ANTIBIOTIC CHART




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Acronyms


Cefadroxil
Duricef®

Dosage forms

Capsule
  • 500 mg ($)
Tablet
  • 1000 mg ($)
Suspension
  • 250 mg/5 ml ($-$$)
  • 500 mg/5 ml ($-$$)

Dosing

Pediatric
  • Impetigo - 30 mg/kg/day (max 1000 mg/day) given once daily or divided into 2 doses (PI)
  • Skin infections - 30 mg/kg/day (max 1000 mg/day) given in 2 divided doses (PI)
  • Strep throat - 30 mg/kg once daily (max 1000 mg/day) for 10 days (IDSA)
  • Urinary tract infection - 30 mg/kg/day (max 1000 mg/day) given in 2 divided doses (PI)
Adults
  • Skin infections - 1000 mg/day given once daily or divided into 2 doses (PI)
  • Strep throat - 1000 mg/day given once daily or divided into 2 doses for 10 days (IDSA)
  • Urinary tract infection 1000 - 2000 mg/day given once daily or divided into 2 doses for 3 - 7 days (IDSA, PI)

Other

  • Cefadroxil is a first generation cephalosporin
  • May take without regard to food
  • Kidney disease (adults)
    • CrCl < 50 ml/min: dose adjustment recommended; see cefadroxil PI

Cephalexin
Keflex®

Dosage forms

Capsule
  • 250 mg ($)
  • 500 mg ($)
  • 750 mg ($$$-$$$$)
Tablet
  • 250 mg ($-$$)
  • 500 mg ($-$$)
Suspension
  • 125 mg/5 ml ($)
  • 250 mg/5 ml ($)

Dosing

Pediatric
  • Cellulitis (non-MRSA) - 25 - 50 mg/kg/day (max 2000 mg/day) given in 4 divided doses for 5 - 10 days (IDSA)
  • Endocarditis prophylaxis - 50 mg/kg (max 2000 mg) 30 - 60 minutes before procedure (penicillin allergic without severe reaction) (AHA)
  • Impetigo - 25 - 50 mg/kg/day (max 1000 mg/day) given in 3 – 4 divided doses for 7 days (IDSA)
  • Otitis media - 75 - 100 mg/kg/day given in 4 divided doses for 5 - 10 days (PI)
  • Strep throat - 40 mg/kg/day (max 1000 mg/day) given in 2 divided doses for 10 days (IDSA)
  • Urinary tract infection - 50 - 100 mg/kg/day (max 2000 mg/day) given in 4 divided doses for 7 - 14 days (CTE)
Adults (15 years and older)

Other

  • Cephalexin is a first generation cephalosporin
  • May take without regard to food
  • Cephalexin may increase metformin levels
  • Kidney disease
    • CrCl ≥ 60 ml/min: no dose adjustment necessary
    • CrCl 30 - 59 ml/min: no dose adjustment; maximum daily dose should not exceed 1000 mg
    • CrCl 15 - 29 ml/min: 250 mg every 8 hours or every 12 hours
    • CrCl 5 - 14 ml/min (nondialysis): 250 mg every 24 hours
    • CrCl 1 - 4 ml/min (nondialysis): 250 mg every 48 hours or every 60 hours

Cefaclor
Ceclor®

Dosage forms

Capsule
  • 250 mg ($)
  • 500 mg ($)
Suspension
  • 125 mg/5 ml ($)
  • 250 mg/5 ml ($$$)
  • 375 mg/5 ml ($$-$$$)

Dosing

Pediatric
Adults

Other

  • Cefaclor is a second generation cephalosporin
  • Food slows absorption but does not affect the extent of absorption
  • Liver disease - manufacturer makes no dosage recommendation
  • Kidney disease - no dose adjustment necessary

Cefprozil
Cefzil®

Dosage forms

Tablet
  • 250 mg ($)
  • 500 mg ($)
Suspension
  • 125 mg/5 ml ($)
  • 250 mg/5 ml ($)

Dosing

Pediatric (6 months - 12 years)
  • Cellulitis - 20 mg/kg/day (max 1000 mg/day) given once daily for 10 days (PI)
  • Otitis media - 30 mg/kg/day (max 1000 mg/day) given in 2 divided doses for 10 days (PI)
  • Pneumonia, community-acquired - 30 mg/kg/day (max 1000 mg/day) given in 2 divided doses for 7 - 10 days (IDSA)
  • Sinusitis - 15 - 30 mg/kg/day (max 1000 mg/day) given in 2 divided doses for 10 days (PI)
  • Strep throat - 15 mg/kg/day (max 500 mg/day) given in 2 divided doses for 10 days (PI)
Adolescents and Adults (age 12 years and older)
  • Cellulitis - 250 - 500 mg twice a day or 500 mg once daily for 10 days (PI)
  • Sinusitis - 250 - 500 mg twice a day for 10 days (PI)
  • Strep throat - 500 mg once daily for 10 days (PI)

Other

  • Cefprozil is a second generation cephalosporin
  • May take without regard to food
  • Liver disease - no dose adjustment necessary
  • Kidney disease
    • CrCl ≤ 29 ml/min: - use half the standard dose

Cefuroxime
Ceftin®

Dosage forms

Tablet
  • 125 mg (?)
  • 250 mg ($)
  • 500 mg ($)
Suspension
  • 125 mg/5 ml ($$$$)
  • 250 mg/5 ml ($$$$)

Dosing

Pediatric (3 months to 12 years)
  • NOTE: Pediatric dosing is for suspension only. Suspension and tablet are not bioequivalent on a mg-to-mg basis.
  • Impetigo - 30 mg/kg/day (max 1000 mg/day) given in 2 divided doses for 10 days (PI)
  • Otitis media - 30 mg/kg/day (max 1000 mg/day) given in 2 divided doses for 5 - 10 days (AAP)
  • Pneumonia, community-acquired - 30 mg/kg/day (max 1000 mg/day) given in 2 divided doses for 7 - 10 days (IDSA)
  • Sinusitis - 30 mg/kg/day (max 1000 mg/day) given in 2 divided doses for a minimum of 10 days (AAP)
  • Strep throat - 20 mg/kg/day (max 500 mg/day) given in 2 divided doses for 10 days (PI)
  • Urinary tract infection - 20 - 30 mg/kg/day (max 1000 mg/day) given in 2 divided doses for 7 - 14 days (CTE)
Adolescents and Adults (13 years and older)

Other

  • Cefuroxime is a second generation cephalosporin
  • Suspension should be taken with food
  • Tablets may be taken without regard to food
  • Tablets and suspension are not substitutable on a mg-to-mg basis
  • Kidney disease
    • CrCl ≥ 30 ml/min - no adjustment necessary
    • CrCl 10 - 29 ml/min - give standard individual dose every 24 hours
    • CrCl < 10 ml/min - give standard individual dose every 48 hours

Cefdinir
Omnicef®

Dosage forms

Capsule
  • 300 mg ($)
Suspension
  • 125 mg/5 ml ($)
  • 250 mg/5 ml ($)

