Aminoglycosides

Drug Dosage Remarks
Gentamicin 5 mg/kg body wt IM 24 hourly Adverse Reactions
  • Ototoxic effects (impaired hearing, dizziness, tinnitus); Renal effects (elevated serum creatinine, oliguria); CNS effects (muscular tics, convulsions, cramps, headache, confusion); Hypersensitivity reactions; Metabolic effects (elevated transaminases, alkaline phosphatases and serum bilirubin, reduced Ca, Mg and K levels); Hematologic effects (anemia, leukopenia, transient agranulocytosis); Other effects (nausea/vomiting, dyspnea, visual disturbances, loss of appetite)
Special Instructions
  • Monitor serum levels and auditory/vestibular function in patients with renal impairment
  • Use with caution in patients with conditions associated with muscle weakness (eg myasthenia gravis, Parkinson’s), patients with pre-existing renal dysfunction, vestibular or cochlear impairment, or hypocalcemia
Kanamycin 1-2 g/day IM divided 12-24 hourly Adverse Reactions
  • Ototoxic effects (irreversible ototoxicity resulting in hearing loss, dizziness, vertigo); Renal effects (reversible nephrotoxicity, acute renal failure when other nephrotoxic drugs have been administered); Neuromuscular effects (neuromuscular paralysis, gait instability); Hypersensitivity reactions
Special Instructions
  • High plasma levels increase the risk of nephrotoxicity and ototoxicity; therefore, monitoring serum concentrations by measuring peak and trough levels is recommended
  • Use with caution in patients with conditions associated with muscle weakness (eg myasthenia gravis, Parkinson’s), patients with pre-existing renal dysfunction, vestibular or cochlear impairment, or hypocalcemia

Antibacterial Combinations

Drug Dosage Remarks
Co-trimoxazole
(Sulfamethoxazole [SMZ] and
Trimethoprim [TM])		 800 mg SMZ/160 mg TM PO 12 hourly x 2 days
Long-term treatment:
400 mg SMZ/80 mg TM PO 12 hourly x ≥14 days		 Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, diarrhea); Dermatological effects (rash, pruritus, photosensitivity); Hypersensitivity reactions (Stevens-Johnson syndrome)
Special Instruction
  • Contraindicated in patients allergic to sulfonamides
  • Use with extreme caution or not at all in patients with hematological disorders especially megaloblastic anemia due to folic acid deficiency
  • Use with caution in patients with renal impairment or severe hepatic dysfunction and those with folate deficiency

Cephalosporins

Drug Dosage Remarks
First Generation
Cefalexin
(Cephalexin)		 250-500 mg PO 6 hourly Adverse Reactions
  • Hypersensitivity reactions (urticaria, pruritus, rash, severe reactions [eg anaphylaxis]); GI effects (diarrhea, nausea/vomiting, rarely antibiotic-associated diarrhea/colitis); CNS effects (headache, vertigo, fatigue); Other effect (candidal infections)
  • High doses may be associated with CNS effects (encephalopathy, convulsions); Rarely hematologic, hepatic and renal effects have occurred
  • Prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), and/or hypoprothrombinemia (with or without bleeding) have been reported and occur most frequently with NMTT side chain-containing cephalosporins
Special Instructions
  • May be taken with food to decrease gastric distress
  • Use with caution in patients allergic to Penicillin, there may be 10% chance of cross sensitivity
  • Use with caution in patients with renal impairment or GI disease (eg colitis)
Second Generation
Cefoxitin 2 g IM as a single dose
Plus
Probenecid 1 g PO as a single dose
Cefuroxime 1 g PO as a single dose or
1.5 g IM as a single dose with Probenecid 1 g PO
Third Generation
Cefdinir 600 mg PO as a single dose or divided 12 hourly
Cefixime 400 mg PO as a single dose
Plus
Azithromycin or Doxycycline1
Cefoperazone 500 mg IM as a single dose
Cefotaxime 500 mg-1 g IM as a single dose
Cefpodoxime 200 mg PO as a single dose
Ceftizoxime 1 g IM as a single dose
Ceftriaxone 250-500 mg IM as a single dose
Plus
Azithromycin or Doxycycline1
Cephalosporin with Beta-lactamase Inhibitor
Cefoperazone/sulbactam 2-4 g/day or 1.5-3 g/day IV/IM divided 12 hourly (1:1) ratio
Max dose: 4 g/day of Sulbactam
Cefuroxime/clavulanate 1 g PO as a single dose
Plus
Probenecid 1 g PO as a single dose
1Please see dosage recommendations under Macrolide and Tetracycline dosage guideline tables.

