Considerations and interactions Some antibiotics aren't suitable for people with certain medical conditions, or women who are pregnant or breastfeeding. Read more about how antibiotics interact with other medicines Types of antibiotics There are hundreds of different types of antibiotics, but most of them can be broadly classified into six groups. These are strains of bacteria that have developed resistance to many different types of antibiotics, including: methicillin-resistant Staphylococcus aureus MRSA Clostridium difficile C.
Accessing medicines self-help guide Visit our self-help guide on accessing medicines if you have difficulty getting the medicines you need. Uses Antibiotics are used to treat or prevent some types of bacterial infections. People at risk of bacterial infections Antibiotics may also be recommended for people who are more vulnerable to the harmful effects of infection. This may include: people aged over 75 years babies less than 72 hours old with a confirmed bacterial infection, or a higher than average risk of developing one people with heart failure people who have to take insulin to control their diabetes people with a weakened immune system — either because of an underlying health condition such as HIV infection or as a side effect of certain treatments, such as chemotherapy Antibiotics to prevent infection Antibiotics are sometimes given as a precaution to prevent, rather than treat, an infection.
For example, it may be used if you're going to have: some types of eye surgery — such as cataract surgery or glaucoma surgery joint replacement surgery breast implant surgery pacemaker surgery surgery to remove the gall bladder surgery to remove the appendix Your surgical team will be able to tell you if you require antibiotic prophylaxis. Bites or wounds Antibiotic prophylaxis may be recommended for a wound that has a high chance of becoming infected — this could be an animal or human bite , for example, or a wound that has come into contact with soil or faeces.
Medical conditions There are several medical conditions that make people particularly vulnerable to infection, making antibiotic prophylaxis necessary. In some cases, antibiotic prophylaxis is prescribed for people who experience a recurring infection that's causing distress or an increased risk of complications, such as: cellulitis a urinary tract infection genital herpes rheumatic fever. Special considerations There are some important things to consider before taking antibiotics.
This page contains information on the 6 main classes of antibiotics: penicillin cephalosporins aminoglycosides tetracyclines macrolides fluoroquinolones Penicillin Don't take one of the penicillin-based antibiotics if you've had an allergic reaction to them in the past.
Penicillins may need to be used at lower doses and with extra caution if you have: severe kidney disease liver disease Pregnancy and breastfeeding Most penicillins can be used during pregnancy and breastfeeding in the usual doses. Cephalosporins If you previously had an allergic reaction to penicillin, there's a chance that you may also be allergic to cephalosporins. Aminoglycosides Aminoglycosides are normally only used in hospital to treat life-threatening conditions such as septicaemia, as they can cause kidney damage in people with pre-existing kidney disease.
They're only used during pregnancy if your doctor believes they're essential. Tetracyclines The use of tetracyclines isn't usually recommended unless absolutely necessary in the following groups: people with kidney disease — except doxycycline, which can be used people with liver disease people with the autoimmune condition lupus — which can cause skin problems, joint pain and swelling, and fatigue feeling tired all the time children under the age of 12 pregnant or breastfeeding women Macrolides You shouldn't take macrolides if you have porphyria — a rare inherited blood disorder.
Other macrolides shouldn't be used during pregnancy, unless advised by a specialist. Fluoroquinolones Fluoroquinolones aren't normally suitable for women who are pregnant or breastfeeding. Side effects The most common side effects of antibiotics affect the digestive system.
Side effects of antibiotics that affect the digestive system include: vomiting nausea feeling like you may vomit diarrhoea bloating and indigestion abdominal pain loss of appetite These side effects are usually mild and should pass once you finish your course of treatment.
Antibiotic allergic reactions Around 1 in 15 people have an allergic reaction to antibiotics, especially penicillin and cephalosporins. In most cases, the allergic reaction is mild to moderate and can take the form of: a raised, itchy skin rash urticaria, or hives coughing wheezing tightness of the throat, which can cause breathing difficulties These mild to moderate allergic reactions can usually be successfully treated by taking antihistamines.
