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Appendix .

THE A-Z OF ANTlBIOnCS

The aim of this comprehensive guide to all antibiotics nowavailable in the UK für human use is to give you the informationnecessary to have an informed discussion with your doctor aboutthe use of antibiotics in the management of bacterial infections. Itis taken tram the standard formularies issued to doctors andincludes lists of the main current uses of all antibiotics. The antibioticslisted include antibacterial and antifungal drugs currently used totreat human disease in Britain. Antiparasitic drugs are not listed.Details current as of January 1995.

CONTENTS OF APPENDIX

1 AMINOGL YCOSillES 10 POL YMYXINS2 BETALACTAMS 11 QUINOLONES

(other than CEPHALOSPORINS 12 SULPHONAMIDES

and PENICn.LINS) 13 TETRACYCLINES3 CEPHALOSPORINS 14 TRlMETHOPRIM

4 CHLORAMPHENICOL 15 ANTIBIOnCS FOR SPECIFIC5 GL YCOPEPTIDES INFECTIONS6 IMIDAZOLES 16 ANTIFUNGAL DRUGS7 LINCOSAMIDES 17 TOPICAL (EXTERNAL) PREPARAnONS

8 MACROLillES 18 TOPICAL PREPARAnONS FOR

9 PENICn.LINS FUNGAL INFECTIONS

HOW TO USE nns APPENDIXIf you want to find out more about an antibiotic that has beenprescribed für rau, look on your prescription sheet or on the labelof your medicine für the name and then look für this name in theindex that starts on page 265. The index will refer you to theappropriate page of the appendix. (It is sometimes necessary to peeloff the chemist's own label to see the name of the particularpreparation you have been given.) You will see that so me of thenames of drugs in the appendix are in ITALIG SMALL GAPS while othersare in SMALL GAPS. The names in ITALIG SMALL GAPS are those given

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to the drugs by their manufacttlrers. In other words, they are tradenames. The same drug is often produced by several differentcompanies, each of which gives it a different name and price. To tryto avoid confusion, the medical profession tries nowadays to referto drugs only by their generic (chemical) names. These genericnames are listed in SMALL GAPS.

Resistance. Overuse and abuse of antibiotics has accelerated thedevelopment of resistant strains of many types of bacteria: these areorten known as 'superbugs'. If an organism is resistant to a particularantibiotic, there is no point in using that antibiotic für an infectioncaused by that organism. The war to avoid this problem is für thedoctor to take a swab or sampIe für laboratory testing beforeprescribing an antibiotic. If an infection fails to res pond to antibiotictreatment, it is always worth considering the possibility ofresistance.

Antibiotic formulations. Antibiotics für internal use can be given astablets, capsules, liquids and also by injection. The types of formulationavailable für each drug are shown in brackets after the name (T fürtablets, C für capsules, L für liquids and I für injections).

Lotions, creams, ointments and sprays für external use arereferred to as topical preparations.

The sources used für this appendix include:BNF, British National Formulary, Number 28, September 1994ABPI Data Sheet Compendium, 1994

New drugs are being introduced all the time. For up-to-date infor-mation, please feier to the current edition of the British National

Formulary.

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Appendix: A-Z of Antibiotics

INDEX OF MANUF ACTURERS' TRADE NAMES .

ACHROMYCIN, 292, 301 BERKMYCEN, 292 DAKTACORT, 303

ACHROMYCIN V,292 BETNESOL-N,300 DAKTARIN, 298,303ACTINAC, 299 BETNOVATE-C,299 DALACIN C, 278ADCORTYL WITH BETNOVATE-N,300 DALACIN T, 299

GRANEODIN, 301 BICILLlN,281 DAPSONE, 290, 294AEROSPORIN, 286 BLEMIX, 292 DEMIX, 292AKNEMIN, 292 BROLENE,301 DERMOVATE-NN,300ALBUCID, 301 BROXIL,281 DETECLO, 292ALCOBON, 297 DICAPEN, 284ALMODAN, 282 CANESTEN, 303 DIFLUCAN, 297, 298AMBAXIN, 283 CANESTEN HC, 303 DISTACLOR, 273AMBISOME,297 CAPASTAT, 295 DISTAOUAINE V-K,281AMFIPEN, 282 CEDAX, 273 DOXYCYCLlNE, 292

AMIKIN,268 CEFlzox,274 DOXYLAR,292AMIX, 282 CEPHALEXIN, 273 DUMICOA T, 303AMORAM, 282 CEPOREX, 273AMOXIL, 282 CHEMOTRIM, 290 ECONACORT, 303AMOXYCILLlN, 282 CHLORAMPHENICOL, 299 ECOSTATIN, 303

AMOXYMED,282 CHLOROMYCETlN,275 ECOSTATIN-1,303AMPHOUL, 297 CHLOROMYCETIN- EL YZOL, 277AMPICILLlN, 282 HYDROCORTISONE, 299 ERADACIN, 287AMPICLOX, 283 CHLOROMYCETIN- ERYCEN, 279AMPICLOX NEONATAL, SNO PHENICOL, 299 ERYMAX,279

283 CIDOMYCIN, 268, 300 ERYTHROCIN, 279AMRIT, 282 CIDOMYCIN- TOPICAL, ERYTHROLAR, 279ApSIN VK, 281 300 ERYTHROMID,279ARPIMYCIN, 279 CINOBAC, 287 ERYTHROMYCIN, 279AUDICORT, 300 CIPROXIN, 287 ERYTHROPED, 279

AUGMENTIN,283 CITATRIN,300 EUMOVATE-N,300AUREOCORT,301 CLAFORAN,274 EXELDERM,304AUREOMYCIN, 292, 299 CLOXACILLlN, 282AzACTAM, 270 CO-FL UAMPICIL , 283 FECTRIM, 290

CO-TRIMOXAZOLE,290 FECTRIM FORTE, 2908ACTRIM, 290 COLOMYCIN, 286 FLAGYL, 277BACTROBAN, 300 COMIXCO, 290 FLAGYL COMPAK, 277BAROUINOL HC, 299 COMOX, 290 304BAXAN , 273 COMPRECIN, 287 FLAGYL S, 277

BAYPEN,284 CRYSTAPEN,281 FLAMAZINE,301BENZOIC ACID - CYCLODOX, 292 FLASIGYN, 277

OINTMENT, 303 CYCLOSERINE, 295 FLOXAPEN, 282

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FLU-AMP, 283 KANNA~N, 268 GHLORAMPHENICOL,

FLUCLOXACILLlN,282 KEFADIM,274 299FML-NEO, 300 KEFADOL, 274 MINIMS-GENTAMICIN,FORTUM, 274 KEFLEX, 273 300FRAMYCET/N- KEFLlN, 273 M/NOCIN, 292

