| Bacteria | Pathogenicity | Antibiotics |
|---|---|---|
| S. aureus | S. aureus causes boils, styes, pustules, impetigo, infections of wounds (cross-infections), ulcers and burns, osteomyelitis, mastitis, septicaemia, meningitis, pneumonia and pleural empyema. Also, toxic food-poisoning (rapid onset, no fever), toxic shock syndrome and toxic skin exfoliation. S. aureus is carried in the nose and on the skin of many healthy people. It is easily spread in hospitals, particularly on surgical wards. | Penicillins*, Vancomycin, Macrolides, Cephalosporins and Fusidic acid *Most strains of S. aureus (particularly hospital strains) are resistant to penicillin due to the production of plasmid-coded beta-lactamase |
| MRSA | Methicillin resistant S. aureus: These strains are resistant to methicillin and related penicillins and are particularly difficult to treat because they are also resistant to most other common antibiotics. MRSA strains cause hospital-acquired infections, particularly wound infections and septicaemia. | Vancomycin is often needed to treat MRSA infections. Cultures are usually a mixture of sensitive and resistant organisms. |
| S. pyogenes | S. pyogenes (Lancefield Group A) causes sore throat (tonsillitis, pharyngitis), peritonsillar abscess (quinsy), scarlet fever, otitis media, cellulitis, impetigo, necrotizing fasciitis, erysipelas, puerperal sepsis, septicaemia, and occasionally toxic shock syndrome. Also immune-mediated post-streptococcal rheumatic fever (following throat infections) and glomerulonephritis (after skin or throat infections). Note: S. pyogenes can be found as a commensal in the upper respiratory tract, particularly of children. |
S. pyogenes strains are susceptible to penicillin. Erythromycin is usually used to treat patients hypersensitive to penicillin but resistance to erythromycin (and also to tetracyclines) is being increasingly reported. |
| Streptococcus agalactiae | S. agalactiae (Lancefield Group B) causes septic abortion and puerperal or gynaecological sepsis, and occasionally urinary tract infection. S. agalactiae forms part of the normal microbial flora of the female genital tract. Occasionally it causes neonatal septicaemia and meningitis (rare in most developing countries). | It is sensitive to penicillin and erythromycin. |
| Streptococcus pneumoniae | S. pneumoniae causes lobar pneumonia, bronchitis (often with H. influenzae), meningitis, bacteraemia, otitis media, sinusitis and conjunctivitis. Severe infections can occur in the elderly and those already in poor health or immunosuppressed. Risk of infection is increased following splenectomy. In tropical and developing countries, S. pneumoniae is a major pathogen, responsible for acute life-threatening pneumonia and bacteraemia in those co-infected with HIV. It is also a common cause of childhood pneumonia and serious infections in patients with sickle cell disease. Pneumococci form part of the normal microbial flora of the upper respiratory tract. |
Antibiotics with activity against pneumococci include penicillin, erythromycin, and co-trimoxazole. Penicillin-resistant strains are becoming an increasing problem in tropical Africa, South Africa, and elsewhere. When testing for susceptibility to penicillin it is best to use a disc containing 1 µg of oxacillin. A zone size less than 20 mm indicates reduced susceptibility. Isolates should also be tested for susceptibility to tetracycline, erythromycin and chloramphenicol. |
| Enterococcus species | E. faecalis (formerly classified Streptococcus. faecalis) is the main pathogen in the genus Enterococcus, causing about 95% of enterococcal infections including infections of the urinary tract, biliary tract, ulcers (e.g. bed sores), wounds (particularly abdominal) and occasionally endocarditis or meningitis. It is a normal commensal of the vagina and intestinal tract. A minority of infections are caused by E.faecium. |
Most enterococci are susceptible to ampicillin and resistant to cephalosporins. Resistance is shown against penicillin. Vancomycin and ampicillin resistance appear to be emerging, associated particularly with hospital infections. |
| Bacillus anthracis | B. anthracis causes anthrax which is mainly a disease of sheep, cattle, goats and other herbivores with humans becoming infected only after coming into contact with infected animals or their skins. | Antibiotics with activity against B. anthracis include penicillin, tetracycline, streptomycin, and co-trimoxazole. Workers at risk of infection should be vaccinated. |
| Bacillus cereus | B. cereus toxin causes food-poisoning. The toxin is produced when the bacilli sporulate, usually in rice or other cereals that have been cooked and then stored in warm temperatures. Occasionally B. cereus causes opportunistic infections in immunocompromised persons, e.g. pneumonia, bacteraemia, wound infections. | Antimicrobials with activity against B.cereus include gentamicin, erythromycin, vancomycin and clindamycin. |
| Corynebacterium diphtheriae | C. diphtheriae causes diphtheria, a severe respiratory infection. Respiratory diphtheria affects the nose, throat, and upper respiratory tract with characteristic grayish-white pseudomembrane formation on tonsils, pharynx, larynx, or nares. Also causes cutaneous diphtheria (skin infections). Systemic complications include myocarditis (10-60% of cases, typically 1-2 weeks after initial infection), peripheral neuropathy and neuritis (10-20% of cases, developing 10 days to 3 months after onset), airway obstruction from pseudomembrane, kidney damage, and bulbar palsy. The disease is preventable through vaccination. |
Erythromycin 500mg PO 4 times daily for 14 days, or Penicillin G 300,000-600,000 units IM every 12 hours followed by Penicillin V 250mg PO 4 times daily for 14 days. Azithromycin (preferred over erythromycin due to better tolerability). IMPORTANT: Antibiotic therapy must be combined with diphtheria antitoxin. Vaccination is essential for prevention. |
| Clostridium perfringens | C. perfringens type A1: Causes gas gangrene (myonecrosis), anaerobic cellulitis, puerperal infection and septicaemia. C. perfringens type A also causes food poisoning. Type C causes necrotizing enteritis (pigbel). Gas gangrene is a life-threatening condition requiring emergency treatment. | Recommended combination: Penicillin G + Clindamycin. Clindamycin inhibits exotoxin production and is highly effective. Alternative regimens for penicillin-allergic patients: Clindamycin + Metronidazole. Other options include tetracycline, rifampin, and chloramphenicol. IMPORTANT: Antibiotics must be combined with aggressive surgical debridement. Protein synthesis inhibitors (clindamycin) may be more effective than penicillin alone as they inhibit clostridial exotoxin synthesis. |
| Clostridium botulinum | C. botulinum causes botulism, a rare but potentially fatal disease in which a lethal neurotoxin is ingested or produced in wounds. Three main forms: foodborne botulism (toxin ingested), wound botulism (toxin produced in infected wounds), and infant botulism (bacteria colonize infant gut and produce toxin). The toxin causes descending flaccid paralysis usually 12–36 h after ingestion. Death usually occurs from respiratory failure. Symptoms include blurred vision, difficulty swallowing, dry mouth, muscle weakness, and progressive paralysis. |
Foodborne/Infant Botulism: Antibiotics have NO role in treatment. Primary treatment is botulinum antitoxin (heptavalent HBAT) which must be administered immediately based on clinical findings. Wound Botulism: Penicillin or Metronidazole after surgical debridement. IMPORTANT: Treatment focuses on supportive care, mechanical ventilation if needed, and antitoxin administration. Antibiotics are only indicated for wound botulism. |
| Neisseria meningitidis | N. meningitidis causes: • Pyogenic (purulent) meningitis, usually following bacteraemia. It often has a sudden onset with intense headache, vomiting and a stiff neck. N. meningitidis occurs as a commensal in the nasopharynx of up to 25% or more of healthy people. • Meningococcal septicaemia, a severe and often fatal condition with high fever and characterized by rapid circulatory collapse and a haemorrhagic rash. Petechiae can often be detected in the conjunctivae. • Chronic meningococcal arthritis, an uncommon condition. |
Most strains of N. meningitidis are susceptible to penicillin, ampicillin, chloramphenicol, rifampicin and ceftriaxone. Penicillin-resistant strains of meningococci have been reported from South Africa and elsewhere, and occasionally also resistance to rifampicin. Vaccines are available against meningococcal groups A, C, Y, W135 as monovalent or polyvalent preparations. |
| Neisseria gonorrhoeae | N. gonorrhoeae causes gonorrhoea of the urogenital tract and less commonly, rectal and pharyngeal infection. Gonorrhoea is sexually transmitted. Infection in men: In men, N. gonorrhoeae infects the urethra and is usually symptomatic, causing dysuria and acute urethritis with a purulent discharge. The organism may spread to the prostate, bladder and epididymes, causing inflammation and swelling. Epididymitis may lead to sterility. Infection in women: In women, N. gonorrhoeae infects the cervix, urethra, vulva and rectum. Many infections are asymptomatic. When untreated, infection may spread upwards causing pelvic inflammatory disease (PID) which may lead to ectopic pregnancy or sterility. • Acute conjunctivitis in infants (ophthalmia neonatorum) • Vulvovaginitis in pre-pubertal girls. • Gonococcal arthritis |
CDC 2021 Guidelines - First-line: Ceftriaxone 500mg IM single dose (for patients <150kg) or 1g IM single dose (for patients ≥150kg). WHO Alternative Options: Ceftriaxone 1g IM single dose, or Cefixime 800mg PO single dose. When cephalosporin resistance suspected: Spectinomycin 2g IM + Azithromycin 2g PO, or Gentamicin 240mg IM + Azithromycin 2g PO. IMPORTANT: N. gonorrhoeae has developed resistance to all first-line therapies historically used. Treat sexual partners. Test for other STIs including HIV and syphilis. |
| Class / Drug | Drugs | Activity | Clinical Uses | Side Effects |
|---|---|---|---|---|
| BETA LACTAM ANTIBIOTICS AND OTHER CELL WALL SYNTHESIS INHIBITORS | ||||
| PENICILLINS | Benzylpenicillin, Penicillin V | Gram positive organisms, gram negative cocci and non beta lactamase producing anaerobes | Streptococci, meningococci, gram positive bacilli, spirochetes, syphilis (drug of choice) | Hypersensitivity reactions include anaphylaxis (IgE mediated), delayed hypersensitivity, erythema nodosum, and skin rashes. Patients with penicillin hypersensitivity may also show allergy to cephalosporins. |
| Penicillinase-resistant | Flucloxacillin, Cloxacillin, Methicillin, Nafcillin, Oxacillin | Staphylococcus and Streptococcus | Known or suspected staphylococcal infections | Similar to penicillin. Flucloxacillin may cause cholestatic jaundice. Methicillin can cause interstitial nephritis (rarely used now). |
| Aminopenicillins | Amoxicillin, Ampicillin | Similar to penicillin G plus enterococci, Listeria monocytogenes, E. coli, Proteus mirabilis, H. influenzae, M. catarrhalis | Respiratory infections, urinary tract infections | Diarrhea (common). Characteristic maculopapular rash occurs in patients with infectious mononucleosis. Hypersensitivity reactions. |
| Carboxypenicillins | Ticarcillin, Piperacillin | Gram negative rods including Pseudomonas aeruginosa, Enterobacter, Klebsiella. Combine with aminoglycosides for synergistic action | Serious gram negative infections | High sodium load, hypokalemia, platelet dysfunction (bleeding risk), hypersensitivity reactions. |
| CEPHALOSPORINS | Stable to staphylococcal penicillinase and have broad spectrum activity | Severe systemic infections caused by aerobic Gram negative organisms | Less likely to cause hypersensitivity than penicillin. Some can damage the kidneys. Expensive. | |
| First Generation | Cephalothin, Cephalexin, Cefazolin | Gram positive cocci including pneumococci, streptococci and staphylococci | Skin and soft tissue infections, urinary tract infections | Gastrointestinal disturbances, hypersensitivity (10% cross-reactivity with penicillin allergy). |
| Second Generation | Cefaclor, Cefuroxime, Cefoxitin, Cefotetan | Slightly less activity against gram positive, extended gram negative coverage, Klebsiella, Bacteroides fragilis | Sinus, ear and respiratory infections caused by H. influenzae or M. catarrhalis | Similar to first generation. Cefotetan may cause bleeding disorders (hypoprothrombinemia). |
| Third Generation | Cefixime, Cefotaxime, Ceftazidime, Ceftriaxone | Increased activity against gram negative organisms resistant to other beta lactam drugs | Serious infections - penicillin resistant pneumococci, gonorrhea, meningitis (with aminoglycosides) | Generally well tolerated. Ceftriaxone may cause biliary sludging, diarrhea. Do not mix with calcium-containing solutions in neonates. |
| Fourth Generation | Cefepime | Combines gram positive activity of first generation with wider gram negative spectrum of third generation | Serious hospital-acquired infections | Similar to third generation. Neurotoxicity (confusion, seizures) in renal impairment. |
| MONOBACTAMS | Aztreonam | Klebsiella, Pseudomonas, Serratia | Gram negative infections in penicillin-allergic patients | Well tolerated. No cross-reactivity with penicillin allergies. Minimal GI side effects. |
| CARBAPENEMS | Imipenem, Meropenem, Ertapenem | Potent activity against wide range of Gram positive and Gram negative bacteria, resistant to beta-lactamases | Serious multi-drug resistant infections | Seizures (especially imipenem in patients with CNS disorders or renal impairment). Nausea, diarrhea. Cross-reactivity with penicillin allergy possible. |
| BETA-LACTAMASE INHIBITORS | Clavulanic acid, Sulbactam, Tazobactam | Used with hydrolyzable penicillins to prevent breakdown | Combined with amoxicillin (Augmentin), piperacillin | Clavulanic acid: increased diarrhea compared to amoxicillin alone. Hepatotoxicity (rare). |
| VANCOMYCIN | Vancomycin | Drug resistant gram positive organisms including MRSA, penicillin resistant pneumococci | Serious infections such as endocarditis and septicaemia caused by Gram positive bacteria, particularly multi-resistant strains | Ototoxicity (hearing damage) and nephrotoxicity (kidney damage). Requires monitoring. |
| CHLORAMPHENICOL, TETRACYCLINES, MACROLIDES, CLINDAMYCIN | ||||