Dosing

Pediatric (6 months - 12 years)
  • Otitis media - 14 mg/kg/day (max 600 mg/day) given in 1 or 2 divided doses for 5 - 10 days (AAP)
  • Sinusitis - 14 mg/kg/day (max 600 mg/day) given in 1 or 2 divided doses for a minimum of 10 days (AAP)
  • Skin infections - 7 mg/kg/dose (max 300 mg/dose) twice a day for 10 days (PI)
  • Strep throat - 7 mg/kg/dose (max 300 mg/dose) twice a day for 5 to 10 days OR 14 mg/kg (max 600 mg/day) once daily for 10 days (PI)
Adults and Adolescents (Age 13 years and older)

Other

  • Cefdinir is a third generation cephalosporin
  • May take without regard to food
  • Iron supplements and antacids reduce cefdinir absorption. Do not take within 2 hours of each other.
  • Cefdinir and iron may cause stool to turn red
  • Liver disease - no dose adjustment necessary
  • Kidney disease
    • CrCl < 30 ml/min: adult dose is 300 mg once daily; pediatric dose is 7 mg/kg/day (max 300 mg/day) given once daily

Cefditoren
Spectracef®

Dosage forms

Tablet
  • 200 mg ($$$$)
  • 400 mg ($$$$)
  • Discontinued in U.S.

Dosing

Adults and Adolescents (Age 12 years and older)

Other

  • Cefditoren has been discontinued in the U.S.
  • Cefditoren is a third generation cephalosporin
  • Take with a meal to increase absorption
  • Drugs that reduce gastric acidity (e.g. antacids, H2 blockers, PPIs) decrease absorption
  • Liver disease
    • Child-Pugh A/B: no dose adjustment necessary
    • Child-Pugh C: has not been studied
  • Kidney disease
    • CrCl > 50 ml/min: No dose adjustment necessary
    • CrCl 30 - 49 ml/min: 200 mg twice a day
    • CrCl < 30 ml/min: 200 mg once daily

Cefixime
Suprax®

Dosage forms

Capsule
  • 400 mg ($ for 2 capsules)
Tablet, chewable
  • 100 mg ($ for 2 tablets)
  • 200 mg ($$ for 2 tablets)
Suspension
  • 100 mg/5 ml ($$ for 50 ml)
  • 200 mg/5 ml ($$$ for 50 ml)
  • 500 mg/5 ml (?)

Dosing

Pediatric (6 months - 12 years)
Adults and Adolescents (Age 12 years and older)

Other

  • Cefixime is a third generation cephalosporin
  • May take without regard to food
  • Kidney disease
    • CrCl ≥ 60 ml/min: no dose adjustment necessary
    • CrCl < 60 ml/min: dose adjustment recommended; see Suprax PI [sec 2.3] for recommendations

Cefpodoxime
Vantin®

Dosage forms

Tablet
  • 100 mg ($)
  • 200 mg ($)
Suspension
  • 50 mg/5 ml ($)
  • 100 mg/5 ml ($)

Dosing

Pediatric (age 2 months through 12 years)
  • Otitis media - 10 mg/kg/day (max 400 mg/day) given in 2 divided doses for 5 - 10 days (AAP)
  • Pneumonia, community-acquired - 10 mg/kg/day (max 400 mg/day) given in 2 divided doses for 7 - 10 days (IDSA)
  • Sinusitis - 10 mg/kg/day (max 400 mg/day) given in 2 divided doses for a minimum of 10 days (AAP)
  • Strep throat - 10 mg/kg/day (max 200 mg/day) given in 2 divided doses for 5 - 10 days (PI)
  • Urinary tract infection - 10 mg/kg/day (max 400 mg/day) given in 2 divided doses for 7 - 14 days (CTE)
Adolescents and Adults (age 12 years and older)

Other

  • Cefpodoxime is a third generation cephalosporin
  • Suspension may be taken without regard to food
  • Tablets should be taken with food
  • Drugs that reduce gastric acidity (e.g. antacids, H2 blockers, PPIs) decrease absorption
  • Liver disease - no dose adjustment necessary
  • Kidney disease
    • CrCl < 30 ml/min: increase dosing interval to every 24 hours

Ceftibuten
Cedax®

Dosage forms

Capsule
  • 400 mg ($$$$)
Suspension
  • 180 mg/5 ml ($$$$)

Dosing

Pediatric
  • Otitis media - 9 mg/kg/day (max 400 mg/day) given once daily for 10 days (PI)
  • Strep throat - 9 mg/kg/day (max 400 mg/day) given once daily for 10 days (PI)
Adolescents and Adults (age 12 years and older)

Other

  • Ceftibuten is a third generation cephalosporin
  • Ceftibuten should be taken at least 2 hours before or one hour after a meal. Food decreases absorption.
  • Liver disease - manufacturer makes no dosage recommendation
  • Kidney disease
    • CrCl > 50 ml/min: No dose adjustment necessary
    • CrCl 30 - 49 ml/min: 4.5 mg/kg/day or 200 mg once daily
    • CrCl 5 - 29 ml/min: 2.25 mg/kg/day or 100 mg once daily

Ceftriaxone
Rocephin®

Dosage forms

Vial
  • 250 mg ($)
  • 500 mg ($)
  • 1000 mg ($)
  • 2000 mg ($)

Dosing

Pediatric
Adults

Other

  • Ceftriaxone is a third generation cephalosporin
  • Do not give to neonates ≤ 28 days old with hyperbilirubinemia
  • Liver disease - no dose adjustment necessary
  • Kidney disease - no dose adjustment necessary
  • Kidney and liver disease (concurrent) - do not exceed 2 grams daily

CEPHALOSPORIN GENERATIONS (IV&PO)

First generation Second generation Third generation Fourth generation
  • Cefadroxil (Duricef®)
  • Cephalexin (Keflex®)
  • Cefazolin (Ancef®)
  • Cefaclor (Ceclor®)
  • Cefoxitin (Mefoxin®)
  • Cefotetan (Cefotan®)
  • Cefprozil (Cefzil®)
  • Cefuroxime (Ceftin®)
  • Cefdinir (Omnicef®)
  • Cefditoren (Spectracef®)
  • Cefixime (Suprax®)
  • Cefotaxime (Claforan®)
  • Cefpodoxime (Vantin®)
  • Ceftazidime (Fortaz®)
  • Ceftibuten (Cedax®)
  • Ceftriaxone (Rocephin®)
  • Cefepime (Maxipime®)


Clindamycin
Cleocin®

Dosage forms

Capsule
  • 75 mg ($)
  • 150 mg ($)
  • 300 mg ($)
Solution
  • 75 mg/5 ml ($$)
Vaginal cream
  • 2%, 40 gm tube ($-$$)
Vaginal cream (Clindesse®)
  • 2%, single-dose 5 gm applicator ($$$)
Vaginal suppository (Cleocin®)
  • 100 mg ($$$$)
  • Comes in carton with 3 suppositories
Topical

