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Bacterial Infections 101: Types, Symptoms, and Treatments

Get more information on bacterial skin infections, which bacteria cause food poisoning, sexually transmitted bacteria, and more.

ORAL CONTRACEPTIVE STEROID PHARMACOKINETICS

The estrogens most commonly found in oral contraceptive preparations are ethinylestradiol and mestranol, a prodrug which is metabolized to ethinylestradiol. After metabolism via the first pass effect, ethinylestradiol has an oral bioavailability of 40% to 50% (2). Hydroxylation is the main metabolic pathway for ethinylestradiol, whereas conjugation is considered to be a minor pathway in most women, resulting in sulphation or glucuronidation of the original estrogenic steroid. Glucuronide and sulphate conjugates reach the small intestine by way of the bile duct. augmentin over the counter Hydrolytic enzymes of intestinal bacteria break the conjugates down, resulting in the release of free, active estrogenic hormone. The active hormone is then available for reabsorption and undergoes enterohepatic cycling, which is responsible for plasma estrogen levels necessary for contraception.

The enzyme responsible for hydroxylation of the estrogen molecule is cytochrome P450 IIIA4 (CYP3A4) and is under polymorphic genetic control (3). As a result, women are able to hydroxylate ethinylestradiol to varying degrees. Therefore, when trying to evaluate which women are at risk for the oral contraceptive and antibiotic drug interaction, the extent to which women can hydroxylate ethinylestradiol is of prime importance because it is only that estrogen which has not been hydroxylated that is available for subsequent conjugation (4). This is significant because only the conjugated hormone can be hydroxylated in the intestine and then enterohepatically recycled to maintain plasma estrogen levels. Unfortunately, at the present time, there is no method to determine which women are at risk.

The progestins present in oral contraceptive pills (eg, levonorgestrel, norethisterone, desogestrel, gestodene, norgestimate) also undergo conjugation. Hydrolysis of conjugates leads to the formation of inactive metabolites because the parent molecule cannot be directly conjugated. Progestins are not thought to undergo extensive enterohepatic cycling and are, thus, less likely to be involved in drug interactions with antibiotics than ethinylestradiol (5).

Development Of Drug-Resistant Bacteria

Prescribing AUGMENTIN in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient, and increases the risk of the development of drug resistant bacteria.

Diverticulitis: Symptoms

Inflammation puts the "itis" into diverticulitis, which is the most common complication of diverticular disease. The bacteria that are packed into feces by the hundreds of millions are responsible for the inflammation of diverticulitis, but doctors don't fully understand why some diverticula become infected and inflamed while many do not. A current theory holds that the wall of the diverticular sac becomes eroded by pressure, trapped fecal material, or both. If the damage is severe enough, a tiny perforation develops in the wall of the sac, allowing bacteria to infect the surrounding tissues. In most cases, the body's immune system is able to contain the infection, confining it to a small area on the outside of the colon. In other cases, though, the infection enlarges to become a larger abscess, or it extends to the entire lining of the abdomen, a critical complication called peritonitis. Pain is the major symptom of diverticulitis. Because diverticulosis typically occurs in the sigmoid colon, the pain is usually most pronounced in the lower left part of the abdomen, but other areas may be involved. Fever is also very common with diverticulitis, sometimes accompanied by chills. If the inflamed sigmoid is up against the bladder, a man may develop enough urinary urgency, frequency, and discomfort to mimic prostatitis or a bladder infection. Other symptoms may include nausea, loss of appetite, and fatigue. Some patients have constipation, others diarrhea.

Hemic And Lymphatic Systems

Anemia, including hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and agranulocytosishave been reported. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena. Thrombocytosis was noted in less than 1% of the patients treated with AUGMENTIN. There have been reports of increased prothrombin time in patients receiving AUGMENTIN and anticoagulant therapy concomitantly. [see DRUG INTERACTIONS]