| CHLORAMPHENICOL | Chloramphenicol | Haemophilus influenzae, Neisseria meningitidis, Bacteroides | Back up drug for severe infections caused by salmonella species, treatment of pneumococcal and meningococcal meningitis in beta lactam sensitive persons, rickettsiae, topical eye infections | Aplastic anaemia, toxic in neonates |
| TETRACYCLINES | Tetracycline, Doxycycline, Minocycline, Tigecycline | Mycoplasma pneumoniae, Chlamydia, Rickettsiae, Vibrios, some spirochetes | Respiratory infections, acne, syphilis alternative, Lyme disease, malaria prophylaxis, cholera, bronchitis prophylaxis, H. pylori ulcers Doxycycline: Lyme disease, malaria prophylaxis, amebiasis, brucellosis Minocycline: Meningococcal carrier state Tigecycline: Tetracycline-resistant infections |
Bacteriostatic broad spectrum antibiotic |
| MACROLIDES | Erythromycin, Azithromycin, Clarithromycin | Campylobacter, Chlamydia, Mycoplasma, Legionella, Gram positive cocci | Staphylococcal infections, respiratory infections, non-specific urethritis, Campylobacter enteritis, second-line for penicillin hypersensitivity Azithromycin: Single dose for C. trachomatis, 4-day course for community acquired pneumonia Clarithromycin: Prophylaxis against M. avium complex, H. pylori ulcers |
Gastrointestinal upsets, rashes |
| CLINDAMYCIN | Clindamycin | Anaerobes such as Bacteroides, Gram positive cocci, MRSA, Pneumocystis jiroveci | Severe infections caused by anaerobes, backup drug against gram positive cocci, prophylaxis of endocarditis in penicillin-allergic patients, with pyrimethamine for AIDS-related toxoplasmosis | Associated with pseudomembranous colitis |
| TELITHROMYCIN | Telithromycin | Same as erythromycin, some macrolide resistant strains susceptible | Community acquired pneumonia including multi-drug resistant organisms | Hepatotoxicity (can be severe), visual disturbances, QT prolongation. Use limited due to safety concerns. |
| STREPTOGRAMINS | Quinupristin/Dalfopristin | Penicillin resistant pneumococci, MRSA, Vancomycin resistant staphylococci | Multi-drug resistant gram positive infections | Arthralgia, myalgia (common, can be severe), phlebitis at infusion site. Must use central venous catheter. |
| LINEZOLID | Linezolid | Drug resistant gram positive cocci, penicillin resistant and vancomycin resistant organisms | Staphylococcal bone and joint infections, anaerobic infections | Associated with pseudomembranous colitis |
| AMINOGLYCOSIDES | ||||
| AMINOGLYCOSIDES | Gentamicin, Tobramycin, Amikacin | Bactericidal, synergy with beta-lactam agents. Aerobic Gram negative bacilli | Severe sepsis due to coliforms and Gram negative aerobic bacilli, endocarditis with beta-lactams | Hypersensitivity reactions, ototoxicity, nephrotoxicity |
| Streptomycin | Streptomycin | Mycobacterium tuberculosis, Yersinia pestis, Francisella tularensis, synergistic with penicillins for enterococci | Enterococcal carditis with penicillins, tuberculosis, plague, tularemia | Ototoxicity (especially vestibular), nephrotoxicity. Requires monitoring. |
| Other | Neomycin, Kanamycin, Spectinomycin | Neomycin/Kanamycin: gram negative bacilli (oral use for bowel decontamination only). Spectinomycin: Neisseria gonorrhoeae | Eliminate bowel flora (neomycin, kanamycin), backup drug for gonorrhea (spectinomycin) | Neomycin: Too toxic for systemic use, can cause ototoxicity and nephrotoxicity even when given orally. Malabsorption syndrome. |
| SULPHONAMIDES, TRIMETHOPRIM AND FLUOROQUINOLONES | ||||
| SULPHONAMIDES | Sulfamethoxazole, Sulfadiazine, Silver sulfadiazine, Sulfasalazine | Gram positive and gram negative organisms, Chlamydia, Nocardia | Simple urinary tract infections, ocular infections (sulfacetamide), burns (mafenide, silver sulfadiazine), ulcerative colitis (sulfasalazine), toxoplasmosis (with pyrimethamine) | Hypersensitivity reactions, rashes, Stevens-Johnson syndrome, crystalluria, kernicterus in neonates, hemolysis in G6PD deficiency. |
| TRIMETHOPRIM | Cotrimoxazole (Trimethoprim + Sulphamethoxazole) | Broad spectrum. Gram positive and negative bacteria, Pneumocystis jiroveci, Toxoplasma gondii, Nocardia, Stenotrophomonas | Urinary tract infections, respiratory infections, ear infections, sinus infections (H. influenzae, M. catarrhalis), opportunistic infections, nocardiosis, cholera, typhoid fever, shigellosis, MRSA, Listeria | Nausea, vomiting, rashes, mouth ulceration, occasionally thrombocytopenia and leucopenia. Stevens-Johnson syndrome, hyperkalemia, folate deficiency. |
| FLUOROQUINOLONES | Ciprofloxacin, Ofloxacin, Levofloxacin, Norfloxacin | Gram negative bacteria, gonococcus, many gram positive cocci, mycoplasma, atypical pneumonia agents | Urinary tract infections, gonorrhea (single oral dose), Chlamydia (7-day ofloxacin), respiratory infections, skin infections, soft tissue infections, Pseudomonas infections (ciprofloxacin) | Tendon rupture (especially Achilles), QT prolongation, peripheral neuropathy, CNS effects. Avoid in children and pregnancy. Photosensitivity. |
| Third Generation | Gemifloxacin, Moxifloxacin | Greater activity against gram positive cocci than earlier generations | Community acquired pneumonia | Similar to other fluoroquinolones. Moxifloxacin has higher risk of QT prolongation. |
| METRONIDAZOLE | Metronidazole | Anaerobic infections, protozoal infections | Anaerobic infections (Bacteroides, anaerobic cocci, clostridia), Vincent's angina, T. vaginalis, E. histolytica, G. lamblia | Metallic taste, nausea, disulfiram-like reaction with alcohol, peripheral neuropathy with prolonged use. Dark urine (harmless). |
| ANTIFUNGAL AGENTS | ||||
| SYSTEMIC ANTIFUNGALS | Amphotericin B | Widest spectrum of any antifungal agent | Drug of choice for most systemic infections: Aspergillus, Blastomyces, Candida, Cryptococcus, Histoplasma, Mucor | Infusion-related reactions (fever, chills, rigors), nephrotoxicity (dose-limiting), hypokalemia, hypomagnesemia, anemia. Liposomal formulations less toxic. |
| Flucytosine | Flucytosine | Candida, Cryptococcus. Narrow spectrum - always used in combination to prevent resistance | Combined with triazole or amphotericin B for Cryptococcus neoformans, systemic candidal infections, chromoblastomycosis | Bone marrow suppression (dose-related), hepatotoxicity, GI disturbances. Monitor blood counts and liver function. |
| AZOLES | Ketoconazole, Fluconazole, Itraconazole, Voriconazole, Posaconazole | Candida, Cryptococcus, dermatophytes. Itraconazole/Voriconazole/Posaconazole: Aspergillus. Fluconazole lacks aspergillus activity | Candidiasis, cryptococcal meningitis, aspergillosis, blastomycosis | Hepatotoxicity, GI disturbances, drug interactions (CYP450 inhibitors). Voriconazole: visual disturbances, photosensitivity. Avoid ketoconazole systemically (severe hepatotoxicity). |
| ECHINOCANDINS | Caspofungin, Anidulafungin, Micafungin | Candida (including azole-resistant), Aspergillus. Not effective against Cryptococcus or endemic fungi | Disseminated and mucocutaneous Candida infections in patients failing amphotericin B, esophageal and invasive candidiasis | Generally well tolerated. Histamine-mediated infusion reactions, hepatotoxicity (rare). Fever, GI disturbances. |
| TOPICAL ANTIFUNGALS | Nystatin, Miconazole, Clotrimazole | Candida species, dermatophytes (azoles only) | Local Candida infections | Local irritation, burning sensation. Nystatin poorly absorbed - safe for oral thrush. Generally well tolerated. |
| SUPERFICIAL FUNGAL | Griseofulvin, Terbinafine | Dermatophytes (Trichophyton, Microsporum, Epidermophyton). Not effective against Candida | Dermatophytoses of skin, hair and nails | Griseofulvin: GI upset, headache, photosensitivity, drug interactions. Terbinafine: GI upset, taste disturbance, hepatotoxicity (rare), rash. |
| ANTIPROTOZOAL DRUGS | ||||
| ANTIMALARIAL AGENTS | Quinine, Mefloquine, Primaquine | Plasmodium species. Quinine: all species. Mefloquine: P. falciparum, P. vivax. Primaquine: liver stages (hypnozoites) of P. vivax and P. ovale | Quinine: Multidrug resistant malaria Mefloquine: Prophylaxis and treatment in chloroquine resistant areas Primaquine: Eradication of liver stages of P. ovale and P. vivax |
Quinine: Cinchonism (tinnitus, headache, nausea), hypoglycemia, QT prolongation. Mefloquine: Neuropsychiatric effects, nightmares. Primaquine: Hemolysis in G6PD deficiency (test before use). |
| Antifolate Drugs | Pyrimethamine, Proguanil, Sulfadoxine, Dapsone | Plasmodium species via folate synthesis inhibition. Used in combination therapy | Pyrimethamine + Sulfadoxine: Chloroquine resistant P. falciparum Proguanil + Atovaquone: Daily chemoprophylaxis for chloroquine resistant malaria |
Pyrimethamine-Sulfadoxine: Stevens-Johnson syndrome, blood dyscrasias, folate deficiency. Atovaquone-Proguanil: Generally well tolerated, GI upset. |
| Artemisinin Derivatives | Artesunate, Artemether, Dihydroartemisinin | Rapid-acting against all Plasmodium species. Always used in combination to prevent resistance (ACTs - Artemisinin-based Combination Therapies) | All forms of malaria (combined with lumefantrine, mefloquine, or amodiaquine). Artesunate IV: severe malaria | Generally well tolerated. Nausea, vomiting, diarrhea. Delayed hemolysis after treatment of severe malaria. Contraindicated in first trimester of pregnancy. |
| DRUGS FOR AMEBIASIS | Diloxanide furoate, Metronidazole, Tinidazole, Iodoquinol, Paromomycin | Entamoeba histolytica. Metronidazole/Tinidazole: tissue amebicides. Diloxanide/Iodoquinol/Paromomycin: luminal amebicides | Asymptomatic intestinal infection: Diloxanide furoate Mild-moderate intestinal: Metronidazole/Tinidazole + luminal agent Severe intestinal: Metronidazole + luminal agent Hepatic abscess: Metronidazole + luminal agent |
Metronidazole: see above. Diloxanide: flatulence, GI upset. Iodoquinol: GI upset, rash. Paromomycin: GI disturbances (aminoglycoside, poorly absorbed). |
| ANTIHELMINTHIC DRUGS | ||||
| BENZIMIDAZOLES | Albendazole, Mebendazole | Broad spectrum. Nematodes (roundworms): Ascaris, hookworm, pinworm, whipworm, Strongyloides. Cestodes (tapeworms): Taenia, Echinococcus. Some trematodes | Albendazole: Intestinal nematodes, hydatid disease, neurocysticercosis, strongyloidiasis, cutaneous larva migrans Mebendazole: Intestinal nematodes (ascariasis, hookworm, pinworm, whipworm) |
Generally well tolerated. Abdominal pain, diarrhea, headache. Albendazole: reversible alopecia, hepatotoxicity (with prolonged use). Teratogenic - avoid in pregnancy. |
| PRAZIQUANTEL | Praziquantel | All trematodes (flukes): Schistosoma, Clonorchis, Paragonimus. Most cestodes (tapeworms): Taenia, Diphyllobothrium, Hymenolepis | Schistosomiasis (drug of choice), liver flukes, lung flukes, intestinal tapeworms, neurocysticercosis (with corticosteroids) | Abdominal pain, dizziness, headache, drowsiness. Usually mild and transient. Take with food to improve absorption. |
| IVERMECTIN | Ivermectin | Tissue nematodes: Onchocerca volvulus, Strongyloides, cutaneous larva migrans. Ectoparasites: scabies, lice | Onchocerciasis (river blindness), strongyloidiasis, scabies (crusted), cutaneous larva migrans, lymphatic filariasis | Mazzotti reaction in onchocerciasis (fever, rash, lymphadenitis from dying microfilariae). Generally well tolerated. Avoid in pregnancy. |
| DIETHYLCARBAMAZINE | Diethylcarbamazine (DEC) | Filarial nematodes: Wuchereria bancrofti, Brugia malayi, Loa loa | Lymphatic filariasis, tropical pulmonary eosinophilia, loiasis | Allergic reactions from dying microfilariae (fever, headache, myalgia). Severe in heavy Loa loa infections (encephalopathy risk). Take after meals. |
| LEVAMISOLE | Levamisole | Ascaris lumbricoides (roundworm) | Ascariasis | Nausea, vomiting, abdominal pain, dizziness. Generally well tolerated for single-dose therapy. |
| PYRANTEL PAMOATE | Pyrantel pamoate | Intestinal nematodes: Ascaris, hookworm, pinworm | Ascariasis, enterobiasis (pinworm), hookworm infections | GI upset, headache, dizziness. Generally safe, available OTC in many countries. |
| Class / Drug | Drugs Available | Mechanism of Action / Activity | Clinical Uses | Side Effects / Contraindications |
|---|---|---|---|---|
| DRUGS ACTING ON INFECTIONS (ANTIBIOTICS) | ||||
| PENICILLINS - Broad Spectrum | Amoxicillin 500mg, Amoxicillin 250mg, Elymox 60ml, Elymox 100ml, Ampiclo 500mg, Ampiclo 60ml, Ampiclo Oral Drops 10ml | Inhibits bacterial cell wall synthesis. Active against Gram-positive cocci, some Gram-negative (H. influenzae, E. coli, P. mirabilis) | Respiratory infections, otitis media, urinary tract infections, salmonella, helicobacter pylori eradication | Hypersensitivity reactions (rash, anaphylaxis), diarrhea, nausea. Rash in mononucleosis. Cross-reactivity with cephalosporins possible. |
| Penicillinase-resistant | Flucloxacillin 500mg, Flucloxacillin 100ml | Resistant to penicillinase. Active against Staphylococcus aureus and Streptococcus species | Staphylococcal skin infections, soft tissue infections, osteomyelitis | Similar to penicillin. Flucloxacillin may cause cholestatic jaundice, hepatotoxicity. GI disturbances. |
| Penicillin + Clavulanate | Amoxiclav 625mg, Augmentin 625mg, Novamentin 625mg, Labckav 625mg, Augmin 625mg, Co-amoxiclav 1g, Labclav 100ml | Amoxicillin combined with clavulanic acid (beta-lactamase inhibitor). Extended spectrum against beta-lactamase producing organisms | Mixed infections, respiratory tract infections, skin and soft tissue infections, otitis media, sinusitis, urinary tract infections | Diarrhea (more common than amoxicillin alone), nausea, vomiting, hypersensitivity reactions. Hepatotoxicity (rare). |
| CEPHALOSPORINS - 1st Generation | Cefalexin/Lexin 100ml | Beta-lactam antibiotics inhibiting cell wall synthesis. Active against Gram-positive cocci (S. aureus, S. pneumoniae, streptococci) | Skin and soft tissue infections, urinary tract infections, respiratory infections (if penicillin-allergic) | GI disturbances, hypersensitivity (10% cross-reactivity with penicillin), rash, diarrhea. |
| 2nd Generation | Cefuroxime 500mg | Enhanced activity against Gram-negative organisms including H. influenzae, M. catarrhalis, Klebsiella. Some anaerobes | Sinusitis, otitis media, bronchitis, pneumonia, skin infections, gonorrhea | Similar to first generation. Cefotetan may cause hypoprothrombinemia and bleeding disorders. |
| 3rd Generation | Cefixime 200mg, Cefixime 400mg, Ceftriaxone 1g (Imaxone), Cefotaxime | Increased activity against Gram-negative organisms resistant to other beta-lactams. Good penetration into CSF | Serious Gram-negative infections, gonorrhea, meningitis, sepsis, pneumonia, complicated UTIs | Generally well tolerated. Ceftriaxone may cause biliary sludging, diarrhea. Do not mix with calcium in neonates. |
