Doctors' Answers to "Frequently Asked Questions" - Antibiotics

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Minocycline Usage [posted 11/19/98]
Question: I am trying to get information on the prescribed drug...minocycline. My fiance went to the doctor for a rash on his back and severe break out of acne on his chest. The doctors took a biopsy, told him it may be skin cancer, and told him they would get back to him within the week. In the mean time, he was prescribed minocycline for the next 11 months. I have been doing some research on this medication and i have yet to read anything good about it. Is monocycline primarly used just for acne? Can you give me some positive feed back on minocycline or should we consider another alternative? Or can you give me an idea of where i can go for better information? Thank you so much for your time.

Answer: This drug belongs to the tetracycline class of drugs, which we use often in the treatment of acne vulgaris. It is usually effective in small doses and tends to have few side effects. However, sun sensitivity, nausea and occasional diarrhea are the usual limiting problems. It is often used in chronic dosing for acne;;but, there are alternative treatments.

More Longterm Antibiotic Treatment Concerns [posted 11/17/98]
Question: Can vision problems occur from long term antibiotic therapy? I was on eight week therapy of Gentamicin and Ampicillin following an infection in my knee replacement.

Answer:  Not usually. Hearing yes, vision would be very uncommon if at all.

Longterm Antibiotic Treatment Concerns [posted 11/5/98]
Question: I have been taking Sulfameth/Trimethoprim 800/160 Tabs ( 1 Tablet twice daily) and Clindamycin 150 mg caps (2 capsules three times daily) For the last three or four years to treat a Stapf / Strep infection I got during a total knee replacement. My question is how is this going to affect my body over the rest of my life. I'm told I have to take then indefinitely. I have noticed that my teeth have started to decay quite badly since starting these medications. Could they be responsible for the decay in my teeth? And what other side effects do I need to prepare myself for. I'm 40 years old and in otherwise good health.

Answer: Have you tried stopping the antibiotics? Three years without symptoms would be a good time from my perspective. They shouldn't be affecting your teeth. There should be no major side effects except possibly diarrhea.

Antibiotic Reaction [posted 10/20/98]
Question: I have been given an antibiotic to fight against a severe ear and throat infection. The name on the prescription bottle reads "ERYC 333 MG". I am supposed to take 1 capsule 3 times daily. I have now taken 3 capsules and have developed a slight rash on my chest, neck and back with some itching. Would this be an allergic reaction? Should I continue or discontinue the use of this antibiotic? What family does this antibiotic belong to? Just to let you know, I developed a similar rash when taking the antibiotic "PenV". Hope to hear from you soon!

Answer: This is time release erthyomycin a macroglide class of antibiotic. Possibly an allergic reaction, most people would tell you to discontinue the antibiotic. No relation to penicillin.

Antibiotics & Alcohol [posted 10/13/98]
Question: If you are taking tetracycline as a preventative treatment after minor surgery, can you drink alcohol in moderation, or not at all? Would it diminish the effects of the drug if you did, or cancel them out altogether?

Answer: Shouldn't be a major problem if in moderation, both can cause gastritis-about the only serious problem.

Antibiotic Side Effects [posted 10/9/98]
Question: Can antibiotics cause pain or agravate an existing problem? I have plantar facitis in both feet and twice now when i have taken bactrim I have experienced severe pain in my feet immediately following the first couple of doses. I asked my foot doctor about this and she thought it was coincidental but when it happened the second time, i really feel the bactrim is having some tpe of adverse side affect. do you have any info on the adverse affects? thank you very much!

Answer: Off hand can't say why, but, if it is repeated, I'd suspect its real. Not a usual problem.

Antibiotic Substitution
Question: Are there any hospitals currently substituting ceclor with another oral cephalosporin, and which one?

Answer: Most hospitals go with the lowest cost alternative to equivalent drugs in a class. As a consequence, each hospital tends to use either low cost generics or have individual contracts with companies to get the lowest cost. There is no one drug they use, except the most cost effective.

Skin Rash caused by Tetracycline
Question: About 10 yrs. ago I was taking tetracycline and was sun bathing at the same time. Now, whenever I go out in the sun and get just a light burn I break out in a rash that lasts at least two weeks and itches real bad. Usually where the rash is it will make my glands in that area swell up. Am I just hopeless and just need to stay out of the sun period?

Answer: Unless you are still taking tetracycline, this is unusual. I'd have your physician check for other problems like lupus, porphyria, etc.