SULPHA TE, 299 KEFZOL, 273 M/RAX/D, 283, 285FRAMYCORT,299 KELF/Z/NE W, 290 MONASPOR,274FRAMYGEN KEMICET/NE,275 MON/STAT,303

SOFRAMYC/N, 299 KLARIC/D, 279 MONOTR/M, 293FUC/BET, 300 MONPHYTOL, 304

FUC/D/N, 294. 300 LADROPEN,282 MULT/LlND,304FUC/DIN H, 300 UM/S/L, 298, 304 MYAMBUTOL, 295FUCIDIN UMPRENE, 294 MYC/FRADIN, 269

INTERTULLE, 300 URATR/M,290 MYCOBUTIN,295FUCITHALM/C, 300 LEDERMYC/N, 292 MYCOTA, 304FULC/N, 298 LINCOC/N, 278 MYNAH, 295FUNG/LlN, 297, 303 LOCERYL CREAM, 299 MYSTECLlN, 292FUNG/ZONE, 297 LOCERYL LACQUER, 299FURADANT/N,296 LOCORTEN-VIOFORM, NALID/X/C AC/D, 288

299 NASEPTRIM,300GALENAMOX, 282 LOTRIDERM, 303 NEBC/N, 269GARAMYC/N, 300 NEGRAM, 288GENT/C/N, 268, 300 MACROB/D, 296 NEO-GORTEF, 300GENT/C/N HG, 300 MACRODANT/N, 296 NEOMYCIN, 300GENT/SONE HG, 300 MAGNAPEN, 282, 283 NEOMYC/N GREAM,GRANEODIN, 300, 301 MALOPR/M, 290 300GREGODERM, 300 MASNODERM, 303 NEOSPORIN, 300GR/SOV/N, 298 MAX/TROL, 301 NET/LLlN, 269

GYNO-OAKTAR/N,303 MEFOXIN,273 NIDAZOL,277GYNO-OAKTAR/N 1, MEGACLOR, 292 NITROFURANTO/N, 296

303 METROGEL, 300 NIVEMYC/N, 269GYNO-PEVARYL, 303 METROL YL, 277 N/ZORAL, 298. 303GYNO-PEVARYL 1, 303 METRON/DAZOLE, 277 NORDOX, 292

METRO TOP, 300 NOROX/N, 301HAELAN-G, 299 MICTRAL, 288 NYSTADERMAL, 304H/PREX, 296 M/N/MS NEOMYC/N- NYSTAFORM, 304

SULPHATE, 300 NYSTAN, 298, 304ILOSONE, 279 M/N/MS NYSTA TIN, 298, 304

/PRAL,293 SULPHACETAM/DE NYSTATIN-OOME,298ISONIAZ/D, 295 SOD/UM, 301 304Iso TONIC GENT/CIN, 268 M/N/MS- NYSTAVESCENT,304

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OPULETS- RIMIFON, 295 TICAR, 284 .CHLORAf.lfPHENICOL, RIMOXALLlN, 282 TIMECEF, 273299 ROCEPHIN, 273 TIMENTIN, 284

ORBENfN, 282 TIMODINE, 304ORELEX, 273 SECUROPEN, 284 TINADERM-M, 304OTOMIZE, 300 SELEXID, 285 TOBRALEX, 301OTOSPORIN, 301 SELEXIDIN, 285 TOPICYCLlNE, 301OXYMYCIN, 292 SEPTRIN, 290 TRA VOGYN, 303OXYTETRACYCLlNE, 292 SOFRADEX, 301 TRI-AocoRTYL, 302OXYTETRAMIX,292 SOFRAMYCIN,301 TRI-AocORffi OTIC, 302

SPORANOX, 298 TRIBIOTIC, 301PENBRITIN, 282 STABILLIN V-K, 281 TRIMETHOPRIM,293PENIDURAL,281 STAFOXIL, 282 TRIMOGAL,293PEVARYL, 303 STIEDEX-LPN, 300 TRIMOPAN, 293PEVARYL TC, 303 STIERMYCIN,299 TRIMOVATE,302PHENOXYMETHYL, 281 STREPTOMYCIN TRIPLDPEN,281PHYTEX, 304 SULPHATE, 269, 295 TROBICIN, 269PHYTOCIL, 304 SULPHADIAZINE, 290 TROSYL, 304PIMAFUCIN, 303 SULPHADIMIDINE, 290PIPRIL, 284 SUPRAX, 273 UNASYN, 284POL YBACTRIN, 269, SUSTAMYCIN, 292 URIBEN, 288

286, 301 SYRAPRIM, 293 UTINOR, 288POL YFAX, 301

POLYTRIM,301 TANDERIL,299 V-CIL-K,281PONDOCILLlN, 283, 285 TARGOCID, 276 VANCOCIN,276PREDSOL-N, 300 TARIVID. 288 VELOSEF, 273PRIMAXIN, 271 TAZOCIN, 284 VIBRAMYCIN, 292PROPADERM-A, 301 TEMOPEN, 282 VIBRAMYCIN-D, 292ProPEN, 284 TERRA-CORTRIL. 301, VIBROSIL. 301

302 VIDOPEN, 282QUINOPED,303 TERRA-CORTRIL- VIOFORM

NYSTATIN,302 HYDROCORTISONE,RAMYSIS, 292 TERRAMYCIN, 292 299RIFADIN. 295 TETRA-CORTRIL, 301 VISTA-METHASONE N,RIFATER, 295 TETRABID,292 301RIFINAH 150,295 TETRACHEL,292RIFINAH 300.295 TETRACYCLlNE,292 ZADSTAT,277RIMACILLlN, 282 TETRACYCLlNE- ZINACEF, 273RIMACTANE, 295 MIXT URE, 301 ZINAMIDE, 295RIMACTAZID 150,295 TETRALYSAL 300,292 ZINNAT,273RIMACTAZID 300, 295 TETREX, 292 ZITHROMAX, 279

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1 AMINOGL YCOSIDES .Historical. Streptomycin was the first important antibiotic to bediscovered after penicillin. Several other aminoglycosides have beendeveloped subsequently. They resemble each other in their mode ofaction and toxicity. The differences in their use reflect variations intheir antibacterial activity.

Common features. The main use of the group is the hospitaltreatment of serious acute bacterial infections. They are notabsorbed from the gut and are therefore given by injection to treatsystemic infections. They are bactericidal (kill bacteria) and areeffective against staphylococci and a wide range of Gram-negativeorganisms. Streptomycin is now used mainly in the treatment oftuberculosis. Spectinomycin is reserved für penicillin-resistantgonorrhoea infection.

Mode of action. Interfere with protein synthesis in bacteria.