| MACROLIDES - Erythromycin | Erythrox 60ml, Erythrox 100ml, Erocin 60ml | Inhibits bacterial protein synthesis by binding to 50S ribosomal subunit. Active against Gram-positive cocci, Mycoplasma, Legionella, Chlamydia | Respiratory infections, pertussis, chlamydia, campylobacter enteritis, diphtheria, as penicillin alternative | GI upset (common - stimulates motilin receptors), QT prolongation, hepatic toxicity, ototoxicity (rare). |
| Azithromycin | Azithromycin 500mg tabs, Azithromycin 15ml, Azivlar 500mg | Similar to erythromycin with longer half-life. Better tissue penetration. Extended spectrum including some Gram-negative | Respiratory infections, community-acquired pneumonia, chlamydia (single dose), typhoid fever, MAC prophylaxis, skin infections | GI upset (less than erythromycin), QT prolongation, taste perversion, diarrhea. Hepatotoxicity (rare). |
| FLUOROQUINOLONES - Ciprofloxacin | Ciprofloxacin 500mg, Ciphex 500mg, Ciproflocacin 500mg | Inhibits bacterial DNA gyrase and topoisomerase IV. Broad spectrum against Gram-negative including Pseudomonas | Urinary tract infections, respiratory infections, gastrointestinal infections (shigella, salmonella), skin infections, gonorrhea | Tendon rupture (especially Achilles), QT prolongation, peripheral neuropathy, CNS effects, photosensitivity. Avoid in children/pregnancy. |
| Ofloxacin | Orav Oz 700mg, Doflodina | DNA gyrase inhibitor. Broad spectrum. Combined with ornidazole for anaerobic coverage | GI infections, respiratory infections, skin infections, STI, pelvic inflammatory disease | Similar to ciprofloxacin. CNS stimulation, GI upset, headache, insomnia. Tendon damage possible. |
| TETRACYCLINES | Racycline, Doxycycline | Inhibits protein synthesis by binding to 30S ribosomal subunit. Broad spectrum: Mycoplasma, Chlamydia, Rickettsiae, some parasites | Acne, rosacea, cholera, rickettsial infections, Lyme disease, malaria prophylaxis, H. pylori, amebiasis | GI upset, photosensitivity, teeth discoloration in children/pregnancy, hepatotoxicity, renal toxicity, benign intracranial hypertension. |
| SULFONAMIDES - Cotrimoxazole | Cotrimoxazole 100ml, Cotrimoxazole 960mg, Biotrim 50ml, Biotrim 100ml, Lecotrim 100ml, Cotricel 50ml | Folate synthesis inhibitor (trimethoprim + sulfamethoxazole). Bactericidal against many Gram-positive and Gram-negative | Urinary tract infections, respiratory infections, otitis media, Pneumocystis jiroveci pneumonia (PCP) prophylaxis, salmonella, shigella, nocardia | Hypersensitivity reactions, rashes, Stevens-Johnson syndrome, crystalluria, hemolysis in G6PD deficiency, folate deficiency, hyperkalemia. |
| Antimalarial Combination | Malodar, Fansidar | Inhibits folate synthesis in malaria parasites. Synergistic combination | Malaria treatment (with Artemether), prevention (limited use due to resistance) | Severe cutaneous reactions (SJS, TEN), blood dyscrasias, crystalluria, folate deficiency, severe hypersensitivity. |
| NITROIMIDAZOLES - Metronidazole | Metrogyl Injection, Eflaron 60ml, Eflaron 100ml, Flagin 100ml, Flagon 60ml, Flazole 200mg, Trogyl 400mg | Reduced to active metabolite that damages DNA. Active against anaerobes, protozoa (Trichomonas, Entamoeba, Giardia) | Anaerobic bacterial infections, amebiasis, giardiasis, trichomoniasis, H. pylori eradication, bacterial vaginosis, C. difficile colitis | Metallic taste, nausea, vomiting, disulfiram-like reaction with alcohol, dark urine (harmless), peripheral neuropathy with prolonged use, candidiasis. |
| Tinidazole | Tinisky 500, Tdex 500mg | Similar to metronidazole with longer half-life. Active against anaerobes and protozoa | Giardiasis, amebiasis, trichomoniasis, bacterial vaginosis, anaerobic infections | Similar to metronidazole. GI upset, metallic taste, dizziness. Disulfiram-like reaction with alcohol. |
| Secnidazole | Dysen 30ml, Senidol 1g, Secnid DS, Agisec 1g | Longer half-life than metronidazole. Single dose therapy for protozoal infections | Single dose treatment for amebiasis, giardiasis, trichomoniasis, bacterial vaginosis | GI disturbances, metallic taste, headache, dizziness. Disulfiram-like reaction with alcohol. |
| OTHER ANTIBIOTICS - Clindamycin | Clindamycin 300mg | Inhibits protein synthesis at 50S ribosome. Active against Gram-positive cocci, anaerobes (Bacteroides), MRSA, Pneumocystis | Anaerobic infections, bone and joint infections, skin infections, abdominal infections, PCP (with trimethoprim), toxic shock syndrome | Pseudomembranous colitis (C. difficile), diarrhea, rash, hepatic toxicity, neutropenia. Risk of C. difficile higher than other antibiotics. |
| Nitrofurantoin | Nitrofurantoin 100mg | Reduced to reactive metabolites that damage bacterial DNA. Concentrated in urine. Bacteriostatic/bactericidal | Uncomplicated urinary tract infections (acute cystitis). Not for pyelonephritis or systemic infections | GI upset (common), hemolysis in G6PD deficiency, pulmonary fibrosis (long-term), peripheral neuropathy (long-term), hepatotoxicity. |
| Griseofulvin | Griseofulvin 125mg, Griseofulvin 250mg, Griseofulvin 500mg | Inhibits fungal cell division by binding to microtubules. Active against dermatophytes (Trichophyton, Microsporum, Epidermophyton) | Dermatophyte infections: tinea corporis, tinea pedis, tinea capitis, onychomycosis | Headache, GI upset, photosensitivity, hepatotoxicity, blood dyscrasias, teratogenic. Interactions: warfarin, oral contraceptives. |
| Penicillin G | Benzapene 1M IU | Inhibits cell wall synthesis. Active against Gram-positive cocci, Gram-negative cocci, spirochetes, anaerobes | Syphilis (drug of choice), meningococcal disease, bacterial endocarditis, anthrax, diphtheria, rat-bite fever | Hypersensitivity reactions (anaphylaxis, rash, serum sickness), JARISCH-HERXHEIMER REACTION in syphilis, hyperkalemia (IV potassium salt). |
| ANTIFUNGALS - Fluconazole | Fluconazole 150mg, Fluconazole 200mg, Fluconazole 35ml, Fluconazole 60ml | Inhibits fungal cytochrome P450 (ergosterol synthesis). Fungistatic. Active against Candida, Cryptococcus, Coccidioides | Oropharyngeal candidiasis, vaginal candidiasis, systemic candidiasis, cryptococcal meningitis, dermatophyte infections, onychomycosis | GI upset, headache, rash, hepatotoxicity, QT prolongation. Multiple drug interactions (statins, warfarin, benzodiazepines). |
| ANTIHELMINTICS (Drugs Acting on Parasites) | ||||
| BENZIMIDAZOLES - Albendazole | Nil Worm 400mg, ABZ, Altoa Syrup, Calben 10ml | Inhibits microtubule polymerization, depletes energy. Effective against roundworms, hookworms, whipworms, pinworms, tapeworms | Ascariasis, enterobiasis (pinworm), hookworm, whipworm, strongyloidiasis, cysticercosis, hydatid disease | GI upset, headache, dizziness, elevated LFTs, alopecia, bone marrow suppression. Avoid in pregnancy (teratogenic). |
| Mebendazole | Natoa 100mg, Natoa 30ml | Similar to albendazole. Inhibits glucose uptake in parasites | Ascariasis, enterobiasis, hookworm, whipworm (single dose or 3-day course) | GI upset, abdominal pain, diarrhea. Rare: elevated LFTs, neutropenia. Avoid in pregnancy. |
| Levamisole | Levamisole Syrup, Letrax 40mg | Stimulates nicotinic receptors, paralyzes worms. Also immunomodulatory effects | Ascariasis, hookworm infections. Also used in autoimmune diseases (less common) | GI upset, headache, dizziness, insomnia, agranulocytosis (rare), disulfiram-like reaction with alcohol. |
| DRUGS ACTING ON THE ALIMENTARY CANAL (GASTROINTESTINAL) | ||||
| ANTACIDS | Allucid, Gastrogel, Alugel, Magnacid Gel, Allucid Plus, Eno, Tumbocid, Gas Off Tabs | Neutralize gastric acid. Aluminium/magnesium compounds provide rapid relief. Calcium carbonate is potent antacid | Hyperacidity, GERD, peptic ulcer disease, dyspepsia, heartburn, indigestion | Constipation (aluminum), diarrhea (magnesium), acid rebound (calcium), milk-alkali syndrome. Drug interactions (fluoroquinolones, tetracyclines, iron). |
| PROTON PUMP INHIBITORS | Omesk 20mg, Lozol 20mg, Esomeprazole 20mg, Esomeprazole 40mg, Esuprone Injection | Irreversibly inhibit H+/K+ ATPase in gastric parietal cells. Suppress gastric acid secretion significantly | Peptic ulcer, GERD, erosive esophagitis, H. pylori eradication, NSAID-induced ulcer prevention, Zollinger-Ellison syndrome | GI upset, headache, increased risk of C. difficile infection, reduced B12 absorption, hypomagnesemia, increased fracture risk, renal disease. |
| H2 RECEPTOR ANTAGONISTS | Ranitidine (if available), Famotidine (if available) | Block H2 receptors on gastric parietal cells. Reduce acid secretion | Peptic ulcer, GERD, dyspepsia, stress ulcer prophylaxis | Generally well tolerated. Headache, dizziness, diarrhea, constipation. Can cause confusion in elderly. Drug interactions. |
| ANTIDIARRHEALS - Loperamide | Immobulk 2mg, Coramide 2mg | Opioid receptor agonist in gut. Reduces intestinal motility, increases intestinal absorption time | Acute and chronic diarrhea, IBS-D, reducing ileostomy output | Constipation, abdominal cramps, dizziness, nausea. Toxic megacolon in ulcerative colitis. Dependence possible with long-term use. |
| ANTISPASMODICS | No Spa 40mg, Entamaxin, Dicyclomine | Anticholinergic (dicyclomine) or calcium channel blocker (drotaverine). Relax smooth muscle in GI tract | Irritable bowel syndrome, intestinal colic, biliary colic, dysmenorrhea | Dry mouth, blurred vision, constipation, urinary retention, tachycardia. Drotaverine: hypotension, dizziness. |
| LAXATIVES | Bisacodyl 5mg, Glycerin Suppositories | Stimulant (bisacodyl) - irritates colon. Osmotic (glycerin) - draws water into colon | Constipation, bowel preparation for procedures | Abdominal cramps, diarrhea, electrolyte imbalance with overuse. Bisacodyl: melanosis coli (long-term). |
| PROKINETICS | Domperidone/Motinorm, Metoclopramide/Matcos | Dopamine antagonists. Increase gastric emptying and lower esophageal sphincter tone | Nausea, vomiting, gastroparesis, functional dyspepsia, reflux | Extrapyramidal symptoms (metoclopramide), prolactin elevation, drowsiness, QT prolongation (domperidone). Tardive dyskinesia (metoclopramide). |
| DRUGS ACTING ON CENTRAL NERVOUS SYSTEM | ||||
| ANALGESICS - Paracetamol | Calpol, Pyremol, Trumol, Betamol, Curamol, Pharmadol, Panadol Advance, Panadol Extra, Cipladon | Inhibits COX-3 in CNS. Analgesic and antipyretic but minimal anti-inflammatory effect | Mild to moderate pain, fever, headache, osteoarthritis. Safe in pregnancy and children | Hepatotoxicity in overdose (N-acetylcysteine is antidote). Rare: Stevens-Johnson syndrome, blood dyscrasias. Safe at recommended doses. |
| NSAIDs - Ibuprofen | Ibumex, Flamofenac, Ibugesic, Brustan, Flamifen | Inhibits COX-1 and COX-2. Analgesic, anti-inflammatory, antipyretic | Pain, inflammation, arthritis, dysmenorrhea, headache, fever, soft tissue injuries | GI upset, peptic ulcer, bleeding, renal impairment, increased cardiovascular risk, fluid retention, asthma exacerbation. Avoid in late pregnancy. |
| Diclofenac | Diclomol, Voltamed, Rheumac, Dinac, New Relief | Potent NSAID inhibiting COX. Strong anti-inflammatory activity | Arthritis, pain, inflammation, acute gout, migraine, dysmenorrhea | Similar to other NSAIDs. Higher cardiovascular risk. GI bleeding, hepatotoxicity, renal impairment. Avoid in pregnancy. |
| Mefenamic Acid | Mefril 250mg, Analmin 500mg | NSAID with analgesic, anti-inflammatory, and antipyretic properties | Dysmenorrhea, pain, fever, menorrhagia | Diarrhea, GI upset, drowsiness, dizziness. Can cause hematemesis. Avoid in inflammatory bowel disease. |
| OPIOID ANALGESICS | Surepyn, Beta Pyn (Paracetamol + Codeine combinations) | Mu receptor agonists in CNS. Potent analgesia, sedation, respiratory depression | Moderate to severe pain, cough suppression (codeine) | Respiratory depression, sedation, constipation, nausea, vomiting, dependence, tolerance. Caution in elderly, respiratory disease. |
| MUSCLE RELAXANTS | Zrtal MR, Acetal MR, Zulu MR (Aceclofenac + Paracetamol + Chlorzoxazone) | Centrally acting muscle relaxant + NSAID combination | Muscle spasm, musculoskeletal pain, strain, sprain, tension headache | Drowsiness, dizziness, GI upset, dry mouth. Chlorzoxazone: hepatotoxicity, GI bleeding. Avoid in liver disease. |
| ANTIEPILEPTICS | Gabapentin/Gabix, Pregabalin/Pergalin, Carbamazepine | Gabapentin/Pregabalin: Bind to voltage-gated calcium channels. Carbamazepine: Na channel blocker | Epilepsy, neuropathic pain, bipolar disorder, trigeminal neuralgia, anxiety | Dizziness, drowsiness, weight gain (gabapentin), ataxia. Carbamazepine: hyponatremia, agranulocytosis, hepatotoxicity, drug interactions. |
| ANTIPARKINSONIAN | Benzhexol 5mg, Bromocriptine 2.5mg | Benzhexol: Anticholinergic. Bromocriptine: Dopamine agonist | Parkinson's disease, drug-induced extrapyramidal symptoms, hyperprolactinemia (bromocriptine) | Dry mouth, blurred vision, constipation, urinary retention, confusion, hallucinations. Bromocriptine: hypotension, nausea, valvulopathy. |
| ANXIOLYTICS & SEDATIVES | Diazepam (if available), Promethazine 25mg, Promezine | Benzodiazepines enhance GABA-A receptor. Promethazine: H1 antagonist with sedative properties | Anxiety, insomnia, seizures, muscle spasm, sedation, motion sickness, allergy, nausea | Drowsiness, sedation, respiratory depression, dependence, withdrawal, confusion (elderly). Promethazine: extrapyramidal effects. |
| CNS STIMULANTS | Homagon, Coldcap, Cofrid, Dacold, Flucoldex | Combination: Chlorpheniramine (antihistamine), Pseudoephedrine (decongestant), Caffeine (stimulant), Paracetamol (analgesic) | Cold symptoms, fatigue, mild drowsiness, allergic rhinitis | Insomnia, tachycardia, hypertension, tremor, anxiety, GI upset. Caffeine: dependence, withdrawal. Pseudoephedrine: hypertension. |
| DRUGS ACTING ON ENT (EAR, NOSE, THROAT) | ||||
| NASAL DECONGESTANTS | Tricohist, Tridahist, Zedcoril, Cadistin, Cadiphen, Delased, Dawahist, Lunahist, Centrihist | Alpha-adrenergic agonists (pseudoephedrine, phenylephrine). Constrict nasal blood vessels | Nasal congestion, allergic rhinitis, common cold, sinusitis | Insomnia, nervousness, tachycardia, hypertension. Topical: rebound congestion (rhinitis medicamentosa). Avoid in hypertension, glaucoma. |
| TOPICAL NASAL | Oxymetazoline, Xylometazoline (if available) | Direct alpha-agonist nasal spray. Rapid and prolonged vasoconstriction | Acute nasal congestion | Rebound congestion with prolonged use (>5-7 days), nasal irritation, epistaxis. Systemic absorption possible in children. |
