Nalidixic acid Nitrofurantoin

Intracranial hypertension has been linked to a number of medications (Table 35-14), including corticosteroids (withdrawal), nalidixic acid, nitrofurantoin, danazol, ciprofloxacin, and amiodarone.The main two categories... 

Glucose 6-phosphate dehydrogenase deficiency (G-6-PD) Aspirin, BAL (dimercaprol), chloroquine, chloramphenicol, dapsone hydroxychloroquine, nalidixic acid, nitrofurantoin, primaquine, probenecid, quinine, quinidine, sulfonamides Hemolytic anemia... 

Examples of urinary anti-infectives include cinoxacin (Cinobac), fosfomycin (Monurol), metlienamine rnande-late (Mandelamine), nalidixic acid (NegGram), and nitrofurantoin (Puradantin). 

Hydrolysis azathioprine benorylate diazepam diphenhydramine frusemide furazolidone nitrofurantoin menaquinone-4 mercaptopurine methotrexate nalidixic acid nicotinamide nicotine nicotinic acid nifedipine... 

Anorexia, nausea, and vomiting are the principal side effects of nitrofurantoin. Neuropathies and hemolytic anemia occur in glucose-6-phosphate dehydrogenase deficiency. Nitrofurantoin antagonizes the action of nalidixic acid. Rashes, pulmonary infiltration and fibrosis, and other hypersensitivity reactions have been reported. 

Nalidixic Acid Nalidixic acid should not be given with nitrofurantoin or mel-phalan. It interacts with cyclosporin, probenecid, and warfarin. 

Drugs that alter the pH of urine can significantly affect the renal excretion of other drugs. Acid urine increases the effectiveness of mercurial diuretics. It also accelerates the excretion of basic drugs such as meperidine, tricyclic antidepressants, amphetamines, and antihistamines. Acidic drugs, such as aspirin, streptomycin, phenobarbital, sulfonamides, nalidixic acid, and nitrofurantoin have been shown to increase renal clearance in alkaline urine (61). The possible effects of urine pH on the renal excretion of drugs has been illustrated by the observation that if urine is rendered sufficiently alkaline, the excretion of amphetamine is markedly delayed and effective blood levels, after a single dose, can be maintained for several days (62). 

Antimicrobials. Metronidazole is present in milk in moderate amounts avoid prolonged exposure. Nalidixic acid and nitrofurantoin should be avoided where glucose-6-phosphate dehydrogenase deficiency is prevalent. Avoid clindamycin, dapsone, Uncomycin, sulphonamides. Regard chloramphenicol as unsafe. 

Chemoprophylaxis is sometimes undertaken in patients liable to recurrent attacks or acute exacerbations of ineradicable infection. It may prevent progressive renal damage in children who are found to have asymptomatic bacteriuria on routine screening. Nitrofurantoin (50-100 mg/d), nalidixic acid (0.5-1.0 g/d) or trimethoprim (100 mg/d) are satisfactory. The drugs are best given as a single oral dose at night. 

Antagonism in antibacterial efficacy between nitrofurantoin and nalidixic acid has been observed (93). 

Uncomplicated community-acquired urinary tract infection presents few problems with management. Drugs such as trimethoprim, ciprofloxacin and ampicillin are widely used. Cure rates are close to 100% for ciprofloxacin, about 80% for trimethoprim and about 50% for ampicillin—to which resistance has been steadily increasing. Treatment for 3 days is generally satisfactory and is usually accompanied by prompt control of symptoms. Single-dose therapy with amoxicillin 3 g has also been shown to be effective in selected individuals. Alternative agents include nitrofurantoin, nalidixic acid and norfloxacin, although these are not as well tolerated. Oral cephalosporins and co-amoxiclav are also used. 

Certain generic or metabolic abnormalities must be considered when prescribing antibiotics. A number of drugs (e.g., sulfonamides, nitrofurantoin, chloramphenicol, and nalidixic acid) may produce acute hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency. Patients who acetylate isoniazid rapidly may have subtherapeutic concentrations of the drug in plasma. 

The sensitivity of the organisms to nitrofurantoin and five other antibiotics and chemotherapeutic agents was compared and, except for the greater sensitivity of Proteus to nalidixic acid, none of the test compounds surpassed the results achieved with nitrofurantoin. An interesting study by King proved that cultures of E. coli and Staph, aureus taken at the Cleveland Clinic in the U.S. between 1956 and 1961 showed increased sensitivity to nitrofurantoin but increased resistance to dihydrostreptomycin, chloramphenicol and neomycin. 

Identify nitrofurantoin, methenamine, and nalidixic acid as urinary antiseptics and describe their toxic effects. 

There appear to be few documented cases of clinically relevant interactions between the quinolones and other antibacterials. However, note that clindamycin may antagonise the effects of ciprofloxacin on S. aureus. Further, in vitro studies have demonstrated antagonistic antibacterial effects when nitrofurantoin and nalidixic acid are used together, and other quinolones are also said to antagonise the effects of nitrofurantoin. 

The antibaeterial aetivily of nalidixic acid can be attenuated by sub-inhibitory concentrations of nitrofurantoin. In 44 out of 53 strains of Escherichia coli. Salmonella and Proteus, antagonism was shown. Another study confirmed these findings. Whether this similarly occurs if both antibacterials are given to patients is uncertain, but the advice that concurrent use should be avoided when treating urinary tract infections seems sound. Active division of bacteria is required for the bactericidal activity of quinolones sttch as nalidixic acid, and the presence of a bacte-... 

Various antibiotics, in particular sulfonamides, beta-lactam compounds, tetracycline and ethambutol, may induce pulmonary toxicities, which usually consist of pulmonary infiltrates with eosinophilia. Dmg-induced lupus states have also been reported with minocychne and tetracycline, nalidixic acid, sulfonamides, and nitrofurantoin (1). 

So far these two properties of Citrobacter have not been systematically studied. According to our experience the great majority of newly isolated strains are completely resistant to sulfonamides and for the most part also to coUimycin [97]. Recently Washington et al. [98] have found fresh cultures of C. intermedins (25 strains) to be highly susceptible to polymyxin B, kana-mycin, gentamycin, nalidixic acid and nitrofurantoin. The susceptibility to chloramphenicol, tetracycline and streptomycin was intermediate. Practically all strains were resistant to cephalodrin. On the other hand, 80 % of strains were inhibited by carbenicillin (10 mcg/ml). 

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