Drugs Used to Treat Infectious Diseases

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acetaminophen (Trade names: Tylenol, Datril, Temora, Volatile) Over-the-counter painkiller and fever reducer used in many nonprescription pain relievers. Often prescribed for mild to moderate pain or fever, it cannot treat inflammation. It is given by mouth and may cause stomach upsets.

Side Effects Allergic reactions. Overdose can cause fatal liver problems.

acyclovir (Trade name: Zovirax) An antiviral drug prescribed for the treatment of herpes simplex, shingles, and chicken pox that is available in oral or topical form. Acyclovir works by inhibiting the synthesis of DNA in cells infected by herpes viruses. The drug also has been helpful to patients receiving bone marrow transplants to prevent the subsequent development of herpes simplex infection.

Oral acyclovir Acyclovir is effective in managing both initial and recurrent infections of herpes and localized shingles. It can prevent subsequent viral attacks if taken continuously soon after infection. However, in cases of recurrent genital herpes, acyclovir therapy doesn't make the lesions heal quicker or ease symptoms.

Topical acyclovir The topical form does not prevent new lesions from forming during the course of the disease. When applied to an existing blister, however, it may relieve symptoms, speed healing, and shorten the duration of the infection and the contagious period.

Adverse Effects Adverse effects are rare. The ointment may cause skin irritation or rash. Taken by mouth, the drug may cause headache, dizziness, nausea/vomiting. Rarely, acyclovir injections may cause kidney damage.

adenosine monophosphate (AMP) A compound containing Adenine, Ribose, and one Phosphate group (AMP), this metabolism byproduct seems to help ease the pain of shingles. In one study, 15 of 17 shingles patients who took the drug reportedly felt no pain within two weeks, and were still pain free two years later. The treatment has no side effects and works best within the first few months of pain, when the nerve endings have experienced minimal damage.

amantadine hydrochloride (Trade names: Symmetrel, Symadine) An antiviral drug that is prescribed to prevent and (in the early stages) to treat type-A influenza virus. It is believed to act by preventing a virus from penetrating into the host's cells.

Side Effects Among the most serious adverse effects are central nervous system effects; nervousness, blurred vision, and slurred speech may also occur. The drug should be used with caution in patients with congestive heart failure or during pregnancy and breast-feeding.

amoxicillin (Trade names: Amoxil, Moxilin, Wymox) A semisynthetic oral penicillin antibiotic, similar to ampicillin. This broad-spectrum antibiotic is prescribed in the treatment of several infections caused by gram-positive and gram-negative bacteria, including bronchitis, cystitis, gonorrhea, and ear and skin infections.

Side Effects Nausea and diarrhea; various allergic reactions include rash, fever, swelling of the mouth, itching, and breathing problems.

amphotericin B (Trade name: Fungizone) An antibiotic drug used to treat deep fungal infections of the skin, available as drops, lotion, or cream. It is inactive against both bacteria and viruses. While it can be given by mouth, it is given by intravenous injection to treat serious systemic infections such as cryptococcosis and histoplasmosis. This drug is usually administered in a hospital setting.

Side Effects Adverse effects are likely only when given as injection; these side effects may include muscle pains, vomiting, fever, headache, or (rarely) seizures. There is also a risk of kidney damage.

ampicillin (Trades names: Amcill, Omnipen, Polycillin, Principen) A penicillin-type semisynthetic antibiotic used to treat conditions caused by a broad spectrum of gram-negative and gram-positive organisms in the urinary, respiratory, biliary, and intestinal tracts. Some of these conditions include cystitis, bronchitis, gonorrhea, typhoid fever, and ear and eye infections. It is inactivated by penicillinase, and therefore cannot be used against organisms that produce this enzyme.

Adverse Effects Nausea, vomiting, fever, or diarrhea. Allergic reactions may include symptoms of rash, diarrhea, and (rarely) fever; swelling of the mouth and tongue; itching; and breathing problems.

azidothymidine (AZT) See zidovudine. AZT See zidovudine.

benethamine penicillin An antibiotic that is effective against most gram-positive bacteria, such as streptococci, staphylococci, and pneu-mococci. This drug is a derivative of ben-zylpenicillin and can be administered by mouth, although it is usually given as an intramuscular injection.

Side Effects As with all penicillins, allergic reactions are common.

benzathine penicillin G (Trade names: Bicillin, Permapen) Long-acting antibiotic given by mouth or injection that is slowly absorbed and effective against most gram-pos itive bacteria, including streptococci, staphylococci, and pneumococci. (See also penicillin.)

Side Effects As with all penicillins, allergic reactions are fairly common.

benzoyl peroxide An antibacterial agent that is extremely effective in suppressing the bacterium Propionibacterium acnes, associated with acne. Probably the most popular of the over-the-counter products, it draws the peroxide into the pore where it releases oxygen, killing the bacteria that can aggravate acne. Benzoyl also suppresses fatty acid cells that irritate pores. It is most effective for patients with inflammatory acne; by inhibiting bacteria, it decreases the inflammatory components in the skin. Benzoyl peroxide is sold in strengths ranging between 5 to 10 percent, but the lower concentration is just as effective and less likely to cause irritation. Most over-the-counter products contain benzoyl peroxide in a lotion base; prescription products contain the chemical in a gel base. A fairly new preparation combining 3 percent erythromycin with 5 percent benzoyl peroxide in a gel base may be more effective than either component by itself.

Adverse Effects Some irritation may follow use with benzoyl peroxide, and allergic sensitization has occasionally occurred. Benzoyl peroxide is closely related to products containing vitamin A (such as Retin-A and Accutane) and they shouldn't be used together.

bleomycin (Trade name: Blenoxane) An antibiotic obtained from a soil fungus, bleomycin is effective in treating warts that have not responded to other treatment. It is administered by injection.

Adverse Effects Bleomycin can cause toxic side effects in skin and lungs and should not be used with patients who have problems with kidney function or lung disease. Other side effects include localized swelling and the development of pneumonitis or rash.

butoconazole nitrate (Trade name: Femstat) An antifungal drug that is derived from imi-

dazole, used to treat vaginal mycotic infections caused by Candida species. Pregnant women should use the drug only in the second and third trimesters.

