Miscellaneous Antibiotics

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New Addtions
New additions: DORIBAX® (doripenem) \| VIBATIV® (telavancin HCL)
Aztreonam - Azactam ®	TMP/SMX - Bactrim ®
Chloramphenicol- Chloromycetin ®	Clindamycin - Cleocin ®
Dapsone:	Daptomycin - Cubicin ®
Ertapenem - Invanz ®	fidaxomicin - DIFICID™
Imipenem/cilastatin -Primaxin ®	Linezolid - Zyvox ®
Meropenem - Merrem ®	Metronidazole - Flagyl ®
Nitrofurantoin	Quinupristin/Dalfopristin - Synercid ®
Rifaximin - Xifaxan ®	Tigecycline - Tygacil ®
Telithromycin - Ketek ®	Tinidazole - Tindamax ®
Sulfa Allergy	--

Aztreonam - Azactam ®:

DOSAGE AND ADMINISTRATION
[Mild infection] (i.e. Urinary tract infection): 500mg to 1 gram IV q8-12h.
[Usual dose]: 1-2 grams IV q8-12h.
[Severe/life threatening infection]: 2 grams IV q6-8h.
[Maximum dose]: 8 grams/day.

Renal dosing:
[CRCL >30 ml/min]: no change.
[10-30 ml/min]: Loading dose: 1-2 grams x 1, then give 50% of the usual dose (e.g. 0.5 - 1 gm) q6-12h.
[<10 ml/min]: 1-2 grams x 1, then 25% of usual dose (e.g. 250-500 mg) q6-12 hours.

Hemodialysis: 1 - 2 grams x 1, then 25% of usual dose q6-12h. (e.g., 250-500 mg q6-12 hours).
For serious or life-threatening infections, give an additional 125mg after each hemodialysis session (1/8th of the usual dose). PD: 1 - 2 grams x 1, then 25% of usual dose q6-12h. (e.g., 250-500 mg q6-12 hours).

TMP/SMX - Bactrim ®:

DOSAGE AND ADMINISTRATION
Dosing: (IV): 8-10mg/kg/day divided q6-12h.
PCP: 15-20mg/kg/day in 3 or 4 divided doses.
(Oral): Urinary tract infection: 1 DS tab (160mg TMP/800mg SMX) po q12h.

Renal Dosing:
[>30 ml/min]: no change .
[15-30] 50% of usual regimen.

Alternatively: 8-10mg/kg/day divided q12h x 1-2 days, then 4-6mg/kg q24h.
[<15] not recommended by manufacturer.

Alternatively: Non PCP: 8-12 mg/kg/dose q48h (or 4-6 mg/kg/day divided q12-24h) .
PCP: 15-20 mg/kg/dose q48h (or 7-10 mg/kg/day divided q12-24h).

Hemodialysis: Not recommended by manufacturer.

Chloramphenicol - Chloromycetin ®:

DOSAGE AND ADMINISTRATION
Dosing: 12.5 mg/kg q6h.
[Severe infections]: 25 mg/kg q6h.

Renal Dosing: No adjustments needed. Hemodialysis: No adjustments needed.

Clindamycin - Cleocin ®:

DOSAGE AND ADMINISTRATION
Dosing:
(IV) 300 to 900 mg q6-8h.
(Oral): 150 to 450 mg q6h.

Renal Dosing:
No adjustments required.

Dapsone:

DOSAGE AND ADMINISTRATION
Dosing: 100 mg po qd.
[PCP]: 100mg po qd.
[Dermatitis herpetiformis]: 50-300 mg qd.

Renal Dosing:
Specific guidelines are not available

Daptomycin - Cubicin ®:

Cyclic Lipopeptide.

DOSAGE AND ADMINISTRATION
Dosing (adults): Skin and/or skin structure infections (complicated): 4 mg/kg IV once daily for 7-14 days. Bacteremia, endocarditis (unlabeled use): 6 mg/kg IV once daily.

Renal Dosing: Crcl <30 mL/min: 4 mg/kg every 48 hours.
Hemodialysis (administer after hemodialysis) and/or CAPD: 4 mg/kg every 48 hours.

Supplied: 250 mg, 500 mg (Injection - powder for reconstitution)

Ertapenem - Invanz ®:

DOSAGE AND ADMINISTRATION
Dosing: Usual dose: 1 gram IM or IV qd.

Renal Dosing:
[CRCL > 30]: No changes.
[</= 30]: 500 mg IV/IM qd.

Hemodialysis:  500 mg IV/IM qd.   Give supplementary dose of 150 mg following the hemodialysis session if the 500mg dose was administered <6 hours prior to hemodialysis.

fidaxomicin - DIFICID™:

INDICATIONS AND USAGE
DIFICID is a macrolide antibacterial drug indicated in adults (18 years of age) for treatment of Clostridium difficile-associated diarrhea

DOSAGE AND ADMINISTRATION
One 200 mg tablet orally twice daily for 10 days with or without food .

HOW SUPPLIED
Film-coated tablets: 200 mg

Imipenem/cilastatin - Primaxin ®:

DOSAGE AND ADMINISTRATION
Dosing: 250mg to 1gm q6h
(Maximum dose is 50mg/kg/day or 4 grams/day, whichever is lowest . Give in divided doses)

Renal Dosing:
[CRCL >71]: No changes.

[41 –70 ]: Max 37.5 mg/kg/day or 3 grams/day. (Range: 9.4 – 37.5mg/kg/day) divided q6-8h.

[21-40]: Max 25 mg/kg/day or 2 grams/day. (Range: 6.25 – 25 mg/kg/day) divided q6-12h.

