Treatment of Skin and soft tissue infections& Dental infections {Clindamycin}

Clindamycin is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms.Clindamycin is a semisynthetic antibiotic derived from lincomycin.

Microbiology: Aerobic gram-positive cocci, including: Staphylococcus aureus, Staphylococcus epidermidis

(penicillinase and non-penicillinase producing strains), Streptococci, Pneumococci. Anaerobic gramnegative bacilli, including: Bacteroides species, Fusobacterium species. Anaerobic gram-positive non-spore forming bacilli, including: Propionibacterium species, Eubacterium species, Actinomyces species. Anaerobic and microaerophilic gram-positive cocci, including: Peptococcus species, Peptostreptococcus species,

Microaerophilic streptococci, C. perferinges

Indication: Clindamycin HCl is indicated in the treatment of the following infections caused by susceptible anaerobic bacteria or susceptible strains of gram positive bacteria such as Streptococci, Staphylococci and Pneumococci; Upper respiratory infections, Lower respiratory infections, Skin and soft tissue infections, Bone and joint infections, Pelvic infections, Intra-abdominal infections, Septicemia and endocarditis, Dental infections. As an alternative therapy when used in combination with quinine or amodiaquine for the treatment of multi-drug resistant Plasmodium falciporum infection.

Dosage and Administration: Serious infections- 150 to 300 mg every 6 hours. More severe infections- 300 to 450 mg every 6 hours. To avoid the possibility of oesophageal irritation, Clindamycin capsules should be taken with a full glass of water.

Side Effects: The adverse effects have been reported with the use of clindamycin are- abdominal pain, oesophagitis and oesophagial ulcer, nausea, vomiting and diarrhoea, pruritus, skin rashes, urticaria

Precautions: Clindamycin should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis

Contraindications: Clindamycin is contraindicated in patients previously found to be sensitive to

clindamycin or any of the ingredients of this medicine.

Pregnancy and Lactation: Pregnancy Category B. Clindamycin has been reported to appear in breast milk in the range of 0.7 to 3.8 mcg/mL. So this drug should be used only if clearly needed.

Pediatric Use: When Clindamycin HCl is administered to the pediatric population (birth to 16 years), appropriate monitoring of organ system functions is desirable.

Geriatric use: Dose adjustment of Clindamycin is not necessary

Drug Interactions: Clindamycin enhance the action of other neuromuscular blocking agents. Therefore, it should be used with caution in patients receiving such agents. Antagonism has been demonstrated between clindamycin and erythromycin in vitro. Because of possible clinical significance, these two drugs should not be administered concurrently.

Overdosage: Overdosage with orally administered clindamycin has been rare. Adverse reactions similar to those seen with normal doses can be expected, however, unexpected reactions could occur. Haemodialysis and peritoneal dialysis are not effective in removing clindamycin from the serum. Overdosage should be treated with simple gastric lavage. No specific antidote is known.

Treatment of Healing of all grades of erosive esophagitis and Gastroesophageal reflux disease (GERD)

Dexlansoprazole is a proton pump inhibitor used to treat-

1. Healing of all grades of erosive esophagitis

2. Maintaining healing of erosive esophagitis

3. Heart burn associated with non-erosive Gastroesophageal reflux disease (GERD)

Dosage & administration: Dexlansoprazole capsule is administered orally. Therecommended doses of Dexlansoprazole for adults are as follows:

Indication Recommended Dose Frequency

Healing of erosive esophagitis 60 mg once daily for up to 8 weeks

Maintenance of Healed erosive esophagitis and relief of heartburn

30 mg once daily for up to 6 months Symptomatic Non-Erosive GERD 30 mg Once daily for 4 weeks

Contraindication: Dexlansoprazole is contraindicated in patients with known hypersensitivity to any component of the formulation. Hypersensitivity and anaphylaxis have been

Reported with Dexlansoprazole

Precaution: Patients taking concomitant Warfarin may require monitoring for increases in international normalized ratio (INR) and prothrombin time. Increases in INR and prothrombin time

May lead to abnormal bleeding and even death.

