A Brief Overview of Tips for Using Antibiotic

Article written by Weston Malek, MPH

As the winter weather is finally upon us, we’ve been seeing a steady uptick in the number of antibiotic and cold medicine prescriptions. Each year, there are more than 250 million antibiotics prescribed in the United States, and winter tends to be time when antibiotics are most frequently prescribed.1,2 This means that there are roughly 4 antibiotic prescriptions for every 5 people in the U.S.

Although most people have taken antibiotics at some point and are comfortable with taking them when they are prescribed, those who are taking other medications or are particularly sensitive to medication side effects might have more concerns about adding on an antibiotic. At Four Corners Pharmacy, we do our best to make sure to always counsel patients on new antibiotics. To help with this further, below is a chart to be used as a quick reference outlining the main points and major drug interactions to be aware of for the most common outpatient antibiotics we see.

First, a few things that are common to most oral antibiotics (unless otherwise noted in the chart):

  • Nausea, vomiting, and stomach upset can be common side effects. Taking doses with food may help reduce stomach upset.
  • Diarrhea may also occur later as normal bacteria in the gut are killed off as well. Stay hydrated and let your doctor know if this is severe or lasts longer than a few days after finishing the antibiotic.
  • Some medications are affected by the normal bacteria in the gastrointestinal tract that get killed off by antibiotics. This may cause fluctuations in the way these medications work. Some such are warfarin (Coumadin) and oral contraceptives.
  • For birth control specifically, it is recommended that patients use an additional contraception method while taking an antibiotic due to the potential for reduced effectiveness of oral contraception while taking an antibiotic
  • For liquid suspensions: shake well before each use and refrigerate if necessary

Antibiotic Class

  • Drug (Brand)

Unique Notes

Drug Interactions

Red/Bold = Avoid

Penicillins

  • Amoxicillin (Amoxil)
  • Amoxicillin/Clavulanate (Augmentin)
  • Penicillin V Potassium (Veetids)
  • Clavulanate tends to increase stomach upset over amoxicillin alone
  • Augmentin better absorbed if given with food
  • Methotrexate

Cephalosporins

  • Cefdinir (Omnicef)
  • Cefixime (Suprax)
  • Cephalexin (Keflex)
  • Only about 10% of people with penicillin allergies will also have cephalosporin allergies
  • Cefdinir only: Wait 2 hours before or after taking food/medications containing aluminum or magnesium (such as some antacids) or iron supplements
  • None significant

Macrolides

  • Azithromycin (Zithromax)
  • Clarithromycin (Biaxin)
  • Wait 2 hours before or after taking food/medications containing aluminum or magnesium (such as some antacids)
  • Ziprasidone
  • Dronedarone
  • Drugs that may affect heart rhythm in combination: Citalopram, Donepezil, Ondansetron, antiarrhythmics, etc.
  • Statins, such as Simvastatin and Lovastatin
  • Warfarin

Quinolones

  • Ciprofloxacin (Cipro)
  • Levofloxacin (Levaquin)
  • Moxifloxacin (Avelox)
  • Wait 2 hours before or after taking food/medications with calcium
  • Tell your doctor if you experience tendon pain
  • Use sunscreen while outside to avoid increase risk of sunburn
  • Tizanidine
  • Ziprasidone
  • Dronedarone
  • Drugs that may affect heart rhythm in combination: Citalopram, Donepezil, Ondansetron, antiarrhythmics, etc.
  • Simvastatin
  • Theophylline

Clindamycin (Cleocin)

  • Take with a full glass of water
  • Erythromycin

Doxycycline (Oracea)

  • Wait 2 hours before or after taking food/medications with calcium, iron, or zinc
  • Use sunscreen while outside to avoid increase risk of sunburn
  • Take with a full glass of water
  • Methotrexate
  • Penicillins

Metronidazole (Flagyl)

  • Avoid alcohol  during and for 72 hours after stopping – reaction with alcohol can cause significant nausea, vomiting, and hangover symptoms
  • Alcohol
  • Dronabinol
  • Ziprasidone
  • Dronedarone
  • Drugs that may affect heart rhythm in combination: Citalopram, Donepezil, Ondansetron, antiarrhythmics, etc

Sulfamethoxazole/
Trimethoprim (Bactrim)

  • Contains sulfa – warning for those with sulfa allergy
  • Stay hydrated to avoid kidney stones
  • Use sunscreen while outside to avoid increase risk of sunburn
  • Amiodarone
  • Warfarin
  • Drugs that increase potassium, such as Lisinopril, Losartan, Valsartan, Spironolactone, potassium supplements, etc.