Side Effects Rarely, side effects include burning or itching.

capsaicin (Trade name: Zostrix) An ointment used to ease the pain of shingles. Its active ingredient is capsaicin, a red pepper derivative used to make chili powder. Zostrix should be used only after all blisters have disappeared. Capsaicin blocks the production of a chemical necessary for pain impulse transmission between nerve cells. Zostrix also has been tested as a treatment for psoriasis; however, it has been approved so far by the Food and Drug Administration only for use with shingles.

Side Effects As a counter-irritant, Zostrix should be used only on patients with unbroken healed skin still experiencing pain from shingles, not for those with open, oozing infections. Zostrix does burn, and it won't be effective unless used often and continuously for three weeks. However, the burning lessens or vanishes if treatments are continued.

cefaclor (Trade name: Ceclor) A common cephalosporin-type antibiotic used to treat ear infections, upper and lower respiratory-tract infections, urinary tract infections, skin infections, pharyngitis (sore throat), and tonsillitis. Given by mouth, the drug should be used with caution in patients who are allergic to penicillin.

Side Effects Severe diarrhea, nausea and vomiting, or skin eruptions.

cefadroxil monohydrate (Trade names: Duricef, Ultracef) A cephalosporin antibiotic used to treat certain bacterial infections, including urinary tract infections, skin infections, pharyngitis, and tonsillitis. Given by mouth, it is administered with caution to patients who have a history of allergy to penicillin.

Side Effects Allergic reactions, generalized itching, severe diarrhea, and nausea and vomiting.

cefazolin sodium (Trade name: Ancef; Kefzol) A cephalosporin antibiotic used to treat certain bacterial infections, including respiratory, urinary tract, skin, biliary, bone, joint, genital infections, and septicemia ("blood poisoning"). It is administered with caution to patients with a history of allergy to penicillin.

Side Effects Hypersensitivity reactions and severe diarrhea, nausea, and vomiting.

cefotaxime sodium (Trade name: Claforan) A cephalosporin antibiotic used to treat lower respiratory tract, genitourinary, gynecologic, intra-abdominal, skin, bone, and joint infections and septicemia. Intravenous route only.

Side Effects Itching, colitis, and fungal infections.

cefoxitin sodium (Trade name: Mefoxin) A cephalosporin antibiotic used to treat certain bacterial infections. It should be administered with caution to patients allergic to penicillin or other cephalosporins. Intravenous route only.

Side Effects Allergic reactions, phlebitis, and pain at the injection site.

ceftazidime (Trade names: Ceptaz, Fortaz, Pentacef, Tazicef, Tazidime) A cephalosporin-type of antibiotic used to treat infections of the lower respiratory tract, urinary tract, skin, abdomen, blood, bones and joints, and central nervous system. It should not be used for anyone allergic to cephalosporin antibiotics and with caution in those allergic to penicillin.

Side Effects Itching, fever, skin rash, diarrhea, phlebitis.

ceftriaxone (Trade name: Rocephin) A cephalosporin-type broad-spectrum antibiotic prescribed for infections of the lower respiratory tract, urinary tract, skin, abdomen, bones, joints, and central nervous system. It is used to treat gonorrhea, septicemia, and meningitis.

It is administered as an IV or intramuscular injection.

Side Effects This drug is usually well tolerated. Occasionally, side effects may include local pain at the injection site, allergic reaction (rash, itching, fever, or chills), blood problems, gastrointestinal problems, headache, or dizziness.

cephalexin (Trade names: Keflex, Biocef, Cephalexin) A cephalosporin antibacterial prescribed orally to treat certain infections, including respiratory tract, skin, bone, and ear infections. Only available orally.

Side Effects Nausea, diarrhea, and allergic reactions.

chloramphenicol (Trade names: Chloromycetin, Chloroptic) An antibiotic and antirickettsial drug derived from the bacterium Streptomyces venezuelae (and also produced synthetically) that is effective against a wide variety of microorganisms. Because of its severe side effects, it is usually reserved for serious infections (such as typhoid fever) when less toxic drugs are not effective. It should not be given to pregnant or breastfeeding women or to anyone with a mild infection.

Side Effects The most serious side effect of this medication is the potential damage to bone marrow.

chlorhexidine (Trade name: Hibiclens) An antimicrobial agent used as a surgical scrub, hand rinse, and topical antiseptic. It is used in solution, creams, gels, and lozenges and in some preparations combined with cetrimide. In very dilute solutions, it can be used as a mouthwash to control mouth infections.

Side Effects Rarely, a skin sensitivity to this product can develop.

chloroproguanil A drug administered by mouth to prevent or treat malaria.

Side Effects Rarely, large doses may cause stomach discomfort and vomiting.

chloroquine (Trade name: Aralen) An antimalarial drug prescribed to treat malaria and amebiasis and certain skin conditions (such as lupus erythematosus). It is administered by mouth or injection.

Side Effects Gastrointestinal problems, headache, visual disturbances, and itching. Those with retina or visual problems or porphyria should not use this drug. Long-term use can lead to eye damage.

ciclopirox olamine (Trade name: Loprox) A broad-spectrum, topical agent used to treat fungus infections (such as ringworm or tinea) by inhibiting the growth of dermatophytes and Candida albicans.

Side Effects The incidence of adverse reactions with this medication is low. A few patients may notice itching at the application site.

cimetidine (Trade name: Tagamet) An antihistamine and antiulcer drug that may be a possible drug treatment for chronic hives and for multiple warts in children. According to research at Children's Memorial Hospital in Chicago and New York University, youngsters whose warts did not respond to more traditional treatment received three daily doses of the drug. Within seven weeks, many of the warts had become flatter and less visible; within two months, the warts disappeared completely in 80 percent of the children.

Adverse Effects Diarrhea, dizziness, and rash.

ciprofloxacin (Trade name: Cipro) An antimicrobial used to treat lower respiratory and urinary tract infection, infections of skin, bone and joints, and gastrointestinal disease. It is administered by mouth or IV.

