Middle ear infection, or otitis media, is extremely common in infants and children. By the age of 1 year, some three out of four children have had at least one episode. It is far less common in older children and adults. Why so?

One of the main reasons is the physical layout of the Eustachian tube, which connects the middle ear and the nose. In the young child, the tube is shorter, narrower, and more horizontal. This makes it easy for bacteria and viruses, present during a cold or nasal congestion, to travel from the nose to the middle ear.

Common symptoms of middle ear infections include ear pain, difficulty in sleeping, irritability, and fever. Some children respond by pulling on the ear. It is important to note that, even in the absence of treatment, the pain and fever are generally gone after two to three days. All the symptoms will be just a bad memory within seven days,although the ear should be checked by a physician to ensure that the infection is gone.

Causes and Treatment of Ear Infections:

Common causes of otitis media include Streptococcus pneumoniae, Haemophilis influenzae, and Moraxella catarrhalis, all Gram-positive bacteria. In passing, it is important to note that almost half of all cases are caused by or at least have viruses present. In these cases, an antibiotic is not necessary.

Treatment of otitis media has three objectives:

(1) relieve pain (often with acetaminophen),

(2) eliminate the infection, and

(3) prevent complications.

Doctors don’t have a single game plan for how they treat ear infections. Some prescribe antibiotics immediately. Others delay antibiotic use for two to three days when, in most cases, the condition will improve even in the absence of drugs. If the condition hasn’t improved after a few days, they prescribe antibiotics.

Why do some doctors hold off on prescribing antibiotics? Doing so avoids exposing the child to antibiotic side effects and also saves money better spent elsewhere. But from a public health perspective, there is a more important reason. Limiting the use of antibiotics when they are not needed delays the development of bacterial resistance to these drugs. With resistance, the antibiotics become less effective.

Amoxicillin, a penicillin-like drug, is the first choice for treating most cases of middle-ear infections. It is highly effective when taken by mouth, quite safe, and inexpensive. If amoxicillin doesn’t work, amoxicillin-clavulanate (Augmentin) or cefuroxime, a cephalosporin, are highly recommended backups. For severe cases that don’t improve with these drugs, or when young patients can’t take drugs by mouth, ceftriaxone is used. The drug’s main downside is that it must be given by intramuscular injection on three consecutive days.

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Pneumonia is the most common cause of death in the United States that is caused by an infectious disease. It is often a terminal illness in the elderly. The general term pneumonia includes all infections of the lung in which the microscopic air sacs are filled with fluid.

Common symptoms of pneumonia include the sudden appearance of fever, chills, and labored breathing, with shortness of breath, and a cough that brings up phlegm.

Causes and Treatment of Pneumonia: An Overview

Pneumonia has many causes that include both Gram-positive and Gram-negative bacteria, as well as viruses and fungi. Chest x-rays are used to confirm a suspected diagnosis of pneumonia. Sputum (mucus from the respiratory tract) sometimes, but not always, provides the identity of the culprit microbe.

Antibiotics are generally started before the precise bacterial cause of the pneumonia has been determined. The antibiotic selected for initial use is generally one that is active against a wide range of bacteria, called a broad-spectrum antibiotic. Many such drugs (e.g., cephalosporins, penicillins) are available and effective for treating bacterial pneumonia.

Pneumonia may be picked up in the community or during a period of hospitalization.

Pneumococcal vaccine (Pneumovax 23, PnuiMmune 23) should be given in patients 65 or older that have a chronic disease (e.g. asthma, diabetes), or that live in nursing homes.

Community-Acquired Pneumonia:

Streptococcus pneumoniae (a.k.a. pneumococcus), a Gram-positive bacterium, accounts for 70percent of all bacterial causes of pneumonia in the United States. Other causes include Hemophilis influenzae and Mycobacterium tuberculosis.

Patients are generally treated orally with erythromycin-like or quinolone-class drugs.

Hospital-Acquired Pneumonia:

It is not uncommon for patients to pick up pneumonia during the course of a hospitalization for other conditions. This most commonly occurs when the patient has been placed on a mechanical ventilator.

Hospital-acquired pneumonia is far more difficult to treat because the patient is often debilitated by another medical condition. Moreover, the Gram-positive and Gram- negative bacteria that cause pneumonia in this setting have often developed resistance to commonly used, and often safer, antibiotics. These include the Gram-positive bacterium Staphlococcus aureus.

Of the several Gram-negative microbes, the most common are Klebsiellapneumoniae and Pseudomonas aeruginosa. Infections caused by these microbes tend to progress rapidly, are very severe, and have a high death rate. Hospital-acquired pneumonia is usually treated with combinations of antibiotics from the aminoglycoside, cephalosporin, quinolones, and penicillin classes.

Pneumonia in Infants and Children:

In young patients, pneumonia is caused by both bacteria and viruses, with viruses being the more common cause. As mentioned previously, with the use of a vaccine to prevent Hemophilus influenzae, this microbe is no longer an important cause of pneumonia.

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The major function of our kidneys is to filter the blood and eliminate waste materials in the urine. Urine travels from the kidney to the bladder through a tube called the ureter. Urine is stored in the bladder before it is eliminated from the body, passing through the urethra.

How to Treat Urinary Tract Infections:

Urinary tract infections (UTIs) are among the most common of all infections and may involve any of the organs of the urinary tract. These include infections of the kidney, bladder, and urethra.

By far the most common infections are caused by Gram-negative bacilli, most often by Escherichia coli. UTIs may also be caused by viruses and fungi. A number of classes Some medicines are used to treat UTIs and prevent recurrent infections, a common problem in women. Depending on the nature and severity of the UTI, oral treatment may be required for 3 to 14 days. of antibacterial drugs are used to treat UTIs.

These include sulfa drugs, penicillins, cephalosporins, tetracyclines, quinolones, and carbapenems. These same medicines are used for infections in other parts of the body. Nitrofurantoin and other urinary tract antiseptics are only used for the treatment of UTIs. The drug chosen depends on the identity of the disease-causing bacteria.

