This Pre-dent has a question for YOU!

[heyitscyndi]

Hi! I am a pre-dent student who has gotten alot of good information from SDN. I now have a question for all you pharmacy people out there! I have a sinus infection and went to get an anti-biotic today. I like taking the Z-pak (Zithromax) because I feel better quicker. The doctor said that they don't like prescribing that pill anymore and I got Augmenton (sp?) instead. My question is why don't they like to give the Z-paks anymore? Thanx in advance for your time! =)

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[ultracet]

Adults and adolescents: The FDA-approved dose is 500 mg PO once daily for 3 days (e.g., Zithromax® Tri-Pak™). A double-blind study in the US compared 3- and 6-day regimens of azithromycin for treating acute bacterial sinusitis with an FDA-approved 10-day amoxicillin-clavulanate regimen. A total of 936 patients randomly received one of 3 regimens: Azithromycin 500 mg PO qd for 3 or 6 days, or amoxicillin; clavulanate 500/125 mg PO tid for 10 days. At the end of the study, all 3 regimens were equivalent in efficacy and had similar safety and compliance rates; however, the azithromycin regimens were better tolerated than the amoxicillin; clavulanate regimen


no difference between the two...
cheaper...
a lot of docs are worried about resistance since a zpak is prescribed so often for an infection that is viral
i'm sure there's more

and honestly i would have thought you would have always gotten augmentin unless you are penn allergic

 

[RxGirl]

Hello,

I am not a pharmacy student yet, but I have had tons of sinus infections. My doctor tells me that z-pack is a VERY STRONG antibiotic and therefore should be used for something more severe. If you use it for something like a sinus infection, then your body won't react react to it when you get something worst (god forbid) like nemonia (i think thats spelled wrong) and you need something strong to clear the bacterial infection. Does this make sense? So the doctors like to use mild antibiotics for mild infections and strong ones for more severe conditions.

Pharmacy students, correct me if im wrong

 

[kwakster928]

azthromycin is usally saved for the mod-severe infections and for the people who will have harder time with compliance issues. QD to TID makes a lot of difference in some. but i am sure you will have no problem taking augmentin tid. azthromycin is also more expensive, so it might save you some money. when penicillin is used with conjunction with clavulanate it shows significant synergistic activity. so it should work for ya, thus they make it combination hehe. alright hope you feel better.

 

[28657]

when penicillin is used with conjunction with clavulanate it shows significant synergistic activity.

Clavulanic acid is a beta lactamase inhibitor; thereby, preventing resistance during treatment with the amoxicillin. That's not synergism. To be synergistic, both drugs have to work against the "culprit". Clavulanate doesn't work on its own.

 

[jdpharmd?]

Personally, if I had a severe sinus infection, I would go for the Augmentin.

Chances are, a drug rep recently visited your Dr touting the countless "benefits" of Augmentin XR (new, $$$ and no more usefull than regular generic augmentin). Esentially they (Zithromax and Augmentin) are both the "outpatient broad spectrum cover-all". Price for both is usually pretty similar. Zpack is usually easier on the stomach from my experience.

a lot of docs are worried about resistance since a zpak is prescribed so often for an infection that is viral

BBmuffin is probably on to something regarding perceived resistance...

If you use it for something like a sinus infection, then your body won't react react to it when you get something worst (god forbid) like nemonia (i think thats spelled wrong) and you need something strong to clear the bacterial infection.

RXgirl, study hard for your pre-pharm. Z-packs are fairly mild, but sinus infections can be anything from viral and mild to severe, bacterial, and chronic. A Z-pack or Augmentin very well might have been appropriate. It's tough to just get the drugs into the sinuses in sufficient amounts, much less overcome bacterial resistance. Biaxin, Augmentin, or a Quinolone (Cipro/Levaquin) are probably all good choices for tough bacterial sinus infections.

Just FYI: the bacteria develop the drug resistance; your body doesn't.

 

[Caverject]

Clavulanic acid is a beta lactamase inhibitor; thereby, preventing resistance during treatment with the amoxicillin. That's not synergism. To be synergistic, both drugs have to work against the "culprit". Clavulanate doesn't work on its own.

Your definition and Kwaksters is the same thing. They are given together to work against the "culprit" and culprit = bacteria. Just like AMG antibiotics and Vanco!