Side Effects Nausea and vomiting, diarrhea, abdominal pain, and headache.

clavulanate potassium (Trade name: Aug-mentin) An oral antibacterial combination of the antibiotic amoxicillin and clavulanate potassium (a potassium salt of clavulanic acid, which is produced by the fermentation of Streptomyces clavuligerus). It is used to treat infections caused by susceptible strains of a variety of organisms that may be resistant to other antibiotics. Some of the conditions it may treat include lower respiratory tract infections, ear infections, sinusitis, skin infections, urinary tract infections, and bite wounds.

Side Effects This drug is usually well tolerated; most side effects (when they occur) are mild and may include diarrhea, skin rash and itching, vomiting, and vaginitis.

clindamycin (Trade name: Cleocin) An antibacterial drug used to treat acne and serious anaerobic infections that haven't responded, or are resistant, to other antibiotics. Clindamycin is especially effective against most anaerobic bacteria, including Propionibacterium acnes. It is also an excellent agent against Staphylococcus aureus and streptococcal species.

Adverse Effects Colitis and severe gastrointestinal problems.

clofazimine (Trade name: Lamprene) A dye used primarily in the treatment of leprosy. This drug has a remarkable lack of toxicity, and although there is no evidence of birth defects, it does cross the placenta and cause pigmentation in offspring. Administered by mouth, it should be taken with meals or milk. For most skin conditions, the drug needs to be taken for at least two months before benefit is seen. The drug should not be taken by women during the first three months of pregnancy, by patients prone to diarrhea or recurrent abdominal pain, or by those with kidney or liver disease.

Adverse Effects The most obvious side effect is a pink, red, or brownish-black discoloration of the skin, especially in areas exposed to sunlight. Hair, sweat, sputum, urine, and feces may also be discolored. These pigmentation side effects are related to dosage, how ever, and begin to fade when therapy is stopped. Other side effects include itching, sensitivity to sunlight, and acnelike skin eruptions. There may also be nausea and vomiting, abdominal pain, and diarrhea.

clotrimazole (Trade names: Gyne-Lotrimin, Lotrimin, Mycelex) A broad-spectrum antifungal drug used in topical applications to treat fungal and yeast infections including ringworm and infections of the genital organs. It is applied as a cream or solution or as vaginal pessaries. It is not prescribed for use in the eyes; contact with eyes should be avoided.

Side Effects Severe skin allergic reactions may occur, as can mild burning or irritation.

cloxacillin (Trade names: Cloxapen, Tegopen) A penicillin-type antibiotic used to treat staphylococcal infections that are resistant to penicillin. Administered by mouth or injection, it should not be taken with acidic fruits or juices or aged cheese. Taken with alcohol, this drug could cause stomach irritation. Use with birth control pills may impair the efficacy of the contraceptive.

Adverse Effects Stomach discomfort and rash, diarrhea or allergic reactions in those sensitive to penicillin.

dapsone (4,4'-diaminodiphenyl-sulfone) An antibacterial drug and a derivative of sulfone used to treat leprosy and dermatitis herpetiformis. Results with this drug (the most often-used of the sulfones) have been variable, but in some cases there have been excellent results. Its mechanism of action is unknown. The introduction of the sulfones in the 1950s had a dramatic impact on the treatment of leprosy, since dapsone was the first safe and effective drug available that stopped the disease and eliminated the need for patient isolation. Although bacterial resistance to dapsone is becoming widespread, it remains the drug of choice in the treatment of leprosy in conjunction with other medication. According to reports, millions of patients have been successfully treated with dapsone for years with a relatively low rate of toxic side effects. Pregnant women should not use dapsone.

Adverse Effects The adverse effects of this drug tend to be dose related and are uncommon on low doses. Concerns over the safety may have been exaggerated by the high doses in some early studies. Severe allergic reactions may occur. Other side effects may include nausea, vomiting, and, rarely, damage to the liver, red blood cells, and nerves. During long-term treatment, blood tests are conducted to monitor liver function and the red blood cell level. Neurological symptoms (such as psychosis) are believed to be dose related; those with.a history of psychiatric problems may be more likely to develop mental problems on this drug.

dideoxyinosine An antiretroviral drug used to treat HIV infections, restricting the viral replication activity.

doxycycline (Trade name: Vibramycin) A tetracycline antibacterial drug used to treat a variety of infections caused by bacteria and other microorganisms. It is administered by mouth.

Side Effects The same as other tetracyclines: Gastrointestinal disturbances, phototoxicity, and discoloration of teeth of children under age eight or in utero. It should not be used in patients with kidney or liver problems or to sensitivity to other tetracyclines, nor should it be prescribed for pregnant women or children under age eight.

econazole (Trade name: Spectrazole) An antifungal drug used to treat ringworm of the scalp, athlete's foot, jock itch, "sun fungus," nail fungus, candidiasis, and others. Available in powder, cream, lotion, ointment, or vaginal tablet, the medication acts quickly (often within two days), killing fungi by damaging the fungal cell wall. The drug may take up to eight weeks to cure the infection.

Adverse Effects Rarely, the drug may cause skin irritation.

erythromycin (Trade names: E-mycin, Ery-thro, Erythrocin, Robimycin, Ery-Tab, Erycette) An antibacterial antibiotic used to treat many bacterial and mycoplasmic infections, especially those that can't be treated with penicillin. In children under age eight, it is the alternative to tetracycline (an antibiotic that can permanently stain developing teeth). Because erythromycin is destroyed by acid in the stomach, the drug should be taken in coated forms or as a compound. Patients with liver disease should not use this drug.

Adverse Effects Possible side effects include nausea and vomiting, abdominal pain, diarrhea, and an itchy rash. To reduce side effects, certain brands of erythromycin may be taken with food to reduce the chance of irritating the stomach. Check with your physician or pharmacist regarding the proper method of taking this medication.

ethambutol (Trade name: Myambutol) An antibiotic drug used to treat pulmonary tuberculosis in conjunction with other drugs. It is not recommended for small children or for those with optic neuritis.