Resistance. Variable. 'Cross-resistance' within this group isbecoming an increasing problem. Bacterial resistance can developquickly and is transferable between different species of bacteria.There are variations in resistance patterns both between andwithin hospitals.

GENERIC NAME TRADE NAME MAIN USES

AMIKICIN AMIKIN (I) Short-term treament ofserious infections.

GENTAMICIN CIOOMYGIN (I) Serious infections /GENT/GIN (I) septicaemia. AlsoISOTONIG GENT/GIN (I) bacterial endocarditis.

KANAMYCIN KANNASYN (I) Serious infections due toorganisms that haveproved resistant to otherantibiotics.

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GENERIC NAME TRADE NAME MAIN USES .~ --

NEOMYCIN SULPHATE MYCIFRADIN (T) Gut sterilisation.NIVEMYCIN (TL)

with polymyxin POL YBACTRIN (L) For bladder irrigation

only.

NETILMICIN NETILLIN (I) Serious infections.

SPECTINOMYCIN TROBICIN (I) Gonorrhoea caused by ,

penicillin-resistant

organisms.

STREPTOMYCIN STREPTOMYCIN Tuberculosis.

SULPHATE (I) Brucellosis.Infective endocarditis.

(Now rarely used.)

TOBRAMYCIN NEBCIN (I) Infections of the nervous

system, bowel, urinary

tract, lungs, skin, bane

and soft tissues.

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2 BET ALACT AMS .Historical. The largest group of antibiotics. The group is dividedinto penicillins (names often end in -cillin), the cephalosporins andcephamycins (recognised by a 'cef' or 'ceph' in their names) and thenewer monobactams and thienamycin betalactams.

Common features. See individual groups. For clarity (and becausethis group is enormous) the betalactam group has been divided inthis appendix, wirb the cephalosporins and penicillins considered asindividual groups.

Mode of action. All betalactams work by interfering wirb bacterialcell wall synthesis. They are 'bactericidal' (kill bacteria).

Precautions. Cephalosporins produce 'cross-reactions' in about 10per cent of penicillin-sensitive patients.

Resistance. Bacteria build up resistance to beta lactams byproducing enzymes called 'betalactamases' (also known as'penicillinases') which are capable of antagonising the bactericidalaction of betalactams. Resistance mayaIso be caused by reducedbinding at or penetration of sire of action.

Some penicillins (and many of the newer cephalosporins) areresistant to the betalactamases.

MONOBACTAMS

GENERIC NAME TRADE NAME MAIN USES--

AZTREONAM AZACTAM (I) Respiratory tract

infections, urinary tract

infections, gonorrhoea,

bane and joint, skin, soft

tissue, intra-abdominal

and gynaecological

infections. Septicaemia

and meningitis. Resistant

to betalactamases.

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TlfiENAMYCIN BET ALACT AMS .GENERIC NAME TRADE NAME MAIN USES

IMIPENEM I PRIMAXIN (I) Very broad spectrum.

CILASTATIN

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3 CEPHALOSPORINS .Historical. First obtained tram a fungus cultured tram the sea neara Sardinian sewage outfall in 1945. Until recently, they were rarelyconsidered as antibiotics of first choice bur now are worldwidebest-seIlers. Relatively infrequently used in the UK. They aredivided info orally active, first, second and third generations. Theearly vers ions (first generation) have, to a large extent, beenreplaced by other antibiotics which are less expensive and easier toadminister. The second generation are less sensitive to betalactamasesand more effective than the first generation. Late versions (thirdgeneration) are less toxic, less sensitive to betalactamases and havea broader range of activity, hut are very expensive.

Common features. Closely related to penicillins. Bactericidal (killbacteria). Wide spectrum of activity bur low toxicity. They are usedtor infections related to the gall-bladder and hilf duct, be foresurgery, tor urinary tract infection caused by multiply-resistantbacteria and to treat penicillin-resistant gonorrhoea.

First, second and third generation are given by injection becausethey are not absorbed after oral administration. Orally activecephalosporins are used to treat urinary tract infections which donot respond to other antibiotics. They can also be used in the treat-ment of bronchitis.

First generation. Largely superseded by newer cephalosporins orother types of antibiotics which are less expensive and easier toadminister.

Second generation Less susceptible to inactivation by betalactamasesthan the first generation.

Third generation May cause 'superinfection' wirb resistant bacteriaor fungi.

Resistance See BETALACTAMS (p. 270).

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GENERIC NAME TRADE NAME MAIN USES .Oral

CEFACLOR DISTACLOR (CL) Urinary and respiratory

traGt infections, middleCEFADROXIL BAXAN (CL) ear infections, skin and

soft tissue infections,CEFIXIME SUPRAX kidney infections and

gonorrhoea. Also usedCEFPODOXIME ORELEX (T) before surgery.

PROXETIL

CEFTIBUTEN CEDAX (C)

CEFUROXIME AXETIL ZINNA T (T)

CEPHALEXIN CEPHALEXIN (TC)CEPOREX (TCL)KEFLEX (TCL)

CEPHRADINE VELOSEF (CU)

First generation (INJECTABLE)

CEPHALOTHIN KEFLIN (I) Before surgery.

CEPHAZOLIN KEFZOL (I) Before surgery.

CEPHRADINE VELOSEF (I) See Oralabove.

Second generation (INJECTABLE)

CEFODIZIME TIMECEF (I) Urinary and lower

respiratory traGt infections.

CEFOXITIN MEFOXIN (I) Abdominal infections

such as peritonitis.

CEFTRIAXONE ROCEPHIN (I) Used before surgery.

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GENERIC NAME TRADEl"AME MAIN USES---~ ~--

CEFUROXIME ZINACEF (/) Before surgery.

Meningitis, penicillin-

resistant infections.

gonorrhoea.

CEPHAMANDOLE KEFADOL (/) Before surgery. Serious

and life-threatening

infections.

Third generation (INJECTABLE)

CEFOTAXIME CLAFORAN (I) Before surgery.

As cefaclor.

CEFSULODIN SODIUM MONASPOR (I) Before surgery.

Respiratory tract, urinary

tract. soft tissue and

bane infections.

CEFTAZIDIME FORTUM (I) As cefaclor.

KEFADIM (I)

CEFTIZOXIME CEFIZOX (I) As cefaclor.

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4 CHLORAMPHENICOL .Historical. Chloramphenicol was one of the first broad-spectrumantibiotics to be discovered and is now used throughout the world.It was originally produced tram a culture of a soil organism(Streptomyces venezuelae) hut is now made synthetically.

Main features. Wide spectrum of antibacterial activity.Chloramphenicol should only be used tor serious infections whereother drugs have failed and is particularly useful in the treatment ofenteric fevers (such as typhoid and paratyphoid fever). It is usedto treat meningitis and epiglottitis in children and is also widelyused to treat eye infections (as ointment or drops).