Kidney Infections:

Kidney infections (sometimes called pyelonephritis) may result from bacteria arising from other parts of the body or by traveling up from the urethra. The risk of this latter cause increases when the normal outward flow of urine is blocked, as might occur during pregnancy.

Common symptoms of a kidney infection are chills, fever, lower-back pain, nausea, vomiting, and frequent and painful urination.

Mild-to-moderate cases are treated with drugs taken by mouth for 7 to 14 days. Severe cases require hospitalization and are treated with intravenous antibacterials for several days, followed by oral medication.

Bladder Infection:

Bladder infections (also called cystitis) are usually seen in women of childbearing age and are often recurring. They are normally associated with sexual intercourse. Common symptoms include frequent urination, the urgent need to urinate, and a painful or burning sensation when urinating.

Acute cases are generally treated for three days with an oral antibacterial drug, although a single dose may be used. Some doctors prefer treating complicated cases for 7 to 10 days. Individuals with recurring bladder infections sometimes take low doses of nitrofurantoin or trimethoprim-sulfamethoxazole daily or several times weekly on an ongoing basis.

Urethral Infection:

Infection of the urethra (a.k.a. urethritis) is most often seen in women and is a sexually transmitted disease. Common symptoms in women include the frequent and urgent need to urinate and a painful sensation when urinating. In addition to these symptoms, a discharge containing pus or mucus is often seen in men. A number of different bacteria, as well as viruses and fungi, can cause these infections. Treatment is based on the identity of the microbe.

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Although our skin comes in regular contact with bacteria and other microbes, and these microbes live on our skin, we rarely develop skin infections.

Susceptibility to bacterial skin infections increases as the result of injury to the skin; conditions such as HIV-AIDS, which reduce our immune defenses; and diabetes. These infections are often on the skin surface and can be easily managed with an OTC antibiotic ointment. Others involving deep tissues and leading to body-wide infections may be life threatening.

How to Treat Skin Infections:

Common bacterial skin infections include folliculitis, abscesses, and carbuncles; impetigo; cellulitis; and necrotizing cellulitis.

Folliculitis, Abscesses, and Carbuncles:

All three skin conditions are pus-filled infections of the hair follicles that are commonly caused by Staphyloccus aureus, a Gram-positive microbe.

• Folliculitis. The infection remains on the skin surface. It is most often seen on the scalp, on the face of bearded men, on legs of women who shave, and on the eyelids in the form of a stye. The affected areas are reddened and may be only slightly tender and may itch.

• Abscesses (also called boils, furuncles). These are infections that travel down single hair follicles into deeper layers of the skin. The pus-filled lesion is deep, firm, red, and painful, and may rupture if not treated.

• Carbuncles. These are infections involving a number of hair follicles that are connected beneath the skin and that may spread to other tissues. They are commonly found on the back of the neck and on the upper regions of the back. The individual often has fever and chills and feels ill.

Folliculitis can be treated with warm compresses and, if necessary, the topical application of clindamycin, eythromycin (both available as generic products), or mupirocin. More severe cases of abscesses and carbuncles are treated with oral doses of clindamycin or dicloxacillin for 7 to 10 days.

Impetigo:

Impetigo is a superficial skin infection caused by Staphylococcus aureus or Staphylococcus pyogenes. The lesions start as small red spots that expand into vesicles filled with an amber-colored fluid. After bursting, 0e discharge dries and forms a yellow crust. This itchy condition most commonly occurs in children. It may be spread by contact with the lesion to the individual or to others.

Impetigo can be treated topically with mupirocin or erythromycin. Toprevent com plications, such as cellulitis, more severe cases are treated with oral dicloxacillin or with cephalexin or cefadroxil.

Penicillin- and cephalosporin-allergic individuals can be treated with clindamycin.

Cellulitis:

Cellulitis is a potentially dangerous condition in which the infection can spread from under the skin into the bloodstream. Commonly seen on the legs, the lesions tend to be red and swollen, and are hot and painful. The individual often has fever, chills, and feels ill.

This condition can occur after a wound, superficial skin infection, or surgery. It sometimes arises in the absence of broken skin in individuals who have impaired immune function. Cellulitis is commonly caused by Streptococcus, Staphylococcus aureus, or Staphylococcus pyogenes, but it’s not uncommon to be caused by multiple microbes.

Drug treatment is intended to rapidly eliminate the infection and prevent its spread to other parts of the body. The choice of antibiotics is based on the identified or suspected microbes. Depending on the severity of the condition, drugs may be given by mouth or intravenously.

The antibiotics given for cellulitis include the following:

• Penicillins, such as dicloxacillin, nafcillin

• Cephalosporins, such as cefaclor, cefuroxime, cefoxitin

• Aminoglycosides, such as gentamicin

• Quinolone, such as ciprofloxacin

Necrotizinng Cellulitis:

Popularized in the press as a “flesh-eating” disease, this rare condition starts off looking like cellulitis. Early on, the affected area is hot, swollen, red, and painful. Rapidly the area becomes purple and, as tissues die, they blacken. Patients experience fever, shock, a drop in blood pressure, and organs fail. Gas bubbles, called gas gangrene, may be present under the skin. In the absence of immediate treatment, the mortality rate ranges from 20 to 50 percent.

Treatment involves the surgical removal of dead tissues and the intravenous injection of multiple antibiotics that are capable of combating a wide range of different bacteria. These include the drugs used to treat cellulitis.

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Blood clotting prevents us from bleeding too much after an injury. However, when clots form abnormally within blood vessels, they may impede the flow of blood and cause potentially life-threatening consequences in the brain (stroke), in the heart (heart attack), in the lungs (thrombosis), and elsewhere in the body.

Let’s take a quick look at the three stages by which the body acts to prevent blood loss:

• A broken blood vessel constricts, reducing the loss of blood.

• Platelets in the blood stick to each other and to proteins in the walls of injured blood vessels to form a platelet plug. For small wounds, this may be adequate to stem blood loss.