Dosing

Pediatric
  • Cellulitis (MRSA coverage) - 30 - 40 mg/kg/day (max 1800 mg/day) given in 3 divided doses for 5 - 10 days (IDSA)
  • Endocarditis prophylaxis - 20 mg/kg (max 600 mg) 30 - 60 minutes before procedure (penicillin allergic) (AHA)
  • Impetigo - 20 mg/kg/day (max 1600 mg/day) given in 3 divided doses for 7 days (IDSA)
  • Otitis media - 30 - 40 mg/kg/day (max 1800 mg/day) given in 3 divided doses for 5 - 10 days (AAP)
  • Sinusitis - 8 - 12 mg/kg/day divided into 3 or 4 equal doses for a minimum of 10 days. Give with Cefixime (Suprax®). See AAP sinusitis recs. (AAP, PI)
  • Strep throat - 7 mg/kg/dose (max 300 mg/dose) three times daily for 10 days (IDSA)
Adults

Other

  • May take without regard to food
  • Liver disease - dose adjustment not likely necessary
  • Kidney disease - no dose adjustment necessary

Fosfomycin
Monurol®

Dosage forms

Powder
  • 3 gram packet ($$)

Dosing

Adults

Other

  • May take without regard to food
  • Mix packet with 3 - 4 ounces of water
  • Kidney disease - clearance is decreased. Manufacturer makes no specific recommendation.

Lefamulin
Xenleta™

Dosage forms

Tablet
  • 600 mg ($$$$)

Dosing

Adults (18 years and older)

Other

  • Take at least 1 hour before a meal or 2 hours after a meal. Food decreases absorption.
  • Do not use in pregnant women
  • Lefamulin is a bacterial ribosomal RNA inhibitor
  • Lefamulin is a sensitive CYP3A4 substrate and inhibitor. Strong and moderate CYP3A4 inducers may decrease the effectiveness of lefamulin. Do not take lefamulin with strong CYP3A4 inhibitors. Monitor for adverse effects when taking with moderate CYP3A4 inhibitors.
  • Lefamulin is a P-glycoprotein substrate. P-glycoprotein inducers may decrease the effectiveness of lefamulin. Do not take with strong P-glycoprotein inhibitors. Monitor for adverse effects when taking with moderate P-glycoprotein inhibitors.
  • Lefamulin can prolong the QT interval. Avoid use in patients with prolonged QT syndrome and in those taking concomitant medications that can prolong the QT interval.
  • Lefamulin is contraindicated with sensitive CYP3A4 substrates that prolong the QT interval (e.g. pimozide)
  • Liver disease
    • Mild (Child-Pugh A): no dose adjustment necessary
    • Moderate to severe (Child-Pugh B/C): has not been evaluated. Not recommended.
  • Kidney disease - no dose adjustment necessary

Studies


Linezolid
Zyvox®

Dosage forms

Tablet
  • 600 mg ($)
Suspension
  • 100 mg/5 ml ($$$$)

Dosing

Pediatric
  • Cellulitis (MRSA coverage)
    • < 5 years old - 10 mg/kg/dose every 8 hours for 5 - 10 days (IDSA, PI)
    • 5 - 11 years old - 10 mg/kg/dose (max 600 mg/dose) twice a day for 5 - 10 days (IDSA, PI)
  • Pneumonia, community-acquired
    • < 12 years old - 30 mg/kg/day given in 3 divided doses for 7 - 10 days (IDSA)
    • ≥ 12 years old - 20 mg/kg/day (max 1200 mg/day) given in 2 divided doses for 7 - 10 days (IDSA)
Adults (12 years and older)

Other

  • May take without regard to food
  • Linezolid is a bacterial ribosomal RNA inhibitor
  • Linezolid is a reversible, nonselective MAO inhibitor. Do not take within 2 weeks of other MAO inhibitors.
  • Linezolid may increase the pressor effect of adrenergic agents including pseudoephedrine and phenylpropanolamine. Foods containing tyramine should also be avoided in large quantities (e.g. aged cheeses, fermented or air-dried meats, sauerkraut, soy sauce, tap beers, and red wines)
  • Linezolid has been shown to increase the risk of serotonin syndrome. Do not use with other serotonergic agents unless no other options are available. If concomitant therapy is necessary, monitor for symptoms of serotonin syndrome for two weeks (five weeks if fluoxetine was taken) or until 24 hours after the last dose of linezolid, whichever comes first.
  • Postmarketing cases of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) have been reported in patients receiving linezolid. Monitor sodium levels during linezolid therapy in patients who are at increased risk of SIADH (e.g. elderly, taking diuretics).
  • Linezolid can cause myelosuppression, including anemia, leukopenia, pancytopenia, and thrombocytopenia. Patients with severe renal impairment and liver disease are at greatest risk. Check weekly CBCs, particularly in patients receiving therapy for more than 2 weeks and those at increased risk of cytopenias (e.g., immunosuppressed, chronic infections, liver disease, kidney disease, pre-existing myelosuppression).
  • Liver disease
    • Mild to moderate (Child-Pugh A/B): no dose adjustment necessary
    • Severe (Child-Pugh C): has not been evaluated
  • Kidney disease - no dose adjustment necessary

Studies


Tedizolid
Sivextro®

Dosage forms

Tablet
  • 200 mg ($$$$)

Dosing

Adults and children (12 years and older)

Other

  • May take without regard to food
  • For a missed dose, take as soon as possible anytime up to 8 hours prior to the next scheduled dose. If less than 8 hours remain before the next dose, wait until next scheduled dose.
  • Tedizolid is a bacterial ribosomal RNA inhibitor
  • Tedizolid is a reversible MAO inhibitor. Do not take within 2 weeks of other MAO inhibitors.
  • Tedizolid is a BCRP inhibitor and may increase exposure to BCRP substrates
  • May increase the pressor effect of adrenergic agents including pseudoephedrine and phenylpropanolamine. Foods containing tyramine should also be avoided in large quantities (e.g. aged cheeses, fermented or air-dried meats, sauerkraut, soy sauce, tap beers, and red wines)
  • May increase the risk of serotonin syndrome. Use caution when taken with antidepressants and other serotonergic drugs. A retrospective cohort study (N=479) among hospitalized patients receiving tedizolid with other serotonergic medications found that the incidence of clinically suspected serotonin syndrome was 0.4%. [PMID 39235251]
  • Liver disease - no dose adjustment necessary
  • Kidney disease - no dose adjustment necessary

Azithromycin
Zithromax®

Dosage forms

Tablet
  • 250 mg ($)
  • 500 mg ($)
  • 600 mg ($)
Suspension
  • 100 mg/5 ml ($)
  • 200 mg/5 ml ($)
Powder, one packet
  • 1000 mg ($)
Suspension, extended-release (Zmax®)
  • 2 grams/bottle ($$$)
Ophthalmic

Dosing

Pediatric (0 - 5 months)
Pediatric (6 months to 12 years)
Adolescents and Adults

Other

  • May take without regard to food
  • Do not take with aluminum or magnesium antacids
  • Azithromycin may cause QT interval prolongation. Use caution in susceptible patients.
  • Liver disease: has not been studied. Manufacturer makes no recommendation. Azithromycin-induced hepatotoxicity has occurred in some patients.
  • Kidney disease
    • CrCl > 10 ml/min: no dose adjustment necessary
    • CrCl < 10 ml/min: use caution

