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Diflucan use during pregnancy and lactation

There have been no adequate and well-controlled studies of the use of fluconazole in pregnant women. During pregnancy, the use of fluconazole should be avoided, except in cases of severe and potentially life-threatening fungal infections, when the expected benefit of treatment to the mother outweighs the possible risk to the fetus.

It is necessary to consider effective methods of contraception in women of childbearing age during the entire period of treatment and for about a week (5-6 half-lives) after taking the last dose of the drug.

Cases of spontaneous abortion and the development of congenital anomalies have been reported in infants whose mothers received fluconazole at a dose of 150 mg once or repeatedly in the first trimester of pregnancy. Cases of multiple congenital malformations have been described in newborns whose mothers received high-dose fluconazole therapy (400-800 mg / day) for most or all of the first trimester. The following developmental disorders were noted: brachycephaly, malformation of the facial part of the skull, malformation of the cranial vault, cleft palate, curvature of the femur, thinning and lengthening of the ribs, arthrogryposis, and congenital heart defects.

Fluconazole is found in breast milk at concentrations close to plasma levels. T1 / 2 of the drug from breast milk is approximately equal to T1 / 2 of plasma – 30 hours The estimated dose of fluconazole absorbed by the infant (taking into account the fact that the average amount of milk consumed is 150 ml / kg daily), and calculated in accordance with the average Cmax of the drug in breast milk, is 0.39 mg / kg / day, which is approximately equal to 40% of the recommended neonatal dose (for children under 2 weeks of age) or 13% of the recommended infant dose for the treatment of mucosal candidiasis.

Breastfeeding can be continued after taking a single 150 mg dose of fluconazole. It is not recommended to breastfeed after multiple or high doses of fluconazole. When deciding on the appointment of the drug Diflucan® against the background of breastfeeding, the following factors should be taken into account: the benefits of breastfeeding for the health and development of the infant, together with the clinical indications for prescribing the drug Diflucan® and the possibility of any potential side effects in the infant or the effect of concomitant pathology of the mother on the health of the baby.

Metronidazole for bacterial infection

Swallow metronidazole tablets with plenty of water. Take them with a meal or a snack.

Do not drink alcohol while you are taking metronidazole, and for 48 hours after finishing your course of treatment.

Space your doses evenly throughout the day, and keep taking the medicine until the course is finished.

Metronidazole is an antibiotic used to treat a wide variety of infections caused by certain types of germ (anaerobic bacteria) and types of micro-organisms called protozoa. These types of organisms often cause infections in areas of the body such as the gums, pelvic cavity and tummy (stomach or intestines) because they do not need oxygen to grow and multiply.

metronidazole mechanism of action

Metronidazole treats infections is commonly prescribed to treat an infection called bacterial vaginosis. It is also prescribed before gynaecological surgery and surgery on the intestines, to prevent infection from developing. This medicine cannot be used to treat a yeast infection. MetronidazoleIt can safely be taken by people who are allergic to penicillin.

Metronidazole is also used, alongside other medicines, to get rid of Helicobacter pylori, a bacterial infection often associated with stomach ulcers.

Metronidazole is available as a skin preparation also. This leaflet does not give information about metronidazole when it is used for skin conditions, but there is more information available in a separate leaflet called Metronidazole skin gel and cream.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking metronidazole it is important that your doctor or dentist knows:

  • If you are pregnant or breastfeeding.
  • If you feel you will be unable to stop drinking alcohol for the duration of your treatment.
  • If you have any problems with the way your liver works such as liver disease.
  • If you have a rare inherited blood disorder called porphyria.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.
metronidazole treatment
  • Before you start this treatment, read the manufacturer’s printed information leaflet from inside your pack. The manufacturer’s leaflet will give you more information about metronidazole and a full list of metronidazole side-effects which you may experience from taking it.
  • Take the tablets or liquid medicine exactly as your doctor or dentist tells you to. The dose you are given will depend upon what type of infection you have, and how severe the infection is.
  • As a guide, a typical dose for an adult would be 400 mg two or three times a day, but your dose may be more or less than this. Doses for children depend upon the child’s age and weight. Your doctor will tell you what dose is right for you (or your child), and this will also be printed on the label of the pack to remind you.
  • Space your doses evenly throughout the day, and keep taking the medicine until the course is finished, unless you are told to stop by your doctor. Your symptoms may return if you stop taking metronidazole before the end of the course prescribed for you.
  • Most courses of metronidazole last for around seven days, but some may be as short as three days and some as long as 14 days. For certain infections you may be given a single, larger dose of metronidazole, usually five 400 mg tablets (2 g) to take at once.
  • Take each of your doses with a snack or just after eating a meal. Swallow the tablets whole (that is, without chewing or crushing them) with a full glass of water.
  • If you forget to take a dose, take it as soon as you remember and try to space your remaining doses evenly throughout the rest of the day. Do not take two doses together to make up for a forgotten dose or skip the missed dose.

