Jul
15
Ampicillin (Acillin)
July 15, 2011 | Leave a Comment
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Aug
1
Clarithromycin 250, 500 mg
August 1, 2009 | Leave a Comment
Generic Name: Clarithromycin
Brand Names: Biaxin
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Type of Drug Macrolide antibiotic.
Prescribed For: Mild to moderate infections of the upper and lower respiratory tract, tonsillitis, pharyngitis, sinusitis, exacerbation of chronic bronchitis, middle-ear infections, and for duodenal ulcers; also used for skin and other infections, including membrane attack complex (MAC) in people with advanced HIV infection.
General Information
Clarithromycin is bacteriostatic (inhibiting bacterial growth), depending on the organism in question and amount of antibiotic present. In ulcer disease, clarithromycin is used to fight Helicobacter pylori infection, which is present in almost all ulcers and most cases of stomach inflammation.
Cautions and Warnings
Do not take clarithromycin if you are allergic or sensitive to any of its ingredients or to any macrolide antibiotic.Clarithromycin should not be used during pregnancy.
Clarithromycin is primarily eliminated from the body through the liver and kidneys. People with severe kidney disease may require dose adjustments. Liver disease generally does not require an adjustment.
Colitis (bowel inflammation) has been associated with all antibiotics (see “Possible Side Effects”). If colitis does develop, your doctor should start appropriate treatment. Mild cases of colitis usually respond to the discontinuation of the medicine.
Possible Side Effects
Most side effects are mild and go away once you stop taking clarithromycin.
✓ Most common: nausea, upset stomach, changes in sense of taste, headache, he. diarrhea, abdominal pain, vomiting, and rash in children. Colitis (symptoms include severe abdominal cramps and severe, persistent, and possibly bloody diarrhea) may develop.
✓ Rare: serious abnormal heart rhythms. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Clarithromycin may increase the anticoagulant (blood-thinning) effects of warfarin in people who take it regularly, especially older adults. This combination requires careful monitoring by your doctor.
• Do not combine clarithromycin with astemizole or terfenadine.
• Combining clarithromycin and omeprazole raises the amount of both drugs in the blood.
• Two deaths have been reported in people combining Clarithromycin should not be used by peibp)e faking a macrolide antibiotic.
• Clarithromycin may raise blood levels of theophylline, possibly leading to a theophylline overdose. It can also increase the effects of caffeine.
• Combining clarithromycin and digoxin, cyclosporine or tacrolimus may lead to serious side effects.
Jul
14
PROSTATE CANCER WHAT’S THE DIAGNOSTIC SEQUENCE?
July 14, 2009 | Leave a Comment
PROSTATE CANCER: WHAT’S THE DIAGNOSTIC SEQUENCE?
A patient goes to a urologist for many reasons. More and more family physicians are doing rectal digital examinations and when they find a lump or nodule on the prostate refer the patient to a specialist. The urologist will confirm the digital diagnosis and then begin other tests to confirm or deny the first decision. He might do a biopsy of the prostate to test the tissue in the hard nodule. He almost certainly will do an ultrasound test and look at the findings on a sonogram or on a screen. There are also two blood tests he’ll do for further confirmation of a cancerous growth. As we pointed out before, there is no connection between an enlarged prostate and cancer. Usually the cancer does not press in on the urethra so there are none of the usual BPH symptoms which might get a man to go see his doctor. There could be some symptoms a man might feel such as pain in the upper thighs, the pelvis or lower back, serious weight loss and shortness of breath. Symptoms such as these might mean nothing unusual, or be a sign of some other physical problem or disease — or they could be from cancer.
If the pain is related to prostate cancer, it may be a sign that the disease has spread outside of the prostate, and often it is too late to save the patient. That’s why prostate cancer is often called a silent killer and the reason that preventive medicine must be practiced, the digital rectal exam, once a year.
Now, back to those tests to determine if the lump or nodule is cancer of the prostate. The drawing on the following page shows one way that cancer might grow in the prostate. This is viewed from the two lobes of the prostate that can be digitally examined. A biopsy is the use of a needle inserted through the perineum or the rectum to remove a sample of tissue from the suspected nodule. This can be done by feel by the urologist or with the help of ultrasound to locate the specific area.
A biopsy can be done in the doctor’s office or as an outpatient at a hospital and requires a local anesthesia. A relatively new way to take a biopsy is with what is called a “biopsy gun”. It isn’t a real. It’s a biopsy needle that is used through the rectum and guided by ultrasound, but is “fired” in and out so quickly that the patient feels pressure and hears the sound the device makes, but he feels almost no pain. No anethesia is given.
