• Well absorbed:
• Highly lipid soluble reaches therapuetic levels in CSF the eye and prostate gland
• smaller dosage than tetracycline eliminated in urine and feces

po/IV 100-200mg

older adults po

• well absorbed after oral
• like doxycline, readily penetrates the CSF
• metabolized more than other tetracyclines, and smaller
• eliminted by the liver

po, 200mg initially then 100mg q12h

older 8y: po, 4 mg/kg initially, then 2 mg/kg q12

richettsiae

chlamydia

protoza

spirochetes

Brucella

vibrio cholerae

Bacillus anthracis (anthrax)

Chlamydia trachomatis

Respiratory tract infection due to mycoplasma pneumiae

• UTI
• Prototype drug
• Marketed under generic and numerous

po 250-500 mg q6h

older than 8 years po 25-50 mg/kg/d in 4 divide doses

• tetraycline most likely to cause photosensitivity
• primarily used to treat inappropriate secretion of antidiuretic horome
• no longer recommend for treatment of gonorrhea

po 150 mg q6h or 300 mg q12h

older than 8years po 8-12 mg/kg/d in 2-4 divided doses

• A short-acting rapidly absorbed & excreted agent for systemic infections
• The addition of folinic acid may be recommended

Nocardiosis

Toxoplasmosis

adults toxoplasmosis po 2-6 daily

in dived doses q 6h in conjunction w/ pyrimethamine

Nocardiosis 4-8 b/ day for minimum of 6 weeks

• porly absobed
• dose not alter normal bacterial in the intestine
• effectiveness in ulcerative colitis may be due to antibacterial

Ulcerative colitis/ Crohn's disease

Rheumatoid arthritis

Adults Ulcerative colitis po 3-4g daily in 4 divided doses intially 2g daily in divided doses for maintenance maximal daily dose 4 g

Rheumatoid arthritis maintenance po 2g daily in divided doses q12h

• Rapidly absorbed rapidly excreted
• Highly soluble and less likely to cause crystalluria than most other sulfonamides

UTI

Ocular infections

May exhibit synergistic effectiveness against many organisms (verifysusceptibility first)

including streptococci (S. viridans) staphylococci (S. epidermidis, S aureus) Escherichia coli, Salmonella, Shigella, Serrtia Klebsiella, Nocardia, and others

• Acute and chronic UTI
• Acute exacerbations of chronic bronchitis
• Acute otitis media caused by susceptible strains of hemophilus influenzae and Streptococcus pneumoniae
• Shigellosis
• Infection by pneumocystis jiroveci (prevention and treatment)

• UTI trimethoprim 160mg and sulfamethoxazole 800 mg po q12h for 10-14 days
• Shigellosis same doses as above for 5 d
• Sever UTI , IV, 8-10 mg (trimethoprin component) kg/d in 2-4 divided doses, up to 14 d

Childern UTI and otitis media, po 8 mg/kg trimethoprim and 40 mg/ kg sulfamethoxazole in 2 divided doses q12h for 10d

Shigellosis same dose as above for 5 d

Sever Uti IV8-10mg (trimethoprim component )/kg in 2-4 divided doses, q 6-8hor q12, up to 14d

• Effective against most gram - negative and gram-negative and gram-positive organisms especially Pseudomonas aeruginosa
• Application cause pain and burning
• Mafenide is absorbed systemically and may produce metabolic acidosis

Topical application to burn area,onece or twice daily in a thin layer

In childern is the same as in adults

• Antibacterial activity against Ecoil and most other organisms that cause UTI
• Used for short-term treatment of UTI or long-term suppression of bacteria in chronic, recurrent UTI
• Bacterial resistance develops slowly and to a limited degree
• Contraindicated in severe renal disease

Macrodantin: PO 50-100 mg 4 times daily; Macrobid 100

mg q12h for 7 d

Prophylaxis of recurrent UTI in women Macrodantin PO 50-100mg at bedtime

In childern: older than 12 years Dual-release capsules 100mg q12h for 7 days

Childern: i mounths and older PO macrocrystal capsules 5-7mg/kg/d in 4 divided dose for 7 days

• An azo dye that acts as a urinary tract analgesic and relives sysmptoms of dysuria, burning, and frequency and urgency of urination, which occur with UTI
• It has no anti-infective action
• It turns urine orange- red which may be mistaken as blood
• It is contraindicated in renal insufficiency and sever hepatitis

Adults PO 100-200mg 3 times Daily after meals

Childern: 6-12 years 12mg/kg/day in 3 divided doses after meals

•  A major concern with the use of tetracyclines and sulfonamides in older adults is renal impairment
• In younger adsults a fluid intake of 2 liters daily is needed to reduce formation of crystals & stones in the urinary tract.
• Severe skin reactions and bone marrow depression are most often reported w/ combination of trimethoprin-sulfamethoxazole

• As discussed previously, most tetracyclines are contraindicated in patients w/ renal impairment. High concentrations of tetracyclines inhibit protein synthesis in human cells.

Azotemia increased blood urea nitrogen, hyperphosphatemia, hyperkalemia, & acidosis.

Acute renal failure (ARF) has occurred when the drugs or their metabolites precipitated in renal tubules and caused obstruction. ARF is rarely associated with newer sulfonamides.