Topic: ABX Recomended 05 JOSEPH J. BURRASCANO JR., M.D.
treepatrol
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JOSEPH J. BURRASCANO JR., M.D.
ANTIBIOTIC CHOICES AND DOSES ORAL THERAPY: Always check blood levels when using agents marked with an *, and adjust dose to achieve a peak level above ten and a trough greater than three. Because of this, the doses listed below may have to be raised.
Consider Doxycycline first in early Lyme due to concern for Ehrlichia co-infections.
*Amoxicillin- Adults: 1g q8h plus probenecid 500mg q8h; doses up to 6 grams daily are often needed Pregnancy: 1g q6h and adjust. Children: 50 mg/kg/day divided into q8h doses.
*Doxycycline- Adults: 200 mg bid with food; doses of up to 600 mg daily are often needed, as If levels are too low at tolerated doses, give parenterally or change to another drug.
*Cefuroxime axetil- Oral alternative that may be effective in amoxicillin and doxycycline failures. Useful in EM rashes co-infected with common skin pathogens. Adults and pregnancy: 1g q12h and adjust. Children: 125 to 500 mg q12h based on weight.
Tetracycline- Adults only, and not in pregnancy. 500 mg tid to qid
Erythromycin- Poor response and not recommended.
Azithromycin- Adults: 500 to 1200 mg/d. Adolescents: 250 to 500 mg/d Add hydroxychloroquine, 200-400 mg/d, or amantadine 100-200 mg/d Cannot be used in pregnancy or in younger children. Overall, poor results when administered orally.
Clarithromycin- Adults: 250 to 500 mg q6h plus hydroxychloroquine, 200-400 mg/d, or amantadine 100-200 mg/d. Cannot be used in pregnancy or in younger children. Clinically more effective than azithromycin.
Telithromycin- Adolescents and adults: 800 mg once daily Do not need to use amantadine or hydroxychloroquine So far, the most effective drug of this class, and possibly the best oral agent if tolerated. Expect strong and quite prolonged Herxheimer reactions. Must watch for drug interactions (CYP3A-4 inhibitor), check the QTc interval, and monitor liver enzymes. Not to be used in pregnancy.
*Augmentin- Standard Augmentin cannot exceed three tablets daily due to the clavulanate, thus is given with amoxicillin, so that the total dose of the amoxicillin component is as listed above for amoxicillin. This combination can be effective when Bb beta lactamase is felt to be significant.
*Augmentin XR 1000- This is a time-release formulation and thus is a better choice than standard Augmentin. Dose- 1000 mg q 8 h, to 2000 mg q 12 h based on blood levels.
Chloramphenicol- Not recommended as not proven and potentially toxic.
Metronidazole: 500 to 1500 mg daily in divided doses. Non-pregnant adults only.
PARENTERAL THERAPY
Ceftriaxone- Risk of biliary sludging (therefore often Actigall is co-administered- one to three tablets daily). Adults and pregnancy: 2g q12 h, 4 days in a row each week Children: 75 mg/kg/day up to 2g/day
Cefotaxime- Comparable efficacy to ceftriaxone; no biliary complications. Adults and pregnancy: 6g to 12g daily. Can be given q 8 h as divided doses, but a continuous infusion may be more efficacious. When exceeding 6 g daily, use pulsed-dose schedule Children: 90 to 180 mg/kg/day dosed q6h (preferred) or q8h, not to exceed 12 g daily.
*Doxycycline- Requires central line as is caustic. Surprisingly effective, probably because blood levels are higher when given parenterally and single large daily doses optimize kinetics of killing with this drug. Always measure blood levels. Adults: Start at 400 mg q24h and adjust based on levels. Cannot be used in pregnancy or in younger children.
Azithromycin- Requires central line as is caustic. Dose: 500 to 1000 mg daily in adolescents and adults.
Penicillin G- IV penicillin G is minimally effective and not recommended.
Benzathine penicillin- Surprisingly effective IM alternative to oral therapy. May need to begin at lower doses as strong, prolonged (6 or more week) Herxheimer-like reactions have been observed. Adults: 1.2 million U- three to four doses weekly. Adolescents: 1.2 to 3.6 million U weekly. May be used in pregnancy.
Vancomycin- observed to be one of the best drugs in treating Lyme, but potential toxicity limits its use. It is a perfect candidate for pulse therapy to minimize these concerns. Use standard doses and confirm levels.
Primaxin and Unisyn- similar in efficacy to cefotaxime, but often work when cephalosporins have failed. Must be given q6 to q8 hours.
Cefuroxime- useful but not demonstrably better than ceftriaxone or cefotaxime.
*Ampicillin IV- more effective than penicillin G. Must be given q6 hours.
-------------------- Do unto others as you would have them do unto you. Remember Iam not a Doctor Just someone struggling like you with Tick Borne Diseases.
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Tree, thanks for updates here as well as on your own newbie links.
Special thanks for showing a reply for the date you are showing NEW info so we can glance at it without looking at all the pages wondering what the additions are. God bless you Tree & Mrs. Tree.
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