Antibiotic Medications

Moxifloxacin

Dosage: 400 mg a day

Route: PO

Contraindications: quinolone hypersensitivity, hepatic insufficiency, syphilis, arrhythmias, myocardial ischemia/infarction, QTs prolongation, hypokalemia, or those receiving Class IA or Class III antiarrhythmic drugs, potential benefits may warrant use in pregnant women despite potential risks if the alternative is worse

Potential Side Effects: dizziness, headaches, peripheral neuropathy, nausea, diarrhea, abdominal pain, vomiting, taste perversion, abnormal LFTs, dyspepsia, tendon rupture

Onset/Peak/Duration: 1hr/2hr/20-24hr

Tactical Considerations: use this from the casualty’s own CWMP (minimal to no mission impact)

Ertapenem

Dosage: 1g

Route: IV, IO, IM

Contraindications: hypersensitivity to carbapenem, beta-lactam, or amide-type local anesthetics (ex., lidocaine), considered relatively safe in pregnancy, if clinically indicated

Potential Side Effects: injection site phlebitis or thrombosis, asthenia, fatigue, feath, fever, leg pain, anxiety, altered mental status, dizziness, headache, insomnia, chest pain, hypo- or hypertension, tachycardia, edema, abdominal pain, diarrhea, acid reflux, constipation, dyspepsia, nausea, vomiting, increased LFTs, cough, dyspnea, pharyngitis, rales, rhonchi, respiratory distress, erythema, pruritus, rash

Onset/Peak/Duration: 30sec-5min/30min-2hr/24hr

Tactical Considerations: for IV reconstitute with 10ml NS; for IM 3.2ml 1.0% lidocaine w/o epinephrine (minimal to no mission impact)

Cephalexin

Dosage: 500mg tab

Route: PO

Contraindications: known hypersensitivity, prolonged use associated with fungal or bacterial superinfection

Potential Side Effects: abdominal pain, agitation, anemia, confusion, diarrhea, elevated transaminases, epidermal necrolysis, erythema multiform, fatigue, gastritis, headache, hypersensitivity, pseudomembranous colitis, thrombocytopenia, toxic epidermal necrolysis, urticaria, vomiting

Onset/Peak/Duration: 1hr/1-2hr/2-6hr

Tactical Considerations: alternative antibiotic given IAW PCC Guidelines

Trimethoprim/Sulfamethoxazole (Bactrim DS)

Dosage: 160mg/800mg 1 tab

Route: PO

Contraindications: known hypersensitivity, known megaloblastic or folate deficiency anemia, pregnant women at term & nursing mothers

Potential Side Effects: anorexia, nausea, vomiting, vertigo, seizure, peripheral neuritis, erythema multiforme, hyperkalemia, rash, urticaria, hypersensitivity reaction, Stevens-Johnson syndrome, toxic epidermal necrolysis, agranulocytosis, aplastic anemia, hyponatremia, fulminate hepatic necrosis

Onset/Peak/Duration: 1-4hr/1-4hr/12hr

Tactical Considerations: alternative antibiotic given IAW PCC Guidelines

Cefazolin

Dosage: 1mg injection

Route: IV/IM

Contraindications: known hypersensitivity; use with caution in those with a seizure disorder

Potential Side Effects: anorexia, diarrhea, eosinophilia, fever, increased transaminases, leukopenia, nausea and vomiting, neutropenia, oral candidiasis, phlebitis, pseudomembranous colitis, seizure, Stevens-Johnson syndrome, thrombocytopenia, thrombocytosis, vaginitis

Onset/Peak/Duration: 0.5-1hr/1-2hr/2-6hr

Tactical Considerations: alternative antibiotic given IAW PCC Guidelines

Clindamycin

Dosage: 150mg 1 tab

Route: PO

Contraindications: known hypersensitivity; risk of potentially fatal pseudomembranous colitis - discontinue if significant abdominal cramps, nausea, or passage of blood or mucous occurs

Potential Side Effects: abdominal pain, agranulocytosis, eosinophilia, diarrhea, fungal overgrowth, pseudomembranous colitis, hypersensitivity, Stevens-Johnson syndrome, rashes, urticaria, hypotension, nausea, vomiting, thrombophlebitis, neutropenia, thrombocytopenia, polyarthritis, renal dysfunction

Onset/Peak/Duration: 1hr/1hr/6hr

Tactical Considerations: alternative antibiotic given IAW PCC Guidelines

Ceftriaxone

Dosage: 250mg injection

Route: IV/IM

Contraindications: known hypersensitivity; associated with tendinitis and tendon ruptures - discontinue if any muscle or tendon/ligament pain occurs

Potential Side Effects: anaphylaxis, anemia, bronchospasm, candidiasis, diaphoresis, dizziness, induration following IM injection, eosinophilia, headache, leukocytosis, nausea, phlebitis, pruritus, thrombocytosis, diarrhea, elevated transaminases, leukopenia, rash

Onset/Peak/Duration: 250mg-2g/24hr, based on clinical condition

Tactical Considerations: alternative antibiotic given IAW PCC Guidelines, must be reconstituted with NS, D5W, lidocaine

Metronidazole

Dosage: 500mg tab

Route: PO

Contraindications: known hypersensitivity, pregnancy in 1st trimester

Potential Side Effects: appetite loss, candidiasis, diarrhea, headache, nausea, vomiting, ataxia, hypersensitivity, neutropenia, metallic taste, neuropathy, pancreatitis, seizures, thrombophlebitis, xerostomia, optic neuropathy, Stevens-Johnson syndrome, toxic epidermal necrolysis

Onset/Peak/Duration:1-2hr/1-2hr/10hr

Tactical Considerations: alternative antibiotic given IAW PGG Guidelines

Clarithromycin

Dosage: 250mg tab

Route: PO

Contraindications: known hypersensitivity, associated with QT prolongation, discontinue if signs of hepatitis occur

Potential Side Effects: abnormal taste, diarrhea, nausea, vomiting, abdominal pain, rash, dyspepsia, headache, anaphylaxis, anorexia, clostridium difficile colitis, dizziness, dyspnea, hepatic dysfunction, hypoglycemia, elevated transaminases, jaundice, manic behavior, leukopenia, neutropenia, pancreatitis, QT prolongation, seizures, Stevens-Johnson syndrome, thrombocytopenia

Onset/Peak/Duration: 0.5-1hr/1-2hr/2-6hr

Tactical Considerations: alternative antibiotic given IAW PCC Guidelines

Ciprofloxacin

Dosage: 500mg tab

Route: PO

Contraindications: known hypersensitivity

Potential Side Effects: nausea, diarrhea, vomiting, abdominal pain, dizziness, insomnia, somnolence, dyspepsia, fever, dyspnea, rash, abnormal transaminases, headache, arthralgia, muscle weakness, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema nodosum, blurred vision, tinnitus, bad taste

Onset/Peak/Duration: .5-1hr/1-2hr/2-6hr

Tactical Considerations: alternative antibiotic given IAW PCC Guidelines