Antibiotics and antidepressants

[Guest guest]

These two articles have a massive amount of valuable information from Dr.

Nicolson. Please note the warning about 2 paragraphs down regarding taking

antidepressants and others with the antibiotics. He also warns against

generics and there is a warning about clindamycin - not sure I spelled that

one right. You will want to print this for future reference. a Carnes

> Prof Garth Nicolson wrote:

> > Reply--If pts do not attend to the other information in our suggestions,

> > then I would not expect them to recover either.

> >

> > >From the Intern. J. Medicine 1998; 1: 115-117, 123-128.

> >

> > CONSIDERATIONS WHEN UNDERGOING TREATMENT FOR GULF WAR ILLNESS, CHRONIC

> > FATIGUE SYNDROME, FIBROMYALGIA SYNDROME OR RHEUMATOID ARTHRITIS

> >

> > by Prof. Garth L. Nicolson

> >

> > The Institute for Molecular Medicine, 15162 Triton Lane, Huntington

> > Beach, California 92649-1041 Tel: (714) 903-2900 Fax: (714)

> > 379-2082 E-mail: gnicimm@... Website: www.immed.org

> > _________________________________________________________

> >

> > There are a number of considerations when undergoing therapy. The IMM

> > is a nonprofit institution and does not endorse commercial products.

> > The products and procedures below are only examples of the types of

> > substances that could be beneficial to patients. Consult your personal

> > physician for advice.

> >

> > Antibiotic Therapy for Chronic Infections and Inhibiting Drugs

> >

> > Subsets of GWI (~45%), FMS (~70%), CFS (~60%) or RA (~50%) patients have

> > chronic mycoplasmal infections, and probably other infections as well.

> > Several months of doxycycline, ciprofloxacin, azithromycin, minocycline,

> > clarithromycin or other antibiotics with cycles of Augmentin in between

> > or concurrently, if needed, work best. Oral antibiotics must be taken

> > with a full glass of water to avoid esophageal irritation. During the

> > first 6 months the cycles are usually run together without a break. To

> > overcome Herxheimer reactions or die-off (chills, fever, night sweats,

> > muscle aches, joint pain, short term memory loss and fatigue) or adverse

> > responses i.v. antibiotics have been used for a few weeks, and a

> > lemon/olive drink is useful (1 blended whole lemon, 1 cup fruit juice, 1

> > tbs olive oil--strain and drink liquid). This period usually passes

> > within 1-2+ weeks. Some add the antiviral Famvir (500 mg 3X/day) for

> > the first 2 weeks in a 6-week antibiotic cycle. Mycoplasmas have some

> > characteristics of viruses, antivirals can have a useful effect, and

> > viral infections are also important in these illnesses. Antibiotic

> > uptake may be inhibited by various drugs, such as anti-depressants

> > (sertaline or Zoloft, fluoxetine or Prozac, amitriptyline or Elavil,

> > maprotiline or Ludiomil, desipramine or Norpramin, clomipramine or

> > Anafranil, nortriptyline or Pamelor, bupropion or Wellbutrin), muscle

> > relaxants (cyclobenzaprine or Flexeril), opiate agonists,

> > anticonvulsives or analgesics (oxycodone or Percodan, carbamazepine or

> > Tegretol, acetaminophen/hydrocodone or Vicodin), narcotics (codeine w/

> > Penergan, propoxyphene or Darvon, morphine), antacids, antidiarrheas,

> > metal salts, others. Some of these (some antibiotics, antidepressants,

> > analgesics, narcotics, etc.) may inhibit immune responses.

> >

> > Oxidative Therapy for Chronic Infections

> >

> > Oxidative therapy appears to be useful in suppressing infections.

> > Hyperbaric oxygen, American Biologics Dioxychlor are useful, or peroxide

> > baths using 2 cups of Epsom salt in 20 inches of hot bath or Jacuzzi.

> > After 5 min add 2-4 bottles 16 oz. of 30% hydrogen peroxide. Repeat

> > 2-3X week; no vitamins 8 hr before bath. The hydrogen peroxide is added

> > after your pores open. Hydrogen peroxide can also be directly applied

> > to skin after a work-out or hot shower/tub. One approach is to apply

> > Swedish Beauty type A tanning accelerator for 5 min before peroxide.