Side Effect: Adverse events are rarely seen; such as diarrhea, abdominal pain, nausea, vomiting, flatulence etc

Drug Interaction: Dexlansoprazole may interfere with the absorption of drugs for whichgastric pH is important for bioavailability (e.g., Ampicillin esters, Digoxin, iron salts, Ketoconazole).

Use in Pregnancy and Lactation: Dexlansoprazole is considered a pregnancy Category B medication. This means that dexlansoprazole is probably safe for use during pregnancy, although the full risks are currently unknown.

Pediatric Use: Safety and effectiveness of Dexlansoprazole in pediatric patients (less than 18 years of age) have not been established.

Geriatric Use: Safety and effectiveness of Dexlansoprazole in geriatric patients is same as Adults.

Overdose: There have been no reports of significant overdose of Dexlansoprazole. It is not expected to be removed from the circulation by hemodialysis. If an overdose occurs, treatment should be symptomatic and supportive

calcium-channel blocker with peripheral and coronary vasodilator properties{Diltiazem}

Diltiazem lowers blood

pressure and has some effect on cardiac conduction. Diltiazem interferes with the influx of calcium ions through the channels of active cell membranes.

Indication

Diltiazem is used for the prophylaxis and treatment of chronic stable (classical) and vasopastic angina pectoris and has also been used alone or in combination in the management of hypertension, also, Diltiazem is effective in myocardial infarction, coronary artery spasm, arrhythmias, Raynaud's phenomenon, oesophageal motility disorder and migraine.

Dosage & Administration

Adult: The usual dose is 60 mg thrice daily. However patient's response may vary and dosage requirements can

differ significantly between individual patients. If necessary, the divided dose may be increased to 180-00mg/day. Dosage may be started as 30 mg four times daily and increasing at 1 to 2 days intervals until the optimum response is achieved. Higher doses upto 480mg/day have been used with benefit in some patients especially in unstable angina. Elderly and patients with impaired hepatic or renal function : The recommended starting dose is 60 mg twice daily. The heart rate should be measurecfregularly and the dose should not be increased if the heart rate falls bejew 50 beats per minute.

Children: Not recommended.

Side-effect

With Diltiazem headache, ankle oedema, hypertension, dizziness, flushing, rashes (toxic erythema), nausea and Gl disturbances may occur. Transient elevation in liver enzyme values and occasionally hepatitis have been reported. Diltiazem may depress cardiac conduction and has occasionally led to AV block, bradycardia and rarely asystole or sinus

arrest. Contraindication Diltiazem is contraindicated to the patients of severe bradycardia, sick sinus syndrome, pregnancy, second or third degree AV block.

Treatment of conditions associated with gastrointestinal spasm{Hyoscme Butylbromide}

Hyoscine butylbromide is a quaternary ammonium antimuscarinic agent. Hyoscine butylbromide does not readily pass the blood-brain barrier. It is a competitive antagonist of the actions of acetylcholine and other muscarinic agonists.

Indications:Hyoscine butylbromide is used in the treatment of conditions associated with gastrointestinal spasm.

Contraindications:Hypersensitivity to Hyoscine butylbromide. Patients with prostatic enlargement, paralytic ileus or pyloric stenosis. It should not be given to patients with myasthenia gravis, unless it is to reduce the adverse muscarinic effects of an anticholinesterase agent. It should be given with caution to pregnant and lactating mothers as safety has not yet been established. It has been stated to cross the placenta.

Dosage and administration:The usual dose is 20 mg intramuscular or intravenous, repeated after 30 minutes, if necessary.

Use in pregnancy and lactation:

Enter post entire body he rCertain medications shouldn't be utilized throughout being pregnant or even nursing. Nevertheless, additional medications might be properly utilized in being pregnant or even nursing supplying the advantages towards the mom outweigh the actual dangers towards the developing fetus. Usually notify your physician if you're expecting or even planning for a being pregnant, prior to utilizing any kind of medication.