One urologist says he shows the patient the device and the noise it will. During the actual biopsy the patient jumps when he hears the sound, not because of pain. For most the use of the biopsy gun is quick, simple and painless. A lot easier than going to the hospital for a biopsy the old way. And that means it’s less costly as well for the patient. One patient said it was less painful for him than a shot in the arm.
The tissue core taken in the biopsy is evaluated to see if it is cancerous. Another technique known as fine-needle aspiration cytology is often used these days. Here a urologist inserts an extremely fine needle through the rectum and removes cells from the prostate in three, four or five different locations. The technique results in minimum pain for the patient and no anesthesia is required. If the tissue shows evidence of cancerous growth, the urologist usually will do more testing. This is to find out the placement of the cancer and the extent of it. One of these tests is the PSA test, the prostate specific antigen test. If the prostate is producing a higher level of antigen than usual, it is a good indication that cancer is present.
The other test, the PAP, or the prostate acid phosphatase, may reveal if the cancer has spread to other parts of the body. If the PAP is elevated, the urologist will follow up with chest X-rays and X-rays of the pelvic area as well as bone scans and perhaps a CAT scan if equipment is available.
There is another way that many men learn that they have cancer of the prostate. This happens during a routine TURP operation where BPH has resulted in an operation. The scrapings of tissue from the prostate are examined to see if they are benign or cancerous. If the pathologist reports there are some flakes that show cancer, the doctor then does more tests to determine the placement of the tumor, and the chance that he has already removed all of the cancerous tissue.
When cancer is found in this instance, it is usually an early beginning of the disease, and one that was not found, or was not in the right place to be discovered, with the digital exam. Again here more tests would be done and the prostate examined again to determine what procedure might be needed. This would be after the regular BPH surgery, since most evaluations of prostate tissue by a pathologist take two to three days in most areas on a routine basis.
Jul
2
Prescription Pills for Acne
July 2, 2009 | Leave a Comment
Prescription Pills for Acne
When topical antibiotics don’t do the job, dermatologists may prescribe oral medication to get the antibiotic into the bloodstream rather than just on the surface of the skin. Tetracycline and clindamycin have been widely prescribed, but some acne-causing bacteria have developed resistance to them. Now, dermatologists may be more likely to prescribe minocycline. Although this antibiotic works against acne, it is not clear that it is either more effective than other oral antibiotics or less likely to cause undesirable reactions. Anyone who is prescribed oral antibiotics needs to know This topical treatment has been flying under the radar for years. Some dermatologists tell us that it should have anti-inflammatory action and may be better tolerated than benzoyl peroxide.
Side effects: Redness, dryness, and burning.
Downside: Hard to find, although it is available from many online pharmacies. May take several weeks to work. Physicians and pharmacists seem unaware of its effectiveness, and studies are few.
Cost: Approximately $30 for a 30-gram tube.
Patients should discuss all the pros and cons of oral (systemic) antibiotic therapy with the doctor prescribing it. Certain drugs may cause rare but potentially serious side effects, such as the pseudomembranous colitis that is sometimes seen with clindamycin. One study found that people using antibiotics (oral or topical) to treat their acne were about twice as likely to come down with an upper respiratory tract infection. Colds, flus, and similar upper respiratory tract infections are usually self-limited and rarely a serious threat to health, but it makes sense to evaluate whether the acne is in fact affecting your life so much that you’d be willing to trade it for a cold. It might not make sense to take an antibiotic for mild acne that is not too bothersome. After completing a course of antibiotic treatment, acne patients may be able to keep their skin clear by using tretinoin gel or a similar product.” Adapalene or tazarotene gel may also be useful.” Using such a topical medicine as follow-up therapy can reduce the amount of antibiotic exposure. Mostly prescribed pills for acne are Cipro and Accutane.
Jul
2
Acne: Prescription Lotions and Gels
July 2, 2009 | Leave a Comment
Prescription Lotions and Gels for Acne Treatment
If treatment with benzoyl peroxide doesn’t get your pimples under control within a couple of months, check with a physician. Dermatologists often prescribe topical antibiotic gels or lotions in addition to or instead of benzoyl peroxide. Erythromycin and clindamycin are old standbys. Because they have been so widely used however, bacteria have begun to develop resistance to them. As a result, dermatologists have been restricting their use and instead turning to other approaches.
One other medication that is being prescribed is azelaic acid (Azelex, Finevin). Like benzoyl peroxide, this topical treatment seems to keep pores from clogging and to discour-age the multiplication and spread of bacteria. It too may result in burning, stinging, redness, or dryness of the skin. In rare instances, dark skin exposed to azelaic acid may develop lighter patches. If you have a cold sore or fever blister that gets worse while you are using an azelaic acid product, notify the prescribing physician immediately.
