2PD Fall 2023 Anti-infective Top 200 drugs

Acyclovir brand name

Zovirax

Zovirax generic name

Acyclovir

Acyclovir therapeutic class

Viral DNA Polymerase Inhibitor

Acyclovir FDA Labeled Indication

Genital herpes Simplex: initial and recurrent episodes, suppressive therapy

Herpes zoster (Shingles)

Varicella (Chickenpox)

Cold sores (Orolabial HSV treatment)

Acyclovir MOA

competitively inhibits viral DNA synthesis by inactivation of viral DNA polymerase and incorporation into and termination of viral DNA replication.

Acyclovir boxed warnings

none

Acyclovir pregnancy category

not contraindicated

Acyclovir ADRs

malaise

Acyclovir key counseling points

Complete full course of therapy.

Ensure adequate hydration.

For HSV, initiate treatment as soon as possible at first sign of lesion (treatment most effective if initiated within 24 h of lesion onset).

For VZV, treatment should begin within 24 h of appearance of rash.

Symptoms should improve within 2-3 d; if they worsen, seek follow-up with HCP.

If using for prophylaxis or suppression of infection, this medication should reduce the number of breakouts.

Maintain adequate hydration during therapy

Amoxicillin brand name

Amoxil, Moxatag, Trimox

Amoxil generic name

Amoxicillin

Moxatag generic name

Amoxicillin

amoxicillin therapeutic class

beta-lactam antibiotic

Amoxicillin FDA Labeled Indication

Acute otitis media:

Lower respiratory tract infection:

Pharyngitis, tonsillitis

Streptococcal pharyngitis:

Ear, nose, and throat infection,

infection of skin and/or subcutaneous tissue,

infection of genitourinary system

H. pylori GI tract infection with PPI

Amoxicillin MOA

Semisynthetic penicillin derivative that inhibits the biosynthesis of bacterial cell wall mucopeptide.

Typically active against Streptococcus, Enterococcus, Staphylococcus, and Enterobacteriaceae.

Amoxicillin boxed warnings

none

Amoxicillin pregnancy category

Not contraindicated, but human data suggest risk in 1st and 3rd trimesters

Amoxicillin ADRs

diarrhea, nausea

Amoxicillin Key counseling points

Complete full course of therapy.

For the suspension, shake well and store in the refrigerator. Note short expiration after reconstitution.

Can take with food if causes upset stomach.

Avoid mixing suspension with food or beverages and use with measuring device that comes with prescription.

Symptoms should improve within 2-3 d; if they worsen, seek follow-up with health-care practitioner.

May decrease effectiveness of oral contraceptives; encourage patients to use backup contraceptive method (eg, condom).

Amoxicillin/Clavulanate brand name

Augmentin

Augmentin generic name

amoxicillin/clavulanate

Amoxicillin/Clavulanate Therapeutic class

beta-lactam antibiotic

Amoxicillin/Clavulanate common FDA indication

Acute otitis media:

Community-acquired pneumonia:

Lower respiratory tract infection:

Sinusitis, infection of skin or subcutaneous tissue, infectious disease of genitourinary system:

Urinary tract infection, acute cystitis:

Urinary tract infection, pyelonephritis:

Amoxicillin/Clavulanate MOA

a semisynthetic penicillin derivative.

Typically active against Streptococcus, Enterococcus, Staphylococcus, and Enterobacteriaceae.

Amoxicillin is not effective against β-lactamase-producing bacteria.

Clavulanate, a β-lactamase inhibitor, has weak antibacterial activity but is a potent inhibitor of plasmid-mediated β-lactamases and protects amoxicillin from degradation by β-lactamases.

Amoxicillin/Clavulanate boxed warnings

none

Amoxicillin/Clavulanate pregnancy category

Human data suggest risk in 1st and 3rd trimesters (amoxicillin); Compatible (clavulanate)

Amoxicillin/Clavulanate ADRs

nausea and diarrhea

Amoxicillin/Clavulanate key counseling points

Complete full course of therapy.

Take dose with food to ensure proper absorption.

For the suspension, shake well and store in the refrigerator. Note short expiration after reconstitution of 10 d.

Avoid mixing suspension with food or beverages.

Symptoms should improve within 2-3 d; if they worsen, seek follow-up with health-care practitioner.

May decrease effectiveness of oral contraceptives; encourage patients to use backup contraceptive method (eg, condom).

