BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic GuidelinesANTIBIOTICS 6.01 AMINOGLYCOSIDES
GENERIC (TRADE) NAME CAT. INDICATION/DOSE Gentamicin Inj 80mg/2ml (as sulphate) Gentamicin Sulphate Impregnated Collagen Fleece (containing 467mg collagen, 58mg gentamicin sulphate corresponding to 35mg gentamicin, 175mg gentamicin crobefate corresponding to 35mg gentamicin) 5 x 8 cm (Septocoll)
COMMENT/CAUTIONS:
• S/E: Dose-related, ototoxicity and nephrotoxicity; avoid concurrent use with
potential y ototoxic diuretics e.g. frusemide, cephalosporins and amphotericin.
• If plasma level monitoring is available: first assay 24 hrs after starting, twice
weekly, peak levels taken 1 hour after dosing (range 5-12mg/L), trough levels
taken just before the next dose (range < 2mg/L).
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines6.02 CEPHALOSPORINS GENERIC (TRADE) NAME CAT. INDICATION/DOSE Cefaclor Tab 250mg & 500mg (Distaclor) Cefalexin Monohydrate Cap 250mg& 500mg; Suspension
child 25-50mg/kg/DAY (max 125mg/5ml & 250mg/5ml (Ceporex) [Cephalexin] Cefazolin Injection 1g vial (Ancef/Kefzol) Ceftazidime Inj 1g vial (Fortum)
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic GuidelinesGENERIC (TRADE) NAME CAT. INDICATION/DOSE Ceftriaxone Sodium Inj 1g vial (IM/IV) (Rocephin)
between 2-4 sites). Infant/child < 12
Cefuroxime Sodium Inj 750mg MSL IM, slow IV or IV infusion, 750mg q6-
(Zinacef)
COMMENT/CAUTIONS:
• 10% of patients with hypersensitivity to penicil in wil also be al ergic to
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines6.03 CHLORAMPHENICOLS GENERIC (TRADE) NAME CAT. INDICATION/DOSE *Chloramphenicol Cap 250mg
in severe infections; infants < 2 wks
COMMENT/CAUTIONS:
• Chloramphenicol is a potent, potential y toxic, broad-spectrum antibiotic,
monitor closely for side effects: may cause marrow depression (rarely
idiosyncratic marrow aplasia that may be fatal, and dose related suppression
reversible on stopping). Monitor blood counts regularly.
6.04 MACROLIDES GENERIC (TRADE) NAME CAT. INDICATION/DOSE *Clarithromycin Tab 250mg (Klacid) Erythromycin Stearate Suspension 125mg/5ml Erythromycin Ethyl Succinate MSL 400mg q6h; max 4g/DAY given in
Tab 400mg (EES) Erythromycin Stearate Tab MSL 250-500mg q 6 hourly; max 4g/DAY
250mg & 500mg COMMENT/CAUTIONS:
• Clarithromycin Indications: Please use for the treatment of complicated
infection especial y respiratory tract infection, unresponsive to standard
macrolides or in patients intolerant or al ergic to standard macrolides.
• Macrolides S/E: nausea/vomiting, diarrhoea, and arrhythmias, avoid
concomitant use with astemizole, terfenadine, cisapride, disopyramide,
amiodarone & other arrhythmogenic drugs.
• Drug interactions: Macrolides are P450 enzyme inhibitors and may increase
levels of anticoagulants, antiepileptics, antipsychotics, anxiolytics/hypnotics,
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines6.05 PENICILLINS
GENERIC (TRADE) NAME CAT. INDICATION/DOSE Amoxicillin 1g/ Clavulanate 200mg Inj (Augmentin 1.2g) [Co-Amoxiclav] Amoxicillin 500mg/ Clavulanate K 125mg Tab [Co-Amoxiclav] (Augmentin 625mg) Amoxicillin 250mg/ Clavulanate K 125mg Tab [Co-Amoxiclav] (Augmentin 375mg) Amoxicillin 200mg/ Clavulanate K 28mg Syrup [Co-Amoxiclav] (Augmentin 228mg/5ml) Amoxicillin Cap 250mg & 500mg, Suspension 125mg/5ml (Amoxyl) Cloxacillin Sodium Cap 500mg & Suspension 125mg/5ml
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic GuidelinesGENERIC (TRADE) NAME CAT. INDICATION/DOSE Cloxacillin Sodium Inj 500mg [Na content: ~2mmol/g] Penicillin G / Benzylpenicillin Inj MSL IM, slow IV or IV infusion, adult 0.3g 600mg [1 mega units/MU] (Crystapen) *Penicillin V / Phenoxymethylpenicillin Tab 250mg & Suspension 125mg/5ml
COMMENT/CAUTIONS:
• Phenoxymethylpenicillin is poorly absorbed oral y; take on an empty
stomach. Large doses esp. benzylpenicillin may cause electrolyte
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines6.06 QUINOLONES
GENERIC (TRADE) NAME CAT. INDICATION/DOSE Ciprofloxacin (as HCl) Tab MSL Adult, 500-750mg q 12 hourly.
