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ANTIBIOTICS Antibiotics are medications used to treat, and in some cases prevent, bacterial infections.

They can be used to treat relatively mild conditions such as acne as well as potentially lifethreatening conditions such as pneumonia (a type of lung infection). Read more about when antibiotics are used.

How do I take antibiotics


Doses of antibiotics can be provided in several ways:

oral antibiotics tablets pills and capsules or a li!uid that you drin" topical antibiotics creams lotions sprays or drops in!ections of antibiotics they can be given as an in#ection or an infusion through a drip directly into the blood or a muscle

$ow the antibiotic is given will depend on the type of infection. Topical antibiotics are often used to treat s"in infections while oral antibiotics can be used to treat most types of mild to moderate infections in the body. %ntibiotic in#ections are usually reserved for more serious infections and are often given in hospital. &t is essential to finish ta"ing a prescribed course of antibiotics even if you feel better unless a healthcare professional tells you otherwise. &f you stop ta"ing an antibiotic part way through a course the bacteria can become resistant to the antibiotic (see below).

T"pes of antibiotics
There are now hundreds of different types of antibiotics but most of them can be broadly classified into si' groups. These are outlined below. #enicillin (enicillin is widely used to treat certain infections such as s"in infections chest infections and urinary tract infections. )ome widely used types of penicillin include:

amo'icillin fluclo'acillin

%round * in *+ people will have an allergic reaction after ta"ing penicillin and a very small number of people will develop a severe allergic reaction (anaphyla'is).

&t,s important to let your doctor or the health professional treating you "now if you thin" you may be allergic to penicillin. %nother problem with penicillin is that some strains of bacteria have become resistant to it because it has been so widely used. Cep$alosporins -ephalosporins are broad-spectrum antibiotics which means they are effective in treating a wide range of different types of infections including more serious infections such as:

septicaemia infection of the blood pneumonia meningitis infection of the outer protective layer of the brain and spinal cord

.'amples of cephalosporins include:


cefale'in cefi'ime

&f you are allergic to penicillin you may also be allergic to cephalosporins. Amino%l"cosides %minoglycosides are a type of antibiotic that used to be widely prescribed until it was found that they could cause both damage to hearing and the "idneys. /ecause of this they tend now to be used only to treat very serious illnesses such as meningitis. %minoglycosides brea" down !uic"ly inside the digestive system so they have to be given by in#ection or as ear or eye drops. The most widely used aminoglycoside in .ngland is called gentamicin. Tetrac"clines Tetracyclines are another type of broad-spectrum antibiotic that can be used to treat a wide range of infections. They are commonly used to treat severe acne and a condition called rosacea which causes flushing of the s"in and spots. &acrolides 0acrolides are a type of antibiotic that can be particularly useful in treating lung and chest infections.

They can also be a useful alternative for people with a penicillin allergy or to treat penicillinresistant strains of bacteria. .'amples of macrolides include:

erythromycin spiramycin

'luoro(uinolones 1luoro!uinolones are the newest type of antibiotic. They are broad-spectrum antibiotics that can be used to treat a wide range of infections. .'amples of fluoro!uinolones are:

ciproflo'acin norflo'acin

Side effects
0ost antibiotics (with the e'ception of the aminoglycosides) don,t cause problems for people who ta"e them and serious side effects are rare. The most common reported side effects of antibiotics are:

being sic" feeling sic" indigestion diarrhoea

Read more about the side effects of antibiotics.

Considerations and interactions


)ome antibiotics are not suitable for people with certain medical conditions or for women who are pregnant or breastfeeding. 2ou should only ever ta"e antibiotics that are prescribed to you never ,borrow, them from a friend of family member. )ome antibiotics can also react unpredictably with other medications and the oral contraceptive pill. &t is therefore important to read the information leaflet that comes with your medication carefully. Read more about things to consider with antibiotics and things that interact with antibiotics.