> > Leave hydrogen peroxide on for 5 min and then wash off. For oral

> > irrigation, mix 1 part 30% hydrogen peroxide with 2 parts water and use

> > like a mouth wash 3X per day. Most chronic illness patients have dental

> > problems, and infections are common.

> >

> > General Nutritional Considerations

> >

> > GWI/CFS/FMS/RA patients are often immunosuppressed and susceptible to

> > opportunistic infections, so proper nutrition is imperative. You should

> > not smoke or drink alcohol or caffeinated products. Drink as much fresh

> > fluids as you can, lots of fruit juices or pure water are best. Try to

> > avoid high sugar and fat foods, such as military (MRE) or other fast

> > foods and acid-forming, allergen-prone and system stressing foods or

> > high fat junk foods. Increase your intake of fresh vegetables, fruits

> > and grains, and decrease your intake of fats and simple or refined

> > sugars that can suppress your immune system. To build your immune

> > system cruciferous vegetables, soluble fiber foods, such as prunes and

> > bran, wheat germ, yogurt, fish and whole grains are useful. In some

> > patients exclusive use of 'organic' foods has been beneficial. Various

> > dietary products have been suggested, but controlled trials have not

> > been conducted.

> > Vitamins and Minerals

> >

> > GWI/CFS/FMS/RA patients are often depleted in vitamins (especially B

> > complex, C, E) and certain minerals. Chronic illnesses often result in

> > poor absorption. Therefore, high doses of some vitamins are useful;

> > others, such as vitamin B complex, cannot be easily absorbed by the gut

> > (oral). Sublingual (under the tongue) natural B-complex vitamins in

> > capsules or liquids (Total B, Real Life Research, Norwalk, CA,

> > 562-926-5522 or GNC) should be used instead of swallowed capsules.

> > General vitamins plus extra C, E, CoQ-10, beta-carotene, folic acid,

> > bioflavoids and biotin are best. L-cysteine, L-tyrosine, L-carnitine,

> > malic acid and especially flaxseed oil are reported to be useful.

> > Certain minerals are depleted in chronic illness patients, such as zinc,

> > magnesium, chromium and selenium. Some recommend up to 300 mcg/day

> > sodium selenite, followed by lower doses. Minerals should not be taken

> > at the same time of day as antibiotics because the minerals can affect

> > the absorption of antibiotics.

> >

> > Replacement of Natural Gut Flora with Lactobacillus

> >

> > Patients undergoing treatment with antibiotics and other substances risk

> > destruction of normal gut flora. Antibiotic use that depletes normal

> > gut bacteria and can result in over-growth of less desirable bacteria.

> > To supplement bacteria in the gastrointestinal system yogurt and

> > especially Lactobacillus acidophillus tablets are recommended. Mixtures

> > of Lactobacillus acidophillus, L. bifidus, B. bifidum, L. bulgaricus and

> > FOS (fructoologosaccharides) to promote growth of these " friendly "

> > bacteria in the gut (example, DDS-1, NeutraCeuticals, DDS-Plusor

> > Multi-Flora ABF, UAS Labs (800-422-3371); Intestinal Care-DF. L.

> > acidophillus mixtures above (2.5-3 billion live organisms) should be

> > taken 3X daily.

> >

> > Natural Immunoenhancers or Immunomodulators

> >

> > A number of natural remedies, such as ginseng root, herbal teas,

> > lemon/olive drink, olive leaf extract with antioxidants and are useful,

> > especially during or after antibiotic therapy. Examples are Immunocal

> > (800-337-2411), Echinacea-C (NF Formulas, 800-547-4891),

> > Super-Immunotone (Phyto Pharmica, 800-553-2370), olive leaf extract

> > (Immuno-screen, 818-966-1610), NSC-100 (Nutritional Supply,

> > 888-246-7224), Nu-Life Formula (Sophista-Care, 760-837-1908), Tahitian

> > Noni (Morinda, 800-445-8596) or Super Defense Plus (BioDefense

> > Nutritionals, 800-669-9205). These have been used to boost immune

> > systems. Although these products appear to help many patients, their

> > clinical effectiveness in chronic illness patients has not been

> > evaluated. They appear to be useful during therapy or after to boost

> > the immune system or after antibiotic therapy in a maintenance program

> > to prevent relapse of illness.