This particular medication isn't generally suggested with regard to make use of throughout being pregnant because it's security is not set up. It will just supply when the anticipated advantage towards the mom is actually more than any kind of feasible dangers towards the building infant, especially within the very first trimester. Look for healthcare guidance out of your physician.
It's not recognized in the event that this particular medication goes by in to breasts whole milk, even though just a small amount could be discovered because of the qualities from the medication. The actual course associated with medications this 1 goes in order to might slow up the manufacturing associated with breasts whole milk. The maker says this medication isn't suggested with regard to make use of throughout nursing. Obtain guidance out of your physician prior to getting this particular medication if you're nursing.

Side-effects and special precautions:Dryness of the mouth, with difficulty in swallowing, thirst, dilatation of the pupils with loss of accommodation and photophobia, increased intra ocular pressure, flushing and dryness of the skin, bradycardia followed by tachycardia, with palpitations and arrhythmias, urinary urgency with the inability to do so, as well as reduction in the tone and motility of the gastrointestinal tract, leading to constipation. Occasionally vomiting, giddiness and staggering may occur. Retrosternal pain may occur due to increased gastric reflux. Patients who experience drowsiness should not drive or operate machinery. Alcohol should be avoided. It has been stated that in elderly patients and patients with inpaired metabolic, liver or Kidney function, adverse central nervous system effects such as

Disorientation, delirium or somnolence has been more likely to occur. It should be used with caution in conditions characterized by tachycardia such as thyrotoxicosis, cardiac insufficiency or failure, and in cardiac surgery where it may further accelerate the heart-rate. Care is required in patients with acute myocardial infarction as ischemia and infarction may be worsened. It should be given with care to patients with hypertension.Hyoscine should be used with care in patients receiving other central depressants concomitantly, as central nervous system depression may be enhanced. The effects of antimuscarinic agents may be enhanced by drugs with antimuscarinic properties, such as amantadine,

some antihistamines, butyrophenones and phenothiazines, and antidepressants. Symptoms of overdosage:Toxic doses cause tachycardia, rapid respiration, hyperpyrexia, restlessness, confusion, excitement, impotence and hallucinations passing into delirium. A rash may appear on face and upper trunk, In severe

intoxication, depression of the central nervous system may occur with circulatory failure and respiratory failure. Quaternary ammonium anticholinergic agents usually have some ganglion blocking action, so that high doses may cause postural hypertension and impotence in toxic doses, nondepolarising neuromuscular block may be produced.

Supportive and symptomatic therapy should be given as required

Treatment of respiratory disorders associatedwith productive cough{Bromohexine Hydrochloride }

Bromhexine HCl is highly effective mucolytic expectorant.

Indication:

Bromhexine HCl is indicated in the treatment of respiratory disorders associated with productive cough. These include; tracheobronchitis, bronchitic with emphysema,

bronchiectasis, bronchitis with bronchospasm, chronic inflammatory pulmonary conditions and pneumoconiosis.

Dosage and administration:

Adults: The recommended daily dose is 2 to 4 teaspoonful 3 tines daily. Initially 4 teaspoonful 3 times daily and then as required.

Children: Suggested dosage for children under 2 years is ¼ teaspoonful 3 times daily, for 2-5 years ½ teaspoonful 3 times daily and for children aged 5-10 years 1 teaspoonful 3 times daily.

Precaution:

Mucolytics may disrupt the gastric mucosa so bromhexine should be used with care in patients with a history of peptic ulceration. Care is also advisable in asthmatic patients.

Contraindication:

Bromhexine is contraindicated for use in patients with known hypersensitivity to bromhexine hydrochloride (or any of the other ingredients in the product).

Side effect:

Gastrointestinal side effects may occur occasionally with Bromhexine and a transient rise in serum aminotransferase values has been reported. Other reported adverse effects include headache, dizziness, sweating and skin rash.

Use in pregnancy and lactation:

Category B: Bromhexine has been taken by a large number of pregnant women and women of child bearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.

