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Date Posted: 13:21:07 01/26/02 Sat
Author: No name
Subject: DRUGS;ETC.

WHAT IS AZITHROMYCIN?
Azithromycin is an antibiotic drug. In the US, its brand name is Zithromax. It is sold under many other brand names in other countries.

Antibiotics fight infections caused by bacteria. Azithromycin is used to fight opportunistic infections in people with HIV. Pfizer manufactures it.


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WHY DO PEOPLE WITH HIV TAKE AZITHROMYCIN?
Azithromycin is used for mild or moderate bacterial infections. It works against several different bacteria, especially chlamydia, hemophilus and streptococcus. These bacteria can infect the skin, nose, throat, and lungs. They can also be transmitted through sexual activity and cause infections in the genital area.

Many germs live in our bodies or are common in our surroundings. A healthy immune system can fight them off or keep them under control. However, HIV infection can weaken the immune system. Infections that take advantage of weakened immune defenses are called "opportunistic infections." People with advanced HIV disease can get opportunistic infections. See Fact Sheet 500 for more information on Opportunistic Infections.

One opportunistic infection in people with HIV is MAC. This stands for mycobacterium avium complex. See Fact Sheet 510 for more information on MAC. People who have a T-cell count of less than 75 may develop MAC.

Azithromycin is often used with another antibiotic to treat MAC. It can also be used to prevent MAC infection. If your T-cell count is below 75, talk to your doctor about using azithromycin.

Some people are allergic to azithromycin and similar antibiotics. Be sure to tell your doctor if you are allergic to erythromycin or other antibiotics.


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WHAT ABOUT DRUG RESISTANCE?
Whenever you take medication, be sure to take all of the prescribed doses. Many people stop if they feel better. This is not a good idea. If the drug doesn't kill all of the germs, they might change (mutate) so that they can survive even when you are taking medications. When this happens, the drug will stop working. This is called "developing resistance" to the drug.

For example, if you are taking azithromycin to fight MAC and you miss too many doses, the MAC in your body could develop resistance to azithromycin. Then you would have to take a different drug or combination of drugs to fight MAC.


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HOW IS AZITHROMYCIN TAKEN?
Azithromycin is available in capsules or tablets of 250 milligram (mg.) There is also a 600 mg tablet. It is also available in powder and liquid forms. To fight most infections, the dose for adults is 500 mg on the first day, and then 250 mg each day for 4 more days.

The dose used to prevent MAC infection is 1200 mg or 1250 mg once a week.

Azithromycin tablets can be taken with or without food. Take it with plenty of water. The capsules or liquid should be taken on an empty stomach, either 1 hour before eating or 2 hours after eating. Be sure to check the instructions carefully.

Do not take azithromycin at the same time as antacids that contain aluminum or magnesium. They will reduce the amount of azithromycin in your blood.


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WHAT ARE THE SIDE EFFECTS?
The side effects of azithromycin mostly affect the digestive system. They include diarrhea, nausea, and pain in the abdomen. Some people get very sensitive to sunlight. Others may get headaches, be dizzy or sleepy, or have some problems hearing. Very few people who take azithromycin get these side effects. However, most anti-HIV medications also cause problems in the digestive system. Azithromycin could make those problems worse.

Antibiotics kill some helpful bacteria that normally live in the digestive system. You can eat yogurt or take supplements of acidophilus to replace them.


--------------------------------------------------------------------------------


HOW DOES AZITHROMYCIN REACT WITH OTHER DRUGS?
Azithromycin is broken down by the liver. It can interact with other drugs that also use the liver. Scientists have not yet studied all the possible interactions. Azithromycin probably interacts with some blood thinners, heart medications, seizure medications, and other antibiotics. Be sure your doctor knows about all the medications you are taking.

Your doctor may need to monitor you carefully if you are taking azithromycin and the protease inhibitor ritonavir.

Antacids with aluminum or magnesium can lower blood levels of azithromycin. Do not take antacids at the same time as azithromycin.



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Revised May 4, 2001



WHAT IS CIPROFLOXACIN?
Ciprofloxacin, also called Cipro®, is an antibiotic drug. Antibiotics fight infections caused by bacteria. Cipro fights many different bacteria. It is also used to fight some opportunistic infections in people with HIV. Bayer Corporation manufactures it.


