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Antibiotic Use During Pregnancy and Lactation

At any given time, more than 10 million women in the United States are pregnant or lactating, and exposing a fetus or newborn to antibiotics can pose a unique threat. Changes during pregnancy and lactation also can trigger pharmacokinetic and pharmacodynamic modifications that alter the effectiveness of antibiotics. buy augmentin 875 mg Nahum and colleagues reviewed the literature on antibiotic use to provide updated, evidence-based information on antibiotic use in women who are pregnant or lactating.

The researchers examined published medical literature, sources on teratogenicity and prescribing for women who are lactating or pregnant, and they abstracted data from product labels for drugs approved by the U.S. Food and Drug Administration (FDA) for use during pregnancy. The authors identified 124 references that covered 11 commonly prescribed antibiotics, all of which cross the placenta and are excreted in human breast milk.

There was no teratogenic potential for penicillins G and V potassium (V-Cillink); unlikely potential for amoxicillin, chloramphenicol (Chloromycetin), ciprofloxacin (Cipro), doxycycline (Vibramycin), levofloxacin (Levaquin), and rifampin (Rifadin); and undetermined potential for clindamycin (Cleocin), vancomycin, and gentamicin (see accompanying table) . All agents were FDA Pregnancy Category B (amoxicillin, clindamycin, penicillin G, penicillin V potassium, and vancomycin) or C (chloramphenicol, ciprofloxacin, gentamicin, levofloxacin, and rifampin), except for doxycycline, which was category D.

Evidence suggested that increased maternal dose or shorter dosing intervals should be considered for amoxicillin, gentamicin, and penicillins G and V potassium. However, information on pharmacokinetics during pregnancy was inadequate for the other antibiotics. There were limited data on several other aspects of antibiotic use during pregnancy, but the authors stress that conducting studies in this area would be challenging.

Despite the lack of scientific evidence, the authors conclude that physicians should make balanced judgments about the well-being of the mother and her child before making decisions about antibiotic use during pregnancy and lactation.

Which Antibiotics Are Best for Skin and Soft Tissue Infections?

Background : Bacterial skin and soft tissue infections (SSTIs) have traditionally responded well to treatment with beta-lactam antibiotics (e.g., penicillin derivatives, first- or second-generation cephalosporins) or macro-lides. However, there has been concern whether they are still effective given the emerging resistance of Staphylococcus and Streptococcus species. Consequently, physicians have started using broader-spectrum beta-lactams (e.g., third-generation cephalosporins) or fluoroqui-nolones to treat SSTIs in the belief that they may be more effective, despite limited evidence to support this approach. Falagas and colleagues conducted a meta-analysis of studies comparing the beta-lactams with fluoro-quinolones in the empiric treatment of SSTIs.

The Study : The PubMed and Cochrane databases were used to identify relevant studies published between Janu-ary 1980 and February 2006. To be included, studies had to be randomized controlled trials that examined the clinical or microbiologic effectiveness of the medications. Studies using febrile neutropenic patients were excluded, as were those evaluating nonclinical markers of effectiveness (e.g., pharmacokinetic analysis). Trials also were excluded if they involved antibiotics that had been withdrawn from the market.

Results : Twenty studies involving 4,817 patients were reviewed. The beta-lactam agents included in the studies were extended-spectrum agents (amoxicillin/clavula-nate [Augmentin], ampicillin/sulbactam [Unasyn], and piperacillin/tazobactam [Zosyn]); first-generation ceph-alosporins (cephalexin [Keflex]); and third-generation cephalosporins (cefotaxime [Claforan] and ceftazidime [Fortaz]). Fluoroquinolones included were ofloxacin (Floxin), ciprofloxacin (Cipro), fleroxacin (not available in the U.S.), levofloxacin (Levaquin), and moxifloxacin (Avelox).

Overall, fluoroquinolones were more effective than beta-lactam antibiotics for empirically treating SSTIs, but the difference was small (90.4 versus 88.2 percent resolution). Fluoroquinolones also were more effective in treating mild to moderate SSTIs. However, both of these advantages disappeared when third-generation cephalosporins were excluded from the analysis. There also was no difference between the antibiotic classes in the treatment of moderate to severe infections.

Fluoroquinolones were no more effective than beta-lactam antibiotics in the treatment of abscesses and wound infections, nor were they more effective in treating patients hospitalized for SSTIs. Microbiologically, eradication rates of S. aureus and streptococci infections were the same for the two groups of medications. However, fluoroquinolones were more effective where gram-negative or anaerobic infections were identified.

No difference in mortality rates was found between the groups. Although most medication-related adverse events were mild and involved the gastrointestinal tract, fluoroquinolones were associated with a significantly higher rate of adverse events compared with beta-lactam antibiotics (19.2 and 15.2 percent, respectively).

Conclusion : The authors concluded that although fluo-roquinolones were slightly more effective in treating SSTIs compared with beta-lactam antibiotics, this difference disappeared when third-generation cephalosporins were excluded. When the greater adverse effect profile of fluoroquinolones was also considered, there was no substantial advantage to using them over beta-lactam agents for the empiric treatment of SSTIs. Although third-generation cephalosporins often are used to treat SSTIs, they appear to be less effective than extended-spectrum penicillins and first-generation cephalosporins.

How to Get Rid of a Yeast Infection Caused by Antibiotics

Yeast infections are caused by an overproduction of yeast in your system, which often happens when you take antibiotics. Some people are more prone to developing yeast problems when taking this medication. Yeast can cause symptoms in various areas of the body, such as the neck, vagina, rectum and even the tongue and lips. It can cause itching, burning, discharge (in the case of vaginal yeast) and physical manifestations that can resemble rashes. There are several different ways that you can fight yeast infections due to antibiotics.

Is Tonsillitis Contagious?

Tonsillitis is a common infection, especially in kids. Tonsillitis is caused by viruses and bacteria like the flu and herpes simplex virus, and Streptococcus bacteria. These viruses and bacterium are spread person to person. Symptoms of tonsillitis are a yellow or white coating on the tonsils, throat pain, pain when swallowing, and hoarseness.