> >

> > Yeast/Fungal or Bacterial Overgrowth

> >

> > Yeast overgrowth can occur, especially in females (vaginal infections).

> > Gynecologists recommend Nizoral, Diflucan, Mycelex, or anti-yeast

> > creams. Metronidazole (Flagyl, Prostat) has been used to prevent fungal

> > or parasite overgrowth or other antifungals (Nystatin, Amphotericin B,

> > Fluconazole, Diflucan) have been administered for fungal infections

> > occuring while on antibiotics. As above, L. acidophillus mixtures are

> > used to restore gut flora. Bacterial overgrowth can also occur, for

> > example, in between cycles of antibiotics or after antibiotics have been

> > stopped. This can be controlled with 2 week courses of Augmentin (3 X

> > 500 mg/day) in between cycles or concurrent with other antibiotics.

> >

> > Flying, Exercise and Saunas

> >

> > Flying, excessive exercise and lack of sleep can make signs/symptoms

> > worse. Flying exposes you to lower oxygen tension, and can stimulate

> > borderline anaerobes that grow better at low oxygen (see above). Some

> > exercise is essential, but avoid relapses due to overexertion. Dry

> > saunas help rid the system of chemicals, and saunas should be taken at

> > least 3X per week--moderate exercise, followed by 15-20 min of dry sauna

> > and tepid shower. Repeat saunas no more than 2X per day. Work up a

> > good sweat, eliminating chemicals without placing too much stress on

> > your system, and replace body fluids after each session. During

> > exercise patients should always avoid pollutant and allergen exposures.

> > For recovery after exercise and to decrease muscle soreness, some use a

> > Jacuzzi or hot tub, but only after a sufficient cool-down period. Don't

> > get overheated in the process. Don't over do it!!!

> > ____________________________________________________________

> >

> > ANTIBIOTICS RECOMMENDED WHEN INDICATED FOR TREATMENT OF GULF WAR

> > ILLNESS, CHRONIC FATIGUE SYNDROME, FIBROMYALIGIA SYNDROME OR RHEUMATOID

> > ARTHRITIS

> >

> > by Prof. Garth L. Nicolson

> >

> > The Institute for Molecular Medicine, 15162 Triton Lane, Huntington

> > Beach, California 92649-1041

> > Tel: (714) 903-2900 Fax: (714) 379-2082 e-mail:

> > gnicimm@... Website: www.immed.org

> > _____________________________________________________________

> >

> > Doxycycline (aka Vibramycin, Monodox, Doxychel, Doxy-D, Doryx)

> >

> > Doxycycline is a broad spectrum tetracycline with good lipid solubility

> > and ability to penetrate the blood-brain-barrier. This antibiotic acts

> > by inhibiting microorganism protein synthesis; it is readily absorbed by

> > the (normal) gut, and peak blood concentrations are maintained between

> > 2-18 hours (half-life, 18-22 hrs) after an oral dose of drug. Food,

> > calcium, magnesium, antacids and some drugs reduce absorption, and

> > alcohol, phenytoin [Dilantin] or barbiturates reduce blood half-life or

> > suppress the immune system. Minocycline (Minocin) can be substituted,

> > and for some illnesses (RA) it is preferred (same dose/day).

> >

> > For GWI/CFS/FMS/RA use, the recommended oral dose is 200-300 mg/day

> > (2-3X 100 mg capsules, 2 in morning) for 6 months. After 6 months, 6

> > week cycles are suggested. Initially, doxycycline exacerbates signs/

> > symptoms (Herxheimer reactions or adverse responses, such as transient

> > fever, skin, gut discomfort, etc.) but these are usually gone within 2

> > weeks or so. Patients usually start feeling better with alleviation of

> > most major signs and symptoms within 12 weeks, but in some patients

> > major symptoms are not alleviated until after 12 weeks. Severe reactions

> > or prior damage to the gastrointestinal track may require i.v.

