Antibiotic, Antifungal, Antiviral Drugs

Spectinomycin is used in the treatment of uncomplicated cervical, urethral, or rectal gonorrhea caused by susceptible Neisseria gonorrhoeae and also is used in the treatment of disseminated gonococcal infections. Although not considered a drug of choice for the treatment of gonococcal infections, spectinomycin is considered a useful alternative for the treatment of gonococcal infections in patients who are hypersensitive to or cannot tolerate cephalosporins and fluoroquinolones.

Oxytetracycline is administered by IM injection. IM oxytetracycline should be reserved for situations in which oral therapy is not feasible; patients receiving the drug should be switched to an oral anti-infective as soon as possible.

Minocycline hydrochloride usually is administered orally. When oral therapy is not feasible, the drug may be given by IV infusion; however, oral therapy should replace IV therapy as soon as possible. If minocycline is given IV, the risk of thrombophlebitis should be considered.

Approximately 90-100% of an oral dose of doxycycline hyclate is absorbed from the GI tract in fasting adults. Following oral administration of capsules containing doxycycline hyclate in fasting adults with normal renal function, peak serum concentrations of doxycycline are attained within 1.5-4 hours and average 1.5-2.1 mcg/mL following a single 100-mg dose and 2.6-3 mcg/mL following a single 200-mg dose.

Doxycycline calcium, doxycycline hyclate, and doxycycline monohydrate are administered orally. When oral therapy is not feasible, doxycycline hyclate may be administered by slow IV infusion; however, oral therapy should replace IV therapy as soon as possible.

Demeclocycline hydrochloride is administered orally. Because food and/or milk reduce GI absorption of demeclocycline hydrochloride, the drug should be given 1 hour before or 2 hours after meals and/or milk.

Tetracyclines, in appropriate dosage forms, are administered orally, IV, or by deep IM injection. IV or IM administration should be used only when the oral route is not feasible, and oral therapy should replace parenteral therapy as soon as possible. IM administration of tetracyclines is rarely indicated because this route of administration is painful and, in the usual dosage, produces lower serum concentrations than does oral administration. If the drugs are given IV, the risk of thrombophlebitis should be considered.

The most frequent adverse reactions to tetracyclines are dose-related GI effects including nausea, vomiting, diarrhea, bulky loose stools, anorexia, flatulence, abdominal discomfort, and epigastric burning and distress. Stomatitis, glossitis, dysphagia, sore throat, hoarseness, black hairy tongue, pancreatitis, and inflammatory lesions in the anogenital region with candidal overgrowth have also been reported occasionally.

Tetracyclines are used principally in the treatment of infections caused by susceptible Rickettsia, Chlamydia, Mycoplasma, and a variety of uncommon gram-negative and gram-positive bacteria.

Sulfisoxazole and its derivatives share the actions and uses of the sulfonamides. The relative solubility of the drug in alkaline and slightly acidic urine makes the drug particularly useful for the treatment of urinary tract infections. A combination product containing sulfisoxazole acetyl and erythromycin ethylsuccinate is commercially available for the treatment of acute otitis media caused by susceptible strains of Haemophilus influenzae in children and is usually active against ampicillin-resistant strains of the organism.