Itraconazole generally is well tolerated. However, serious potentially life-threatening adverse effects, including congestive heart failure, pulmonary edema, and hepatotoxicity, have occurred rarely in patients receiving IV or oral itraconazole. In clinical studies evaluating itraconazole for the treatment of systemic fungal infections, adverse effects requiring discontinuance of the drug occurred in up to 11% of patients; the median duration of therapy before discontinuance was 81 days (range: 2-776 days).
Terbinafine Hydrochloride
Terbinafine hydrochloride is a synthetic allylamine antifungal agent. Terbinafine is structurally and pharmacologically related to naftifine.
Quinupristin and Dalfopristin
Quinupristin and dalfopristin is a combination of 2 semisynthetic streptogramin (synergistin) antibiotics that act synergistically against susceptible gram-positive bacteria.
Quinupristin and Dalfopristin: Dosage and Administration
Quinupristin and dalfopristin is administered by IV infusion over 60 minutes. Quinupristin and dalfopristin powder for injection must be reconstituted and diluted prior to administration. The manufacturer states that only 5% dextrose injection or sterile water for injection should be used to reconstitute the powder, and further dilution should be with 5% dextrose. Strict aseptic technique must be observed since the drug contains no preservative.
Polymyxin B Sulfate
Systemic use of polymyxin B has, in most cases, been replaced by more effective and less toxic antibiotics for infections caused by susceptible organisms. However, polymyxin B may be useful in infections caused by organisms resistant to these drugs.
Colistimethate Sodium
Colistimethate sodium is used in the treatment of acute or chronic infections caused by susceptible strains of certain gram-negative bacteria (e.g., Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa).
Lincomycin Hydrochloride
Lincomycin should be not used for the treatment of minor bacterial infections or for nonbacterial infections. Because of poor CNS penetration, lincomycin should not be used in the treatment of meningitis.
Lincomycin Hydrochloride: Cautions
Adverse GI effects frequently occur with oral, IM, or IV lincomycin and may be severe enough to necessitate discontinuance of the drug. Adverse GI effects of lincomycin include nausea, vomiting, diarrhea, abdominal pain, tenesmus, glossitis, stomatitis, and pruritus ani.
Clindamycin (Cleocin)
The drug also is active in vitro against Arcanobacterium haemolyticum (formerly Corynebacterium haemolyticum). Clindamycin is active against some anaerobic and microaerophilic gram-negative and gram-positive organisms including Actinomyces, Bacteroides, Eubacterium, Fusobacterium, Propionibacterium, microaerophilic streptococci, Peptococcus, Peptostreptococcus, and Veillonella. Clindamycin is active in vitro against Prevotella and Porphyromonas (both formerly classified as Bacteroides); Mobiluncus (motile, anaerobic, curved rods) also are inhibited in vitro by the drug. Clostridium perfringens, C. tetani, Corynebacterium diphtheriae, and Mycoplasma are also inhibited by clindamycin.
Vancomycin Hydrochloride
Limited information is available on the acute toxicity of vancomycin. The IV LD50 of the drug in rats or mice is 319 or 400 mg/kg, respectively. Treatment of vancomycin overdosage is mainly supportive with maintenance of glomerular filtration.