Antibiotic resistance
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/oth the 3$) and health organisations across the world are trying to reduce the use of antibiotics especially for conditions that are not serious. This is to try to combat the problem of antibiotic resistance which is when a strain of bacteria no longer responds to treatment with one or more types of antibiotics. %ntibiotic resistance can occur in several ways. )trains of bacteria can mutate (change) and over time become resistant to a specific antibiotic. The chance of this increases if a person does not finish the course of antibiotics as some bacteria may be left to develop resistance. %lso antibiotics can destroy many of the harmless strains of bacteria that live in and on the body. This allows resistant bacteria to multiply !uic"ly and replace them. The overuse of antibiotics in recent years has played a ma#or part in antibiotic resistance. This includes using antibiotics to treat minor conditions that would have got better anyway. &t has led to the emergence of so-called 4superbugs5. These are strains of bacteria that have developed resistance to many different types of antibiotics. They include:

meticillin-resistant )taphylococcus aureus (0R)%) -lostridium difficile (-. diff) the bacteria that cause multi-drug-resistant tuberculosis (0DR-T/)

These types of infections can be serious and challenging to treat and are becoming an increasing cause of disability and death across the world. 1or e'ample the 6orld $ealth 7rgani8ation (6$7) estimates that there are around *+9 999 deaths due to 0DR-T/ each year. The biggest worry is that there may emerge new strains of bacteria that are effectively untreatable by any e'isting antibiotics. There are already signs of this with the emergence of a type of bacteria called 3ew Delhi metallo-beta-lactamase (3D0-*) which appears to be highly resistant to treatment. Read more about how you can help prevent the further progression of antibiotic resistance. )$at are Antibiotics The word :antibiotics: comes from the ;ree" anti (:against:) and bios (:life:). The noun <antibiotic= was suggested in *>?@ by Dr. )elman %. 6a"sman soil microbiologist ?. %n antibiotic is a drug that "ills or slows the growth of bacteria. %ntibiotics are one class of antimicrobials a larger group which also includes anti-viral anti-fungal and anti-parasitic drugs. %ntibiotics are chemicals produced by or derived from microorganisms (i.e. bugs or germs such
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as bacteria and fungi). The first antibiotic was discovered by %le'ander 1leming in *>@A in a significant brea"through for medical science. %ntibiotics are among the most fre!uently prescribed medications in modern medicine. %ntibiotics are used to treat many different bacterial infections. %ntibiotics cure disease by "illing or in#uring bacteria. /acteria are simple one-celled organisms that can be found by the billions all around us: on furniture and counter-tops in the soil and on plants and animals. They are a natural and needed part of life. /acteria cause disease and infection when they are able to gain access to more vulnerable parts of our bodies and multiply rapidly. /acteria can infect many parts of the body: eyes ears throat sinuses lungs airways s"in stomach colon bones genitals. Bactericidal and Bacteriostatic Antibiotics )ome antibiotics are bactericidal meaning that they wor" by "illing bacteria. 7ther antibiotics are bacteriostatic meaning that they wor" by stopping bacteria multiplying. .ach different type of antibiotic affects different bacteria in different ways. 1or e'ample an antibiotic might inhibit a bacterium,s ability to turn glucose into energy or its ability to construct its cell wall. 6hen this happens the bacterium dies instead of reproducing. Broad*spectrum and Narrow*spectrum Antibiotics )ome antibiotics can be used to treat a wide range of infections and are "nown as broadspectrum antibiotics. 7thers are only effective against a few types of bacteria and are called narrow-spectrum antibiotics. Antibiotic resistance %ntibiotics are e'tremely important in medicine but unfortunately bacteria are capable of developing resistance to them. %ntibiotic-resistant bacteria are germs that are not "illed by commonly used antibiotics. 6hen bacteria are e'posed to the same antibiotics over and over the bacteria can change and are no longer affected by the drug. /acteria have number of ways how they become antibiotic-resistant. 1or e'ample they possess an internal mechanism of changing their structure so the antibiotic no longer wor"s they develop ways to inactivate or neutrali8e the antibiotic. %lso bacteria can transfer the genes coding for antibiotic resistance between them ma"ing it possible for bacteria never e'posed to an antibiotic to ac!uire resistance from those which have. The problem of antibiotic resistance is worsened when antibiotics are used to treat disorders in which they have no efficacy (e.g. antibiotics are not effective against infections caused by viruses) and when they are used widely as prophyla'is rather than treatment. Resistance to antibiotics poses a serious and growing problem because some infectious diseases are becoming more difficult to treat. Resistant bacteria do not respond to the antibiotics and continue to cause infection. )ome of these resistant bacteria can be treated with more powerful
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medicines but there some infections that are difficult to cure even with new or e'perimental drugs. Antibiotics Classification %lthough there are several classification schemes for antibiotics based on bacterial spectrum (broad versus narrow) or type of activity (bactericidal vs. bacteriostatic) the most useful is based on chemical structure. %ntibiotics within a structural class will generally have similar patterns of effectiveness to'icity and allergic potential. The main classes of antibiotics are:

/eta-Bactams o (enicillins
o

-ephalosporins

0acrolides 1luoro!uinolones Tetracyclines %minoglycosides

0ost commonly used types of antibiotics are: %minoglycosides (enicillins 1luoro!uinolones -ephalosporins 0acrolides and Tetracyclines. 6hile each class is composed of multiple drugs each drug is uni!ue in some way. #enicillins The penicillins are the oldest class of antibiotics. (enicillins have a common chemical structure which they share with the cephalosporins. (enicillins are generally bactericidal inhibiting formation of the cell wall. (enicillins are used to treat s"in infections dental infections ear infections respiratory tract infections urinary tract infections gonorrhea. There are four types of penicillins:

The natural penicillins are based on the original penicillin-; structure. (enicillin-; types are effective against gram-positive strains of streptococci staphylococci and some gram-negative bacteria such as meningococcus. Penicillinase-resistant penicillins notably methicillin and o'acillin are active even in the presence of the bacterial en8yme that inactivates most natural penicillins.

Aminopenicillins such as ampicillin and amo'icillin have an e'tended spectrum of action compared with the natural penicillins. .'tended spectrum penicillins are effective against a wider range of bacteria.

#enicillins side effects (enicillins are among the least to'ic drugs "nown. The most common side effect of penicillin is diarrhea. 3ausea vomiting and upset stomach are also common. &n rare cases penicillins can cause immediate and delayed allergic reactions - specifically s"in rashes fever and anaphylactic shoc". (enicillins are classed as category / during pregnancy. Cep$alosporins -ephalosporins have a mechanism of action identical to that of the penicillins. $owever the basic chemical structure of the penicillins and cephalosporins differs in other respects resulting in some difference in the spectrum of antibacterial activity. Bi"e the penicillins cephalosporins have a beta-lactam ring structure that interferes with synthesis of the bacterial cell wall and so are bactericidal. -ephalosporins are derived from cephalosporin - which is produced from -ephalosporium acremonium. -ephalosporins are used to treat pneumonia strep throat staph infections tonsillitis bronchitis otitis media various types of s"in infections gonorrhea urinary tract infections -ephalosporin antibiotics are also commonly used for surgical prophyla'is. -ephale'in can also be used to treat bone infections. -ephalosporins are among the most diverse classes of antibiotics they are grouped into :generations: by their antimicrobial properties. .ach newer generation has a broader spectrum of activity than the one before.

The first generation cephalosporins include: Their spectrums of activity are !uite similar. They possess generally e'cellent coverage against most gram-positive pathogens and variable to poor coverage against most gram negative pathogens. The first generation includes: o cephalothin
o o o o o

cefa8olin cephapirin cephradine cephale'in cefadro'il

The second generation cephalosporins. &n addition to the gram positive spectrum of the first generation cephalosporins these agents have e'panded gram negative spectrum. -efo'itin and cefotetan also have good activity against /acteroides fragilis. .nough

variation e'ists between the second generation cephalosporins in regard to their spectrums of activity against most species of gram negative bacteria that susceptibility testing is generally re!uired to determine sensitivity. The second generation includes:
o o o o o

cefaclor cefamandole cefonicid ceforanide cefuro'ime

The third generation cephalosporins have much e'panded gram negative activity. $owever some members of this group have decreased activity against gram-positive organisms. They have the advantage of convenient administration but they are e'pensive. The third generation includes:
o o o o o o o o o o o o o

cefcapene cefdalo'ime cefditoren cefetamet cefi'ime cefmeno'ime cefodi8ime cefopera8one cefota'ime cefpimi8ole cefpodo'ime ceftibuten ceftria'one

The fourth generation cephalosporins are e'tended-spectrum agents with similar activity against gram-positive organisms as first-generation cephalosporins. They also have a greater resistance to beta-lactamases than the third generation cephalosporins. 0any fourth generation cephalosporins can cross blood brain barrier and are effective in meningitis. The fourth generation includes:
o