Mode of action. Bacteriostatic and bactericidal. Inhibits bacterial

protein synthesis.

Resistance. Same bacterial resistance to chloramphenicol is nowcommon.


CHLORAMPHENICOL CHLOROMYC~/N (CU) Severe (Iife-threatening)KEMIC~/NE (I) infections, meningitis,

typhoid fever, other

salmonella infections and

cholera.

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5 GL YCOPEPTIDES .Historical. The glycopeptides include vancomycin and teicoplanin. .Vancomycin has been available für many years while teicoplanin isa new drug.

Common features. Glycopeptides are natural antibiotics. They aresimilar hut teicoplanin is longer acting than vancomycin.

Mode of action. Penetrates the cell wall of Gram-positive bacteria.Bactericidal (kills bacteria). Not absorbed by the gut and must

! therefore be given by injection. Vancomycin is given by mouth in! the management of pseudomembraneous colitis.

Resistance. Resistance pattern has changed little since vancomycinwas introduced 30 years aga; same enterococci are vancomycin-resistant. There is no cross resistance with other drugs.


TEICOPLANIN TARGOCID (I) For serious infections(e.g. endocarditis,peritonitis and infections

caused by Staph. aureus).

VANCOMYCIN VANCOCIN (I) Potentially life-threateninginfections. Often used

combined with

aminoglycosides. Used

in the treatment of MRSA

(methicillin-resistant

Staph. aureus) infection;

and pseudomembranous

colitis associated with

antibiotic treatment.

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6 IMIDAZOLES .Historical. Metronidazole and tinidazole both belang to a group ofantimicrobials called imidazoles. They are active only againstanaerobic bacteria and protozoa. A number of very toxic organismsare anaerobic. The use of imidazoles against anaerobic infectionswas first discovered by a dentist whose patient recovered unexpectedlyfrom gum infecrion while taking metronidazole für dysentery.

, Mode of action. Metronidazole and tinidazole are very similar in

action and act by interfering with bacterial DNA. Metronidazole isthe more widely used hut tinidazole has a longer duration of action.Their main use is in the treatment of deep-seated infections (such asabscesses).

Resistance. Rare.


METRONIDAZOLE EL YZOL (8) Vaginal infections. pelvic

FLAGYL (TI8) infections. peritonitis,

FLAGYL COMPAK septicaemia. wound

FLAGYL 8 (L) infections, osteomyelitisMETROL YL (TI8) end abscesses, AlsoMETRONIOAZOLE (T) inflammation of the gums,NIOAZOL (T) colitis. dysentery end

ZAOSTAT (TI8) Guinea warm infestations.

TINIDAZOLE FLASIGYN (T) Similar to metronidazole.

Longer action.

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7 LINCOSAMIDES .Historical. Lincomycin is a natural antibiotic derived from a soilorganism. Clindamycin is produced by chemical modification of

lincomycin.

Common features. The two drugs that make up this group havesimilar properties. Their use is limited because of the seriousadverse effects they may cause.

Mode of action. Lincosamides inhibit protein synthesis in bacterialcells, hut not, apparencly, human cells. They are bacteriostatic (stopbacterial growth) in low concentrations hut can be bactericidal (killbacteria) in high doses.

Resistance. Cross resistance may occur with macrolides.Staphylococci may develop resistance during treatment.


CLiNDAMYCIN DALACIN C (CU) Staphylococcal bane and

joint infections, peritonitis,and infections of the

female genital tract. Mayalso be used to treatsusceptible strains of

Staph. aureus in people

allergic to penicillins

and/or cephalosporins.

LlNCOMYCIN UNCOCIN (CU) Lincomycin is no Ion gergenerally available. It

has been replaced byclindamycin, which is

more active and better

absorbed.

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8 MACROLIDES .Historical. Only erythromycin is now actually used in the UK. Itwas introduced in 1952 with the hüpf that it would solve the prob-lem of resistant betalactamase producing bacteria. However, it wassoon found that organisms (mainly Staph. aureus) could developresistance during lang courses of treatment.

Common features. Similar to tetracyclines. Bacteriostatic in lowconcentrations hut can be bactericidal in high doses.

Mode of action. Erythromycin inhibits protein synthesis inbacterial cells hut not, apparently, human cells. It has a similarspectrum of activity to benzylpenicillin.

Resistance. Resistance is rare during short-term treatment, hut mayoccur during prolonged treatment.


AZITHROMYCIN ERYTHROMYCIN (TL) As alternative toZITHROMAX (G) penicillin, particularly in

penicillin-allergic people.CLARITHROMYCIN ARPIMYCIN (L) Used as drug of first

KLARICID (T) choice in respiratoryinfections in children,

ERYTHROMYCIN ERYCEN (TL) whooping-coughERYMAX (G) prevention, Legionnaires'ERYTHROCIN (TI) disease, campylobacter,ERYTHROLAR (L) enteritis and chronicERYTHROMID (T) prostatitis.ERYTHROPED (TI)

ILOSONE (TGL)

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9 PENICILLINS .Historical. Penicillin is produced by the fungus Penici/liumnotatum and was first described by Fleming in 1928. It waspurified and adapted tor therapeutic use by Florey and Chain in1941. The first semi-synthetic penicillins welf produced in 1957.Penicillins can be divided into the following groups:

Natural penicillins. Betalactamase sensitive. (Betalactamase is anenzyme made by certain bacteria which makes them resistant tobetalactam antibiotics. See betalactams.)

Semisynthetic. 1 Betalactamase resistant: Betalactamase resistantpenicillins are used tor serious infections (lung abscess, acuteosteomyelitis, etc) caused by penicillinase producing staphylococci.90 per cent of hospital acquired staphylococcal infections arecaused by betalactamase (penicillinase) producing strains.Betalactamase resistant penicillins are effective against beta-lactamase-producing staphylococci, bur these penicillins are far lesseffective against other bacterial species than benzyl penicillin.2 Broad spectrum: These are subdivided into aminopenicillins,ureidopenicillins, aminopenicillins (mecillinams) and antipseudomonalpenicillins (also known as carboxypenicillins).

Mode of action. The penicillins are bactericidal and act by interferingwith bacterial cell wall synthesis. They are excreted in the urine. Thedrug Probenecid can be raken at the same time to achieve a higherconcentration of penicillin in the body.

Non-human use. Penicillins are used extensivelyon farm animals toprevent and treat disease.

