Monthly Archives: April 2013

Kids and OTC Medicines Kids Should NOT Take!

FDA Statement: “Aside from drugs for fever or pain, most over-the-counter products haven’t actually been studied in children for effectiveness, safety, or dosing.”

In a recent poll conducted by University of Michigan C.S. Mott Children’s Hospital, 40 percent of parents are giving some_drugs_are_not_for_childrenchildren under the age of 4 over the counter cold medicines, even after the FDA issued a warning that OTC medicines should not be used in this age group.  Twenty Five percent of these parents gave their child decongestants!

Manufacturers of OTC cold medicines changed their warning labels in 2008 to reflect the dangers of giving these medicines to young children, Six years of age and under.

One of the problems is that the medicines themselves are still labeled “Children’s” medication, and just like the issue with “Baby” aspirin, parents don’t think to read the label and they assume the product is safe for all children when in fact, it is not.

(Currently, there is no longer a product packaged or marketed as “baby aspirin” because in 2011, the National Reye’s Syndrome Foundation met with the FDA, stressing the danger in using the term “baby” in representing low-dose aspirin. FDA and aspirin manufacturers agreed, and there is no such thing as ‘baby’ aspirin anymore, and children are safer because of this change.)

The side effects from use of cough and cold medicines in young children may include:

  • allergic reactions
  • increased or uneven heart rate
  • drowsiness or sleeplessness
  • slow and shallow breathing
  • confusion or hallucinations
  • convulsions
  • nausea
  • constipation.

“Products like these may work for adults, and parents think it could help their children as well. But what’s good for adults is not always good for children,” says Dr Matthew Davis, Director of the C.S. Mott Children’s Hospital National Poll on Children’s Health.

READ. THE. LABEL.learn_to_read_labels

OTC drugs have information on the bottle or box. Always read this information before using the medicine. This information tells you:

How much to give; Medication doses for infants and young children are based on age and weight. Know your child’s weight.

Follow the directions for age and weight. If the recommended age is not your child’s age, don’t give the medicine.

If no dose is given on the bottle or package for children under 12 years old, ask your doctor or pharmacist if it is OK to give the medicine to your child, how much you should give, and when you should give it.

Liquid medicines usually come with a cup, spoon or syringe to help measure the right dose. Always use these devices to give medicine to infants and very young children. Using a kitchen teaspoon is not an accurate way to measure. A teaspoon is usually considered to be 5 cc or 5 mL, but kitchen teaspoons can vary in size from between 2 mL and 10 mL.

If you want to mix medicine with milk or formula, first put the medicine in one ounce of milk and have the child drink it all. Then feed the remaining formula or milk in the bottle and let them finish however much more they want.

Always measure or give medication with a good light turned on. Insufficient light could cause you to give the wrong medicine or the wrong dose.

Never let young children take medicine by themselves.

How often to give Medicines; Some medicines state every 6 hours, or every 8 hours. Does this mean ‘waking’ hours; hours when the child is awake, or actual hours as around the clock? Ask your Pharmacist this question so you know exactly when to give your child the medicine. Then keep track of the times you give the medicine to your child on a chart tapped to your refridgerator, or the location the medication is stored.

What the drug contains – Be certain you are not double dosing your child!

Many OTC cough and cold medicines contain a combination of ingredients to treat several symptoms. Your child might be getting some of the same ingredients in other medicines. For example, Tylenol and Nyquil contain the same ingredient, acetaminophen. Be sure to read the list of active ingredients (the ingredients that make the medicine work) for each OTC medicine you give your child to make sure he or she is not getting a double dose of the same medication. You need to make sure that the total amount of a medicine does not exceed the recommended dose.

Combinations of medicines found in multi-symptom medicines may cause side effects in children. The combination of antihistamines and decongestants in some “cold remedy” medicines can have side effects such as hyperactivity, sleeplessness and irritability in children. To be safe, don’t combine prescriptions, supplements or multi-symptom medicines without checking with your health care provider or pharmacist.

