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Dr.D's Antibiotic Brief
Here is some basic info on how they work, which work best or are most common and what kind of doses might be employed. You wouldn’t do a test only cycle without Nolva, right? Of course not, you’d be asking for gyno. Don’t deposit a liquid under your skin without some antibiotics, because it’s not a question of “if” but rather “when.” Use strict aseptic injection techniques and hopefully your need for this info will be very infrequent. Also, if you do not understand how to apply this info, and feel you may have an infection, it’s best to just go and see a doctor. I am not encouraging you to treat yourself, but it is responsible to be able to do so if needed.
Having a ready supply of various antibiotics(AB) can be very important to the athlete who must injection frequently for whatever reason. Antibiotics are chemical compounds either from living or synthetic sources that, in low concentrations, are capable of inhibiting the life processes of microorganisms. AB are either ‘cidal’ or ‘static’ meaning that they either directly kill or inhibit further reproductive cycles of the microbe.
Short breakdown of the classes…
PENICILLINS:
Crystalline(powder) and salt forms(pills) are stable at room temperature for years. Although they do not require cold storage, they must be kept dry. The water-insoluble salts are stable in solution for up to 6 years in my experience, but should be kept at std refrigeration temp. 1.0mg of Pen G Procaine salt is equal to 1009units. Some are allergic to pens and should determine sensitivity before use. Eating is usually not a problem with oral pen but buffers and anti-acids are to be avoided. This class is active against gram (-) and some gram (+).
Common products, doses and duration of therapy:
Pen G Procaine…… 600,000u IM 1x/day for 1-10days (this is my favorite injectable pen)
Pen G Benzathine… 1,200,000u IM 1-2x/wk for 1-2 weeks (1 shot only may fix it, long acting)
Pen V……………... 125-250mg Oral 4x/day for about 2 weeks
Ampicillin………… 250-500mg Oral 4x/day for NLT 10days
Amoxicillin……….. 500mg Oral 3-4x/day for NLT 10days
Augmentin………… 875mg Oral 2x/day for NLT 10days (this is a good form of Amox)
CEPHALOSPORINS:
These compounds are bacteriocidal in a similar way as to pens. They interfere with bacteria cell wall cross-linking. Although they are closely related to pens, people are less likely to demonstrate allergic reactions, due to certain changes in the basic structure. This class has gram (-) and (+) activity. These are generally very good for soft tissue infection like an athlete my encounter.
Common products, doses and duration of therapy:
Cephalexin ……….. 125-250mg Oral 6x/day for NLT 10days (this works fast, my favorite ceph)
Cefaclor…………… 250mg Oral 3xdaily for NLT 10days
Cefoxitin………….. 2g IV daily for 1 or 2 weeks
MACROLIDES:
These compounds are very effective bacteriostatics that work by interfereing with protein synthesis at the 50S subunit of ribosomes. They are generally more effective against gram (+) organisms. They are also fairly stable in solution at or below room temp.
Common products, doses and duration of therapy:
Erythromycin S.…... 500mg Oral 4x/day for about 2 weeks (stomach upset can be a prob)
Clarithromycin……. 500mg Oral 2x/day for NLT 5days
Azithromycin……… 500mg Oral 1x/day for 3-10days
TETRACYCLINES:
This is a good class of broad spectrum agents. Old, expired tetracycline sometimes contains a very nasty, toxic deg that is quite kidney toxic. If the pills or powder have been stored in cold, this is not usually a prob, but when in doubt, don’t use old tetracycline. Other drugs in this class are not prone to this breakdown. These compounds interfere with 30S subunit ribosomal protein synthesis. Tets work by chelating minerals, so iron, calcium and magnesium sups should be discontinued when on them.
Common products, doses and duration of therapy:
Tetracycline………. 500mg Oral 4x/day for NLT 10days (stomach upset can be a prob)
Doxycycline H……. 200mg Oral 1x/day for 5-30days (this is one of my favorite broad spec)
QUINOLONES:
Work on a variety of gram (-) and (+) organisms. It is cidal in that it inhibits DNA/m-RNA synthesis in an ATP-dependant manner. These are great broad spectrums, but can be toxic with extended use. Trovan(trovafloxacin) for example, was withdrawn due to many cases of liver damage a few years ago, but was reintroduced in Canada and maybe in the US recently, I’m not sure. It’s my all time favorite bug killer. If you can find it, get some, it’s like AB gold.
Common products, doses and duration of therapy:
Ciprofloxacin……... 250-750mg Oral 2-3x/day for NLT 5days
Norfloxacin……….. 400mg Oral 2x/day for 3-30days
Trovafloxacin……... 200mg Oral 1x/day (often 2 doses will kill anything, the best around IMO)
LINCOSAMIDES:
These are broad spectrums that interfere with 50s subunit ribosomal protein synthesis in a static way. They have a tendency toward pseudomembranous colitis (severe diarrhea) when used at high doses or for too long, but nevertheless, are great AB that I utilize as a first line of defense in many cases. They work fast and are strong. If oral Clindamycin is combined with an equal dose of metronidazole or cholestyramine resin, these sides are often totally avoidable. If it does happen, stop use at once.
