Antibiotic, Antifungal, Antiviral Drugs

Ciprofloxacin generally is well tolerated, and adverse effects of the drug are similar to those reported with other quinolone anti-infectives (e.g., norfloxacin, ofloxacin). Adverse effects have been reported in 5-14% of patients receiving ciprofloxacin, and have been severe enough to require discontinuance in 2-3.5% of patients.

Ciprofloxacin also is used orally for the treatment of acute sinusitis, uncomplicated cervical and urethral gonorrhea, typhoid fever, and GI infections caused by susceptible bacteria. Ciprofloxacin is used in conjunction with metronidazole for the treatment of complicated intra-abdominal infections caused by E. coli, Ps. aeruginosa, P. mirabilis, K. pneumoniae, or Bacteroides fragilis. Because ciprofloxacin is inactive against most anaerobic bacteria, the drug is ineffective in and should not be used alone if a mixed aerobic-anaerobic bacterial infection is suspected. IV ciprofloxacin is used in conjunction with IV piperacillin sodium (no longer commercially available in the US as a single-entity preparation) for empiric anti-infective therapy in febrile neutropenic patients.

Adverse effects reported with ticarcillin disodium and clavulanate potassium are similar to those reported with ticarcillin alone. For information on adverse effects reported with ticarcillin and other extended-spectrum penicillins, see Cautions in the Extended-Spectrum Penicillins General Statement 8:12.16.16. Rash, pruritus, urticaria, and fever have been reported with ticarcillin disodium and clavulanate potassium.

Vials of ticarcillin disodium and clavulanate potassium labeled as containing a combined potency of 3.1 g of the drugs are reconstituted by adding approximately 13 mL of sterile water for injection or sodium chloride injection to provide a solution containing approximately 200 mg of ticarcillin per mL and 6.7 mg of clavulanic acid per mL. The vial should be shaken until the drug is dissolved.

Ticarcillin disodium and clavulanate potassium is used for the treatment of lower respiratory tract infections, skin and skin structure infections, complicated and uncomplicated urinary tract infections, bone and joint infections, septicemia, intra-abdominal infections (e.g., peritonitis), and gynecologic infections (e.g., endometritis), caused by susceptible organisms.

The drug also has been used for the treatment of anaerobic or mixed aerobic-anaerobic bacterial infections or for empiric anti-infective therapy in febrile granulocytopenic patients. For specific information on the uses of ticarcillin, seeUses in the Extended-Spectrum Penicillins General Statement 8:12.16.16. For information on the uses of ticarcillin in a fixed-ratio combination with clavulanic acid. Ticarcillin disodium is administered by slow IV injection or infusion or by deep IM injection.

Piperacillin sodium and tazobactam sodium is used parenterally for the treatment of moderate to severe infections caused by, or suspected of being caused by, susceptible b-lactamase-producing bacteria when piperacillin alone would be ineffective.

Dosage of piperacillin sodium and tazobactam sodium is expressed in terms of the total of the piperacillin and tazobactam content of the fixed combination. Potency of both piperacillin sodium and tazobactam sodium are expressed in terms of the bases of the drugs.

Oral carbenicillin indanyl sodium has been used with some success for short-term therapy or long-term suppressive therapy in the treatment of acute or chronic infections of the upper and lower urinary tract or for asymptomatic bacteriuria caused by susceptible strains of enterococci, Enterobacter, Escherichia coli, Morganella morganii, Proteus mirabilis, P. vulgaris, P. rettgeri, or Pseudomonas aeruginosa. However, most clinicians state that the drug is not a drug of choice for these infections. Some clinicians suggest that uncomplicated urinary tract infections should be treated with co-trimoxazole, fluoroquinolones, oral cephalosporins, nitrofurantoin, or fosfomycin; complicated urinary tract infections generally require parenteral therapy.

Amikacin, gentamicin, kanamycin, or tobramycin is used IM or IV in the short-term treatment of serious infections such as septicemia (including neonatal sepsis), bone and joint infections, skin and soft tissue infections (including those resulting from burns), respiratory tract infections, and postoperative and intra-abdominal infections (including peritonitis) caused by susceptible strains of gram-negative bacteria.