 

[LVPharm]

Your definition and Kwaksters is the same thing. They are given together to work against the "culprit" and culprit = bacteria. Just like AMG antibiotics and Vanco!

but..but..that's just it...clavulanate works against the enzyme produced by the bacteria, not the bacter...oh never mind

 

[ultracet]

Just FYI: the bacteria develop the drug resistance; your body doesn't.

yes you are absolutely correct....

the fact still remains that more than likely you have all sorts of bugs in you at any given time they are just not causing infection and treating something with antibioticss that is unnecessary will probably aid to resistance


Also I would probably recommend saline nasal spray along with the antibiotics just to work on the sinuses because like Jd said... its hard to get the drug up there.
it is unpleasant but in my experience, it helps


Also I heard in class at some point (dont remember the class or the year) that resistance to azithromycin is increasing
has anyone else heard anything about this?
I know i was also told this about quinolones (which i believe i remember said on several occasions)

for someone who is penn/ceph/sulfa allergic this could really be a problem....

 

[vafcarrot]

but..but..that's just it...clavulanate works against the enzyme produced by the bacteria, not the bacter...oh never mind

but that means it works against the bacteria unless you're real cool and make bacterical enzymes

 

[jemc2000]

My ex-father-in-law just eats Vick's Vapo-rub. He swears it takes care of it all.

 

[ultracet]

My ex-father-in-law just eats Vick's Vapo-rub. He swears it takes care of it all.

eats it???

now that's just gross

 

[jemc2000]

eats it???

now that's just gross

Yup. He also, ummmmmm, places it, to relieve hemorroids.

 

[heyitscyndi]

yes you are absolutely correct....

the fact still remains that more than likely you have all sorts of bugs in you at any given time they are just not causing infection and treating something with antibioticss that is unnecessary will probably aid to resistance


Also I would probably recommend saline nasal spray along with the antibiotics just to work on the sinuses because like Jd said... its hard to get the drug up there.
it is unpleasant but in my experience, it helps


Also I heard in class at some point (dont remember the class or the year) that resistance to azithromycin is increasing
has anyone else heard anything about this?
I know i was also told this about quinolones (which i believe i remember said on several occasions)

for someone who is penn/ceph/sulfa allergic this could really be a problem....

Fabulous, I've been using Simply Saline nose spray and it does work great.

Question, for people who are penn/ceph/sulfa allergic (some ppl in my family), what would they be able to use instead if that is going to be a problem?

 

[heyitscyndi]

Hey, thanks everyone who has been posting on this forum, I've really been learning alot! You all are super helpful and I have no doubt in my mind that you will make amazing pharmacists!

 

[Glycerin]

My ex-father-in-law just eats Vick's Vapo-rub. He swears it takes care of it all.

Kind of like the dad and Windex in My Big Fat Greek Wedding?

 

[28657]

Fabulous, I've been using Simply Saline nose spray and it does work great.

Question, for people who are penn/ceph/sulfa allergic (some ppl in my family), what would they be able to use instead if that is going to be a problem?

Although resistance to antibiotics is always increasing, the possible situation with quinolones and azithromycin is not clinically significant right now. What I mean by that is, if your family member is allergic to pen/ceph/sulfa then the doc will still prescribe Z-pac, if that doesn't work they'll go to a fluoroquinolone. If by some weird chance the FQ doesn't work (because of resistance or simply just because the infection is too great) the next step is physically scraping out the sinuses! OUCH!!!

 

[heyitscyndi]

Although resistance to antibiotics is always increasing, the possible situation with quinolones and azithromycin is not clinically significant right now. What I mean by that is, if your family member is allergic to pen/ceph/sulfa then the doc will still prescribe Z-pac, if that doesn't work they'll go to a fluoroquinolone. If by some weird chance the FQ doesn't work (because of resistance or simply just because the infection is too great) the next step is physically scraping out the sinuses! OUCH!!!

Ooh, well as much fun as that sounds...no mas. lol. That's interesting, they've never taken fluroquinolone yet from what I can remember. They pretty much always get a Z-pack. That's really cool, I'm learning so much!!

 

[GravyRPH]

Although resistance to antibiotics is always increasing, the possible situation with quinolones and azithromycin is not clinically significant right now. What I mean by that is, if your family member is allergic to pen/ceph/sulfa then the doc will still prescribe Z-pac, if that doesn't work they'll go to a fluoroquinolone. If by some weird chance the FQ doesn't work (because of resistance or simply just because the infection is too great) the next step is physically scraping out the sinuses! OUCH!!!

I believe it was a panel member from ASCAP or some such orginization that predicted current FQ's would be useless within the decade due to resistance. I don't know about that, but this is what those people do, so his "prediction" is at least based on some sort of science. We have really curved Tequin use at our institution to try and save the world one prescription at a time.