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WHY DO PEOPLE WITH HIV TAKE CIPRO?
Cipro is used for a wide range of bacterial infections. It works against many different bacteria. Cipro works against some bacteria that are resistant to other antibiotics, including penicillin.

Many germs live in our bodies or are common in our surroundings. A healthy immune system can fight them off or keep them under control. However, HIV infection can weaken the immune system. Infections that take advantage of weakened immune defenses are called "opportunistic infections." People with advanced HIV disease can get opportunistic infections. See Fact Sheet 500 for more information on Opportunistic Infections.

One opportunistic infection in people with HIV is MAC. This stands for mycobacterium avium complex. See Fact Sheet 510 for more information on MAC. People who have a T-cell count of less than 75 may develop MAC.

Cipro is often used along with other antibiotics to treat MAC. If your T-cell count is below 75, talk to your doctor about using Cipro.

Some people are allergic to Cipro and similar antibiotics. Be sure to tell your doctor if you are allergic to any antibiotics.



--------------------------------------------------------------------------------


WHAT ABOUT DRUG RESISTANCE?
Whenever you take medication, be sure to take all of the prescribed doses. Many people stop if they feel better. This is not a good idea. If the drug doesn't kill all of the germs, they might change (mutate) so that they can survive even when you are taking medications. When this happens, the drug will stop working. This is called "developing resistance" to the drug.


For example, if you are taking Cipro to fight MAC and you miss too many doses, the MAC in your body could develop resistance to Cipro. Then you would have to take a different drug or combination of drugs to fight MAC.



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HOW IS CIPRO TAKEN?
Cipro is available in several different strength tablets. They contain between 100 milligrams (mg) and 750 mg of Cipro. It is also available in a liquid form. Cipro is taken every 12 hours. The dose of Cipro and the length of time you will take it depend on the type of infection you have.

Cipro tablets can be taken with or without food. Take them with plenty of water. Drink lots of water while you are taking Cipro to make sure the drug doesn't accumulate in your kidneys.

Do not take Cipro at the same time as antacids that contain aluminum or magnesium. They will reduce the amount of Cipro in your blood.



--------------------------------------------------------------------------------


WHAT ARE THE SIDE EFFECTS?
The most common side effects of Cipro are nausea, diarrhea, vomiting, abdominal pain or discomfort, headache, rash and restlessness. It can also cause dizziness and drowsiness. Very few people who take Cipro get these side effects. However, most anti-HIV medications also cause problems in the digestive system. Cipro could make these problems worse.

Cipro makes some people very sensitive to sunlight. It increases the effects of caffeine and can make you very jittery and nervous. In rare cases, Cipro causes an allergic reaction that can be serious.

Antibiotics kill some helpful bacteria that normally live in the digestive system. You can eat yogurt or take supplements of acidophilus to replace them.



--------------------------------------------------------------------------------


HOW DOES CIPRO REACT WITH OTHER DRUGS?
Cipro is not broken down by the liver. This means that it does not have many interactions with HIV antiviral medications. However, it is still a good idea to tell your doctor about all the medications you are taking.

Antacids that contain aluminum or magnesium can lower blood levels of Cipro. Do not take antacids at the same time as Cipro.

Supplements that contain calcium, iron, or zinc can also reduce levels of Cipro. Do not take them while you are taking Cipro. Ask your doctor whether you should keep taking multivitamins that contain iron, calcium or zinc while you are taking Cipro.

Probenecid is a drug used to lower uric acid levels. This is a treatment for gout. Probenecid causes large increases in the blood levels of Cipro.

Cipro can increase methadone levels, possibly causing a serious overdose.



--------------------------------------------------------------------------------


Revised May 4, 2001



WHAT IS CLARITHROMYCIN?
Clarithromycin is an antibiotic drug. In the US, its brand name is Biaxin®.

Antibiotics fight infections caused by bacteria. Clarithromycin is also used to fight opportunistic infections in people with HIV. Abbott manufactures it.



