Before selecting an antibacterial the clinician must first consider two factors—the patient and the known or likely causative organism. Factors related to the patient which must be considered include a history of allergy, renal and hepatic function, susceptibility to infection, ability to tolerate drugs by mouth, severity of illness, ethnic origin, age, whether taking other medication and, if female, whether pregnant, breast-feeding or taking an oral contraceptive. The known or likely organism and its antibacterial sensitivity, in association with the above factors, will suggest one or more antibacterial, the final choice depending on the microbiological, pharmacological, and toxicological properties.
Drugs for dementia
Indications: mild to moderate dementia in Alzheimer's disease or in Parkinson's disease.
Dose and Administration: Initially 1.5 mg twice daily, increased in steps of 1.5 mg twice daily at intervals of at least 2 weeks according to response and tolerance; usual range 3–6 mg twice daily; max. 6 mg twice daily.
Indications: moderate to severe dementia in Alzheimer’s disease.
Dose and Administration: Initially 5 mg in the morning, increased in steps of 5 mg at weekly intervals, up to max. 10 mg twice daily; doses over 5 mg given in 2 divided doses.
In idiopathic Parkinson's disease, the progressive degeneration of pigmented neurones in the substantia nigra leads to a deficiency of the neurotransmitter dopamine. The resulting neurochemical imbalance in the basal ganglia causes the characteristic signs and symptoms of the illness. Drug therapy does not prevent disease progression, but it improves most patients' quality of life. Treatment is usually not started until symptoms cause significant disruption of daily activities.
Opioid analgesics are usually used to relieve moderate to severe pain particularly of visceral origin. Repeated administration may cause dependence and tolerance, but this is no deterrent in the control of pain in terminal illness. Regular use of a potent opioid may be appropriate for certain cases of chronic non-malignant pain; treatment should be supervised by a specialist and the patient should be assessed at regular intervals. Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, shock, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders.
SSRIs are better tolerated and are safer in overdose than other classes of antidepressants and should be considered first-line for treating depression. In patients with unstable angina or who have had a recent myocardial infarction, sertraline has been shown to be safe.