Watch The Ingredients List:

Sometimes the ingredients for a medicine change but the name stays the same. For example, the formulation of Kaopectate, an OTC medicine for diarrhea, changed so it now contains bismuth subsalicylate. The older versions contained only kaolin and pectin. (Bismuth subsalicylate is also found in Pepto-Bismol, an OTC medicine for upset stomach and diarrhea.) Bismuth subsalicylate is NOT recommended for children younger than 19 because of the risk of the rare but deadly condition; Reye’s Syndrome.

Because of Reye’s syndrome, DO NOT give a child younger than 19 any product with aspirin or similar drugs called “salicylates” unless your doctor tells you to. Instead of aspirin or other salicylates, you can give your child acetaminophen (sold as Tylenol and other brands). There are many names for aspirin (salicylates) and you can see the list here: https://reyessyndrome.wordpress.com/2012/12/30/other-names-for-aspirin/

Be sure to take into consideration the concentrations of ingredients when you determine the amount you give your child. Medicines with the same brand name can be sold in different strengths, including infant, children and adult formulas. Infant drops of some medicines, for example, are stronger than the liquid elixir of the same medicine for toddlers or children. This is because infants may not be able to drink a large volume of medicine to give their proper dosage. Don’t make the mistake of giving higher doses of the infant drops to a toddler thinking the drops are not as strong.

Warnings about using the drug: Always Read the ‘Black Box’ – the warnings box!

If the drug is safe for children of certain ages: If your child’s age is not listed, do not use the product. One exception to age, is the Reye’s Syndrome warning on labels: The National Reye’s Syndrome Foundation collects Case Reports of Reye’s Syndrome and has found that Reye’s predominately attacks children up to the age of 19, whereas the FDA label only states age 12. Don’t use aspirin or aspirin containing products in children under the age of 19.

And if you are not sure – Ask the Pharmacist at the store. They will be happy to help you!

Other Tips:

Talk to your doctor, pharmacist, or nurse to find out what mixes well and what doesn’t. Medicines, vitamins, supplements, foods and beverages don’t always mix well with one another. Select products with the fewest number of ingredients needed to treat your symptoms.

Talk to your Doctor or Pharmacist before giving a child a ‘home remedy’, or homeopathic drug found on the Internet!  Many of these are quite harmful, and have no professional approval to use.  Know what you are giving your child, otherwise, it could be deadly!

Don’t call medications “candy.” If children come upon medications at a later time, they may consider it “candy” and eat it without your knowing.

Always use child-resistant caps and store medicines in a safe place. Relock the cap after each use. Be especially careful with any products that contain iron; they are the leading cause of poisoning deaths in young children. All medications become less effective (expire) over time and should be replaced. Check the expiration date before using any product.

Store medicines in a cool, dry area. The heat from kitchens and the moisture from bathrooms decrease the effectiveness of medications.  Store all medications out of the reach of children.

Before you give a medicine, check the outside packaging for damage such as cuts, slices, or tears; check the label on the download_free_medication_chartinside package to be sure you have the right medicine. Make sure the lid and seal are not broken. Check the color, shape, size and smell of the medicine. If you notice anything different or unusual, talk to a pharmacist or your health care provider.

Use a chart to keep track of dosage dates and times.  A Free Chart can be downloaded by clicking here.

Classes of OTC Medicines

Analgesics treat pain and fever:

Use caution with different forms of these drugs, because some are more concentrated than others. Common analgesics for infants and children are acetaminophen (Tylenol) and ibuprofen (Advil and Motrin).

WARNINGS:

  • DO NOT give aspirin to children younger than 19, because it can cause a rare but deadly disease called Reye’s Syndrome.
  • DO NOT use ibuprofen in children younger than 6 months. Know how much your child weighs before giving ibuprofen.