> > administration of 100-150 mg/day (rapid i.v. administration must be

> > avoided) for 2-3 weeks, then the remainder of the course should be oral

> > (to avoid thrombophlebitis complications which can occur with prolonged

> > i.v. therapy). Some react to the starch filler in the capsules and must

> > use Doryx, a granular form of pure doxycycline. Virtually all patients

> > relapse (show the same major signs and symptoms) if they stop therapy

> > before 6 months. In a pilot study, ~85% relapsed after 12 weeks of

> > therapy, but after 5 and 6 cycles additional 6-week courses, only 27%

> > and 11%, respectively, still relapsed after therapy. Doxycycline has

> > been used successfully with other antibiotics in situations where either

> > antibiotic alone had minimal effects (ie., doxycycline with

> > ciprofloxacin or azithromycin).

> >

> > Doxycycline and minocycline are primarily bacteriostatic and effective

> > against the following organisms: gram-negative bacteria (N.

> > gonorrhoeae, Haemophilus influenzae, Shigella species, Yersinia pestis,

> > Brucella species, Vibrio cholera); gram-positive bacteria (Streptococcus

> > pneumoniae, Streptococcus pyogenes); mycoplasmas (Mycoplasma pneumoniae,

> > Mycoplasma fermentans [incognitis], Mycoplasma penetrans); others

> > (Bacillus anthracis [anthrax], Clostridium species, Chlamydia species,

> > Actinomyces species, Entamoeba species, Treponema pallidum [syphilis],

> > Plasmodium falciparum [malaria] and Borelia species).

> >

> > Precautions: Avoid direct sunlight and drink fluids liberally,

> > especially with oral capsules. Doxycycline or minocycline therapy may

> > result in overgrowth of fungi or yeast and nonsensitive microorganisms

> > (see Considerations, p.1). Patients on anticoagulants may require lower

> > anticoagulant doses. Use during pregnancy or in children under 8 years

> > are not recommended, in the latter case due to tooth discoloration, but

> > lower doses of doxycycline have proven to be very effective in children

> > with GWI/CFS (weight 100 lbs or less, 1-2 mg/lb divided into two doses;

> > weight over 100 lbs use adult dose). Patients with impaired kidney

> > function should not take doxycycline, and the following drugs should not

> > be taken with doxycycline: methoxyflurane [Penthrane], carbamazepine

> > [Tegretol], digoxin or diuretics. Other drugs can effect uptake or

> > immune systems (see above). For complicating bacterial infections, 2

> > weeks Augmentin (3X 500 mg/day) can be taken inbetween courses of

> > antibiotics. For fungal and yeast complications, please see the

> > instructions under Other Considerations.

> >

> > Adverse Reactions: In a few patients doxycycline causes gastrointestinal

> > irration, anorexia, vomiting, nausea, diarrhea, rashes, mouth dryness,

> > hoarseness and in rare cases hypersensitivity reactions, hemolytic

> > anemia, skin hypersensitivity and reduced white blood cell counts. In

> > general, doxycycline is considered a safe drug, in that there are few

> > adverse reactions reported in the literature.

> >

> > Ciprofloxacin (aka Cipro, Cifox, Cifran, Ciloxan, Ciplox)

> >

> > Ciprofloxacin is a broad spectrum synthetic fluoroquinolone antibiotic

> > with good absorption characteristics. This drug acts on bacterial DNA

> > gyrase to inhibit bacterial DNA synthesis. Ciprofloxacin is secreted

> > rapidly in the urine and has a half-life in the blood of ~4 hrs. Food

> > delays the absorption (by ~2 hrs) but doesn't effect total absorption;

> > antacids containing magnesium, aluminum or other salts as well as

> > various drugs reduce absorption and should not be taken at the same time

> > of day.

> >

> > For GWI/CFS/FMS use, the recommended dose is 1,500 mg/day (oral, 3X 500

> > mg capsules, 2 in morning) for 6 months, then 6 week cycles of therapy.

> > Ciprofloxacin may or may not be taken with meals. Initially,

> > ciprofloxacin may exacerbate some signs/symptoms (Herxheimer reactions

> > or adverse antibiotic responses) but these are usually gone within 2+

> > weeks or so. Patients report that doses of 1000 mg/day or lower are not

> > effective in alleviating symptoms. Patients usually start feeling

> > better with alleviation of major signs/symptoms within 4-6 weeks, but in

> > some patients signs/symptoms are not reduced until after 6 weeks.

> > Ciprofloxacin has been used in patients in which doxycycline cannot be

> > tolerated or in some patients that no longer respond to doxycycline. In

> > a few cases ciprofloxacin has been used simultaneously with

> > doxycycline. Herxheimer reactions, if present, usually pass within days

> > to 2+ weeks; prior damage to the gastrointestinal system may require

> > i.v. 400-500 mg X2/day (over one hour per each infusion, rapid i.v.

