Anti-Infectives
Antibiotics and Antivirals
Grepafloxacin (Raxar), Sparfloxacin (Zagam), Levofloxaquin (Levaquin)
These are all new antibacterials of the quinolone series. All three can be considered 2nd - 3rd generation of this class as their activity is greater than earlier quinolones against certain gram positive and negative organisms. Grepafloxacin has a broader spectrum than previous analogues of this class being active against most of the organisms producing chronic bronchitis, community acquired pneumonia, and certain STD's. It is active against S. pneumoniae, H. influenzae, mycoplasma, chlamydia and N. gonorrhae. Side effects include: nausea, taste disturbances, dizziness, vaginitis and increased skin sensitivity toward sunlight . It is contraindicated in patients with prolonged QTc prolongation. Dose is once daily for 10 days. Sparfloxacin and levofloxacin are also active against penicillin-resistant S. pneumoniae, mycoplasma, and chlamydia. They are not as active against pseudomonas as ciprofloxacin. Side effects are similar to other quinolones with insomnia and tendonitis being unusual in this class compared with other antibacterials.
Fosfomycin (Monurol)
A single dose oral antibiotic indicated for the treatment of uncomplicated urinary tract infractions (bladder) in women. The major advantage is not in bacterial spectrum but in compliance where multiple doses over 5-10 days are not required. The single dose powder should be mixed with 3-4 oz. of cold water. Multiple dosing is not recommended.
Antiretrovirals
Nelfinavir (Viracept)
This a the newest protease inhibitor which is used in combination with other antiretroviral agents (usually 2 reverse transcriptase inhibitors) in the treatment of HIV infections. When used in combination a reduction in viral load to non-detectable levels in 50% of patients can be anticipated. It may be useful in HIV infections which have become resistant to other protease inhibitors. The main side effect is diarrhea which occurs in up to 25% of patients. The diarrhea is lessened through the use of common antidiarrheal preparations. There are a significant number of drug-drug interactions to be aware of particularly an increase in blood levels of rifabutin and decreased effectiveness when used with rifampin. Nelfinavir may also decrease the effectiveness of birth control medications.
Delaviridine (Rescriptor)
This is the second non-nucleoside reverse transcriptase inhibitor which is indicated as an alternate drug in the treatment of HIV infections. When it is used alone resistance occurs rapidly thus it should always be used combined with other antiretrovirals. Side effects include a skin rash (10%) the incidence of which can be expected to be additive if this drug is used along with other antiretrovirals which also produce a rash. Due to interference with liver enzymes which metabolize many drugs, there are a number of drugs whose effects are increased by delaviridine. Among these are: antianxiety agents, quinidine, calcium channel blockers, and warfarin.
Saquinavir (Fortovase)
This is an improved formulation of Invirase (which will be discontinued mid-1998). Although neither the daily dose nor price has not been changed, the improved absorption of this form has resulted in increased effectiveness. This new preparation can be expected to yield results similar to those of other protease inhibitors.
Zidovudine, 300 mg and lamuvidine, 150 mg (Combivir) - this combines the two most widely prescribed drugs for the treatment of HIV infections into one tablet. The dose of 1 tablet two times a day reduces from 8 (if use 100 mg capsules) to 2 the number of tablets/capsules to be taken each day. This may be expected to have a favorable effect on patient compliance, an important issue in slowing the development of resistance to any of the antiretrovirals. The price is the same as if each drug were purchased separately.
Hepatitis C
Interferon alfacon-l (Infergen)
This injectable agent is indicated in the suppression of liver damage characteristic in chronic hepatitis C infections. Side effects are generally mild and consist of flu-like symptoms consisting of headache, fatigue, muscle pain and sweating. As with the other interferons, this product should not be used in patients with a history of psychiatric disorders, particularly depression. The drug is administered three time a week and may be of value in those whose liver function failed to improve while taking previous interferon therapy or those who have become resistant.
Condyloma Acuminata
Imiquimod (Aldara)
This new agent is applied topically and is an immune response modifier. The mechanism of action is treating condyloma acuminata is unknown. Although very effective, treatment is required for 16 weeks and patient adherance to therapy is of utmost importance or the lersions will return. The most common side effect is a local reddening of the skin.
Herpes Simplex
Penciclovir (Denavir)
This topical antiviral drug is indicated for the treatment of cold sores due to Herpes simplex. To be effective it must be applied every 2 hours while awake for 4 days. It must be used early in the evolution of the cold sore to be effective. If used after 72 hr of sore presence, it is not effective in reducing duration of the lesion.
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