250mg & 500mg (Ciprobay)
COMMENT/CAUTIONS:
• Quinolones: Equivalent plasma concentrations when given oral y or IV, so use oral route as soon as possible. Cautious use in pregnancy, children
and epilepsy. May cause tendon damage: at the first sign of unexplained pain
or inflammation, advise patient to discontinue treatment and rest the affected
limb until tendon symptoms have resolved.
6.07 SULPHONAMIDES
GENERIC (TRADE) NAME CAT. INDICATION/DOSE *Trimethoprim 40mg + Sulfamethoxazole 200mg /5ml Susp [Co-trimoxazole] (Bactrim 240mg/5ml) *Trimethoprim 160mg + MSL 960mg q12h, double dose in severe
Sulfamethoxazole 800mg Tab [Co-trimoxazole] (Bactrim
> 14 days. High dose for P. carini 960/tab)
COMMENT/CAUTIONS:
• Trimethoprim – Avoid in the first trimester of pregnancy.
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines6.08 TETRACYCLINES
GENERIC (TRADE) NAME CAT. INDICATION/DOSE *Doxycycline Cap 100mg MSL Take with plenty of fluid, general
(Vibramycin)
Malaria prophylaxis, adult & child >
COMMENT/CAUTIONS:
• Doxycycline Drug Interaction: Antacids and iron and zinc salts may reduce
• S/E: deposited in growing bone/teeth, may cause staining and occasional y
dental hypoplasia, do not give to children under 12 years or to
pregnant/breast-feeding women. May cause photosensitivity - avoid skin
exposure to direct sunlight or sun lamps.
6.09 OTHER ANTIBACTERIALS
GENERIC (TRADE) NAME CAT. INDICATION/DOSE *Clindamycin HCl Hydrate Cap 300mg (Dalacin C)
30mg/kg/DAY given q6-8h.
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic GuidelinesGENERIC (TRADE) NAME CAT. INDICATION/DOSE *Metronidazole Inj 500mg/100ml (Flagyl) *Metronidazole Tab 200mg or MSL Anaerobic, 400-500mg q8h; child
250mg & Suspension 200mg/5ml or 125mg/5ml (Flagyl) *Metronidazole Suppository MSL Insert 1g suppository rectal y every 8
500mg & 1g (Flagyl) *Rifampicin Cap 300mg *Trimethoprim Tab 100mg *Vancomycin (as HCl) Inj 1g Specified indication only (see Comment).
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic GuidelinesCOMMENT/CAUTIONS:
• Clindamycin S/E: Discontinue immediately if diarrhoea develops.
• Metronidazole S/E: avoid alcohol, may cause a disulfiram-like reaction
(flushing, palpitations etc). Others: unpleasant taste, furred tongue, dizziness,
headache, ataxia, dark urine, leucopoenia, rarely peripheral neuropathy.
• Rifampicin Drug Interactions: potent hepatic enzyme inducer, may reduce
levels of other drugs, e.g. estrogens, corticosteroids, phenytoin,
• Rifampicin S/E: transient increase in liver enzymes level (seek urgent
medical advice if nausea/vomiting or jaundice; monitor liver function); red
discoloration – urine/sputum/tears/soft contact lenses.