| EAR PREPARATIONS | Ciprofloxacin Ear Drops, Clotrimazole Ear Drops (if available) | Antibiotic or antifungal topical preparations | Otitis externa, otitis media, otomycosis | Local irritation, itching. Rare: allergic reactions. |
| THROAT PREPARATIONS | Zecuf Lozenges, Dazole Mouth Paint, Povidone Iodine | Antiseptic and anti-inflammatory lozenges/gargles | Sore throat, mouth ulcers, gingivitis, pharyngitis | Local irritation, taste disturbance. Povidone iodine: thyroid dysfunction with prolonged use. |
| ENDOCRINE DRUGS | ||||
| ANTIDIABETIC - Metformin | Metformin/Glucomet 500mg | Decreases hepatic glucose production, improves insulin sensitivity. Increases peripheral glucose utilization | Type 2 Diabetes mellitus, PCOS (off-label), obesity with diabetes | GI upset (common), metallic taste, B12 deficiency, lactic acidosis (rare, contraindicated in renal impairment). Avoid in liver disease, alcohol. |
| CORTICOSTEROIDS | Prednisolone 5mg, Dexamethasone 4mg, Dexamar, Hydrocortisone Injection, Labohydro, Prednisolone Eye Drops | Glucocorticoid: inhibit inflammatory mediators, suppress immune response, affect metabolism | Inflammation, allergic reactions, asthma exacerbation, adrenal insufficiency, autoimmune diseases, skin conditions | Hyperglycemia, hypertension, osteoporosis, peptic ulcer, cataracts, mood changes, immunosuppression, adrenal suppression (long-term), fluid retention. |
| CONTRACEPTIVES | Postinor 2, Safe 72, Lydia Postpil, Femiplan | Levonorgestrel: Progesterone agonist. Inhibits ovulation, thickens cervical mucus, prevents implantation | Emergency contraception (within 72-120 hours), regular contraception | Nausea, vomiting, menstrual irregularities, abdominal pain, fatigue, headache. Irregular bleeding. Ectopic pregnancy risk if fails. |
| SEX HORMONES - Progestins | Norethisterone 5mg, Dydrogesterone 10mg | Synthetic progesterone. Support pregnancy, regulate menstrual cycle | Menstrual disorders, endometriosis, contraception, threatened miscarriage | Mood changes, breast tenderness, weight gain, irregular bleeding, headache. |
| Fertility | Clomiphene Citrate 50mg | Selective estrogen receptor modulator. Stimulates GnRH release, induces ovulation | Female infertility (anovulation), PCOS | Hot flashes, mood swings, visual disturbances, ovarian hyperstimulation syndrome, multiple pregnancies, ovarian cysts. |
| ANTIMALARIALS | Artemether + Lumefantrine, Malodar, Fansidar | Artemether: Heme polymerase inhibitor (fast-acting). Lumefantrine: unclear mechanism. Fansidar: folate antagonist | Treatment of uncomplicated Plasmodium falciparum malaria | Artemether/Lumefantrine: headache, nausea, vomiting, anorexia, dizziness, palpitations, QT prolongation. Fansidar: severe cutaneous reactions. |
| DRUGS ACTING ON GENITOURINARY SYSTEM | ||||
| DIURETICS - Loop Diuretics | Furosemide 40mg | Inhibits Na/K/2Cl cotransporter in thick ascending limb. Potent diuretic | Edema (heart failure, renal, hepatic), hypertension, pulmonary edema, hypercalcemia | Hypokalemia, hyponatremia, hypotension, dehydration, ototoxicity, hyperuricemia, metabolic alkalosis. |
| ERECTILE DYSFUNCTION | Sildenafil 50mg, Sildenafil 100mg, Vega Sildenafil, Kifaru Sildenafil | Phosphodiesterase type 5 inhibitor. Increases cGMP, promotes vasodilation in corpus cavernosum | Erectile dysfunction, pulmonary hypertension | Headache, flushing, visual disturbances, hypotension, priapism. Contraindicated with nitrates (dangerous hypotension). |
| VAGINAL PREPARATIONS | Clotrimazole Vaginal Pessaries, Benasten, OG Kit | Antifungal (clotrimazole) or antiseptic. Local application | Vaginal candidiasis, bacterial vaginosis, STI treatment | Local irritation, burning, itching. Rare: systemic effects. |
| DRUGS AFFECTING NUTRITION AND METABOLISM | ||||
| VITAMINS - B Complex | Vitamin B Complex Injection, Fevit B, Tribees Forte | Coenzymes in metabolic processes. Essential for cellular function | B vitamin deficiency, fatigue, neuropathy, alcoholism, malnutrition | Generally non-toxic (water-soluble). Injection: pain at site. Rare: hypersensitivity. |
| Vitamin C | Ezeevit C | Antioxidant, collagen synthesis, iron absorption enhancement | Vitamin C deficiency, scurvy, immune support, wound healing | High doses: GI upset, diarrhea, kidney stones. Generally safe. |
| Vitamin D & Calcium | Osteocare, Zedcal | Calcium absorption, bone mineralization, immune function | Osteoporosis, osteomalacia, calcium deficiency, rickets, hypoparathyroidism | Hypercalcemia (overdose), kidney stones, constipation, nausea. Monitor calcium levels. |
| MINERAL SUPPLEMENTS - Iron | Vitaglobin, Ranferon, Hemovit, Fevit B, Ascard | Essential for hemoglobin synthesis. Ferrous salts have best absorption | Iron deficiency anemia, pregnancy, blood loss | GI upset, constipation, dark stools, metallic taste. Overdose: acute toxicity (gastric necrosis), chronic: hemochromatosis. |
| Zinc | Just Zinc, Ezeevit C | Essential mineral. Immune function, wound healing, protein synthesis | Zinc deficiency, diarrhea in children, wound healing, immune support | GI upset, nausea, headache. High doses: copper deficiency, immunosuppression. |
| NUTRITIONAL TONICS | Nutrivita, Cyprob Plus, Cypon, Gypon, Scotts Emulsion | Multivitamin and mineral combinations for supplementation | Malnutrition, vitamin deficiency, appetite stimulation, fatigue | Generally safe. Rare: allergic reactions. Cyproheptadine: sedation, increased appetite. |
| APPETITE STIMULANTS | Cyprob Plus, Cypon, Becoactin | Cyproheptadine: Antihistamine with orexigenic effect. Blocks serotonin receptors | Cachexia, anorexia, malnutrition, underweight patients | Drowsiness, sedation, dry mouth, weight gain, paradoxical excitation in children. |
| ORS | Electrorush ORS | Oral rehydration salts: glucose-electrolyte solution. Promotes water absorption via SGLT1 | Dehydration from diarrhea (all ages), cholera, gastroenteritis | Generally safe. Incorrect preparation: electrolyte imbalance. Vomiting (if given too quickly). |
| ANTIOXIDANTS | Nervidoc, Omega H3 | Neurotrophic vitamins: B12, alpha-lipoic acid. Protect nerves, reduce oxidative stress | Diabetic neuropathy, peripheral neuropathy, B12 deficiency | Generally well tolerated. B12: rare allergic reactions. Alpha-lipoic acid: GI upset. |
| ANTIALLERGIC AND ANTIANAPHYLACTIC DRUGS | ||||
| ANTIHISTAMINES - 1st Generation | Piriton, Chlorpheniramine/Toramin, Phenalan, Pirinox, Cophydrex, Dawa CPM, Cadistin, Cadiphen | H1 receptor antagonists. Cross blood-brain barrier causing sedation | Allergic rhinitis, urticaria, itching, motion sickness, insomnia, cough (cold preparations) | Drowsiness, sedation, anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention), cognitive impairment. Caution in elderly. |
| 2nd Generation | Cetrizine, Zyncet, Cetzan, Lorhistina, Flamoset, Controzel, Azinex, Piriclor | H1 antagonists with reduced CNS penetration. Less sedating | Allergic rhinitis, chronic urticaria, allergic conjunctivitis, pruritus | Generally non-sedating. Headache, dry mouth, fatigue. Loratadine: less sedating than cetrizine. |
| Combination | Allercet, Celestinac, Vilestamine (Betamethasone + Dexchlorpheniramine) | Corticosteroid + antihistamine combination | Severe allergic conditions, allergic dermatitis, urticaria | Steroid side effects with prolonged use: hyperglycemia, immunosuppression. Antihistamine: drowsiness. |
| ANTIANAPHYLACTIC | Epinephrine/Adrenaline (reference) | Alpha and beta adrenergic agonist. Vasoconstriction, bronchodilation, increased cardiac output | Anaphylaxis (first-line), cardiac arrest, severe asthma (life-threatening), angioedema | Tachycardia, hypertension, arrhythmias, tremor, anxiety, hypokalemia. Extravasation can cause necrosis. |
| LEUKOTRIENE INHIBITORS | Montelukast/Vitaget, Ucon | Leukotriene receptor antagonist. Blocks LTD4 receptors | Asthma prophylaxis, allergic rhinitis, exercise-induced bronchospasm | Headache, GI upset, neuropsychiatric effects (depression, suicidal thoughts), Churg-Strauss syndrome (rare). |
| DRUGS ACTING ON RESPIRATORY SYSTEM | ||||
| BRONCHODILATORS - Beta-2 Agonists | Ventil, Salbut 4mg | Selectively stimulate beta-2 receptors in lungs. Relax bronchial smooth muscle | Acute asthma, COPD, bronchospasm, exercise-induced bronchospasm | Tremor, tachycardia, palpitations, hypokalemia, hyperglycemia. Paradoxical bronchospasm possible. |
| Methylxanthines | Theophed | Non-selective phosphodiesterase inhibitor. Bronchodilation, cardiac stimulation | Asthma, COPD (less preferred now due to narrow therapeutic index) | Nausea, vomiting, tachycardia, arrhythmias, seizures (toxicity). Narrow therapeutic index requires monitoring. |
| MUCOLYTICS | Thiocarb, Ambrox, Broxol, Lacoff | Break disulfide bonds in mucus (carbocisteine, ambroxol). Reduce viscosity | Productive cough, chronic bronchitis, bronchiectasis, cystic fibrosis | GI upset, rash, hypersensitivity. Bronchospasm (rare). |
| EXPECTORANTS | Eascof, Zedcoril, Piriton Expectorant, Ascoff, Consed, Dawahist | Guaiphenesin: increases respiratory tract secretions, reduces mucus viscosity. Promotes cough clearance | Productive cough, upper respiratory infections | Nausea, vomiting, drowsiness. High doses: hepatotoxicity. |
| ANTITUSSIVES | Delased Dry Cough, Benacoff, Brozelin, Zefcolin, Dacold | Dextromethorphan: NMDA antagonist, suppresses cough center. Opioids: mu receptor agonists | Dry, non-productive cough | Dizziness, drowsiness, nausea. High doses: dissociative effects, respiratory depression (opioids). |
| COLD PREPARATIONS | Tricohist, Tridahist, Coldcap, Flucodex, Coldamol, Dacold, Flugone, Olsolone | Combination: antihistamine + decongestant + analgesic + often caffeine | Common cold, flu symptoms, allergic rhinitis, sinusitis | Insomnia (caffeine), tachycardia, hypertension, drowsiness or stimulation, dry mouth, urinary retention. |
| RESPIRATORY CORTICOSTEROIDS | Prednisolone (oral), Budesonide/Fluticasone (inhaled - reference) | Potent anti-inflammatory. Inhaled: direct lung targeting with reduced systemic effects | Asthma prophylaxis, COPD, allergic rhinitis, acute exacerbations | Inhaled: oral candidiasis, hoarseness, cough. Systemic: same as oral steroids. Adrenal suppression (long-term high dose). |
| OPHTHALMIC DRUGS | ||||
| ANTIBIOTIC EYE DROPS | Ciprofloxacin, Gentamicin, Chloramphenicol (if available) | Topical antibiotic preparations for eye infections | Bacterial conjunctivitis, keratitis, blepharitis, corneal ulcers | Local irritation, burning, redness. Rare: allergic reactions, systemic effects. |
| CORTICOSTEROID EYE DROPS | Prednisolone Eye Drops, Dexamethasone Eye Drops | Potent anti-inflammatory for eye conditions | Uveitis, iritis, allergic conjunctivitis, post-operative inflammation | Increased intraocular pressure (glaucoma), cataracts, delayed wound healing, risk of secondary infection. |
| ANTIGLAUCOMA | Timolol, Latanoprost (reference) | Timolol: Beta-blocker reduces aqueous humor production. Latanoprost: Prostaglandin analog increases outflow | Open-angle glaucoma, ocular hypertension | Ocular irritation, blurred vision, systemic effects (beta-blockers: bradycardia, hypotension, bronchospasm). |
| ARTIFICIAL TEARS | Hypromellose, Carboxymethylcellulose (reference) | Lubricating eye drops. Replace or supplement natural tears | Dry eye syndrome, eye irritation, contact lens lubrication | Usually safe. Rare: blurred vision, irritation, allergic reactions. |
| DERMATOLOGIC PREPARATIONS | ||||
| TOPICAL ANTIBIOTICS | Mupiban, Silverderm, Dazole Cream | Mupirocin: inhibits bacterial protein synthesis. Silver sulfadiazine: broad antimicrobial | Impetigo, wound infections, minor burns, skin infections | Local irritation, burning, allergic contact dermatitis. Silver: argyria (long-term), sulfa allergy. |
| TOPICAL ANTIFUNGALS | Candid B, Exevate, Entezma, Funbact A, Kenazole, Fungistan | Azoles inhibit ergosterol synthesis. Disrupt fungal cell membrane | Tinea (corporis, pedis, cruris), pityriasis versicolor, candidiasis, ringworm | Local irritation, burning, redness. Rare: allergic reactions, systemic absorption (minimal). |
| TOPICAL CORTICOSTEROIDS | Betamethasone Diproate, Hydrocortisone/Hycorum | Anti-inflammatory, antipruritic, vasoconstrictive effects | Eczema, dermatitis, psoriasis, allergic reactions, pruritus | Skin atrophy, striae, telangiectasia, hypopigmentation, contact dermatitis. Systemic absorption with prolonged use. |
| ANTISEPTICS | Povidone Iodine, Gentian Violet, Tincture of Iodine, Methylated Spirit | Kill or inhibit microorganisms on skin | Skin antisepsis, wound care, surgical preparation, mouth gargle | Skin irritation, staining, allergic reactions. Iodine: thyroid effects with prolonged use. Alcohol: drying, flammable. |
| SILVER PREPARATIONS | Silverderm, Silver Sulphadiazine | Broad-spectrum antimicrobial. Disrupts bacterial cell wall and enzymes | Burn wound infections, leg ulcers, wounds at risk of infection | Argynia (skin discoloration), local pain, hypersensitivity. Sulfa component: sulfa allergy. |
| ACNE PREPARATIONS | Tretinoin/Acnesol, Acnestar | Tretinoin: Retinoid. Increases cell turnover, reduces comedones. Antibiotics: reduce P. acnes | Acne vulgaris, photoaging, hyperpigmentation | Dryness, erythema, peeling, photosensitivity, initial acne flare. Teratogenic (systemic retinoids). |
| MOISTURIZERS | Lanolin, Xraderm, Hitoral | Emollients and occlusives. Trap water in skin, restore barrier function | Dry skin, xerosis, eczema, ichthyosis | Generally safe. Rare: allergic contact dermatitis (lanolin). |
| LOCAL ANESTHETICS | Nilbact (Lidocaine + Prilocaine) | Block sodium channels. Prevent nerve impulse transmission | Local anesthesia, painful wounds, procedures | Local numbness, allergic reactions (rare). Systemic absorption: CNS toxicity, cardiac toxicity (overdose). |
| DENTAL PREPARATIONS | Dentogel, Aystons, Sensodyne | Antiseptic, fluoride (caries prevention), desensitizing (potassium nitrate) | Oral hygiene, gingivitis, tooth sensitivity, caries prevention | Generally safe. Fluorosis (children with excess). Taste disturbances. |
| # | Drug | Price | Composition / Notes |
|---|---|---|---|
| 349 | Azithromycin 500mg Tabs | 200 | Azithromycin |
| FLUOROQUINOLONES | |||
| Ciprofloxacin | Ciprofloxacin 500mg, Ciphex 500mg, Ciproflocacin 500mg | Ciprofloxacin HCl | UTIs, respiratory, GI, skin infections |
| Ofloxacin | Orav Oz 700mg, Doflodina | Ofloxacin 200mg + Ornidazole 500mg | GI infections, respiratory, STD |
| TETRACYCLINES | |||
| Tetracycline | Racycline | Tetracycline hydrochloride | Acne, cholera, rickettsial infections |
