EXPLAINER: What Filipinos can including more needs a person may have for a disease in

expect from the Universal Health its case rates.

Care Law? Article from RAPPLER
By Ms. Sofia Tomacruz 3. PhilHealth will become the “national purchaser” of health
goods and services
All Filipinos will be granted health This means that PhilHealth will be in charge of paying
coverage but not everything will health care providers like hospitals and clinics for services
be free. given to Filipinos. Allocating more funds to PhilHealth will
also strengthen its negotiating power with health care
1. ALL Filipinos are covered providers, which will foreseeably improve the quality of
Every single Filipino citizen is services and lower health costs.
automatically enrolled into the Funds for PhilHealth will be sourced from the following:
newly created National Health • Philippine Amusement and Gaming Corporation –
Insurance Program (NHIP) Filipinos will also be enrolled 50% of national government’s share
with a primary health care provider of their choice. The • Philippine Charity Sweepstakes Office (PCSO) – 40%
primary care provider is the health worker they can go and of its charity fund, net of document stamp tax
seek treatment from for health concerns. They will also payments, and mandatory PCSO contributions
serve as the person in charge of referring and • Premium contributions of direct contributory
coordinating with other health centers if patients need members
further treatment. Citizens will not need to present any • PhilHealth annual budget
PhilHealth ID to avail of these benefits. Meanwhile, poor
Filipinos or those who are located in geographically By giving PhilHealth more funds, a goal of the UHC is to
isolated areas will also be given priority when ensuring make PhilHealth the national purchaser of medicines. This
access to health services. can lower the cost of medicines as these will be bought in
bulk.
2. It is not completely free
Contrary to what some people may think, UHC does not 4. DOH will still be in charge of “population-based” health
mean every single health expense will be made free. The services
law outlines that basic services accommodations will be While PhilHealth, along with other private health
covered by PhilHealth. As a patient, that means that if insurance companies, is expected to cover services for
you’re admitted in a hospital you can expect regular individuals, the DOH is still in charge of delivering health
meals, a bed in a shared room with fan ventilation, and a services that cover entire populations. Think of these as
shared toilet and bath to be covered. All are also entitled programs for disease surveillance, health promotion
to an “essential health benefit package,” which includes campaigns, and mass immunization campaigns. The DOH
primary care, medicines, diagnostic, and laboratory tests. will do this by contracting public health care providers in
It also includes preventive, curative, and rehabilitative cities and provinces.
services. It will no longer be free when one wants to stay
in a hospital room offering private accommodation, air 5. Health systems will become city-wide and province-wide
conditioning, telephone, television, and meal choices, Provinces and highly urbanized cities will now be in
among others. charge of overseeing health services in areas as opposed
to the current set-up where municipalities are tasked with
Meanwhile, public and private hospitals are expected to managing their own health centers. The DOH will need to
allocate a certain portion of their beds as basic work with the Department of the Interior and Local
accommodations in the following amounts: Government (DILG) to have province- and city-wide
Government hospitals – at least 90% of beds health systems or networks in about two years after the
Specialty hospitals – at least 70% of beds law takes affect.
Private hospitals – at least 10% of beds
6. A “Health Technology and Assessment Council” (HTAC)
As long as a patient avail of these basic accommodations, will be created
it will be covered by PhilHealth whether in a public or Another important feature of the law is the creation of the
private hospital. The law also states that if patients need HTAC – a group of health experts who will be responsible
to pay for extra expenses, their “co-payment” – or what is for evaluating latest health developments and
paid on top of basic services – should be regulated by the recommending their use to DOH and PhilHealth. The
DOH in public hospitals. This means that you should know HTAC will be responsible for assessing the safety and
what to expect in terms of bills, as opposed to being effectiveness of health technology, devices, medicines,
shocked after treatment. vaccines, health procedures, and other health-related
advances developed to solve health problems. Reviewing
Aside from this, current case rates or packages PhilHealth the social, economic, and ethical issues when using these
has crafted for certain diseases will remain. But together technologies or programs is also required.
with the DOH, PhilHealth is expected to work towards