> > administration is to be avoided) for 2-4 weeks, then the remainder on

> > oral antibiotic (oral doses). Virtually all patients relapse (with

> > major signs/symptoms) if drug is stopped at a 6-12 week course of

> > therapy. Additional antibiotic courses result in milder relapses after

> > drug is discontinued. Subsequent cycles of antibiotics may require the

> > use of doxycycline or other antibiotics. Sparfloxacin, a floxacin with

> > better tissue penetration, can be substituted (oral dose, 400 mg/day).

> >

> > Ciprofloxacin is effective against the following organisms:

> > gram-negative bacteria (Shigella species, Citrobacter diversus,

> > Citrobacter freundii, Escherichia coli, Klebisella pneumoniae,

> > Haemophilus influenzae, Enterobacter species, Proteus vulgaris,

> > Psuedomonas aeruginosa, Yersinia pestis, Vibrio cholera), Moraxella

> > catarrhalis; gram-positive bacteria (Streptococcus pneumoniae,

> > Streptococcus pyogenes, Staphylococcus hominis, Staphylococcus aureus,

> > Staphylococcus saprophytieus); mycoplasmas, moderately active

> > (Mycoplasma species); others (Clostridium species, Chlamydia species,

> > Mycobacterium tuberculosis).

> >

> > Precautions: Direct sunlight is to be avoided, especially with

> > sparfloxacin, and patients should not take floxacin and theophylline

> > concurrently. Ciprofloxacin therapy may result in drug crystals in the

> > urine in rare cases, and patients should be well hydrated to prevent

> > concentration of urine. Pregnant women and children should not use this

> > drug due to reduction in bone and cartilage development.

> >

> > Adverse Reactions: Adverse antibiotic responses resulted in

> > discontinuing drug in ~3.5% of patients, and such reactions included

> > nausea (5%), diarrhea (2%), vomiting (2%) abdominal pain (1.7%),

> > headache (1.2%) and rash (1.1%). In rare cases cirprofloxacin may cause

> > cardiovascular problems (<1%) and central nervous system (dizziness,

> > insomnia, tremor, confusion, convulsions and other reactions (<1%).

> > Small numbers of patients have experienced hypersensitivity

> > (anaphylactic) reactions which have required immediate emergency

> > treatment. Other drugs may effect absorption and immune systems.

> >

> > Azithromycin (aka Zithromax)

> >

> > Azithromycin is a azalide (macrolide) antibiotic with good absorption

> > and a serum half-life of ~68 hrs. This class of drug acts by binding to

> > the 50S ribosomal subunit of susceptible organisms where it interferes

> > with protein synthesis. Food decreases absorption rate, but absorption

> > is unaffected by antacids containing magnesium, aluminum or other salts;

> > other drugs may affect absorption (see above).

> >

> > For GWI/CFS/FMS use, the recommended dose is 500 mg/day (oral, 2X 250 mg

> > capsules taken at once) for each 6-week cycle of therapy. Azithromycin

> > should not be taken with meals (1 hour before or 1hour after).

> > Initially, azithromycin may exacerbate some symptoms but these are

> > usually gone within 2+ weeks. Patients usually start feeling better

> > with alleviation of most major signs/symptoms within weeks, but in some

> > patients major symptoms are not alleviated within months. Azithromycin

> > has been used in patients in which doxycycline cannot be tolerated or in

> > patients that no longer respond to doxycycline. Herxheimer reactions

> > are rare and usually passes within a few days to weeks. Virtually all

> > patients relapse (show the same major signs/symptoms) after 12 weeks

> > then terminating therapy. Additional cycles of antibiotic result in

> > milder relapses after drug is discontinued. Azithromycin has been shown

> > to be safe for pediatric use (10 mg/kg/day is recommended for children

> > under 14, but see below).

> >

> > Azithromycin is effective against the following organisms:

> > gram-negative bacteria (Bordetella pertussis, Shigella species,

> > Haemophilus influenzae, Chlamydia species, Yersinia pestis, Brucella

> > species, Vibrio cholera); gram-positive bacteria (Streptococci group C,

> > F, G); mycoplasmas (Mycoplasma species); others (Clostridium species,

> > Treponema pallidum [syphilis], and Borelia sp).