Chloramphenicols

Drug Dosage Remarks
Chloramphenicol 2-3 g/day slow IV injection divided 6-8 hourly Adverse Reactions
  • Hematologic effects (bone marrow depression, serious/fatal blood dyscrasias); Other effects (GI disturbance, peripheral and optic neuritis)
Special Instructions
  • Avoid use in patients with hypersensitivity to Chloramphenicol
  • Use with caution in patients with hepatic disease, bone marrow depression and kidney malfunction
  • Monitor erythrocyte and leukocyte differential counts every 2-3 days
Thiamphenicol 500 mg PO 8 hourly or
2.5 g/day PO for 1-2 days or
2.5 g PO on the first day followed by
2 g/day PO on the next 4 consecutive days		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea); Other effects (reversible bone marrow depression, peripheral and optic neuritis)
Special Instructions
  • Should be taken on an empty stomach or 1 hour before or 2 hours after meals
  • Avoid use in patients with pre-existing bone marrow depression or blood dyscrasias
  • Use with caution in patients with hepatic and renal impairment
  • Monitor blood counts periodically

Macrolides

Drug Dosage Remarks
Azithromycin If given with cephalosporin:
1 g PO as a single dose
For patients with severe cephalosporin allergy:
2 g PO as a single dose		 Adverse Reactions
  • GI effects (nausea/vomiting, abdominal discomfort, diarrhea and other GI disturbances, antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
  • Hypersensitivity reactions are uncommon (urticaria, pruritus, rash, rarely anaphylaxis); Rarely altered cardiac conduction, hepatotoxicity; Dose-related tinnitus/hearing loss has occurred with some macrolides
Special Instructions
  • May take with food to decrease gastric distress
  • Use with caution in patients with hepatic dysfunction and severe renal impairment
Erythromycin Erythromycin estolate:
250-500 mg PO 6 hourly
Erythromycin ethylsuccinate:
400-800 mg PO 6 hourly
Erythromycin lactobionate:
25-50 mg/kg/day IV divided 6 hourly or 1-2 g/day IV 6 hourly
Erythromycin stearate:
250-500 mg PO 6 hourly		 Adverse Reactions
  • GI effects (nausea/vomiting, abdominal pain, diarrhea); Other effects (seizure, urticaria, anaphylaxis, injection site phlebitis, weakness, ventricular arrhythmia, hearing loss, abnormal LFTs)
Special Instructions
  • May take with food to decrease gastric distress
  • Use with caution in patients with hepatic impairment, myasthenia gravis
  • Avoid in patients with hypersensitivity to Erythromycin, any macrolide antibiotics, or any component of the formulation

Other Antibiotics

Drug Dosage Remarks
Gepotidacin 3 g PO as single dose followed by a second 3 g dose PO after 12 hours Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, abdominal pain, flatulence, soft feces); CNS effects (headache, dizziness, fatigue); Other effect (hyperhidrosis)
Special Instructions
  • Take after meals
  • Avoid use in patients with hypersensitivity to Gepotidacin, history of QTc prolongation, with relevant pre-existing cardiac disease or patients receiving drugs that prolong the QTc interval, severe renal or hepatic impairment, concomitant use of strong CYP3A4 inhibitors
  • Monitor kidney function and electrolytes at baseline and periodically
Rifampicin 900 mg PO as single dose Adverse Reactions
  • Hematologic effects (decreased hemoglobin, disseminated intravascular coagulation, eosinophilia, hemolysis, hemolytic anemia, leukopenia, thrombocytopenia, vitamin K-dependent coagulopathy, bleeding); Other effects (hypersensitivity reactions, increased liver enzymes, exacerbation of porphyria)
Special Instructions
  • Should be taken on an empty stomach
  • Avoid in patients with jaundice, hypersensitivity to Rifampicin, concurrent use with Saquinavir, Saquinavir/Ritonavir combination, Atazanavir, Darunavir, Fosamprenavir, Tipranavir, Praziquantel and Lurasidone
  • Use with caution in patients with DM, porphyria, risk factors for hepatotoxicity, renal and hepatic impairment
Spectinomycin 2 g IM as a single dose
Max dose: 4 g		 Adverse Reactions
  • GI effect (nausea); CNS effects (dizziness, headache, insomnia, fever and chills); Hypersensitivity reactions (urticaria, rarely anaphylaxis)
  • Hematologic effects, alterations in kidney and liver functions occasionally seen with repeated doses
Special Instruction
  • May mask or delay symptoms of incubating syphilis
  • Serologic test for syphilis at the time of gonorrhea diagnosis and 3 months after is advised to all patients being treated for gonorrhea with Spectinomycin
Zoliflodacin 3 g PO as single dose Adverse Reactions
  • Hematologic effects (neutropenia, decreased hemoglobin and monocytes, leukopenia, thrombocytopenia); Dermatologic effects (alopecia, pruritus, rash, tinea); GI effects (abdominal distention, abdominal pain, constipation, diarrhea, nausea/vomiting, flatulence); CNS effects (dizziness, drowsiness, fatigue, headache, hypersomnia, insomnia, malaise); Other effects (hot flash, palpitations, hematuria, candidiasis, increased serum bilirubin and alanine aminotransferase, fever, cough, musculoskeletal pain, night sweats)
Special Instruction
  • Mix granules with water before administration
  • Administration with regards to food is based on body weight:
    • 35-<50 kg: Take on an empty stomach or 1 hour before or 2 hours after meals
    • ≥50 kg: Take with meals
  • Avoid use in patients with hypersensitivity to Zoliflodacin
  • May result in fungal or bacterial superinfection including C difficile-associated diarrhea and pseudomembranous colitis

