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Suggest Effective Alternative To Levaquin That Does Not Interfere With Methadone
Question: I went to the ER about a week ago for a pressure sore they did a culture and sent me home with 2 scripts one keflex at 4 times daily and 1 sulfameth/Trimethoprine
the culture came back 2 days later showing positive for pseudomonas and staff. the. attending not knowing I take methadone prescribed levaquin which has a drug interaction. I called the ER as the pharmacy would not fill the script due to the conflict and was told by a nurse that the kefle, would take care of both what my question is is will the keflex take care of it or is there an alternative medicine to levaquin that won't interact with methadone?
the culture came back 2 days later showing positive for pseudomonas and staff. the. attending not knowing I take methadone prescribed levaquin which has a drug interaction. I called the ER as the pharmacy would not fill the script due to the conflict and was told by a nurse that the kefle, would take care of both what my question is is will the keflex take care of it or is there an alternative medicine to levaquin that won't interact with methadone?
Brief Answer:
Keflex use should be culture sensitivity result based...
Detailed Answer:
Hi,
I am sorry to know about this infection.
Keflex (cephalexin) is a first generation cephalosporin. And like any other first generation cephalosporin, it has better actions against gram positive organisms. Against pseudomonas it has restricted action. I would preferably use a third generation cephalosporin - like cefotaxim or cefoperazone or ceftazidime or even ceftriaxone against pseudomonas infection.
However antibiotics against bacterial infection is culture sensitivity report based. Clinically we need to cross verify culture sensitivity report before continuing antibiotic.
In short and simple terms, if you have culture sensitivity report look for antibiotic sensitivity of cephalexin against cultured organism (pseudomonas). We can continue keflex if it is sensitive against pseudomonas.
Hope this is clear. Let me know if you need clarifications.
Regards
Keflex use should be culture sensitivity result based...
Detailed Answer:
Hi,
I am sorry to know about this infection.
Keflex (cephalexin) is a first generation cephalosporin. And like any other first generation cephalosporin, it has better actions against gram positive organisms. Against pseudomonas it has restricted action. I would preferably use a third generation cephalosporin - like cefotaxim or cefoperazone or ceftazidime or even ceftriaxone against pseudomonas infection.
However antibiotics against bacterial infection is culture sensitivity report based. Clinically we need to cross verify culture sensitivity report before continuing antibiotic.
In short and simple terms, if you have culture sensitivity report look for antibiotic sensitivity of cephalexin against cultured organism (pseudomonas). We can continue keflex if it is sensitive against pseudomonas.
Hope this is clear. Let me know if you need clarifications.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
are you saying that the keflex should be sufficient in the treatment of the pseudomonas and the staph? and if not what medication should I seek out from my physician?
Brief Answer:
I prefer use of antibiotics that are sensitive...
Detailed Answer:
I think I wasn't clear in my first reply. Let me explain again.
Well in most cases when bacterial culture is performed it is followed by antibiotic sensitivity test. The coupled test is referred to as culture and sensitivity report. This test is extremely helpful to determine whether the prescribed antibiotic is effective or resistent to the cultured bacteria. In your case this culture and sensitivity will report if cephalexin (keflex) is effective against staphylococcus and pseudomonas growth.
If antibiotic sensitivity wasn't performed, then I would prefer to use third generation cephalosporin (cefoperazone or
I prefer use of antibiotics that are sensitive...
Detailed Answer:
I think I wasn't clear in my first reply. Let me explain again.
Well in most cases when bacterial culture is performed it is followed by antibiotic sensitivity test. The coupled test is referred to as culture and sensitivity report. This test is extremely helpful to determine whether the prescribed antibiotic is effective or resistent to the cultured bacteria. In your case this culture and sensitivity will report if cephalexin (keflex) is effective against staphylococcus and pseudomonas growth.
If antibiotic sensitivity wasn't performed, then I would prefer to use third generation cephalosporin (cefoperazone or
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
are you saying that the keflex should be sufficient in the treatment of the pseudomonas and the staph? and if not what medication should I seek out from my physician?
Oh I think I understand. .. the thing I'm worried about is that I've been taking the keflex for a week now and the wound doesn't show any progress in healing it's still raw extremely pussie and discharging the same if not more.
Oh I think I understand. .. the thing I'm worried about is that I've been taking the keflex for a week now and the wound doesn't show any progress in healing it's still raw extremely pussie and discharging the same if not more.
Brief Answer:
I would follow culture sensitivity report.
Detailed Answer:
I am sorry, my previous reply was truncated. I accidentally clicked submit while replying to you. What I couldn't complete was if we don't have culture sensitivity report, I would prefer the use of third generation cephalosporin (ceftazidime or cefoperazone) which are known to cover pseudomonas along with another one that covers staphylococcus.
Pseudomonas infection are slightly difficult to treat. I have seen many patients needing more than 2 weeks of antibiotics before showing signs of healing. However if there is no clear signs of healing despite a week of keflex, I would go back to culture sensitivity report and start another antibiotic that is sensitive. If the culture sensitivity test wasn't performed earlier, perhaps it could be done now.
Moreover proper cleaning and dressing of wound is also as important as starting right antibiotic while treating larger wounds / pressure sores. I would suggest twice a week if not alternate day wound cleaning and dressing performed with utmost aseptic precautions. In the meanwhile we could opt to change antibiotic / redo culture sensitivity report.
Hope this is clear. I will be available to answer anymore follow ups.
Good luck
I would follow culture sensitivity report.
Detailed Answer:
I am sorry, my previous reply was truncated. I accidentally clicked submit while replying to you. What I couldn't complete was if we don't have culture sensitivity report, I would prefer the use of third generation cephalosporin (ceftazidime or cefoperazone) which are known to cover pseudomonas along with another one that covers staphylococcus.
Pseudomonas infection are slightly difficult to treat. I have seen many patients needing more than 2 weeks of antibiotics before showing signs of healing. However if there is no clear signs of healing despite a week of keflex, I would go back to culture sensitivity report and start another antibiotic that is sensitive. If the culture sensitivity test wasn't performed earlier, perhaps it could be done now.
Moreover proper cleaning and dressing of wound is also as important as starting right antibiotic while treating larger wounds / pressure sores. I would suggest twice a week if not alternate day wound cleaning and dressing performed with utmost aseptic precautions. In the meanwhile we could opt to change antibiotic / redo culture sensitivity report.
Hope this is clear. I will be available to answer anymore follow ups.
Good luck
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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