It is not known whether Bromhexine is excreted in breast milk or whether it has a harmful effect on the breastfeeding infant. Therefore it is not recommended for breastfeeding mothers unless the potential benefits to the patient are weighed against the possible risk to the infant

Treatment of conditions associated with zinc deficiency such as acrodermatitis enteropathica{zinc sulfate}

Zinc Sulfate is a source of Zinc, which is an essential element of nutrition and traces are present in a wide range of foods. Zinc is a constituent of many enzyme systems and is present in all tissues. Features of Zinc deficiency include growth retardation and defects of rapidly dividing tissues such as the skin, the immune system and the intestinal mucosa. Zinc salts (generally Zinc Sulfate) are used as supplements to correct Zinc deficiency; they have been tried in the treatment of a large number of conditions because of an associated reduced concentration of Zinc in body.

Indication

Zinc Sulfate is indicated in following conditions

· Growth retardation

· Skin lesion

· Increased susceptibility of infections

· Failure to thrive in children

· Absent perceptions of taste and smell

· Alopecia

· Diarrhea

· Immunologic dysfunction

· Psychological disturbances

· Impaired spermatogenesis

· Congenital malformation

· Acrodermatitis enteropathica

Dosage and administration

Children under 10 kg: 2 teaspoonfuls/day after food (in divided doses)

Children within 10 to 30 kg: 2 teaspoonfuls 1-3 times/day after food.

Adults & over 30 kg: 4 teaspoonful 1-3 times/day after food.

Side effect

Side effects are particularly common if taken on an empty stomach. Zinc salts may cause abdominal pain and dyspepsia.

Chronic Zinc poisoning has not been identified with certainty, although prolonged use may lead to Copper deficiency with associated anemia & Neutrogena. In acute over dosage Zinc salts are corrosive due to the formation of Zinc Chloride by stomach acid; corrosion can be avoided with administration of milk or alkali carbonates & activated charcoal.

Pregnancy and lactation

Zinc sulfate has been assigned to pregnancy category C by the FDA. Safety for use in pregnancy has not been established. The risk of fetal harm if used during pregnancy is remote. A dietary intake of 11 mg of zinc per day (19 to 50 years of age) and 12 mg per day (14 to 18 years of age) is recommended during pregnancy. Additional zinc sulfate should only be given during pregnancy when need has been clearly established.

Precaution

Accumulation of zinc may occur in case of renal failure. Zinc may inhibit the absorption of concurrently administered Tetracycline.

Treatmentof bacterial infections in many different parts of the body{ciprofloxacin}

Ciprofloxacin  is a broad-spectrum synthetic quinolone antibacterial agent. h is active against most of the gram-negative aerobic barteria like Enterobacteriaceas & Pseudomonas aeruginosa and gram positive aerobic bacteria including penicillinase producing, penicillinase non-producing and Methicillin-resistant Staphylococci. The bactericidal action of Ciprofloxacin results from interfering with the enzyme DNA gyrase.

Indications

Ciprofloxacin is indicated for the management of single or mixed infections caused by two or more susceptible mirooraganisms. It can also be used against infections caused by organisms resistant to other antibiotics. Ciprofloxacin is indicated for the treatment of the following infections.

Gastrointestinal tract infection: Typhoid fever and infected diarrhoea. Urinary tract infection:

Complicated and uncomplicated urethritis, cystitis, pyelonephritis, prostatitis and epididymitis.

Respiratory tract infection: Pneumonia, acute and chronic bronchitis, cystic fibrosis, bronchiectasis and empyema. Skin and soft tissue infection: Wound infection, abscess, infected ulcer, cellulitis, infected burn, erysipelas and otitis externa. Severe systemic infection: Septicemia, bacteremia, infection in immunosuppressive patient with hematological or solid tumors. Biliary tract infection: Cholangitis, cholecystitis, empyema of the gall bladder. Eye, ear, nose and throat infection: Otitis media, sinusitis, mastoiditis and tonsillitis. Bone and joint infection: Osteomylitis and arthritis. Pelvic infection: Salpingitis, endometritis and pelvic inflammatory diseases. Abdominal infection: Peritonitis & infra-abdominal abscess. Gonorrhea: Urethral, rectal and pharyngeal gonorrhea caused by beta-lactate producing

organisms or organisms moderately sensitive to penicillin.