[6-20 ]: Max 12.5 mg/kg/day (max dose 1 gram/day). Range: 6.25 – 12.5 mg/kg/day) divided q12h. (Usual: 250mg q12h).

Hemodialysis: 125 – 500 mg q12h. (Max 12.5 mg/kg/day). Give dose after dialysis. PD: 125 – 250 mg q12h

Linezolid - Zyvox ®:

DOSAGE AND ADMINISTRATION
Dosing:
vancomycin-resistant Enterococcus faecium (VRE) infections: Oral, IV: 600 mg every 12 hours for 14-28 days.
Nosocomial pneumonia, complicated skin and skin structure infections, community-acquired pneumonia including concurrent bacteremia: Oral, IV: 600 mg every 12 hours for 10-14 days.

Uncomplicated skin and skin structure infections: Oral: 400 mg every 12 hours for 10-14 days.

Renal Dosing: no adjustment necessary.
(Two primary metabolites of linezolid may accumulate in patients with renal insufficiency- more studies are needed to determine the clinical significance).
Hemodialysis: No adjustment necessary. On dialysis days, schedule dose after dialysis. (~30% extraction).

Important Drug Interactions:
Linezolid is a reversible, nonselective inhibitor of monoamine oxidase (MOA), and a potential interaction with adrenergic or serotonergic agents is possible. A significant pressor response was observed when administered with tyramine; therefore, patients should avoid consuming food or beverages containing tyramine. More commonly used agents such as dopamine (Intropin), epinephrine, or decongestants containing pseudoephedrine may also produce an exaggerated pressor response. In healthy normotensive subjects receiving linezolid and pseudoephedrine, the mean maximum increase in systolic blood pressure was 32 mm Hg. Maximum elevation occurred at two to three hours and returned to baseline within three hours. No affect on heart rate was observed. Careful dosing titration is recommended when initiating dopamine or epinephrine.

The potential for a serotonergic interaction with dextromethorphan (Robitussin DM) was evaluated in healthy subjects. No serotonin syndrome effects (confusion, delirium, tremors, restlessness, hyperpyrexia, or diaphoresis) were observed with this combination. No effects of serotonin syndrome were observed during a phase III study of 52 patients comparing fluoxetine, paroxetine and sertraline with linezolid. Nevertheless, caution is therefore recommended when using linezolid with agents such as citalopram (Celexa), fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) until clinical safety is demonstrated.
Source: www.aafp.org/afp/20020215/663.html

Meropenem - Merrem ®:

DOSAGE AND ADMINISTRATION
Dosing: 1 gram IV q8h

Renal Dosing:
[CRCL >50]: no change. [26-50]: 1 gram q12h. [10-25]: 500 mg q12h. [<10]: 500mg q24h. Hemodialysis: 500mg q24h + 500mg after each HD. PD: 500mg q24h.

Metronidazole - Flagyl ®:

DOSAGE AND ADMINISTRATION
Dosing: 500 mg oral/IV q6-8h.

Renal Dosing:
[CRCL > 10]: no changes.
[<10]: 500mg q8-12h or (50% of usual dose at same interval).

Hemodialysis: 500mg q8-12h (usually q12h) or (50% of usual dose at same interval). On dialysis days, schedule dose after dialysis.

Nitrofurantoin:

DOSAGE AND ADMINISTRATION
Dosing: 50-100 mg q6h.
Macrobid: 100 mg q12h.

Renal Dosing:
[CRCL >50]: Normal dose.
[0-49]: Avoid use.
Hemo: Avoid use.

Quinupristin/Dalfopristin - Synercid ®:

DOSAGE AND ADMINISTRATION
Dosing: 7.5 mg/kg q8-12h.

Renal Dosing: No adjustment necessary.

Rifaximin - Xifaxan ®:

DOSAGE AND ADMINISTRATION
Dosing (Adults): Travelers' diarrhea: Oral: 200 mg 3 times/day for 3 days.

Supplied: 200 mg tab.

Tigecycline - Tygacil ®:

Glycylcycline antibiotic. Derivative of minocycline.

DOSAGE AND ADMINISTRATION
Dosing (Adults):
Complicated skin/skin structure or intra-abdominal infections:
Initial: 100 mg IV as a single dose.
Maintenance dose: 50 mg every 12 hours.
Recommended duration of therapy: Intra-abdominal infections or complicated skin/skin structure infections: 5-14 days.

Renal Dosing: No adjustment necessary.

Supplied: 50 mg (Injection - powder for reconstitution)

Telithromycin - Ketek ®:

Ketolide antibiotic.

DOSAGE AND ADMINISTRATION
Dosing (Adults):

Acute exacerbation of chronic bronchitis, acute bacterial sinusitis: 800 mg orally once daily for 5 days.

Community-acquired pneumonia: 800 orally mg once daily for 7-10 days.

Renal Dosing: crcl <30 mL/minute: 600 mg once daily. When renal impairment is accompanied by hepatic impairment, reduce dosage to 400 mg once daily. Hemodialysis: Administer dose following dialysis.

Supplied: 300 mg, 400mg tab.

Tinidazole - Tindamax ®:

Antiprotozoal.

DOSAGE AND ADMINISTRATION
Dosing (Adults):
Amebiasis, intestinal: Oral: 2 g/day for 3 days.

Amebiasis, liver abscess: Oral: 2 g/day for 3-5 days.

Giardiasis: Oral: 2 g as a single dose.

Trichomoniasis: Oral: 2 g as a single dose; sexual partners should be treated at the same time.

Renal Dosing:   no adjustment necessary.

Supplied: 250 mg, 500 mg tab.

Sulfa Allergy:

®:

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.