Studies


Clarithromycin
Biaxin®

Dosage forms

Tablet
  • 250 mg ($)
  • 500 mg ($)
Suspension
  • 125 mg/5 ml ($)
  • 250 mg/5 ml ($$)
Tablet, extended-release (Biaxin XL®)
  • 500 mg ($)

Dosing

Pediatric (0 - 5 months)
Pediatric (≥ 6 months and children)
Adults

Other

  • Standard-release tablet and suspension may be taken without regard to food. Extended-release tablets should be taken with food.
  • Clarithromycin is a CYP3A4 strong inhibitor and is contraindicated with a number of CYP3A4 sensitive substrates. See Biaxin PI for more.
  • Clarithromycin is not recommended in patients with heart disease because of a potential increased risk of heart problems or death that can occur years later
  • Clarithromycin is not recommended in pregnancy
  • Liver disease - no dose adjustment necessary
  • Kidney disease
    • CrCl < 30 ml/min: - reduce dose by 50%

Studies


Erythromycin
Eryc®, ERY-tab®, E.E.S.®, Eryped®, PCE®

Erythromycin base

Tablet
  • 250 mg ($$-$$$)
  • 500 mg ($$-$$$)
Capsule, enteric-coated (Eryc®)
  • 250 mg ($$)
Tablet, delayed-release (Ery-tab®)
  • 250 mg ($-$$)
  • 333 mg ($$)
  • 500 mg ($$-$$$)
Tablet, enteric-coated (PCE®)
  • 333 mg ($$$$)
  • 500 mg ($$$$)
Ophthalmic
Topical

Erythromycin ethylsuccinate

Tablet (E.E.S.®)
  • 400 mg ($$$$)
Suspension (E.E.S.®, Eryped®)
  • 200 mg/5 ml ($$-$$$)
  • 400 mg/5 ml ($$$$)

Dosing

Pediatric (0 - 5 months)
  • Bordetella pertussis (treatment or postexposure prophylaxis)
    • < 1 month: 40 - 50 mg/kg/day given in 4 divided doses for 14 days. Dosing is for erythromycin base. Azithromycin is the preferred agent in this age group. (CDC)
    • 1 - 5 months: 40 - 50 mg/kg/day given in 4 divided doses for 14 days. Dosing is for erythromycin base. (CDC)
Pediatric (≥ 6 months and children)
Adolescents and adults
  • Acne
    • Erythromycin base: 250 - 500 mg once daily or 250 - 500 mg twice a day (AAP)
  • Bordetella pertussis (treatment or postexposure prophylaxis)
    • Erythromycin base - 500 mg four times a day for 14 days (CDC)
  • Campylobacter
    • Erythromycin base - 500 mg two to four times a day for 3 - 5 days (IDSA/CTE)
  • Chlamydia
    • Erythromycin base - 500 mg four times a day for 7 days (CDC)
    • Erythromycin ethylsuccinate - 800 mg four times a day for 7 days (CDC)
  • Impetigo
    • Erythromycin base - 250 mg four times a day for 7 days (IDSA)
    • Erythromycin ethylsuccinate - 400 mg four times a day for 7 days (IDSA)
  • Pneumonia, community-acquired
    • Erythromycin base - 500 mg four times a day or 1000 mg twice a day for 7 - 14 days (CTE) [2]
    • Erythromycin ethylsuccinate - 800 mg four times a day or 1600 mg twice a day for 7 - 14 days

Other

  • May take without regard to food
  • 400 mg of erythromycin ethylsuccinate is equivalent to 250 mg of erythromycin base or stearate
  • Erythromycin is a Moderate CYP3A4 inhibitor
  • Erythromycin is contraindicated with lovastatin and simvastatin
  • Liver disease - use caution. Manufacturer makes no specific recommendation.
  • Kidney disease - erythromycin is mostly excreted in the bile. Manufacturer makes no specific recommendation.

Studies


Fidaxomicin
Dificid®

Dosage forms

Tablet
  • 200 mg ($$$$)
Granules for oral suspension
  • 40 mg/ml ($$$$)
  • One bottle contains 136 ml after reconstitution

Dosing

Pediatric (≥ 6 months old)
  • Clostridium difficile
    • Weight 8.8 lbs (4 kg) to 15.3 lbs (6.9 kg): 80 mg twice daily for 10 days
    • Weight 15.4 lbs (7 kg) to 19.7 lbs (8.9 kg): 120 mg twice daily for 10 days
    • Weight 19.8 lbs (9 kg) to 27.4 lbs (12.4 kg): 160 mg twice daily for 10 days
    • Weight ≥ 27.5 lbs (12.5 kg): 200 mg twice daily for 10 days (PI)
Adults

Other

  • May take without regard to food
  • After granules are reconstituted, they should be refrigerated and are good for up to 12 days
  • Fidaxomicin undergoes minimal absorption and should not be used for systemic infections
  • Liver disease - fidaxomicin undergoes minimal absorption. Liver disease should not affect.
  • Kidney disease - no dose adjustment necessary

Nitazoxanide
Alinia®

Dosage forms

Tablet
  • 500 mg ($$$$)
Oral suspension
  • 100 mg/5 ml ($$$$)
  • Comes in bottle of 60 ml

Dosing

Pediatric (1 - 11 years old)
  • Cryptosporidium parvum
    • 1 - 3 years: 5 ml (100 mg) twice a day with food for 3 days [CDC/PI] ($$$$)
    • 4 - 11 years: 10 ml (200 mg) twice a day with food for 3 days [CDC/PI] ($$$$)
  • Giardia
    • 1 - 3 years: 5 ml (100 mg) twice a day with food for 3 days [CDC/PI] ($$$$)
    • 4 - 11 years: 10 ml (200 mg) twice a day with food for 3 days [CDC/PI] ($$$$)
Adolescents and Adults (age 12 years and older)

Other

  • Take with food. Food increases absorption.
  • Nitazoxanide is a highly protein-bound drug (> 99%)
  • Liver disease - has not been studied. Manufacturer makes no recommendation.
  • Kidney disease - has not been studied. Manufacturer makes no recommendation.

Nitrofurantoin
Macrobid®, Macrodantin®, Furadantin®

Dosage forms

Macrobid® capsule
  • Nitrofurantoin monohydrate : Nitrofurantoin macrocrystalline
    • 75 mg : 25 mg ($)
Macrodantin® capsule
  • Nitrofurantoin macrocrystalline
    • 25 mg ($)
    • 50 mg ($)
    • 100 mg ($)
Furadantin® suspension
  • Nitrofurantoin
    • 25 mg/5 ml ($$$$)

Dosing

Pediatric (one month and older)
Adults
  • Urinary tract infection
    • Macrobid® - 100 mg twice a day for 5 days (IDSA)
    • Macrodantin® - 50 - 100 mg 4 times a day for 7 days (PI)
  • Urinary tract infection, prophylaxis
    • Postcoital - 50 - 100 mg one time postcoital (Macrobid® or Macrodantin®) (CTE)
    • Continuous - 50 - 100 mg once daily (Macrobid® or Macrodantin®) (CTE)

