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l Zidovudine (ZDV) short course 4 страница
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Carbapenems
Description: Imipenem and cilastatin sodium is a fixed combination of imipenem monohydrate (a semisynthetic carbapenem ß -lactam antibiotic) and cilastatin sodium, which prevents renal metabolism of imipenem by dehydropeptidase.
Indications: Imipenem (tienam) and cilastatin sodium solution is used IV in the treatment of serious infections caused by susceptible organisms including lower respiratory tract, skin and skin structure, intra-abdominal, gynecologic, or bone and joint infections. The drug is also used IV in the treatment of serious complicated or uncomplicated urinary tract infections, septicemia, or endocarditis caused by susceptible organisms.
Dosage: For IV/IM use 1-2 g/d droppingly (divided into 3-4 infusions by 40-60 min). The maximum daily dose may be 4 g/d.
For the treatment of mild infections, the usual adult IV dosage of imipenem is 250 mg every 6 hours (1 g daily) for infections caused by fully susceptible gram-positive or -negative aerobic or anaerobic bacteria and 500 mg every 6 hours (2 g daily) for infections caused by moderately susceptible bacteria. Adults with moderately severe infections caused by fully susceptible organisms should receive 500 mg of imipenem IV every 6 (2 g daily) or 8 (1. 5 g daily) hours, and adults with moderately severe infections caused by moderately susceptible organisms should receive 500 mg every 6 hours (2 g daily) to 1 g IV every 8 hours (3 g daily). For the treatment of severe, life-threatening infections, adults should receive 500 mg IV every 6 hours (2 g daily) for infections caused by fully susceptible organisms and 1 g IV every 6 (4 g daily) or 8 (3 g daily) hours for infections caused by moderately susceptible organisms.
The maximum adult IV dosage of imipenem recommended by the manufacturer is 50 mg/kg daily or 4 g daily, whichever is lower. However, patients older than 12 years of age with cystic fibrosis who had normal renal function have received daily dosages up to 90 mg/kg (maximum daily dosage: 4 g), given in divided doses.
Meropenem is a synthetic carbapenem ß -lactam antibiotic that is structurally and pharmacologically related to imipenem, but that does not require concomitant administration with a DHP-1 inhibitor such as cilastatin.
Indications: Meropenam is used for the treatment of intra-abdominal infections and meningitis caused by susceptible organisms.
Dosage: For IM/IV use 500 mg every 8 hours.
Penicillins
Beta-lactam antibacterials are the oldest class of antibacterials used in the treatment of infections during pregnancy. They are water-soluble, cross the placenta by diffusion, circulate in the fetus, are excreted into the amniotic fluid, and recycle in the fetus by gastrointestinal absorption. Penicillins and their derivatives have not been shown to be associated with congenital malformations and are considered safe in pregnancy.
Descriptions: Amoxicillin, Amoxicillin and Clavulanate Potassium, Ampicillin, Ampicillin Sodium, Ampicillin Sodium and Sulbactam Sodium, Ampicillin Trihydrate. Aminopenicillins are semisynthetic penicillin antibiotics that have enhanced activity against gram-negative bacteria compared with natural and penicillinase-resistant penicillins. They are generally active against gram-positive aerobic cocci and gram-positive aerobic bacilli, anaerobic bacteria, some Enterobacteriaceae including some strains of Escherichia coli, Proteus mirabilis, Salmonella, and Shigella.
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Indications: Amoxicillin and ampicillin are used orally for the treatment of upper and lower respiratory tract infections, GI tract infections, skin and skin structure infections, genitourinary tract infections, and otitis media caused by susceptible organisms. Amoxicillin and ampicillin have been used orally for the treatment of gonorrhea caused by susceptible Neisseria gonorrhoeae; ampicillin is used IM or IV for the treatment of meningitis, endocarditis, or severe respiratory tract, GI tract, bone and joint, or genitourinary tract infections caused by susceptible organisms. Aminopenicillins are used principally for the treatment of infections caused by susceptible and gram-negative aerobic bacilli (e. g., Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Salmonella). Aminopenicillins are also used for the treatment of infections caused by susceptible gram-positive aerobic cocci (e. g., enterococci, Streptococcus pneumoniae, nonpenicillinase-producing Staphylococcus aureus and S. epidermidis) or gram-positive bacilli (e. g., Listeria monocytogenes). However, with the possible exception of enterococcal infections, natural penicillins are generally the penicillins of choice for the treatment of infections caused by susceptible gram-positive cocci and aminopenicillins should not be used when penicillin G or penicillin V would be effective.
