 u/mL penicillin G benzathine Bicillin L-A, Permapen Parenteral: 300,000u/mL, 600,000u/mL penicillin G procaine/ penicillin G benzathine combination Bicillin C-R Parenteral: 150,000u/150,000 u/mL, 150,000/450,000 u/mL, 300,000/30,000 u/mL Penicillinase-Resistant Penicillins  methicillin Staphcillin no longer available nafcillin various generics Parenteral: 20 mg/mL vials oxacillin Bactocill Capsules: 250, 500mg Solution: 250mg/5mL Parenteral: 500mg, 1, 2, 4 g vials cloxacillin various generics Capsules: 250, 500mg Solution: 125mg/5 mL dicloxacillin Dynapen Capsules: 250, 500mg Suspension: 62.5 mg/5 mL Aminopenicillins   ampicillin Principen Capsules: 250, 500 mg Suspension: 125 mg/5 mL, 250 mg/5 mL Parenteral: 125, 250, 500 mg, 1, 2 g vials amoxicillin Amoxil,  Trimox Capsules: 250, 500 mg Chewable tablets: 125, 250, 400 mg Film-coated tablets: 500, 875 mg Suspension: 50mg/mL, 125 mg/5 mL, 200 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL bacampicillin Spectrobid no longer available Carboxypenicillins  carbenicillin Geocillin Tablets: 382 mg ticarcillin Ticar Parenteral: 1, 3, 6 g vials Ureidopenicillins and piperazine penicillin  azlocillin Azlin no longer available in U.S. market mezlocillin    Mezlin no longer available in U.S. market piperacillin Pipracil  Parenteral: 2, 3, 4g vials. 1 = not all formulations are available with every brandÂ. Table 2.  Minimal Inhibitory Concentrations (MIC50) of Specific OrganismsÂ.  MIC-50 (µg/mL) Organism Penicillin G Penicillin V Oxacillin Ampicillin/Amoxicillin Ticarcillin Mezlocillin Piperacillin Gram-Positive aerobes       Enterococcus sp. 2.0 4.0 >32 0.5 64 2 Staphylococcus aureus         (Non Penicillinase producing) 0.03 0.03 0.4 0.06 1.0 0.06   (Penicillinase-producing) >32 >32 1.6 >32 32 32 Staphlyococcus epidermidis 0.02 0.02 0.2 0.05 1.0 1.0 Streptococcus pneumoniae 0.01 0.01 0.1 0.02 0.4 0.02 Viridans streptococci 0.01 0.01 0.2 0.05 0.5 0.25 Streptococcus pyogenes 0.015 0.015 0.04 0.03 0.25 0.125 Listeria monocytogenes 0.25 0.25 >4 0.25 4 0.5 Gram-negative aerobes       Neisseria gonorrhoeae a 0.25  1.0 0.06 0.03 0.015 Neisseria meningitidis 0.03  0.06 0.06 0.03 0.03 Escherichia coli 64 128 8 2 4 2 Proteus mirabilis 32 128 4 0.5 2 1 Indole + P. mirabilis >500  >500 >128 64 4 1 Hemophilus influenzaea 0.4 6.3 25 0.25 0.012 0.03 Salmonella sp. 16 64  4   Serratia marcescens >128 >128 >128 >500 16 88 Klebsiella sp. >128 >128 >128 16 8 16 Pseudomonas aeruginosa >128 >128 >128 >500 16 8 Anaerobes       Peptostreptococcus 0.1  >32 0.5 0.5 0.5 Fusobacterium nucleatum 64 64 64 16 16 32. Minimal Inhibitory Concentrations (MIC-90) of Specific OrganismsÂ. Table 4. In Vitro  Post-Antibiotic Effect of Selected Penicillins. faecalis penicillin G 2-3.5 hrs 2.5-3.5 hrs 2.5-3.5 hrs ampicillin 2-2.5 hrs 2-6 hrs 0.5-2.5 hrs nafcillin 1.5-2 hrs ND ND piperacillin £0.5 hr ND £0.5 hr. Prevalence of Resistance of Organisms to Penicillins. Organism Prevalence Gram-positive  Streptococcus pneumoniae a,b Intermediate pcn resistance 11-28% Highly PCN resistant 11-33% Staphylococcus aureus PCN resistant >95%, Methicillin resistant (nosocomial) 23-38% Gram-negative  Haemophilus influenzae ampicillin 1-64% Moraxella catarrhalis up to 85% Escherichia coli ampicillin 30-50% Neisseria gonorrhoeae 1.2-38% Neisseria meningitidis up to 20% Extended-spectrum beta-lactamase producers  Klebsiella pneumoniae up to 24% Pseudomonas aeruginosa piperacillin 5-30% a intermediate resistant strains have MICs of 0.12-1.0 µg/mL. highly resistant strains have MICs of ³2.0 µg/mL. Table 6. Pharmacokinetic Properties of  Penicillins. 