Other Beta-Lactams

Drug Dosage Remarks
Aztreonam 1 g IM as single dose Adverse Reactions
  • Local injection site reactions (pain, swelling)
Special Instructions
  • Avoid in patients with hypersensitivity to Aztreonam
  • Use with caution in patients with hepatic and renal impairment, pregnancy and lactation
Imipenem/cilastatin 500 mg IM as single dose Adverse Reactions
  • Local injection site reactions (pain, thrombophlebitis)
Special Instructions
  • Avoid in patients with hypersensitivity to components
  • Use with caution in pregnant patients, patients with renal impairment

Penicillins

Drug Dosage Remarks
Benzylpenicillin Na/procaine benzylpenicillin 1.2-2.4 MIU IM as single dose Adverse Reactions
  • Hypersensitivity reactions (rash, urticaria, pruritus, severe reactions [eg anaphylaxis] can occur); GI effects (diarrhea, nausea/vomiting, rarely antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
  • Rarely hematologic effects; renal and hepatic effects have occurred; high doses may be associated with CNS effects (encephalopathy, convulsions)
Special Instructions
  • Avoid in patients with Penicillin allergy
  • Use with caution in patients with renal impairment
Aminopenicillins with or without Beta-lactamase Inhibitors
Amoxicillin
(Amoxycillin)		 3 g PO as a single dose or divided 12 hourly
Amoxicillin/clavulanic acid
(Amoxicillin/clavulanate, Co-amoxiclav)		 375-625 mg PO 8 hourly
Ampicillin 500 mg IM/IV 4-6 hourly or
500 mg 2 doses IM/IV 8-12 hourly or
2-4 g IV infusion 24 hourly in 1 or 2 equal doses over 1-2 hours or
2 g PO as single dose plus Probenecid 1g PO
Ampicillin/sulbactam
(Sultamicillin: Pro-drug of Ampicillin/sulbactam)		 2.25 g PO as single dose or
1.5 g IM/IV as single dose plus
Probenecid 1 g PO or
750-1,500 mg slow IV injection over at least 10-15 minutes or IV infusion over 15-30 minutes or deep IM 6-8 hourly
Max dose: 4 g/day Sulbactam
Antipseudomonal Penicillin with Beta-lactamase Inhibitor
Piperacillin/tazobactam 2 g IM as a single dose
May be given Probenecid 1 g PO 30 minutes prior to injection

Quinolones

Drug Dosage Remarks
Ciprofloxacin 250-500 mg PO as a single dose Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, dyspepsia, diarrhea, rarely antibiotic-associated diarrhea/colitis); CNS effects (headache, dizziness, sleep disorders, restlessness, drowsiness); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity reactions can range from mild (eg rash) to severe/life-threatening (eg Stevens-Johnson syndrome)
  • Rarely hematologic effects; hepatic and renal effects
  • Some quinolones have the potential to prolong the QT interval
Special Instructions
  • Administer at least 2 hours before or 3 hours after Al- or Mg-containing antacids, dietary supplements containing Zn or Fe or buffered Didanosine preparations
  • Avoid exposure to strong sunlight or tanning beds
  • Use with caution in patients with epilepsy or history of CNS disorders, in patients with impaired renal or hepatic function and in those with G6PD deficiency
Levofloxacin 250-500 mg PO 12-24 hourly
Norfloxacin 800 mg PO as a single dose
Ofloxacin 400 mg PO 24 hourly for 7 days
Pefloxacin 400 mg PO 12 hourly
Pipemidic acid 400 mg PO 12 hourly

Tetracyclines

Drug Dosage Remarks
Doxycycline Given with cephalosporin:
100 mg PO 12 hourly x 7 days		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, antibiotic-associated diarrhea/colitis, dysphagia, esophageal ulceration when taken with an insufficient amount of liquid); Dermatologic effect (photosensitivity); Other effects (candidal infections, discoloration of teeth, interference with bone growth in young infants/pregnant women)
  • Rarely renal dysfunction, hepatotoxicity, hematologic effects, increased intracranial pressure with headache and visual disturbances; Hypersensitivity reactions have occurred
Special Instructions
  • Avoid long exposure to sunlight or tanning beds
  • Take with plenty of fluids while sitting or standing and well before retiring to bed
  • Avoid in pregnant women and in patients with SLE
  • Use with caution in patients with renal or hepatic impairment
Minocycline Initially 200 mg PO then 100 mg PO 12 hourly for at least 4 days
Tetracycline 250-500 mg PO 6-12 hourly

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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