Side Effects Diminished visual acuity and allergic reactions (such as rashes). It may sometimes cause visual problems that ease when the drug is withdrawn.

ethionamide (Trade name: Trecator-SC) An antibacterial drug used to treat tuberculosis, usually in conjunction with other drugs. It is administered by mouth or as a suppository. Patients with liver damage should not use this drug.

Side Effects Loss of appetite, nausea, and vomiting are common. Other side effects include skin rash, jaundice, mental depression, or gastrointestinal problems.

foscarnet (phosphonoformic acid, trisodium salt) An antiviral that acts directly on the viral DNA of herpes simplex viruses and cytomegalovirus, and on retroviruses. The major use of foscarnet has been to treat severe infections caused by acyclovir-resistant herpes simplex viruses.

furazolidone (Trade name: Furoxone) An antiinfective and antiprotozoal drug prescribed for certain bacterial or protozoal infections of the gastrointestinal tract. This drug is not prescribed for infants under age one.

Side Effects This drug is not used with drugs that should not be taken with monoamine oxidase (MAO) inhibitors (a class of drugs used primarily to treat depression). Among the more serious reactions are fever and hemolytic anemia (destruction of red blood cells). Skin rash and stomach pain may occur.

gamma benzene hexachloride (lindane)

(Trade name: Scabene) A medication used to treat lice and that is no longer recommended by the National Pediculosis Association because of its potential toxicity. Other products, according to the association, work equally well with less risk. It is not usually given to infants or pregnant women and should not be applied to the face.

Side Effects Among the most serious reactions are neurologic damage and aplastic anemia (a deficiency of the elements of the blood). Eyes or skin may be irritated by topical use. Lindane also may irritate the skin and scalp, or cause itching.

ganciclovir sodium (Trade name: Cytovene) A drug related to acyclovir used to prevent cytomegalovirus infection after bone marrow transplantation and in AIDS patients. It is administered intravenously, orally, and via ocular implants.

Side Effects During clinical trails, this drug was withdrawn in about 32 percent of patients because of adverse reactions, including most frequently liver and kidney problems and fever, rash, and malaise. Other side effects include headache, confusion, sepsis, swelling, high or low blood pressure, disturbing and intrusive thoughts and dreams, nausea and vomiting, loss of appetite, diarrhea, abdominal pain.

gentamicin (Trade names: Gentacidin, Brista-gen, Garamycin, Genoptic Liquifilm) An aminoglycoside antibiotic prescribed to ease the effects of a wide variety of severe bacterial infections. It can be administered by injection or applied as a cream, or as drops to the ears and eyes. It should not be used together with other drugs that may be potentially harmful to the kidneys or hearing. It should be used cautiously with patients who have kidney problems. Blood tests may be given during treatment to monitor kidney function.

Side Effects The more serious adverse reactions (especially at high doses) include kidney, hearing, or balance problems and problems along the pathways between brain and muscles.

griseofulvin (Trade names: Griseofulvin, Fulvicin, Grisactin) One of the oldest antifungal drugs available in America; it is used to treat infections of the skin, nails, or hair. It is particularly effective against superficial dermatophytes infections of the scalp, beard, palms, soles, and nails, including ringworm of the scalp (tinea capitis), ringworm of the body (tinea corporis), and athlete's foot. It is not effective against bacteria, deep fungi, or Candida albicans. Even with prolonged treatment, many nail infections do not respond completely or else they recur. Resistance may develop to this drug. When griseofulvin is taken with a high-fat meal, it is better absorbed and tolerated. Griseofulvin should not be taken by patients suffering with acute intermittent porphyria, since it may cause an acute abdominal attack. The drug may also interact with birth control pills, producing breakthrough bleeding or pregnancy.

Adverse Effects The most common side effects are headache and gastrointestinal problems; others ihclude loss of taste, rashes, and increased sun sensitivity. Long-term treatment may cause liver or bone marrow damage. The most serious problems include abnormal blood conditions.

hydrogen peroxide A colorless topical antiseptic used to treat skin infections, to cleanse open wounds, or as a deodorant mouthwash. The solution combines with catalase (an enzyme present in the skin) to release oxygen, which kills bacteria and cleanses the infected areas.

Adverse Effects Strong solutions sometimes irritate the skin.

idoxuridine (IDU) An antiviral that apparently acts by being incorporated into newly synthesized DNA; this drug is highly toxic to host cells. Thus, clinical use has been limited to topical therapy of herpes simplex infections of the eye because of its high systemic toxicity.

Side Effects When used in the eye, it may cause irritation, pain, itching, and inflammation or swelling of the eyelids; rare allergic reactions and light sensitivity have been reported.

interferons Natural cellular products released from infected host cells in response to viral (or other foreign) nucleic acids. While scientists don't fully understand how they act, they know that interferon selectively blocks translation and transcription of viral RNA, stopping viral replication without interfering with normal host cell functions. Interferon may be active against many viruses, but it can only be used in the same species that initially produced it.

Interferon-alpha is approved for use in some patients with hairy cell leukemia, Kaposi's sarcoma, or condylomata acuminata. Studies have shown that interferon-alpha2 nasal spray can prevent upper respiratory infections caused by rhinoviruses. Interferon is also effective against shingles in patients with impaired immune systems.

Combining interferon with either acyclovir or vidarabine is useful in treating various versions of hepatitis. Thanks to recombinant DNA technology, interferon is now available in large enough quantities from bacterial cells and many studies around the country are currently under way.

isoniazid (isonicotinic acid hydrazide, INH)

(Trade names: Cotinazin, INH, Nydrazid) An antibacterial used to prevent and treat tuberculosis, usually given by mouth. Isoniazid may be given to close contacts of patients who have TB to prevent the spread of the disease. Becase TB bacteria soon become resistant to isoniazid, it is usually given in combination with streptomycin or other antibacterial drugs. Since the drug may hasten the depletion of pyridoxine (vitamin Be) in the body, vitamin B6 supplements are usually given to prevent nerve damage.