> >

> > Precautions: Azithromycin is principally absorbed by the liver, and

> > caution should be exercised with patients with impaired liver function.

> > Antacids containing magnesium, aluminum or other salts should not be

> > taken at the same time of day with azithromycin. Other drugs can also

> > interfere. Macrolides and terfenadine (Seldane) or astemizole (Hismaral)

> > may dangeriously evelate plasma antihistamine and cause arrhythmias and

> > increase serum theophyline levels in some patients, particularly those

> > receiving methylated xanthine causing nausea, vomiting, seizures.

> > Plasma levels of carbamazepine (Tegretol) can also be elevated, leading

> > to carbamazepine toxicity and nausea, vomiting, drowsiness and ataxia.

> >

> > Adverse Reactions: Adverse antibiotic responses were mild to moderate in

> > clinical trials and included diarrhea (5%), nausea (3%), abdominal pain

> > (3%). In rare cases (<1%) azithromycin may cause cardiovascular

> > problems (palpitations, tachycardia, chest pain) and central nervous

> > system (dizziness, headache, vertigo), allergic (rash, photosensitivity,

> > angioderma), fatigue and other reactions (<1%). In pediatric patients

> > >80% of the adverse reponses were gastrointestinal. In children, doses

above the suggested 10 mg/kg/day have been shown to produce hearing loss in

some patients.

> >

> > Clarithromycin (aka Biaxin)

> >

> > Clarithromycin is a broad spectrum macrolide antibiotic with good

> > absorption and serum half-life. This drug acts by binding to the 50S

> > ribosomal subunit of susceptible organisms and interfering with protein

> > synthesis. The drug is mostly bacterostatic but high concentrations can

> > be bactericidal. Food decreases absorption rate, but absorption is

> > unaffected by antacids containing magnesium, aluminum or other salts.

> > Some drugs may interfere with absorption or depress immune systems (see

> > above).

> >

> > The recommended dose is 500-750 mg/day (oral, 2-3X 250 mg capsules, 2

> > taken in morning) for 6 months of therapy, then 6-week cycles.

> > Clarithromycin should not be taken with meals (1 hr before or 1 hr

> > after). Initially, clarithromycin may exacerbate some symptoms due to

> > Herxheimer reactions and bacterial death but these are usually gone

> > within weeks. Patients usually start feeling better with alleviation of

> > most major signs and symptoms within 1-2 weeks, but in some patients

> > major symptoms are not alleviated until after 12 weeks or so.

> > Clarithromycin has been used in patients that do not respond or cannot

> > tolerate doxycycline. Herxheimer reactions usually pass within days to

> > weeks. Virtually all patients relapse (show the same major

> > signs/symptoms) when therapy stopped within 12 weeks. Additional

> > cycles of antibiotic result in milder relapses after drug is

> > discontinued. For children, the recommended dose is 15 mg/kg/day X2; at

> > this dose some children have gastrointestinal problems.

> >

> > Clarithromycin is effective against the following organisms:

> > gram-negative bacteria (Neisseria gonorrhoeae, N. menigitidis, Moraxella

> > catarrhalis, Campylobacter jejuni, Eikenella corrodens, Haemophilus

> > ducreyi, Bordetella pertussis, Shigella species, Salmonella species,

> > Haemophilus influenzae, Chlamydia species, Yersinia pestis, Brucella

> > species, Vibrio cholera, Aeromonos species, E. coli, gram-positive

> > bacteria (Streptococcus pyogenes, S. pneumeniae, anerobic Streptococci,

> > Enterococcus faccalis, Staphlococcus aureus, S. epidermidis, Bacillus

> > anthracis, Corynebacterium diptheriae, C. minutissimum, Listeria

> > monocytogenes, Actinomyces israelii); mycoplasmas (Mycoplasma species,

> > M. pneumoniae, Ureaplasma urealyticum); others (Clostridium species,

> > Treponema pallidum [syphilis], Legionella pneumophilia, L. micdadei,

> > Mycobacterium avium, M. chelonae, M. chelonae absessus, M. fortuitim,

> > Rickettsia species and Borrelia species). Yeasts, fungi and viruses are

> > resistant.