• For larger wounds, the plug must be reinforced and strengthened. Fibers of a blood protein called fibrin are produced, then trap platelets, blood cells, and plasma to form a clot. Coagulation is the formation of a clot. Thrombin is needed for fibrin formation.

Blood-Clotting Drugs & Medicines: An Overview

Two primary kinds of drugs are used for the treatment of abnormal blood-clotting conditions in the legs and lungs, and each works in a different way:

• Blood thinners or anticoagulants (such as warfarin and heparin) interfere with the coagulation of blood by preventing the formation of fibrin.

• Clot-dissolvers or fibrolytic drugs (such as alteplase [tPA] and streptokinase) promote the breakdown of fibrin, which causes the dissolution of the clot.

Blood Thinners (Anticoagulants):

Blood thinners, also called anticoagulants, are taken by mouth (warfarin) or by injection (heparin). Although they are both used to treat the same condition, they work in dramatically different ways.

Oral Anticoagulants: Warfarin

Warfarin (Coumadin) is used on a chronic basis to prevent abnormal clot formation, in particular, in veins where blood flow tends to be slow.

This may happen during prolonged periods of bed rest or extended plane flights. When they occur in the deep veins in the legs, the condition is called deep vein thrombosis (DVT). After such clots form, they may break away, and travel to and lodge themselves in such sites as the lungs (this is called a pulmonary embolism) where they block blood flow.

This may lead to death of lung tissue and can be fatal. Warfarin is also used on an ongoing basis to prevent clot formation in patients with artificial heart valves or abnormal heart rhythms (atrial fibrillation) when there is a high risk of stroke. Because warfarin’s peak effects are not seen for days,it cannot be used to treat emergency problems; in these cases, heparin-like drugs are used.

Warfarin works by blocking the effects of vitamin K, a vitamin essential for the manufacture of clotting factors. Its effects may not be seen for up to several days after the drug has been started, and its effects continue for several days after the drug has been discontinued.

Missed Doses:

If a dose is missed,it should be taken as soon as possible, and the regular dosing schedule resumed. If the missed dose is not realized until the following day, forget the missed dose and don’t double the next dose. Doubling the dose may increase the risk of bleeding. Just return to the regular dosing schedule.

Overdoses:

Bleeding is the major problem caused by excessive doses of warfarin. Patients using anticoagulants should know the signs of overdoses and, if they appear, contact their doctor immediately.

These signs include bleeding from the gums when brushing teeth, sudden nose- bleeds, skin bruising or purplish blotch- ing of the skin, unusually heavy bleeding from cuts or wounds or during menstrual bleeding.

Signs of internal bleeding include abdominal or stomach pain or swelling; backaches; blood in the urine; bloody or tarry stools; coughing upor vomiting blood; constipation; severe and long- lasting headaches; joint pain, swelling, or stiffness.

Bleeding caused by excessive doses of warfarin can be stopped with vitamin K1 (phytonadione), which can be taken by mouth or injection.

Common Side Effects:

Do not use warfarin if pregnant. It has been shown to cause bleeding in the fetus, resulting in deformities and even death.

In addition, warfarin should not be used by people with a vitamin K deficiency, liver disease, alcoholism, deficiency of platelets (thrombocytopenia), or uncontrollable bleeding. Warfarin should not be used during or immediately after surgery of the brain, spinal cord, or eye, or by patients having lumbar puncture (spinal tap) or regional anesthesia.

Use warfarin with great caution if you have gastrointestinal ulcers or severe high blood pressure.

Drug-Drug and Drug-Food Interactions:

A large number of medicines-both prescription and OTC-may increase or decrease the effects of blood thinners. Check with your doctor or pharmacist before taking any new drugs or discontinuing old ones. These include prescription and OTC drugs and dietary supplements.

Drugs that may increase the effects of warfarin and increase the risk of bleeding include the following:

• Acetaminophen

• Alcohol

• Antibiotics (oral)

• Aspirin

• Cimetidine

• Clofibrate

• Disulfiram

• Heparin

• Phenylbutazone

• Sulfa drugs

Drugs that may decrease the effects of warfarin and increase the risk of clotting include the following:

• Barbiturates

• Cholestyramine

• Ginseng

• Green tea

• Griseofulvin

• Rifampin

• St.John’s wort

• Vitamin K

Foods that may decrease the effects of warfarin and increase clotting risks include green, leafy vegetables that are rich in vitamin K.

Injectable Anticoagulants: Heparin-Like

Heparin and warfarin are different in several important ways. Heparin cannot be absorbed into the blood when taken by mouth, nor does it cross the placenta. So, unlike warfarin, heparin can be used during pregnancy. It is administered by intravenous injection or under the skin (subcutaneously).

Unlike warfarin, heparin is a very rapid-acting blood thinner that can be used in emergency situations. It produces effects within minutes after it is injected intravenously and continues working for several hours.

Heparin is used as a blood-thinner to treat blood clots in the lungs, when a stroke is developing, for heart attack, and when blood clots are present in deep veins in the legs. It is also used to prevent clot formation during open-heart surgery and kidney dialysis. Heparin works by inactivating thrombin and other clotting factors that are required for the formation of fibrin. The major risk associated with heparin is bleeding.

If bleeding does occur, as the result of an overdose, intravenous protamine sulfate can be used as an immediate-acting antidote. Signs of bleeding and cautions associated with its use are the same as for warfarin.

In addition, heparin may reduce the levels of platelets in the blood (a.k.a. thrombocytopenia), which increases the risk of bleeding. Drugs that interfere with the function of platelets, in particular aspirin, can further increase this risk.

Heparin is obtained commercially from the lungs of cattle or the intestines of pigs. Individuals who have experienced unusual reactions or allergic responses to pork or beef may be at greater risk for being allergic to heparin. Common signs of allergy include chills, fever, and hives.