Side Effects Because long-term treatment may be associated with liver problems, isoniazid should not be used by patients with liver disease. High doses or prolonged treatment has been associated with problems with the peripheral nervous system (the motor and sensory nerves outside the brain and spinal cord). Other side effects that commonly occur are rash and fever; occasionally, patients may experience dry mouth and digestive problems.

kanamycin (Trade names: Kantrex, Kantrim, Klebcil) An aminoglycoside antibiotic used to treat certain severe bacterial infections, especially those resistant to other antibiotics. It should not be used at the same time as other ototoxic drugs (medicines potentially harmful to hearing). It is given mainly by injection, but it is administered by mouth for infections of the intestines and by inhalation for respiratory infections.

Side Effects Mild side effects occasionally occur, including skin rash, fever, headache, nausea and vomiting, and tingling sensations. Others include renal failure and deafness.

ketoconazole (Trade name: Nizoral) An antifungal agent prescribed to treat fungal diseases, including tinea versicolor, candidiasis, coccidiomycosis, and histoplasmosis when other antifungal preparations have not been effective. It should not be used to treat fungal meningitis.

Side Effects The most serious—but rare— adverse reactions are liver disorders. Ketoconazole may also cause nausea, but this may be avoided by taking the drug with food; it should not be taken at the same time as antacids. Other side effects include itching, headache, dizziness, abdominal pain, constipation, diarrhea, nervousness, or rash. Occasionally, patients may experience hives and allergic reactions with the first dose. Drug interactions with ketoconazole can be serious; this drug should not be taken with rifampin, isoniazid, warfarin, cyclosporine, or pheny-toin.

lindane See gamma benzene hexachlo-ride.

mebendazole (Trade name: Vermox) An anthelminthic used to treat infestations of pin-worms, whipworms, roundworms, and hookworms. Pregnant women should not use this drug.

Side Effects Abdominal pain and diarrhea are among the most serious side effects.

mefloquine (Trade name: Lariam) An antimalarial drug that is effective in preventing and treating chloroquine-resistant falciparum and vivax malaria.

Side Effects Vomiting, dizziness, nausea and fever, chills, diarrhea, fatigue.

metronidazole (Trade names: Flagyl, Metro I.V., Metryl, Protostat, Satric) An antibiotic particularly useful in fighting infections caused by anaerobic bacteria. This antimicrobial drug is used to treat infections of the genital, urinary, and digestive systems, such as amebiasis, trichomonas, and giardiasis. It is administered by mouth or in suppositories. It should not be used by pregnant women in the first trimester or by patients with organic disease, central nervous system disorders, or blood conditions.

Side Effects Possible effects include severe nausea and vomiting, appetite loss, abdominal pain, dark-colored urine, dizziness, neurological disturbances, or decrease in certain white blood cells (neutropenia). Many patients report that this drug creates a metallic taste in the mouth. Drinking alcohol during treatment with this drug can trigger particularly unpleasant reactions such as nausea, vomiting, hot flashes, and headache.

miconazole (Trade names: Micatin, Monistat) An antifungal medicine used on the skin to treat certain fungal infections of the skin and vagina, such as ringworm of the scalp, body, and feet, fungal meningitis, coccidioidomycosis, and candidiasis. It is given intravenously or by injection to treat systemic fungal infections, as well as topically or intravaginally.

Side Effects Among the more serious reactions following application to the skin are irritation and burning. When used systemically, the drug may trigger nausea, itching, phlebitis, and anemia.

neomycin (Trade names: Mycifradin, Myciguent, Neobiotic) An aminoglycoside antibiotic used to treat infections of the intestine, eyes, and (topically) of the skin caused by a wide range of bacteria. It is usually applied in creams or drops with other antibiotics, but it can also be given by mouth. Neomycin should not be used by anyone with kidney problems or an intestinal obstruction.

Side Effects Possible adverse effects include nausea and vomiting, rash, itching, diarrhea, hearing loss, dizziness, and tinnitus (ringing in the ears). Application of this medication to the skin may lead to allergic reactions.

niclosamide (Trade name: Niclocide) An anthelminthic prescribed to treat beef or fish tapeworm infestation. Its safety for small children, pregnant women, or nursing mothers has not been established.

Side Effects Rectal bleeding, palpitations, hearing loss, swelling, nausea, and vomiting.

norfloxacin (Trade name: Chibroxin, Noroxin) An oral antibacterial drug prescribed for the treatment of urinary tract infections. It is not recommended for children or pregnant women. Nitrofurantoin drugs should not be used together with this medicine.

Side Effects Nausea, dizziness, and headache have been reported.

nystatin (Trade names: Mycostatin, Nilstat, Nystex, O-U Statin) An antifungal antibiotic for the treatment of fungal infections of the gastrointestinal tract, vagina, and skin. It is applied as a cream for skin infections, by mouth for oral and intestinal infections, as pessaries or suppositories for vaginal and anal infections, or as eye drops for eye infections.

Side Effects There are no known serious side effects; some patients may experience mild gastrointestinal irritation or mild skin reactions.

ofloxacin (Trade name: Floxin) A broad-spectrum injectable and oral antimicrobial used to treat adults with mild to moderate infections caused by susceptible strains of certain microorganisms in a variety of infections involving the lower respiratory tract, skin, urinary tract, and prostate. It is also used to treat a variety of sexually transmitted diseases. It should not be given to anyone allergic to drugs in the quinolone group.

Side Effects Nausea, insomnia, headache, dizziness, diarrhea, vomiting, rash, itching, vaginitis, tendonitis, and tendon rupture.

oxytetracycline (Trade name: Terramycin) One of the tetracyclines, this antibiotic is used to treat a wide variety of bacterial and rickettsial infections, including chlamydia, syphilis, Rocky Mountain spotted fever, and cholera. It is administered by mouth or injec tion, or applied to the skin as a cream. Oxytetracycline should be used with caution in patients with kidney or liver problems.

Adverse Effects Possible side effects include rash, increased skin sensitivity to the sun, nausea, and vomiting. Because it may discolor developing teeth, it is not prescribed for pregnant women or children under age eight.

para-aminosalicylic acid (PAS) A drug that is chemically related to aspirin that is used (together with isoniazid or streptomycin) to treat various types of tuberculosis. It is administered by mouth.