Azithromycin brand name

Zithromax, Z-Pak

Z-Pak generic name

Azithromycin

Zithromax generic name

Azithromycin

Azithromycin therapeutic class

macrolide antibiotic

Azithromycin Common FDA Label Indication

Acute infective exacerbation of COPD, skin or tissue infection:

Bacterial sinusitis:

Chancroid, nongonococcal cervicitis, nongonococcal urethritis:

Community-acquired pneumonia:

Sexually transmitted infections:

Streptococcal pharyngitis:

Azithromycin MOA

a macrolide antibiotic that is slightly less active than erythromycin against gram-positive bacteria but substantially more active against M. (B.), Haemophilus sp., Legionella sp., Neisseria sp., Bordetella sp., Mycoplasma sp., and C. trachomatis.

It binds to the 50S ribosomal subunit, thus interfering with microbial protein synthesis.

Azithromycin boxed warnings

none

Azithromycin pregnancy category

compatible, not contraindicated

Azithromycin ADRs

Diarrhea, nausea, vomiting

Azithromycin Key Counseling Points

Complete full course of therapy.

Take tablets with or without food, although some patients report increased tolerability when given with food.

Avoid mixing suspension with food or beverages, but food can be taken afterward.

Symptoms should improve within 2-3 d; if they worsen, seek follow-up with healthcare practitioner.

Cefdinir brand name

Omnicef

Omnicef generic name

Cefdinir

cefdinir therapeutic class

Third-Generation Cephalosporin (cefdree)

Cefdinir Common FDA Label Indication

Acute otitis media, pharyngitis, tonsillitis:

Bronchitis, acute, secondary bacterial infection:

Community-acquired pneumonia, uncomplicated skin, and/or subcutaneous tissue infection:

COPD, acute exacerbation:

Streptococcal pharyngitis, group A (alternative agent for mild, nonanaphylactic, penicillin allergy):

Cefdinir MOA

a 3rd-generation cephalosporin with activity against a number of gram-positive and gram-negative bacteria including β-lactamase-producing strains.

Inhibits bacterial cell wall synthesis via acylation transpeptidase enzyme

Cefdinir boxed warnings

none

Cefdinir pregnancy category

Compatible, not contraindicated

Cefdinir ADRs

diarrhea

cefdinir key counseling points

Complete full course of therapy.

For the suspension, shake well and can be stored at room temperature. Note 10 d expiration after reconstitution.

Avoid mixing suspension with food or beverages, but food can be taken afterward.

Symptoms should improve within 2-3 d; if they worsen, seek follow-up with HCP.

Separate administration of antacids, iron, and vitamins by 2 h.

Cephalexin brand name

Keflex, Daxbia

Keflex generic name

cephalexin

Daxbia generic name

cephalexin

Cephalexin therapeutic class

First-Generation Cephalosporin

Cephalexin FDA Labeled Indication

Infection of skin and/or subcutaneous tissue:

Osteomyelitis:

Otitis media, respiratory tract infection, UTI:

Streptococcal pharyngitis:

Cellulitis (nonpurulent), erysipelas:

Cephalexin MOA

a 1st-generation cephalosporin that inhibits bacterial wall synthesis of actively dividing cells by binding to ≥1 penicillin-binding proteins (PBPs).

Most gram-positive bacteria, including non-penicillinase- and penicillinase-producing staphylococci and streptococci. Activity against gram-negative bacteria is less than that observed with the 2nd- and 3rd-generation cephalosporins and is primarily restricted to E. coli, Klebsiella, and Proteus mirabilis.

Cephalexin boxed warnings

none

Cephalexin pregnancy category

Compatible, not contraindicated

Cephalexin ADRs

nausea

Cephalexin Key counseling points

Seek medical attention if rash develops.

Complete full course of therapy.

For the suspension, shake well and store in the refrigerator. Note short expiration after reconstitution.

Avoid mixing suspension with food or beverages, but food can be taken afterward.

Symptoms should improve within 2-3 d; if they worsen, seek follow-up with health-care practitioner.

Ciprofloxacin brand name

Cipro, Cipro XR

Cipro generic name

Ciprofloxacin

Ciprofloxacin therapeutic class

Fluoroquinolone Antibiotic

Ciprofloxacin FDA labeled indications

Anthrax, postexposure prophylaxis:

Bacterial prostatitis, chronic:

Bronchitis, lower respiratory tract infection, infection of bone, skin, or soft tissue, sinusitis:

Urinary tract infectious disease:

Ciprofloxacin MOA

a fluoroquinolone that inhibits bacterial DNA gyrase and Topoisomerase IV. It is highly active against aerobic, gram-negative bacilli.