Initial symptoms of anaphylaxis are often the same as above and can lead to: a rapid heartbeat increasing difficulty breathing caused by swelling and tightening of the neck a sudden intense feeling of apprehension and fear a sharp and sudden drop in your blood pressure, which can make you feel light-headed and confused falling unconscious Anaphylaxis is a medical emergency and can be life-threatening if prompt treatment isn't given.
Tetracyclines and sensitivity to light Tetracyclines can make your skin sensitive to sunlight and artificial sources of light, such as sun lamps and sunbeds. You should avoid prolonged exposure to bright light while taking these drugs. Interactions with other medicines Antibiotics can sometimes interact with other medicines or substances.
Some of the more common interactions are listed below, but this isn't a complete list. Alcohol You should completely avoid alcohol while taking the antibiotics metronidazole or tinidazole, and for 48 hours afterwards, as this combination can cause very unpleasant side effects, such as: feeling and being sick stomach pain hot flushes headaches It's recommended that you don't drink alcohol while taking antibiotics.
Combined oral contraceptives Some antibiotics, such as rifampicin and rifabutin, can reduce the effectiveness of the combined oral contraceptive pill.
Medications Some of the medications you may need to avoid, or seek advice on, while taking a specific class of antibiotic are outlined below. Penicillins It's usually recommended that you avoid taking penicillin at the same time as methotrexate, which is used to treat psoriasis , rheumatoid arthritis and some forms of cancer. Cephalosporins Cephalosporins may increase the chance of bleeding if you're taking blood-thinning medications anticoagulants such as heparin and warfarin.
Aminoglycosides The risk of damage to your kidneys and hearing is increased if you're taking one or more of the following medications: antifungals — used to treat fungal infections cyclosporin — used to treat autoimmune conditions such as Crohn's disease and given to people who have had an organ transplant diuretics — used to remove water from the body muscle relaxants The risk of kidney and hearing damage has to be balanced against the benefits of using aminoglycosides to treat life-threatening conditions such as septicaemia.
This includes: antacids zinc supplements some types of multivitamin supplements. Tweet Click here to share this page on Twitter This will open a new window.
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Am Fam Physician. What are antibiotics? Do antibiotics always work? What is bacterial resistance? What can I do to help myself? How do I know when I need antibiotics? It depends on what is causing your infection. The following are some basic guidelines: Colds and flu. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. For example, there are several types of ear infections — most need antibiotics, but some do not.
Most cases of sore throat are caused by viruses. One kind, strep throat, diagnosed by a lab test, needs antibiotics. Common viral infections, like coughs or a cold, can sometimes become complicated and a bacterial infection can develop. However, treating viral infections with antibiotics in order to prevent bacterial infections is not recommended because of the risk of causing bacterial resistance:.
Remember that antibiotics do not work against viral colds and the flu, and that unnecessary antibiotics can be harmful. Talk with your healthcare provider about antibiotics and find out about the differences between viruses and bacteria, and when antibiotics should and should not be used.
If your child receives an antibiotic, be sure to give it exactly as prescribed to decrease the development of resistant bacteria. Have your child finish the entire prescription. Don't stop when the symptoms of infection go away. Never save the left over antibiotics to use "just in case.
Fleming began working with both these drugs and had stopped working with penicillin by That he was still interested in penicillin would, in later years, be obvious. During this same ten year period, between , Dr. Howard W. Florey, Professor of Pathology at Oxford's Sir William Dunn School of Pathology, also became interested in research on lysozymes, and later, in , in antibiotic when he came across Fleming's paper on penicillin.
Florey, however, did not work alone, he had a team of scientist that consisted of Drs. Ernst B. Chain, Leslie Falk, Norman G. Heatley and twenty other scientists and technicians. Where Fleming had a poorly equipped lab with no staff support, Florey's lab was well staffed and equipped.
There are many conflicting stories concerning the relationship between Florey and Chain. Chain is always credited as the person who actually began working with penicillin in Florey's lab and even located a culture that was sub-cultured from Fleming's original isolate of P. Florey, on the other hand, was the person in charge of the research program, but was often thought of as not being very knowledgeable about penicillin before Chain's rediscovery of Fleming's paper.
This seems unlikely since Florey had been on the editorial board of the journal which published Fleming's first penicillin paper and there is every likelihood that he may have even helped in editing it.