Other

  • Take with food
  • Do not take with antacids containing magnesium
  • Nitrofurantoin has been associated with rare cases of interstitial lung disease in patients who took it for ≥ 6 months
  • Kidney disease
    • CrCl < 60 ml/min: - do not use

Metronidazole
Flagyl®, Likmez®, Metrogel®, Vandazole®, Nuvessa®

Dosage forms

Tablet
  • 250 mg ($)
  • 500 mg ($)
Tablet, extended-release (Flagyl® ER)
  • 750 mg ($$$$)
Capsule
  • 375 mg ($$)
Oral suspension (Likmez®)
  • 500 mg/5 ml ($$$$)
  • Comes in 200 ml bottle
  • Store at room temp
Vaginal gel (Metrogel-vaginal®)
  • 0.75% gel ($)
  • Comes in 70 g tube
Vaginal gel (Vandazole®)
  • 0.75% gel ($)
  • Comes in 70 g tube
Vaginal gel (Nuvessa®)
  • 1.3% gel ($$$$)
  • Comes in single-dose applicator
Topical (rosacea)

Dosing

Pediatric
Adults

Other

  • May take standard-release without regard to food. Extended-release should be taken one hour before or 2 hours after meals.
  • Potential for disulfiram-like reaction if taken with alcohol. Do not ingest alcohol during, or for 3 days after stopping metronidazole.
  • Liver disease
    • Mild to moderate (Child-Pugh A/B): no dose adjustment necessary
    • Severe (Child-Pugh C): reduce dose by 50%
  • Kidney disease - patients with end-stage renal disease may have decreased clearance. Manufacturer makes no specific recommendation.

Secnidazole
Solosec®

Dosage forms

Oral granules
  • 2 grams ($$$$)

Dosing

Adults and pediatric patients ≥ 12 years old

Other

  • May take without regard to food
  • Granules are sprinkled on applesauce, yogurt, or pudding. Mixture should be consumed within 30 minutes without chewing.
  • Granules do not dissolve and are not meant to be dissolved in liquid
  • Avoid consumption of alcoholic beverages and preparations containing ethanol or propylene glycol during treatment and for at least 2 days after completing therapy
  • Liver disease - manufacturer makes no specific recommendation
  • Kidney disease - manufacturer makes no specific recommendation

Tinidazole
Tindamax®

Dosage forms

Tablet
  • 250 mg ($)
  • 500 mg ($)

Dosing

Pediatric (3 years and older)
  • Entamoeba histolytica - 50 mg/kg/day (max 2000 mg/day) given once daily for 3 days (PI)
  • Giardia - 50 mg/kg (max 2000 mg) given as a one time dose (PI)
Adults

Other

  • Take with food to minimize stomach upset
  • Tinidazole is a CYP3A4 sensitive substrate
  • Potential for disulfiram-like reaction if taken with alcohol. Do not ingest alcohol during, or for 3 days after stopping tinidazole.
  • Liver disease - use caution. Manufacturer makes no specific recommendation.
  • Kidney disease - no dose adjustment necessary

Amoxicillin
Amoxil®

Dosage forms

Capsule
  • 250 mg ($)
  • 500 mg ($)
Tablet
  • 500 mg ($)
  • 875 mg ($)
Tablet, chewable
  • 125 mg ($)
  • 250 mg ($)
Suspension
  • 125 mg/5 ml ($)
  • 200 mg/5 ml ($)
  • 250 mg/5 ml ($)
  • 400 mg/5 ml ($)

Dosing

Pediatric
  • Endocarditis prophylaxis - 50 mg/kg (max 2000 mg) 30 - 60 minutes before procedure (AHA)
  • H. pylori - Amoxicillin - 50 mg/kg/day (max 2000 mg/day) given in 2 divided doses +
  • H. pylori, sequential therapy - see H. pylori treatment
  • Otitis media - 80 - 90 mg/kg/day given in 2 divided doses for 5 - 10 days (AAP)
  • Pneumonia, community-acquired - 90 mg/kg/day (max 4000 mg/day) given in 2 divided doses for 7 - 10 days (IDSA)
  • Sinusitis
    • Standard therapy - 45 mg/kg/day given in 2 divided doses for a minimum of 10 days (AAP)
    • High-dose therapy - 80 to 90 mg/kg/day (max 4000 mg/day) given in 2 divided doses for a minimum of 10 days (AAP)
  • Strep throat - 50 mg/kg/day (max 1000 mg/day) given once daily or in 2 divided doses for 10 days (IDSA)
Adults

Other

  • May take without regard to food
  • Kidney disease
    • CrCl 10 - 30 ml/min: 250 - 500 mg every 12 hours
    • CrCl < 10 ml/min: 250 - 500 mg every 24 hours

Amoxicillin-Clavulanate potassium
Augmentin®

Dosage forms

Tablet (amoxil : clav)
  • 250 mg : 125 mg ($)
  • 500 mg : 125 mg ($)
  • 875 mg : 125 mg ($)
Tablet, chewable (amoxil : clav)
  • 200 mg : 28.5 mg ($)
  • 400 mg : 57 mg ($)
Tablet, extended-release (Augmentin XR®)
  • 1000 mg : 62.5 mg ($$-$$$)
Suspension (amoxil:clav)
  • 4:1 ratio
    • 125 mg : 31.25 mg/5 ml ($$$$)
    • 250 mg : 62.5 mg/5 ml ($)
  • 7:1 ratio
    • 200 mg : 28.5 mg/5 ml ($)
    • 400 mg : 57 mg/5 ml ($)
  • 14:1 ratio (Augmentin ES®)
    • 600 mg : 42.9 mg/5 ml ($)

Dosing

Pediatric
  • Impetigo - 25 mg/kg/day (max 1750 mg/day) of the amoxicillin component given in 2 divided doses for 7 days (IDSA)
  • Otitis media - 90 mg/kg/day of amoxicillin, with 6.4 mg/kg/day of clavulanate [amoxicillin to clavulanate ratio, 14:1] (max 4000 mg/day) in 2 divided doses for 5 - 10 days (AAP)
  • Pneumonia, community-acquired - 90 mg/kg/day (max 4000 mg/day) given in 2 divided doses for 7 - 10 days (IDSA)
  • Sinusitis - 80 - 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate [amoxicillin to clavulanate ratio, 14:1] in 2 divided doses (max 4000 mg/day) for a minimum of 10 days (AAP)
  • Urinary tract infection - 20 - 40 mg/kg/day given in 3 divided doses for 7 - 14 days (CTE)
  • Urinary tract infection, prophylaxis - 15 mg/kg/day (amoxicillin component) given once daily (CTE)
Adults

Other

  • May take without regard to meals, although taking with food may help reduce gastrointestinal upset
  • Amoxicillin-clavulanate preparations with a 14:1 ratio of amoxicillin-clavulanate may be less likely to cause diarrhea than preparations with a lower ratio
  • Kidney disease
    • Standard tablet and suspension
      • CrCl < 30 ml/min: do not give 875 mg dose
      • CrCl 10 - 30 ml/min: 250 - 500 mg every 12 hours
      • CrCl < 10 ml/min: 250 - 500 mg every 24 hours

Dicloxacillin

Dosage forms

Capsule
  • 250 mg
  • 500 mg ($)

Dosing

Pediatric
  • Cellulitis (non-MRSA) - 25 - 50 mg/kg/day (max 2000 mg/day) given in 4 divided doses for 5 - 10 days (IDSA)
Adults

Other

  • Should be taken on an empty stomach at least 1 hour before and 2 hours after a meal
  • Kidney disease - dose reduction recommended. Manufacturer makes no specific recommendation.