New Heparin-Like Drugs:

In recent years, heparin has been broken into smaller units, which are referred to as low-molecular-weight heparins (a.k.a. LMWHs). These drugs can be used for the same conditions as heparin and have several advantages: they work for a longer period of time, give more reliable effects after a dose,and are less likely to reduce blood platelets.

In addition to preventing clot formation in deep leg veins, LMWHs are also used to prevent clots in patients having hip and knee replacement surgery.

Patients receiving LMWHs and undergoing spinal anesthesia or spinal tap are at increased risk of developing long-term or even permanent paralysis. This risk is increased when such individuals are also taking drugs that affect clotting, such as aspirin and related nonsteroidal anti-inflammatory drugs (NSAIDs).

Thrombin Inhibitors:

Thrombin is needed for the formation of fibrin fibers, which serve as the backbone for clots. Thrombin inhibitors, a very new class of drugs, directly and immediately prevent thrombin from working-hence no fibrin fibers and no clot.

Drugs such as desirudin are used to prevent deep-vein clot formation in patients undergoing hip replacement therapy. The full potential of these drugs has yet to be determined.

Clot Dissolvers:

After an injured blood vessel has healed, the body has no further need of the clot and disposes it. Plasmin is an enzyme present in the blood that breaks down fibrin fibers.

Unlike anticoagulants, which prevent the formation of clots, clot dissolvers are enzymes that cause dissolution of clots that have been formed. These drugs, called fibrinolytic or thrombolytic drugs, include alteplace (tPA) and streptokinase.

Clot dissolvers are injected intravenously and are used to break down clots in the heart, lungs, legs, and elsewhere in the body. Their use carries the potential risk of serious bleeding, and their benefits for these conditions have not been clearly proven. Hence, they are generally used only when anticoagulants have not been effective or when gangrene is present in the limb.

To reduce the risk of bleeding throughout the body, clot-dissolving drugs are generally applied directly to the clot. As discussed in the section on heart attacks, they are more often used to dissolve clots blocking blood flow in the arteries in the heart.

Blood Clotting Condition Drugs & Medication:

• Blood thinners (anticoagulants) are used to prevent the development of clots in the body and risk of these clots traveling to the lungs and brain.

• The dose of warfarin, the most widely used oral anticoagulant, must be carefully adjusted to fit the needs of each patient to prevent clotting while reducing the risk of bleeding.

• Persons taking warfarin must be careful to avoid activities that can cause bleeding.

• Persons taking warfarin and heparin must be careful to prevent drug-drug and drug-food interactions.

• Unlike warfarin, heparin-related drugs can be used during pregnancy and when it is necessary to rapidly produce an anticoagulant effect.

• Clot dissolvers (a.k.a. fibrinolytic drugs) are used intravenously to dissolve clots in the legs and lungs when blood thinners are ineffective or gangrene is present in the leg.

Drugs Used to Treat Coagulation Conditions:

.

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Bladder incontinence, also called urinary incontinence, is the inability to control urination. Some of the leading causes of bladder incontinence are diseases, injuries, pregnancy and childbirth, menopause, as a complication of prostate surgery, and drugs. Incontinence mostly affects elderly individuals, and is more common in women than men.

How to Treat Bladder Incontinence with Drugs & Medication:

To better understand this condition, let’s briefly consider how the urinary tract works. Urine is produced by the kidneys and stored in the bladder.

It is eliminated from the body through the urethra, a tube running from the bottom of the bladder. The process of urination is controlled by muscles called sphincters. When the sphincters contract, urine does not flow. When they relax, urine passes.

Types of Incontinence:

There are several types of incontinence, two of the most common being stress incontinence and urge incontinence. Mixed incontinence is a combination of both .

• Stress incontinence is most common in women under 60 and in men who have had prostate surgery. Here, the sphincter does not completely contract, and small amounts of urine may be lost during exercise, coughing, laughing, or sneezing. Pelvic muscle exercises and prescription creams containing estrogen applied to the vagina or oral estrogens are often helpful for use by women after menopause. Specific drug treatments are not available to treat stress incontinence .

• Urge incontinence (also known as bladder over-activity) is most common in older individuals or those with Parkinson’s disease or stroke patients. There is a sudden and intense urge to urinate and urination occurs frequently, including at nighttime. It is caused by an unexpected and unintended contraction of the bladder. Atropine-like drugs relax the bladder, preventing its contraction, and are effective in treating urge incontinence.

Atropine-Like Drugs:

Drugs with atropine-like effects, such as oxybutynin, are the most effective drugs available for the management of urge incontinence. Oxybutynin is available as an immediate-release (IR) tablet and syrup, which is taken three times a day; an extended-release (XL) tablet taken once daily; and a transdermal or skin patch (TDS), applied twice weekly.

Oxybutynin appears to be more effective than tolterodine for urge incontinence, with extended-release tolterodine working better than the immediate-release product. The most common side effect with these drugs is dry mouth, which may be so severe that the user can’t speak or swallow.

Other effects include blurred vision, constipation, indigestion, headache, and drowsiness. Extended-release oxybutynin is more effective than immediate-release in reducing incontinence episodes and it has fewer side effects.

Drug Treatment for Bladder Incontinence:

• Some of the leading causes of bladder incontinence are diseases, injuries, pregnancy and childbirth, menopause, as a complication of prostate surgery, and drugs.

• Urge incontinence, most common in the elderly, is effectively treated with atropine-like drugs, such as oxybutynin.

• Stress incontinence is most common in women under 60and in men who have had prostate surgery.

Drugs Used for Urinary Incontinence:

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Bipolar disorder is characterized by recurrent fluctuations in mood, energy level, and behavioral symptoms. Also called manic-depressive disorder, sufferers experience alternating episodes of mania and depression. The disease has a strong genetic predisposition.

During the manic phase, the mood is extremely elevated (called euphoria). Ideas rapidly come and go, talk is apparently never-ending, and energy levels are high, with no need to sleep. The individual is larger than life, has extreme self-confidence, and may engage in risk-taking behavior.

