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Drugs

Drugs follows the pharmacology and usage of all drugs available for the treatment of Infectious Diseases. Individual buttons list drugs by spectrum, toxic effect, drug-drug interaction and trade name.

The following buttons are used to sort drugs based on Susceptibility, Toxicity, Interaction and Trade name.

Susceptibility

Choose from comprehensive list of organisms and display list of drugs known to be effective against those pathogens:

Toxicity

List of untoward effects, which may complicate antimicrobial therapy:

Interactions

List of drugs, which may interact with antimicrobial agents in-vivo:

Trade Names

Lists available trade names of selected drugs:

Selecting a drug from the list displays relevant information in the right-hand column.  The following four tabs can be selected to access specific drug information:

General

The General tab reviews:

  • Mechanism of action.
  • Typical adult dosage.
  • Typical pediatric dosage.
  • CSF penetration (inflamed meninges).
  • Typical drug dosing for renal dysfunction.
  • Dosage interval for creatine clearance.
  • Additional dose given following Hemodialysis.
  • Dosage given during continuous peritoneal dialysis.

The dosages listed represent “typical” regimens for patients with normal renal and hepatic function, and may not be applicable to a specific patient. Pediatric dosage schedules do not necessarily apply to infants. Where indicated, infant dosages apply to full-term babies with birth weight over 2,000 g.

The penetrability of drugs into cerebrospinal fluid (in the presence of meningeal inflammation) is displayed. These data do not imply an indication for any specific agent in cases of meningitis.

Dosage adjustments for patients with various levels of creatinine clearance are also displayed. These dosages should be viewed as initial guidelines, and must be adjusted according to serum levels as possible. In some cases, drugs having alternative routes of excretion and lacking in potential nephrotoxicty may be preferable.

Warnings

The Warnings tab includes two lists:

  • Toxic Effects: Lists toxic effects associated with the drug in question. The list is comprehensive, and individual forms of toxicity may not necessarily be common for any given drug.
  • Interactions: Lists drugs known to interact with the antimicrobial agent in question. The nature of the interaction is specified. The list is comprehensive; and specific forms of interaction are not necessarily common. The list does not include all instances of synergy or antagonism between anti-infective agents, or effects on laboratory reagents and tests.


Not all of the interactions listed are common. GIDEON has opted to present a comprehensive listing of potential and reported interactions.

The letter S enclosed in carats <S> designates pathogens and infections for which surgery (excision, extraction) is often necessary. Often, multiple pathogens are identified or implicated during a given infection episode.

Note that not all forms of toxicity are equally common among the drugs listed. GIDEON has attempted to present a comprehensive listing of potential and reported effects. Minor and local effects such as pain on injection and phlebitis are not included. In many cases, data regarding teratogenicity and contraindication in pregnancy are based on animal studies only. The use of any drug or vaccine during pregnancy must consider all alternatives, potential risks and benefits to the specific patient.  The incidence of specific adverse reactions has not been listed, since published figures vary considerably and are often determined by patient age, dosage, duration of therapy and other factors.

Trade Names

The tab displays a list of proprietary (trade) names for the selected drug.
For example, selecting Acyclovir displays:

Spectrum

The Spectrum tab includes two lists:

  • A list of all pathogens known to be susceptible to a selected drug. Where relevant, “Susceptible” is defined as “MIC-50 within therapeutic range”
  • Diseases or organisms for which clinical data indicate susceptibility.

A list of diseases and pathogens will appear in the right-hand column of the Drugs section when a drug is selected in the left-hand window. The following icons may be found next to the name of certain pathogens:

  • indicates that the drug in question is considered the drug of choice as designated in the Medical Letter, the Sanford Guide to Antimicrobial Therapy, and other standard references. When more than one organism is selected for a Susceptibility filter, these indicators will not appear.
  • indicates that the drug should be used in combination with another drug. Some of the entries display <S> following their names, indicating that they are pathogens and infections for which surgery (excision, extraction) is often necessary. These designations reflect The Medical Letter, The Sanford Guide to Antimicrobial Therapy, and other standard references.

The following example shows the Spectrum tab results for the drug Albendazole, including both of the icons listed above:

For purposes of this list, “susceptible” indicates that over 50% of isolates are susceptible in-vitro or respond clinically when appropriate dosages are employed. This designation should not imply a clinical indication for any specific drug-pathogen pair. Drugs, which are available for topical use only, are not included in the database. In some cases (e.g., methenamine) drug usage is limited to specific sites of infection only.

Susceptibility Testing Guidelines

Susceptibility to the drug can be found by scrolling to the bottom of the drug spectrum list.  Drug susceptibility summarizes published guidelines used in the in vitro testing of antimicrobial susceptibility. Inhibitory drug concentrations, which characterize bacteria as R [resistant] and S [susceptible], are also displayed.

For example, the susceptibility of Penicillin V is shown below:

Lists of drugs and interpretive criteria may change as new data are published. The figures in this window are valid only when using procedures, media, reagents and conditions of incubation outlined in standard texts. The designation Susceptible [S] should be taken as “Susceptible in-vitro to blood levels expected when proper dosage is given.” 
The designation ‘susceptible’ indicates that 1) the drug in question is recognized by the American Federal Drug Administration [FDA] or similar agencies as acceptable therapy for the pathogen in question; or 2) has been found effective in clinical or laboratory studies published in peer-reviewed journals and standard text books.

In-vitro susceptibility does not necessarily imply clinical use for a drug, and should not be construed as a recommendation for therapy. Reliable standards for anti-fungal, antiviral and anti-parasitic agents are not yet published in this form.

Additional information

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