Streptococcus spp., Staphylococcus spp., H. influenzae, M. catarrhalis, Bacteroides spp., (Clostridia spp.of variable susceptibility) Prevotella spp., Fusobacterium spp., Veillonella spp., Chlamydia trachomatis
Binds to the 50S ribosomal subunit of rRNA and inhibits the initiation of peptide chain synthesis
Cmax (900mg IV): 15.1mcg/ml; Half-life: Approximately 3 hours; Figure 2, 3
GI: diarrhea, C. difficile associated diarrhea
Skin: rash, anaphylaxis, Stevens-Johnson syndrome
GU: cervicitis, vaginitis
Capsule: 150 mg, 300 mg
Cream, vaginal, as phosphate: 2% (40 g)
Foam, topical, as phosphate 1%: (50 g, 100 g)
Gel, topical 1%: (30 g, 60 g, or 40ml, 75ml)
Granules for oral solution: 75 mg/5 mL (100 mL)
IV: 300 mg (50 mL), 600 mg (50 mL), 900 mg (50 mL)
Lotion 1%: 60 mL
Pledgets, topical 1%: #60
Solution, topical 1%: (30 mL, 60 mL)
Vaginal Suppository: 100 mg #3
Adults: 300mg PO q 6 hours; IV: 600mg to 1200mg/day divided q 12 – 6 hours (1200 to 2700mg/day divided for serious infections); topical: apply to affected area q 12 hours; Intra-vaginal cream: One applicatorful hs for 3 or 7 days (vaginal suppository for 3 days).
Children > 10kg: 8-25mg/kg/day PO divided q 8 – 6 hours (palmitate salt suspension)
Children < 10kg: 37.5mg PO q 8 hours
Children > 1 month: 20 – 40mg/kg/day IV divided q 8 – 6 hours
Children > 12 years old (topical foam): apply once daily to affected areas
Neonates < 1 month: 15 – 20mg/kg/day IV divided q 8 – 6 hours
Renal failure: Dosing adjustments not necessary
Hepatic failure: Dosing adjustments not necessary
CVVH (Continuous venovenous hemofiltration): 600-900mg q8h
CVVHD (Continuous venovenous hemodialysis): 600-900mg q8h
CVVHDF (Continuous venovenous hemodiafiltration) 600-900mg q8h
Note: CVVH is mainly for fluid removal alone. Many institutions will employ more CVVHD or CVVHDF which combine dialysis with fluid removal.
Erythromycin (macrolides): In-vitro antagonism – clinical significance unknown
Skeletal muscle relaxants (atracurium, vecuronium, pancuronium, cyclobenzaprine, and others): enhanced neuromuscular blockade.
Category C: Risk unknown. Human studies inadequate.
Therapeutic: Culture and sensitivities, signs and symptoms of infection
Toxic: In severe renal or hepatic failure, serum concentration monitoring is recommended.
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