--------------------------------------------------------------------------------


WHY DO PEOPLE WITH HIV TAKE CLARITHROMYCIN?
Clarithromycin is used for mild or moderate bacterial infections. It works against several different bacteria, especially chlamydia, hemophilus and streptococcus. These bacteria can infect the skin, nose, throat, lungs and ears.

Many germs live in our bodies or are common in our surroundings. A healthy immune system can fight them off or keep them under control. However, HIV infection can weaken the immune system. Infections that take advantage of weakened immune defenses are called "opportunistic infections." People with advanced HIV disease can get opportunistic infections. See Fact Sheet 500 for more information on Opportunistic Infections.

One opportunistic infection in people with HIV is MAC. This stands for mycobacterium avium complex. See Fact Sheet 510 for more information on MAC. People who have a T-cell count of less than 75 may develop MAC.

Clarithromycin is often used with other antibiotics to treat MAC. It can also be used to prevent MAC infection. If your T-cell count is below 75, talk to your doctor about using clarithromycin.

Some people are allergic to clarithromycin and similar antibiotics. Be sure to tell your doctor if you are allergic to erythromycin or other antibiotics.



--------------------------------------------------------------------------------


WHAT ABOUT DRUG RESISTANCE?
Whenever you take medication, be sure to take all of the prescribed doses. Many people stop if they feel better. This is not a good idea. If the drug doesn't kill all of the germs, they might change (mutate) so that they can survive even when you are taking medications. When this happens, the drug will stop working. This is called "developing resistance" to the drug.


For example, if you are taking clarithromycin to fight MAC and you miss too many doses, the MAC in your body could develop resistance to clarithromycin. Then you would have to take a different drug or combination of drugs to fight MAC.



--------------------------------------------------------------------------------


HOW IS CLARITHROMYCIN TAKEN?
Clarithromycin is available in tablets of 250 or 500 milligrams (mg.) It is also available in granules to prepare a liquid form. The dose and the length of time you will take it depend on the type of infection you have.

The dose used to prevent MAC infection is 500 mg every 12 hours. The treatment continues as long as your T-cell count is low enough for you to develop MAC.

Regular clarithromycin tablets can be taken with or without food. There is also "Biaxin XL" which is an extended release version. Biaxin XL should be taken with food. Taking Biaxin with food can reduce stomach upset.

Take clarithromycin with a full glass of water.



--------------------------------------------------------------------------------


WHAT ARE THE SIDE EFFECTS?
The side effects of clarithromycin mostly affect the digestive system. They include diarrhea, nausea, heartburn and pain in the abdomen. Some people get headaches or rash. Very few people who take clarithromycin get these side effects. However, most anti-HIV medications also cause problems in the digestive system. Clarithromycin could make those problems worse.

Clarithromycin can be hard on the liver. Your doctor will probably watch your lab results carefully for any sign of liver damage. Let your doctor know if your urine gets dark or your bowel movements get light-colored.

Antibiotics kill some helpful bacteria that normally live in the digestive system. You can eat yogurt or take supplements of acidophilus to replace them.



--------------------------------------------------------------------------------


HOW DOES CLARITHROMYCIN REACT WITH OTHER DRUGS?
Clarithromycin is broken down by the liver. It can interact with other drugs that also use the liver. Scientists have not yet studied all the possible interactions. Clarithromycin probably interacts with all of the non-nucleoside reverse transcriptase inhibitors (NNRTIs), some blood thinners, heart medications, seizure medications, and other antibiotics. Be sure your doctor knows about all the medications you are taking.

The protease inhibitors ritonavir (Norvir) or lopinavir (Kaletra) can increase blood levels of clarithromycin.

Clarithromycin may change blood levels of zidovudine (AZT, Retrovir.)



--------------------------------------------------------------------------------


Revised November 22, 2000



WHAT IS DAPSONE?
Dapsone is an antibiotic drug. It is sold as Dapsone or Avlosulfon®.

Antibiotics fight infections caused by bacteria. Dapsone is also used to fight opportunistic infections in people with HIV. Jacobus manufactures it.


--------------------------------------------------------------------------------


WHY DO PEOPLE WITH HIV TAKE DAPSONE?
Dapsone is usually used to fight leprosy or a skin problem called dermatitis herpetiformis.

