Ecodax G

Indications

• Vaginal candidiasis
• Vulval candidiasis
• Superficial fungal infections

Dosage

Children: Refer to BNF for Children for appropriate dosing information.

Adults: For vaginal candidiasis, 1 pessary or 5 g of cream should be applied intravaginally at night for at least 14 days, with the course possibly repeated if necessary. For vulval candidiasis, apply cream 2-3 times a day to the affected area for the same duration.

Mechanism of action

Econazole nitrate exerts its antifungal effects by inhibiting the enzyme lanosterol 14-alpha-demethylase, which is crucial for the conversion of lanosterol to ergosterol in the fungal cell membrane. This disruption in ergosterol synthesis compromises the structural integrity of the fungal cell membrane, leading to increased permeability, cell lysis, and ultimately, cell death.

Pharmacodynamics

Econazole exhibits broad-spectrum antifungal activity against various fungi, including Candida species and dermatophytes. It is effective in treating superficial fungal infections due to its ability to penetrate the skin and mucosal tissues. The drug's effectiveness is enhanced when used consistently over the recommended treatment duration, which is typically at least 14 days for most infections.

Pharmacokinetics

Econazole is primarily administered topically, leading to minimal systemic absorption. When applied to the skin or vaginal mucosa, it achieves localized concentrations sufficient for antifungal activity. The pharmacokinetics of econazole indicate a high degree of binding to skin and mucosal tissues, allowing for sustained release and prolonged antifungal action. The elimination half-life is not well defined due to its local application and limited systemic exposure.

Contra-indications

• Hypersensitivity to econazole nitrate or any of the excipients
• Pregnancy, particularly during the first trimester

Adverse effects

• Skin reactions
• Vaginal burning
• Angioedema

Interactions

• May damage latex condoms and diaphragms

Precautions

• Use with caution in patients with a history of hypersensitivity reactions
• Monitor for skin reactions
• Avoid use during the first trimester of pregnancy

Pregnancy

Oral antifungal treatments should be avoided during pregnancy. Pregnant women may need a longer duration of treatment, usually about 7 days, to clear the infection.

Breast-feeding

Limited data available, but caution is advised as econazole may be excreted in breast milk.

Storage

Store below 25 degrees Celsius. Keep the container tightly closed and protect from light.

Formulations

• Econazole nitrate 10 mg per 1 gram cream
• Econazole nitrate vaginal pessaries

Indications

• Prophylaxis of asthma
• Management of allergic rhinitis
• Treatment of nasal polyps

Dosage

Children: For children aged 2–11 years, the dose is 100–200 micrograms twice daily; for children aged 12–17 years, 200–400 micrograms twice daily, adjusted according to response.

Adults: For adults and children over 12 years with chronic asthma, the usual starting dose is 200-400 micrograms twice daily, which may be increased if necessary.

Mechanism of action

Beclometasone dipropionate acts by binding to glucocorticoid receptors in target cells, leading to the modulation of gene expression and the inhibition of pro-inflammatory cytokines, thereby reducing inflammation and hyperresponsiveness in the airways.

Pharmacodynamics

As a potent anti-inflammatory agent, beclometasone dipropionate decreases the infiltration of inflammatory cells into the airways, reduces mucus production, and enhances beta-adrenergic responsiveness. This results in improved airflow and reduced asthma symptoms.

Pharmacokinetics

Beclometasone dipropionate is administered via inhalation, where it undergoes extensive first-pass metabolism in the liver. Its systemic bioavailability is low due to significant hepatic metabolism. The drug has a long duration of action, with effects lasting for 12-24 hours, allowing for once or twice-daily dosing.

Contra-indications

• Hypersensitivity to beclometasone dipropionate or any of its excipients
• Hypersensitivity to atropine or its derivatives

Adverse effects

• Throat irritation
• Wheezing
• Nasal complaints
• Headache
• Nausea
• Stomatitis
• Gastrointestinal absorption may occur
• Corneal oedema
• Eye disorders
• Eye pain
• Palpitations

Precautions

• Monitor growth in children receiving prolonged treatment
• Consider systemic corticosteroid side effects with high doses or prolonged use

Pregnancy

Manufacturer advises only use if potential benefit outweighs the risk.

Breast-feeding

No information available-manufacturer advises only use if potential benefit outweighs risk.

Storage

Store at room temperature, away from moisture and heat.

Formulations

• Inhalation aerosol (Clenil Modulite®)
• Inhalation powder (Qvar®)

Indications

• Bacterial infections
• Sepsis
• Pneumonia
• Meningitis
• Endocarditis
• Biliary tract infections
• Prostatitis
• Surgical prophylaxis
• Acute diverticulitis
• Leg ulcer infections

Dosage

Adults: 3–5 mg/kg daily in 3 divided doses, or a single daily dose of 5–7 mg/kg adjusted according to serum-gentamicin concentration. For surgical prophylaxis, 1.5 mg/kg administered intraven

Mechanism of action

Gentamicin exerts its antibacterial effects through a multi-phase mechanism. Initially, it binds to negatively charged components of bacterial cell membranes, increasing membrane permeability. Following this, it enters the bacterial cell via energy-dependent transport mechanisms, where it binds to the 30S ribosomal subunit. This binding causes mistranslation of proteins and disrupts membrane integrity, resulting in bacterial cell death. The action is concentration-dependent, leading to rapid bactericidal effects.