In severe cases, schizophrenic symptoms may be present, with delusions and hallucinations. The manic phase is followed by a depressive phase, in which the patient has a sad mood, experiences sleep disturbances and decreased energy, among other things.

Bipolar disorder has many variations. These differ based on the severity of the episode and how often the individual cycles between moods. Some individuals simultaneously experience mixed symptoms of mania and depression.

Drug Treatment of Bipolar Disorder: An Overview

Treatment of bipolar disorder has two primary objectives:

• Treatment of the immediate, or acute, condition. The immediate goal is to control the current mood, e.g., calm the patients so that they don’t harm themselves or others .

• Maintenance therapy for preventing or reducing the severity of future manic- depressive episodes.

Lithium, divalproex, and lamotrigine have been shown effective for both acute treatment of bipolar disorder and to prevent mood swings. How they work is not clear. A number of anti-seizure (such as carbamazepine) and anti-psychotic drugs are used as backups. Combinations of drugs are often used, and psychotherapy is used with drugs.

Lithium:

Lithium is the drug of choice for both acute and maintenance therapy. Feelings of extreme mood elevation and increased activity lessen within five to seven days after oral lithium. Maximum benefits do not occur for several weeks.

Until lithium takes hold, severely agitated patients may be given a benzodiazepine anti-anxiety drug. Severe behavioral symptoms are treated with anti-psychotic drugs.

Lithium cautions:

• Toxic effects. Increasing blood levels of lithium are linked to toxicity. Early signs include nausea, vomiting, diarrhea, hand tremors, tired feeling, mental dullness, and excessive urination. Higher levels cause gross tremors, lack of coordination, and seizures.

• Long-term lithium use can depress thyroid function and can cause enlargement of the thyroid gland (goiter).

• Do not use if pregnant or nursing.

• Use with caution. Can cause toxicity in high doses if you have kidney or severe heart disease. Water pills (diuretics) increase the risk of lithium toxicity.

Divalproex:

Divalproex (valproate) is used alone or in combination with lithium for acute and maintenance bipolar therapy. It may be better than lithium for individuals who rapidly cycle between mania and depression and those having mixed symptoms of both mania and depression.

Divalproex is also used to treat epilepsy and migraine.

Divalproex cautions:

• Common side effects. Loss of appetite, nausea, indigestion, mild diarrhea. With long-term treatment, weight gain may occur. Unlike lithium, divalproex does not cause severe toxicity when high doses are taken.

• Do not take. History of liver disease.

• Use with caution. If pregnant, because of potential birth defects. Risk may be reduced by taking folic acid. Pregnant women should discuss drug risks versus benefits of the drug with their doctors.

Lamotrigine:

Originally used as an anti-seizure drug, lamotrigine is used for bipolar disorder, in particular for patients showing strong depression.

Lamotrigine cautions:

• Common side effects. Headache, nausea, dizziness, drowsiness.

• Caution. May cause a potentially life-threatening skin rash. If a rash appears, it may not be possible to predict which are not serious and which are life- threatening. Lamotrigine should be discontinued at the first sign of a rash, unless it is certain that the rash is not caused by the drug.

All About Treating Bipolar Disorder with Drugs & Medication

• Drug treatment of bipolar disorder is intended to control the acute condition and prevent wide mood swings of mania and depression.

• Lithium, divalproex, and lamotrigine have been shown to effectively control and prevent these mood disorders.

Drugs Used for Bipolar Disorder:

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More than six dozen different drugs are used to combat bacterial infections, and they fall into about 10 different classes. Each of these classes has its own distinct characteristics.

Types of Antibacterial Drug:

Your doctor takes the following factors into account when selecting an antibacterial drug for your infection:

• Cause of infection. On the basis of the patient’s signs and symptoms and the results of laboratory tests, the doctor attempts to determine the cause of the infection. If the germ is a bacterium, which one? Because antibacterial drugs don’t work against viruses, they shouldn’t be prescribed .

• Bacterial sensitivity to drug. The doctor selects the drug class and the specific drug that works best against the bacteria. If multiple microbes are causing the infection, particularly a life-threatening infection, a combination of drugs may be needed.

• Patient factors. Use of some drugs during pregnancy or when nursing may expose the fetus or newborn to its potentially harmful effects. Patients allergic to one antibiotic will likely be also allergic to all other members of the same antibiotic class (such as to all penicillins).

  Moreover, they may also be allergic to closely related antibiotics (such as the cephalosporins). Some drugs are mainly eliminated from the body by the kidneys. This could be a problem for individuals with reduced kidney function.

  Many of these drugs are very expensive. Check with your doctor or pharmacist to see whether the same or a comparable drug is available as a generically equivalent product .

• How the drug is given. When the patient is treated at home, an oral medicine is generally prescribed. If a severe infection requires hospitalization, the patient is often started on intravenous therapy for several days. After the infection is brought under control and the patient is “out of the woods,” a longer period of oral drug use may follow.

Antibiotic Resistance:

One of the greatest challenges facing doctors and their patients is the development of microbial resistance to antibiotics. “When we talk about resistance, we are interested in the development of resistance by microbes that were once sensitive to that antibiotic.

With resistance, the drug becomes progressively less effective. Higher doses must be used to fight the injection, which increases the patient’s exposure to the adverse effects of the medicine. In time, the drug may fail to work at all.

This may necessitate the use of more powerful, potentially harmful, and expensive alternatives.

Classes of Antibacterial Medicines:

In this section, we talk about the general properties of the most important classes of antibacterial medicines. These classes include aminoglycosides, carbapenems, cephalosporins, eythromycins, penicillins, quinolones, sulfas, tetracyclines, and the urinary tract antiseptics.

Antibacterial drugs work in several ways to combat microbes:

• Prevention of the manufacture of the cell wall of bacteria, a structure essential for its survival: penicillins, cephalosporins, carbapenems

• Interference with manufacture of proteins required for survival, growth, and reproduction: tetracyclines, erythromycins

• Interference with manufacture of DNA, needed for bacterial cell reproduction: quinolones

Aminoglycosides:

Aminoglycosides, such as gentamicin, are antibiotics that work against only Gram-negative bacteria. Common examples of such bacteria include Escherichia coli and Psudomonas aeruginosa. These bacteria might be responsible for hospital-acquired pneumonia, cellulitis, and severe urinary tract infections.