Antihistamines treat runny noses, itchy eyes and sneezing caused by allergies (but not colds). Some can cause sleepiness. Examples of antihistamines include brompheniramine (often in combination with decongestants such as phenylephrine as in Dimetapp and other medicines); chlorpheniramine (Chlor-Trimeton and other medicines); diphenhydramine (Benadryl and other medicines); cetrizine (Zyrtec); and loratadine (Claritin and other medicines).

WARNINGS:

  • These are not recommended for children younger than 6, because they can even affect learning.
  • Use only with your health care provider’s advice in young infants or children with asthma.

Expectorants and combination cough medications may help loosen mucus. Cough suppressants numb the reflex to cough. Coughing is necessary to clear mucus and debris bacteria from the lungs, so check with your child’s health care provider before using cough-suppressing syrups. Guaifenesin, an expectorant, promotes the production of thin mucus that is more easily removed by coughing.

WARNINGS:

  • These are not recomended for children under the age of 6.

Decongestants can relieve stuffiness caused by allergies or colds by temporarily shrinking the membranes in the nose to make breathing easier. They should not be used for more than two to three consecutive days. Decongestants taken by mouth can have a number of side effects such as irritability, sleeplessness, dizziness. Examples of decongestants include phenylephrine (found in Neo-Synephrine nose drops and other medicines); and pseudoephedrine (Sudafed, PediaCare Infant Decongestant Drops and other medicines).

WARNINGS:

  • These are not recommended for children under the age of 6.

Medicines for diarrhea. These are usually not necessary. Instead, give your child plenty of fluids and let the disease run its course. Diarrhea, however, can be dangerous in newborns and infants. In small children, severe diarrhea lasting just a day or two can lead to dehydration. Because a child can die from dehydration within a few days, you should see a health care provider as soon as possible if an infant has diarrhea. Talk to your provider before giving these medicines to infants or children.

WARNINGS:

  • Diarrhea medicines containing bismuth subsalicylate (Pepto-Bismol, Kaopectate, and other medicines) should NOT be given to a child younger than 19, as these could trigger Reye’s Syndrome, a deadly disease in children.
  • Loperamide (Imodium and other medicines), should NOT be given to a child younger than 6.

Laxatives relieve constipation and work by several methods. Some add fiber or water to stool to make it more bulky and easier for intestines to eliminate it; some coat the surface of the stool to make it more slippery; some soften the stool so it passes more easily; and others cause the intestines to contract more forcefully. Examples of laxatives include glycerin suppositories; magnesium citrate; magnesium hydroxide (Milk of Magnesia and other medicines); mineral oil (Agoral, Kondremul and other medicines); psyllium (Metamucil, Fiberall and other medicines); senna (Senokot, Ex-Lax and other medicines); methylcellulose (Citrucel and others), castor oil, and sodium phosphate (Fleet and other medicines).

WARNINGS:

  • DO NOT give infants or children laxatives without talking to your child’s health care provider.

Summary:
Aside from drugs for fever or pain, most over-the-counter products haven’t actually been studied in children for effectiveness, safety, or dosing.

  • When you give medicine to your child, be sure you’re giving the right medicine and the right amount.
  • Read and follow the label directions.
  • Use the correct dosing device. If the label says two teaspoons and you’re using a dosing cup with ounces only, don’t guess. Get the proper measuring device. Don’t substitute another item, such as a kitchen spoon.
  • Talk to your doctor, pharmacist, or other health care provider before giving two medicines at the same time. That way, you can avoid a possible overdose or an unwanted interaction.
  • Follow age and weight limit recommendations. If the label says don’t give to children under a certain age or weight, don’t do it.

