Here is a question we received about H.Pylori: 

Hi there! This question is NOT for me but for a friend…She has H. Pylori and this is the 2nd time that she’s had it…She doesn’t want to take the reflux meds because, for some crazy reason, it makes her lose hair…She really wants to know how else she can get rid of it…Also, her report now says that it’s “incidental,” does this mean that it’s not serious?
I was tested for it myself, but never had it (I have digestion problems, but not h. pylori)..
Thanks in advance!

My reply:

Dificid (fidaxomicin) is approved to treat C.diff only.  Typically, it is taken twice daily for 10 days.  It works as well as oral vancomycin.  There was one study that showed that patients treated with Dificid had a slightly lower risk of recurrent infection then those treated with oral vancomycin. 

Here is the kicker…

option 1: oral metronidazole 500mg three times a day for 10-14 days -COST: ~$4 to $8

option 2: oral vancomycin capsules four times a day for 14 days -COST: $1,800

option 3: using the injectable vancomycin but taking it orally four times a day for 14 days-COST: $40

and the new one -option 4: Dificid 200mg twice daily for 10 days -COST: ~$2,800 – ouch!

Which one looks best to you?! 

Just a note here, if you are having trouble with recurrent C.diff  that has already been treated with metronidazole and vancomycin then Dificid is definitely an option.  However, a large part of recurrent C.diff infections are caused by a specific strain -BI/NAP1/027 .  For this strain, Dificid has NOT been proven to work better then oral vancomycin and recurrent rates are the same.

Keep these points in mind when you discuss your options with your physician.  If you need some hints on the best way for your physician to write a script for injectable vanco taken orally -please see the article Oral Vancomycin.

First some background…

Vancomycin is an antibiotic that is most commonly used IV to treat methicillin resistant staphylococcus aureus.  However it can also be used orally to treat clostridium difficile (c.diff). 

C.diff is an intestinal infection that occurs most often in hospitalized patients after treatment with broadspectrum antibiotics.

Treatments for C.diff  include Flagyl (metronidazole) and oral vancomycin.  Typical dose of oral vancomycin is 125mg four times a day for 10 -14 days.

Cost? Vancocin capsules cost about $1,800 for a 14 day treatment -pricey no?!  That is the cash price but even with insurance the copay is typically wicked high!  Well, good news -there is an alternative.  A  hospital outpatient pharmacy (yes, most hospitals have outpatient pharmacies) can provide the IV vancomycin liquid that can be used orally and is much less expensive because it is available in generic.  How less expensive….about $40 for a 14 day treatment (cash price) -that is a savings of about 1,760 bucks!

I have c.diff -now what? Talk with your physician about the options -Flagyl (metronidazole) is a great option because it works well and is on the $4 list at Walmart and Target.  If your physician decides that oral vancomycin is what is needed, then call your local hospital and ask to speak with the outpatient pharmacy.  Typically, the pharmacy will dispense small syringes filled with clear fluid (vancomycin)…the largest amount should be 15mls (1 tablespoon).  Small warning, it doesn’t taste that great -so you may want a chaser after you take it but it does the job and at a fraction of the cost!

How to make it easy:

1) Ask your physician to write for “IV vancomycin fluid 10mg/ml -12.5ml by mouth four times a day for ____days”

2) Call local hospital and ask if they have an outpatient pharmacy -if so, have script filled there (retail/community pharmacies will most likely not be able to provide).

3) Take medicine as prescribed!  And take a deep sigh of relief that you didn’t have to pay $1,800!

Have you taken oral vancomycin?  What do you think -please leave a comment!

So, there is no supporting evidence that cranberries/cranberry juice treats UTIs.  But there are some studies that show cranberries can help prevent UTIs.

Cranberries work by stopping bacteria from sticking to the bladder wall…making it difficult for the bacteria to stick around and start an infection.  Using cranberries to prevent UTIs is still debated, but as they say, “it can’t hurt!”

Studies that showed cranberries can help prevent UTIs used specific products:

1.  300ml (10 oz)/day of Ocean Spray Cranberry Juice Cocktail

2.  500mg/day of Cran-Max capsules

3.  400mg/day of Cranactin capsules

Azo Cranberry is very popular but hasn’t been proven to work.  However, it will most likely work as well as the Cran-Max or Cranactin caps.

If you want a natural product that can prevent and treat UTIs, see Catie’s article D-Mannose for UTI Prevention and Treatment.

If all else fails, use of Bactrim or nitrofurantoin daily can be an option for prevention. 

Do you swear by the power of cranberries?  I would love to hear about it.  Please leave a comment

Here ya go

Trimethoprim-sulfamethoxazole (Bactrim, Septra, Sulfatrim) is a sulfa antibiotic combo that has been around since the 1960s. It is used in kids most commonly to treat urinary tract infections (UTIs), otitis media, chronic bronchitis, acne and typhoid fever.