Most generic aminoglycosides end in “mycin” or “micin,” Because aminoglycosides do not enter the blood after being taken by mouth, they must be given by intravenous or intramuscular injection. Their use is primarily limited to a hospital setting. Some are also applied topically to the eyes to treat conjunctivitis.

Aminoglycosides can cause significant toxicity to the kidneys and to the inner ear, causing permanent hearing loss and dizziness. The dosage must be reduced or doses must be given less frequently to patients with impaired kidney function.

The risk of kidney toxicity is increased when aminoglycosides are used with other drugs capable of causing kidney damage, such as amphotericin B, cephalosporins, polymyxins, and vancomycin.

The risk of damage to the inner ear is increased when used with ethacrynic acid.

Carbapenems:

Imipenem and related carbapenems are active against a wide range of Gram-positive and Gram-negative bacteria that cause infections of the respiratory tract, urinary tract, abdominal area, bone, skin, and blood. They are particularly useful in treating serious infections that are caused by multiple microbes or where the specific microbe has not been identified.

Generic versions of carbapenems have names ending in “penem.”

These drugs do not enter the blood after being taken by mouth. Their use is primarily in a hospital setting because they must be given by intravenous or intramuscular injection. Side effects are few and include nausea and vomiting. Seizures rarely occur.

Cephalosporins:

Cephalosporins are the most widely used class of antibiotics. Asa group, they are effective against a very wide range of Gram-positive and Gram-negative bacteria, cause relatively little toxicity, and can be given by mouth or injection.

Because these drugs are often given to children, palatable, fruit-flavored oral, liquid dosage forms are available.

Name hint: most generic names start with “cef’ or “ceph.”

Over the years, more than 20cephalosporins have appeared on the market,and their activity against different microbes has expanded. These have been differentiated into one of four “generations,” based on when they were introduced and their antimicro- bial activity:

• First generation (such as cephalothin). Primarily active against Gram-positive bacteria (staphylococci, streptococci), with little activity against Gram-negative microbes. Common uses: skin infections and given prior to surgery to prevent infections.

• Second generation (such as cefuroxime). Primarily active against Gram-negative bacteria, with less effectiveness against Gram-positive microbes. Common uses:ear, sinus, respiratory tract, and abdominal infections .

• Third generation (such as cefotaxime). Highly active against Gram-negative bacteria but also effective against Gram-positive microbes. Useful in urinary tract infections.

• Fourth generation (such as cefepime). Even more highly active against Gram-negative bacteria but also effective against Gram-positive microbes.

The first and second-generation drugs are typically backups to preferred drugs, whereas the third- and fourth-generation drugs are first-choice selections in some cases. Unlike first- and second-generation drugs, third- and fourth-generation drugs enter the nervous system and are effective against such infections as meningitis.

In general, cephalosporins are among the safest antimicrobial medicines, with diarrhea a common side effect.

Some people develop allergic reactions to cephalosporins, including a rash that develops after several days. Cephalosporins chemically resemble penicillin, and the rashes are similar to that produced by penicillin. If difficulties in breathing are experienced when taking these drugs, the doctor should be contacted immediately.

The effects of cephalosporins are prolonged by probenecid.

The specific cephalosporins – cefmetazole, cefoperazone, and cefotexan – produce significant alcohol intolerance. Alcohol should not be taken with these drugs. These same medicines increase bleeding tendencies, in particular, when they are used with blood thinners and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin.

Erythromycins:

Erythromycin-like drugs (a.k.a. macrolides) act against the same types of bacteria as penicillin and are a safe alternative for patients who are allergic to penicillin. These include most Gram-positive and some Gram-negative bacteria.

Erythromycins are used as the first-choice medicines for the treatment of such infectious diseases as whooping cough, diphtheria, and Legionnaire’s disease.

Most generic erythromycin-like drugs have names ending in “mycin.” Erythromycins are best taken on an empty stomach (one hour before meals or two hours after) with a full glass of water. Common side effects include indigestion, nausea, vomiting, and diarrhea.

These adverse effects can be minimized by taking the drug with meals. Individuals should notify their doctor, if they have severe abdominal pain, yellow coloration of the eyes or skin, or dark urine. These are signs of drug-caused liver toxicity. Individuals with a history of liver disease should not take these drugs.

Penicillins:

Penicillins were the first class of antibiotics to be discovered and continue to be among the most effective antibiotics and least toxic of all medicines.

The early penicillins were primarily active against Gram-positive cocci, such as Steptococci; these are called the “narrow-spectrum” penicillins. Derivatives have been prepared over the years that are active against both Gram-positive and particularly Gram-negative microbes; these are called “broad-spectrum” penicillins.

The many infectious diseases treated with penicillins include pneumonia, meningitis, tetanus, anthrax, gas gangrene, and syphilis. It is also used in combination with other antibiotics.

Generic penicillins have names ending in “cillin.” Depending on the penicillin derivative, of which there are more than 10, they can be taken by mouth or by intramuscular or intravenous injection.

Whereas penicillins are very safe drugs, their use poses a risk of causing an allergic reaction. Various sources report that anywhere from 1 to 10percent of all individuals are penicillin allergic, although 2 percent may be closer to the mark.

Signs of allergic response may vary in severity from a slight rash to a rare but life- threatening inability to breathe (caused by a constriction of airway passages) and a sudden drop in blood pressure. In such cases, emergency treatment involves an injection of epinephrine, in addition to mechanical support of breathing.

Individuals allergic to one penicillin are likely to be allergic to all other penicillins. If a severe penicillin-allergic reaction is experienced, no penicillin-, cephalosporin-, or carbapenem-like drugs should be taken.