1 % Bioavailability Half-Life (hours) %PPB 2 Natural penicillins      benzylpenicillin 2g 20 µg/mL na 0.5 50-60 penicillin G oral 3 400,000 u 0.3 µg/mL 15-30 0.5  penicillin VK 250 mg 3 µg/mL 60 0.5 75-85 procaine pen G IM 300,000 u 0.9 µg/mL    benzathine pen G IM 1.2 mu 0.09 µg/mL     Penicillinase-resistant penicillins      nafcillin IV 1g 20 µg/mL na 0.5-1.0 90 oxacillin IV 500mg 52-63µg/mL na 0.5-0.7 94 oxacillin oral 500mg 5-7 µg/mL 30-35% 0.5-0.7  cloxacillin oral 500mg 7.5-14µg/mL 50 0.5 95 dicloxacillin oral 500mg 10-17µg/mL 37 0.8 98 Aminopenicillins      ampicillin IV 1g 40 µg/mL na 1-1.3 20 ampicillin oral 1g  3 µg/mL 30-50 1-1.3  amoxicillin oral 1g 7.5 µg/mL 80 1-1.3 20 Extended-spectrum penicillins      carbenicillin IV 3g 223 µg/mL na 1.1 50 carbenicillin oral 1g 9 µg/mL 30   ticarcillin 3.5g 210 µg/mL na 1.2 45 mezlocillin 3g 263 µg/mL na 0.8 16-42 piperacillin 4g 240 µg/mL na 1.0 16.                                           Â. 1 data complied from product package information and Donowitz 1988. Table 7. Guidelines for Adult and Pediatric Dosing of Penicillins. Drug Normal adult dose a,b Normal pediatric dose c  Dosage adjustment in renal impairment d,e Natural penicillins    benzylpenicillin (penicillin G) enterococcal endocarditis: 4-6 mub IV q4h ? 1week and > 2kg: 20,000-50,000 u/kg IV q8h CrCL 10-50 mL/min: Increase dosing interval to q6-8h ? 1 week and ? 2kg: 20,000-50,000 u/kg IV q12h > 1 week and ? 2kg: 25,000-65,000 u/kg IV q8h amoxicillin & clavulanic acid Streptococcal meningitis: 2-3 mu IV q4h > 1 week and > 2kg: 25,000-65,000 u/kg IV q6h Streptococcal infection: 2mu IV q4-6h > 1month and 12 years: usual adult dose CrCL 12 years: usual adult dose  neurosyphilis: 3-4 mu IV q4h   penicillin VK Streptococcal pharyngitis: 500 mg po bid-tid for 10 days > 1 month: 15-62.5 mg/kg/day po in 3-6 divided doses Little data available. Adjust dose if CrCL 1 month and 1 month: 50-100 mg/kg/day po in 3-4 divided doses CrCL 1 month: IV data limited, 100-200mg/kg/day in 4-6 divided doses oxacillin 500mg-1g po q4-6h  > 1 month and 1 month and 1 month and 40 kg: usual adult dose CrCL 1 month and 20 kg: usual adult dose CrCL 1 month and a intramuscular. c These dosages are ranges of acceptable doses. The lower range of usual dose is generally used for mild infection, upper range for severe infection (e.g. meningitis, endocarditis). Higher dosages than recommended may be used in certain circumstances. Clinical judgment should be used when dosing and prescribing information for the specific drugs should be consulted for more information. d clinical judgment should be utilized when making decisions regarding dosage adjustment in renally impaired patients, taking into account severity of renal impairment, site of infection, expected length of amoxicillin 875 mg pink therapy, organism isolated, etc. e data complied using McEvoy 2003 AHFS Drug Information and product package inserts. Table 8. Approximate Cost of Typical Therapeutic Regimens of Selected Penicillins 1. Drug Dosing regimen Cost 1 Oral agents   ampicillin 500mg po q6h x 10d $5.00 penicillin VK 500mg po q8h x 10d $4.00 amoxicillin 500mg po q8h x 10d $5.00 Long-acting agents   procaine penicillin G 1.2 mu IM x1 $5.00 benzathine penicillin G 2.4mu IM x1 $15.00 Intravenous agents   ampicillin 2g IV q4h x 10d $57.00 penicillin G potassium 2 mu IV q4h x 10d $21.00 penicillin G sodium 2 mu IV q4h x 10d $158.00 oxacillin 1g IV q6h x 10d $109.00 ticarcillin 3g IV q4h x 10d $375.00 piperacillin 4g IV q6h x 10d $390.00.
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