• Vancomycin indications: 1) Confirmed MRSA infection; 2) MRSA
prophylaxis in ICU; 3) septicaemia in IV drug users; 4) bone infections
(haematogenous, adult/child/prosthetic joint); 5) gastroenteritis with
clostridium difficile toxin & positive antibiotic associated colitis.
• Vancomycin is not absorbed oral y, oral route is only for treating
• Vancomycin S/E: Monitor renal & auditory function in patients prescribed
concurrent drugs that are neurotoxic and/or nephrotoxic e.g.
aminoglycosides, amphotericin B and frusemide.
• Vancomycin Injection: Avoid rapid IV infusions, may lead to anaphylactoid
reactions. If plasma level monitoring is available: target peak level (1 hr after
end of an infusion) 29-45mg/l, trough level (just before next dose) 5-10mg/l.
6.10 ANTIFUNGALS
GENERIC (TRADE) NAME CAT. INDICATION/DOSE *Amphotericin B (as sodium deoxycholate complex) Inj 50mg (Fungizone) °Fridge Item Clotrimazole Vaginal Tab 500mg (Canesten) Griseofulvin Tab 500mg (Grivin)
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic GuidelinesGENERIC (TRADE) NAME CAT. INDICATION/DOSE Itraconazole Cap 100mg (Sporanox) *Ketoconazole Tab 200mg (Nizoral) Nystatin Suspension 100,000 units/ml (Mycostatin)
COMMENT/CAUTIONS:
• Amphotericin lipid complex (Abelcet), liposomal (Ambisone) and col oidal
(Amphotec/Amphocil) formulations have different drug profiles compared to
conventional Amphothericin B (Fungizone). Consult individual product
• Amphotericin is toxic when given parenteral y. Reconstitute each 50mg vial
with 10ml WFI to produce a 5mg/ml solution, then dilute further in 490ml of
D5 to a 100ug/ml (1mg/10ml) solution (pH of glucose must not be below 4.2);
give initial test dose of 1mg in 10mls over 20-30 min, observe patient, if no
adverse reaction after 30min infuse dose as required over 2-4 hours, protect
from light, incompatible with saline solutions. Side effects include fever, chil s,
hypotension, nausea, nephrotoxicity and thrombophlebitis. Monitor for
hypokalaemia and weekly blood counts are advisable. Systemic
corticosteroids may be needed. Avoid giving other nephrotoxic drugs
• DRUG-INDUCED CANDIDIASIS: oral thrush and other stomatitis are
sometimes induced by broad-spectrum antibiotics & cytotoxics (withdraw if
possible) or inhaled corticosteroids (reduce by using spacer device, or
rinsing/wiping mouth with water after inhalation).
• Ketoconazole has been associated with fatal hepatotoxicity, monitor liver
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines6.11 ANTIMALARIALS
[Note: Please refer to current local and national guidelines for drug and regimen
of choice for malaria prophylaxis and treatment, advise on importance of
GENERIC (TRADE) NAME CAT. INDICATION/DOSE Artemether 20mg +
NF Treatment, with food: adult & child >
Lumefantrine 120mg Tab [Co-Artemether] Atovaqone 250mg + Proguanil
Treatment: Adult & child > 40 kg, 4
100mg Tab (Malarone) NOTE: Limited stocks on board, please prescribe for treatment *Chloroquine Tab base 150mg vivax, ovale & malariae) with
[250mg phosphate salt = 150mg
Prophylaxis: adult & child > 13 yo (>
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines
[Note: Please refer to current local and national guidelines for drug and regimen
of choice for malaria prophylaxis and treatment, advise on importance of
GENERIC (TRADE) NAME CAT. INDICATION/DOSE *Chloroquine Suspension 10mg/ml (base) *Doxycycline Cap 100mg MSL Treatment of malignant malaria (P. (Vibramycin) falciparum), with quinine, adult only,
*Mefloquine Tab 250mg (Lariam)
malignant malaria (P. falciparum),
Prophylaxis: adult or > 13 yo (> 45
*Proguanil Tab 100mg
or > 13 yo (> 45 kg), 200mg (2 tabs)
Quinine Sulphate Tab 300mg
Treatment of malignant malaria (P. falciparum), dose as salt, adult [300mg salt = 250mg base]
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines
[Note: Please refer to current local and national guidelines for drug and regimen
of choice for malaria prophylaxis and treatment, advise on importance of
GENERIC (TRADE) NAME CAT. INDICATION/DOSE Quinine DiHCl Inj 600mg/2ml
seriously il patient (P. falciparum),
dose as salt, adult, IV (in NS) Sulfadoxine 500mg, Pyrimethamine 25mg Tab
chloroquine for benign malaria (P. (Fansidar) vivax, ovale & malariae) or with
quinine for malignant malaria (P. falciparum), adult 3 tabs; child < 4 yo
half a tablet; 4-8 yo 1 tab; > 8 yo 2
COMMENT/CAUTIONS:
• ChloroquineS/E: hepatic/renal impairment, avoid concurrent therapy with
hepatotoxic drugs. May cause reversible retinal damage (ophthalmic
• Proguanil: If used in pregnancy for prophylaxis, give 5mg folic acid oral
• Mefloquine & chloroquine: Avoid in patients with a history of epilepsy.