If you have been given metronidazole suppositories

  1. Remove the suppository from its wrapping.
  2. Using your finger, gently push the suppository into your back passage (rectum) as far as is comfortable. Many people find that inserting a suppository is easier if they squat or bend forward.
  3. Remain still for a few moments to help you to hold the suppository in place.
  4. Wash your hands.
  • Important: do not drink alcohol while you are on metronidazole and for 48 hours after finishing your course of treatment. This could cause a harmful drug interaction andis because drinking alcohol with metronidazole is likely to make you feel very sick (nauseated) and cause other unpleasant effects, such as the sensation of having a ‘thumping heart’ (palpitations), hot flushes and headache.
  • While you are taking metronidazole your urine may look a darker colour than normal. On its own this is nothing to worry about. However, if you also experience tummy (abdominal) pain, or if you feel sick (nausea) or feel generally unwell, you should calllet your doctor know.
  • If you buy any medicines, check with a pharmacist that they are safe to take with metronidazole. Some cough and cold preparations contain alcohol and should not be taken with metronidazole.
  • If you need to take metronidazole for longer than ten days, your doctor may want you to have some tests. Make sure you keep any appointments that your doctor gives to you.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the metronidazole side-effects. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but seek medical advicespeak with your doctor or pharmacist if any of the following continue or you experience adverse effectsbecome troublesome.

Metronidazole side-effectsWhat can I do if I experience this?
Feeling sick (nausea) or being sick (vomiting)Stick to simple foods. Make sure you take your doses after a meal or a snack
Changes in the way things taste, an unpleasant sharp or metallic taste, furred tongue, sore mouthAsk your pharmacist to recommend a suitable mouthwash
Lack of appetiteThis should soon pass, but in the meantime choose food that you usually enjoy

If you experience any other symptoms which you think may be due to this medicine, talk tospeak with your doctor or pharmacist.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Fungal Eye Infections

Eye infections can be caused by many different organisms, including bacteria, viruses, amoeba, and fungi. Eye infections caused by fungi are extremely rare, but they can be very serious.

Types of fungal eye infections
Fungal infections can affect different parts of the eye.

  • Keratitis is an infection of the clear, front layer of the eye (the cornea).
  • Endophthalmitis is an infection of the inside of the eye (the vitreous and/or aqueous humor). There are two types of endophthalmitis: exogenous and endogenous. Exogenous fungal endophthalmitis occurs after fungal spores enter the eye from an external source. Endogenous endophthalmitis occurs when a bloodstream infection (for example, candidemia) spreads to one or both eyes.
Fusarium, a fungus that can cause eye infections.

Types of fungi that cause eye infections
Many of different types of fungi can cause eye infections. Common types include:

  • Fusarium – a fungus that lives in the environment, especially in soil and on plants
  • Aspergillus – a common fungus that lives in indoor and outdoor environments
  • Candida – a type of yeast that normally lives on human skin and on the protective lining inside the body called the mucous membrane

What Causes Fungal Eye Infections?

Eye Injuries

The most common way for someone to get a fungal eye infection is because of an eye injury, particularly if plant material such as a stick or a thorn 1 caused the injury. Some fungi that cause eye infections, such as Fusarium, live in the environment and are often associated with plant material. Fungi can enter the eye and cause infection after an injury.