Many germs live in our bodies or are common in our surroundings. A healthy immune system can fight them off or keep them under control. However, HIV infection can weaken the immune system. Infections that take advantage of weakened immune defenses are called "opportunistic infections." People with advanced HIV disease can get opportunistic infections. See Fact Sheet 500 for more information on Opportunistic Infections.

One opportunistic infection in people with HIV is PCP. This stands for pneumocystis carinii pneumonia, which affects the lungs. See Fact Sheet 512 for more information on PCP. People who have a T-cell count of less than 200 may develop PCP.

Doctors sometimes use a combination of trimethoprim and dapsone to treat PCP. Dapsone can also be used to prevent PCP. If your T-cell count is below 200, ask your doctor if you should be taking dapsone or another drug to prevent PCP.

Another opportunistic infection is toxoplasmosis (toxo), which affects the brain. See Fact Sheet 517 for more information on toxo. People who have a T-cell count of less than 100 may develop toxo. Dapsone can be used with the drug pyrimethamine to treat cases of toxo. This combination can also be used to prevent toxo.

Some people are allergic to dapsone. Be sure to tell your doctor if you are allergic to any antibiotics.

Dapsone can cause anemia, so people who are anemic should talk to their doctor about whether dapsone is the best drug for them. Also, some people have low levels of an enzyme known as glucose-6-phosphate dehydrogenase or G6PD. Up to 15% of African-American men, and many men of Mediterranean ancestry have this shortage and should not take dapsone. They could develop sudden, severe anemia.


--------------------------------------------------------------------------------


WHAT ABOUT DRUG RESISTANCE?
Whenever you take medication, be sure to take all of the prescribed doses. Many people stop if they feel better. This is not a good idea. If the drug doesn't kill all of the germs, they might change (mutate) so that they can survive even when you are taking medications. When this happens, the drug will stop working. This is called "developing resistance" to the drug.

For example, if you are taking dapsone to fight PCP and you miss too many doses, the PCP in your body could develop resistance to dapsone. Then you would have to take a different drug or combination of drugs to fight it.


--------------------------------------------------------------------------------


HOW IS DAPSONE TAKEN?
Dapsone is available in tablets of 25 or 100 milligrams (mg.) It is normally taken once a day. The dose you take depends on the type of infection you are trying to treat or prevent.

The treatment continues as long as your T-cell count is low enough for you to develop toxo or PCP.

Dapsone can be taken with or without food. If your stomach gets upset when you take dapsone, take it with food.


--------------------------------------------------------------------------------


WHAT ARE THE SIDE EFFECTS?
The main side effect of dapsone is anemia, a loss of red blood cells. Stomach upset is also common. A few people get nausea, vomiting, headache, dizziness, or peripheral neuropathy (See Fact Sheet 553 on Peripheral Neuropathy.)

Dapsone can also make you sensitive to sunlight. If this occurs, use sun block on your skin and/or wear sunglasses.

Tell your doctor if your skin gets pale or yellowish, or you get a sore throat, fever, or rash, even after a few weeks of taking dapsone. These might indicate a serious drug reaction.


--------------------------------------------------------------------------------


HOW DOES DAPSONE REACT WITH OTHER DRUGS?
Dapsone is broken down by the liver. It can interact with other drugs that also use the liver. Scientists have not yet studied all the possible interactions. Dapsone probably interacts with some blood thinners, heart medications, seizure medications, and other antibiotics. Be sure your doctor knows about all the medications you are taking.

Your doctor should watch carefully for drug interactions if you are taking dapsone along with the protease inhibitors amprenavir (Ziagen®) or saquinavir (Fortovase®), or the non-nucleoside reverse transcriptase inhibitor delavirdine (Rescriptor®).

Blood levels of dapsone can be reduced if you take rifampin, a drug used to treat tuberculosis or MAC. Also, ddI can reduce absorption of dapsone. Take dapsone at least 2 hours before or after you take ddI.

The risk of developing anemia is higher if you take dapsone at the same time as other drugs that can cause anemia, such as AZT.

The risk of developing peripheral neuropathy is higher if you take dapsone at the same time as other drugs that can cause neuropathy, such as ddI, ddC, and d4T.



