MEDICATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 521

Tetracyclinesarepoorlyabsorbedfromthestomachwhengivenwithmilkorotherdairy
products, with antacids, or with bismuth (PeptoBismol®). They should be given one hour
before or two hours after meals.
After their expiration date tetracyclines may become toxic, unlike most drugs that just
become less potent.
The Quinolones: Levofloxacin, Ciprofloxacin, Moxifloxacin, and Ofloxacin
Levofloxacin (Levaquin®), ciprofloxacin (Cipro®), moxifloxacin (Avelox®), and
ofloxacin (Floxin®) are quinolones: antimicrobial agents effective against a broad range
of bacteria. Levofloxacin is particularly useful for treating pulmonary infections; cipro-
floxacin is much less effective for such disorders. Both are useful for urinary tract and
gastrointestinal infections, although resistance to ciprofloxacin is developing in southern
and Southeast Asia.
Quinoloneeyedropsaremadewithciprofloxacinaswellasmoxifloxacinandofloxacin,
two similar agents. Such eyedrops are the preferred therapy for conjunctivitis.
Precautions: Quinolones should not be administered to children or pregnant women.
High doses given to immature animals produced permanent cartilage damage. However, in
emergencies ciprofloxacin has been given to children with no adverse results.
Trimethoprim-Sulfamethoxazole (TMP-SMX)
Trimethoprim-sulfamethoxazole (Bactrim, Septra®, trimethoprim-sulfa, TMP-SMX, or
cotrimoxazole [the latter is the British-approved name]) is a combination of two agents,
one of which is a sulfonamide. Sulfonamides are useful for treating many gastrointestinal
and urinary tract infections because they can be administered in preparations that produce
high concentrations of the drugs in these organs. In addition, some organisms resistant to
antibiotics, particularly methicillin resistant Staphylococcus aureus (MRSA), are readily
destroyed by sulfonamides.
Precautions: Sulfonamides in general are not very soluble in water and tend to precip-
itate in the urine, in effect forming small kidney stones that can cause significant damage.
To prevent such damage, persons receiving these drugs must consume large quantities of
fluids to maintain a high urinary volume.
Some persons are allergic to sulfonamides and should not be treated with them. Sulf-
onamides should not be taken by individuals with glucose-6-phosphatase deficiency. (This
disorder, which must be diagnosed by a physician, usually causes mild anemia and is ag-
gravated by certain drugs, particularly some sulfonamides.)
Sulfonamidescrosstheplacenta,areexcretedinmilk,andcanhaveharmfuleffectsona
fetus or newborn. Only a physician should administer them during the last months of preg-
nancy and to nursing mothers.