cefclidine

o o o o o

cefepime cefluprenam cefo8opran cefpirome cef!uinome

Cep$alosporins side effects -ephalosporins generally cause few side effects. -ommon side effects associated these drugs include: diarrhoea nausea mild stomach cramps or upset. %ppro'imately +*9C of patients with allergic hypersensitivity to penicillins will also have cross-reactivity with cephalosporins. Thus cephalosporin antibiotics are contraindicated in people with a history of allergic reactions (urticaria anaphyla'is interstitial nephritis etc) to penicillins or cephalosporins. -ephalosporin antibiotics are classed as pregnancy category /. 'luoro(uinoloness 1luoro!uinolones (fluoridated !uinolones) are the newest class of antibiotics. Their generic name often contains the root :flo'acin:. They are synthetic antibiotics and not derived from bacteria. 1luoro!uinolones belong to the family of antibiotics called !uinolones. The older !uinolones are not well absorbed and are used to treat mostly urinary tract infections. The newer fluoro!uinolones are broad-spectrum bacteriocidal drugs that are chemically unrelated to the penicillins or the cephalosporins. /ecause of their e'cellent absorption fluoro!uinolones can be administered not only by intravenous but orally as well. 1luoro!uinolones are used to treat most common urinary tract infections s"in infections and respiratory infections (such as sinusitis pneumonia bronchitis). 1luoro!uinolones inhibit bacteria by interfering with their ability to ma"e D3%. This activity ma"es it difficult for bacteria to multiply. This effect is bacteriocidal. 1luoro!uinolone grope includes:

ciproflo'acin levoflo'acin lomeflo'acin norflo'acin sparflo'acin clinaflo'acin

gatiflo'acin oflo'acin trovaflo'acin

'luoro(uinolones side effects 1luoro!uinolones are well tolerated and relatively safe. The most common side effects include nausea vomiting diarrhea abdominal pain. 7ther more serious but less common side effects are central nervous system effects (headache confusion and di88iness) phototo'icity (more common with lomeflo'acin and sparflo'acin). %ll drugs in this class have been associated with convulsions. 1luoro!uinolones are classed as pregnancy category -. Tetrac"clines Tetracyclines got their name because they share a chemical structure that has four rings. They are derived from a species of )treptomyces bacteria. Tetracycline antibiotics are broad-spectrum bacteriostatic agents and wor" by inhibiting the bacterial protein synthesis. Tetracyclines may be effective against a wide variety of microorganisms including ric"ettsia and amebic parasites. Tetracyclines are used in the treatment of infections of the respiratory tract sinuses middle ear urinary tract s"in intestines. Tetracyclines also are used to treat ;onorrhoea Roc"y 0ountain spotted fever Byme Disease typhus. Their most common current use is in the treatment of moderately severe acne and rosacea. Tetracycline antibiotics are:

tetracycline do'ycycline minocycline o'ytetracycline

Tetrac"clines side effects Drugs in the tetracycline class become to'ic over time. .'pired drugs can cause a dangerous syndrome resulting in damage to the "idneys. -ommon side effects associated with tetracyclines include cramps or burning of the stomach diarrhea sore mouth or tongue. Tetracyclines can cause s"in photosensitivity which increases the ris" of sunburn under e'posure to DE light. This may be of particular importance for those intending to ta"e on holidays long-term do'ycycline as a malaria prophyla'is. Rarely

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tetracyclines may cause allergic reactions. Eery rarely severe headache and vision problems may be signs of dangerous secondary intracranial hypertension. Tetracycline antibiotics should not be used in children under the age of A and specifically during periods of tooth development. Tetracyclines are classed as pregnancy category D. Dse during pregnancy may cause alterations in bone development. &acrolides The macrolide antibiotics are derived from )treptomyces bacteria and got their name because they all have a macrocyclic lactone chemical structure. The macrolides are bacteriostatic binding with bacterial ribosomes to inhibit protein synthesis. .rythromycin the prototype of this class has a spectrum and use similar to penicillin. 3ewer members of the group a8ithromycin and clarithyromycin are particularly useful for their high level of lung penetration. 0acrolide antibiotics are used to treat respiratory tract infections (such as pharyngitis sinusitis and bronchitis) genital gastrointestinal tract and s"in infections. 0acrolide antibiotics are:

erythromycin clarithromycin a8ithromycin dirithromycin ro'ithromycin troleandomycin