--------------------------------------------------------------------------------


Revised May 4, 2001



WHAT IS FLUCONAZOLE?
Fluconazole is an antifungal drug. In the US, its brand name is Diflucan®. It is sold under many different names in other parts of the world.

Antifungals fight infections caused by fungus. Fluconazole fights opportunistic infections in people with HIV. Pfizer manufactures it.



--------------------------------------------------------------------------------


WHY DO PEOPLE WITH HIV TAKE IT?
Fluconazole is used when fungal infections can't be treated with skin lotions or creams. It works against several different types of fungus, including the yeast infection called candidiasis or thrush.

Many germs live in our bodies or are common in our surroundings. A healthy immune system can fight them off or keep them under control. However, HIV infection can weaken the immune system. Infections that take advantage of weakened immune defenses are called "opportunistic infections." People with advanced HIV disease can get opportunistic infections. See Fact Sheet 500 for more information on Opportunistic Infections.

The yeast infection candidiasis, or thrush, is fairly common. It can be more serious in people with HIV. See Fact Sheet 516 for more information on thrush. Another opportunistic infection, cryptococcal meningitis, is discussed in Fact Sheet 503. Fluconazole has been approved to treat both of these infections.

Some doctors also use fluconazole to treat other opportunistic infections caused by fungus.



--------------------------------------------------------------------------------


WHAT ABOUT DRUG RESISTANCE?
Whenever you take medication, be sure to take all of the prescribed doses. Many people stop if they feel better. This is not a good idea. If the drug doesn't kill all of the germs, they might change (mutate) so that they can survive even when you are taking medications. When this happens, the drug will stop working. This is called "developing resistance" to the drug.

For example, if you are taking fluconazole to fight thrush and you miss too many doses, the thrush in your body could develop resistance to fluconazole. Then you would have to take a different drug or combination of drugs to fight thrush.

Many doctors prefer to treat thrush with creams, or lozenges that dissolve in the mouth. Thrush is much less likely to develop resistance when the treatment is applied directly to the infection instead of through the whole body.



--------------------------------------------------------------------------------


HOW IS IT TAKEN?
Fluconazole is available in several forms. It comes in tablets of 50, 100, 150, or 200 milligrams (mg.) It is also available in granules to prepare a liquid form, and as a liquid for intravenous use. The dose and the length of time you will take it depend on the type of infection you have.

If you have had kidney problems, your doctor might need to reduce your dose of fluconazole.

You can take fluconazole with or without food.



--------------------------------------------------------------------------------


WHAT ARE THE SIDE EFFECTS?
The most common side effects of fluconazole are headache, nausea and pain in the abdomen. A few people get diarrhea. Most anti-HIV medications cause problems in the digestive system. Fluconazole could make those problems worse.

Fluconazole can be hard on the liver. Your doctor will probably watch your lab results carefully for any sign of liver damage. Let your doctor know if your urine gets dark or your bowel movements get light-colored.

Fluconazole can also cause kidney damage. Let your doctor know if you notice a rapid increase in your weight, or if any part of your body gets swollen.

In rare cases, fluconazole can cause a serious reaction (Stevens-Johnson syndrome) that shows up as a skin rash.



--------------------------------------------------------------------------------


HOW DOES FLUCONAZOLE REACT WITH OTHER DRUGS?
Fluconazole is mostly processed by the kidneys. It does not interact very much with drugs that use the liver, including most antiviral drugs used to fight HIV. However, fluconazole interacts with several other types of drugs. These include some blood thinners, seizure medications, water pills (diuretics), pills to lower blood sugar, and other antibiotics. Be sure your doctor knows about all the medications you are taking.



--------------------------------------------------------------------------------


Revised December 19, 2001



WHAT IS TMP/SMX?
TMP/SMX is combination of two antibiotic drugs: trimethoprim and sulfamethoxazole. It is also known as cotrimoxazole. It is sold as Bactrim® (manufactured by Roche) or Septra® (by Monarch Pharmaceuticals). TMP/SMX is sold under many other names in different parts of the world.

Antibiotics fight infections caused by bacteria. TMP/SMX is also used to fight some infections caused by protozoa, and some opportunistic infections in people with HIV.