Dosage: PO 0. 5 g every 4–6 hours, in severe cases the dose may be stepped up to 10 g/d. IM/IV 500 mg every 6-4 hours, in severe cases a daily dose may be 10 g.
Side Effects: allergic reactions.
Precautions: caution with allergic history, renal dysfunctions.
Carbenicillin (Piopen)
Description: Extended-spectrum penicillin. Extended-spectrum penicillins are generally active against gram-negative bacilli that are susceptible to aminopenicillins. The drugs are also active against many strains of Enterobacteriaceae and some strains of Pseudomonas that are resistant to other currently available penicillins. They are active against some strains of E. coli, Morganella morganii (formerly Proteus morganii), Proteus mirabilis, P. vulgaris, Providencia rettgeri, Salmonella, Shigella, and Ps. aeruginosa. In addition to these organisms, acylaminopenicillins are generally active against some strains of Citrobacter, Enterobacter, Klebsiella. Extended-spectrum penicillins are generally more active against Bacteroides fragilis than other currently available penicillins.
Indications: It is used principally for the treatment of infections caused by susceptible and gram-negative bacteria (endocarditis, pneumonia, infections of urogenital tract, suppurative otitis, wound infection, etc).
Dosage: For IM use 4-8 g/d depending on the causative agent.
Cautions: Hypersensitivity reactions.
Piperacillin Sodium and Tazobactam Sodium
Descriptions: Piperacillin sodium and tazobactam sodium are a fixed combination of the sodium salts of piperacillin (an extended-spectrum penicillin antibiotic) and tazobactam (a ß -lactamase inhibitor); tazobactam synergistically expands piperacillin's spectrum of activity against many strains of ß -lactamase-producing bacteria.
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Indications: Piperacillin sodium and tazobactam sodium is used parenterally for the treatment of moderate to severe infections caused by, or suspected of being caused by, susceptible ß -lactamase-producing bacteria when piperacillin alone would be ineffective. Piperacillin sodium and tazobactam sodium is used for the treatment of intra-abdominal infections, including peritonitis, appendicitis (complicated by rupture or abscess), postpartum endometritis, pelvic inflammatory diseases, caused by piperacillin-resistant, ß -lactamase-producing strains of Escherichia coli and for peritonitis or appendicitis caused by piperacillin-resistant, ß -lactamase-producing Bacteroides fragilis, B. ovatus, B. thetaiotamicron, or B. vulgatus. The drug is also used for the treatment of uncomplicated and complicated skin and skin structure infections (including cellulitis, cutaneous abscesses, ischemic/diabetic foot infections) caused by piperacillin-resistant, ß -lactamase-producing Staphylococcus aureus; for moderately severe community-acquired pneumonia caused by piperacillin-resistant, ß -lactamase-producing Haemophilus influenzae; and for moderate to severe nosocomial pneumonia caused by piperacillin-resistant ß -lactamase-producing S. aureus or Acinetobacter baumanii, H. influenzae, Klebsiella pneumoniae, and Pseudomonoas aeruginosa susceptible to piperacillin sodium and tazobactam sodium.
