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Ch33 Antiseptics
Antiseptics and Urinary Antiinfectives
| Generic (Brand) | Route and Dosage | Uses and Considerations |
|---|---|---|
| methenamine mandelate (Mandelamine, Mandameth) | A: PO: 1 g q.i.d. p.c.C: 6–12 y PO: 0.5 g q.i.d. p.c. or 50 mg/kg in 4 divided doses p.c.C: <6 y PO: 18.4 mg/kg q.i.d. | For chronic UTIs. Urine pH should be acidic (<5.5). It should not be used with sulfonamides. May cause crystalluria, so push fluids. It can cause GI irritation, so take with meals. Pregnancy category: C; PB: UK; t½: 3–6 h |
| methenamine hippurate (Hiprex, Urex) | A: PO: 1 g b.i.d.C: 6–12 y 0.5-1 g b.i.d. | For chronic UTIs. Urine pH should be acidic (<5.5). It should not be used with sulfonamides. May cause crystalluria, so push fluids. It can cause GI irritation, so take with meals. Pregnancy category: C; PB: UK; t½: 3–6 h |
| nitrofurantoin (Furalan, Furadantin, Macrodantin) | Initial/recurrent UTI:A: PO: 50–100 mg q.i.d. with meals and at bedtime; takewith foodC: 1 mo-12 y: PO: 5–7 mg/kg in 4 divided dosesLong-term prophylaxis:A: PO: 50–100 mg at bedtimeC: 1 mo-12 y: PO: 1 mg/kg in 1–2 divided doses | To treat acute and chronic UTIs;Inhibits bacterial enzymes and metabolism; Side Effects:Anorexia, nausea, vomiting, rust/brown discoloration of urine, diarrhea, rash, pruritus, dizziness, headache, drowsiness |
| trimethoprim (Proloprim, Trimpex) | A: PO: 100 mg q12h or 200 mg q24h; if CLcr (CrCl) is 15–30 ml/min: 50 mg q12h; if CLcr <15 ml/min: do not use | For prevention and treatment of acute and chronic UTIs in both men and women. High doses can cause GI upset. Drug can be combined with sul-famethoxazole (Bactrim). Pregnancy category: C; PB: UK; t½: 8–11 h |
| ertapenem (Invanz) | A: IM/IV: 1 g every day for 10–14 days | To treat complicated UTIs. Effective against gram-positive and gram-negative bacteria. Commonly causes diarrhea, nausea, and headache. Pregnancy category: B; PB: 85%-95%; t½: 2–4 h |
| trimethoprim-sulfamethox-azole (TMP-SMZ, co-trimoxazole, Bactrim, Cotrim, Septra) | A: PO: 160/800 mg q12h (160 mg [TMP]/800 mg [SMZ])IV: 8–10 mg/kg/d in 2–4 divided doses; infuse over 1 to 1.5 hC: PO: <40 kg: 4 mg/kg/d in 2 divided dosesPO: >40 kg: same as adultIV: > 2 mo: same as adult | should not be used in infants younger than 2 months.Effective for serious UTIs and otitis media. Pregnancy category: C; PB: 60%-70%; t½: 9 h |
| cinoxacin (Cinobac) | A: PO: 1 g/d in 2–4 doses for 1–2 wkRenal dysfunction:Initially: 500 mg; if CLcr is >80 ml/min: 500 mg b.i.d.; 80–50 ml/min: 250 mg t.i.d.; 50–20 ml/min: 250 mg b.i.d.; <20 ml/min: 250 mg | For acute and chronic UTIs. More effective than nalidixic acid. Absorbed in prostatic tissue. Can cause dizziness and photosensitivity. Avoid excessive exposure to sunlight. Pregnancy category: C; PB: 60%-80%; t½: 1.5 |
| ciprofloxacin (Cipro) | A: PO: mild to moderate: 250 mg q12hA: PO: severe/complicated: 500–750 mg q12hA: IV: 200–400 mg q12h; dilute and infuse over 1 hRenal dysfunction:Decrease dosageHemo or peritoneal dialysis:250-500 mg q24h after dialysis | Has a broad-spectrum. For UTI, skin and soft tissue infections, bone and joint infections, and anthrax infection. Antacid inhibits drug absorption. Use with caution in clients with seizure disorders. Pregnancy category: C; PB: 20%-40%; t½: 4–6 h |