Side Effects Nausea and vomiting, diarrhea and abdominal pain, fever, rash, goiter, hypokalemia (loss of potassium in the blood), and acid-base imbalance.

penicillin (penicillin G [benzylpenicillin])

(Trade names: Bicillin, Cilloral, Crystapen, Falapen, Liquapen, Pentids, Permapen, Pfiz-erpen) An antibiotic derived from cultures of species of the mold Penicillium notatum used to treat a wide variety of bacterial infections, such as meningococcal, pneumococcal, and streptococcal infections, syphilis and many other diseases. It is rapidly absorbed when injected, but it is inactivated by stomach acid. It is often not effective against staphylococcus aureus. There are several similar drugs prepared from P. notatum (benethamine penicillin and benzathine penicillin) and a group of antibiotics derived from the penicillins, known as semisynthetic penicillins (including ampicillin and cloxacillin).

Side Effects Allergic reactions are common, and include skin rash, hives, and anaphylaxis. Any patient who has had an allergic reaction to one type of penicillin should not be given any other. Other side effects include vomiting and diarrhea.

penicillin V (phenethicillin) An antibiotic similar to penicillin that is active against gram-positive bacteria (except certain strains of staphylococci). It can be administered by mouth.

Side Effects Diarrhea and allergic reactions.

permethrin (Trade names: Elimite, Rid) A drug used on the skin to treat head lice and their nits. It should not be used by anyone allergic to pyrethrine, pyrethroids, or chrysanthemum flowers.

Side Effects Reported reactions include itching, mild burning or stinging, numbness, discomfort, mild redness, or scalp rash.

piperazine (Trade names: Antepar, Bryrel) A drug used to treat infestations by roundworms and thread worms. It is administered by mouth.

Side Effects Rarely, side effects (nausea and vomiting, headache, tingling, and rashes) may follow high doses.

podofilox (Trade name: Condylox) An antimitotic drug synthesized from plants used to treat external genital warts (condyloma acuminatum). It is not used to treat perianal or mucous membrane warts. Correct diagnosis of the lesions is essential.

Side Effects There is a likelihood of side effects, including burning, pain, inflammation, erosion, and itching; burning and itching occur more often among women. Other, more rare side effects include pain with intercourse, insomnia, tingling, bleeding, tenderness, chafing, bad odor, dizziness, scarring, blisters, crusting, and swelling.

polymyxin B (Trade name: Aerosporin) An antibiotic prescribed for infections caused by Pseudomonas, such as urinary tract infections, septicemia ("blood poisoning"), and eye infections.

Side Effects It should be used with extreme caution in patients with kidney problems. Drug fever, kidney, and liver problems may be caused by this drug. Mild dizziness may also occur.

polymyxins A group of antibiotics derived from the bacterium Bacillus polymyxa used to treat gram-negative bacterial infections that cause a variety of conditions such as meningitis, corneal ulcers, and ear infections. The polymyxins include colistin and polymyxin B.

Side Effects Taken orally, colistin is associated with pseudomembranous enterocolitis— a severe, life-threatening type of diarrhea sometimes caused by antibiotics. It may also cause liver problems and various neurologic changes when taken internally. When applied on the skin, irritation and allergic reactions may occur.

praziquantel (Trade name: Biltricide) A drug used to treat schistosome infections and infections of liver fluke.

Side Effects Praziquantel is usually well tolerated; side effects are usually mild and don't last long. They include headache, dizziness, abdominal discomfort, fever, hives.

pyrantel pamoate An antihelminthic used to treat infestation of roundworms or pinworms. It should be used with caution in patients with anemia or severe malnutrition.

Side Effects Nausea, abdominal cramps, diarrhea, dizziness, and skin rash.

pyrazinamide An antimycobacterial drug prescribed in combination drug therapy to treat hospitalized patients with tuberculosis who don't respond to other drugs. Patients with severe liver damage should not use this drug.

Side Effects Joint pain, fever, and rash. At high doses, the drug may cause toxic effects on the liver.

pyrethrin (Trade name: A-200 shampoo) Used together with piperonyl butoxide, this is a fixed-combination medication used to treat head, body, and pubic lice and scabies. Patients with a sensitivity to ragweed should not use this medication.

Side Effects Irritation of skin and mucous membranes.

pyrimethamine (Trade names: Daraprim, Fansidar) An antimalarial prescribed in the treatment of malaria and toxoplasmosis. It should not be used to treat chloroguanide-resistant malaria, and it is prescribed cautiously in patients with toxoplasmosis because the dosage needed may be near toxic levels. It also may be used together with sul-fadozine to treat malaria. This combination should not be used to treat pregnant women at term or while nursing, infants under age two months, or patients with the blood disorder megaloblastic anemia.

Side Effects Adverse reactions occur especially with large doses, and may include blood disorders, very sore tongue (atrophic glossitis), low levels of some types of white blood cells (leukopenia), and convulsions. Side effects to the pyrimethamine and sulfa-doxine combination may include pancreatitis, depression, convulsions, hallucinations, and several types of blood disorders.

quinacrine (Trade name: Atabrine) A drug used since World War II to suppress malaria; it is now used to treat the intestinal infections, giardiasis, or cestodiasis. It should not be used during pregnancy or together with the drug primaquine, and it should be administered with caution to patients over age 60 or anyone with a history of psychosis.

Side Effects Possible adverse effects include nausea and vomiting and yellow discoloration of the skin and urine. Prolonged use can cause blood disorders or psychological problems. Other side effects include severe psoriasis, aplastic anemia, acute kidney problems.

quinine (Trade name: Quinamm, Quinine) The oldest drug treatment for malaria. Quinine had been abandoned and replaced by more effective, less toxic drugs, but in the wake of resistant forms of malaria it is being reintroduced as a potential malaria treatment. Today, it is used mainly to treat strains of the disease that are resistant to other antimalarial drugs (especially in malaria caused by Plasmodium falciparum). Patients with certain types of heart problems should not use this drug.