&acrolides side effects )ide effects associated with macrolides include nausea vomiting and diarrheaF infre!uently there may be temporary auditory impairment. %8ithromycin has been rarely associated with allergic reactions including angioedema anaphyla'is and dermatologic reactions. 7ral erythromycin may be highly irritating to the stomach and when given by in#ection may cause severe phlebitis. 0acrolide antibiotics should be used with caution in patients with liver dysfunction. (regnancy category /: %8ithromycin erythromycin. (regnancy category -: -larithromycin dirithromycin troleandomycin. Amino%l"cosides %minoglycosides are derived from various species of Streptomyces. &n *>?G )elman 6a"sman together with his co-wor"ers discovered that a fungus Streptomyces griseus produced an antibiotic substance which they named :streptomycin.: )elman 6a"sman
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was awarded the 3obel (ri8e in (hysiology or 0edicine in *>+@ for his discovery of streptomycin. The aminoglycosides are bactericidal and wor" by stopping bacteria from ma"ing proteins. %minoglycoside antibiotics are used to treat infections caused by gram-negative bacteria. %minoglycosides may be used along with penicillins or cephalosporins to give a two-pronged attac" on the bacteria. %minoglycosides wor" !uite well but bacteria can become resistant to them. )ince aminoglycosides are bro"en down easily in the stomach they can,t be given by mouth and must be in#ected. ;enerally aminoglycosides are given for short time periods. %minoglycoside grope includes:

ami"acin gentamicin "anamycin neomycin streptomycin tobramycin

Amino%l"cosides side effects The ma#or irreversible to'icity of aminoglycosides is ototo'icity that is damage to the ear and hearing. %mong them streptomycin and gentamicin are primarily vestibuloto'ic whereas ami"acin neomycin dihydrosterptomycin and "anamicin are primarily cochleoto'ic. %nother important concern with aminoglycoside antibiotics is nephroto'icity that is "idney damage. 'urt$er readin% %ntibiotics for )trep Throat %ntibiotics for .ar &nfections

%ntibiotics for -hlamydia

Uses of antibiotics
Antibiotics are no lon%er routinel" used to treat infections for a number of important reasons+

many infections are caused by viruses so antibiotics are not effective

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even if the infection is bacterial, the use of antibiotics is unlikely to have much benefit in terms of s eedin! u the healin! rocess and can cause un leasant side effects the more antibiotics are used to treat trivial conditions the more likely they are to become ineffective in treatin! more serious conditions because of antibiotic resistance

1or e'ample antibiotics are now no longer routinely used to treat chest infections ear infections in children and sore throats. 2our ;( will only prescribe antibiotics to treat:

conditions that are not es ecially serious but are unlikely to clear u "ithout the use of antibiotics, such as moderately severe acne conditions that are not es ecially serious but could s read to other eo le if not rom tly treated, such as the skin infection im eti!o or the se#ually transmitted infection chlamydia conditions "here there is evidence that usin! antibiotics "ould si!nificantly s eed u the recovery time, such as a kidney infection conditions that carry a risk of causin! more serious com lications, such as cellulitis $an infection of the dee er layer of the skin% or neumonia $lun! infection%

%ntibiotics may also be recommended for people who are more vulnerable to the harmful effects of infection. This may include:

eo le a!ed over 75 years eo le "ith heart failure eo le "ho have to take insulin to control their diabetes eo le "ith a "eakened immune system & either due to an underlyin! health condition such as '() or as a side effect of certain treatments such as chemothera y

Intravenous antibiotics
&ntravenous antibiotics (in#ections or infusions of antibiotics directly into the blood or less commonly the muscles) are usually only re!uired to treat more serious bacterial infections such as:

bacterial menin!itis se ticaemia $blood oisonin!% infection of the outer layer of the heart $endocarditis% $some cases of% *+,- infection

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an infection that develo s inside a bone $osteomyelitis%

Antibiotics to prevent infection


There are several circumstances in which you may be given antibiotics as a precaution to prevent rather than treat an infection. This is "nown as antibiotic prophyla'is. 1or e'ample antibiotic prophyla'is is normally recommended if you are having surgery on a certain part of the body that is "nown to carry a high ris" of infection or that could lead to devastating effects if it were to become accidentally infected. 1or e'ample it may be used if you are going to have:

some ty es of eye sur!ery & such as cataract sur!ery or !laucoma sur!ery breast im lant sur!ery acemaker sur!ery sur!ery to remove the !all bladder sur!ery to remove the a endi#

2our surgical team will be able to tell you if you re!uire antibiotic prophyla'is. %ntibiotic prophyla'is may also be recommended if you have a bite or wound that has a high chance of becoming infected for e'ample because it has come into contact with soil or faeces. There are also several medical conditions that ma"e people particularly vulnerable to infection meaning antibiotic prophyla'is is necessary. 1or e'ample people with the blood disorder sic"le cell anaemia often have to ta"e antibiotics for the rest of their lives as their spleen does not wor" properly. (The spleen plays an important role in filtering out harmful bacteria from the blood.)