Isotretinoin or a similar compound in the vitamin A family can be very effective in treating acne and reducing the inflammation associated with severe acne. Using topical vitamin A–like compounds (retinoids) early in the course of acne lessens the likelihood of scarring, a complication of the condition. Some doctors prescribe tretinoin together with benzoyl peroxide or with an oral antibiotic such as doxycycline to clear the skin faster.
Clindamycin Gel (Cleocin T, Clinda-Derm, Evoclin Topical Foam
Clindamycin is an antibiotic that can be applied to the skin to fight acne-causing bacteria. It may take 2 months to see significant improvement, but generally this treatment is effective. Other topical antibiotics such as erythromycin gel are also effective. Some prescription products combine an antibiotic with benzoyl peroxide for greater effectiveness. These include BenzaClin and Duac Gel (clindamycin plus benzoyl peroxide) and Benzamycin (erythromycin plus benzoyl peroxide). These are effective but expensive because no generic equivalents are available.
Side effects: Itching, burning, dryness, and peeling. A rare but very serious and dangerous side effect of clindamycin that is extremely unlikely to occur but still possible with the topical form is pseudomembranous colitis. Notify your doctor immediately if you develop persistent or bloody diarrhea.
Downside: Skin bacteria (P. aches) are beginning to develop resistance to topical clindamycin.
Cost: Approximately $50 for a 60-gram tube Tretinoin Gel (Retin-A).
Retin-A speeds up cell turnover and normalizes the lower levels of the skin. With 6 weeks or more of treatment, it is frequently very helpful against acne.
Side effects: Stinging, dryness, redness, flaking, and irritation.
Downside: Retin-A makes skin more sensitive to sunburn and sun damage, so stay out of the sun and use effective protection against ultraviolet rays.
Cost: $35 to $50 for 15 grams.
There is another prescription gel or cream that is based on a vitamin. Nicomide-T gel or cream contains nicotinamide, a form of niacin. Like Retin-A, it is topical but not an antibiotic, so theoretically bacteria should not develop resistance to it. A preliminary study showed that Nicomide-T gel is as effective as clindamycin gel in reducing blemishes.” Other research confirmed that it can protect the skin and is less likely to dry it than a number of other acne treatments. It is not clear whether Nicomide-T is as effective as Retin-A, though some studies conducted by the manufacturer, Sirius Laboratories, suggest that adding it to other treatments boosts the effectiveness of both.
Jul
2
Acne: Over-the-Counter Treatment
Benzoyl peroxide is the primary ingredient in most OTC acne treatments. This compound has antimicrobial activity and is usually quite effective for mild acne.
Q. My teenage son has a mild case of acne, but to him it is huge. He washes with strong cleansers and uses a variety of acne medicines. Can you recommend something that will clear up his skin so he doesn’t scrub so much? His face is bright red after all the washing, and I don’t think that is good.
A. You’re right! Acne is not caused by dirt, so vigorous washing won’t help. It may even make things worse.
OTC benzoyl peroxide (Benzac, Clearasil Acne Treatment, Oxy 5, etc.) should do the job. If not, your son should see a dermatologist. Retin-A (tretinoin) and/or antibiotics can work wonders.
Benzoyl peroxide is found in a number of different products, from cleansing bars and liquid cleansers to lotions and even shaving creams. Read the instructions on the label and follow them; the procedure varies a little for the different forms. Benzoyl peroxide can dry the skin and cause irritation. If that happens, use it a little less frequently or look for a product with a lower concentration of the ingredient.
Benzoyl peroxide unplugs pores and discourages thegrowth of skin bacteria. It is not, however, an antibiotic, and skin bacteria don’t seem to develop resistance to it.. Follow the instructions on the product label for application and use.
Side effects: Skin irritation, dryness, redness, scaling, and rash.
Downside: Acne may worsen initially before improving. Use the product for 6 weeks to 2 months to evaluate its effectiveness..
Cost: Varies, depending on - the product; approximately $20 to $30 for a month’s worth of gel .
individuals are allergic to benzoyl peroxide and break out in hives or swelling, so try it out on your forearm first to make sure you will not react badly. If you do, you will have to forgo benzoyl peroxide treatment and look for another way to manage your acne.
A few nonprescription acne products contain active ingredients other than benzoyl peroxide. Resorcinol is generally used in combination with sulfur (Clearasil Adult Care contains them both). Salicylic acid is also found in some OTC acne products. None of these should be used in combination with benzoyl peroxide. All may irritate and dry the skin, and they should not be combined with other products that might irritate the skin. Prescription acne treatment drugs are Cipro and Accutane which are commercial names for generic Ciprofloxacin and Isotretion.