SAFE ANTIBIOTICS
Pen VK: Normal dose
Amoxicillin: Normal dose
Augmentin: Normal dose
Keflex: Normal dose
Duricef: Normal dose
Clindamycin: Normal dose with Hepatitis
Clarithromycin: Normal dose with normal kidney function
Metronidazole: Normal dose with mild liver disease
Doxycycline: Normal dose
IV Vancomycin: Normal dose
ANTIBIOTICS WITH ALERTS
Ampicillin: Use caution/avoid
Azithromycin: Avoid
Clindamycin: 50% dose with Cirrhosis
Metronidazole: 50% dose with moderate or severe liver disease
Tetracycline HCL: Avoid
1)Pen VK: No dose alteration needed
2)Amoxicillin: No dose adjustment
3)Azithromycin: Avoid Azithromycin in patients with Liver disease
4)Clindamycin:
a)Hepatitis: Full dose can be used with non-acute, non-fulminant hepatitis
b)Cirrhosis: Decrease Clindamycin total dose by 50%
5)Metronidazole (Flagyl)
a)mild Liver Disease: Prescribe the normal dose
b)moderate & severe Liver Disease: Decrease the total dose by at least 50%
c)Decreased dose of Flagyl used if both liver and kidney are affected: 250 mg q12h
6)Tetracycline HCL: Avoid Tetracycline HCL with Liver Disease
7)Doxycycline: No dose change needed with kidney/live/kidney & liver disease
" The Professional Man has no right to be other than a continuous student "
Quote of the day
Wednesday, September 8, 2010
Antibiotics safe in Liver Disease
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The sole purpose of writing this blog is to be a continuous learner, to share information and to keep that information safe and easily accessible before it vanishes in pages of history.
1 comment:
In cases of amoxicillin-clavulanate-induced hepatotoxicity, biopsy findings have typically revealed evidence of cholestatic injury. However, hepatocellular and mixed-type (cholestatic and hepatocellular) injury have also been documented. In many instances, hepatotoxicity may be due to a hypersensitivity. Onset of symptoms has been delayed in some patients, with presentation occurring after therapy has been discontinued. Prolonged treatment may increase the risk of hepatotoxicity. Elderly patients may be at increased risk of developing amoxicillin-clavulanate-induced jaundice. Fatalities are rare, but have been reported.
Rechallenge with amoxicillin alone has not been followed by a recurrence of hepatitis. However, rechallenge with amoxicillin-clavulanate has resulted in a relapse of liver injury. Therefore, the clavulanic acid may be the hepatotoxic part of the drug.
In patients with liver disease, frequent monitoring of liver function tests during amoxicillin-clavulanate therapy is recommended.
Hepatic side effects have included moderate elevations in serum transaminases (ALT and/or AST). Hepatic dysfunction (including cholestatic jaundice and hepatitis, increases in ALT and/or AST, serum bilirubin, and/or alkaline phosphatase) has been reported infrequently. Rare cases of jaundice, ductopenia, cholestatic hepatitis, granulomatous hepatitis, hepatic necrosis, and hepatocellular damage have also been reported. Less than 1 death per approximately 4 million prescriptions has been reported worldwide. Hepatic cholestasis and acute cytolytic hepatitis have been reported with amoxicillin use.
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