Bactrim belongs to the class of drugs called sulfonamides. Bactrim is the most well-known of the group. Others include dapsone (Alczone), sulfadiazine and sulfasalazine (Azulfidine). These are the antibiotics that should be avoided if your child has a sulfa allergy.

Bactrim is available in IV formula, oral suspension (Sulfatrim) and tablets. It is approved for kids 2 months and older. Bactrim is dosed on the trimethoprim portion of the combo. Typical dosing for treating kids ranges from 6-20mg trimethoprim/kg divided into two to four doses a day. Dosing for UTI prophylaxis 2mg trimethoprim/kg once daily or 5mg/kg twice weekly.

Bactrim has an interesting way of fighting bacteria. It uses sequential inhibition. Which means it inhibits two enzymes necessary in the step by step process for bacteria to make folic acid. The sulfamethoxazole inhibits the first enzyme and the trimethoprim inhibits the second. Alone these antibiotics would be bacteriostatic but together they can actually kill the bacteria. On occasion, when taken for a prolonged period of time, this can actually decrease folic acid in humans.  However, this is rare for two reasons –human folic acid enzymes are less sensitive to Bactrim and humans can ingest folic acid.

Common side effects include belly upset, diarrhea, lack of appetite, headache, dry eyes and bladder stones. There are more serious side effects, mostly associated with an allergic reaction – the dreaded sulfa allergy.  An allergic reaction can create joint swelling and liver and kidney issues. Bactrim can also cause Stevens-Johnson syndrome, which includes a blistering rash and flu-like symptoms. Stevens-Johnson syndrome is scary but extremely rare with only about 300 new cases in the States a year and mostly in adult women. To avoid these severe side effects, Bactrim should not be given to patients with a known sulfa allergy or G-6-PD deficiency. If the child develops problems breathing or a rash, stop the antibiotic right away.

 If taking the suspension, it can be stored at room temperature.  Be sure to shake the suspension well before giving dose. If taking the tablets, drink it with a full glass of water to avoid the risk of bladder stones. The medicine can be taken with food if it causes belly upset. Bactrim can interact with quite a few other medications, so check with your child’s physician or pharmacist.

 Bactrim is available in generic so it is reasonably priced. It is a good first line choice for treatment of UTIs and a great option for kids with an allergy to penicillins.

Whadyathink?  Please leave a comment/question!

I saw your Youtube page and I am now interested in getting some advice from you.  I have some flushes in my face and they turn a patchy red by my cheeks, towards my nose. My doctor prescribed me Metronidazole, Ovace,
and Doryx. I am fine taking the Metro lotion and ovace but I am a little “iffy” about taking the oral antibiotic, Doryx. My flush isn’t too bad but it is a bit noticeable. Combined with these other medications, would it be best to try to topical lotion first?

 Also, with the metro lotion, will alcohol still effect me if the metro is topical? I know that we shouldn’t mix alcohol with anything, but  I’m wondering if it makes a difference if it is topical or oral.

 To my understanding, antibiotics can kill the ‘good’ bacteria. I don’t like using antibiotics ever even if I have a sinus infection. I believe it is best for my body to build up that defense on its own.

Please let me know your thoughts on this. And thanks for sharing your advice.

Here is my answer: 

I am glad you contacted us!  Your symptoms and medications point toward you having rosacea.  There are a couple of options at this point.  

 1)  Start with topical medications only -which can take over 6 weeks for symptoms to improve.  Oral antibiotics can always be added later if needed.

 2) Start with topical and oral for about 4-6 weeks then slowly (over 4 weeks) taper off the oral antibiotics.   

The benefit of starting with topical and oral is that the symptoms will improve more quickly.  However, it is not a bad choice to just use topicals alone.   Just an FYI here about saving money with Doryx.  Doryx is extended release doxycyline.  To save money, you can take generic doxycyline twice a day instead of Doryx once a day.  It depends -money versus convenience.  

 The topical treatment of metronidazole should be safe with alcohol because it is minimally absorbed into the body.  

You are right -antibiotics do not discriminate -they kill good and bad bacteria.  We have “good” bacteria in our gut that the antibiotics can kill and cause issues such as fungal infections, belly ache and diarrhea.  If you choose to take the oral antibiotics, consider also taking probiotics.  The probiotics replace the good bacteria.  To get these probiotics, you can either eat yogurt daily or if that is not your thing, you can find capsules of acidophilus or lactobacillus OTC at most pharmacies.   

Okay, almost done here!  Just a note about rosacea and lifestyle changes.  There are some triggers that can worsen rosacea -everyone is different so your triggers can be unique to you.  However, general triggers include: spicy food, hot foods, alcohol -red wine, hot temperatures and sunlight.

End of email!

Would you like to discuss rosacea some more?  Please email me at nova@getpharmacyadvice.com or just leave us a comment!

Want to learn more about drug side effects and drug interactions….have any specific questions?  Just drop us an email or comment!