Resistance. Most staphylococci are now resistant to benzyl penicillin.Staph. aureus strains resistant to methicillin and cloxacillin(commonly called MRSAs) are a major problem in some hospitals;luckily these organisms so far remain sensitive to vancomycin. Allthe broad spectrum penicillins are inactivated by betalactamaseproducing bacteria. Cloxacillin and fIucloxacillin are not completelyresistant to staphylococcal betalactamases, and, tor serious infection,they are used in combination with other antibiotics, such asgentamicin, fusidic acid or erythromycin.

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Appendix: A-l of Antibiotics

BET ALACT AMASE SENSmVE (natural) PENICll..LINS .


BENZYL PENICILLIN CRYSTAPEN (I) Infections of skin, soft(Penicillin G) tissue, respiratory tract,

ear, no se and throat.BENETHAMINE* TRIPLOPEN (I) Also gonorrhoea and

(Penicillin G) syphilis, bacterial

endocarditis, meningitis.BENZATHINE* PENIDURAL (L) anthrax, gas gangrene,

(Penicillin G) tetanus, leptospirosisand actinomycosis.

PHENETHICILLlN* BROXIL (CL) Occasionally used tor

(Penicillin V) congenital syphilis in

babies.

PHENOXYMETHYL ApSIN VK (CL) Similar to benzylpenicillin.

PENICILLIN OISTAOUAINE V-K (TL) but less active. Mainly(Penicillin V) PHENOXYMETHYL (C) used tor respiratory tract

STABILLIN V-K (TL) infections in children,

V-CIL -K (TCL) middle ear infections,erysipelas, tonsillitis and

tor protection againstinfection followingrheumatic fever.

PROCAINE PENICILLIN BICILLIN (I) Useful against syphilis in

early stages. Long actingintra-muscular injections

are used to treat syphilisand gonorrhoea.

. Historically important, hut no longer available.

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BET ALACf AMASE RESISTANT PENICll..LINS


CLOXACILLIN CLOXAC/LLIN (C) Infections due to

ORBEN/N (CLI) betalactamase-producing

staphylococci.

FLUCLOXACILLIN FLOXAPEN (CU) Similar to Cloxacillin but

FLUCLOXAC/LLIN (CL) usually more effective.

LADROPEN (CI)MAGNAPEN (CLI)

STAFOX/L (C)

TEMOCILLIN TEMOPEN (I) Infections due to

penicillinase-producingbacteria.

AMINO PENI Cll..LINS


AMOXYCILLIN ALMODAN (I) Serious respiratory andAM/X (C) urinary traGt infections,

AMORAM (C) gonorrhoea, ear, nase,AMOX/L (TCU) throat and soft tissue

AMOXYC/LLIN (CL) infections.

AMOXYMED (C)AMR/T (C)

GALENAMOX (C)

R/MOXALLIN (C)

AMPICILLIN AMF/PEN (L) As above.AMP/C/LLIN (CL)PENBR/T/N (CU)

R/MAC/LLIN (L)V/DOPEN (I)

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Appendix: A-Z of Antibiotics"

GENERIC NAME TRADE NAME MAIN USES.

AMPICLOX (I) Ear, nose, throat,

AMPICLOX respiratory and softNEONATAL (L) tissue infections. Urinary

tract infections andwith flucloxacillin FLU-AMP (C) gonorrhoea. Also before

MAGNAPEN (CU) surgery.

BACAMPICILLIN AMBAXIN (T) As above. Used in

HYDROCHLORIDE treatment of gonorrhoea.

CO-FLUAMPICIL CO-R-UAMPICIL (CU) For infections involving

FLU-AMP (C) betalactamase-producingMAGNAPEN (CU) staphylococci.

PIVAMPICILLIN PONDOCILLIN (TCL) Infections of the respiratory

tract, ear, nose and

throat infections, skin,

soft tissue, urinary tractinfections and gonorrhoea.

with pivmecillinam MIRAXID (TL) As tor ampicillin and

pivampicillin, also

glandular tever.

BROAD SPECTRUM PENICll..LINS COMBINED wrrnBET ALACf AMASE INHIBrrORS


CO-AMOXICLAV AUGMENTIN (TU) Effective against moststrains of penicillin/

amoxycillin resistant

organisms. Mainly usedtor respiratory and

urinary tract infections.Also used in typhoid and

betore dental surgery.

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GENERIC NAME TRADE..NAME MAIN USES

AMPICILLIN O'CAPEN (I) For infections involvingwith sulbactam UNASYN (TI) betalactamase producing

bacteria. Also before

surgery.

UREIOO PENICILLIN


MEZLOCILLIN BAYPEN (I) Used tor infectionstollowing abdominal or

gynaecological surgery.

CARBOXYPENICILLINS (antipseudomonal penicillins)


AZLOCILLIN SECUROPEN (I) Systemic and localintections, especially of

CARBENICILLIN PrOPEN (I) the respiratory and

urinary tracts. Also post

surgical infections,infected wounds and

burns.

PIPERACILLIN PIPRIL (I) As azlocillin.

with tazobactam T AZOCIN (I)

TICARCILLIN TICAR (I) As azlocillin.

with clavulanic acid TIMENTIN (I) Severe infections inhospitalised patients with

impaired or suppressed

immune system.

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AMmINOPENIClll.lN (Mecillinams) .


MECILLINAM SELEXIDIN (I) Severe bowel infections.Urinary tract infections.

PIVMECILLINAM SELEXID (TL) Acute cystitis. Chronic orrecurrent bacteria in the

urine. Salmonella

infection.

with pivampicillin PONDOCILLIN (T) See pivampicillin.MIRAXID (T)

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10 POLYMYXINS .Historical. A farnily of antibiotics produced by a bacteriurn (Bacillus

polymyxa).

Common features. Polymyxins are comparatively toxic and havebeen largely superseded by other antibiotics, like aminoglycosidesand quinolones. They are not absorbed from the gut and are thusused mainly in topical preparations, tor bladder irrigation and torbowel sterilisation. They are rarely used to treat systemic infections.

Mode of action. Disrupt cell membranes.


COLISTIN COLOMYCIN (TSI) See above.

POLYMYXIN B AEROSPORIN (I) See above.SULPHATE POL YBACTRIN (L) For bladder irrigation.

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11 QUINOLONES .Historical. Nalidixic acid (discovered 1962) was the first quinoloneto be synthesised. Its clinical use is limited by its narrow spectrumof activity and paar distribution in the body, other chan in urine.The newer members of the group are ca lied 4-quinolones.

Common features. Synthetic. Bactericidal. Used tor the treatmentof urinary tract infections and gut infections, notably dysentery.Should only be used tor the treatment of infections caused byorganisms resistant to standard drugs. The 4-quinolones need oxygen

I in order to kill bacteria. When oxygen is absent, chef merely stopthe growth of bacterial colonies.

Mode of action. Quinolones act on bacterial DNA.