Considerations
Some important considerations associated wit$ t$e si, main classes of antibiotics are listed below.

#enicillin
Do not ta"e penicillins if you have had a previous allergic reaction to them. (atients with a history of allergies such as asthma ec8ema or hay fever are at higher ris" of developing a serious allergic reaction (anaphylactic shoc") to penicillins. $owever such reactions are rare. (atients who are allergic to one type of penicillin will be allergic to all (the allergy is related to the basic penicillin structure). (enicillin may not be suitable if you:
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have severe kidney disease have liver disease are re!nant or breastfeedin! $see belo"%

0ost penicillins can be used during pregnancy and breastfeeding in the usual doses. $owever the safe use of pheno'ymethylpenicillin during pregnancy has not been definitely established. &t should not be used during pregnancy unless clearly needed. (heno'ymethylpenicillin passes into breast mil" so it should be used with caution in women who are breastfeeding as even small amounts can cause an allergic reaction in a susceptible baby. (enicillins that are combined with clavulanic acid should not be used during pregnancy and breastfeeding unless absolutely necessary. These penicillins include co-amo'iclav (brand name %ugmentin) and ta8obactam (brand name Ta8ocin). Tell your healthcare professional if you are pregnant or breastfeeding so they can prescribe the most suitable antibiotic for you.

Cep$alosporins
&f you have had a previous allergic reaction to penicillin you may also be allergic to cephalosporins. -ephalosporins may not be suitable if you have "idney disease. &f the professional in charge of your care does decide to prescribe cephalosporins it will probably be at a lower dose. 2ou should never ta"e a cephalosporin if you have acute porphyria which is a genetic condition that can cause s"in and nerve problems. -ephalosporins are thought to be safe to ta"e during pregnancy but as a precaution they are only ever used if the benefits of treatment are thought to outweigh potential ris"s. -ephalosporins are not recommended for women who are breastfeeding.

Amino%l"cosides
%minoglycosides are normally only used to treat life-threatening conditions such as meningitis as they can cause "idney damage in people with pre-e'isting "idney disease. &t is unclear whether aminoglycosides are safe to use during pregnancy. 2our doctor will advise you.

Tetrac"clines

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The use of tetracyclines is not usually recommended (unless absolutely necessary) in the following groups:

eo le "ith kidney disease eo le "ith liver disease eo le "ith the autoimmune condition lu us, "hich can cause skin roblems, .oint ain and s"ellin!, and fati!ue $feelin! tired all the time% children under the a!e of 12 re!nant or breastfeedin! "omen

&acrolides
2ou should not ta"e macrolides if:

you have or hyria you have a heart rhythm disorder $or you are at risk of develo in! a heart rhythm disorder% such as atrial fibrillation, "here the heart beats abnormally fast

2ou should not ta"e a type of macrolide called telithromycin if you have myasthenia gravis which is an uncommon condition that causes muscle wea"ness. &f you are pregnant or are breastfeeding the only type of macrolide you can ta"e is erythromycin (.ryma' .rythrocin .rythroped or .rythroped %). .rythromycin can be used at the usual doses throughout your pregnancy and while you are breastfeeding. 7ther macrolides should not be used during pregnancy unless there is no suitable alternative.

'luoro(uinolones
1luoro!uinolones are not recommended for children as there is a ris" that the medications can interfere with children,s physical growth. 1luoro!uinolones are not suitable for women who are pregnant or breastfeeding.

Side effects of antibiotics

Tetrac"clines and sensitivit" to li%$t


Tetracyclines can ma"e your s"in sensitive to sunlight as well as artificial sources of light such as sun lamps and sunbeds. 2ou should avoid prolonged e'posure to bright light while ta"ing tetracyclines.

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T$e most common side effects of antibiotics affect t$e di%estive s"stem. T$ese occur in around - in -. people. )ide effects of antibiotics that affect the digestive system include:

bein! sick feelin! sick diarrhoea bloatin! and indi!estion abdominal ain loss of a etite

These side effects are usually mild and should pass once you finish your course of treatment. &f you e'perience any additional side effects other than those listed above you should contact your ;( or the doctor in charge of your care for advice.