> >

> > Precautions: Clarithromycin is principally absorbed by the liver, and

> > caution should be exercised with patients with impaired liver function.

> > Antacids containing magnesium, aluminum or other salts should not be

> > taken at the same of day as azithromycin. Other drugs may also

> > interfere (see above). Macrolides and terfenadine (Seldane) or

> > astemizole (Hismaral) may dangerously elevate plasma antihistamine and

> > cause arrhythmias and increase serum theophyline levels in some

> > patients, particularly those receiving methylated xanthine causing

> > nausea, vomiting, seizures. Plasma levels of carbamazepine (Tegretol)

> > can also be elevated, leading to carbamazepine toxicity and nausea,

> > vomiting, drowsiness and ataxia. Macrolides like clarithromycin should

> > not be used with cyclosporin (Sandimmune).

> >

> > Adverse Reactions: Adverse antibiotic responses were mild to moderate in

> > clinical trials and included diarrhea , nausea, and abdominal pain. In

> > rare cases (<1%) azithromycin may cause cardiovascular problems

> > (palpitations, tachycardia, chest pain) and central nervous system

> > (dizziness, headache, vertigo), allergic (rash, photosensitivity,

> > angioderma) and fatigue.

> >

> > Clindamycin (aka Cleocin, Dalacin, Lacin)

> >

> > Clindamycin is a semisynthetic antibiotic made from lincomycin and is

> > effective against severe anaerobic infections. It is primarily

> > bacteriostatic against a wide range of Gram-positive and anaerobic

> > pathogens, including some protozoa. It has good absorption and tissue

> > penetration; its half-life is ~3 hrs in adults and ~2 in children.

> > Since clindamycin use can result in severe colitis even weeks after

> > cessation of therapy, it should not be used as primary therapy. Food

> > does not adversely affect absorption rate, but absorption is affected by

> > antacids containing magnesium, aluminum or other salts. Some drugs may

> > interfere with absorption or depress immune systems (see above).

> >

> > The recommended dose is 600-1200 mg/day (oral, 4-8X 150 mg capsules, in

> > three divided doses) for 6-week cycles of therapy. Herxheimer reactions

> > may exacerbate signs/symptoms but these are usually gone within

> > days-weeks. Patients usually start feeling better with alleviation of

> > most major signs and symptoms within days to weeks, but in some patients

> > major symptoms are not alleviated until after several weeks or so. For

> > children, the recommended dose is 8-16 mg/kg/day divided into 3-4 doses.

> >

> > Precautions: Clindamycin should not be used in patients with

> > nonbacterial (viral, fungal) infections. Its use is associated in some

> > patients with colitis and severe, persistent diarrhea and abdominal

> > cramps, and when this occurs the drug should be discontinued. It must

> > not be used with opiates or diphenoxylate with atropine (Lomotil).

> > Patients with hepatic or renal problems require dosage adjustment.

> > Antidiarrheal drugs that reduce peristalsis, such as dipenoxylate,

> > loperamide or opioids, should be avoided. If prolonged therapy is used,

> > periodic liver and kidney function tests and blood counts should be

> > performed. It should not be used by pregnant women. Prolonged use can

> > result in overgrowth of yeasts and other nonsusceptible microorganisms.

> > Cholestyramine or colestipol resins bind clindamycin and should not be

> > administered simultaneously.

> >

> > Adverse Reactions: Adverse antibiotic responses were mainly diarrhea in

> > 2-20% of cases, some severe and dangerous (colitis). Psuedomembranous

> > colitis may develop during or several weeks after therapy. This can be

> > serious if ignored. Other gastrointestinal effects of the drug have

> > been reported (nausea, vomiting, esophagitis, abdominal pain or cramps),

> > and hypersensitivity reactions, including skin rashes occur in up to 10%

> > of patients. Mild cases of colitis should be managed promptly with

> > fluid, electrolyte and protein supplementation as indicated. Other

> > effects include transient leucopenia, polyarthritis and abnormal liver

> > function (jaundice and hepatic damage rarely occur). Clindamycin should

> > not be used with erythromycin. Clindamycin has been shown to have

> > neuromuscular blocking properties that may enhance the action of other

> > neuromuscular drugs. It should only be used with caution in patients

> > receiving such drugs.

>

> gnicimm@...

>

>