Eye Surgery

Less often, infection can occur after eye surgery such as corneal transplant surgery or cataract surgery.

eye surgery

People who have had surgery to replace their corneas (the clear, front layer of the eye) are at higher risk of fungal eye infections. Each year, about 50,000 Americans have a corneal transplant to replace injured or diseased corneas. A small number of people who have this surgery (about 4 to 7 for every 10,000 transplants) develop a fungal eye infection.

From 2007 to 2014, endophthalmitis, or infection of the interior of the eye, became more than twice as common for people with recent corneal transplant surgery. In the past, this type of endophthalmitis was most commonly caused by bacteria. However, now fungi (most often the Candida species) cause about two-thirds of infections. CDC is working with partners to understand the reasons for this increase in fungal endophthalmitis following corneal transplant surgery and to find ways to prevent it.

Invasive Eye Procedure

Fungal eye infections could happen after an invasive eye procedure such as an injection. Some infections have been traced to contaminated medical products such as contact lens solution, irrigation solution  and dye used during eye surgery, or corticosteroids injected directly into the eye.

Fungal Bloodstream Infection

Rarely, fungal eye infections can happen after a fungal bloodstream infection such as candidemia spreads to the eye.

Treatment for Fungal Eye Infections

The treatment for a fungal eye infection depends on:

  • The type of fungus,
  • The severity of the infection, and
  • The parts of the eye that are affected.

Possible forms of treatment for fungal eye infections include:

  • Antifungal eye drops
  • Antifungal medication given as a pill or through a vein
  • Antifungal medication injected directly into the eye
  • Eye surgery
antifungal

All types of fungal eye infections must be treated with prescription antifungal medication, usually for several weeks to months. Natamycin is a topical (meaning it’s given in the form of eye drops) antifungal medication that works well for fungal infections involving the outer layer of the eye, particularly those caused by fungi such as Aspergillus and Fusarium. However, infections that are deeper and more severe may require treatment with antifungal medication such as amphotericin B, fluconazole, or voriconazole. These medications can be given by mouth, through a vein, or injected directly into the eye. Patients whose infections don’t get better after using antifungal medications may need surgery, including corneal transplantation, removal of vitreous gel from the interior of the eye (vitrectomy), or, in extreme cases, removal of the eye (enucleation).

An epidemic outbreak of Mesoamerican Nephropathy in Nicaragua linked to nickel toxicity

For over 20 years, researchers have tried to solve the medical mystery behind Mesoamerican Nephropathy, a form of chronic kidney disease that has caused more than 50,000 deaths in coastal South America. Now, researchers present the strongest evidence to date on the cause of the disease in one of the worst-hit hotspots in the region, Nicaragua, using an unlikely source, the toenails of individuals with the disease.

Delirium in older adults

Delirium is a serious and common syndrome characterized by acute deterioration of mental status. Patients show attentional deficits and commonly also altered levels of arousal and psychotic features. Detection can be assisted through use of validated tools such as the 4AT. Delirium is associated with multiple adverse outcomes including patient and carer distress, increased length of hospital stay, risk of future dementia, new institutionalization and death. Old age, dementia and frailty are the main predisposing factors, but there are a number of modifiable risk factors that are important within hospital environments.

Diagnosis and management of dementia in older people

Dementia is a leading cause of morbidity and death in the UK. Diagnostic criteria exist for the different aetiologies and subtypes. Alzheimer’s disease is the most common type and there is evidence of benefit from acetylcholinesterase inhibitors for some people living with Alzheimer’s disease. Care for people living with dementia in hospital and in the community needs improvement. Non-pharmacological means of managing distress people living with dementia should be prioritized over the use of antipsychotic and sedative medications, and greater focus on symptom management towards the end of life is required.

Parkinson’s disease in older people

The prevalence of Parkinson’s disease (PD) increases with age. Caring for people with this condition frequently requires it to be considered within a wider context of both health and social factors. Diagnosis is made eliciting the hallmark motor signs, which can be confounded by signs from other co-morbidities such as depression, arthritis and cognitive impairment. The disease can be divided into four stages – diagnostic, maintenance, complex and palliative – reflecting an individual’s needs. Alternative approaches include the Braak, and Hoehn and Yahr, stagings, using pathophysiological and clinical features, respectively.