Penicillin G benzathine
Bicillin L-A®

Dosage forms

Disposable syringe
  • 1 ml - 600,000 units ($$)
  • 2 ml - 1,200,000 units ($$$$)
  • 4 ml - 2,400,000 units ($$$$)

Dosing

Pediatric
  • Rheumatic fever prevention
    • ≤ 27 kg: 600,000 units IM every 4 weeks (AHA/AAP)
    • > 27 kg: 1,200,000 units IM every 4 weeks (AHA/AAP)
  • Strep throat
    • < 27 kg: 600,000 units IM single dose (IDSA)
    • ≥ 27 kg: 1,200,000 units IM single dose (IDSA)
  • Impetigo
    • ≤ 6 kg: 225 mg (300,000 units) IM given as a one time dose
    • 6.1 - 10 kg: 337.5 mg (450,000 units) IM given as a one time dose
    • 10.1 - 15 kg: 450 mg (600,000 units) IM given as a one time dose
    • 15.1 - 20 kg: 675 mg (900,000 units) IM given as a one time dose
    • > 20 kg: 900 mg (1,200,000 units) IM given as a one time dose
Adults
  • Rheumatic fever prevention - 1,200,000 units IM every 4 weeks (AHA)
  • Strep throat - 1,200,000 units IM single dose
  • Syphilis
    • Primary and secondary - 2.4 million units IM single dose (CDC)
    • Early latent - 2.4 million units IM single dose (CDC)
    • Latent - 2.4 million units IM once a week for a total of 3 doses (CDC)
    • Tertiary - 2.4 million units IM once a week for a total of 3 doses (CDC)

Other

  • For intramuscular use only
  • Kidney disease - clearance is decreased. Manufacturer makes no specific recommendation.
  • Milligram-unit conversion
    • 225 mg = 300,000 units
    • 337.5 mg = 450,000 units
    • 450 mg = 600,000 units
    • 675 mg = 900,000 units
    • 900 mg = 1,200,000 units

Penicillin
Pen VK®

Dosage forms

Tablet
  • 250 mg ($)
  • 500 mg ($)
Solution
  • 125 mg/5 ml ($)
  • 250 mg/5 ml ($)

Dosing

Pediatric
Adults

Other

  • May take without regard to meals
  • Kidney disease - drug clearance is decreased. Manufacturer makes no specific dosage recommendation.

Pivmecillinam
Pivya®

Dosage forms

Tablet
  • 185 mg ($$$$)
  • Comes in pack of 9 tablets
  • Discontinued in the U.S.

Dosing

Adults (female)

Other

  • May take without regard to meals
  • Pivya contains pivalate, an acid that improves absorption but also depletes carnitine, a compound involved in muscle fatty acid metabolism. It should not be given to patients with carnitine deficiency or those receiving other carnitine-depleting drugs, including valproic acid, valproate, carbamazepine, and phenytoin.
  • Kidney disease - no dose adjustment necessary

Ciprofloxacin
Cipro®

Dosage forms

Tablet
  • 100 mg (?)
  • 250 mg ($)
  • 500 mg ($)
  • 750 mg ($)
Tablet, extended-release (Cipro XR®)
  • 500 mg ($-$$)
  • 1000 mg ($-$$)
Suspension
  • 250 mg/5 ml ($-$$)
  • 500 mg/5 ml ($-$$)
Ophthalmic
Otic

Dosing

Pediatric (≥ 1 year old)
Adults

Other

  • May take without regard to food
  • Do not take with tizanidine (Zanaflex®)
  • Take 2 hours before or 6 hours after magnesium- or aluminum-containing antacids
  • Ciprofloxacin is a Strong CYP1A2 inhibitor
  • May cause photosensitivity. Limit sun exposure and use sunscreen.
  • Liver disease - in studies involving patients with chronic cirrhosis, no significant changes in ciprofloxacin pharmacokinetics were observed. The effects of acute hepatic insufficiency on ciprofloxacin are unknown.
  • Kidney disease
    • Standard-release
      • CrCl > 50 ml/min: no dose adjustment necessary
      • CrCl 30 - 50 ml/min: 250 - 500 mg every 12 hours
      • CrCl 5 - 29 ml/min: 250 - 500 mg every 18 hours
    • Extended-release
      • CrCl ≤ 30 ml/min: 500 mg once daily

Delafloxacin
Baxdela™

Dosage forms

Tablet
  • 450 mg ($$$$)

Dosing

Adults

Other

  • May take without regard to food
  • Take 2 hours before or 6 hours after chelating agents (e.g. magnesium or aluminum antacids, sucralfate, multivitamins, iron)
  • Liver disease - no dosage adjustment necessary
  • Kidney disease
    • CrCl ≥ 15 ml/min: no dose adjustment necessary for tablets
    • CrCl < 15 ml/min: not recommended

Gemifloxacin
Factive®

Dosage forms

Tablet
  • 320 mg ($$$$)

Dosing

Adults

Other

  • May take without regard to food
  • Antacids, sucralfate, metal cations (e.g. iron), and multivitamins may reduce gemifloxacin absorption. Gemifloxacin should be taken 3 hours before or 2 hours after these medications.
  • Liver disease - no dose adjustment necessary
  • Kidney disease
    • CrCl ≤ 40 ml/min: 160 mg every 24 hours

Levofloxacin
Levaquin®

Dosage forms

Tablet
  • 250 mg ($)
  • 500 mg ($)
  • 750 mg ($)
Solution
  • 25 mg/ml ($$)
Ophthalmic

Dosing

Pediatric
  • Pneumonia, community-acquired
    • 6 months - 5 years old - 16 - 20 mg/kg/day given in 2 divided doses for 7 - 10 days (IDSA)
    • 5 - 16 years old - 8 - 10 mg/kg/day (max 750 mg/day) given once daily for 7 - 10 days (IDSA)
  • Sinusitis - 16 mg/kg/day (max 500 mg/day) given in 2 divided doses for a minimum of 10 days (AAP)
Adults
  • aDue to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multidrug-resistant isolates [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae
  • bDue to Streptococcus pneumoniae (excluding multi-drug-resistant isolates [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae
  • c due to Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and pyelonephritis due to E. coli, including cases with concurrent bacteremia
  • d Enterococcus faecalis, Enterococcus cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa; and for pyelonephritis due to E. coli

Other

  • May take without regard to food
  • Antacids, sucralfate, metal cations (e.g. iron), and multivitamins may reduce levofloxacin absorption. Do not take within 2 hours of each other.
  • Quinolones have not been considered first-line agents in children because of the possible risk of adverse effects on developing cartilage. In studies, these effects appear to be uncommon. [1]
  • May cause photosensitivity. Limit sun exposure and use sunscreen.
  • Liver disease - no dose adjustment necessary
  • Kidney disease
    • CrCl ≤ 49 ml/min: dose adjustment recommended; see Levaquin® PI for more.