While the actual choice of antibiotic and dosing will vary based on the patient and what’s being treated, a few recommendations are generally always true:

  • Take your antibiotics according to the instructions on the prescription, and never take an antibiotic unless your doctor determines it is necessary. Many colds are caused by viruses, which will not be affected by an antibiotic. Sometimes “watchful waiting” to see if symptoms improve is better than starting a potentially unnecessary antibiotic immediately.
  • Take the full amount of your antibiotic prescription even if you start to feel better sooner (unless otherwise directed by your doctor). The full course is necessary to kill off bacteria, and taking a shorter course can encourage the development of antibiotic resistance.
  • Medications such as cough syrup, decongestants, and pain relievers, on the other hand, only need to be taken when needed to control symptoms.
  • Other techniques may also be used to help you feel better faster, including drinking extra water/fluids, using a humidifier, using lozenges/honey for sore throat and cough, and, of course, getting more rest.

Keep in mind, this is only a general guide, and some people may have additional concerns that require more individual consideration. As always, feel free to ask us at the pharmacy if you have any questions.

References

  1. Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions — United States, 2014 [Internet]. 2017 [cited 2017 Dec 17] Available from: https://www.cdc.gov/antibiotic-use/community/pdfs/annual-reportsummary_2014.pdf.
  2. Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Taylor TH. Trends and seasonal variation in outpatient antibiotic prescription rates in the United States, 2006 to 2010. Antimicrob Agents Chemother. 2014 May;58(5):2763-6.
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New guidelines released to manage hypertension treatment

Article written by Weston Malek, MPH

Last year, the American Heart Association (AHA) and American College of Cardiology (ACC) released a joint guideline changing the criteria used to diagnose and treat high blood pressure. As doctors will soon begin to use these new guidelines to manage hypertension treatment, it’s important to consider what this will mean for patients.

High blood pressure, or hypertension, had previously been defined by guidelines as blood pressure ≥ 140/90 mmHg. As such, about 72 million American adults were considered to have hypertension and it is one of the most commonly diagnosed chronic conditions. Under the new guideline criteria, anyone with systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg will now be diagnosed as hypertension. This results in an additional 29 million hypertensive Americans. However, the AHA/ACC statement suggests that only a small percentage – about 4.2 million people – of newly-diagnosed adults will be recommended to use blood pressure-lowering medications that are already suggested to those diagnosed according to the previous guidelines.

The reason only a fraction of those now considered hypotensive will receive medication treatment is because the guidelines distinguish those with blood pressures ranging from 130-139 mmHg systolic blood pressure or 80-89 mmHg diastolic blood pressure as having stage 1 hypertension, and those with higher blood pressures (≥ 140 mmHg systolic blood pressure or ≥ 90 mmHg diastolic blood pressure) to have stage 2 hypertension. In stage 1, the primary recommendation is to address high blood pressure with lifestyle changes, such as following the DASH diet with an emphasis on fruits and vegetables, reducing sodium intake, increasing potassium intake, exercising 90 to 150 minutes per week, and maintaining a healthy body weight. Only those diagnosed with stage 1 hypertension at a heightened risk of developing heart disease or stroke within 10 years are recommended to start on blood pressure-lowering medication in addition to lifestyle changes. Those at higher risk include patients with cardiovascular disease, diabetes, or chronic kidney disease, or those who have a > 10% risk using the AHA’s atherosclerotic cardiovascular disease (ASCVD) risk calculator (available online at: http://static.heart.org/riskcalc/app/index.html#!/baseline-risk).

So, while the change in the number of people diagnosed with high blood pressure according to new guidelines seems alarming, the majority of individuals will not see a significant change in their doctor’s recommendations. Overall, the criteria change represents a need to shift perception about the risk associated with high blood pressure and begin to make dedicated efforts to lower blood pressure earlier.

References

1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/
AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2017 Nov 13. doi: 10.1016/j.jacc.2017.11.006.