Dosage and administration

Adult: The usual adult dose is 250-750 mg 12 hourly. Usual dosage schedule Typhoid Fever: 500 mg 12 hourly 7-14 days

Infected Diarrhea: 500 mg 12 hourly 5-7 days

Chronic Salmonella Carriers: 500-750 mg 12 hourly 28 days Complicated UTI:

500 mg 12 hourly 3-5 days

Uncomplicated UTI: 250 mg 12 hourly 3-5 days

Respiratory Tract Infection: 500-750 mg 12 hourly 7-14 days Skin and Soft Tissue Infection: 500-750 mg

12 hourly 7-14 days Uncomplicated Gonorrhea: 250 mg single dose

Uncomplicated Gonorrhea: 250 mg single dose

Wound Infection: 500 mg 12 hourly 7-14 days

Bone and Joint Infection: 500-750 mg 12 hourly 7-14 days

Other Infection: 500.750 mg 12 hourly 7-14 days

Adolescent and Children: Generally not recommended but where the benefit is more than potential risk, the dose should be 10-30 mg/kg/day depending upon the severity of Infection, administered in two divided doses.

Side effects

Ciprofloxacin is generally well tolerated. Gastrointestinal disturbances like nausea, vomiting, diarrhea, dyspepsia and abdominal pain; CNS disturbances e.g. dizziness, drowsiness, headache, tiredness, confusion. convulsion, skin rashes, prurient and possible systemic reactions may occur. It has also been reported that joint pain, mild photo sensitivity may occur and liver enzyme, serum bilirubin, creation levels may increase slightly

after administration.

Precautions

Ciprofloxacin should be used with great caution it patient with a known history of epilepsy or other factors, which predispose to seizure and convulsion. Patients should be advised to take Clprofloxacin two hours after meal. Patients should be advised not to take Antacid containing aluminum or magnesium concomitantly or within two hours after dosing and also requested to drink plenty of water.

Pregnancy and lactation

Ciprofloxacin has been shown to cause arthropathy it immature annals and therefore its use during pregnancy is not yet recommended. It has been reported that Ciprofloxacin is secreted in milk during administration to nursing mother and is thus not also recommended yet.

Drug interactions

Concurrent administration of Ciprofloxacin with Theophyline and Caffeine may potentiate the adverse effects of theophyline and caffeine. Antacid containing aluminum or magnesium may decrease the bioavailablllty of Clprofloxacin. Quinolones, including Ciprofloxacin, have been reported to enhance the effects of the oral anticoagulant Warfarin or its derivatives.

Treatment of muscle relaxant and antispastic{Baclofen BP}

Baclofen BP

Pharmacology: Baclofen is an effective muscle relaxant and antispastic agent with a spinal site of action. Its mode of action is not fully understood. Baclofen inhibits both monosynaptic and polysynaptic reflexes at the spinal level by stimulating the GABAB-receptors, which inhibits the release of glutamate and aspartate. It may also act at intraspinal sites producing CNS depression. Neuromuscular transmission is not affected by

Baclofen. Baclofen also exerts antinociceptive effect.

Indication: Baclofen is indicated for

· Spasm

· Reflex muscle contractions

· Spasticity resulting from multiple sclerosis

· Skeletal muscle spasm resulting from rheumatic disorders

· Flexor spasms and concomitant pain,clonus and muscular rigidity

· Spinal cord injuries and other spinal cord diseases

· Cerebrovascular accidents or neoplastic or degenerative brain disease

· Tension type headache

Dosage & administration: Adult The initial dose of baclofen is 5 mg three times daily by mouth preferably with or after food or milk-The total daily dose is increased by 15 mg every fourth day (i.e. the dosage regimen

is 5 mg 3 times a day for 3 days, then 10 mg 3 times a day for 3 days, then 15 mg 3 times a day for 3 days), until either a dose of 20 mg three times a day is reached or until the desired therapeutic effect is obtained.