--------------------------------------------------------------------------------


WHY DO PEOPLE WITH HIV TAKE TMP/SMX?
TMP/SMX is used for many bacterial infections. It is effective and inexpensive. Unfortunately, up to one third of the people who take it get an allergic reaction

Many germs live in our bodies or are common in our surroundings. A healthy immune system can fight them off or keep them under control. However, HIV infection can weaken the immune system. Infections that take advantage of weakened immune defenses are called "opportunistic infections." People with advanced HIV disease can get opportunistic infections. See Fact Sheet 500 for more information on Opportunistic Infections.

One opportunistic infection in people with HIV is PCP. This stands for pneumocystis carinii pneumonia, which affects the lungs. See Fact Sheet 512 for more information on PCP. People who have a T-cell count of less than 200 may develop PCP.

TMP/SMX is the first choice to treat or prevent PCP. If your T-cell count is below 200, ask your doctor if you should be taking TMP/SMX or another drug to prevent PCP.

Another opportunistic infection is toxoplasmosis (toxo), which affects the brain. See Fact Sheet 517 for more information on toxo. People who have a T-cell count of less than 100 may develop toxo. TMP/SMX is sometimes used to treat or prevent cases of toxo.

Some people are allergic to TMP/SMX. Be sure to tell your doctor if you are allergic to sulfa drugs or antibiotics. People who are anemic should not use TMP/SMX.


--------------------------------------------------------------------------------


WHAT ABOUT DRUG RESISTANCE?
Whenever you take medication, be sure to take all of the prescribed doses. Many people stop if they feel better. This is not a good idea. If the drug doesn't kill all of the germs, they might change (mutate) so that they can survive even when you are taking medications. When this happens, the drug will stop working. This is called "developing resistance" to the drug.

For example, if you are taking TMP/SMX to fight PCP and you miss too many doses, the PCP in your body could develop resistance to TMP/SMX. Then you would have to take a different drug or combination of drugs to fight it.


--------------------------------------------------------------------------------


HOW IS TMP/SMX TAKEN?
TMP/SMX is available in tablets that contain 80 milligrams (mg) of trimethoprim and 400 mg of sulfamethoxazole. There is also a "double strength" tablet with 160 mg of trimethoprim and 800 mg of sulfamethoxazole. The dose you take depends on the type of infection you are trying to treat or prevent.

The treatment continues as long as your T-cell count is low enough for you to develop toxo or PCP.

TMP/SMX can be taken with or without food. You should drink plenty of water when taking TMP/SMX.


--------------------------------------------------------------------------------


WHAT ARE THE SIDE EFFECTS?
HIV infection causes higher rates of TMP/SMX side effects. The main side effects of TMP/SMX are nausea, vomiting, loss of appetite, and allergic skin reactions (rashes.) The skin rashes can be fairly common. TMP/SMX can cause Stevens-Johnson syndrome, a very serious skin rash.

TMP/SMX can also cause neutropenia, a low level of neutrophils. These are white blood cells that fight bacterial infections. HIV infection can also cause neutropenia.

Some doctors use a "desensitization" procedure with patients who get an allergic reaction. Starting with a very low dose of TMP/SMX that does not cause an allergic reaction, they gradually increase the dose to the full amount. Another option is to use the drug Dapsone (See Fact Sheet 533.)

TMP/SMX can also make you sensitive to sunlight. If this occurs, use sun block on your skin and/or wear sunglasses.

Tell your doctor if your skin gets pale or yellowish, or you get a sore throat, fever, or rash, even after a few weeks of taking TMP/SMX. These might indicate a serious drug reaction.


--------------------------------------------------------------------------------


HOW DOES TMP/SMX REACT WITH OTHER DRUGS?
TMP/SMX is mostly processed by the kidneys. It does not interact very much with drugs that use the liver, including most antiviral drugs used to fight HIV. However, TMP/SMX interacts with several other types of drugs, including some blood thinners, pills to lower blood sugar, seizure medications, and water pills. Be sure your doctor knows about all the medications you are taking.

The risk of developing anemia is higher if you take TMP/SMX at the same time as other drugs that can cause it, such as AZT.

The risk of developing neutropenia is higher if you take TMP/SMX at the same time as other drugs that can cause it, such as AZT or ganciclovir.



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Revised May 4, 2001

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