Antibiotics

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

Copyright 2007 Lippincott Williams & Wilkins

> Table of Contents > Drugs > Antibiotics

Antibiotics

A. See also

Infection, p. 212.

B. Neurological SEs of

• Acyclovir: May see encephalopathy in association with renal failure, methotrexate, or interferon.

• Aminoglycosides: Vestibular and ototoxicity, neuromuscular blockade (especially in myasthenia).

• Amphotericin B: Rare headache, tremor, confusion, akinetic mutism.

• Dideoxynucleosides (stavudine, didanosine, zalcitabine): Distal symmetrical polyneuropathy.

• Isoniazid: Seizures, altered mental status, optic neuritis.

• Metronidazole: Distal axonopathy, psychosis, hallucinations.

• Penicillin derivatives: Rare myoclonus, asterixis, coma.

• Tetracyclines: Rare pseudotumor cerebri in infants.

• Vancomycin: Ototoxicity.

• Zidovudine (AZT): HA, insomnia, sometimes confusion, seizures, myopathy.

P.159

Table 43. Commonly used antibiotics.

		Max. Dose in Renal Failure
Antibiotic	Normal Dose	GFR >50	GFR 10-50	GFR <10	Dialysis Removes?
Gentamicin	80 mg IV q8h	1.0-1.7 mg/kg q (8 serum Cr) h			Yes H + P
Tobramycin	80 mg IV q8h	1.0-1.7 mg/kg q (8 serum Cr) h			Yes H + P
Amikacin	300 mg q8h	5 mg/kg q (8 serum Cr) h			Yes H + P
Cefazolin	1 g IV q8h	q8h	bid	qd	Yes H, No P
Cefotaxime	1 g IV q6h	NC	NC	1-2 g bid	Yes H, No P
Cefotetan	1 g IV q12h	NC	1-2 g qd	1 g qd	Yes H
Ceftazidime	1 g IV q8h	NC	1-2 g bid	1 g qd	Yes H + P
Ceftriaxone	1 g IV q24h	NC	NC	NC	No H
Cefuroxime	0.75 g IV q6h	NC	1 g q8h	0.75 g qd	Yes H + P
	0.5 g PO bid	NC	NC	0.25 g qd
Cephalexin	0.5 g PO qid	NC	NC	NC	Yes H + P
Cephalothin	1 g IV q4h	1 g q6h	1-2 g q6h	1 g q8h	Yes H + P
Amoxicillin	0.5 g PO tid	NC	0.25 g bid	0.25 g bid	Yes H, No P
Amox.-clav.	0.5 g PO tid	NC	0.25 g bid	0.25 g bid	Yes H, No P
Ampicillin	1 g IV q4h	NC	1 g q8h	1-2 g bid	Yes H, No P
Amp.-sulbact.	3 g IV q6h	NC	1 g bid	1.5-3 g	qd
Dicloxacillin	0.5 g PO qid	NC	NC	NC	No H + P
Imipen.-cilast.	0.5 g IV q6h	NC	0.25 g q8h	0.2 g bid	Yes H
Mezlocillin	4 g IV q4-6h	NC	2-3 g q6h	2-3 g bid	Yes H, No P
Nafcillin	1.5 g IV q4h	NC	NC	NC	No H,P
Oxacillin	1.5 g IV q4h	NC	NC	NC	No H,P
Penicillin G	2 MU IV q4h	NC	NC	1-2 MU q4h	Yes H, No P
Penicillin VK	0.5 g PO qid	NC	NC	NC	Yes H, No P
Piperacillin	4 g IV q6h	NC	2-4 g q8h	2-4 g bid	Yes H, No P
Piper.-tazobact.	4.5 g IV q6h	NC	2.25 g q6h	2.25 g q8h	Yes H
Ticarcillin	3 g IV q4h	NC	2-3 g q6h	2 g bid	Yes H + P
Ticar.-clavulan.	3.1 g IV q6h	NC	3.1 g q6-8h	2 g bid	Yes H
Ciprofloxacin	0. 5 g PO bid	NC	0.25 g bid	0.25 g qd
	0.4 g IV q12h	NC	0.4 g q12h	0.4 g q24h
Levofloxacin	0.5 g PO/IV qd	NC
Ofloxacin	0.4 g PO/IV bid	NC	0.4 g q24h	0.2 g q24h
Azithromycin	0.5 g qd	?	?	?
Clarithromycin	0.5 g PO bid	?	?	?
Erythromycin	0.5 g PO q6h	NC	NC	NC	No H,P
Clindamycin	0.6 g IV q8h	NC	NC	NC	No H,P
	0.3 g PO qid	NC	NC	NC	No H,P
Tetracycline	0.5 g PO qid	0.5 g q8h	Avoid	Avoid	No H,P
Doxycycline	100 mg q12h	NC	NC	NC	No H,P
Aztreonam	1 g IV q8h	NC	NC	1 g IV bid	Yes H + P
Chloramphen	1 g IV/PO q6h	NC	NC	NC	Yes H, No P
Metronidazole	0.5 g IV/PO q6h	NC	NC	NC	Yes H, No P
Nitrofurantoin	50-100 mg q6h	NC	Avoid	Avoid	Yes H
TMP-SMX	DS PO bid	NC	2 mg/kg bid	Avoid	Yes H, No P
Vancomycin	0.5 g IV q6h	1 g q1-3d	Follow levels;	redose 10	No H,P
GFR glomerular filtration rate; H hemodialysis; P peritoneal dialysis; NC no change; MU million units.