He also knew Fleming quite well from attending professional meetings and considering Fleming's obsession with penicillin, it seems highly unlikely that the subject would not have come around to penicillin. Finally, when Florey met Paine in , Florey had heard about the potential for penicillin.
However, when questioned about the latter, Florey denied that this had any influence on his direction of research and that he had forgotten that conversation by , when he choose to work on penicillin.
Nevertheless, one of his former students remembered quite distinctly that Florey mentioned Paine's work in a lecture, at Oxford, in One thing that Florey and Chain did agree upon was that scientific interest rather than the desire to introduce a life-saving drug was the reason they devoted their efforts into penicillin research. This would be one of the few things that Chain and Florey would agree upon.
As the years passed, there would be an ever widening rift between the two. Chain explained his motive for working with penicillin:. I became interested - immediately - in Fleming's paper, not because I hoped to discover a miraculous drug for the treatment of bacterial infection which for some reason had been overlooked, but because I thought it had great scientific interest.
In fact, if I had been working at that time in aim-directed scientific surroundings, say in the laboratory of a pharmaceutical firm, it is my belief that I would never have obtained the agreement of my bosses to proceed with my project to work with penicillin. I thought this would be a relevant passage to quote because in many universities, this one in particular, there are those politicians who wish to restrict apparently purely academic research because they see no value in its pursue.
They should probably read this passage by Chain. It was also Chain who began immediate work with penicillin by extracting what he believed to purified penicillin. After a great deal of effort, enough was extracted for experimentation to begin. Tests began with laboratory animals. Initially only two mice were tested. Chain was anxious to begin, but being a biochemist by training, he was not qualified to inject laboratory animals. Rather than Florey, Chain asked another colleague, J.
Barnes, to inject the two mice. The two mice were injected and were unharmed. Chain explained Barnes involvement was due to the absence of Florey who was away from Oxford and explained that he had approached Florey four times in several weeks about doing the injections.
The last time he requested his assistance, Florey turned to Mrs. Margaret Jennings, who was in the lab, and said, pointing to Chain, "in one of my weak moments I promised this man to test his fractions and here he comes pestering me again. As another digression, following this successful inoculation, Florey was not at all pleased with this test being done in his absence.
Chain maintained that Florey was not interested in participating until after he had carried out this test successfully. Following the successful injection of two white mice, fifty white mice were inoculated with deadly Streptococcus germs, followed by injection of penicillin in half the mice. The second group, did not receive penicillin. All of the latter group died the next day while the former mice all recovered.
Florey now thought they were ready to test penicillin on human subjects. However, it would be difficult to produce enough penicillin, For initial tests, by Florey, in , on human subjects, it had required two professors, five graduates and ten assistants working almost every day of the week for several months to produce enough penicillin to treat six patients.
The first real test for the Florey lab came when Albert Alexander, a 48 year old London policeman had nicked himself while shaving. It was only a minor cut and was ignored for several days, but this would have a major impact on medical history. After a time, Alexander's face became swollen and infected and developed a temperature that rose to F.
The minor cut had developed septicemia. When he was rushed to Radcliffe Hospital, sulfa drugs were administered without success. When the doctors believed that the policeman only had several more hours of life remaining, Florey and Chain requested that they be given permission to treat this patient with their "purified" penicillin.
This would be their first human subject to which penicillin was applied. Florey and Chain took charge of the case personally and injections of penicillin were begun. After five days, the impossible had happened, the patient was recovering. Unfortunately, because penicillin was in such short supply, that small amounts had to be extracted from the patient's urine.
There was no more penicillin available, and the policeman had a relapse and died five days later. However, the experiment did demonstrate that penicillin was not harmful to humans and was effective.
Penicillin had temporarily halted the infection, but in the end it had failed in its first test. Unfortunately, because the patient had died, there were a number of macabre jokes that came about, one that is well known, even to this day: "the treatment was a success, but the patient died. The next two treatments, however, would be successful.
The first was a 15 year old boy who had a form of blood poisoning from a badly inflamed hip joint and the second was a 48 year old laborer who had a large carbuncle on his back. In both cases, the penicillin treatment was a success. Encouraged with this success, they next tested penicillin on a 4 year old boy who was ill from an infection, following measles.