Dosage and Administration: Piperacillin sodium and tazobactam sodium is administered by IV infusion over 30 minutes. Vials of piperacillin sodium and tazobactam sodium labeled as containing 2 g of piperacillin and 0. 25 g of tazobactam, 3 g of piperacillin and 0. 375 g of tazobactam, or 4 g of piperacillin and 0. 5 g of tazobactam should be reconstituted with 10, 15, or 20 ml, respectively, of compatible diluent (0. 9% sodium chloride injection, sterile water for injection, 5% dextrose injection, and bacteriostatic water for injection). Reconstituted single-dose vials of piperacillin sodium and tazobactam sodium injection should be used immediately after reconstitution. Prior to administration, reconstituted piperacillin sodium and tazobactam sodium can be diluted further to the desired volume (usually 50-150 ml) with a compatible diluent. The dosage of piperacillin sodium and tazobactam sodium recommended by the manufacturer for adults is 3. 375 g (3 g of piperacillin and 0. 375 g of tazobactam) every 6 hours.
Side Effects: Diarrhea, nausea, and constipation have been reported in up to 11% of patients receiving parenteral piperacillin sodium and tazobactam sodium. Vomiting, dyspepsia, stool changes, and abdominal pain have been reported in up to 3%, and melena, flatulence, hemorrhage, gastritis, hiccup, and ulcerative stomatitis have been reported in 1% or less of patients receiving the drug. Rash (maculopapular, bullous, urticarial, eczemoid), pruritus and fever have been reported too. Decreases in hemoglobin and hematocrit, thrombocytopenia, increases in platelet count, transient eosinophilia, transient leukopenia, and neutropenia have been reported in patients receiving piperacillin sodium and tazobactam sodium.
Precautions and Contraindications: Piperacillin sodium and tazobactam sodium is contraindicated in patients who are hypersensitive to any penicillin, cephalosporin, or ß -lactamase inhibitor. Safe use of piperacillin sodium and tazobactam sodium during pregnancy has not been established definitely. There are no adequate or controlled studies using piperacillin or tazobactam alone or piperacillin sodium and tazobactam sodium in pregnant women, and the drug should be used during pregnancy only when clearly needed.
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Macrolides
Description: Erythromycins (Erythromycin, Erythromycin Stearate), Azithromycin, Clarithromycin, Josamicin (Vilpraphen).
Macrolides are active principally against gram-positive cocci and bacilli and to a lesser extent gram-negative cocci and bacilli; the drugs also exhibit activity against chlamydia, mycoplasma, ureaplasma, spirochetes, and mycobacteria.
Indications: Macrolides are used orally in adults for the treatment of mild to moderate upper and lower respiratory tract infections and uncomplicated skin and skin structure infections caused by susceptible organisms. Oral azithromycin is also used for the treatment of urethritis or cervicitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae, and for the treatment of chancroid caused by Haemophilus ducreyi. Azithromycin is used orally for the treatment of disseminated infections caused by Mycobacterium avium complex (MAC) in patients with human immunodeficiency virus (HIV) infection and for prevention of disseminated MAC infection (both primary and secondary prophylaxis) in HIV-infected individuals. Erythromycin is considered safe for use in pregnancy. The estolate form of erythromycin is associated with hepatotoxicity in the mother and should be avoided in pregnancy. Azithromycin is a relatively new macrolide with a prolonged half-life. No studies for safety in pregnancy have been done in humans. Clarithromycin has been used in pregnancy to treat or prevent Mycobacterium avium complex (MAC) in human immunodeficiency virus (HIV)-positive women. No studies of its safety in pregnancy have been done in humans.
Dosages: Erythromycin is administered by IV injection or PO. Administration usually starts with 0. 4-0. 6 g, then 0. 2-0. 4 g every 6 hours.
Azithromycin: For PO use 0. 25-0. 5g daily.
Clarithromycin: For PO/IV use 250 mg every 12 hours during 2-5 days.
Josamicin (Vilpraphen): For PO use 0. 8-2 g/d, divided into 3 single doses.
Quinolones
Description: Ciprofloxacin Hydrochloride. Ciprofloxacin is a fluoroquinolone anti-infective agent.