Common products, doses and duration of therapy:
Clindamycin (base).. 150mg Oral 4x/day for 3-7days.
Clindamycin Phos… 300mg IV or IM 2x/day for 5-10days.
Lincomycin HCl…... 300-600mg IV or IM 1-2x/day for up to 1month.
MISC:
These are lesser used, or unclassified, but can still have a valuable place here. They all have special toxicity issues that should be investigated before attempting to use one of them.
Common products, doses and duration of therapy:
Vancomycin HCl…. 500mg IV 4x/day for weeks if needed.
Cycloserine……….. 250mg Oral 2-4x/day for weeks or longer.
Chloramphenicol…. 250mg Oral 4x/day for NLT 10days.
Streptomycin SO4… 1g IM 1x/day for weeks as needed.
Note:
To conclude, it is not as hard as one may thing to treat an abscess. The trick is to catch it fast at the first sign of infection. A preventative dose of 400mg doxycycline at the first signs of an infection is often times enough to knock it out and avoid a full course of harsher AB therapy. Drug interactions can be of concern on AB and should be investigated by the user prior to initiation. However, it is rarely necessary to discontinue a cycle unless you are physically unable to lift due to the infection, because there are different enzymes involved in most cases. Also, with oral AB, it is usually wise to initiate therapy with a double dose just to get levels up fast. Another important consideration is to restore “friendly flora” in between doses of AB with acidophilus in the form of powder or yogurt. Never take them at the same time though.
I will amend this material as new info is required, or if I have documented misinformation that should be updated. Stay healthy guys!
Footnote: 'Gram' is just a classification catagory based on an organisms color change to a std staining technique. Gram (-) bacteria (like E. Coli) cause probs because many species are pathogenic. This is usually associated with certain components of their cell walls, particularly the lipopolysaccharide layer. Most enteric (bowel related) illnesses can also be attributed to this group of bacteria. Mycobacterium are treated well with doxy and strepto, but I think there may be some newer ones designed just for Crohn's. A 5-aminosalicylate derivative if I remember correctly is giving some successful feedback. But metro kills the colitis for me, I take it with clin everytime and cipro just to be safe. You may want to avoid the clin but try stacking the metro with doxy. I like Pen G because it's cheap and effective. One shot and forget about it until the next day or 2. It's best to start with the older stuff and see if it works, then move on to the stronger stuff if needed, not the other way around. Plus, injects will mess with your intestines less than orals, just by proxy. Colitis is slower to develope. Pen doesn't have a bad rep for colitis and I have never gotten it from Pens even on long courses.
Here is some basic info on how they work, which work best or are most common and what kind of doses might be employed. You wouldn’t do a test only cycle without Nolva, right? Of course not, you’d be asking for gyno. Don’t deposit a liquid under your skin without some antibiotics, because it’s not a question of “if” but rather “when.” Use strict aseptic injection techniques and hopefully your need for this info will be very infrequent. Also, if you do not understand how to apply this info, and feel you may have an infection, it’s best to just go and see a doctor. I am not encouraging you to treat yourself, but it is responsible to be able to do so if needed.
Having a ready supply of various antibiotics(AB) can be very important to the athlete who must injection frequently for whatever reason. Antibiotics are chemical compounds either from living or synthetic sources that, in low concentrations, are capable of inhibiting the life processes of microorganisms. AB are either ‘cidal’ or ‘static’ meaning that they either directly kill or inhibit further reproductive cycles of the microbe.
Short breakdown of the classes…
PENICILLINS:
Crystalline(powder) and salt forms(pills) are stable at room temperature for years. Although they do not require cold storage, they must be kept dry. The water-insoluble salts are stable in solution for up to 6 years in my experience, but should be kept at std refrigeration temp. 1.0mg of Pen G Procaine salt is equal to 1009units. Some are allergic to pens and should determine sensitivity before use. Eating is usually not a problem with oral pen but buffers and anti-acids are to be avoided. This class is active against gram (-) and some gram (+).
Common products, doses and duration of therapy:
Pen G Procaine…… 600,000u IM 1x/day for 1-10days (this is my favorite injectable pen)
Pen G Benzathine… 1,200,000u IM 1-2x/wk for 1-2 weeks (1 shot only may fix it, long acting)
Pen V……………... 125-250mg Oral 4x/day for about 2 weeks
Ampicillin………… 250-500mg Oral 4x/day for NLT 10days
Amoxicillin……….. 500mg Oral 3-4x/day for NLT 10days
Augmentin………… 875mg Oral 2x/day for NLT 10days (this is a good form of Amox)
CEPHALOSPORINS:
These compounds are bacteriocidal in a similar way as to pens. They interfere with bacteria cell wall cross-linking. Although they are closely related to pens, people are less likely to demonstrate allergic reactions, due to certain changes in the basic structure. This class has gram (-) and (+) activity. These are generally very good for soft tissue infection like an athlete my encounter.