Sulpha drugs were used unsuccessfully. The boy, by this time, had developed an infection in one eye socket which spread to the base of the skull and was semi-comatose and it was believed that he had contracted meningitis by this time.
Penicillin was not tried until the infection had already progressed to this advanced state. On the third day of penicillin treatment, the swelling in the boy's eye had retreated and he was emerging from the coma.
The infection had been defeated and the penicillin injections stopped in order to preserve the supply of penicillin. Then suddenly the boy had a sudden convulsion and he died four days later. Although the boy died, the autopsy revealed that he had died of a burst blood vessel in his brain, and that the infection had been cured by the penicillin injections.
During this period Fleming was not idle. Fleming contacted Florey to request penicillin for the treatment of an old friend Harry Lambert, who was in critical condition, suffering from meningitis. Sulfa drugs had already been used and without success. Florey thought the procedure planned by Fleming a risky one, but did supply him with the penicillin. Fleming injected the penicillin into his friend's spine and the treatment proved completely successful, with his friend making a miraculous recovery.
However, Florey had, at the same time, injected penicillin into the spines of artificially infected animals, with the result that they had all died! Luckily, Fleming did not learn about Florey's result until after he had injected Lambert. He probably would have hesitated to give the injection resulting in the death of his friend. Although the relationship between Florey and Fleming seemed to be an amiable one. It would later turn sour. By this time, it was now , it was now acknowledged that penicillin was indeed a worthwhile drug and could save thousands of lives.
Unfortunately, the process that Florey and Chain developed, for extracting penicillin, was producing only one part penicillin per million part of culture medium.
Thus, their penicillin was not purified as they thought it had been. The amount was small indeed, and scientist could be heard saying, "you could get more gold out of ordinary seawater than penicillin out of the mold.
Florey and Chain would be unable to utilize any factory resources in England to experiment further with producing penicillin in adequate amounts to be useful for large scale usage. Also, it was feared that even if a factory could be utilized, it was feared that all their efforts cold possibly be lost if the factory was bombed. However, during the summer of , Florey had negotiated an agreement with the Rockefeller Foundation, which had been funding his research, to fly he and one of his assistant to the United States to continue his work with penicillin.
This gave added incentive to the penicillin project which became declared a war project and was given top priority. Despite the efforts and resources that were being given to producing large quantities of penicillin, it soon became obvious that Fleming's original culture would not be able to produce enough penicillin regardless of the environment in which the fungus was grown.
By , there was only enough penicillin produced to treat a few hundred people. There are many species of Penicillium , and a search was started to find other species that could be tested for penicillin production. Eventually, one was found, on a moldy cantaloupe in a market in Peoria, Illinois. This species would be identified as Penicillium chrysogeum , and would produce approximately times as much penicillin than P. This is the species that is currently used to produce penicillin.
However, even this amount would be inadequate to produce the amount that would be required. Scientist then began to try to increase the amount of penicillin produced by P. This eventually lead to a mutant that produced times the amount of penicillin than Fleming's original culture. In addition to the development of this mutant, a new means of growing the mold was also perfected.
Previously, penicillin was grown in flask, the size of milk bottles, and hundreds of bottles of Penicillium notatum were needed to produce enough penicillin for only a single person. The new method involved growing the mold in large metal tanks, which held 25, gallons of nutrient, were aerated so that the mold could grow throughout the entire tank rather than on top.
Aeration was the key to growing it in such large tanks. Previously, this had not been tried because it was known that the mold would only grow on the surface of the liquid medium. Thus, utilization of a large tank, under such circumstances would be highly inefficient in terms of cost, space and penicillin production.
With this new method, production quantity began to rise. In , 29 pounds were produced, and with increases in the number of pharmaceutical companies producing penicillin, there was a tremendous increase. With respect to the war, the use of penicillin was immediately apparent.
One illness after another, that was tested, was cured by penicillin, which was by this time dubbed a "wonder drug. During this period of time when mass production of penicillin was being perfected, Fleming had little to do with penicillin.
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