| Doxycycline | Doxycycline | Doxycycline | Malaria prophylaxis, respiratory, Lyme disease |
| SULFONAMIDES & COMBINATIONS | |||
| Cotrimoxazole | Cotrimoxazole 100ml, Cotrimoxazole 960mg, Biotrim 50ml, Biotrim 100ml, Lecotrim 100ml, Cotricel 50ml | Sulfamethoxazole 200mg + Trimethoprim 40mg | UTIs, respiratory, PCP prophylaxis, salmonella |
| Antimalarial Combination | Malodar, Fansidar | Sulfadoxine + Pyrimethamine | Malaria treatment (with Artemether) |
| NITROIMIDAZOLES | |||
| Metronidazole | Metrogyl Injection, Eflaron 60ml, Eflaron 100ml, Flagin 100ml, Flagon 60ml, Flazole 200mg, Trogyl 400mg | Metronidazole 200mg | Anaerobic infections, protozoal, H. pylori |
| Tinidazole | Tinisky 500, Tdex 500mg | Tinidazole 500mg | Giardiasis, amebiasis, trichomoniasis |
| Secnidazole | Dysen 30ml, Senidol 1g, Secnid DS, Agisec 1g | Secnidazole 750mg-1000mg | Single dose for amebiasis, giardiasis |
| OTHER ANTIBIOTICS | |||
| Clindamycin | Clindamycin 300mg | Clindamycin | Anaerobic infections, MRSA, acne |
| Nitrofurantoin | Nitrofurantoin 100mg | Nitrofurantoin | Uncomplicated UTIs |
| Griseofulvin | Griseofulvin 125mg, Griseofulvin 250mg, Griseofulvin 500mg | Griseofulvin | Dermatophyte infections, ringworm |
| Penicillin G | Benzapene 1M IU | Benzyl penicillin | Syphilis, bacterial endocarditis, meningitis |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| ANTACIDS | |||
| Aluminium Hydroxide | Allucid 100ml, Gastrogel 100ml, Alugel 100ml, Gas Off Tabs | Aluminium hydroxide, Mg hydroxide, simethicone | Hyperacidity, GERD, peptic ulcer |
| Magnesium/Aluminium Combination | Magnacid Gel 100ml, Allucid Plus 100ml | Mg hydroxide + Al hydroxide | Hyperacidity, dyspepsia |
| Calcium Carbonate | Eno Tabs, Tumbocid | Calcium carbonate | Heartburn, acid indigestion |
| ANTIULCER DRUGS | |||
| Proton Pump Inhibitors | Omesk 20mg, Lozol 20mg, Esomeprazole 20mg, Esomeprazole 40mg, Esuprone Injection | Omeprazole, Esomeprazole | Peptic ulcer, GERD, H. pylori eradication |
| ANTIDIARRHEALS | |||
| Antisecretory | Immobulk 2mg, Coramide 2mg | Loperamide 2mg | Acute and chronic diarrhea |
| ANTISPASMODICS | |||
| Anticholinergics | No Spa 40mg, Entamaxin Capsules | Drotaverine, Dicyclomine | Intestinal colic, IBS, biliary colic |
| LAXATIVES | |||
| Stimulant Laxatives | Bisacodyl 5mg | Bisacodyl | Constipation, bowel preparation |
| Osmotic Laxatives | Glycerin Suppositories | Glycerin | Constipation |
| ANTIPROTOZOALS (GI) | |||
| Amoebicides | Eflaron Plus, Entamaxin, Natoa, Altoa, Nil Worm, ABZ, Calben | Metronidazole, Diloxanide furoate, Albendazole, Mebendazole | Amoebiasis, giardiasis, worm infestations |
| Anthelmintics | Natoa 100mg, Natoa 30ml, Altoa Syrup, Nil Worm 400mg, Levamisole Syrup, Letrax 40mg, ABZ | Mebendazole, Albendazole, Levamisole | Roundworm, hookworm, pinworm, tapeworm |
| ANTIRETROVIRALS (GI effects) | |||
| HIV Kits | Meriscreen Malaria Kit, Suretest HIV, Erovita HIV Test Kit | Rapid diagnostic tests | HIV screening |
| DIGESTIVE ENZYMES | |||
| Pancreatic Enzymes | Enzoklein (if available) | Pancreatin | Pancreatic insufficiency, indigestion |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| ANALGESICS & ANTIPYRETICS | |||
| Paracetamol | Calpol 100ml, Calpol 120ml, Pyremol 60ml, Trumol 60ml, Betamol 60ml, Curamol 60ml, Pharmadol 500mg, Panadol Advance, Panadol Extra, Cipladon 100mg | Paracetamol 120-500mg | Pain, fever, mild to moderate analgesia |
| NSAIDs | Ibumex 100ml, Flamofenac, Ibugesic, Brustan, Flamifen 100mg, Rheumac 50, Diclofenac/Diclomol 100mg, Dinac 100 Retard, Voltamed 100mg, Mefril 250mg, Analmin 500mg, Roxicam 20mg | Ibuprofen, Aceclofenac, Diclofenac, Mefenamic acid, Piroxicam | Pain, inflammation, arthritis, dysmenorrhea |
| Opioid Analgesics | Surepyn, Beta Pyn | Paracetamol + Codeine + Caffeine | Moderate to severe pain |
| MUSCLE RELAXANTS | |||
| Skeletal Muscle Relaxants | Zrtal MR, Acetal MR, Zulu MR | Aceclofenac + Paracetamol + Chlorzoxazone | Muscle spasm, musculoskeletal pain |
| ANTIEPILEPTICS | |||
| Anticonvulsants | Gabix 300mg, Pergalin 75mg | Gabapentin, Pregabalin | Epilepsy, neuropathic pain |
| Carbamazepine | Carbamazepine 200mg | Carbamazepine | Epilepsy, trigeminal neuralgia, bipolar |
| ANTIPARKINSONIAN | |||
| Anticholinergics | Benzhexol 5mg | Benzhexol (Trihexyphenidyl) | Parkinson's disease, drug-induced extrapyramidal symptoms |
| ANXIOLYTICS & SEDATIVES | |||
| Benzodiazepines | Diazepam (if available) | Diazepam | Anxiety, insomnia, seizures, muscle spasm |
| Phenothiazines | Promethazine 25mg, Promethazine 60ml (Promezine) | Promethazine hydrochloride | Allergy, motion sickness, sedation, nausea |
| STIMULANTS | |||
| CNS Stimulants | Homagon, Coldcap Tabs, Cofrid Lo Tabs, Dacold Caps, Flucoldex | Chlorpheniramine + Caffeine + Pseudoephedrine + Paracetamol | Cold symptoms, fatigue, alertness |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| NASAL DECONGESTANTS | |||
| Oral Decongestants | Tricohist, Tridahist, Zedcoril, Cadistin, Cadiphen, Delased, Dazawa Hhist, Dawahist, Lunahist, Centrihist | Triprolidine, Pseudoephedrine, Chlorpheniramine, Phenylephrine | Nasal congestion, allergic rhinitis, cold symptoms |
| Nasal Sprays | Oxymetazoline, Xylometazoline (if available) | Oxymetazoline | Nasal congestion |
| EAR PREPARATIONS | |||
| Antibiotic Ear Drops | Ciprofloxacin Ear Drops (if available) | Ciprofloxacin | Otitis externa, otitis media |
| Antifungal Ear Drops | Clotrimazole Ear Drops (if available) | Clotrimazole | Otomycosis |
| THROAT PREPARATIONS | |||
| Lozenges | Zecuf Lozenges | Glycyrrhiza glabra, Menthol, Herbals | Sore throat, cough |
| Mouth Paint | Dazole Mouth Paint | Dexamethasone + Neomycin + Nystatin | Mouth ulcers, gingivitis |
| Antiseptic Solutions | Povidone Iodine (Peardine, Bestdine) | Povidone iodine 10% | Mouthwash, throat gargle, antisepsis |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| ANTIDIABETIC DRUGS | |||
| Biguanides | Metformin/Glucomet 500mg | Metformin HCl | Type 2 Diabetes mellitus |
| Insulin | Insulin (various types - reference only) | Insulin (rapid, short, intermediate, long-acting) | Type 1 & Type 2 Diabetes |
| THYROID DRUGS | |||
| Thyroid Hormones | Levothyroxine (if available) | Levothyroxine sodium | Hypothyroidism |
| CORTICOSTEROIDS | |||
| Glucocorticoids | Prednisolone 5mg, Prednisolone Eye Drops, Dexamethasone 4mg, Dexamar 4mg, Hydrocortisone Injection, Labohydro 100mg | Prednisolone, Dexamethasone, Hydrocortisone | Inflammation, allergic reactions, adrenal insufficiency, asthma |
| Mineralocorticoids | Fludrocortisone (if available) | Fludrocortisone | Addison's disease, adrenal insufficiency |
| SEX HORMONES | |||
| Contraceptives | Postinor 2, Safe 72, Lydia Postpil 2, Lydia Contraceptive, Femiplan | Levonorgestrel, Ethinylestradiol + Levonorgestrel | Emergency contraception, family planning |
| Progestins | Norethisterone 5mg, Dydrogesterone 10mg | Norethisterone, Dydrogesterone | Menstrual disorders, endometriosis, contraception |
| Fertility Drugs | Clomiphene Citrate 50mg | Clomiphene citrate | Female infertility, ovulation induction |
| ANTIPRODUCTIVE DRUGS | |||
| Prolactin Inhibitors | Bromocriptine 2.5mg | Bromocriptine | Hyperprolactinemia, Parkinson's, lactation suppression |
| ANTIMALARIALS | |||
| Artemisinin Derivatives | Artemether 20mg + Lumefantrine 120mg, Artemether 80mg + Lumefantrine 480mg | Artemether + Lumefantrine | Uncomplicated malaria |
| Other Antimalarials | Malodar, Fansidar | Sulfadoxine + Pyrimethamine | Malaria (combination therapy) |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| URINARY ANTI-INFECTIVES | |||
| Nitrofurans | Nitrofurantoin 100mg | Nitrofurantoin | Uncomplicated UTIs |
| Quinolones | Ciprofloxacin 500mg, Norfloxacin (if available) | Ciprofloxacin | Complicated UTIs, prostatitis |
| DIURETICS | |||
| Loop Diuretics | Furosemide 40mg | Furosemide | Edema, hypertension, heart failure |
| ANTISPASMODICS (UROLOGICAL) | |||
| Anticholinergics | No Spa 40mg | Drotaverine | Renal colic, ureteral spasm |
| BENIGN PROSTATIC HYPERPLASIA | |||
| Alpha Blockers | Tamsulosin (if available) | Tamsulosin | BPH |
| ERECTILE DYSFUNCTION | |||
| PDE5 Inhibitors | Sildenafil 50mg, Sildenafil 100mg, Vega Sildenafil 100mg, Kifaru Sildenafil 100mg | Sildenafil citrate | Erectile dysfunction |
| OBSTETRICS & GYNECOLOGY | |||
| Oxytocics | Oxytocin (if available) | Oxytocin | Induction of labor, postpartum hemorrhage |
| Vaginal Antiseptics | Clotrimazole Vaginal Pessaries, Benasten Vaginal Pessaries | Clotrimazole, Antiseptic | Vaginal candidiasis, bacterial vaginosis |
| OG Kit | OG Kit (Fluconazole, Azithromycin, Secnidazole) | Fluconazole + Azithromycin + Secnidazole | STI treatment (comprehensive) |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| VITAMINS | |||
| Vitamin B Complex | Vitamin B Complex Injection, Fevit B Complex, Fevit B 100ml, Tribees Forte | B1, B2, B3, B5, B6, B12 | B vitamin deficiency, fatigue, neuropathy |
| Vitamin C | Ezeevit C | Vitamin C 1000mg + Zinc | Vitamin C deficiency, immune support |
| Vitamin D & Calcium | Osteocare, Zedcal | Vitamin D + Calcium + Magnesium + Zinc | Osteoporosis, calcium deficiency |
| Multivitamins | Super Power Multivitamin, Cyprob Plus, Cypon, Becoactin, Enervit | Multivitamins + Minerals | General vitamin deficiency, fatigue, malnutrition |
| MINERALS & SUPPLEMENTS | |||
| Iron Preparations | Vitaglobin 100ml, Ranferon 12, Hemovit, Fevit B, Ranferon Capsules, Ascard 75 | Ferrous sulfate/fumarate + Folic acid + B12 | Iron deficiency anemia |
| Zinc Supplements | Just Zinc, Ezeevit C | Zinc sulfate 20mg | Zinc deficiency, diarrhea, wound healing |
| NUTRITIONAL SUPPLEMENTS | |||
| Nutritional Tonics | Nutrivita, Cyprob Plus, Cypon, Gypon, Scotch Emulsion | Vitamins + Minerals + Cod liver oil | Malnutrition, appetite stimulation |
| Appetite Stimulants | Cyprob Plus, Cypon, Becoactin | Cyproheptadine + B vitamins + minerals | Loss of appetite, cachexia |
| ORS | Electrorush ORS | Oral Rehydration Salts | Dehydration from diarrhea |
| ANTIOXIDANTS | |||
| Neurotrophic Vitamins | Nervidoc, Omega H3 | Methylcobalamin + Alpha lipoic acid + B vitamins | Neuropathy, diabetic neuropathy |
| ANOREXIANTS | |||
| Weight Management | Cyprob Plus (appetite stimulation) | Cyproheptadine | Weight gain, cachexia |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| RENAL DRUGS | |||
| Diuretics | Furosemide 40mg | Furosemide | Edema, renal impairment, hypertension |
| Phosphate Binders | Sevelamer (if available) | Sevelamer carbonate | Hyperphosphatemia in CKD |
| Renal Protection | Acetylcysteine (if available) | N-acetylcysteine | Contrast-induced nephropathy |
| ONCOLOGY SUPPORTIVE CARE | |||
| Antiemetics | Metoclopramide/Matcos 10mg | Metoclopramide | Chemotherapy-induced nausea |
| Colony Stimulating Factors | Filgrastim (reference only) | Filgrastim | Neutropenia, bone marrow support |
| Bisphosphonates | Zoledronic acid (reference only) | Zoledronic acid | Bone metastases, hypercalcemia |
| DIAGNOSTIC KITS | |||
| Diagnostic Tests | H. Pylori Test Kit, HIV Test Kits, Pregnancy Test | Rapid diagnostic tests | Screening and diagnosis |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| ANTIHISTAMINES (H1 BLOCKERS) | |||
| First Generation | Piriton Syrup, Chlorpheniramine/Toramin, Phenalan, Pirinox, Cophydrex, Dawa CPM, Cadistin, Cadiphen, Phenalin | Chlorpheniramine maleate, Promethazine | Allergic rhinitis, urticaria, itching, motion sickness |
| Second Generation | Cetrizine/Cetrizine 60ml, Zyncet, Cetzan, Lorhistina 10mg, Flamoset, Controzel 60ml, Azinex, Piriclor | Cetrizine, Loratadine, Levocetrizine | Allergic rhinitis, chronic urticaria, allergic conjunctivitis |
| Combination | Allercet, Celestinac, Vilestamine | Betamethasone + Dexchlorpheniramine | Severe allergies, allergic dermatitis |
| ANTIANAPHYLACTIC | |||
| Epinephrine | Epinephrine/Adrenaline (reference) | Epinephrine 1:1000 | Anaphylaxis, cardiac arrest |
| MAST CELL STABILIZERS | |||
| Leukotriene Inhibitors | Montelukast/Vitaget 5mg, Vitaget 10mg, Ucon 10 | Montelukast | Asthma prophylaxis, allergic rhinitis |
| TOPICAL ANTIHISTAMINES | |||
| Calamine Lotion | Calamine Lotion | Zinc oxide + Iron oxide | Itching, mild irritant dermatitis |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| BRONCHODILATORS | |||
| Beta-2 Agonists | Ventil 60ml, Ventil 100ml, Salbut 4mg, Salbutamol (reference) | Salbutamol 2mg/5ml | Asthma, COPD, bronchospasm |
| Methylxanthines | Theophed | Theophylline + Ephedrine | Asthma, COPD |
| MUCOLYTICS & EXPECTORANTS | |||
| Mucolytics | Thiocarb, Ambrox, Broxol, Lacoff | Carbocisteine, Ambroxol, Bromhexine | Mucous congestion, productive cough |
| Expectorants | Eascof, Zedcoril, Piriton Expectorant, Ascoff, Consed, Dawahist | Guaiphenesin + Bromhexine/Salbutamol | Productive cough |
| ANTITUSSIVES | |||
| Opioid Antitussives | Codeine preparations (if available) | Codeine phosphate | Dry, persistent cough |
| Non-Opioid Antitussives | Delased Dry Cough, Benacoff, Brozelin, Zefcolin, Dacold | Dextromethorphan, Chlorpheniramine + Phenylephrine | Dry cough, cold symptoms |
| COLD PREPARATIONS (COMBINATIONS) | |||
| Syrups | Tricohist, Tridahist, Coldcap, Flucodex, Coldamol P, Dacold, Flugone Syrup, Flugone P, Flugone DM, Olsolone | Antihistamine + Decongestant + Analgesic combinations | Common cold, flu symptoms |
| Tablets/Capsules | Homagon, Coldcap Tabs, Cofrid Lo, Dacold Caps, Flucoldex, Flugone Capsules | Chlorpheniramine + Pseudoephedrine + Paracetamol + Caffeine | Cold & flu symptoms |
| RESPIRATORY CORTICOSTEROIDS | |||
| Inhaled Corticosteroids | Budesonide, Fluticasone (reference) | Budesonide, Fluticasone | Asthma prophylaxis, COPD |
| Oral Corticosteroids | Prednisolone 5mg, Prednisolone Eye Drops, Dexamethasone, Olsolone 5mg | Prednisolone, Dexamethasone | Acute asthma exacerbation, severe allergic reactions |
| ANTICHOLINERGICS | |||
| Antimuscarinics | Ipratropium (reference) | Ipratropium bromide | COPD, asthma |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| ANTIBIOTIC EYE DROPS | |||
| Fluoroquinolones | Ciprofloxacin Eye Drops (reference) | Ciprofloxacin 0.3% | Bacterial conjunctivitis, keratitis |
| Aminoglycosides | Gentamicin Eye Drops (reference) | Gentamicin 0.3% | Bacterial eye infections |
| Chloramphenicol | Chloramphenicol Eye Drops (reference) | Chloramphenicol 0.5% | Bacterial conjunctivitis |
| CORTICOSTEROID EYE DROPS | |||
| Steroids | Prednisolone Eye Drops, Dexamethasone Eye Drops | Prednisolone, Dexamethasone | Inflammatory eye conditions, uveitis |
| ANTIHISTAMINE EYE DROPS | |||
