Oral antibiotics

Systemic antibiotics are indicated for moderate-severe inflammatory acne not responding to topical treatments. Systemic antibiotics act on 1) suppression of P. acnes growth 2) inhibition of bacterial lipases 3) reduction of free fatty acids and 4) reduction of inflammation. Oxytetracycline and its derivatives are the most commonly used oral antibiotics. Second-generation tetracyclines such as minocycline, doxy-cycline and lymecycline present longer half-lives, enhanced bacterial activity and lower... 

Less severe infections may be treated with topical antibiotic cream, although this practice is controversial. Oral antibiotics... 

Moderate to severe acne can be effectively treated with oral antibiotics, especially when treatment with topical therapy has failed. Because of their ability to decrease P. acnes colonization, oral antibiotics can prevent acne lesions from developing.8 Improvement of symptoms is generally evident at 6 to 10 weeks, with maximum benefits occurring after 6 months of therapy.23... 

Although tetracycline, doxycycline, and minocycline are the most commonly prescribed oral antibiotics for acne, erythromycin and clindamycin are appropriate second-line agents for use when patients cannot tolerate or have developed resistance to tetracycline or its derivatives.3 See Table 62-3 for antibiotic dosing guidelines. 

BPO = benzoyl peroxide AA = azelaic acid TR = topical retinoid SA = salicylic acid OA = oral antibiotic TA = topical antimicrobial... 

In uncomplicated cases, prompt oral antibiotic therapy with amoxicillin or a first-generation cephalosporin halts the progression of lymphangitis. Clindamycin may be used if the patient has a significant (1-lactam allergy. Intravenous antibiotics (penicillinase-stable penicillins, first-generation cephalosporins,... 

Host Factors Probable Etiologic Bacteria Mild Infection or Step-Down Therapy3 (Oral Antibiotic Therapy) Moderate-Severe Infection3 (IV Antibiotic Therapy)... 

Mild Infection (Topical or Oral Antibiotics)3 Moderate to Severe Infection (Parenteral Antibiotics)3... 

A 62-year-old male with history of diabetes and PVD comes to the emergency department complaining of a "painful sore" on his left lower leg. After questioning him, you determine that the wound has been present for months and has not responded to oral antibiotic therapy. On physical examination, a large, deep wound with purulent drainage is seen. 

The patient received 4 weeks of intravenous antimicrobial therapy following debridement. Due to clinical improvement, the physician contacts you for a recommendation for an oral antibiotic to complete a total of 6 weeks of therapy. 

For patients receiving oral antibiotics either prophylacti-cally or as treatment of febrile neutropenia, counsel them that initial or persistent fever should be reported promptly and that compliance with the regimen is critical. Patients also should have easy access to medical care and adequate caregiver support. Provide information on drug interactions and adverse effects. 

Outpatient IV antibiotics with or without oral antibiotics after appropriate period of observation... 

DuPont HL Community-acquired diarrheal disease in western countries Applications of nonabsorbable oral antibiotic therapy. Adv Stud Med 2003 3(suppl A) S945-S950. 

Clearly, the route of administration of antibiotics can affect the rates of AAD. Rates of diarrhea are lower with intravenous than oral antibiotics. Specific rates of diarrhea for all individual antibiotics are not available. Some... 

Bartlett JG, Condon RE, Gorbach SL, Clarke JS, Nichols RL, Ochi S Veterans Administration Cooperative Study on Bowel Preparation for Elective Colorectal Operations Impact of oral antibiotic regimen on colonic flora, wound irrigation cultures and bacteriology of septic complications. Ann Surg 1978,188 249-254. 

Guslandi M, Giollo P, Testoni PA Corticosteroid-sparing effect of rifaximin, a nonabsorbable oral antibiotic in active ulcerative colitis Preliminary clinical experience. Curr Ther Res 2004 65 292-296. 

Shafran I, Dondelinger PJ, Johnson LK, et al Efficacy and tolerability of rifaximin, a nonab-sorbed, gut-selective, oral antibiotic in the... 

Preoperative colon preparation Intestinal antisepsis Oral antibiotics Erythromycin-neomycin... 

Oral antibiotic(s) Number using parenteral antibiotic(s)... 

The clinical conditions that most often necessitate emergency colonic operations are acute hemorrhage, perforation, ischemia, obstruction and trauma. In these circumstances, the operation must be performed without any bowel preparation because oral antibiotic prophylaxis and mechanical cleansing are either impossible or potentially harmful. 

Preoperative oral antibiotic bowel preparation none... 

Clarke JS, Condon RE, Bartlett JG, Gorbach SL, Nichols RL, Ochi S Preoperative oral antibiotics reduce septic complications of colon operations Results of a prospective, randomized, double-blind clinical study. Ann Surg 1977 186 251-259. 

The answer is b. (Katzung, p J129.) Ampicillin decreases the entero-hepatic circulation of estrogen, thereby reducing its efficacy It is thought that this occurs because of an alteration in the gastrointestinal flora. Other oral antibiotics may produce a similar effect... 

Moderate acne can be managed with topical retinoids in combination with oral antibiotics and, if indicated, benzoyl peroxide. 

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