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Thread: Probenecid (Probalan) for the SHTF pharmacy?

  1. #1
    Join Date
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    Default Probenecid (Probalan) for the SHTF pharmacy?

    Was reading the 2012 version of "Antibiotic Guidelines for Primary Care" (can't find the 2012 version anymore), and found this under the cellulitis section in the old version:

    "Keep affected limb elevated. Do not use NSAIDs (increased risk of necrotising fasciitis). See Diabetic foot infection if relevant. To boost flucloxacillin or cephalexin levels consider probenecid 250-500mg with each dose of antibiotic"
    and in the same doc:

    "Practice Tip: To boost serum and tissue antibiotic levels by up to 200% in patients with moderate infections, probenecid 250-500mg orally three or four times daily can be given with penicillin, amoxycillin, flucloxacillin, cephalexin or cefaclor. Probenecid reduces renal and gut secretion of these antibiotics; this interaction does not occur in moderate or severe renal impairment. Beware nausea. Halve dose of concomitant paracetamol and NSAIDs."
    Some web research into probenecid as an adjunct to antibiotic therapy led to looking at the half-lifes of some of the commonly recommended prepper-antibiotics and the relationship to their dosing frequency, antibiotics and the infections where loading doses are often recommended, and a bunch of scholarly articles on therapeutic serum levels that I didn't understand.

    In addition to inhibiting secretion of penicillins and cephalosprins the wiki on probenecid also mentioned quinolones, and seems that's true too:

    https://www.ncbi.nlm.nih.gov/pubmed/20233180
    https://www.ncbi.nlm.nih.gov/pubmed/7586947

    So to the med pros here, what's your thoughts on adding probenecid where the diagnosis calls for treatment with penicillins, cephalosporins, or quinolones for moderate/severe infections at TEOTW? Say, for example, where an otherwise healthy adult patient presents with a 3 day-old, and clearly infected, wound on an arm or leg and you're thinking of treating it with keflex or cipro? If so, what about probenecid combined with an initial 2X loading dose of the antibiotic, in the hope of getting a faster indication that the chosen antibiotic has activity against the bacteria?
    Everything marked, everything 'membered. You wait, you'll see.

  2. #2
    Join Date
    Jan 2014
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    Bumping

    A loading dose of Cefazolin (2g, IV) and Probenecid (1-2g, PO) is the current recommendations for empiric outpatient treatment of cellulitis, on Prince Edward Island anyway: http://www.gov.pe.ca/photos/original/hpei_skintisue.pdf

    Not finding much on probenecid + the selected antibiotics for treating other bacterial infections outside of cellulitis. Except for UTIs, where its use seems counterproductive (?), any other infections where it would be of benefit since we're all going to be outpatients if the SHTF? Or more generally, in the absence of IV antibiotics, as a means to maintain adequate antibiotic serum levels over a longer period using only oral antibiotics?
    Everything marked, everything 'membered. You wait, you'll see.

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