Resources:
National Reye’s Syndrome Foundation, Food and Drug Administration, CDC, National Institutes of Health

Related Information:
What Is Reye’s Syndrome
Aspirin and Reye’s Syndrome
Other Names for Aspirin
Teens & Aspirin
Chicken Pox Parties
Herbal Remedies

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Effectiveness of Sunscreen Products

On June 14, 2011 the U.S. Food and Drug Administration (FDA) announced new requirements for sunscreens currently sold over-the-counter (OTC) (i.e. non-prescription). These requirements support the Agency’s ongoing efforts to ensure that sunscreens meet modern-day standards for safety and effectiveness.

sunscreen_broad_spectrumPrior rules on sunscreens dealt almost exclusively with protection against sunburn, which is primarily caused by ultraviolet B (UVB) radiation from the sun, and did not address ultraviolet A (UVA) radiation, which contributes to skin cancer and early skin aging. After reviewing the latest science, FDA determined that sufficient data are available to establish a “broad spectrum” test for determining a sunscreen product’s UVA protection. Passing the broad spectrum test shows that the product provides UVA protection that is proportional to its UVB protection.

Sunscreen products that pass the broad spectrum test are allowed to be labeled as “Broad Spectrum.” These “Broad Spectrum” sunscreens protect against both UVA and UVB rays. Scientific data demonstrated that products that are “Broad Spectrum SPF 15 [or higher]” have been shown to reduce the risk of skin cancer and early skin aging when used with other sun protection measures, in addition to helping prevent sunburn. Other sun protection measures include limiting time in the sun and wearing protective clothing.

These measures are necessary, says Lydia Velazquez, PharmD, in FDA’s Division of Nonprescription Regulation Development, because “our scientific understanding has grown. We want consumers to understand that not all sunscreens are created equal.”

“This new information will help consumers know which products offer the best protection from the harmful rays of the sun,” Velazquez says.  “It is important for consumers to read the entire label, both front and back, in order to choose the appropriate sunscreen for their needs.”

Everyone is potentially susceptible to sunburn and the other detrimental effects of exposure to UV radiation.

Products that pass the broad spectrum test will provide protection against both ultraviolet B radiation (UVB) and ultraviolet A radiation (UVA).  Sunburn is primarily caused by UVB.  Both UVB and UVA can cause sunburn, skin cancer, and premature skin aging.  A certain percentage of a broad spectrum product’s total protection is against UVA.

Under the new regulations, sunscreen products that protect against all types of sun-induced skin damage will be labeled “Broad Spectrum” and “SPF 15” (or higher) on the front.

The new labeling will also tell consumers on the back of the product that sunscreens labeled as both “Broad Spectrum” and “SPF 15” (or higher) not only protect against sunburn, but, if used as directed with other sun protection measures, can reduce the risk of skin cancer and early skin aging. For these broad spectrum products, higher SPF (Sun Protection Factor) values also indicate higher levels of overall protection.

By contrast, any sunscreen not labeled as “Broad Spectrum” or that has an SPF value between 2 and 14, has only been shown to help prevent sunburn.

In addition to the final regulations, in June 2011 FDA proposed a regulation that would require sunscreen products that have SPF values higher than 50 to be labeled as “SPF 50+.” FDA does not have adequate data demonstrating that products with SPF values higher than 50 provide additional protection compared to products with SPF values of 50.

FDA also requested data and information on different dosage forms of sunscreen products.  The agency currently considers sunscreens in the form of oils, creams, lotions, gels, butters, pastes, ointments, sticks, and sprays to be eligible for potential inclusion in the OTC sunscreen monograph – meaning that they can be marketed without individual product approvals.

The agency currently considers wipes, towelettes, powders, body washes, and shampoo not eligible for the monograph. Therefore, they cannot be marketed without an approved application.

For sunscreen spray products, the agency requested additional data to establish effectiveness and to determine whether they present a safety concern if inhaled unintentionally.  These requests arose because sprays are applied differently from other sunscreen dosage forms, such as lotions and sticks.

In addition, FDA issued a draft guidance to help sunscreen manufacturers understand how to label and test their products in light of the final and proposed regulations and the data request on dosage forms.