Antibiotic aller%ic reactions


%round * person in *+ has an allergic reaction to antibiotics especially penicillin and cephalosporins. &n most cases the allergic reaction is mild to moderate and can ta"e the form of:

a raised itchy skin rash $urticaria or /hives0% cou!hin! "hee1in! ti!htness of the throat, "hich can cause breathin! difficulties

These mild to moderate allergic reactions can usually be successfully treated by ta"ing a medication "nown as antihistamines. $owever if you are concerned or your symptoms fail to respond to treatment then you should call your ;( for advice. &f you can,t contact your ;( call 3$) Direct on 9A?+ ?H ?I. &n very rare cases (estimated to be somewhere between one and five in *9 999) an antibiotic can cause a severe and potentially life-threatening allergic reaction "nown as anaphyla'is. &nitial symptoms of anaphyla'is are often the same as above and can lead to:

a ra id heartbeat increasin! breathin! difficulties due to s"ellin! and ti!htenin! of the neck a sudden intense feelin! of a rehension and fear

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a shar and sudden dro in your blood ressure, "hich can make you feel li!ht2headed and confused unconsciousness

%naphyla'is is a medical emergency and without prompt treatment can be life-threatening. Dial >>> immediately and as" for an ambulance if you thin" that you or someone you "now is e'periencing anaphyla'is.

Interactions with other medicines


Antibiotics can sometimes interact wit$ ot$er medicines or ot$er substances. T$is means t$at t$e effects of one of t$e medicines can be altered b" t$e ot$er. )ome of the more common interactions are listed below. $owever this is not a complete list. &f you want to chec" that your medicines are safe to ta"e with your antibiotics as" your ;( or local pharmacist. 2ou should also always carefully read the patient information leaflet that comes with your medicine.

Combined oral contraceptives


)ome antibiotics such as rifampicin and rifabutin (which can be used to treat tuberculosis and meningitis) can reduce the effectiveness of the combined oral contraceptive pill. 7ther antibiotics do not have this effect. &f you are prescribed rifampicin or rifabutin you may need to use an additional form of contraception such as condoms while ta"ing the antibiotic. )pea" to your ;( or nurse for advice.

&edications
)ome of the medications you may need to avoid or see" advice on if ta"ing a specific class of antibiotic are outlined below. #enicillin &t is usually recommended that you avoid ta"ing penicillin at the same time as a medication called methotre'ate which is used to treat some types of cancers and severe autoimmune conditions such as the s"in condition psoriasis. This is because combining the two medications can cause a range of unpleasant and sometimes serious side effects. 2ou may e'perience a s"in rash if you ta"e penicillin and a medication called allopurinol which is used to treat gout. Cep$alosporins
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-ephalosporins may not be suitable to ta"e if you are also ta"ing blood-thinning medications such as heparin and warfarin. &f you need treatment with cephalosporins you may temporarily have to stop ta"ing the bloodthinning medication. Amino%l"cosides The ris" of damage to your "idneys and hearing is increased if you are ta"ing one or more of the following medications:

antifun!als & used to treat fun!al infections cyclos orin & used to treat autoimmune conditions such as 3rohn0s disease and !iven to eo le "ho have had an or!an trans lant diuretics & used to remove "ater from the body muscle rela#ants

$owever the ris" of "idney and hearing damage has to be balanced against the benefits of using aminoglycosides to treat life-threatening conditions such as meningitis. Tetrac"clines 2ou should chec" with your ;( or pharmacist before ta"ing a tetracycline if you are currently ta"ing any of the following medications:

vitamin - su lements retinoids such as acitretin, isotretinoin and tretinoin used to treat severe acne blood2thinnin! medication diuretics kaolin2 ectin and bismuth subsalicylate used to treat diarrhoea medicines to treat diabetes such as insulin atova4uone used to treat neumonia antacids used to treat indi!estion and heartburn sucralfate used to treat ulcers lithium used to treat bi olar disorder and severe de ression di!o#in to treat heart rhythm disorders methotre#ate strontium ranelate used to treat osteo orosis

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colesti ol or colestyramine used to treat hi!h cholesterol er!otamine and methyser!ide used to treat mi!raines

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

terfenadine, astemi1ole and mi1olastine & "hich are all antihistamines used to treat aller!ic conditions such as hay fever amisul ride & used to treat e isodes of sychosis tolterodine & used to treat urinary incontinence simvastatin & used to treat hi!h cholesterol