Resistance. Quinolones have already been excessively used, andbacterial resistance is already a problem. Resistance has developedrapidly in patients suffering flom infection wirb pseudomonas,citrobacrer or campylobacrer (causing wound, gut and hone infecrion).Resistance to one 4-quinolone seems to confer at least same resistanceto the other members of the group.


ACROSOXACIN ERADACIN (G) Gonorrhoea.

CINOXACIN GINOBAC (G) Urinary tract infections.

CIPROFLOXACIN GIPROXIN (TI) Infections of therespiratory gastro-intestinal and urinarytracts. Also gonorrhoeaand septicaemia.

ENOXACIN GOMPRECIN (T) Urinary tract and skininfections. Alsogonorrhoea and dysentery.

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GENERIC NAME TRADE tJAME MAIN USES

NALIDIXIC ACID NALIDIXIC ACID (T) Urinary tract infections.

MICTRAL (L)

NEGRAM (TL)

URIBEN (L)

NORFLOXACIN UTINOR (T) Urinary tract infections.

OFLOXACIN TARIVID (TI) Urinary tract infections,

jung infections,gonorrhoea, urethritisand cervicitis.

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12 SULPHONAMIDES .Historical. Discovered in 1935. The first preparations were derivedtram dyes, hut it was soon discovered that sulphonamides hadantibacterial effects that did not depend on the presence of dyemolecules. They made a dramatic impact on the hospital treatmentof infections. Following the introduction of sulphonamide therapy,the mortality rate tram streptococcal infections fell tram 23 percent in January 1938 to 4.7 per cent fight months later. In 1938,sulphapyridine (M&B 693) was introduced and a wide range ofdifferent preparations followed.

Common features. Broad spectrum. Synthetic. Old fashioned.Comparatively toxic. They all have a similar spectrum of activity.Rapidly absorbed tram the gut. Excreted via the kidneys into theurine. Currently the main use is in the treatment of uncomplicatedurinary tract infections and in the prophylaxis of recurrent urinaryinfections. Sulphapyridine in low doses over lang periods may beused to control dermatitis herpetiformis. Sulphonamides are alsoused für the treatment of meningococcal meningitis (like sulpadiazinewhich enters the cerebrospinal fluid (CSF) more readily than theothers).

Mode of action. Bacteria need folic acid für their growth.Sulphonamides 'look like' folic acid and fool the bacteria intoabsorbing them. The bacteria thus become deprived of folic acidand cease to multiply. Sulphonamides are thus 'bacteriostatic'.

Resistance. Now very commOD. Sulphonamides have increasinglybeen replaced by more active and less toxic antibiotics, apart tramco-trimoxazole.

,.

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GENERIC NAME TRADE~AME MAIN USES

CO-TRIMOXAZOLE BACTRIM (TCLI) Widely used, particularlyCHEMOTRIM (L) für urinary and respiratory

COMIXCO (L) tract infections. AlsoCOMOX (T) used für middle ear

CO- TRIMOXAZOLE (TL) infection, sinusitis,FECTRIM (T) typhoid, paratyphoid.

FECTRIM FORTE (T) cholera, shigellosis, skin

LA RA TRIM (L) and wound infections,SEPTRIN (TI) acute and chronic

osteomyelitis, brucellosis,and tor gonorrhoea in

penicillin sensitive

patients.

SULFA-METOPYRAZINE KELFIZINE W (T) Urinary tract infections.

Chronic bronchitis.

SULPHADIAZINE SULPHADIAZINE (TI) Meningitis.

SULPHADIMIDINE SULPHADIMIDINE (T) Urinary tract infections.

DAPSONE DAPSONE (T) Leprosy, dermatitis,MALOPRIM (T) herpetiformis, malaria.

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13 TETRACYCLINES .Historical. The first broad spectrum bacteriostatic antibiotic to bediscovered (1948). All tetracyclines are structurally related andhave a similar spectrum of action.

Common features. Used in the treatment of acne, bronchitis,non specific urethritis, atypical pneumonia, typhus, brucellosis,lymphogranuloma venereum, Q fever, conjunctivitis, cholera,chlamydial infections and tropical sprue. However, bacterialresistance is increasing in an unpredictable manner and thus tetra-cyclines are rarely first choice drugs in the treatment of hospital.. infections.

Mode ofaction. Tetracyclines inhibit protein synthesis in bacteriaand also affect pro tein metabolism in anima I cells.

Non-human use. Oxytetracycline is used extensivelyon farm ani-mals to prevent and treat disease. Cattle (beef and dairy), pigs and

I poultry are all treated routinely wich tetracyclines. Tetracyclines arealso used as antibiotics in horticulture and to promote growth onfruit trees.

Resistance. When tetracyclines were in widespread use tor thetreatment of common infections, unpredictable and increasingresistance was a major problem. However, the use of tetracyclinesin Britain has declined in the last ren years and resistance hasdecreased accordingly. Resistance to one tetracycline automaticallytransfers to all the others.

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TETRACYCLINE ACHROMYCIN (TGLI) Ear, nase and throat

ACHROMYCIN V (G) infections, lung infections,

OETECLO (T) urinary tract infections,

SUSTAMYCIN (G) gut infections (e.g. cholera,

TETRABIO (G) dysentery), venereal

TETRACHEL (TG) diseases (e.g. gonorrhoea

TETRACYCLINE (T) and syphilis), acne and

TETREX (G) soft tissue infections.

plus nystatin MYSTECLIN (T)

CHLORTETRACYCLINE AUREOMYCIN (G) As tetracycline.

CLOMOCYCLINE MEGACLOR (G) As tetracycline.

SODIUM

DEMECLOCYCLINE LEDERMYCIN (TG) As tetracycline.

HYDROCHLORIDE

DOXYCYCLINE GYCLODOX (G) As tetracycline.

OEMIX (G)

OOXYCYCLINE (G)

OOXYLAR (G)

NORDOX (G)

RAMYSIS (G)

VIBRAMYCIN (GL)

VIBRAMYCIN-O (T) Also prostatitis and

sinusitis.

LYMECYCLINE TETRALYSAL 300 (G) As tetracycline.

MINOCYCLINE AKNEMIN (G) As tetracycline.

ßLEMIX (T)

MINOCIN (T)

OXYTETRACYCLINE ßERKMYCEN (T) As tetracycline.

OXYMYCIN (T)

OXYTETRACYCLINE (TG)

OXYTETRAMIX (T)

TERRAMYCIN (TG)

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14 TRIMETHOPRIM .Historical. For many years, trimethoprim was only available incombination wirb the sulphonamide sulphamethoxazole in apreparationcalled co-trimoxazole (see sulphonamides). This combination producesmore adverse reactions than trimethoprim on its own.