Sun Safety Tips

Spending time in the sun increases the risk of skin cancer and early skin aging.  To reduce this risk, consumers should sun_plus_must_havesregularly use sun protection measures including:

  • Use sunscreens with broad spectrum SPF values of 15 or higher regularly and as directed.
  • Limit time in the sun, especially between the hours of 10 a.m. and 2 p.m., when the sun’s rays are most intense.
  • Wear clothing to cover skin exposed to the sun; for example, long-sleeved shirts, pants, sunglasses, and broad-brimmed hats.
  • Reapply sunscreen at least every 2 hours, more often if you’re sweating or jumping in and out of the water.
  • Hydrate!  Drink lots of water and good fluids! (Soda products will just make you more thirsty, so try homemade lemonade or iced tea, or just plain water.
  • Wear protective eye ware! Even children should wear real sunglasses with UV protection, not just those play sunglasses.

Located here, are a couple of helpful videos.

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Sunscreen; Children & Teens

Sun safety is never out of season. Summer’s arrival means it’s time for picnics, trips to the pool and beach—and a spike in the number of sunburns. But winter skiers and fall hikers should be as wary of the sun’s rays as swimmers. People who work outdoors need to take precautions, too.

The need for sun safety has become clearer over the past 30 years. Studies show that exposure to the sun can cause skin cancer. Harmful rays from the sun—and from sunlamps and tanning beds—may also cause eye problems, weaken your immune system, and give you skin spots, wrinkles, or “leathery” skin.

Sun damage to the body is caused by invisible ultraviolet (UV) radiation. People recognize sunburn as a type of skin damage caused by the sun. Tanning is also a sign of the skin reacting to potentially damaging UV radiation by producing additional pigmentation that provides it with some—but often not enough—protection against sunburn.

Whatever our skin color, we’re all potentially susceptible to sunburn and other harmful effects of exposure to UV radiation. Although we all need to take precautions to protect our skin, people who need to be especially careful in the sun are those who have

  • pale skin
  • blond, red, or light brown hair
  • been treated for skin cancer
  • a family member who’s had skin cancer

If you take medicines, ask your health care professional about sun-care precautions; some medications may increase sun sensitivity.

Reduce Time in the Sun

It’s important to limit sun exposure between 10 a.m. and 2 p.m., when the sun’s rays are strongest. Even on an overcast day, up to 80 percent of the sun’s UV rays can get through the clouds. Stay in the shade as much as possible throughout the day.

Dress with Care

Wear clothes that protect your body. If you plan on being outside on a sunny day, cover as much of your body as smart_sun_sense_childrenpossible. Wear a wide-brimmed hat, long sleeves, and pants. Sun-protective clothing is now available. However, FDA only regulates such products if the manufacturer intends to make a medical claim. Consider using an umbrella for shade.

Be Serious about Sunscreen

Check product labels to make sure you get

  • a “sun protection factor” (SPF) of 15 or more. SPF represents the degree to which a sunscreen can protect the skin from sunburn.
  • “broad spectrum” protection—sunscreen that protects against all types of skin damage caused by sunlight
  • water resistance—sunscreen that stays on your skin longer, even if it gets wet. Reapply water-resistant sunscreens as instructed on the label.

Look For:  Active Ingredients: Zinc Oxide, Titanium Dioxide, Mexoryl SX, or Avobensone(3%)

Look For:  SPF of 15 to 50, depending on your skin tone and the sun’s intensity – being near or in the water, or taking a walk through a wooded park.

Look For:  Lotions, not sprays or powdered formulas – you have more control over coverage.

Look For:  A Water Resistant formula for the beach or swimming pool, or for boating.

Avoid:  Salicylates – Salicylates were first used in cosmetics as Benzyl salicylates. Currently octyl salicylate is the major salicylate component of sunscreen.  Salicylates protect against a small part of the UVB spectrum and must be used in high concentrations. They are aspirin-like substances.

With the increased use of sunscreens it is not surprising that there has been an increase in reports of adverse reactions to sunscreens.

Avoid: Vitamin A (retinyl palmitate) which causes skin cancer in laboratory tests.

