DRUG INFORMATION SERVICE CLERKSHIP 2014/2015

NAME:
KHIU POH SHYAN (1108-2191)

DATE OF ATTACHMENT
12th - 14th NOV 2014

SUPERVISORS NAME
DR. ZAINOL AKBAR ZAINAL
2014

Submitted in partial fulfillment for the requirements of the Bachelor of Pharmacy (Hons)
at Cyberjaya University College of Medical Sciences

Question 21

What is the optional antibiotics treatment for leptospirosis?

What is Leptospirosis?

-It is an infectious disease caused by pathogenic organisms belonging

to genus Leptospira, that are transmitted directly or indirectly from
animal to humans.
-Naturally aquatic organisms and are found in fresh water, damp
soil, and mud.
-Sources of infection: rat, dogs, cattle and other wild animals.
-Disease acquired through contact with contaminated water, soil, or
through contact with urine or tissues of infected animals.

Information required

-What is the patient current condition? Mild or severe?

Treatment of leptospirosis differs depending on severity.
-What is the patient age, body weight, pregnant?
Dose initiation, choice of antibiotic
-The patient renal function?
Dose adjustment
-Is the patient allergy to any medication?
-Is the patient under any other medication?
Mild disease (orally)
Severe disease

Treatment

(Duration of
Treatment :7 days)

Evidences

Reference dis.

Doxycycline 100mg BD
Or
Amoxicillin 500mg q6hr

IV penicillin G 1.5 mU q6hr

Or
IV Ceftriaxone 1g OD

-Doxycycline

(100 mg twice a day for 7 days) was shown to

reduce the duration and severity of illness in anicteric
leptospirosis by an average of 2 days
-Intravenous penicillin was given at a dosage of 6 MU/day for 7 days
and found to halve the duration of fever.
-There have been no controlled trials of penicillin versus doxycycline
for treatment of leptospirosis.
-There is no significant between IV penicillin G 1.5mU q6hr and IV
Ceftriaxone 1g OD
-Based on the studies, majority of the clinical trials were low and
moderate quality.
-Guide to Antimicogial thereay Levett, P. (2001). Leptospirosis.
Clinical Microbiology Reviews, 14(2), 296-326.
-Brett-Major, D., & Coldren, R. (1996). Antibiotics for leptospirosis.
Cochrane Database Of Systematic Reviews.
-Jaykaran, C., Deepak, S., Summaiya, M., & Preeti, Y. (2012).
Antibiotics for treatment of Leptospirosis: Systematic Review and
Meta- Analysis of Controlled Trials. International Journal of
Preventive Medicine. It is an infectious disease caused by pathogenic
organisms belonging to genus Leptospira, that are transmitted
directly or indirectly from animal to humans.

Question 22

What is the dose for NAC (PO and IV) for CT scan?

N-acetylcysteine indications

Used
-Bronchospasm (Mucolytic agent)
-Antidote for acute acetaminophen poisoning
Unlabelled Used
-Prevention of CIN

What is CIN?

Contrast-induced nephropathy (CIN) is most precisely

defined as an acute deterioration in renal function after
exposure to, and as a result of, radio-contrast media. Occur
within 24 to 72 hours after administration of iodinated
contrast medium.

Information Required

-Patient indication to undergo this procedure?

-Is patient allergy to any medication?
-Patient past medical History?
-Patient medication History?

Dose

PO: Adult 600mg caps BD, for two days

(on the day before and the day of exposure to contrast) (this
medication is not listed in FUKKM)
IV: 150 mg/kg in 500 ml N/saline over 30 min immediately
before contrast followed by 50 mg/kg in 500 ml N/saline
over 4 hrs.

Recommendation

-Alternatively higher dose maybe given only on the day of

the procedure (600-1200mg)
-IV route is reasonable when oral treatment is not possible.
-In addition to NAC, IV hydration should be used where
clinically appropriate.
Drug Information Handbook, 22nd Edition. 2013-2014.

Feferences

Baker, C., Wragg, A., Kumar, S., De Palma, R., Baker, L.,
& Knight, C. (2003). A rapid protocol for the prevention of
contrast-induced renal dysfunction: the RAPPID study.
Journal Of The American College Of Cardiology, 41(12),
2114-2118. x

Fishbane, S. (2008). N-Acetylcysteine in the Prevention of

Contrast-Induced Nephropathy. Clinical Journal Of The
American Society Of Nephrology, 3(1), 281-287.