Moxifloxacin
Avelox®

Dosage forms

Tablet
  • 400 mg ($)
Ophthalmic

Dosing

Adults

Other

  • May take without regard to food
  • Antacids, sucralfate, metal cations (e.g. iron), and multivitamins may reduce moxifloxacin absorption. Moxifloxacin should be taken 4 hours before or 8 hours after these medications.
  • Liver disease - no dose adjustment necessary
  • Kidney disease - no dose adjustment necessary

Ofloxacin

Dosage forms

Tablet
  • 200 mg
  • 300 mg
  • 400 mg ($$)
Ophthalmic
Otic

Dosing

Adults

Other

  • May take without regard to food
  • Antacids, sucralfate, metal cations (e.g. iron), and multivitamins may reduce ofloxacin absorption. Do not take within 2 hours of each other.
  • May cause photosensitivity. Limit sun exposure and use sunscreen.
  • Liver disease
    • Severe (Child-Pugh C): do not exceed 400 mg/day
  • Kidney disease
    • CrCl 20 - 50 ml/min: usual dose every 24 hours
    • CrCl < 20 ml/min: half the usual dose every 24 hours

Rifamycin
Aemcolo®

Dosage forms

Tablet, delayed-release
  • 194 mg ($$$$)
  • Comes in package of 12 tablets

Dosing

Adults

Other

  • Take dose with 6 - 8 ounces of liquid
  • DO NOT TAKE with alcohol
  • May take without regard to food
  • Swallow tablets whole. Do not crush, cut, or chew.
  • Rifamycin is not effective against diarrhea complicated by fever and/or blood in stool or diarrhea due to pathogens other than E. Coli
  • Rifamycin undergoes minimal systemic absorption and clinically relevant drug interactions are not expected
  • Liver disease - given its minimal absorption, a dose adjustment is not necessary
  • Kidney disease - given its minimal absorption, a dose adjustment is not necessary

Rifaximin
Xifaxan®

Dosage forms

Tablet
  • 200 mg ($$$$)
  • 550 mg ($$$$)

Dosing

Adults and children ≥ 12 years old
Adults (≥ 18 years old)
  • Hepatic encephalopathy - 550 mg two times a day (PI)
  • Irritable bowel syndrome (IBS) with diarrhea - 550 mg three times a day for 14 days. Patients with recurrence may be retreated up to two times with the same regimen. (PI)

Other

  • May take without regard to food
  • Rifaximin is not effective against diarrhea complicated by fever and/or blood in stool or diarrhea due to pathogens other than E. Coli
  • Rifaximin undergoes minimal systemic absorption and its effects are thought to be local
  • Rifaximin is a P-glycoprotein substrate. P-glycoprotein inhibitors may increase systemic exposure. The clinical significance of increased rifaximin exposure is unknown.
  • Liver disease
    • Mild to moderate (Child-Pugh A/B): Exposure is increased. No dose adjustment recommended.
    • Severe (Child-Pugh C): Exposure is increased. No dose adjustment recommended. Use caution.
  • Kidney disease - has not been studied

Sulfadiazine

Dosage forms

Tablet
  • 500 mg ($$$$)

Dosing

Pediatric (> 2 months old)
Adults

Other

  • Not recommended for the treatment of group A strep infections
  • Do not use in pregnancy near term or during nursing. May cause kernicterus.
  • Liver disease - clearance is reduced. Use caution. Manufacturer makes no specific recommendation.
  • Kidney disease - clearance is reduced. Use caution. Manufacturer makes no specific recommendation.

Sulfamethoxazole-Trimethoprim
Septra®, Bactrim®

Dosage forms

Tablet (Sulfa/TMP)
  • 800/160 mg (double strength) ($)
  • 400/80 mg (single strength) ($)
Suspension (Sulfa/TMP)
  • 200 mg/40 mg/5 ml ($)

Dosing

Pediatric (≥ 2 months old)
  • NOTE: All pediatric dosing based on trimethoprim component
Adolescents and adults

Other

  • May be taken without regard to food
  • May cause photosensitivity. Limit sun exposure and use sunscreen.
  • Trimethoprim may raise potassium levels in susceptible patients
  • Trimethoprim is a CYP2C8 inhibitor and a OCT2 inhibitor and substrate
  • Sulfamethoxazole is a weak CYP2C9 inhibitor
  • Liver disease - do not use in patients with significant liver disease
  • Kidney disease
    • CrCL > 30 ml/min: no dose adjustment necessary
    • CrCl 15 - 30 ml/min: use half the usual dose
    • CrCl < 15 ml/min: do not use

Sulopenem + probenecid
Orlynvah®

Dosage forms

Tablet
  • Each tablet contains 500 mg sulopenem and 500 mg probenecid ($$$$)

Dosing

 
Adult
 

Other

  • Sulopenem is a beta-lactam antibiotic in the penem class that inhibits bacterial cell wall synthesis. Probenecid inhibits OAT3-mediated renal clearance of sulopenem, increasing its exposure. Probenecid also increases renal uric acid excretion and is used to treat gout (see probenecid in gout).
  • Orlynvah should be taken with food
  • Diarrhea (10%) and nausea (4%) were the most common side effects in trials
  • Probenecid inhibits renal OAT1/3 and can increase OAT1/3 substrate exposure. Orlynvah should not be coadministered with ketorolac or ketoprofen, and caution should be used when given with indomethacin, naproxen, methotrexate, rifampin, lorazepam, and sulfonylureas.
  • Kidney disease
    • CrCl ≥ 15 mL/min: no dosage adjustment is required
    • CrCl < 15 mL/min: not recommended
    • Hemodialysis: administration of Orlynvah is not recommended
  • Liver disease
    • The effect of hepatic impairment on Orlynvah pharmacokinetics is unknown

Studies


Doxycycline
Acticlate®, Vibramycin®, Doryx®, Oracea®

Doxycycline monohydrate

Tablet
  • 50 mg ($)
  • 75 mg ($)
  • 100 mg ($)
  • 150 mg ($$)
Capsule
  • 50 mg ($)
  • 75 mg ($$-$$$)
  • 100 mg ($)
  • 150 mg ($$$-$$$$)
Capsule (Oracea®)
  • 40 mg ($$$$)
  • Contains 30 mg immediate release and 10 mg delayed release
Suspension
  • 25 mg/5 ml ($)
  • Comes in 60 ml bottle

Doxycycline hyclate

Capsule
  • 50 mg ($)
  • 100 mg ($)
Tablet
  • 20 mg ($)
  • 50 mg ($$$)
  • 75 mg ($)
  • 100 mg ($)
  • 150 mg ($$$)
Tablet (Acticlate®)
  • 75 mg ($$$$)
  • 150 mg ($$$$)
Tablet, delayed release (Doryx®)
  • 50 mg ($$)
  • 75 mg ($)
  • 100 mg ($)
  • 150 mg ($)
  • 200 mg ($$$$)
Tablet, delayed release (Doryx® MPC)
  • 60 mg ($$$$)
  • 120 mg ($$$$)
  • Doryx® MPC 120 mg = 100 mg of standard doxycycline, and 60 mg = 50 mg