Mode of action. Trimethoprim is a synthetic antibiotic. It isbacteriostatic (stops bacterial growth) and effective against a widespectrum of bacteria. Acts by interfering wirb bacterial DNA.Theoretical risk of damage to human DNA. It is more active thanthe sulphonamides against most strains. It is used mainly torurinary infections.

Resistance. Uncommon.


TRIMETHOPRIM TRIMETHOPRIM (T) Urinary and respiratoryIpRAL (T) tract infections. Malaria.MONOTRIM (TLI)$YRAPRIM (TI)TRIMOGAL (T)TRIMOPAN (T)

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15 ANTIBIOnCS RESERVFD FOR SPECIFIC INFECnONS

Certain antibacterials are reserved für the treatment of specificinfections. This is because same drugs are very toxic and onlyliEf threatening diseases can justify their use, and also becausebacterial resistance increases with increased use of antibiotics. Inorder to deal with this problem same antibiotics are used only fürspecific conditions.

LEPROSY (Hansen's Disease)

Leprosy is still very common worldwide, especially in the tropics,subtropics and the Middle East. There are three major types, fachrequiring a different treatment regimen. Dapsone was the drug offirst choice für many years, hut resistance is becoming an increasingproblem and the World Health Organisation is now advising amore va ried treatment programme. The treatment is always langterm, often lasting five years or more.

In the treatment of 'multibacillary leprosy' all three drugs areused together. For 'paucibacillary leprosy' rifampicin and dapsoneare used together.

GENERIC NAME TRADE NAME

CLOFAZIMINE LAMPRENEDAPSONE OAPSONE TABLETSRIFAMPICIN see under tuberculosis

PENICll..LIN RESISTANT ST APHYLOCOCCI

Sodium fusidate is a narrow spectrum steroid antibiotic reservedfür severe infections caused by penicillin-resistant staphylococci. Itis used as an alternative für patients allergic to penicillin and in thetreatment of osteomyelitis. Resistance develops quickly so sodiumfusidate is usually prescribed together with another antibiotic.


SODIUM FUSIDATE FUGIDIN (TL!)

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Appendix: A-Z 01 Antibiotics

TUBERCULOSIS .Same drugs are used solely tor the treatment of tuberculosis. Thetreatment of TB has two phases, 'initial' and 'continuation'. Theinitial phase of treatment lasts fight weeks and aims to reduce thepopulation of TB bacteria as quickly as possible. It involves the useof at least three drugs used simultaneously, such as isoniazid,rifampicin and pyrazinamide (ethambutol or streptomycin areadded in cases of resistance). The continuation phase involves treat-ment with isoniazid, rifampicin, pyrazinamide or ethambutol andmay last up to 9 months.


CAPREOMYCIN CAPASTAT (I)

CYCLOSERINE CYCLOSERINE (C)

ETHAMBUTOL MYAMBUTOL (T)

HYDROCHLORIDE MYNAH (T)

ISONIAZID ISONIAZID (TL)

RIMIFON (I)

PYRAZINAMIDE ZINAMIDE (T)

RIFABUTIN MYCOBUTIN (C)

RIFAMPICIN RIFADIN (CU)

combinations RIFA TER (T)

RIFINAH 150 (T)

RIFINAH 300 (T)

RIMACTANE (CLI)

RIMACTAZID 150 (T)

RIMACTAZID 300 (T)

STREPTOMYCIN STREPTOMYCINSULPHATE (I)

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URIN AR Y TRA CT INFE CTI 0 NS

Many antibiotics are used für the treatment of urinary tractinfections and can be found und er their specific chemical groupselsewhere in the appendix. The antibiotics mentioned below do notfit in with any of those groups and are reserved für use againsturinary tract infections only.

Urinary tract infections are much more common in women thanin men. They te nd to be chronic and recurrent. Before starting anti-biotic therapy, a specimen of urine should be collected für tests.Bacterial resistance is an increasing problem in the management ofurinary tract infections, hut not (yet) to nitrofurantoin (below).


NITROFURANTOIN FURADANTIN (TL)MACROBID (G)MACRODANTIN (G)NITROFURANTOIN (T)

HEXAMINE HIPPURATE HIPREX (T)

(Methanamine hippurate)

f i 296r I! [.

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16 ANTIFUNGAL DRUGS .Fungal cells are quite similar to anima I cells and containsophisticated intracellular structures which are not found inbacterial cells. While the differences between bacteria and animalcells enable antibacterial drugs to act selectively, the similaritybetween fungal and animal cells makes antifungal drugs generallymore toxic than antibacterial drugs. Moreover, resistance ortendevelops during antifungal treatment making fungal infectionsvery hard to eradicate.

Some antifungals used to treat systemic infections have to begiven by injection since they cannot be absorbed through the gut.However, oral preparations can be used to treat fungal infections inthe mouth, oesophagus (gullet), stomach or intestine.

Fungal infections of the genitalia are commoner in women andcan be treated with antifungal pessaries, capsules, tablets or creaminserted into the vagina (see Topical Preparations). Recurrence iscommon if the woman is pregnant, suffering from diabetes or istaking oral antibiotics or oral contraceptives. The risk of re-infectionis high if there are fungal infections in other sites such as fingernails, umbilicus, gut or bladder. Sexual partners should be treatedsimultaneously. Treatment with oral antifungals is sometimesadvised in cases of resistant or recurrent infections.


AMPHOTERICIN B AMBISOME (I) Given by injection to treat

AMPHOUL (I) systemic fungal infections.FUNGILIN (TL) Broad spectrum.FUNGIZONE (I)

FLUCONAZOLE DIFLUCAN (CI) Used orally tor systemicfungal infections such as

candidiasis, cryptococcalinfections (e.g. meningitisin AIDS sufferers).

FLUCYTOSINE ALCOBON (TI) Systemic fungal infections.Narrow spectrum.

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GENERIC NAME TRADE.NAME MAIN USES

GRISEOFULVIN FULC/N (TL) Fungal infections of skin,

GR/SOV/N (T) scalp, hair and nails. Skin

infections need at least 6

weeks treatment and nailinfections may take up to

12 months to eradicate.

ITRACONAZOLE SPORANOX (G) Fungal infections of skin

and vagina.

KETOCONAZOLE N/ZORAL (TL) Serious systemic thrush.

MICONAZOLE DAKTAR/N (TL!) Oral, vaginal and intestinal

D/FLUCAN (G) fungal infections,systemic candidiasis

and ringworm.

NYSTATIN NYSTAN (TL) Mainly used tor treatment

NYSTAT/N (L) of candida infection

NYSTAT/N-DoME (L) of skin and mucousmembranes (as in gut

and vagina). Too toxic to

use by injection.

TERBINAFINE UM/S/L (T) Fungal skin infections.