Children: The usual dosage range for children is 0.75 to 2 mg/kg body weight per day. In children aged over

10 years a maximum daily dose of 2.5 mg/kg body weight may be given. The usual starting dose is 2.5 mg given four times daily increased cautiously about every three days until the desired therapeutic effect is obtained. The recommended daily maintenance doses are: 12

months to 2 years of age, 10 to 20 mg; 2 to 6 years, 20 to 30 mg; 6 to 10 years, 30 to 60 mg.

Contraindication: Baclofen is contraindicated in patients who are hypersensitive to any component of this product.

Precaution: Baclofen stimulates gastric acid secretion and should be used with caution in patients with a history of peptic ulcer and avoided in those with active peptic ulcer disease, Liver function should be

monitored in patients with liver disease, patients with renal impairment need a reduced dose.

Baclofen should be used with caution in patients with respiratory impairment. Baclofen may cause

drowsiness, patients affected should not drive

or operate machinery.

Side Effect: The most common side effects include day time drowsiness, sedation, lethargy, dizziness,

headache, nausea and diarrhea. Other infrequent side-effects are muscular hypotonia, urinary

disturbances, confusion, speech disturbance, insomnia, depression, anxiety, agitation, myalgia, fever,

respiratory depression, hypotension, dry mouth, sexual dysfunction, visual disorders, rash, pruritis, weight

gain, taste alterations, blood sugar changes.

Drug Interaction: Alcohol and other CNS depressants may exacerbate the CNS effects of baclofen and

should be avoided, severe aggravation of hyperkinetic symptoms may possibly occur in patients taking lithium,

Ibuprofen and other drugs that produce renal insufficiency may reduce baclofen excretion leading to toxicity.

Use in Pregnancy and Lactation: The safety of baclofen in women who are or who may become pregnant has

not been established. Baclofen crosses the placental barrier. Baclofen should be used during pregnancy only if

the potential benefit justifies the potential risk to the fetus. Baclofen is excreted in breast milk however

evidence to date suggests that the quantities are so small that no undesirable effects on the infant would be

expected.

Treatment of following major Infections {Ceftriaxone}

Ceftriaxone Sodium USP.

Description:

Ceftriaxone is a board spectrum parenteral third generation cephalosporin antibiotic. The drug is highly resistant to bacterial beta-lactamase and has a good activity against many gram-positive and gram-negative aerobic and some anaerobic bacteria. It inhibits bacterial cell wall synthesis in a manner similar to that of penicillin.

Indication:

Ceftriaxone is indicated for the treatment of the following major infections when caused by susceptible organisms: 1.Renal & urinary tract infection;

2. Lower respiratory tract infection particularly pneumonia;

3. Gonococcal infection; 4.Skin, soft tissue, bone & joint infection;

5.Bacterial meningitis;

6.Serious bacterial infection e.g. septicemia; 7.ENT infection;

8.Infection in cancer patients; 9.Prevention of postoperative infection;

10.Pre-operative prophylaxis of infection associated with surgery;

11.Typhoid fever.

Dosage and Administration:

Adult: It is usually given to adults in a dose of 1 to 2 gm daily as a once daily dose or in two divided doses depending on the type and severity of infection. In severe infection up to 4 gm daily may be given. A single intramuscular dose of 250 mg is recommended for the treatment of uncomplicated gonorrhea in adult. For surgical prophylaxis in adults, single dose of 1 gm may be administered 0.5 to 2 hours prior to surgery.

Children: Suggested doses for infants and children are 50 to 75 mg per kg body weight once a day; for severe infection up to 80 mg per kg body weight daily may be given.

Neonates: The maximum dose should not exceed 50 mg per kg; intravenous doses in neonates should be given over 60 minutes.

Duration of Therapy: The duration of therapy varies according to the course of the diseases be continued for a minimum of 48-72 hours after the patients has become a febrile or evidence of bacterial eradication has been obtained.

Side effect:

Well tolerated, side effects are relatively infrequent, usually mild and transient. The most common side

Effects are gastro-intestinal consisting mainly of loose stool, diarrhea, nausea, vomiting steatites and

glossitis.

Contra-indication:

Ceftriaxone sodium should not give in patients with a history of hypersensitivity to cephalosporin antibiotics. It is contraindicated in premature infants and in full- term infants during the first 6 weeks of life