| Anti-allergic | Olopatadine Eye Drops (reference) | Olopatadine | Allergic conjunctivitis |
| ANTIGLAUCOMA | |||
| Prostaglandin Analogs | Latanoprost (reference) | Latanoprost | Open-angle glaucoma |
| Beta Blockers | Timolol Eye Drops (reference) | Timolol maleate | Glaucoma, ocular hypertension |
| ARTIFICIAL TEARS & LUBRICANTS | |||
| Lubricants | Hypromellose, Carboxymethylcellulose drops (reference) | Hydroxypropyl methylcellulose | Dry eye syndrome |
| MYDRIATICS | |||
| Cycloplegics | Atropine Eye Drops (reference) | Atropine sulfate | Uveitis, ocular examination |
| ANTISEPTICS | |||
| Antiseptic Solutions | Gentian Violet, Povidone Iodine | Gentian violet, Povidone iodine | Eye antisepsis, conjunctivitis |
| Category | Drugs Available | Composition | Indications |
|---|---|---|---|
| ANTIBIOTIC CREAMS | |||
| Topical Antibiotics | Mupiban Cream, Silverderm, Dazole Cream | Mupirocin, Silver sulfadiazine | Wound infections, burns, impetigo |
| ANTIFUNGAL CREAMS | |||
| Azoles | Candid B Cream, Exevate Cream, Exevate MF Cream, Entezma Cream, Funbact A Cream, Kenazole Cream | Clotrimazole, Miconazole, Econazole | Tinea, ringworm, candidiasis, pityriasis |
| Other Antifungals | Fungistan Cream | Undecylenic acid derivatives | Fungal skin infections |
| CORTICOSTEROID CREAMS | |||
| Potent Steroids | Betamethasone Diproate Cream | Betamethasone dipropionate | Severe eczema, psoriasis, dermatitis |
| Moderate Steroids | Hycorum Cream | Hydrocortisone | Mild eczema, dermatitis, itching |
| ANTISEPTICS & DISINFECTANTS | |||
| Antiseptics | Povidone Iodine (Peardine, Bestdine), Gentian Violet, Tincture of Iodine, Methylated Spirit, Surgical Spirit | Povidone iodine, Gentian violet, Alcohol | Skin antisepsis, wound care |
| Silver Preparations | Silverderm Cream, Silver Sulphadiazine Cream | Silver sulfadiazine | Burn wound infections |
| ACNE PREPARATIONS | |||
| Retinoids | Tretinoin/Acnesol Cream | Tretinoin | Acne vulgaris, photoaging |
| Anti-acne Antibiotics | Acnestar Cream | Antibiotic + Anti-inflammatory combination | Acne vulgaris |
| MOISTURIZERS & EMOLLIENTS | |||
| Emollients | Lanolin Cream, Xraderm Cream, Hitoral Cream | Lanolin, Petroleum jelly, Moisturizers | Dry skin, eczema, xerosis |
| WOUND CARE | |||
| Dressings | Bandage, Crepe Bandage, Plaster | Cotton, Elastic | Wound support, compression |
| Topical Analgesics | Nilbact Cream | Lidocaine + Prilocaine | Local anesthesia, painful wounds |
| DENTAL PREPARATIONS | |||
| Oral Care | Dentogel, Aystons, Sensodyne Colgate | Antiseptic, Fluoride, Desensitizing | Oral hygiene, tooth sensitivity, gingivitis |
| Drug Class | Mechanism of Action (Molecular Level) | Pharmacokinetics | Adult Dose | Key Interactions | Contraindications |
|---|---|---|---|---|---|
| BETA-LACTAM ANTIBIOTICS - PENICILLINS | |||||
| BENZYL PENICILLIN (Penicillin G) |
Molecular Target: Bacterial cell wall transpeptidases (Penicillin-Binding Proteins - PBPs) MOA: 1) Binds to PBPs in bacterial cell wall 2) Inhibits cross-linking of peptidoglycan 3) Activates autolytic enzymes 4) Cell wall weakens → bacteriolysis Note: Irreversibly binds D-Ala-D-Ala terminus of peptidoglycan precursors |
Absorption: Poor oral (destroyed by gastric acid) Bioavailability: IV/IM: 100% Distribution: Vd 0.3-0.4 L/kg; Good in most body fluids; Poor CSF (meninges inflamed: 5-10%) Protein Binding: 60% Half-life: 30-60 min Excretion: Renal (80% unchanged, tubular secretion) |
Adult: 1-2 million units IV/IM q4-6h Syphilis: 2.4 million units IM daily × 10 days Meningitis: 2-4 million units IV q4h Max: 24 million units/day |
• Probenecid: increases levels • Aspirin: displaces from protein binding • Anticoagulants: bleeding risk • Aminoglycosides: synergistic (don't mix in same IV) |
• Penicillin allergy • History of anaphylaxis • Avoid in bronchoscopy (large doses → Herxheimer) |
| AMOXICILLIN | Molecular Target: Same as Penicillin G - PBPs MOA: Bactericidal; Time-dependent killing; Exhibits post-antibiotic effect (PAE) against some organisms Note: Acid-stable (orally active); Broadened spectrum vs Penicillin G; Susceptible to beta-lactamases |
Absorption: Excellent oral (74-92%) Tmax: 1-2 hours Distribution: Vd 0.3-0.4 L/kg; Good tissue penetration; Tonsils, middle ear; Poor CSF (10%) Protein Binding: 20% Half-life: 1-1.5 hours Excretion: Renal (60% unchanged) |
UTI: 250-500mg PO q8h Otitis Media: 500mg PO q8h or 875mg q12h Pneumonia: 500mg PO q8h H. pylori: 1g PO q12h + clarithromycin + PPI Anthrax: 500mg PO q8h Max: 3g/day |
• Probenecid: blocks excretion • Allopurinol: increased rash risk • Oral contraceptives: reduced efficacy • Warfarin: potentiated effect |
• Penicillin allergy • Infectious mononucleosis (rash) • Cephalosporin allergy (relative) |
| FLUCLOXACILLIN | Molecular Target: PBPs - same as penicillins MOA: Bactericidal; Beta-lactamase resistant due to steric hindrance from isoxazolyl side chain Note: Isoxazolyl penicillin; Resistant to staphylococcal penicillinase; NOT effective against MRSA (different resistance mechanism) |
Absorption: Oral: 30-50% (fasting); Food: reduced absorption Tmax: 1-1.5 hours Distribution: Good tissue penetration; Bone (adequate); Poor CSF Protein Binding: 95% Half-life: 0.75-1 hour Excretion: Renal (50-60% unchanged) |
Adult: 250-500mg PO q6h Serious: 1-2g IV q6h Skin: 250mg q6h Max: 8g/day IV |
• Probenecid: increased levels • Warfarin: enhanced anticoagulation • Hepatotoxic with other agents |
• Penicillin allergy • History of cholestatic jaundice with flucloxacillin • Severe hepatic impairment |
| AMOXICILLIN/CLAVULANATE (Augmentin) |
Molecular Target: Dual action 1) Amoxicillin: Binds PBPs, inhibits cell wall synthesis 2) Clavulanic acid: Beta-lactamase inhibitor; Suicide inhibitor; Forms stable complex with bacterial beta-lactamases Note: Extends spectrum to beta-lactamase producing organisms; Ratio: 2:1, 4:1, 7:1 (amox:clav) |
Absorption: Oral: good; Enhanced with food Tmax: 1-1.5 hours Distribution: Good tissue/fluid penetration; Vd 0.3 L/kg Protein Binding: Amox: 20%; Clav: 25% Half-life: Amox: 1-1.5h; Clav: 0.8-1h Excretion: Renal (50-70% both) |
Mild-Mod: 500/125mg PO q8h or 875/125mg q12h Severe: 2g/200mg IV q8h Otitis: 90/6.4mg/kg/day div q12h Max: Amox 6g/day, Clav 600mg/day |
• Methotrexate: increased toxicity • Warfarin: enhanced anticoagulation • Allopurinol: increased rash • Oral contraceptives: reduced efficacy |
• Penicillin allergy • History of cholestatic jaundice with amox/clav • Severe hepatic impairment • Cephalosporin allergy (relative) |
| CEPHALOSPORINS | |||||
| CEPHALEXIN (1st Generation) |
Molecular Target: PBPs in bacterial cell wall MOA: Same as penicillins - inhibits transpeptidation; Bactericidal Note: Acid-stable; 7-aminocephalosporanic acid core; Good Gram+ activity; Some beta-lactamase resistance |
Absorption: Oral: 90-95% Tmax: 1 hour Distribution: Good tissue penetration; Lung, kidney, skin; Poor CSF (<1%) Protein Binding: 10-15% Half-life: 0.9-1.2 hours Excretion: Renal (90% unchanged) |
Adult: 250-500mg PO q6h UTI: 500mg q6h or 1g q12h Skin: 500mg q6h Max: 4g/day |
• Probenecid: blocks excretion • Aminoglycosides: nephrotoxicity risk • Furosemide: nephrotoxicity risk |
• Cephalosporin allergy • Penicillin allergy (10% cross-reactivity) • Severe renal impairment |
| CEFUROXIME (2nd Generation) |
Molecular Target: PBPs MOA: Bactericidal; Inhibits cell wall synthesis Note: Enhanced Gram- activity vs 1st gen; Better beta-lactamase resistance; Includes methoxyimino group for stability |
Absorption: Oral: 30-50% (food enhances) Tmax: 2-2.5 hours (PO) Distribution: Good tissue penetration; CSF (when inflamed); Middle ear Protein Binding: 50% Half-life: 1.3-1.5 hours Excretion: Renal (66% unchanged) |
Adult: 250-500mg PO q12h UTI: 250mg q12h LRTI: 500mg q12h Lyme Disease: 500mg q12h × 14-21 days Max: 1g/day |
• Probenecid: increased levels • Anticoagulants: bleeding risk • H2 blockers: reduced absorption |
• Cephalosporin allergy • Penicillin allergy (5-10% cross-reactivity) • Severe renal impairment |
| CEFIXIME (3rd Generation) |
Molecular Target: PBPs MOA: Bactericidal; Highest Gram- activity of all cephalosporins; Enhanced beta-lactamase stability; Reduced affinity for some PBPs Note: Excellent activity against Enterobacteriaceae; Poor staphylococcal coverage |
Absorption: Oral: 40-50% Tmax: 2-4 hours Distribution: Good tissue; Moderate CSF penetration (when inflamed) Protein Binding: 60-70% Half-life: 3-4 hours (longest oral cephalosporin) Excretion: Renal (20-50% unchanged); Some biliary |
Adult: 400mg PO daily OR 200mg q12h UTI: 400mg daily Gonorrhea: 400mg single dose + Azithro Otitis: 8mg/kg daily Max: 400mg/day |
• Carbamazepine: increased levels • Warfarin: enhanced effect • Antacids: reduced absorption |
• Cephalosporin allergy • Penicillin allergy (2-5% cross-reactivity) • Severe renal impairment |
| CEFTRIAXONE (3rd Generation) |
Molecular Target: PBPs MOA: Bactericidal; Excellent penetration into tissues/fluids; Highly protein-bound (carrier effect); Long PAE Note: Once-daily dosing; Crosses inflamed meninges well; Precipitates with calcium (NOT in neonates) |
Absorption: IM: 100% Distribution: Excellent; CSF (high with inflammation); Vd 5.8-13.5 L; Bile, lung, kidney Protein Binding: 90-95% Half-life: 5.5-10 hours (adults); Longer in neonates Excretion: Renal (33-67%); Biliary (35-45%) |
• 1-2g IV/IM daily Meningitis: 2g q12h Gonorrhea: 500mg IM single dose Lyme: 2g daily × 14-21 days Max: 4g/day |
• Aminoglycosides: synergistic • Chloramphenicol: antagonistic (meningitis) • IV calcium: precipitate (avoid in neonates) |
• Cephalosporin allergy • Hyperbilirubinemia in neonates • Concurrent calcium-containing solutions |
| MACROLIDES | |||||
| ERYTHROMYCIN | Molecular Target: 50S ribosomal subunit MOA: 1) Binds to 50S ribosome at peptidyl transferase center 2) Blocks translocation of tRNA 3) Inhibits formation of peptide bonds 4) Bacteriostatic (bactericidal at high concentrations) Note: Macrocyclic lactone ring; Stimulates motilin receptors (GI effects) |
Absorption: Variable; Estolate: 30-50%; Ethylsuccinate: 15-45% Tmax: 2-4 hours Distribution: Good tissue; Lung, liver, spleen; Poor CSF (<5%) Protein Binding: 70-90% (estolate) Half-life: 1.5-2 hours Excretion: Hepatic metabolism; Biliary excretion |
Adult: 250-500mg PO q6h STD: 500mg PO q6h × 7 days Legionella: 1-2g IV daily div q6h Max: 4g/day |
• THEOPHYLLINE: increased levels (CYP1A2) • WARFARIN: increased effect • DIGOXIN: increased levels • STATINS: rhabdomyolysis risk (simvastatin) • QT prolongation with other QT drugs |
• Liver disease • Prolonged QT interval • Known macrolide allergy • Concomitant QT-prolonging drugs |
| AZITHROMYCIN | Molecular Target: 50S ribosomal subunit MOA: Same as erythromycin BUT: 1) Longer half-life in tissues 2) Binds to 50S more extensively 3) Concentrates in phagocytes/fibroblasts 4) Bacteriostatic Note: 15-membered macrolide; Most tissue-specific antibiotic; Single-dose therapy possible |
Absorption: Oral: 37% Tmax: 2-3 hours Distribution: Excellent tissue; Very high tissue:plasma ratio (10-100:1); Lung, tonsil, prostate; Poor CSF Protein Binding: 12-50% (variable) Half-life: 68 hours (tissue) Excretion: Biliary (50%); Renal (6%) |
CAP: 500mg day 1, then 250mg days 2-5 Chlamydia: 1g single dose MAC prophylaxis: 1.2g weekly or 600mg biw STD: 1g single dose Max: 500mg/day |
• Antacids: reduced absorption • Theophylline: increased levels • Digoxin: increased levels • QT prolongation with other drugs |
• Known macrolide allergy • Severe hepatic impairment • Prolonged QT interval • Myasthenia gravis (worsens) |
| FLUOROQUINOLONES | |||||
| CIPROFLOXACIN | Molecular Target: DNA gyrase and Topoisomerase IV MOA: 1) Inhibits DNA gyrase (Gram-): prevents supercoiling 2) Inhibits topoisomerase IV (Gram+): blocks decatenation 3) Causes double-strand breaks 4) Bactericidal Note: Broadest Gram- activity; NOT Enterococcus coverage; Crystalluria risk |
Absorption: Oral: 50-70% Tmax: 1-2 hours Distribution: Good; Lung, kidney, prostate, bone; CSF (poor-moderate when inflamed) Protein Binding: 20-40% Half-life: 3-5 hours Excretion: Renal (40-60%); Biliary (15%) |
UTI: 250-500mg PO q12h Prostatitis: 500mg q12h × 4 weeks Pneumonia: 750mg q12h Anthrax: 500mg q12h Max: 1.5g/day PO, 400mg IV q8h |
• THEOPHYLLINE: increased levels • CYCLOSPORINE: nephrotoxicity • Tizanidine: severe hypotension • Antacids/Minerals: reduced absorption (Ca, Mg, Fe, Zn) • QT prolongation |
• Known quinolone allergy • Children <18y (cartilage damage) • Pregnancy • Seizure disorder • Myasthenia gravis |
| LEVOFLOXACIN | Molecular Target: DNA gyrase and Topoisomerase IV MOA: Same as ciprofloxacin; L-isomer has enhanced activity; More potent inhibitor of Gram+ organisms Note: 3rd generation; Better Gram+ and atypical coverage vs ciprofloxacin; Less CYP interactions |
Absorption: Oral: 99% Tmax: 1-2 hours Distribution: Excellent; Lung, skin, soft tissue, kidney; CSF (moderate) Protein Binding: 30-40% Half-life: 6-8 hours Excretion: Renal (70-80%) |
CAP: 500mg daily × 5-7 days HAP: 750mg daily × 7-14 days UTI: 250-500mg daily Skin: 500mg q12h Max: 750mg/day |
• Antacids: reduced absorption • QT prolongation with other drugs • NSAIDs: increased CNS stimulation • Theophylline: less interaction than cipro |
• Known quinolone allergy • Children <18y • Pregnancy • Seizure history • Tendon disorders |
| TETRACYCLINES | |||||
| DOXYCYCLINE | Molecular Target: 30S ribosomal subunit MOA: 1) Binds to 30S at A-site 2) Blocks tRNA attachment 3) Inhibits protein synthesis 4) Bacteriostatic Note: Lipid-soluble tetracycline; Long tissue half-life; Inhibits matrix metalloproteinases |
Absorption: Oral: 90-100% Tmax: 2-3 hours Distribution: Excellent; Lung, liver, kidney; Prostate; CSF (10-20%); Vd 0.75 L/kg Protein Binding: 80-93% Half-life: 15-25 hours (longest tetracycline) Excretion: Renal (30-55%); Fecal (30%) |
Adult: 100mg PO q12h day 1, then 100mg daily Acne: 100mg daily Malaria: 200mg weekly (prophylaxis) Lyme: 100mg q12h × 14-21 days Max: 200mg/day |
• ANTACIDS/MINERALS: chelation (take 2h apart) • WARFARIN: enhanced effect • ORAL CONTRACEPTIVES: reduced efficacy • ISOTRETINOIN: pseudotumor cerebri risk • CARBAMAZEPINE/PHENYTOIN: reduced levels |
• Known tetracycline allergy • Children <8y (teeth discoloration) • Pregnancy (fetal damage) • Severe hepatic/renal impairment • Myasthenia gravis |
| AMINOGLYCOSIDES | |||||
| GENTAMICIN | Molecular Target: 30S ribosomal subunit MOA: 1) Irreversibly binds to 30S at 30S initiation complex 2) Causes mRNA misreading 3) Produces non-functional/toxic proteins 4) Bactericidal Note: Requires O2 for uptake (anaerobes resistant); Concentration-dependent killing; Post-antibiotic effect |
