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Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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Drug information contained herein may be time sensitive.

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If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. When you're sick, antibiotics are not always the answer. In fact, taking antibiotics when you

don

This article answers some common questions about when antibiotics are helpful and when they are not.

There are two main types of organisms that cause infections: viruses and bacteria.

Illnesses caused by viruses (especially in the nose and throat) are more common than illnesses caused by bacteria.

Common illnesses caused by viruses are colds, most sore throats, and most coughs. Antibiotics are strong medicines that treat bacterial infections.

Antibiotics won't treat viral infections because they can't kill

viruses

You'll get better when the viral infection has run its course.

Common illnesses caused by bacteria are urinary tract infections, strep throat, and some pneumonia. Antibiotics can treat bacterial

infections

This makes it harder for the medicine to kill the bacteria and treat the infection. The increase in resistant bacteria is caused when people: Don't take antibiotics as directed (such as not finishing the entire prescription given by the doctor).

Note: If you are taking any other medicine, either prescription or over-the-counter, talk to your doctor or

pharmacist

If you have severe ear pain or ear pain that continues for more than 48 to 72 hours, schedule an appointment with your doctor.

Your doctor can tell if you have a bacterial infection and give you a prescription for antibiotics. Sinus infections: If you have a long-lasting or severe sinus infection, your doctor might decide to start you on antibiotics. If you have thick or green mucus, you probably don't have a sinus infection. Cough or bronchitis: Viruses usually cause bronchitis and coughs, and antibiotics won't help you get better. The Consulting Nurse Service will have ideas about what you can do to feel more comfortable while the viral infection runs its course.

Sore throat: Viruses are the cause of most sore throats and can't be treated with antibiotics.

However, strep throat is caused by bacteria and antibiotics can help.

In most cases, your doctor will take a throat swab to test for strep before prescribing an antibiotic for a sore throat. The Consulting Nurse

Service

During a viral infection, it's normal for the mucus to get thick and change color.

Antibiotics are useful when used to treat certain bacterial infections.

Talk to your doctor to decide which infections need antibiotics. If your doctor prescribes antibiotics for you: Take them exactly as directed and finish all pills, even if you start feeling better.

This way you'll be more likely to kill all the bacteria, not just the weaker bacteria. Never save pills for later or share them with others. Remember to wash your hands, especially when you use the toilet; change diapers; blow your nose, cough, or sneeze; touch

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We also review other treatment approaches for pain, fatigue, insomnia, memory, and mood.

We refer the reader to other sources that describe why patients might have persistent symptoms and other treatment options (e.g., in portions of our book Conquering Lyme Disease: Science Bridges the Great Divide ). Here we simply wish to provide some important facts that people should know about various treatments.

Doctors are taught in medical school: "Above all due no harm".

However, nearly all treatments have both benefits and risks.

Therefore prior to any thereapeutic intervention (e.g, medicinal, herbal, diet change, even exercise), individuals need to review how this intervention might impact them. When considering treatment options for Lyme disease, patients should find out how

well

Patients should also keep an open mind regarding what might help as some symptoms may reflect active infection (and therefore benefit from antibiotics) while others may reflect the residual effects on the body of the prior infection (and therefore require non-antibiotic approaches). The goal is to restore one's health and functional status so as to maximize quality of life. As with all recommendations on this website, the taking of over-the-counter or prescribed medications should be carefully reviewed with a physician to ensure safety and efficacy and to assess for potentially harmful drug interactions.

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penicillin-resistant

Cefuroxime (Ceftin) Cefuroxime, a bacteriocidal 2nd generation cephalosporin, is FDA approved for the treatment of

early

(The term “

generation

Note: if one is

penicillin

neurologic Lyme disease as the genospecies causing neurologic Lyme in the US is B.burgdorferi while in Europe it is most commonly caused by B.garinii. Doxycycline absorption is decreased by food and milk and especially decreased by antacids or laxatives that contain calcium, magnesium, or aluminum or vitamins that contain iron.

The latter medications or vitamins should be taken 6 hours before or 2 hours after the doxcycline.

Note 1: Doxycycline raises the risk of sunburns due to increased skin sensitivity to sunlight.

Doxycycline side effects include moderate to severe gastric symptoms (nausea, vomiting, diarrhea), vaginal yeast infections, decreased effectiveness of birth control pills, and rarely liver damage or esophagitis. Doxycycline should not be combined with the acne drug isotretinoin as that will increase the risk of elevated intracranial pressure (and the potential for vision loss).

Note 2: Use of any tetracycline-class agent (like doxycycline) with alcohol may lead to a bad reaction with symptoms such as headaches, nausea, vomiting, confusion, and flushing. Note 3: Doxycycline is contra-indicated in pregnancy.

Previously its use was discouraged in children under age 8, but the American Academy of Pediatrics has recently revised their guidelines to allow use. Note 4: Patients on blood thinners (anti-coagulants) should be aware that doxycycline can lead to an enhancement of the anti-coagulant effect, possibly increasing the risk of bleeding. The impact of anti-coagulants while on doxycycline should be amoxicillin with potassium clavulanate monitored by the health care provider. Ceftriaxone (Rocephin) Ceftriaxone is a third generation cephalosporin and, like other cephalosporins, is bacteriocidal. Individuals with neurologic Lyme disease, cardiac Lyme disease, or Lyme arthritis that hasn’t responded well to oral antibiotic treatment will often be given intravenous ceftriaxone. Ceftriaxone has excellent penetration of the blood-brain barrier and is one of the most effective drugs for Lyme disease.

Ceftriaxone is typically given once a day intravenously, typically in 45 minutes. While this can be administered in the doctor’s office on a daily basis through a peripheral vein, most commonly it is administered through a mid-line or a PICC line that once inserted can be accessed for the daily infusions at home (thereby eliminating the discomfort and inconvenience of daily needle sticks). Note 1: Ceftriaxone can result in biliary sludging that in some patients leads to biliary stones and need for gall bladder removal; in our research study, one patient of 37 developed biliary stones ( 2.7%) which is similar to what has been reported in the literature. Some doctors prescribe “Actigall” to dissolve biliary stone formation, especially if the patient is starting to complain of epigastric pain or nausea. Some doctors order an ultrasonogram of the gall bladder prior to initiating ceftriaxone therapy to identify those patients who might be at greatest risk of forming gall stones. Note 2: While the ease of administration is enhanced when ceftriaxone is administered intravenously through a Mid-line or a PICC line, the presence of this indwelling line also increases the risk of systemic infection and serious blood clots.

Therefore, patients need to remember to flush their PICC or Mid-line daily, to keep the PICC line site clean, and to not engage in “jerky” arm movements, such as might occur when washing windows or playing tennis or golf.

IN the evaluation of the patient prior to insertion of a PICC line or a Mid-Line, the clinician order blood tests to determine if

the

Note 3: Rarely ceftriaxone can trigger

hemolytic

Note 4: Cefotaxime (Clarforan) is also a 3rd generation intravenous antibiotic. While Cefotaxime is less likely to cause gallstones, it requires 3x daily dosing which for most patients is too difficult to maintain.