Azithromycin belongs to a group of antibiotics called macrolides.  Other macrolides include erythromycin (Ery-Tab), clindamycin (Cleocin), clarithromycin (Klaricid) and telithromycin (Ketek).  Macrolides work by preventing bacteria from multiplying and producing proteins that are essential for their growth. The bacteria eventually die or are killed by the immune system.  Macrolides are bacteriostatic. 

Just a note here about antibiotics and the difference between bacteriostatic versus bactericidal antibiotics.  Bacteriostatic antibiotics work by stopping the growth of the bacteria and helping to rid the body’s immune system of the bacteria.  Bactericidal antibiotics actually kill the bacteria. 

Azithromycin is available in tablets, suspension, IV and ophthalmic solution.  The solution is approved for kids over six months. Pediatric doses range from 5-20mg/kg.  Usually, azithromycin is started with a loading dose, so a common script will read as 10mg/kg on day one, 5mg/kg on days two thru five. That is right, typically treatment is for only five days!

In addition to the short duration of therapy, most kids really like the cherry/banana flavouring.  For those kids who are not fans of cherry/banana, azithromycin is easily flavoured at the pharmacy.  Azithromycin liquid is a suspension, which means always shake well.  It can be given with or without food, but with a meal may reduce and belly upset for the child. However, azithromycin should not be given with antacids that contain aluminum or magnesium because the antacid will bind the antibiotic and prevent absorption.  

Once azithromycin is reconstituted at the pharmacy, it can be stored at room temperature or in the fridge for 10 days.  The most common side effects are belly related –nausea, vomiting, diarrhea and belly ache.  Kids may also complain of headache, dizziness and agitation.  Rare side effects include kidney, liver and heart issues.  This may sound quite scary but the side effects are very rare and more likely when used in the IV formulation (which isn’t approved for children).

Oftentimes, I am asked why one antibiotic is chosen over another.  When deciding what antibiotic is best to use, we often consider the severity of the infection, where the infection is, what kind of bacteria is most likely causing the infection, patient specific information –like allergies and age, and price. 

Azithromycin is commonly a good choice for treatment in kids.  Available in generic, it is reasonably priced.  It is well received by both kids and parents and it is effective against many common childhood bacterial infections.

The initial post, ”Is Nitrofurantoin Safe to Use During Pregnancy?” was viewed by a blog follower in New Zealand who is currently pregnant and was prescribed nitrofurantoin (Yup, that’s right, GPA.com has traveled across the world…wicked exciting to me!).

The soon-to-be mom was concerned for her baby’s safety, so she e-mailed the following message:

Hi im 34 weeks pregnant and my midwife have me on 4 x 50mg a day for 7 days as i have a uti and im very worried about the effects i will have on my babies development and wellbeing. My midwife said its very safe and that my baby will be fine but as this is my first pregnancy im worried as i dont know anyone close that has had uti  antibiotics during pregnancy and feel scared as i dont want to harm my baby in any way. Am feeling a bit scared as its not 100% sure. What do you think.

My response was:

Hi Jane Doe (or whatever name you’d like to insert!),

I definitely understand your concern about taking medications during your pregnancy, especially since it’s your first time through such an experience! 

You have the right idea…best to to avoid taking any medications, but sometimes the benefits outweigh the risks.   

I’m not sure if you’re familiar with the U.S. Food and Drug Administration (FDA), as I believe you live in another country (New Zealand? based on your e-mail address), but they have setup categories for the use of medications in pregnancy. 

 The categories include A, B, C, D, and X, with A being the safest category on down to X being extremely dangerous.    Nitrofurantoin falls into category B: Animal studies have shown no evidence of risk to the fetus, but there are not enough studies in humans to come to the same conclusion OR animal studies have shown risk BUT there are adequate studies in humans showing no risk to the fetus.  

 The fact that nitrofurantoin is a category B based on the FDA guidelines would make give me great comfort if I were in your situation!   

 If you were at full term (between 38 to 42 weeks) or could go into labor at any moment, there is concern that your newborn could experience what’s called hemolytic anemia (not enough red blood cells in the blood).  

I know that sounds scary, but this hemolytic anemia was reported in mothers with G-6PD deficiency (a rare condition that you’d probably know if you had), which can also occur in the fetus.    

The best news about this chance of hemolytic anemia is that it is extremely rare….the risk is 0.0004%!   A comprehensive review of available studies on treatment of UTIs in pregnancy has shown nitrofurantoin (and other antibiotics) to be very effective and complications to be rare.   

With all of this being said, I agree with your midwife, and if I were in your place, I would take the nitrofurantoin.  To me, the risk of not treating the infection outweighs the risk that nitrofurantoin poses to the fetus, especially because the infection can become worse and lead to undesirable outcomes.    

I hope I have been of at least some help and that you can use this information as a way to help you decide what’s best for your situation.    

Have a great night (or in your case, day!) and thanks for getting in touch,

Cate   

END OF RESPONSE!

Any comments? Questions? Concerns? Leave a comment below or e-mail me at Cate@getpharmacyadvice.com!

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