'luoro(uinolones 2ou should chec" with your ;( or pharmacist before ta"ing a fluoro!uinolone if you are currently ta"ing any of the following medications:

theo hylline, "hich is used to treat asthma and also found in some cou!h and cold medicines the non2steroidal anti2inflammatory dru! $5,-(6% ainkillers such as ibu rofen ciclos orin robenecid used to treat !out clo1a ine used to treat schi1o hrenia ro inirole used to treat 7arkinson8s disease ti1anadine used to treat muscle s asms !libenclamide used to treat diabetes cisa ride used to treat indi!estion, heartburn, vomitin! or nausea tricyclic antide ressants, such as amitri tyline, steroid medications $corticosteroids%

)ome fluoro!uinolones can intensify the effects of caffeine (a stimulant found in coffee tea and cola) which could ma"e you feel irritable restless and cause problems falling asleep (insomnia). 1inally you may need to avoid ta"ing medication that contains high levels of minerals or iron as this can bloc" the beneficial effects of fluoro!uinolones. This includes:
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antacids 1inc su lements some ty es of multivitamin su lements

Missed or extra doses


Take antibiotics as directed on t$e packet or t$e patient information leaflet t$at comes wit$ t$e medicine, or as instructed b" "our /# or p$armacist.

&issed dose
&f you forget to ta"e a dose of your antibiotics ta"e that dose as soon as you remember and then continue to ta"e your course of antibiotics as normal. $owever if it is almost time for the ne't dose s"ip the missed dose and continue your regular dosing schedule. Do not ta"e a double dose to ma"e up for a missed one. &f you have to ta"e two doses closer together than normal there is an increased ris" of side effects.

Accidentall" takin% an e,tra dose


%ccidentally ta"ing one e'tra dose of your antibiotic is unli"ely to cause you any serious harm. $owever it will increase your chances of e'periencing side effects such as pain in your stomach diarrhoea and feeling or being sic". &f you are worried or are e'periencing severe side effects spea" to your ;( or call 3$) Direct on 9A?+ ?H ?I.

Accidentall" takin% more t$an one e,tra dose


&f you accidentally ta"e more than one e'tra dose of your antibiotic contact your ;( or call 3$) Direct on 9A?+ ?H ?I as soon as possible.

Frequently asked questions

)$" s$ould antibiotics not be used to treat cou%$s and colds


%ll colds and most coughs and sore throats are caused by viruses. %ntibiotics do not wor" against viral infections.

How s$ould I treat m" cold

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The best way to treat most colds coughs or sore throats is to rest and drin" plenty of fluids. -olds can last about two wee"s and may end with a cough that brings up phlegm. There are many over-the-counter remedies to ease the symptoms for e'ample paracetamol. %s" your pharmacist for advice. &f the cold lasts more than three wee"s or you become breathless or have chest pains or if you already have a chest complaint see your ;(. Read more about treating the common cold coughs and sore throats.

But w$at about m" c$ildren T$e"0re alwa"s %ettin% cou%$s and colds.
&t is common for children to get coughs and colds especially when they go to school and mi' with other children. %s" your pharmacist for advice. &f the symptoms persist and you are concerned see your ;( but do not e'pect to be prescribed antibiotics.

)$at is antibiotic resistance


/acteria can adapt and find ways to survive the effects of an antibiotic. They become antibiotic resistant which means that the antibiotic no longer "ills the bacteria. The more we use an antibiotic the more li"ely it is that bacteria will become resistant to it. )ome bacteria that cause infections in hospitals such as 0R)% are resistant to several antibiotics.

)$" can0t ot$er antibiotics be used instead


7ther antibiotics can be used but they may not be as effective and they may have more side effects. .ventually the bacteria will become resistant to them too. 7nly two new types of antibiotics have been found in the past G9 years and there is no guarantee that new ones will be discovered.

How can antibiotic resistance be avoided


/y using antibiotics carefully we can slow down the development of resistance. &t is not possible to stop it completely but slowing it down stops resistance spreading and buys some time to develop new types of antibiotics.

)$at can I do about antibiotic resistance


2ou should only use antibiotics when it is appropriate to do so. 6e now "now that most coughs and colds get better #ust as !uic"ly without antibiotics. 6hen antibiotics are prescribed the complete course should be ta"en to get rid of the bacteria completely. &f the course is not completed some bacteria may be left to develop resistance.

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So w$en will I be prescribed antibiotics


2our doctor will only prescribe antibiotics when you need them for e'ample for a "idney infection or pneumonia. %ntibiotics may be life-saving for infections such as meningitis. /y using them only when necessary they are more li"ely to wor" when we need them in future.

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