• Return from malarial region: Advise to see doctor and mention possible
exposure to malaria if malaria symptoms develop, especial y within 3 months
• See section 6.08 Tetracyclines on notes on Doxycycline dose & side effects.
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic Guidelines6.12 ANTHELMINTICS/ANTIPARASITICS
GENERIC (TRADE) NAME CAT. INDICATION/DOSE Albendazole Tab Chewable Diethylcarbamazine Tab 50mg (Hetrazan) bancrofti and Brugia malayi: initial y
Levamisole Tab 50mg (Decaris, Ergamisol)
infections: adult & child > 2 mth
Mebendazole Tab Chewable MSL Threadworms/pinworms (Enterobius 100mg (Vermox) vermicularis), adult & child > 2 yo,
(Ascaris lumbricoides), adult & child
Metronidazole Tab 200mg, MSL Invasive intestinal amoebiasis: in 3-4
Suspension 200mg/5ml
Giardiasis (Giardia lamblia): 250mg
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic GuidelinesGENERIC (TRADE) NAME CAT. INDICATION/DOSE Praziquantel Tab 600mg (Cysticide) haematobium or S. mansoni):
COMMENT/CAUTIONS:
• Anthelmintics should be combined with hygienic measures to break the
autoinfection cycle – advise patients to wash hands and scrub fingernails
before meals and after visits to the toilet and to bath/shower daily. If patient
has normal bowel movements a purgative is not needed. Al members of the
6.13 ANTIVIRALS
GENERIC (TRADE) NAME CAT. INDICATION/DOSE Aciclovir Tab 200mg (Zovirax)
for 5 days or child < 2 yo 200mg 4
Aciclovir Cream 5% (Zovirax)
times daily) for 5 days. Cont. next page
BNF 5.1-5.5 All recommendations subjected to local & current Antibiotic GuidelinesGENERIC (TRADE) NAME CAT. INDICATION/DOSE Indinavir Cap 400mg (Crixivan) Specified indication only. Lamivudine Tab 150mg (Zeffix) Specified indication only. Zidovudine Cap 100mg (Retrovir) [Azidothymidine/AZT] Specified indication only. COMMENT/CAUTIONS:
• Aciclovir: higher doses may be required in immunocompromised patients. To
reduce risk of nephrotoxicity with IV route it is essential to give infusion over
60 minutes, maintaining adequate hydration and avoiding concurrent
administration of other nephrotoxic drugs.
• Post-Exposure Prophylaxis (PEP) – please refer to current guidelines.
PESTICIDE MODES OF ACTIVITY – THE IMPORTANCE OF ROTATION Roger Bryan and Raymond Cloyd Today’s insecticides and fungicides are manufactured from literally hundreds of chemical compounds – both organic and inorganic. These chemical compounds, in turn, can be grouped into several dozen chemical groups. Each group of insecticides and fungicides has associated with it a particular mode o
Metformin inhibits leptin secretion via a mitogen-activated protein kinase signalling pathway in brown adipocytes Johannes Klein*, Sören Westphal*, Daniel Kraus, Britta Meier, Nina Perwitz, Volker Ott, Mathias Fasshauer1 and H Harald Klein2 Department of Internal Medicine I, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany1Department of Internal Medicine III, Universit