Indications: Ciprofloxacin is used orally or IV in adults for the treatment of urinary tract infections, acute sinusitis, lower respiratory tract infections, skin and skin structure infections, or bone and joint caused by susceptible gram-negative and gram-positive aerobic bacteria. Ciprofloxacin is used in conjunction with metronidazole for the treatment of complicated intra-abdominal infections caused by E. coli, Ps. aeruginosa, P. mirabilis, K. pneumoniae, or Bacteroides fragilis. Because ciprofloxacin is inactive against most anaerobic bacteria, the drug is ineffective and should not be used alone if a mixed aerobic-anaerobic bacterial infection is suspected. IV ciprofloxacin is used in conjunction with IV piperacillin sodium for empiric anti-infective therapy in febrile neutropenic patients.
Dosages: Ciprofloxacin is administered orally as conventional tablets containing the hydrochloride. Ciprofloxacin is also given by IV infusion as the lactate salt. Based on pharmacokinetic parameters (i. e., area under the plasma concentration-time curve), the following regimens are considered equivalent: ciprofloxacin conventional tablets 250 mg every 12 hours—ciprofloxacin 200 mg IV every 12 hours; ciprofloxacin conventional tablets 500 mg every 12 hours—ciprofloxacin 400 mg IV every 12 hours; ciprofloxacin conventional tablets 750 mg every 12 hours—ciprofloxacin 400 mg IV every 8 hours.
Caution: There are no adequate and controlled studies to date using ciprofloxacin in pregnant women. Since the drug, like most other fluoroquinolones, causes arthropathy in immature animals, ciprofloxacin should not be used in pregnant women except for the treatment or prevention of inhalational anthrax.
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Tetracyclines
Description: Doxycycline Calcium, Doxycycline Hyclate, Doxycycline Monohydrate, Minocycline Hydrochloride, Oxytetracycline, Tetracycline, Tetracycline Hydrochloride. Tetracyclines are antibiotics and semisynthetic antibiotic derivatives obtained from cultures of Streptomyces.
Tetracycline use during pregnancy may result in genitourinary and limb abnormalities. It chelates calcium and results in staining of the teeth and bones. Tetracyclines are associated with hepatotoxicity in the mother and should be avoided in pregnancy. Nowadays they are not useful in obstetrical practice.
Lincosamides
Description: Lincomycin, Clindamycin.
Indications: Lincomycin, clindamycin are generally used for the treatment of serious infections caused by susceptible gram-positive bacteria and for the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin may be used in pregnant women who are allergic to penicillin or erythromycin. No human studies have been done; there is no evidence of teratogenicity in animal models.
Dosage: Lincomycin use PO is by 0. 5 g 3-4 times a day. Highest daily dose is 0. 6 g (divided into 2 single doses).
Clindamycin use PO is by 0. 15-0. 45 g 4 times a day.
Nitroimidasoles
Description: Metronidazole (Klion), Ornidasol, Tinidasol.
Nitroimidasoles should be avoided in the first trimester. Human studies are conflicting, but animal models demonstrate carcinogenesis. Some practitioners use it during the latter half of pregnancy because no human teratogenesis has been found.
Indications: Trichomonas colpitis and urethritis, lambliosis, amebic dysentery. They are also used for prophylaxis of anaerobic infection in abdominal surgery.
Dosages: Metronidazole for PO use 0. 75-1. 0 g/d (divided into 3 single doses).
Tinidasol for PO use is 2 g/d during 3 days (for treatment of amebic dysentery), IV 0. 4-0. 8 g for treatment of anaerobic infections.
Sulfonamides
Description: Sulfadiazine, Sulfamethizole, Sulfapyridine, Sulfasalazine, Sulfisoxazole, Sulfisoxazole Acetyl. Sulfonamides, synthetic derivatives of p-aminobenzenesulfonamide (sulfanilamide), are classified as anti-infectives if they possess antibacterial activity that is antagonized by p-aminobenzoic acid or p-aminobenzoyl glutamic acid.
Usage: Although at one time sulfonamides were widely used in the treatment and prophylaxis of infections, the development of resistance in formerly susceptible organisms has greatly limited the clinical usefulness of the drugs. Whenever possible, sulfonamide therapy should be justified by bacteriologic diagnosis. The sulfonamides readily cross the placenta. Their use in the third trimester should be avoided because they compete with bilirubin for albumin-binding sites and may cause kernicterus.