Antibiotics and Vaccines
Question: There has been a lot of media coverage lately concerning bacteria which have developed a resistance to antibiotics. Is there any reason why it would be medically impossible (or highly unlikely) for viruses to develop a similar resistance to vaccines?

Answer: Viruses also develop resistance to antibiotics like bacteria. This is especially seen in treating HIV patients where the virus can easily develop resistance to some of the treatment drugs. However, this is to antibiotics not vaccines. Vaccines develop anti-bodies which directly attack the organisms(bacteria or virus). There does not appear to be much resistance to this mode of attack. Bacterial and viral organisms will develop defenses to chemicals(antibiotics) and their mode of interfering with the organisms life cycle-- often by passing small bits of DNA or RNA back and forth to each other. There is a marked difference between resistance to chemicals and resistance to antibodies.

Antibiotics - Ceftin
Question: My doctor surgically removed a small, dark freckle from my skin, thinking it might be cancerous. I am in good health and have no infections. The doctor gave me Ceftin samples and advised me to take one tablet twice a day (he gave me 3 days worth). I asked if I was supposed to take these only if I got an infection, and he said no. He wanted me to take the Ceftin to prevent an infection. I have read the long, fine print document for this drug, and nowhere does it refer to using it to prevent an infection. I ask because I have heard that you shouldn't take antibiotics unless you really need them, as the germs can become resistant to drugs. Please advise what the conventional wisdom is on this issue.

Answer: This type of antibiotic is commonly used when the integrity of the skin is broken to ensure that bacteria do not begin to spread in the wound area. This is a usual and custom practice for most physicians. Short term use will not be expected to produce resistant strains of bacteria.

Prophylactic antibiotics
Question: My wife and I will be traveling to Mexico (Cabo San Lucas). My wife wants to take a prophylactic regime of antibiotics upon starting our trip. Is this recommended by the experts?

Answer: There are several schools of thought. It depends on how much fresh fruit vegetables. etc. you’ll be consuming and how critical is the trip. If you limit your intake to bottled beverages and cooked food (no uncooked fruit or vegetables), the risk of diarrhea is small. If you then develop diarrhea, take antibiotics(there are several regimens). On long trips this may bepreferred. Some people take the antibiotics daily to avoid diarrhea, but be advised that most have potential sun sensitivity and you can ruin your trip with a sun rash/reaction. I usually advise taking the antibiotics and taking them at the first sign of diarrhea.

Antibiotic Reactions
Question: I was recently dignosed with H. Pylori and was put on a 7 day regimen of Biaxin, Flagyl, and Prilosec. 3.5 days into this I started experiencing severe dizzy spells. I stopped the meds, but 1 week later I am still very dizzy and the back of my head feels very tingly. Doctors opinions are ambiguous. My personal physician wants me on Xanax and the gastroenterologist wants me on nothing. He says the meds are still in my system and need to wear off. I did see an emergency room doc and he said the antibiotics should be out of my system by now. I am 40 and otherwise in good health. I did have complete blood/urine analysis and head MRI-all normal.

Answer: I would have difficulty trying to find a mechanism to explain lasting headaches from the antibiotics. It is possible that your inner ear has been affected; but, this would be unusual with these drugs. They certainly are "out" of your system by this time. I would probably consult a neurologist about the "dizzy" spells.

Trimox
Question:I was given a prescription for Trimox (Apothecon) to take prior to dental work. Will this help my sore throat?

Answer: Trimox is a brand name for ampicillin. This is a penicillin like drug and is effective for treating sore throats(pharyngitis) due to bacteria called Streptocci-or Strep throat. Antibiotics are given before dental procedures to protect the heart and heart valves against infbction by bacteria dislodged during the cleaning process. These bacteria in general belong to the same family -the Streptocci foamily- and are usually very sensitive to penicillin like drugs.

PO Antibiotics
Question: When starting a patient on a po antibiotic if there is going to be a reaction in what time frame does this normally occur?

Answer: Depends on their allergy. Very allergic patients can have respiratory arrest within minutes of taking antibiotics. Less allergic patients will develop a rash up to two weeks after cessation of the antibiotics. Most patients are in the middle.

PO Antibiotics
Question: Would you need to monitor vital signs on individuals for a three day duration that are starting on a po antibiotic? Is there a rational for this? The setting is a extended care facility.

Answer: Not usually, but, the vitals may be necessary due to the original infection.

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