Pharmacodynamics

Gentamicin has a rapid onset of action due to its mechanism of disrupting the bacterial cell membrane and inhibiting protein synthesis. Its effectiveness is enhanced by higher concentrations, and it demonstrates a post-antibiotic effect where bacteria remain suppressed even after drug levels fall below the minimum inhibitory concentration. The drug's efficacy is influenced by factors like the bacterial strain and its susceptibility patterns.

Pharmacokinetics

Gentamicin is usually administered intravenously or intramuscularly. It has a volume of distribution of approximately 0.25 L/kg and is not significantly protein-bound. The drug is primarily eliminated via renal excretion, with a half-life of 2 to 3 hours in individuals with normal renal function. Dosing adjustments are necessary in patients with renal impairment to avoid toxicity. Serum levels should be monitored to optimize therapeutic efficacy while minimizing toxicity.

Contra-indications

• Hypersensitivity to gentamicin or any aminoglycoside
• Severe renal impairment
• Pre-existing auditory or vestibular dysfunction

Adverse effects

• Ototoxicity (hearing loss, vertigo, tinnitus)
• Nephrotoxicity
• Neuromuscular blockade
• Allergic reactions (rash, pruritus)
• Injection site reactions

Interactions

• Gentamicin + relugolix: Unknown (increases exposure)
• Gentamicin + other nephrotoxic drugs (e.g., vancomycin, cisplatin): Increased risk of nephrotoxicity
• Gentamicin + neuromuscular blocking agents: Enhanced neuromuscular blockade

Precautions

• Monitor renal function during therapy, especially in patients with pre-existing renal impairment
• Caution in patients with pre-existing hearing loss or vestibular disorders
• Use with caution in pregnant women and during breastfeeding

Pregnancy

Use only if clearly needed and the benefit justifies the risk to the fetus. Limited data on use in pregnancy.

Breast-feeding

Gentamicin is excreted in breast milk, exercise caution when administering to breastfeeding mothers. Monitor infant for possible side effects.

Storage

Store below 25°C. Protect from light. Do not freeze.

Formulations

• Injection solution (various concentrations)
• Ophthalmic solution (0.3% w/v)
• Topical ointment (0.1% w/v)

Indications

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Allergic rhinitis
• Topical treatment of inflammatory skin conditions

Dosage

Children: Dosing in children should be determined based on the BNF for Children. Refer to the BNF for specific paediatric dosing information.

Adults: The dosage for adults varies depending on the condition being treated. Refer to the BNF for specific dosing guidelines.

Mechanism of action

Beclometasone acts by binding to glucocorticoid receptors, leading to the modulation of gene expression. This results in the inhibition of pro-inflammatory cytokines and the promotion of anti-inflammatory proteins, thereby reducing inflammation and immune response.

Pharmacodynamics

As a corticosteroid, beclometasone exerts its effects by modulating various cellular functions. It decreases the migration of leukocytes to sites of inflammation, reduces capillary permeability, and inhibits the release of enzymes that contribute to the inflammatory response. The therapeutic effects are evident in conditions characterized by excessive inflammation.

Pharmacokinetics

Beclometasone is well-absorbed when administered by inhalation, and its bioavailability is significantly enhanced when delivered directly to the lungs. It undergoes extensive first-pass metabolism in the liver, which reduces systemic exposure. The half-life of beclometasone is approximately 15 hours, and it is primarily excreted via the urine as metabolites.

Contra-indications

• Hypersensitivity to beclometasone or any of its components
• Systemic fungal infections
• Active or latent tuberculosis

Adverse effects

• Local irritation
• Dryness of the throat
• Cough
• Dysphonia
• Oral candidiasis
• Adrenal suppression (with prolonged use)

Interactions

• cobicistat+beclometasone: Unknown (increases exposure)
• idelalisib+beclometasone: Unknown (increases exposure)
• clarithromycin+beclometasone: Unknown (increases exposure)

Precautions

• Use with caution in patients with active infections
• Monitor for signs of adrenal insufficiency in long-term therapy
• Consider alternate therapy in patients with a history of severe allergic reactions

Pregnancy

Beclometasone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult a healthcare provider.

Breast-feeding

Beclometasone is excreted in breast milk. Caution should be exercised when administering to nursing mothers.

Storage

Store at room temperature, away from direct sunlight and moisture. Keep out of reach of children.

Formulations

• Inhaler
• Nasal spray
• Topical cream
• Topical ointment

Indications

• Tinea pedis (athlete's foot)
• Tinea cruris (jock itch)
• Tinea corporis (ringworm)
• Candidiasis (yeast infections)
• Dermatophyte infections

Dosage

Children: For children, refer to the BNF for Children for appropriate dosing information.