Absorption: Oral: <1%; IM: 100% Distribution: Extracellular fluid; Poor CSF (<10%); Vd 0.3 L/kg Protein Binding: <10% Half-life: 2-3 hours (longer in renal impairment) Excretion: Renal (90% unchanged, glomerular filtration) |
Adult: 3-5mg/kg/day div q8h Once-daily: 5-7mg/kg daily UTI: 80mg IM q8h Max: Based on levels |
• OTHER AMINOGLYCOSIDES: additive toxicity • CEPHALOSPORINS: nephrotoxicity • VANCOMYCIN: nephrotoxicity • FUROSEMIDE: ototoxicity • NM BLOCKERS: enhanced blockade |
• Known aminoglycoside allergy • Renal impairment (use cautiously) • Myasthenia gravis (neuromuscular blockade) • Pregnancy (fetal ototoxicity) |
| SULFONAMIDES & COMBINATIONS | |||||
| CO-TRIMOXAZOLE (Sulfamethoxazole + Trimethoprim) |
Molecular Target: Folate synthesis pathway (sequential blockade) MOA: 1) SMX: Competes with PABA; Inhibits dihydropteroate synthase (DHPS) 2) TMP: Inhibits dihydrofolate reductase (DHFR) 3) Synergistic effect (1+1>2) Note: 5:1 ratio; Bactericidal; Sequential blockade prevents resistance |
Absorption: Oral: 90-100% (both) Tmax: SMX: 2-4h; TMP: 1-4h Distribution: Good; Lung, kidney, prostate; CSF (30-50% for SMX) Protein Binding: SMX: 70%; TMP: 40-70% Half-life: SMX: 10-12h; TMP: 10-12h Excretion: Renal (60-80%) |
Adult: 800/160mg (1 DS) q12h PCP Prophylaxis: 800/160mg daily UTI: 400/80mg q12h Max: 2.4g SMX/day |
• WARFARIN: increased effect • PHENYTOIN: increased levels • METHOTREXATE: increased toxicity • ACEI/ARBs: hyperkalemia risk • DRUGS causing folate deficiency |
• Sulfa allergy • Pregnancy (near term) • Severe renal impairment • Folate deficiency • History of Stevens-Johnson |
| NITROIMIDAZOLES | |||||
| METRONIDAZOLE | Molecular Target: Anaerobic microbial DNA MOA: 1) Enters cell via diffusion 2) Reduced by ferredoxin-like proteins in anaerobes 3) Forms nitroso radical 4) Causes DNA strand breaks 5) Bactericidal Note: Only effective against anaerobes and protozoa; Requires anaerobic metabolism for activation |
Absorption: Oral: 80-100% Tmax: 1-3 hours Distribution: Excellent; All tissues including brain, liver, lung; CSF (high); Vd 0.6-0.7 L/kg Protein Binding: <20% Half-life: 6-8 hours Excretion: Renal (60-80%); Fecal (6-15%) |
Anaerobic: 500mg IV/PO q8h Giardia: 2g daily × 3-5 days C. difficile: 500mg PO q8h × 10-14 days H. pylori: 500mg q8h × 14 days Max: 4g/day |
• ALCOHOL: disulfiram-like reaction • WARFARIN: increased effect • LITHIUM: increased toxicity • DISULFIRAM: psychosis risk • PHENYTOIN: increased levels |
• Known metronidazole allergy • First trimester pregnancy • CNS disorders (seizure risk) • Severe hepatic impairment • Cockayne syndrome |
| ANTITUBERCULAR DRUGS | |||||
| ISONIAZID (INH) | Molecular Target: Mycolic acid synthesis MOA: 1) Activated by KatG (mycobacterial catalase-peroxidase) 2) Inhibits InhA (enoyl-ACP reductase) 3) Blocks mycolic acid synthesis 4) Bactericidal (active) or bacteriostatic (latent) Note: Only mycobacterial species affected; Requires KatG for activation; Fast-acting in active disease |
Absorption: Oral: 100% Tmax: 1-2 hours Distribution: Excellent; All body fluids/tissues; CSF (high); Vd 0.6 L/kg Protein Binding: 0-10% Half-life: 0.5-5 hours (fast acetylators: 0.5-1.5h; Slow: 2-5h) Excretion: Renal (75-95%, mostly inactive metabolites) |
Adult: 5mg/kg max 300mg daily OR 15mg/kg max 900mg 2-3x/week Prophylaxis: 300mg daily × 6-9 months Max: 300mg/day (daily), 900mg (intermittent) |
• PHENYTOIN/CARBAMAZEPINE: increased levels/toxicity • WARFARIN: increased effect • PREDNISONE: reduced INH levels • ANTACIDS: reduced absorption • CYSTEINE: increased toxicity |
• Isoniazid allergy • Drug-induced liver disease • Acute liver disease • History of INH-induced hepatitis |
| RIFAMPICIN | Molecular Target: Bacterial DNA-dependent RNA polymerase MOA: 1) Binds to β-subunit of RNA polymerase 2) Blocks transcription initiation 3) Prevents RNA chain elongation 4) Bactericidal Note: Broad-spectrum (mycobacteria, Gram+, some Gram-); Strong CYP450 inducer; Colors body fluids orange |
Absorption: Oral: 90-100% (fasting); Food: reduced Tmax: 2-4 hours Distribution: Excellent; All tissues/fluids; Liver, lung, kidney; CSF (20-50% when inflamed) Protein Binding: 80% Half-life: 3-5 hours (decreases with induction) Excretion: Biliary (60-65%); Renal (30%) |
TB: 10mg/kg max 600mg daily OR 10-20mg/kg 2-3x/week Prophylaxis: 600mg daily Max: 600mg/day |
• CIGARETTES: induces metabolism • ORAL CONTRACEPTIVES: treatment failure • WARFARIN: treatment failure • PROTEASE INHIBITORS: reduced levels • CORTICOSTEROIDS: reduced effect |
• Rifampicin allergy • Jaundice • Concurrent saquinavir/ritonavir • History of porphyria |
| PYRAZINAMIDE | Molecular Target: Bacterial fatty acid synthase / Membrane MOA: 1) Converted to pyrazinoic acid (POA) by pyrazinamidase 2) POA lowers intracellular pH 3) Disrupts membrane transport 4) Inhibits fatty acid synthase 5) Bactericidal Note: Active in acidic environments (macrophages); Sterilizing activity (kills persisters); Short-course therapy essential |
Absorption: Oral: 90-100% Tmax: 2 hours Distribution: Good; Lung, liver, kidney; CSF (high); Vd 0.6-0.9 L/kg Protein Binding: 10-20% Half-life: 9-10 hours Excretion: Renal (70%, mostly metabolites) |
Adult: 20-25mg/kg max 2g daily OR 50mg/kg 2x/week Max: 2g/day (regardless of weight) |
• PROBENECID: increased levels • GOUT: hyperuricemia worsens • ANTI-TB drugs: additive hepatotoxicity |
• Pyrazinamide allergy • Severe hepatic impairment • Gout • Acute porphyria |
| ETHAMBUTOL | Molecular Target: Arabinosyl transferase MOA: 1) Inhibits arabinosyl transferase (embCAB operon) 2) Blocks arabinogalactan synthesis 3) Impairs mycobacterial cell wall 4) Bacteriostatic (bactericidal at high doses) Note: Only mycobacterial coverage; Requires functional embB gene; Prevents resistance emergence |
Absorption: Oral: 75-80% Tmax: 2-4 hours Distribution: Good; Lung, kidney, liver; CSF (10-50% when inflamed); Vd 2 L/kg Protein Binding: 20-30% Half-life: 3-4 hours Excretion: Renal (80% unchanged) |
Adult: 15-20mg/kg daily OR 40-50mg/kg 2x/week Retinitis: Use 25mg/kg if vision monitoring available Max: 1.6g/day (daily), 2.4g (intermittent) |
• ANTACIDS: reduced absorption • Other ototoxic drugs: additive risk |
• Ethambutol allergy • Optic neuritis (pre-existing) • Unable to monitor vision • Severe renal impairment |
| ANTIRETROVIRALS - NRTIs | |||||
| ZIDOVUDINE (AZT) | Molecular Target: HIV Reverse Transcriptase MOA: 1) Phosphorylated to zidovudine triphosphate 2) Competes with dTTP for incorporation 3) Lacks 3'-OH (chain terminator) 4) Incorporation stops DNA chain elongation 5) HIV-1 RT inhibition Note: First approved ARV; Reduces MTCT; Can cause bone marrow suppression |
Absorption: Oral: 60-70% Tmax: 0.5-1.5 hours Distribution: Good; CSF (60% of plasma); Vd 1-2 L/kg Protein Binding: 30-38% Half-life: 1 hour (plasma); Intracellular: 3-4 hours Excretion: Renal (60-80%, metabolites); Hepatic (glucuronidation) |
Adult: 300mg PO q12h IV: 1mg/kg q4h PMTCT: 300mg q12h from week 14 Max: 600mg/day |
• GANCICLOVIR: increased bone marrow suppression • PROBENECID: increased levels • INTERFERON: increased toxicity • Other myelosuppressive drugs |
• Hypersensitivity • Severe anemia (Hb <7.5g/dL) • Neutropenia (ANC <750) • Lactation |
| LAMIVUDINE (3TC) | Molecular Target: HIV-1/2 Reverse Transcriptase + HBV polymerase MOA: 1) Phosphorylated to triphosphate 2) Competes with dCTP 3) Incorporates into viral DNA 4) Chain termination (lacks 3'-OH) Note: Also active against HBV; Well-tolerated; Often combined with other NRTIs |
Absorption: Oral: 80-85% Tmax: 0.5-1.5 hours Distribution: Good; CSF (10% of plasma); Vd 1.3 L/kg Protein Binding: <36% Half-life: 5-7 hours (intracellular: 16-19h) Excretion: Renal (70-90% unchanged) |
Adult: 150mg PO q12h OR 300mg daily HBV: 100mg daily Children: 4mg/kg q12h Max: 300mg/day |
• TRIMETHOPRIM: increased 3TC levels (renal transport) • Other nucleoside analogs: lactic acidosis risk |
• Hypersensitivity • Severe hepatic impairment • Pancreatitis history |
| ANTIRETROVIRALS - NNRTIs | |||||
| NEVIRAPINE (NVP) | Molecular Target: HIV-1 Reverse Transcriptase (allosteric site) MOA: 1) Binds to NNRTI pocket (hydrophobic region) 2) Induces conformational change 3) Blocks RNA-dependent DNA polymerase activity 4) Prevents DNA chain elongation Note: HIV-1 only; Potent inducer of CYP3A4; Requires lead-in dosing; Rash/HEp most common |
Absorption: Oral: >90% Tmax: 2-4 hours Distribution: Good; CSF (30-60% of plasma); Vd 1.2-1.7 L/kg Protein Binding: 60% Half-life: 25-30 hours (after 2-4 weeks); Single dose: 45 hours Excretion: Hepatic (CYP3A4 metabolism); Fecal (80%); Renal (<3%) |
Lead-in: 200mg daily × 14 days Maintenance: 200mg q12h Max: 400mg/day |
• CYP3A4 SUBSTRATES: reduced levels (rifampin, EFV) • HORMONAL CONTRACEPTIVES: reduced efficacy • METHADONE: withdrawal • WARFARIN: reduced effect |
• Hypersensitivity • Moderate-severe hepatic impairment • Rash with prior NVP use • SJS/TEN history |
| EFAVIRENZ (EFV) | Molecular Target: HIV-1 Reverse Transcriptase MOA: Same as nevirapine - binds NNRTI pocket; Allosteric inhibition of RT Note: HIV-1 only; Once-daily; CNS effects common (take at bedtime); Also CYP3A4 inducer/inhibitor |
Absorption: Oral: 40-50% (enhanced with fat) Tmax: 3-5 hours Distribution: Good; CSF (0.5% of plasma); Vd 2-3 L/kg; Testes Protein Binding: 99% Half-life: 40-55 hours Excretion: Hepatic (CYP2B6, CYP3A4); Fecal (14-34%); Renal (<1%) |
Adult: 600mg daily (at bedtime) Weight-based: >50kg: 600mg; 40-50kg: 400mg Max: 600mg/day |
• CYP3A4 SUBSTRATES: variable effect • WARFARIN: increased effect • SIMVASTATIN: increased levels • ANTICONVULSANTS:相互作用 • BELLY BUTTON |
• Hypersensitivity • First trimester pregnancy (teratogenic) • Severe hepatic impairment • Psychiatric illness (worsens) |
| ANTIFUNGALS | |||||
| FLUCONAZOLE | Molecular Target: Fungal cytochrome P450 (lanosterol 14α-demethylase) MOA: 1) Inhibits fungal CYP450 (Erg11) 2) Blocks demethylation of lanosterol 3) Accumulates toxic methylsterols 4) Disrupts ergosterol synthesis 5) Fungistatic Note: Broadest triazole; Highest oral bioavailability; Least protein binding |
Absorption: Oral: >90% Tmax: 1-2 hours Distribution: Good; CSF (70-90% of plasma); Eye, peritoneal fluid; Vd 0.7 L/kg Protein Binding: 12% Half-life: 27-37 hours (longest azole) Excretion: Renal (80% unchanged) |
Candidiasis: 150mg single or 50-400mg daily Crypto meningitis: 400mg day1, then 200-400mg daily × 6-8 weeks Prophylaxis: 100-400mg daily Max: 400mg/day (candidemia: 800mg) |
• WARFARIN: increased effect • PHENYTOIN: increased levels • CYCLOSPORINE: increased levels • THEOPHYLLINE: increased levels • ORAL CONTRACEPTIVES: variable effect • QT prolongation with other drugs |
• Known fluconazole allergy • Concurrent QT-prolonging drugs • Severe hepatic impairment • Pregnancy (high doses) |
| AMPHOTERICIN B | Molecular Target: Fungal cell membrane (ergosterol) MOA: 1) Binds to ergosterol in fungal membrane 2) Forms pores/channels 3) Causes leakage of cellular contents 4) Also binds human cholesterol (toxicity) 5) Fungicidal Note: Broadest antifungal spectrum; Amphotericin B deoxycholate = conventional; Lipid formulations reduce toxicity |
Absorption: Oral: negligible; IV only Distribution: Vd 4L/kg (extracellular); Liver, spleen, lung, kidney; Poor CSF (<3%) Protein Binding: 90-95% Half-life: 24-36 hours (biphasic); Terminal: 15 days Excretion: Slow biliary (30-50%); Renal (2-5%) |
Conventional: 0.5-1mg/kg IV daily Liposomal: 3-5mg/kg IV daily Max: 1.5mg/kg/day (conventional) |
• NEPHROTOXIC DRUGS: additive renal toxicity • AMINOGLYCOSIDES: nephrotoxicity • CORTICOSTEROIDS: hypokalemia • DIGOXIN: toxicity (hypokalemia) |
• Known amphotericin allergy • Severe renal impairment (conventional - relative) • Concurrent potassium-wasting diuretics |
| ANTIMALARIALS | |||||
| ARTEMETHER/LUMEFANTRINE | Molecular Targets: Artemether: Heme polymerase (falcipain-2) Lumefantrine: Mitochondrial ATP MOA: 1) Artemether: Generates reactive oxygen species; Cleaves hemoglobin; Inhibits parasite protein synthesis 2) Lumefantrine: Blocks electron transport; Inhibits nucleic acid synthesis Note: Fast-acting; Combination prevents resistance; Artemether has short T½ (2h), lumefantrine long (6-7 days) |
Absorption: Artemether: variable; Lumefantrine: enhanced with fat Tmax: Artemether: 2h; Lumefantrine: 6-8h Distribution: Artemether: Vd 2-5 L/kg; Lumefantrine: Vd 0.3-0.5 L/kg; High protein binding Protein Binding: Lumefantrine: 99% Half-life: Artemether: 2h; Lumefantrine: 6-7 days Excretion: Hepatic (CYP3A4); Fecal |
Adult: 4 tablets (80/480mg) at 0h, 8h, 24h, 36h, 48h, 60h (6 doses) Children: Based on weight (5-<15kg: 1 tab; 15-<25kg: 2 tabs; 25-<35kg: 3 tabs) Max: 24 tablets/3 days |
• QT PROLONGING drugs: arrhythmias • CYP3A4 inhibitors: increased lumefantrine • CYP3A4 inducers: reduced efficacy (rifampin, carbamazepine) • ANTIMALARIALS: additive toxicity |
• First trimester pregnancy • Known QT prolongation • Severe cardiac disease • Artemether/lumefantrine allergy |
| SULFADOXINE/PYRIMETHAMINE (Fansidar) |
Molecular Targets: Folate synthesis pathway MOA: 1) Sulfadoxine: PABA analog; Inhibits dihydropteroate synthase (DHPS) 2) Pyrimethamine: Inhibits dihydrofolate reductase (DHFR) 3) Sequential blockade = synergistic Note: Long half-life (100-200h); Slow-acting; Resistance widespread; Used with artemisinin |
Absorption: Sulfadoxine: good; Pyrimethamine: 100% Tmax: Sulfadoxine: 4h; Pyrimethamine: 2-3h Distribution: Good tissue penetration; Vd: Sulfadoxine 0.3 L/kg; Pyrimethamine 2.4 L/kg Protein Binding: Sulfadoxine: 90%; Pyrimethamine: 80-90% Half-life: Sulfadoxine: 100-200h; Pyrimethamine: 80-100h Excretion: Renal |
Adult: 3 tablets (1500/75mg) single dose Children: Based on age/weight Max: 3 tablets as single dose |
• FOLATE antagonists: bone marrow toxicity • WARFARIN: increased effect • SULFA drugs: cross-reactivity |
• Sulfa allergy • Pregnancy (first trimester) • Severe renal impairment • History of SJS/TEN |
| Drug | Molecular Target | Pharmacokinetics | Adult Dose | Key Interactions | Contraindications |
|---|---|---|---|---|---|
| HERPESVIRUS DRUGS | |||||
| ACYCLOVIR | Molecular Target: Viral thymidine kinase (TK) + DNA polymerase MOA: 1) Phosphorylated by viral TK (first step - SELECTIVE) 2) Phosphorylated by cellular kinases to triphosphate 3) Acyclovir triphosphate competes with dGTP 4) Incorporated into viral DNA 5) Chain termination (lacks 3'-OH) Note: HSV > VZV > CMV; Selectivity from viral TK; Resistance via TK deficiency |