Avoid: Oxybensone – a hormone disruptor and skin allergen

Avoid: High SPF’s – it is misleading and offers little additional benefits

Tips for Applying Sunscreen

  • Apply the recommended amount evenly to all uncovered skin, especially your lips, nose, ears, neck, hands, and feet.
  • Apply sunscreen 15 minutes before going out in the sun.
  • If you don’t have much hair, apply sunscreen to the top of your head, or wear a hat.
  • Reapply at least every two hours.
  • Give babies and children extra care in the sun. Ask a health care professional before applying sunscreen to children under 6 months old.
  • Apply sunscreen to children older than 6 months every time they go out.

Protect the Eyes

Sunlight reflecting off snow, sand, or water further increases exposure to UV radiation and increases your risk of developing eye problems.

Tips for eye-related sun safety include:

  • When buying sunglasses, look for a label that specifically offers 99 to 100 percent UV protection.childrens_sunglasses
  • Eye wear should be labeled “sunglasses.” Otherwise, you can’t be sure they will offer enough protection.
  • Pricier sunglasses don’t ensure greater UV protection.
  • Ask an eye care professional to test your sunglasses if you don’t know their level of UV protection.
  • People who wear contact lenses that offer UV protection should still wear sunglasses.
  • Wraparound sunglasses offer the most protection.
  • Children should wear real sunglasses (not toy sunglasses!) that indicate the UV protection level.

Never give a child up to the age of 19 aspirin or aspirin containing products because you could trigger a deadly disease known as Reye’s Syndrome.

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Kids and Sunscreen (Infants)

You’re at the beach, slathered in sunscreen. Your 5-month-old baby is there, too. Should you put sunscreen on her? Not usually, according to Hari Cheryl Sachs, M.D., a pediatrician at the Food and Drug Administration (FDA).

The best approach is to keep infants under 6 months out of the sun,” Sachs says, “and to avoid exposure to the sun in the hours between 10 a.m. and 2 p.m., when ultraviolet (UV) rays are most intense.”  infants_and_sunscreen

Sunscreens are recommended for children and adults. What makes babies so different?

For one thing, babies’ skin is much thinner than that of adults, and it absorbs the active, chemical ingredients in sunscreen more easily, explains Sachs. For another, infants have a high surface-area to body-weight ratio compared to older children and adults. Both these factors mean that an infant’s exposure to the chemicals in sunscreens is much greater, increasing the risk of allergic reaction or inflammation.

The best protection is to keep your baby in the shade, if possible, Sachs says. If there’s no natural shade, create your own with an umbrella or the canopy of the stroller.

If there’s no way to keep an infant out of the sun, you can apply a small amount of sunscreen—with a sun protection factor (SPF) of at least 15—to small areas such as the cheeks and back of the hands. Sachs suggests testing your baby’s sensitivity to sunscreen by first trying a small amount on the inner wrist.

Cover Up

The American Academy of Pediatrics (AAP) suggests dressing infants in lightweight long pants, long-sleeved shirts, and brimmed hats that shade the neck to prevent sunburn. Tight weaves are better than loose. Keep in mind that while baseball caps are cute, they don’t shade the neck and ears, sensitive areas for a baby.

Summer’s heat presents other challenges for babies.

Younger infants also don’t sweat like we do, Sachs says. Sweat naturally cools the rest of us down when we’re hot, but babies haven’t yet fully developed that built-in heating-and-cooling system. So you want to make sure your baby doesn’t get overheated.

In the heat, babies are also at greater risk of becoming dehydrated. To make sure they’re adequately hydrated, offer them their usual feeding of breast milk or formula, says Sachs. The water content in both will help keep them well hydrated. A small of amount water in between these feedings is also okay.

sun_hat_baby

Make this oh-so-cute Sun Hat for Baby!

Here are some things to keep in mind this summer when outside with infants:

Keep your baby in the shade as much as possible. If you do use a small amount of sunscreen on your baby, don’t assume the child is well protected.