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17 TOPICAL (EXTERmL) PREPARAnONS

Superficial infections of the skin, eyes, ears, nase, and genitalia canbe caused by many different organisms and there are many topicalpreparations available containing antibiotics. Most doctors avoidusing topical antibiotic preparations für skin infections, preferringinstead to use simple disinfectants (except in the case of fungal skininfections where same antibiotic creams and ointments are ofproven value).


AMOROLFINE LOCERYL CREAM SkinLOCERYL NAIL LACOUER Nails

CHLORAMPHENICOL AcTINAC Acne

GHLORAMPHENICOL EyeGHLORAMPHENICOL EAR DROPS Ear

GHLOROMYCETIN-HYDROCORTISONE Eye

GHLOROMYCETIN-$NO PHENICOL EyeMINIMS-GHLORAMPHENICOL Eye

QpULETS-GHLORAMPHENICOL EyeT ANDERIL Eye

CHLORTETRACYCLINE AUREOMYCIN Eye/skin

CLiNDAMYCIN OALACIN T Acne

CLlOQUINOL ßAROUINOL HG Skin

ßETNOVA TE-G Skin

HAELAN-G SkinLOCORTEN- VIOFORM Skin

VIOFORM-HYDROCORTISONE Skin

ERYTHROMYCIN $TIERMYCIN Acne

FRAMYCETIN FRAMYCETIN-$ULPHA TE Ear/eye/skin

FRAMYCORT Ear/eye/skinFRAMYGEN $OFRAMYCIN Ear/eye/skin

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GENERIC NAME TRADE~AME MAIN USES

FUSIDIC ACID FUGIBET Skin

FUGIDIN Skin

FUGIDIN H Skin

FUGIDIN INTERTULLE Skin

FUGITHALMIG Eye

GENTAMICIN GIDOMYGIN Ear/eye

GIDOMYGIN- TOPIGAL Skin

GARAMYGIN Ear/eyeGENTIGIN Ear/eye/skin

GENTIGIN HG Skin

GENTISONE HG Ear

MINIMS-GENTAMIGIN Eye

METRONIDAZOLE METROGEL Acne

METRO TOP Skin

MUPIROCIN BAGTROBAN Nase/skin

(Pseudomonic Acid)

NEOMYCIN AUDIGORT Ear

BETNESOL-N Ear/eye/naseBETNOVA TE-N SkinGITATRIN Skin

OERMOVA TE-NN Skin

EUMOVA TE-N Eye

FML-NEO EyeGRANEODIN Eye

GREGODERM SkinMINIMS NEOMYGIN-SULPHA TE Eye

NASEPTRIM Nase

NEO-GORTEF Ear/eyeNEOMYGIN Eye

NEOMYGIN GREAM Skin

NEOSPORIN EyeOTOMIZE Ear

PREDSOL-N Ear/eyeSTIEDEX-LPN Skin

i 300

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GENERIC NAME Tp.,ADE NAME MAIN USES

VIBROSIL NoseVISTA-METHASONE N Ear/eye/nose

NORFLOXACIN NOROXIN OPTHALMIC SOLUTION Eyes

OXYTETRACYCLINE TERRA-CORTRIL Skin

POL YMYXIN POL YFAX Eye/skin

POL YTRIM Eye

PROPAMIDINE BROLENE EyeISETHIONATE

SILVER SULPHADIAZINE FLAMAZINE Skin/gums

SULPHACETAMIDE ALBUCIO EyeSODIUM MINIMS SULPHACETAMIOE SOOIUM Eye

TETRACYCLINE ACHROMYCIN Ear/skinI AUREOCORT Skin

PROPAOERM-A SkinTETRACYCLINE - MIXTURE Mouthwash

TOPICYCLINE Acne

TOBRAMYCIN TOBRALEX Eye

NEOMYCINI POL YMYXIN MAXITROL Eye

0 TOSPORIN EarPOL YBACTRIN Skin

TRIBIOTIC Skin

FRAMYCETIN I SOFRAOEX Ear

GRAMICIDIN SOFRAMYCIN Ear

OXYTETRACYCLINE I TETRA-CORTRIL EarPOL YMYXIN

GRAMICIN/NEOMYCIN AOCORTYL WITH GRANEOOIN Skin

GRANEOOIN Skin

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GRAMICIDIN/NEOMYCINI TRI-AOCORTYL Skin

NYSTATIN TRI-AOCORTYL OTIC Ear

NYSTATIN/ TERRA-CORTRIL Ear

OXYTETRACYCLINE TERRA-CORTRIL -NYSTA TIN Skin

TRIMOVATE Skin

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Appendix: A-l of Antibiotics

18 TOPICAL PREPARAllONS FOR FUNGAL INFECllONS

r ",) GENERIC NAME TRADE NAME MAIN USES

AMPHOTERICIN B FUNGILIN Genitalia

Mouth/skin

BENZOIC ACID ßENZOIC ACID - OINTMENT Ringworm

BENZOYL PEROXIDE QUINOPED Skin

CLOTRIMAZOLE CANESTEN Genitalia/skinlear

CANESTEN HC Skin

LOTRIDERM Skin

MASNODERM Skin

ECONAZOLE ECONACORT Genitalia/skin

ECOSTATIN Genitalia/skinECOSTATIN-1 Genitalia

i GYNO-PEVARYL Genitalia

i GYNO-PEVARYL -1 Genitalia/skin

PEVARYL Genitalia/skin

PEVARYL TC Skin

ISOCONAZOLE TRA VOGYN Genitalia

KETOCONAZOLE NIZORAL Genitalia/skin

MICONAZOLE OAKTACORT Skin

OAKTARIN Mouth/skinOUMICOAT Nails

GYNO-OAKTARIN GenitaliaGYNO-OAKTARIN 1 Genitalia

MONISTAT Genitalia

NATAMYCIN PIMAFUCIN Genitalia/skinl

mouth

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GENERIC NAME TRADE NAME MAIN USES.

NYSTATIN MULTILIND Skin

NYSTADERMAL Skin

NYSTAFORM Skin

NYSTAN Genitalia/

mouth/skin

NYSTATIN Mouth

NYSTATIN-OOME Mouth

NYSTAVESCENT Genitalia

TIMODINE Skin

TINADERM-M Skin

NYSTATINI FLAGYL COMPAK Genitalia/

METRONIDAZOLE mouth/skin

SALICYLIC ACID PHYTEX Nails

PHYTOCIL Ringworm

SULCONAZOLE EXELDERM Skin

TERBINAFINE LAMISIL Skin

TIOCONAZOLE TROSYL Nails

UNDECENOATES MONPHYTOL Skin/nails

MYCOTA

PHYTOCIL

II[

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