Administration and Dosage:
Sulfadiazine: Sulfadiazine is administered orally. The usual adult dosage of sulfadiazine is 2-4 g initially, followed by 2-4 g daily administered in 3-6 equally divided doses.
Sulfamethizole: 0. 5-1 g administered 3 or 4 times daily.
Cautions: Adverse effects of sulfonamides are numerous and may involve nearly all organ systems. Although serious, in some cases fatal, reactions have been reported, they occur infrequently.
Antituberculous Agents
Description: synthetic, isonicotinic acid-derivative antituberculosis agents (Isoniazid INH, Ftivazid), rifamycin B-derivative antibiotics (Rifampin, Rifampicin), Kanamycin, synthetic antituberculosis agents (Ethambutol Hydrochloride).
Indications: Isoniazid is considered part of the optimal treatment of tuberculosis in pregnant women. It is considered significantly more beneficial than the risk of untreated tuberculosis in the mother or fetus. Rifampin is active against mycobacteria and some gram-positive and -negative bacteria; it crosses the placenta and has been implicated in congenital abnormalities in case reports. The benefit of rifampin also outweighs the risk of untreated disease in pregnancy and should be used along with ethambutol when indicated. Ethambutol also crosses the placenta but has not been associated with any congenital defects. It is considered safe in pregnancy.
Dosages: Isoniazid: for PO, IM use 0. 3g 1-3 times a day. Highest single dose is 0. 5g. Highest daily dose is 0. 9 g.
Rifampicin (Rifampin, Rifadin, Rimactan): for PO use 0. 3 g 3 times a day. For IV use 0. 45-0. 6 g, highest daily dose is 1. 2 g in severe cases. For treatment of acute gonorrhea use 0. 9 g/daily orally.
Ethambutol for PO use is once a day in dosage 15 mg/kg (as starting treatment) or 25 mg/d (following treatment).
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Side effects: dizziness, headache, irritability, insomnia, paresthesia, allergic reactions, icterus, nausea and vomiting, multiple neuritis.
Precautions and contraindications: epilepsy, susceptibility to convulsions, mental diseases, atherosclerosis, renal and liver failure.
Antifungal Agents
Fluconazole (analogues: Itraconazole, Ketoconazole)
Description: synthetic triazole derivative, an azole antifungal agent.
Indications: Fluconazole is used for the treatment of oropharyngeal, esophageal, or vulvovaginal candidiasis and in the treatment of other serious systemic candidal infections (e. g., urinary tract infections, peritonitis, candidemia, disseminated candidiasis, meningitis, pneumonia). The drug is also used for the treatment of meningitis caused by Cryptococcus neoformans and for the treatment of blastomycosis, coccidioidomycosis, and histoplasmosis. Fluconazole has been used for less severe infections such as superficial fungal infections, dermatophytoses, and onychomycosis. In addition, the drug is used for prevention of serious fungal infections (e. g., coccidioidomycosis, cryptococcosis, mucocutaneous candidiasis) in patients with human immunodeficiency virus (HIV) infection and for prevention of fungal infections in other immunocompromised individuals (e. g., cancer patients, bone marrow transplant patients).
Dosage: Fluconazole is administered orally (without regard to meals) or by IV infusion. Oral and IV dosage of fluconazole are identical. For the treatment of uncomplicated vulvovaginal candidiasis in nonpregnant women, the usual dosage of oral fluconazole is a single (1 day only) 150-mg oral dose. For the treatment of recurrent vulvovaginal candidiasis in nonpregnant women, two 150-mg doses of oral fluconazole should be given 3 days apart to achieve mycologic remission and then a maintenance regimen of 100-150 mg once weekly should be given for 6 months to prevent recurrence. A 2-dose regimen of oral fluconazole (two 150-mg doses given 3 days apart) is also recommended for the treatment of severe vulvovaginal candidiasis in nonpregnant women. For the treatment of oropharyngeal candidiasis, the usual adult dosage of fluconazole is 200 mg given as a single dose on the first day of therapy, followed by 100- or 200-mg doses given once daily. Dosages up to 400 mg given once daily may be used depending on the patient's response. Although clinical evidence of different candidiasis generally resolves within several days following initiation of fluconazole therapy, the manufacturer and some clinicians recommend that the drug be continued for at least 2 weeks to decrease the likelihood of relapse.