Side Effects Large doses of this drug are needed, and therefore there is a high risk of adverse effects due to severe poisoning: headache, fever, nausea and vomiting, confusion, hearing loss, ringing in the ears, and blurred vision.

ribavirin (Trade name: Virazole) An aerosol antiviral drug prescribed to treat respiratory syncytial virus (RSV) infections of the lower respiratory tract in infants and small children and other RNA and DNA viruses. It is not recommended for infants who need help in breathing, and its role in healthy children remains to be defined. It also appears to have some effectiveness against influenza A and B, but its role in treating these diseases is not defined. It has also been used successfully against lassa fever.

Side Effects Reported side effects include bacterial pneumonia, pneumothorax, breathing cessation (apnea), low blood pressure, and cardiac arrest (these reported conditions could have been caused by the underlying disease and not the medication). Other side effects may include eye infection, impaired breathing function, and an increase in immature red blood cells (reticulocytosis).

rifampin (Trade names: Rifadin, Rimactane) An antibacterial drug prescribed to treat various infections, particularly tuberculosis. It is also used to prevent meningococcal meningitis in people who are exposed to someone with the disease. It is usually prescribed with other antibacterials because some strains of bacteria quickly develop resistance to rifampin alone. The drug should not be used by pregnant women or anyone with liver problems.

Side Effects Liver toxicity and a syndrome that resembles influenza. Other side effects include a harmless, orange-red discoloration of urine, saliva, and other body secretions; gastrointestinal distress; aches and cramps; jaundice; rash; or itching.

rimantadine An analog of amantadine that shares the same effectiveness, but appears to produce fewer side effects.

silver sulfadiazine (Trade name: Silvadene) A topical antibacterial cream used to prevent infections in skin grafts or second- and third-degree burns. It is especially helpful in keeping burn sites sterile, reducing the chance of secondary infection.

Adverse Effects Possible side effects include allergic reactions (with rash, itching, or burning). Long-term use may rarely produce serious blood disorders or kidney damage. It is not recommended for patients who are sensitive to sulfonamide drugs, nor should it be used for newborns or premature infants.

streptomycin An aminoglycoside antibiotic derived from Streptomyces griseus that is used to treat a wide variety of bacterial infections, including tularemia, plague, brucellosis, and glanders. It is administered by injection and is sometimes given together with a penicillin drug to treat endocarditis (inflammation of the lining of the heart and its valves). Streptomycin was once used to treat a variety of other infections, but it has now been surpassed by newer more effective drugs with less serious side effects. When it was discovered, it was the first effective drug treatment for tuberculosis; it is still sometimes used (together with isoniazid) to treat a resistant strain of bacteria. Streptomycin should be used with caution by the elderly and those with kidney problems.

Side Effects Its most serious adverse affect is the possibility of damage to the inner ear, disturbing balance and causing dizziness, ringing in the ears and deafness. For this reason, patients with labyrinthine disease should not take this drug. It must also be used with caution with those with kidney problems and the elderly. Other possible problems include facial numbness, tingling in the hands, headache, malaise, nausea, and vomiting.

sulfacetamide (Trade names: Bleph-10, Cetamide, Sebizon, Sulamyd, Sulf-10, Sul-facet-R) A topical sulfonamide-type of antibacterial drug used to treat conjunctivitis (pinkeye) and sometimes given to treat blepharitis (inflammation of the eyelids). It may also be used to prevent infection after an eye injury or the removal of a foreign object. Those with impaired kidney function should not use this drug.

Adverse Effects Stinging and possible allergic reactions such as itching, redness, and swelling of the eyelids.

Sulfacet-R Brand name drug for a topical combination medicine containing a scabicide (sulfur), an antibacterial (sulfacetamide sodium), and an antiseptic and astringent (zinc oxide).

sulfachlorpyridazine A sulfonamide-type of antibacterial drug used to treat infection (especially of the urinary tract). It should not be used if the urinary tract is blocked.

Adverse Effects Among the more serious reactions are photosensitivity and severe allergic reactions.

sulfacytine A sulfonamide antibacterial used to treat infection, especially pyelonephritis and cystitis. It should not be used in patients who have porphyria or an obstructed urinary tract.

Side Effects Photosensitivity, severe allergic reactions, a variety of blood conditions, or crystals in the urine (crystalluria).

sulfadiazine Sulfonamide antibacterial prescribed to treat infection (especially of the urinary tract) and to prevent the development of rheumatic fever. They should not be used in patients who have porphyria or an obstructed urinary tract.

Side Effects Photosensitivity, severe allergic reactions, a variety of blood conditions, or crystals in the urine (crystalluria).

sulfamethoxazole (Trade name: Gantanol) A sulfonamide-type antibacterial used to treat ear infection (otitis media), pinkeye, skin infections, and certain urinary tract infections. When combined with the antibacterial drug trimethoprim (as Bactrim or Septra), the two are given to treat a variety of respiratory tract infections, including pneumocystic pneumonia. It should not be given during the last trimester of pregnancy, during breast-feeding, or to children under age two months.

Adverse Effects Rash, fever, nausea, vomiting, diarrhea, headache, dizziness, muscle or joint pain, or crystals in the urine.

sulfonamides (sulfa drugs) A large group of synthetic antibacterial agents that are effective in treating infections caused by many gram-negative and gram-positive microorganisms responsible for urinary tract infections, some types of pneumonia, and middle-ear infections, among other diseases. The sulfonamides are derived from a red dye known as sulfanilamide. Before the development of penicillin drugs, the sulfonamides were widely used to treat infections. Most sulfonamides are given by mouth and are available in a range of effectiveness from short- to long-acting, depending on the speed with which they are excreted from the patient's body. Most (including sulfamethoxazole and sulfaphenazole) are quickly absorbed from the stomach and small intestine and should be taken at frequent intervals. Some (such as sul-fadoxine) are used for leprosy and malaria; sulfalene is a long-acting drug that need only be taken once a day. Others (such as sulfaguanidine) are poorly absorbed and are used to treat infections of the gastrointestinal tract, such as bacillary dysentery and gastroenteritis.