Common products, doses and duration of therapy:
Cephalexin ……….. 125-250mg Oral 6x/day for NLT 10days (this works fast, my favorite ceph)
Cefaclor…………… 250mg Oral 3xdaily for NLT 10days
Cefoxitin………….. 2g IV daily for 1 or 2 weeks
MACROLIDES:
These compounds are very effective bacteriostatics that work by interfereing with protein synthesis at the 50S subunit of ribosomes. They are generally more effective against gram (+) organisms. They are also fairly stable in solution at or below room temp.
Common products, doses and duration of therapy:
Erythromycin S.…... 500mg Oral 4x/day for about 2 weeks (stomach upset can be a prob)
Clarithromycin……. 500mg Oral 2x/day for NLT 5days
Azithromycin……… 500mg Oral 1x/day for 3-10days
TETRACYCLINES:
This is a good class of broad spectrum agents. Old, expired tetracycline sometimes contains a very nasty, toxic deg that is quite kidney toxic. If the pills or powder have been stored in cold, this is not usually a prob, but when in doubt, don’t use old tetracycline. Other drugs in this class are not prone to this breakdown. These compounds interfere with 30S subunit ribosomal protein synthesis. Tets work by chelating minerals, so iron, calcium and magnesium sups should be discontinued when on them.
Common products, doses and duration of therapy:
Tetracycline………. 500mg Oral 4x/day for NLT 10days (stomach upset can be a prob)
Doxycycline H……. 200mg Oral 1x/day for 5-30days (this is one of my favorite broad spec)
QUINOLONES:
Work on a variety of gram (-) and (+) organisms. It is cidal in that it inhibits DNA/m-RNA synthesis in an ATP-dependant manner. These are great broad spectrums, but can be toxic with extended use. Trovan(trovafloxacin) for example, was withdrawn due to many cases of liver damage a few years ago, but was reintroduced in Canada and maybe in the US recently, I’m not sure. It’s my all time favorite bug killer. If you can find it, get some, it’s like AB gold.
Common products, doses and duration of therapy:
Ciprofloxacin……... 250-750mg Oral 2-3x/day for NLT 5days
Norfloxacin……….. 400mg Oral 2x/day for 3-30days
Trovafloxacin……... 200mg Oral 1x/day (often 2 doses will kill anything, the best around IMO)
LINCOSAMIDES:
These are broad spectrums that interfere with 50s subunit ribosomal protein synthesis in a static way. They have a tendency toward pseudomembranous colitis (severe diarrhea) when used at high doses or for too long, but nevertheless, are great AB that I utilize as a first line of defense in many cases. They work fast and are strong. If oral Clindamycin is combined with an equal dose of metronidazole or cholestyramine resin, these sides are often totally avoidable. If it does happen, stop use at once.
Common products, doses and duration of therapy:
Clindamycin (base).. 150mg Oral 4x/day for 3-7days.
Clindamycin Phos… 300mg IV or IM 2x/day for 5-10days.
Lincomycin HCl…... 300-600mg IV or IM 1-2x/day for up to 1month.
MISC:
These are lesser used, or unclassified, but can still have a valuable place here. They all have special toxicity issues that should be investigated before attempting to use one of them.
Common products, doses and duration of therapy:
Vancomycin HCl…. 500mg IV 4x/day for weeks if needed.
Cycloserine……….. 250mg Oral 2-4x/day for weeks or longer.
Chloramphenicol…. 250mg Oral 4x/day for NLT 10days.
Streptomycin SO4… 1g IM 1x/day for weeks as needed.
Note:
To conclude, it is not as hard as one may thing to treat an abscess. The trick is to catch it fast at the first sign of infection. A preventative dose of 400mg doxycycline at the first signs of an infection is often times enough to knock it out and avoid a full course of harsher AB therapy. Drug interactions can be of concern on AB and should be investigated by the user prior to initiation. However, it is rarely necessary to discontinue a cycle unless you are physically unable to lift due to the infection, because there are different enzymes involved in most cases. Also, with oral AB, it is usually wise to initiate therapy with a double dose just to get levels up fast. Another important consideration is to restore “friendly flora” in between doses of AB with acidophilus in the form of powder or yogurt. Never take them at the same time though.
I will amend this material as new info is required, or if I have documented misinformation that should be updated. Stay healthy guys!
Footnote: 'Gram' is just a classification catagory based on an organisms color change to a std staining technique. Gram (-) bacteria (like E. Coli) cause probs because many species are pathogenic. This is usually associated with certain components of their cell walls, particularly the lipopolysaccharide layer. Most enteric (bowel related) illnesses can also be attributed to this group of bacteria. Mycobacterium are treated well with doxy and strepto, but I think there may be some newer ones designed just for Crohn's. A 5-aminosalicylate derivative if I remember correctly is giving some successful feedback. But metro kills the colitis for me, I take it with clin everytime and cipro just to be safe. You may want to avoid the clin but try stacking the metro with doxy. I like Pen G because it's cheap and effective. One shot and forget about it until the next day or 2. It's best to start with the older stuff and see if it works, then move on to the stronger stuff if needed, not the other way around. Plus, injects will mess with your intestines less than orals, just by proxy. Colitis is slower to develope. Pen doesn't have a bad rep for colitis and I have never gotten it from Pens even on long courses.
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