Precautions and Contraindications: Fluconazole is generally well tolerated. However, there have been rare reports of serious hepatotoxicity (including some fatalities), mild to moderate nausea and vomiting, abdominal pain in patients receiving fluconazole. Fluconazole is contraindicated in patients with known hypersensitivity to the drug or any ingredient in the respective formulation. In pregnancy: Ketoconazole has caused syndactyly, oligodactyly, and cataracts in animals. It can also block androgens and may interfere with genital development of male fetuses. Itraconazole has caused skeletal defects, encephalocele, and macroglossia in animals.
Nystatin
Description: Nystatin is an antifungal antibiotic.
Indications: Nystatin is used orally for the treatment of intestinal candidiasis. Nystatin is poorly absorbed from skin, mucous membranes, and the gastrointestinal tract. It is considered safe for use in pregnancy.
Dosage and Administration: Nystatin is administered orally. For the treatment of intestinal candidiasis (with or without coexisting vulvovaginal candidiasis), nystatin is given in dose of 500, 000 to 1 million units 3 times daily. The drug should be administered for at least 48 hours after clinical cure to prevent relapse. As an adjunct to topical nystatin therapy for the treatment of candidal diaper rash, the drug has been administered as an oral suspension in a dosage of 100, 000 units 4 times daily.
Side Effects: Adverse effects occur infrequently with oral nystatin therapy. Mild and transitory nausea, vomiting, GI distress, and diarrhea have occurred; high oral doses (e. g., greater than 5 million units daily) are most likely to produce these adverse GI effects. Hypersensitivity reactions have been reported very rarely.
Precautions and Contraindications: Nystatin is contraindicated in individuals who are hypersensitive to the drug or any ingredient in the respective formulation.
Clotrimazole (Kanesten)
Description: Extended-spectrum antifungal agent.
Indications: Clotrimazole is used for the treatment of dermatophytosis, candidiasis. In addition, clotrimazole has been used in the treatment of patients with staphylococcosis and streptococcosis.
Dosage: Clotrimazole vaginal tablets are used by 0. 1g once a day, in the evening, during 6-7 days. 1% cream is used outwardly. Clotrimazole and miconazole use in pregnancy has not been shown to be associated with fetal abnormality and is considered safe. However, it is not recommended for use in patients with early terms of pregnancy (1-3 months).
Griseofulvin
Description: Griseofulvin is a fungistatic antibiotic.
Indications: Dermatophytoses. Griseofulvin is used in the treatment of tineas (ringworm infections) of the skin, hair, and nails, including tinea barbae, tinea capitis, tinea corporis, tinea cruris, tinea pedis, and tinea unguium (onychomycosis) caused by susceptible species of Trichophyton, Microsporum, or Epidermophyton. Griseofulvin is not effective in the treatment of pityriasis (tinea) versicolor, candidiasis, deep mycotic infections, or bacterial infections, and safety and efficacy of the drug for prophylaxis of fungal infections have not been established. Griseofulvin may cause fetal toxicity when administered to pregnant women. Griseofulvin is embryotoxic and/or teratogenic in animals. There are two reports of conjoined twins in human pregnancies. The manufacturers state that griseofulvin is contraindicated in women who are or may become pregnant.
Antivirals
Acyclovir, Acyclovir Sodium
Description: Acyclovir (ACV) is a synthetic purine nucleoside analog antiviral agent derived from guanine and is active against Herpesviridae.
Indications: Acyclovir sodium is used for the treatment of initial and recurrent mucocutaneous herpes simplex virus (HSV-1 and HSV-2) infections and the treatment of varicella-zoster infections in immunocompromised adults and children; for the treatment of severe first episodes of genital herpes infections in immunocompetent individuals; and for the treatment of HSV encephalitis and neonatal HSV infections. Acyclovir is used orally for the treatment of initial and recurrent episodes of genital herpes; for the acute treatment of herpes zoster (shingles, zoster) in immunocompetent individuals; and for the treatment of varicella (chickenpox) in immunocompetent individuals. Acyclovir has been used during all stages of pregnancy and has not been associated with adverse effects on the fetus or newborn.