  • Make sure your child wears clothing that covers and protects sensitive skin. Use common sense; if you hold the fabric against your hand and it’s so sheer that you can see through it, it probably doesn’t offer enough protection.
  • Make sure your baby wears a hat that provides sufficient shade at all times.
  • Watch your baby carefully to make sure he or she doesn’t show warning signs of sunburn or dehydration. These include fussiness, redness and excessive crying.
  • Hydrate! Give your baby formula, breast milk, or a small amount of water between feedings if you’re out in the sun for more than a few minutes. Don’t forget to use a cooler to store the liquids.
  • Take note of how much your baby is urinating. If it’s less than usual, it may be a sign of dehydration, and that more fluids are needed until the flow is back to normal.
  • Avoid sunscreens containing the insect repellent DEET on infants, particularly on their hands. Young children may lick their hands or put them in their mouths. According to AAP, DEET should not be used on infants less than 2 months old.
  • If you do notice your baby is becoming sunburned, get out of the sun right away and apply cold compresses to the affected areas.
  • Make sure you talk with your pediatrician, or pharmacist if your baby is taking medications of any kind.  Sun and some Medications can cause bad interactions.
  • Never give an Infant or Child under the age of 19 aspirin, or use aspirin (salicylate) containing products as it could trigger Reye’s Syndrome, a deadly disease.

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Antibiotics – Don’t Take This With That!

Antibiotics are medicines that help stop bacterial infections. Protect yourself and your family by taking them correctly. There are times when you should and when you should not take antibiotics.

In children, antibiotics are the most common cause of emergency department visits for adverse drug events. Rest, fluids, and over-the-counter products may be your or your child’s best treatment option.

And NEVER give a child under the age of 19 aspirin or aspirin containing products, as it could trigger Reye’s Syndrome, a deadly disease!

The main types of germs that cause infections:antibiotics_dttwt

Viruses and bacteria are the two main types of germs that cause infection.

Antibiotics cannot kill viruses but can kill bacteria. Viral infections should not be treated with antibiotics.

Viral illnesses include:

  • Common cold – stuffy nose, sore throat, sneezing, cough headache.
  • Influenza (flu) – fever, chills, body aches, headache, sore throat, dry cough.
  • Many coughs.
  • Acute bronchitis (cough, fever) – almost always caused by viruses.
  • Pharyngitis (sore throat) – most sore throats are caused by viruses and are not effectively treated with an antibiotic.
  • Viral gastroenteritis.

Bacterial infections should be treated with antibiotics. Bacterial infections can include:

  • Ear infections – antibiotics are used for most, but not all ear infections.
  • Severe sinus infections – lasting two or more weeks.
  • Strep throat.
  • Urinary tract infection.

Antibiotics can sometimes interact with other medicines or other substances. This means that the effects of one of the medicines can be altered by the other.

Some of the more common interactions are listed below. However, this is not a complete list.

If you want to check that your medicines are safe to take with your antibiotics, ask your GP or local pharmacist. You should also always carefully read the patient information leaflet that comes with your medicine.

Combined oral contraceptives

Antibiotics may cause your combined oral contraceptive pill to be less effective at preventing pregnancy.

Women taking combined oral contraceptives should use an extra method of contraception (for example, condoms) while taking the antibiotics and, in some cases, for seven days after finishing the course. Your GP will be able to advise you.

Medications To Avoid:

Penicillin

It is usually recommended that you avoid taking penicillin at the same time as a medication called methotrexate, which is used to treat some types of cancers and severe autoimmune conditions such as the skin condition psoriasis. This is because combining the two medications can cause a range of unpleasant and sometimes serious side effects.

You may experience a skin rash if you take penicillin and a medication called allopurinol, which is used to treat gout.

Cephalosporins

Cephalosporins may not be suitable to take if you are also taking blood-thinning medications such as heparin and warfarin.

If you need treatment with cephalosporins, you may temporarily have to stop taking the blood-thinning medication.