Quinolones:

Quinolones, such as ciprofloxacin, are active by mouth or injection against a wide range of Gram-positive and Gram-negative bacteria. These drugs are primarily used for the treatment of infections caused by Gram- negative bacteria involving the urinary tract, prostate gland, respiratory tract, skin, and bones.

They are also used to treat gonorrhea, anthrax, and respiratory infections caused by Pseudomonas aeruginosa in individuals with cystic fibrosis.

Generic quinolones usually have names ending in “floxacin.”

Side effects are mild and infrequent and include nausea, vomiting, and diarrhea, as well as dizziness and nervousness. On rare occasions, quinolones cause rupture of the tendons. Most often this involves the Achilles tendon and occurs in children under 18.

Drug use should be discontinued at the first sign of pain or inflammation of the tendon. The absorption of quinolones into the blood is reduced by antacids containing aluminum or magnesium, and by iron and zinc salts, and milk and other dairy products.

This interaction may result in a reduction in their antibacterial effectiveness. Quinolones can increase blood levels and the intensity of the effects of theophylline and the blood thinner warfarin. To avoid the risk of adverse effects, the doses of these drugs may have to be reduced.

Sulfa Drugs:

The sulfa drugs (a.k.a. sulfonamides) appeared in the mid-1930s and were the first medicines used for the treatment of bacterial infections. Once widely used, sulfa drugs have been largely replaced by safer and less-toxic antibiotics.

Orally active sulfas, in particular sulfisoxazole, are used to treat urinary tract infections. Topical sulfas are used to treat eye infections (sulfacetamide) and infections associated with burns (silver sulfadiazine).

Generic sulfa drugs usually begin with “sulfa.” Sulfa drugs cause many side effects, which have contributed to their loss of popularity. These include hypersensitivity disorders, including skin rash and excessive sensitivity to sun, and the Stevens-Johnson syndrome, a life-threatening skin disorder. Individuals with a history of sulfa allergies should avoid using these drugs.

Other problems include red blood cell destruction (a.k.a. hemolytic anemia) and the deposition of bilirubin in the brains of newborns, causing brain damage (a.k.a. kernicterus).

Sulfamethoxazole in combination with the antibacterial drug trimethoprim (TMP- SMZ) is used around the world. Uses include urinary tract infections; ear infections; gastrointestinal infections caused by Gram-negative bacteria; and Pneumocystitis carinii infections, a pneumonia often seen in AIDS patients.

The most common side effects with TMP-SMZ are nausea, vomiting, and skin rash. Less commonly seen are the side effects caused by sulfa drugs when used alone.

Tetracyclines:

The tetracyclines, such as doxycycline, are active against a very wide range of microbes including Gram-positive and Gram-negative microbes, Rickettsia, Spirochetes, Chlamydia, Mycoplasma, and Heliobacter pylori.

Their widespread use in the past has led to the development of bacterial resistance, and they are now relegated to being backup drugs for many conditions. All tetracyclines are active orally but can also be given by injection.

Tetracyclines continue to be the first-choice medicines for the treatment of the following:

• Richettsial disorders, including Rocky Mountain spotted fever and typhus fever

• Chlamydia infections such as trachoma and selected sexually transmitted diseases

• Cholera and brucellosis

• Mycoplasma pneumoniae-caused pneumonia, the most common pneumonia in people ages 5 to 35

• Lyme disease and ehrlichioses, tick-borne diseases

• Heliobacterpylori, a stomach-dwelling bacterium that is a major cause of peptic ulcer disease

• Severe acne

Generic names of tetracyclines end in “cycline.”

Gastrointestinal disturbances are the most common side effect, and these include indigestion, nausea, and diarrhea, which can be potentially dangerous.

Tetracyclines readily bind to calcium in newly formed teeth, including those of the fetus. This can lead to yellow-brown discoloration of teeth. If given to children, there is the risk of permanent tooth discoloration. Tetracyclines are not recommended for children under the age of 8.

Tetracyclines can impair liver function, particularly when high doses are given intravenously to pregnant women. These drugs may worsen kidney function, particularly in individuals with a history of kidney disease.

These drugs increase sensitivity to the sun, with a greater risk of severe sunburn. Individuals, particularly those with fair skin, taking tetracyclines should limit their exposure to sun, use sunscreen, and wear protective clothing.

Tetracyclines bind to metals such as calcium, magnesium, aluminum, and iron, which interfere with their absorption into the bloodstream. Antibiotic levels in the blood are reduced, reducing their antibacterial effectiveness. Calcium supplements, most antacids, and iron supplements should be taken one hour before or two hours after tetracyclines.

Milk and other calcium-rich dairy products interfere with tetracycline absorption and lower their blood levels. Food interferes with the absorption of all tetracyclines, except doxycycline and minocycline. Other tetracyclines should be taken one hour before or two hours after meals and with a full glass of water.

Urinary Tract Antiseptics:

After being taken by mouth, urinary antiseptics concentrate in the urine. Their concentrations in the blood are not sufficiently high to treat systemic infections.

Nitrofurantoin is used to treat active urinary tract infections and on a continuous basis to prevent the recurrence of such infections.

Methenamine is only used to prevent infections. Neither drug is useful for the treatment of kidney infections.

Anti-bacterial Drugs Summary:

• Antibacterial drug classes include the aminoglycosides (e.g., gentamicin), carbapenems (imipenem), cephalosporins (cefotaxime), erythromycins (a.k.a. macrolides such as erythromycin), penicillins (ampicillin), quinolones (ciprofloxacin), sulfa drugs (sulfamethoxazole), and tetracyclines (doxycycline).

• Some antibiotics treat infections caused bya limited number of microbes (“narrow-spectrum” antibiotics, such as the aminoglycosides), whereas others are effective against a wide range of different microbes (“broad-spectrum” antibiotics, such as tetracyclines and some cephalosporins and penicillins).

• The development of microbial resistance to antibiotics is the greatest challenge in the successful treatment of infectious diseases.