Absorption: Oral: 15-30% (low) Tmax: 1.5-2 hours Distribution: Good tissue; CSF (50% of plasma); Brain, lungs, liver; Vd 0.7 L/kg Protein Binding: 15% Half-life: 2.5-3.5 hours (plasma); Intracellular: >12h Excretion: Renal (60-90% unchanged) |
HSV: 200mg 5x/day or 400mg q8h PO VZV: 800mg 5x/day PO IV: 5-10mg/kg q8h Max: 20mg/kg/day IV |
• PROBENECID: decreases clearance • NEPHROTOXIC drugs: additive renal toxicity • ZIDOVUDINE: increased CNS toxicity |
• Acyclovir allergy • Severe renal impairment (adjust dose) • IV: caution in dehydration |
| VALACYCLOVIR | Molecular Target: Same as acyclovir MOA: Prodrug of acyclovir (L-valyl ester); Converted to acyclovir after absorption; Better bioavailability (55%) Note: Same mechanism as acyclovir; Higher plasma levels; Used for HSV suppression, shingles |
Absorption: Oral: 55% (converted to acyclovir) Tmax: 1-2 hours (aciclovir) Distribution: Same as acyclovir Protein Binding: Acyclovir: 15% Half-life: 3 hours (aciclovir) Excretion: Renal (aciclovir) |
HSV: 1g q12h Shingles: 1g q8h × 7 days Suppression: 500mg daily Max: 3g/day |
• Same as acyclovir • Probenecid: increased levels |
• Valacyclovir/acyclovir allergy • Renal impairment (adjust dose) • Elderly (CNS effects) |
| FAMCICLOVIR | Molecular Target: Viral TK + DNA polymerase MOA: Prodrug of penciclovir; Phosphorylated by viral TK; Penciclovir triphosphate competes with dGTP Note: Penciclovir has longer intracellular half-life than acyclovir; Similar activity spectrum |
Absorption: Oral: 77% Tmax: 1 hour Distribution: Good tissue penetration Protein Binding: <20% Half-life: 2-3 hours (penciclovir) Excretion: Renal (penciclovir) |
HSV: 250mg q8h Shingles: 500mg q8h × 7 days Suppression: 250mg q12h Max: 750mg/day |
• DIGOXIN: may increase levels • PROBENECID: decreased clearance |
• Famciclovir/penciclovir allergy • Renal impairment (adjust dose) |
| GANCICLOVIR | Molecular Target: Viral UL97 phosphotransferase + cellular kinases + DNA polymerase MOA: 1) Phosphorylated by viral UL97 (CMV phosphotransferase) 2) Further phosphorylated by cellular kinases 3) Ganciclovir triphosphate 4) Competes with dGTP 5) Incorporated into DNA 6) Chain termination Note: CMV drug of choice; More toxic than others; IV only for systemic; Oral for maintenance |
Absorption: Oral: 6% (poor) Tmax: 1-3 hours Distribution: Good; CSF (24-67%); Vd 0.7-1 L/kg Protein Binding: 1-2% Half-life: 1.7-5.8 hours (plasma); Intracellular: >24h Excretion: Renal (90% unchanged) |
Induction: 5mg/kg IV q12h × 14-21 days Maintenance: 5mg/kg/day IV OR 1g q8h PO Max: 10mg/kg/day |
• ZIDOVUDINE: increased myelosuppression • IMIPENEM: seizures • MYELOSUPPRESSIVE drugs: additive toxicity • PROBENECID: decreased clearance |
• Ganciclovir allergy • Severe neutropenia (<500) • Severe thrombocytopenia • Pregnancy (teratogenic) |
| INFLUENZA DRUGS | |||||
| OSELTAMIVIR (TAMIFLU) | Molecular Target: Viral neuraminidase MOA: 1) Competitive inhibitor of viral neuraminidase 2) Blocks cleavage of sialic acid from host cells 3) Prevents release of new virions 4) Traps virions at cell surface 5) Reduces viral spread Note: Active vs influenza A and B; Must start within 48h for best effect; Resistance emerging (H275Y mutation) |
Absorption: Oral: 80% Tmax: 2-4 hours Distribution: Good tissue; Lung, bronchoalveolar; Not CSF; Vd 23-26 L Protein Binding: 42% Half-life: 6-10 hours Excretion: Renal (>90% as metabolite) |
Treatment: 75mg q12h × 5 days Prophylaxis: 75mg daily Children: Based on weight Max: 150mg/day |
• PROBENECID: increases levels (no dose adjustment needed) • No major drug interactions |
• Oseltamivir allergy • Severe renal impairment (adjust dose) • Pregnancy (use if benefit > risk) |
| ZANAMIVIR (RELENZA) | Molecular Target: Viral neuraminidase MOA: Same as oseltamivir - inhibits neuraminidase; Blocks viral release Note: Inhaled powder; Local action in respiratory tract; Alternative to oseltamivir; Resistance rare |
Absorption: Inhaled: 14-21% Tmax: 1-2 hours Distribution: Local respiratory tract; Low systemic Protein Binding: <10% Half-life: 2.5-5 hours Excretion: Renal |
Treatment: 2 inhalations (10mg) q12h × 5 days Prophylaxis: 2 inhalations daily Max: 20mg/day |
• No significant drug interactions | • Zanamivir allergy • Asthma/COPD (bronchospasm risk - use with bronchodilator) • Lactose allergy (contains lactose) |
| HEPATITIS DRUGS | |||||
| RIBAVIRIN (VIRAZOLE) | Molecular Target: Viral IMP dehydrogenase + RNA-dependent RNA polymerase (RdRp) MOA: 1) Inhibits IMP dehydrogenase 2) Depletes intracellular GTP pools 3) Inhibits viral RNA polymerase 4) Causes lethal mutagenesis (error catastrophe) Note: Broad antiviral; RSV (aerosol), HCV (with DAAs), Lassa fever; Highly teratogenic |
Absorption: Oral: 45-65% Tmax: 1-2 hours Distribution: High; Vd 500-900 L; RBCs (high conc - 16 day accumulation) Protein Binding: None Half-life: 0.5-2 hours (plasma); 40 hours (RBCs) Excretion: Renal (30% unchanged) |
RSV: 6g/day aerosol × 12-18h/d × 3-7 days HCV: 1000-1200mg/day div (with sofosbuvir/IFN) Max: Based on weight/Hb |
• ZIDOVUDINE: increased myelosuppression • DIDANOSINE: mitochondrial toxicity (AVOID) • STAVUDINE: mitochondrial toxicity • AZATHIOPRINE: severe anemia |
• Pregnancy (teratogenic - both partners must avoid) • Severe cardiac disease • Hemoglobinopathies • Severe renal impairment |
| SOFOSBUVIR (SOVALDI) | Molecular Target: NS5B RNA-dependent RNA polymerase MOA: 1) Prodrug - phosphorylated intracellularly 2) Sofosbuvir triphosphate 3) Chain terminator (uridine analog) 4) Inhibits NS5B RNA-dependent RNA polymerase 5) Blocks viral RNA synthesis Note: Pangenotypic; DAAs backbone; High barrier to resistance; With ledipasvir for GT 1,4 |
Absorption: High (with food: 71%) Tmax: 0.5-1 hour Distribution: Protein binding: 65% (sofosbuvir), 99% (GS-331007) Protein Binding: 65-99% Half-life: 0.5 hours (sofosbuvir), 27 hours (metabolite) Excretion: Renal (80% as metabolite) |
HCV: 400mg daily × 12-24 weeks (with other DAAs) Max: 400mg/day |
• P-gp/BCRP INHIBITORS: increased levels (amiodarone - AVOID bradycardia) • P-gp/BCRP INDUCERS: reduced efficacy (rifampin, carbamazepine, phenytoin, St. John's wort - AVOID) |
• Sofosbuvir allergy • Severe renal impairment (CKD 4-5 - limited data) • Pregnancy (no data) |
| Vaccine | Type | Target Pathogen | Composition | Schedule | Immunity | Contraindications | Adverse Reactions |
|---|---|---|---|---|---|---|---|
| LIVE ATTENUATED VACCINES | |||||||
| BCG (Bacillus Calmette-Guerin) | Live attenuated bacterial | Mycobacterium tuberculosis | Live attenuated M. bovis (Danish 1331, Pasteur 1173 P2) | Birth (single dose). HIV+ exposed: consult | Variable: 10-20 years (variable protection) | Immunodeficiency (HIV symptomatic, severe). TB unknown. Pregnancy. | Ulcer at site (scar). Lymphadenitis. Disseminated BCG (immunosuppressed). |
| OPV (Oral Polio) | Live attenuated viral (Sabin) | Poliovirus types 1, 2, 3 | Attenuated poliovirus strains (Sabin) | Birth, 6, 10, 14 weeks | Lifelong (intestinal immunity) | Immunodeficiency. Severe GI illness. | VAPP: 1 per 2.4 million doses |
| MEASLES | Live attenuated viral | Measles virus | Live attenuated Edmonston-Zagreb or Moraten strain | 9 months (6mo if outbreak). 15-18 months | Lifelong (2 doses give 97%) | Immunodeficiency. Pregnancy. Severe allergy to neomycin/gelatin. | Fever >39.4C (day 6-12). Rash. Febrile seizures. SSPE (rare). |
| YELLOW FEVER | Live attenuated viral | Yellow fever virus | Live attenuated 17D strain (17D-204 or 17DD) | 9-12 months (endemic areas). Travelers >9 months | Lifelong (10 years per WHO) | Age <6 months. Immunodeficiency. Thymus disorder. Pregnancy. Egg allergy. | Mild: fever, headache (10-30%). YEL-AVD: 0.05/100,000. YEL-SAID: 0.05/100,000. |
| ROTAVIRUS | Live attenuated oral viral | Rotavirus (G1P[8] and others) | Human-bovine reassortant (RotaTeq: pentavalent) or monovalent (Rotarix) | RotaTeq: 6, 10, 14 weeks. Rotarix: 6, 10 weeks | At least 3 years | SCID. Intussusception history. Severe allergy. | Diarrhea, vomiting (7d). Intussusception (1-2/100,000 - RotaTeq). |
| INACTIVATED VACCINES | |||||||
| IPV (Inactivated Polio) | Inactivated viral (Salk) | Poliovirus types 1, 2, 3 | Inactivated (formaldehyde) wild-type strains | 6, 10, 14 weeks. 15-18 months. 5 years | Lifelong (humoral) | Severe allergy to components. Anaphylaxis to neomycin/streptomycin. | Local: pain, redness, swelling. Fever >39.5C (rare). |
| DTwP/DTaP | Toxoid + inactivated bacterial | Corynebacterium diphtheriae, Clostridium tetani, Bordetella pertussis | Diphtheria toxoid + Tetanus toxoid + Inactivated B. pertussis (whole cell or acellular) | 6, 10, 14 weeks. 15-18 months. 4-7 years | Diphtheria: 10y. Tetanus: 10y. Pertussis: 5-10y | Encephalopathy within 7d. Severe reaction. Progressive neurological disorder. | Local swelling. Fever >40.5C. Persistent crying >3h (whole cell). Seizures (rare). |
| HEPATITIS B | Recombinant subunit (HBsAg) | Hepatitis B virus | Recombinant HBsAg from yeast (Saccharomyces cerevisiae) | Birth, 6, 14 weeks (or 6, 10, 14). Catch-up: 0, 1, 6 months | Long-term (decades) if seroconversion | Severe allergy to yeast. Moderate/severe illness (delay). | Local: pain, redness. Fatigue, headache. Fever >37.7C. Anaphylaxis (rare). |
| HiB (Haemophilus influenzae b) | Conjugate vaccine | Haemophilus influenzae type b | PRP conjugated to tetanus toxoid (PRP-T) or MenB protein | 6, 10, 14 weeks. 12-15 months | Long-term (>10 years) | Severe allergy. Age <6 weeks. | Local: redness, swelling. Fever. Irritability. Severe reaction (rare). |
| PCV13 (Pneumococcal) | Conjugate vaccine | Streptococcus pneumoniae (13 serotypes) | Capsular polysaccharides (13 serotypes) conjugated to CRM197 | 6, 10, 14 weeks. 12-15 months | At least 5 years | Severe allergy to components. Anaphylaxis to previous dose. | Tenderness, redness, swelling. Fever >38C. Irritability. Severe (rare). |
| INFLUENZA (Flu Shot) | Inactivated (injectable) or Live attenuated (nasal) | Influenza A, B (strains updated yearly) | Inactivated: split virion or subunit. LAIV: attenuated live virus | Annual: before flu season. Children 6mo-8y: 2 doses first year | 6-12 months (strains change) | Egg allergy (severe - observe). Immunosuppression (LAIV). Guillain-Barré (inactivated: 1-2/million). | Local: soreness. Systemic: fever, malaise (1-2 days). LAIV: runny nose, wheeze. |
| RABIES (PVRV or HDCV) | Inactivated viral | Rabies virus | Inactivated rabies virus (Vero cells or human diploid) | Pre-exposure: 0, 7, 21 or 28 days. Post-exposure: 0, 3, 7, 14, 28 (+RIG) | Long-term (years with boosters) | Severe allergy to vaccine components. Pregnancy (relative - use if needed). | Local: pain, swelling, itching. Systemic: headache, fever, chills. Neuroparalytic (rare). |
| Drug Class | Enzyme Effect | Key Interactions | Clinical Significance |
|---|---|---|---|
| CYP450 EFFECTS ON OTHER DRUGS | |||
| ERYTHROMYCIN | CYP3A4 STRONG INHIBITOR | ↑ Theophylline, Warfarin, Digoxin, Statins (esp. simvastatin), Carbamazepine, Ciclosporin, QT drugs | HIGH - Monitor levels/toxicity |
| CIPROFLOXACIN | CYP1A2 INHIBITOR | ↑ Theophylline, Caffeine, Tizanidine, Duloxetine | HIGH - Avoid or reduce theophylline |
| RIFAMPICIN | CYP450 STRONG INDUCER (1A2, 2C9, 2C19, 3A4) | ↓ Anticoagulants, Antiretrovirals, Contraceptives, steroids, QT drugs, TB drugs | HIGH - May need dose adjustment |
| ISONIAZID | CYP2C9, 2C19, 3A4 INHIBITOR | ↑ Phenytoin, Carbamazepine, Warfarin | MODERATE - Monitor levels |
| PHENYTOIN | CYP450 INDUCER | ↓ Oral contraceptives, Warfarin, Many others | HIGH - Need alternative contraception |
| DRUGS REQUIRING SPECIFIC MONITORING | |||
| AMINOGLYCOSIDES (Gentamicin, Amikacin) |
Nephrotoxic + Ototoxic | • Vancomycin = additive nephrotoxicity • Loop diuretics = ototoxicity • NSAIDs = nephrotoxicity |
Monitor: Serum creatinine, drug levels, audiology |
| VANCOMYCIN | Nephrotoxic + Ototoxic | • Aminoglycosides = additive nephrotoxicity • Loop diuretics = ototoxicity |
Monitor: Trough levels, renal function, hearing |
| WARFARIN | CYP2C9 substrate | • Many antibiotics ↑ INR • NSAIDs = bleeding • Many interactions |
Monitor: INR closely, bleeding |
| METHOTREXATE | Folate antagonist | • Trimethoprim/SMX = bone marrow • NSAIDs = toxicity • Probenecid = increased levels |
Monitor: CBC, renal, folate levels |
| QT PROLONGATION RISK | |||
| QT-RISK DRUGS | Blocks cardiac potassium channels | • Macrolides (esp. erythro + azithro) • Fluoroquinolones (moxiflox > levoflox > cipro) • Antipsychotics • Antidepressants • Antiarrhythmics |
Check ECG if: underlying heart disease, bradycardia, on multiple QT drugs |
| PREGNANCY CATEGORIES & LACTATION | |||
| ABSOLUTELY AVOID IN PREGNANCY | Teratogenic | • ACE inhibitors/ARBs (renal) • Methotrexate (teratogenic) • Warfarin (teratogenic) • Tetracyclines (bones/teeth) • Fluoroquinolones (cartilage) • Efavirenz (neural tube) |
Always check pregnancy status |
| AVOID IN BREASTFEEDING | Excreted in breast milk | • Tetracyclines • Metronidazole (single dose) • Ciprofloxacin • Lithium • Antiretrovirals |
Check individual drugs |
| Drug | Bioavailability | Protein Binding | Half-life | CSF Penetration | Renal Excretion |
|---|---|---|---|---|---|
| ANTIBIOTICS - BETA-LACTAMS | |||||
| Penicillin G | IM/IV: 100% | 60% | 30-60 min | Poor (5-10% inflamed) | 80% unchanged |
| Amoxicillin | 74-92% | 20% | 1-1.5h | 10% | 60% unchanged |
| Cephalexin | 90-95% | 10-15% | 0.9-1.2h | <1% | 90% unchanged |
| Cefuroxime | 30-50% | 50% | 1.3-1.5h | Good (inflamed) | 66% unchanged |
| Ceftriaxone | IM: 100% | 90-95% | 5.5-10h | HIGH | 33-67% |
| MACROLIDES | |||||
| Erythromycin | 15-50% | 70-90% | 1.5-2h | <5% | Hepatic |
| Azithromycin | 37% | 12-50% | 68h (tissue) | Poor | 6% |
| FLUOROQUINOLONES | |||||
| Ciprofloxacin | 50-70% | 20-40% | 3-5h | Moderate | 40-60% |
| Levofloxacin | 99% | 30-40% | 6-8h | Moderate | 70-80% |
| OTHER ANTIBIOTICS | |||||
| Doxycycline | 90-100% | 80-93% | 15-25h | 10-20% | 30-55% |
| Gentamicin | IM: 100% | <10% | 2-3h | <10% | 90% unchanged |
| Metronidazole | 80-100% | <20% | 6-8h | HIGH | 60-80% |
| Co-trimoxazole | 90-100% | SMX: 70%; TMP: 40% | 10-12h | 30-50% | 60-80% |
| ANTITUBERCULARS | |||||
| Isoniazid | 100% | 0-10% | 0.5-5h (acetylator) | HIGH | 75-95% |
| Rifampicin | 90-100% | 80% | 3-5h | 20-50% | 30% |
| Pyrazinamide | 90-100% | 10-20% | 9-10h | HIGH | 70% |
| Ethambutol | 75-80% | 20-30% | 3-4h | 10-50% | 80% |
| ANTIFUNGALS | |||||
| Fluconazole | >90% | 12% | 27-37h | 70-90% | 80% |
| Amphotericin B | IV only | 90-95% | 24-36h (term 15d) | <3% | 2-5% |