Dosing

Pediatric (≥ 8 years old)
Adolescents and adults

Other

  • May be taken without regard to food (except Oracea®)
  • Take with full glass of water to reduce risk of esophageal irritation
  • Dairy products do not affect doxycycline absorption
  • Tetracyclines should not be used during the second and third trimesters of pregnancy, infancy, and childhood up to 8 years. All tetracyclines bind calcium in tissues, and this can lead to inhibition of bone growth, tooth discoloration (yellow-gray-brown), and enamel hypoplasia.
  • Concomitant use of tetracyclines and isotretinoin has been associated with pseudotumor cerebri. Concurrent use should be avoided.
  • May cause photosensitivity. Limit sun exposure and use sunscreen.
  • Antacids and bismuth subsalicylate decrease doxycycline bioavailability. Do not take within 4 hours of each other.
  • Kidney disease - no dose adjustment necessary

Minocycline
Minocin®, Dynacin®, Solodyn®, Ximino™, Minolira™

Dosage forms

Capsule (Minocin®)
  • 50 mg ($)
  • 75 mg ($)
  • 100 mg ($)
Tablet (Dynacin®)
  • 50 mg ($)
  • 75 mg ($)
  • 100 mg ($)
Tablet, extended-release (Minolira™)
  • 105 mg ($$$$)
  • 135 mg ($$$$)
  • Tablets are scored and may be split
Tablet, extended-release (Solodyn®)
  • 45 mg ($$$)
  • 55 mg ($$-$$$$)
  • 65 mg ($$$)
  • 80 mg ($$$)
  • 90 mg ($$-$$$)
  • 105 mg ($$-$$$)
  • 115 mg ($$$)
  • 135 mg ($$$)
Capsule, extended-release (Ximino™)
  • 45 mg ($$$$)
  • 90 mg ($$$$)
  • 135 mg ($$$$)
Topical

Dosing

Minocycline standard-release (≥ 12 years old)
Minolira™ (≥ 12 years old)
  • Acne ∼ 1 mg/kg/day (max 135 mg/day) given once daily. Tablets are scored and may be split. (PI)
Solodyn® (≥ 12 years old)
  • Acne ∼ 1 mg/kg/day (max 135 mg/day) given once daily (PI)
Ximino™ (≥ 12 years old)
  • Acne ∼ 1 mg/kg/day (max 135 mg/day) given once daily (PI)

Other

  • May be taken without regard to food
  • Dairy products do not affect minocycline absorption
  • Take with full glass of water to reduce risk of esophageal irritation
  • Tetracyclines should not be used during the second and third trimesters of pregnancy, infancy, and childhood up to 8 years. All tetracyclines bind calcium in tissues, and this can lead to inhibition of bone growth, tooth discoloration (yellow-gray-brown), and enamel hypoplasia.
  • Antacids may decrease bioavailability of minocycline. Do not take within 4 hours of each other.
  • May cause photosensitivity. Limit sun exposure and use sunscreen.
  • Concomitant use of tetracyclines and isotretinoin has been associated with pseudotumor cerebri. Concurrent use should be avoided.
  • May cause hyperpigmentation around scars, shins, and mucous membranes with prolonged use
  • Liver disease - use caution. Manufacturer makes no specific recommendation.
  • Kidney disease - has not been studied. Manufacturer makes no specific recommendation.

Omadacycline
Nuzyra®

Dosage forms

Tablet
  • 150 mg ($$$$)

Dosing

Adults

Other

  • Fast for at least 4 hours and then take with water. After oral dosing, no food or drink (except water) is to be consumed for 2 hours and no dairy products, antacids, or multivitamins for 4 hours.
  • Tetracyclines should not be used during the second and third trimesters of pregnancy, infancy, and childhood up to 8 years. All tetracyclines bind calcium in tissues, and this can lead to inhibition of bone growth, tooth discoloration (yellow-gray-brown), and enamel hypoplasia.
  • May cause photosensitivity. Limit sun exposure and use sunscreen.
  • Concomitant use of tetracyclines and isotretinoin has been associated with pseudotumor cerebri. Concurrent use should be avoided.
  • Liver disease - no dose adjustment necessary
  • Kidney disease - no dose adjustment necessary

Sarecycline
Seysara™

Dosage forms

Tablet
  • 60 mg ($$$$)
  • 100 mg ($$$$)
  • 150 mg ($$$$)

Dosing

Children ≥ 9 years old and adults
  • Acne
    • 33 - 54 kg: 60 mg once daily
    • 55 - 84 kg: 100 mg once daily
    • 85 - 136 kg: 150 mg once daily (PI)

Other

  • May take without regard to food
  • Take with full glass of water to reduce risk of esophageal irritation
  • Tetracyclines should not be used during the second and third trimesters of pregnancy, infancy, and childhood up to 8 years. All tetracyclines bind calcium in tissues, and this can lead to inhibition of bone growth, tooth discoloration (yellow-gray-brown), and enamel hypoplasia.
  • May cause photosensitivity. Limit sun exposure and use sunscreen.
  • Antacids may decrease bioavailability of sarecycline. Do not take within 4 hours of each other.
  • Concomitant use of tetracyclines and isotretinoin has been associated with pseudotumor cerebri. Concurrent use should be avoided.
  • Sarecycline is a P-glycoprotein inhibitor
  • Liver disease
    • Child-Pugh A/B: no dose adjustment necessary
    • Child-Pugh C: has not been studied
  • Kidney disease - manufacturer states that "renal impairment" has no clinically significant effect on pharmacokinetics, but it has not been studied in end-stage renal disease

Tetracycline
Achromycin V®

Dosage forms

Capsule
  • 250 mg ($$-$$$)
  • 500 mg ($$-$$$)

Dosing

Adolescents and adults

Other

  • Take at least 1 hour before food or two hours after
  • Dairy products taken at the same time as tetracycline may decrease absorption
  • Take with full glass of water to reduce risk of esophageal irritation
  • Tetracyclines should not be used during the second and third trimesters of pregnancy, infancy, and childhood up to 8 years. All tetracyclines bind calcium in tissues, and this can lead to inhibition of bone growth, tooth discoloration (yellow-gray-brown), and enamel hypoplasia.
  • Antacids may decrease bioavailability of tetracycline. Do not take within 4 hours of each other.
  • May cause photosensitivity. Limit sun exposure and use sunscreen.
  • Concomitant use of tetracyclines and isotretinoin has been associated with pseudotumor cerebri. Concurrent use should be avoided.
  • Liver disease - manufacturer makes no specific recommendation
  • Kidney disease - dose reduction recommended. Manufacturer makes no specific recommendation.

PRICE ($) INFO

  • $ = 0 - $50
  • $$ = $51 - $100
  • $$$ = $101 - $150
  • $$$$ = > $151
  • ? = Pricing not found. Availability may be limited.
  • Pricing based on one course of therapy at standard dosing in an adult
  • Pricing based on information from GoodRX.com®
  • Pricing may vary by region and availability

BIBLIOGRAPHY