Adults: Apply to the affected area once daily for 2 to 4 weeks, depending on the specific infection being treated.

Mechanism of action

Econazole interacts with 14-alpha demethylase, a cytochrome P-450 enzyme necessary for converting lanosterol to ergosterol. Inhibition of ergosterol synthesis results in increased cellular permeability and leakage of cellular contents. Additionally, econazole may inhibit endogenous respiration, interact with membrane phospholipids, inhibit the transformation of yeasts to mycelial forms, inhibit purine uptake, and impair triglyceride and/or phospholipid biosynthesis.

Pharmacodynamics

Econazole is an antifungal agent related to other azoles such as fluconazole, ketoconazole, itraconazole, and clotrimazole. It prevents fungal organisms from producing vital substances required for their growth and function, making it effective only against fungal infections.

Pregnancy

Econazole should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Econazole may be excreted in human breast milk, use caution when administering to nursing mothers.

Storage

Store at room temperature, away from moisture and heat.

Formulations

• Topical cream
• Topical solution
• Vaginal cream

Mechanism of action

There are 3 key phases of aminoglycoside entry into cells. The first “ionic binding phase” occurs when polycationic aminoglycosides bind electrostatically to negatively charged components of bacterial cell membranes including with lipopolysaccharides and phospholipids within the outer membrane of Gram-negative bacteria and to teichoic acids and phospholipids within the cell membrane of Gram-positive bacteria. This binding results in displacement of divalent cations and increased membrane permeability, allowing for aminoglycoside entry. The second “energy-dependent phase I” of aminoglycoside entry into the cytoplasm relies on the proton-motive force and allows a limited amount of aminoglycoside access to its primary intracellular target - the bacterial 30S ribosome. This ultimately results in the mistranslation of proteins and disruption of the cytoplasmic membrane. Finally, in the “energy-dependent phase II” stage, concentration-dependent bacterial killing is observed. Aminoglycoside rapidly accumulates in the cell due to the damaged cytoplasmic membrane, and protein mistranslation and synthesis inhibition is amplified. The necessity of oxygen-dependent active transport explains why aminoglycosides are ineffective against anaerobic bacteria. Hence, aminoglycosides have both immediate bactericidal effects through membrane disruption and delayed bactericidal effects through impaired protein synthesis; observed experimental data and mathematical modeling support this two-mechanism model. Inhibition of protein synthesis is a key component of aminoglycoside efficacy. Structural and cell biological studies suggest that aminoglycosides bind to the 16S rRNA in helix 44 (h44), near the A site of the 30S ribosomal subunit, altering interactions between h44 and h45. This binding also displaces two important residues, A1492 and A1493, from h44, mimicking normal conformational changes that occur with successful codon-anticodon pairing in the A site. Overall, aminoglycoside binding has several negative effects including inhibition of translation, initiation, elongation, and ribosome recycling. Recent evidence suggests that the latter effect is due to a cryptic second binding site situated in h69 of the 23S rRNA of the 50S ribosomal subunit. Also, by stabilizing a conformation that mimics correct codon-anticodon pairing, aminoglycosides promote error-prone translation. Mistranslated proteins can incorporate into the cell membrane, inducing the damage discussed above. Aminoglycosides are usually bactericidal in action. Although the exact mechanism of action has not been fully elucidated, the drugs appear to inhibit protein synthesis in susceptible bacteria by irreversibly binding to 30S ribosomal subunits. /Aminoglycosides/ ... Aminoglycosides are aminocyclitols that kill bacteria by inhibiting protein synthesis as they bind to the 16S rRNA and by disrupting the integrity of bacterial cell membrane. Aminoglycoside resistance mechanisms include: (a) the deactivation of aminoglycosides by N-acetylation, adenylylation or O-phosphorylation, (b) the reduction of the intracellular concentration of aminoglycosides by changes in outer membrane permeability, decreased inner membrane transport, active efflux, and drug trapping, (c) the alteration of the 30S ribosomal subunit target by mutation, and (d) methylation of the aminoglycoside binding site. ... /Aminoglycosides/

Mechanism of action

Econazole interacts with 14-α demethylase, a cytochrome P-450 enzyme necessary to convert lanosterol to ergosterol. As ergosterol is an essential component of the fungal cell membrane, inhibition of its synthesis results in increased cellular permeability causing leakage of cellular contents. Econazole may also inhibit endogenous respiration, interact with membrane phospholipids, inhibit the transformation of yeasts to mycelial forms, inhibit purine uptake, and impair triglyceride and/or phospholipid biosynthesis.

Pharmacodynamics

Econazole is an antifungal medication related to fluconazole (Diflucan), ketoconazole (Nizoral), itraconazole (Sporanox), and clotrimazole (Lotrimin, Mycelex). Econazole prevents fungal organisms from producing vital substances required for growth and function. This medication is effective only for infections caused by fungal organisms. It will not work for bacterial or viral infections.