Side Effects Hemolytic anemia, agranulocytosis, thrombocytopenia or aplastic anemia, drug fever or jaundice, or allergic reactions. Adverse effects are more common with the long-acting sulfonamides that are given for more than 10 days. Sulfonamides are also given cautiously to people with impaired liver or kidney function. They are not given in the last three months of pregnancy or to infants because of the risk of mental retardation. In general, patients should avoid exposure to direct sunlight when taking these drugs. Prolonged use of these drugs leads to the development of resistant strains of microorganisms in the gut.

sulfones One of a group of drugs closely related to the sulfa drugs in their structure and the way they act. Sulfones are powerful agents in the fight against the bacteria that cause leprosy and tuberculosis. Patients who take these drugs require frequent evaluation, including complete blood counts, a chemistry profile (including liver and kidney tests), and urine tests.

sulfisoxazole (Trade name: Gantrisin) A sulfonamide-type of antibacterial drug used to treat urinary tract infections (including vaginitis, cystitis, and pyelonephritis) and eye infections (pinkeye).

Adverse Effects Nausea, vomiting, appetite loss, diarrhea, headache, dizziness, or rash. There may be a severe hypersensitivity reaction. The drug is not given during the last trimester of pregnancy, or to children under age two months.

tetracycline (Trade names: Achromycin, Cyclopar, Panmycin, Polycycline, Sumycin, Tetracyn, Tetrex, Topicycline) Any one of a group of broad-spectrum antibiotics derived from cultures of Streptomyces bacteria (chlorte-tracycline, doxycycline, oxytetracycline, and tetracycline). They are prescribed for the treatment of many bacterial and rickettsial infections, including respiratory-tract infections, syphilis, and acne. Because tetracycline may cause permanent discoloration of the teeth, it is not used during the last half of pregnancy or during a child's first eight years of life. Patients with significant liver or kidney problems should not use this drug.

Side Effects Nausea and vomiting and diarrhea are fairly common side effects. Others include more severe gastrointestinal disturbances, kidney and liver damage, inflammatory lesions in the anal-genital area, hemolytic anemia, and rash. Patients may also be susceptible to infection with tetracycline-resistant organisms.

thiabendazole (Trade name: Mintezol) An anthelmintic used to treat a variety of worm infestations, including roundworms, pin-worms, and hookworms. People with erythema multiforme (an allergic syndrome associated with some drugs) or Stevens-Johnson syndrome (a severe form of erythema multiforme) should not use this medication.

Side Effects Loss of appetite, central nervous system effects, severe gastrointestinal problems, dizziness, and low blood pressure.

tolnaftate (Trade names: Aftate, Tinactin) An antifungal drug used to treat superficial fungus infections of the skin, including some types of ringworm (including athlete's foot, ringworm of the body, and tinea versicolor). It is available without a prescription as a cream, powder, or aerosol. Tolnaftate is not effective in candidiasis.

Side Effects In rare cases, it may cause skin irritation or rash.

trifluridine (trifluorothymidine) This antiviral drug interferes with DNA synthesis and is effective in treating eye infections caused by herpes simplex 1 and 2.

Side Effects Burning or stinging in the eye.

trimethoprim (Trade names: Proloprim, Trimpex) An antibacterial drug used to treat various infections such as malaria, chronic infections of the urinary tract, and infections of the middle ear and bronchi. It should not be used to treat streptococcal pharyngitis (strep throat). It is often administered by mouth in a combined preparation with sulfamethoxazole (Bactrim, Septra).

Side Effects A range of blood abnormalities, allergies, gastrointestinal problems, and central nervous system problems. Long-term treatment may cause an impairment of bone marrow production.

trimethoprim and sulfamethoxazole (Trade names: Bactrim, Septra) A fixed-combina-tion antibacterial drug used to treat urinary tract infections, ear infections, and shigellosis. It is not recommended for use in infants under age two months, or in the last three months of pregnancy. It should be used with caution by patients with kidney or liver problems, or who have a possible folate deficiency.

Side Effects Crystals in the urine, rash, fever, and allergic reactions.

undecylenic acid (Trade names: Breezee Mist Foot Powder; Fungi-Nail Solution, Gordo-chom solution) An antifungal agent used to treat athlete's foot and ringworm. It is applied to the skin as a powder, ointment, lotion, or aerosol spray, but should not be used in the eyes or on mucous membranes. Diabetic patients should use this drug with caution.

Side Effects Skin irritation and allergic reactions.

vidarabine An antiviral that interferes with viral DNA synthesis. It is used to treat herpes simplex infections and appears to be less susceptible to development of drug-resistant viral strains than idoxuridine (used to treat herpes simplex infections of the eye).

When used against herpes simplex encephalitis, it has cut mortality from 70 percent to 28 percent; therapy is most effective when started early, and is least effective when begun once the patient is comatose. It is also effective in treating shingles infections in those with an impaired immune system, shortening the period of viral shedding and lessening the incidence of postherpetic neuralgia.

While effective, however, studies have shown that acyclovir is more effective than vidarabine against both shingles and herpes simplex encephalitis.

Side Effects Possible effects for treatments in the eye include tearing, irritation, pain, and sensitivity to light. Systemic use may cause nausea, vomiting, tremor, and phlebitis at the infusion site. This drug may be toxic to bone marrow and liver when given in high doses.

Zostrix See capsaicin.

zalcitabine (Trade name: Hivid) A new anti-retroviral drug used in combination with AZT (zidovudine) to treat adult patients with advanced HIV infection whose condition is deteriorating.

Side Effects Only limited data on safety are available, but side effects that have been reported include oral ulcers, nausea, loss of appetite, abdominal pain, vomiting, rash and itching, dizziness, headache, fatigue, and sore throat.

zidovudine (Trade name: Retrovir) An antiviral drug formerly known as azi-dothymidine (AZT) that is used in the treatment of AIDS and severe AIDS-related complex. The drug slows the growth of HIV infection in the body but cannot cure the infection; it works by interfering with DNA synthesis. It is used in conjunction with other drugs that help eradicate HIV.

Side Effects Nausea, headache, and insomnia.

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