Drugs Used to Treat Bacterial Infections:

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Attention deficit/ hyperactivity disorder (ADHD) is the most common behavioral disorder in children. It has three characteristic hallmarks: inattentiveness, excessive physical activity (hyperactivity), and impulsive behavior. The first signs are typically seen by the age of 3 but must be seen by 7. It may continue into the adolescent years and even during adulthood.

The reported prevalence of ADHD among school-age children varies considerably among sources, some estimating 3 to 5 percent, whereas others push the range to 4 to 12 percent. Some researchers have questioned whether ADHD is being over-diagnosed.

It is generally agreed that it may be 4- to 8-fold more common in boys than girls. Both genetic and non-genetic factors appear to contribute to this condition.

Drug Treatment of ADHD: An Overview

The most effective treatment approaches combine behavioral measures with medication. ADHD drugs are classified as stimulants and non-stimulants.

Stimulants:

Stimulants, such as methylphenidate and amphetamines, are the first drug choice for treating ADHD. They are very widely
used and have proved effective in improving manyof the ADHD symptoms in 70 to 95 percent of treated children.

Within 30 to 60 minutes after their oral administration, there is a reduction in physical movements and impulsive behavior and an increase in attention span. When given over an extended period of time, academic performance improves.

The drugs are not making kids any smarter but rather they are improving their focus on their schoolwork.

Methylphenidate is the most commonly used drug for ADHD. It is available in tablets that are taken two to three times daily and long-acting tablets taken only once daily. A methylphenidate-containing patch (Daytrana) is also available for once a day use by children 6 to 12.

Common side effects of stimulants include reduced appetite, insomnia, irritability, and stomachache.

Growth may be suppressed or delayed when stimulants are used. This effect may result from the reduction in appetite.

Experts recommend drug-free periods, such as during weekends or school holidays. These breaks provide an opportunity to assess the benefits of treatment and for greater growth to occur. After stimulants are discontinued, children experience a growth spurt, and the final height attained at adulthood is not generally reduced.

Although methylphenidate and the amphetamines are subject to abuse by adolescents and adults, their abuse potential in children doesn’t appear to be an important risk.

Nonstimulants:

Nonstimulants used for ADHD include several antidepressants and atomoxetine. These drugs are backups when stimulants are not effective or cannot be taken.

Imipramine and desipramine, tricyclic antidepressants, must be given for two to four weeks before they provide benefits in ADHD. They primarily reduce excessive activity but dolittle to improve inattention or impulsive behavior. When used over a period of several months, they become less effective.

When taken in excessive doses, tricyclics can produce adverse effects to the heart. However, they do not cause insomnia nor suppress growth.

Selective serotonin-reuptake inhibitors (SSRIs) do not appear to be effective for ADHD.

Atomoxetine (Strattera) is the first non-stimulant approved specifically for the treatment of ADHD. Benefits occur within two to four weeks after treatment begins. Early studies suggest that it may be as effective as the stimulant methylphenidate. Common side effects of atomoxetine include headache, insomnia, dry mouth, and nausea.

Drug-drug interaction: At least two weeks should pass after using a monoamine oxidase inhibitor (MAGI) and atomoxetine.

All About Treating Attention Deficit/ Hyperactivity Disorder (ADHD):

• Stimulants, such as methylphenidate and the amphetamines, are the most effective drugs for treating ADHD.
• Stimulants decrease excessive activity and impulsive behavior and increase attention span.
• Drug-free periods should be instituted for children receiving stimulants.
• Atomoxetine, a nonstimulant effective for ADHD, may, in rare instances, cause severe liver toxicity.

Drugs Used for Treatment of ADHD:

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Autism is a developmental condition, appearing in early childhood, in which there are deficiencies in social relationships, language skills, interpretation of the feelings and thoughts of others, and behavior and control of emotions.

Compulsive and ritualistic routines are common; mental retardation (IQ less than 70) occurs in about 70 percent of afflicted children. Many theories have been offered as to its cause, but to date, none have been proven.

Treatment of Autism with Drugs & Medication: An Overview

It is generally accepted that there is no single best treatment for all children with autism. Treatment approaches include behavioral modification, communication therapy, dietary changes, and drugs. Drugs are used to control the symptoms seen in autism.

They do not modify the underlying causes of this condition. Classes of drugs prescribed for autism include medicines primarily intended for the treatment of depression, psychoses, seizures, and attention-deficit/hyperactivity disorder.

Antidepressant Drugs:

Medications primarily intended to treat depression and obsessive-compulsive disorders (OCD) may reduce the repetitive actions and aggressive behavior seen in autism. Eye contact and social contact may also improve. These medications include antidepressants of the selective-serotonin reuptake inhibitor class (SSRl) and clomipramine.

Common side effects include headache, insomnia, dizziness, and drowsiness.

Anti-psychotic Drugs:

Anti-psychotic medications have been used to lessen increased activity, aggressiveness, and other behavioral problems. In addition, these drugs may decrease the social withdrawal seen in autistic patients.

Common side effects include nervousness, drowsiness, dizziness, headache, restlessness, muscle stiffness, and tremors.

Anti-seizure Drugs:

Medications approved for epilepsy and other seizure conditions often reduce the frequency of seizures that occur in many autistic children. Such medication, however, does not eliminate seizure activity.

Side effects vary with the specific drugs used. The lowest effective doses should be used to avoid potentially severe adverse effects.

Attention-Deficit/Hyperactivity Drugs:

Selective medications with stimulant properties, used for ADHD, such as methylphenidate (Ritalin), may also reduce the impulsive and excessive activity seen in autism.

Common side effects include insomnia, nervousness, loss of appetite, abdominal pains, and increases in blood pressure.

Summary of Treating Autism with Drugs:

• There is no best single treatment for all children with autism, and no drug has been approved by the FDA for its treatment.
• Medications are used to reduce such autistic symptoms as repetitive and aggressive behaviors, social withdrawal, impulsive and excessive activity, and seizures.

Drugs for Treatment of Autism:

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