Aminoglycosides

The risk of damage to your kidneys and hearing is increased if you are taking one or more of the following medications:

  • antifungals – used to treat fungal infections
  • cyclosporin – used to treat autoimmune conditions such as Crohn’s disease and given to people who have had an organ transplant
  • diuretics – used to remove water from the body
  • muscle relaxants

However, the risk of kidney and hearing damage has to be balanced against the benefits of using aminoglycosides to treat life-threatening conditions such as meningitis.

Tetracyclines

You should check with your GP or pharmacist before taking a tetracycline if you are currently taking any of the following medications:

  • vitamin A supplements
  • retinoids such as acitretin, isotretinoin and tretinoin used to treat severe acne
  • blood-thinning medication
  • diuretics
  • kaolin-pectin and bismuth subsalicylate (Pepto Bismol) used to treat diarrhea
  • medicines to treat diabetes such as insulin
  • atovaquone used to treat pneumonia
  • antacids used to treat indigestion and heartburn
  • sucralfate used to treat ulcers
  • lithium used to treat bipolar disorder and severe depression
  • digoxin to treat heart rhythm disorders
  • methotrexate
  • strontium ranelate used to treat osteoporosis
  • colestipol or colestyramine used to treat high cholesterol
  • ergotamine and methysergide used to treat migraines

Macrolides

It is highly recommended that you do not combine a macrolide with any of the following medications (unless directly instructed to by your GP), as the combination could cause heart problems:

  • terfenadine, astemizole and mizolastine – which are all antihistamines used to treat allergic conditions such as hay fever
  • amisulpride – used to treat episodes of psychosis
  • tolterodine – used to treat urinary incontinence
  • simvastatin – used to treat high cholesterol

Fluoroquinolones

You should check with your GP or pharmacist before taking a fluoroquinolone if you are currently taking any of the following medications:

  • theophylline, which is used to treat asthma and also found in some cough and cold medicines
  • the non-steroidal anti-inflammatory drug (NSAID) painkillers such as ibuprofen
  • ciclosporin
  • probenecid used to treat gout
  • clozapine used to treat schizophrenia
  • ropinirole used to treat Parkinson’s disease
  • tizanadine used to treat muscle spasms
  • glibenclamide used to treat diabetes
  • cisapride used to treat indigestion, heartburn, vomiting or nausea
  • tricyclic antidepressants, such as amitriptyline, steroid medications (corticosteroids)

Some fluoroquinolones can intensify the effects of caffeine (a stimulant found in coffee, tea and cola), which could make you feel irritable, restless and cause problems falling asleep (insomnia).

Finally, you may need to avoid taking medication that contains high levels of minerals or iron as this can block the beneficial effects of fluoroquinolones. This includes:

  • antacids
  • zinc supplements
  • some types of multivitamin supplements

Antibiotics that can cause Sun Sensitivity include:  Doxycycline, tetracycline, ciprofloxacin, ofloxacin, levofloxacin, trimethoprim. In some people, the sensitivity can last long after the antibiotic regimine is complete.

Phototoxicity. This is the most common type of sun-sensitivity drug reaction. It can occur when skin is exposed to the sun after certain medications are injected, taken orally, or applied to the skin. The drug absorbs the UV light, then releases it into the skin, causing cell death. Within a few days, symptoms appear on the exposed areas of the body. In some people, symptoms can persist up to 20 years after the medication is stopped. Among the most common phototoxic drugs are the tetracycline family, NSAIDs (nonsteroidal anti-inflammatory drugs such as ibuprofen), and amiodarone (Cordarone, a heart medication).

It’s important to note that not every person who uses these drugs has a reaction. If it does happen, it can be a one-time occurrence, or it can happen each time the drug is taken and sun exposure occurs. People with HIV are among the most likely group to experience sun sensitivity to drugs.

Can I drink alcohol when on an antibiotic?

Alcohol is a drug and in combination with other drugs including antibiotics, can cause an interaction with undesirable results. Ask your doctor about your specific medication, but in general, you should avoid combining alcohol with any medication.

A list of ingredients to avoid, (other names for aspirin) can be downloaded here, or you can email the NRSF for a wallet size card(s) you can carry with you when shopping for medications.

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