| enoxacin (Penetrex) | Uncomplicated UTI:A: PO: 200 mg q12h for 7 dComplicated or severe UTI:A: PO: 400 mg q12h for 14 dIf CLcr <30 ml/min, reduce dose by 50%. | Effective against complicated and uncomplicated UTIs. Fluid intake should be increased. Take before or after meals. Phototoxicity may occur. Pregnancy category: C (pregnant: X); PB: UK; t½: 3–6 h |
| lomefloxacin (Maxaquin) | A: PO: 400 mg/d × 10 d | For UTIs and transurethral surgery prophylaxis. Pregnancy category: C; PB: UK; t½: 6.25-7.75 h |
| nalidixic acid (NegGram) | A: PO: 1 g q.i.d. for 1–2 wk; 1 g b.i.d. for long-term useC: PO: 55 mg/kg/d in 4 divided doses for 1–2 wk; 33 mg/kg/d for long-term useC: <3 mo: Do not use | For acute and chronic UTIs. Resistance to drug may occur. Highly protein-bound. Not distributed in prostatic fluid. Take with food to avoid GI upset. Photosensitivity can occur. Pregnancy category: B; PB: 93%; t½: 1–2 h (elderly: 12 h |
| norfloxacin (Noroxin) | A: PO: 400 mg b.i.d. for 1–2 wk on empty stomachUncomplicated cystitis caused by E. coli, K. pneu-moniae, P. mirabilis: 400 mg b.i.d. 3 × dUncomplicated UTI caused by any other organism: 400 mg b.i.d. × 7–10 d | Complicated UTI:400 mg b.i.d. × 10–21 dRenal impairment (CLcr <50 ml/min):400 mg daily;For acute and chronic UTIs. Most potent drug of the quinolone group. Food may inhibit drug absorption. Pregnancy category: C; PB: 10%-15%; t½: 3–4 h |
| ofloxacin (Floxin) | A: PO: IV: 200 mg q12h × 10 d | For UTIs, respiratory tract and skin infections. May cause headaches, dizziness, insomnia. Pregnancy category: C; PB: 20%-32%; t½: 5-7.5 h |
| aztreonam (Azactam) | A: IM/IV: 500 mg-1 g q8-12h | Treatment of UTIs caused by gram-negative organisms. Also useful for lower respiratory infection and septicemia. Pregnancy category: B; PB: 56%-60%; t½: 1.5-2 h |
| imipenem/cilastatin sodium (Primaxin) | A: IV: 250 mg-1 g q6h; max: 4 g/d or 50 mg/kg/d, whichever is the lesser amountC: Safety and efficacy not establishedAdjust dosing in clients with renal impairment | Treatment of serious UTIs. Also useful for lower respiratory, bone, and joint infections; septicemia; endocarditis. Pregnancy category: C; PB: 20%-40%; t½: 1 h |
| polymyxin B SO4 (Aerosporin) | A & C: IV: 15,000-25,000 units/kg/d in divided doses q12h | Effective for UTIs and prevention of bacteruria from indwelling catheter. Can cause nephrotoxicity. Monitor renal function (BUN, serum creatinine). Pregnancy category: B; PB: UK; t½: 4–6 h |
| fosfomycin tromethamine (Monurol) | A & C: >12 y: PO: 1–3 g packet dissolved in 4 oz water, as a single dose | To treat uncomplicated UTIs in women. Has a bactericidal effect against most gram-negative and gram-positive bacteria. Side effects include headaches and diarrhea. Pregnancy category: B; PB: 0; t½: 5.7 h |
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zoranrula@yahoo.com
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