Ciprofloxacin Box Warning

May exacerbate muscle weakness in patients with myasthenia gravis,

tendon inflammation and rupture,

peripheral neuropathy, CNS effects,

cardiac, dermatologic and hypersensitivity reactions,

aortic dissection and rupture,

hypoglycemia,

mental health adverse effects

Ciprofloxacin pregnancy category

Contraindicated, Category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Ciprofloxacin ADRs

Tooth discoloration in infants (as tetracyclines), musculoskeletal signs and symptoms

ciprofloxacin key counseling points

Seek medical attention if decreased urination, yellowing of eyes, blistering skin rash or extreme fatigue, unusual bruising or bleeding, shortness of breath or chest pain, tendon pain, muscle weakness, a "pins and needles" tingling or pricking sensation, numbness in the arms or legs, confusion or hallucinations.

Take with or without food, but not with milk or other dairy products.

Take at least 2 h before or 6 h after antacids, sucralfate, or mineral supplements and multivitamins with calcium, iron, or zinc. (as Cefdinir)

If using the suspension, shake well before use; suspension may be stored at room temperature.

Ciprofloxacin Otic brand name

Cetraxal, Otiprio

Cetraxal generic name

Ciprofloxacin otic

Otiprio generic name

Ciprofloxacin Otic

Ciprofloxacin Otic Therapeutic class

Fluoroquinolone Antibiotic

Ciprofloxacin Otic FDA labeled indications

Otitis externa, acute:

Otitis media with effusion:

Ciprofloxacin Otic MOA

a fluoroquinolone that inhibits bacterial DNA gyrase and Topoisomerase IV. It is highly active against aerobic, gram-negative bacilli.

Ciprofloxacin Otic Box warnings

none

Ciprofloxacin Otic pregnancy category

Weigh risks and benefits, no adequate studies yet

Ciprofloxacin otic ADRs

Application site pain and itching

Ciprofloxacin otic key counseling points

Warm solution by holding container in hands for at least 1 min before administering.

Patient should lie with affected ear upward; position should be maintained for at least 1 min after instillation; repeat in the opposite ear if necessary.

Clindamycin brand name

Cleocin

cleocin generic name

Clindamycin

clindamycin therapeutic class (including topical)

lincosamide antibiotic

Clindamycin common FDA labeled indication

Bacterial infectious disease, susceptible infections due to anaerobic organisms, staphylococci, streptococci, pneumococci:

Infection of skin and/or subcutaneous tissue:

Lower respiratory tract infection:

Pelvic inflammatory disease:

Septicemia:

Osteomyelitis:

Diabetic foot infection:

Clindamycin MOA (including topical)

a semisynthetic 7-chloro-7-deoxylincomycin derivative that is active against most gram-positive organisms except enterococci and C. difficile. Gram-negative aerobes are resistant, but most anaerobes are sensitive.

It inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit; it is bactericidal or bacteriostatic depending on the concentration, organism, and inoculums.

Clindamycin boxed warning

Colitis (C.Diff)

Clindamycin (including topical) pregnancy category

compatible, not contraindicated

clindamycin ADRs

Nausea

Clindamycin Key counseling points

Complete full course of therapy. Symptoms should improve within 2-3 d; if they worsen, seek follow-up with HCP.

Take with full glass of water.

Remain upright for 30 min after dose to minimize risk of GI ulceration.

Clindamycin topical brand name

Cleocin T, Clindagel, Clindesse, Evoclin

Cleocin generic name

Clindamycin

Clindagel generic name

Clindamycin

Clindesse generic name

Clindamycin

Evoclin generic name

Clindamycin

Clindamycin Topical FDA labeled indication

Acne vulgaris: Topical solution, lotion, gel, apply thin-film bid to affected areas; Foam, apply once daily to affected areas

Bacterial vaginosis: Suppositories

Clindamycin topical box warnings

none

Clindamycin topical ADRs

dry skin

Clindamycin topical key counseling points

Wash and dry face prior to application. Use on skin only, avoid eyes and mucous membranes, avoid cut or broken skin.

Shake well before use. Liquid is flammable;

avoid smoking while applying or exposure to heat or open flame.

For the foam, apply to tissue and use that to apply to face.

Doxycycline brand name

Vibramycin, Doxy 100

Vibramycin generic name

Doxycycline

Doxy 100 generic name

Doxycycline

doxycycline therapeutic class

Tetracycline Antibiotic

Doxycycline Common FDA Label Indication

Acinetobacter infection:

Acne vulgaris:

Gonorrhea, uncomplicated:

Staphylococcal infection of skin:

Pneumonia, community-acquired, empiric therapy:

doxycycline boxed warning

None