Dosage and Administrations: Acyclovir is administered orally and acyclovir sodium is administered by slow IV infusion at a constant rate over at least 1 hour. For the treatment of initial episodes of genital herpes in immunocompetent individuals, the dosage of oral acyclovir recommended by the manufacturer is 200 mg every 4 hours while awake (5 times daily) for 10 days. Other clinicians state that the usual dosage of oral acyclovir for the treatment of initial genital herpes in immunocompetent adults or adolescents is 400 mg 3 times daily or 200 mg 5 times daily given for 7-10 days. IV dosage of acyclovir sodium: the manufacturer states that the maximum dosage of IV acyclovir is 20 mg/kg every 8 hours.
Side Effects: Adverse reactions generally have been minimal following oral or IV administration of acyclovir. However, potentially serious reactions (e. g., renal failure, thrombotic thrombocytopenic purpura/hemolytic uremic syndrome) can occur and fatalities have been reported.
The most frequent adverse effects of IV acyclovir are local reactions at the injection site. Renal failure, headache, encephalopathic effect, GI effects, anemia, leukocytoclastic vasculitis, leukopenia, lymphadenopathy, and thrombocytopenia have been reported in patients receiving oral acyclovir.
Precautions and Contraindications: The manufacturer cautions that both the dose and dosage interval should be carefully adjusted in patients with renal failure or in patients undergoing hemodialysis to prevent drug accumulation, decrease the risk of toxicity, and maintain adequate plasma concentrations of acyclovir. There are no adequate and controlled studies to date using acyclovir in pregnant women, and the drug should be used during pregnancy only when the potential benefits justify the possible risks to the fetus. IV acyclovir has been used during the second or third trimester of pregnancy without apparent adverse effects to the fetus.
Zidovudine
Description: Zidovudine, a synthetic antiretroviral agent, is a nucleoside reverse transcriptase inhibitor. Analoques: abacavir sulfate, delavirdine mesylate, didanosine, enfuvirtide, lamivudine, lopinavir and ritonavir, nevirapine, ritonavir, saquinavir, stavudine, tenofovir disoproxil fumarate, zalcitabine. The fixed-combination preparation containing lamivudine and zidovudine (Combivir®), the fixed-combination preparation containing abacavir, lamivudine, and zidovudine (Trizivir®) are most useful.
Indications: Oral zidovudine and IV zidovudine are used in combination with other antiretroviral agents for the treatment of human immunodeficiency virus (HIV) infection in adults and pediatric patients. Oral and IV zidovudine are used in the management of HIV infection in pregnant women and for the prevention of maternal-fetal transmission of HIV in a regimen that includes antepartum and intrapartum zidovudine therapy in the mother and zidovudine therapy in the neonate. In addition, oral zidovudine is used in conjunction with other antiretroviral agents for postexposure chemoprophylaxis of HIV infection in health-care workers and other individuals exposed occupationally via percutaneous injury or mucous membrane or skin contact with blood, tissues, or other body fluids associated with a risk for transmission of the virus.
Dosage and Administration: Zidovudine is administered orally or by intermittent IV infusion. The drug has also been given by continuous IV infusion. Combivir® and Trizivir® are administered orally, and may be administered without regard to meals. The recommended oral dosage of zidovudine for the treatment of HIV infection in adults and adolescents is 600 mg daily in divided doses. Zidovudine usually is given in a dosage of 200 mg 3 times daily or 300 mg twice daily. When Combivir® is used, adults and adolescents 12 years of age or older should receive 1 tablet (300 mg of zidovudine and 150 mg of lamivudine) twice daily. When Trizivir® is used, adults and adolescents weighing 40 kg or more should receive 1 tablet (300 mg of abacavir, 150 mg of lamivudine, and 300 mg of zidovudine) twice daily.
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