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7. Health information will be collected Socioeconomic Planning Secretary Ernesto M. Pernia said
Both public and private hospitals and health insurers will that successful implementation of the sin tax reform law has
be required to maintain a health information system that been a boost to programs and projects of the DOH. Based on
will contain electronic health records, prescription logs, the agency’s budget brochures, DOH’s budget, including its
and “human resource information.” This system will be attached agencies and corporations, increased by 13 percent
developed and funded by DOH and PhilHealth. It will also from PHP151 billion in 2017 to PHP171 billion in 2018. This was
be subject to patient confidentiality rules and data privacy due to PHP113-billion six tax revenues, of which PHP48 billion
laws. was allocated to PhilHealth’s premium subsidy for the
indigent, senior citizens, and sponsored members.
EXPLAINER: UNIVERSAL HEALTH CARE LAW AND WHAT IT
MEANS TO PH DEVELOPMENT By the National Economic MORE REFORMS
and Development Authority Secretary Pernia said more reforms should be done to ensure
the smooth implementation of the UHC law. While the law
For the National Economic and Development Authority, already provides the mechanisms to improve health care in
which led the crafting of the Philippine Development Plan the Philippines, he said that actual rollout by all those
(PDP) 2017-2022, the signing of the law is a big leap towards concerned is crucial, starting with agency budgets. “The
reforming the country’s health care system. enactment of the UHC law is a defining moment for the
Philippine health system. We, at NEDA, are optimistic that its
It assures 100 percent population coverage of PhilHealth - implementation will open the doors for more reforms that will
from the 98 percent population coverage in 2018 based on improve the health of Filipino people,” Pernia said. He noted
the same year’s Socioeconomic Report by NEDA. that the law brings the country closer to its collective
longterm vision, AmBisyon Natin 2040, where all Filipinos live
long and healthy lives and where healthcare is affordable and
accessible.

REPUBLIC ACT NO. 11223 UNIVERSAL HEALTH CARE ACT

IT IS THE POLICY OF THE STATE TO PROTECT AND
PROMOTE THE RIGHT TO HEALTH OF ALL FILIPINOS AND
INSTILL HEALTH CONSCIOUSNESS AMONG THEM.
TOWARDS THIS END, THE STATE SHALL ADOPT:

1) An integrated and comprehensive approach to ensure

The law also addresses the fragmented and overlapping
that all Filipinos are health literate, provided with healthy
roles and responsibilities of various health agencies. This
living conditions, and protected from hazards and risks
means Filipinos will no longer have to hop from one
that could affect their health
charitable institution to another. For instance, the Department
2) A health care model that provides all Filipinos access to
of Health (DOH) and local government units (LGU) will be
a comprehensive set of quality and cost-effective,
responsible for population-based interventions and health
promotive, preventive, curative, rehabilitative and
services (e.g., immunization programs and health promotion
palliative health services without causing financial
programs) while PhilHealth will be responsible for financing
hardship,, and prioritizes the needs of the population
individual-based health services.
who cannot afford such services
3) A framework that fosters a whole-of-system, whole-of-
government, and whole-of-society approach in the
development, implementation, monitoring, and
evaluation of health policies, programs and plans
4) A people-oriented approach for the delivery of health
services that is centered on people’s needs and well-
being, and cognizant of the differences in culture,
values, and beliefs

GENERAL OBJECTIVES
FUNDING 1) Progressively realize universal health care in the country
According to the DOH, the implementation of the UHC law for through a systemic approach and clear delineation of
its first year needs P257 billion. roles of key agencies and stakeholders towards better
performance in the health system
This will be sourced from sin tax collections and partly from 2) Ensure that all Filipinos are guaranteed equitable access
income generated by the Philippine Amusement and Gaming to quality and affordable health care goods and
Corporation (PAGCOR) and PCSO in view of improving benefit services, and protected against financial risk
packages. This is apart from providing immediate eligibility
and access to health services, including preventive, UNIVERSAL HEALTH CARE (UHC)
promotive, curative, rehabilitative, and palliative care, as well POPULATION COVERAGE
as out-patient drugs. Every Filipino citizen shall be automatically included into the
National Health Insurance Program (NHIP)

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SERVICE COVERAGE ADMINISTRATIVE EXPENSE
1) Every Filipino shall be granted immediate eligibility and No more than 7.5% of the actual total premium collected from
access to preventive, promotive, curative, rehabilitative, direct and indirect contributory members during the
and palliative care for medical, dental, mental and immediately preceding year shall be allotted for the
emergency health services, delivered either as administrative cost of implementing the Program.
population-based or individual-based health services:
Provided, That the goods and services to be included PHILHEALTH BOARD OF DIRECTORS
shall be determined through a fair and transparent HTA The PhilHealth Board of Directors is reconstituted to have a
process; maximum of thirteen (13) members, consisting of the
2) Within two (2) years from the effectivity of this Act, following:
PhilHealth shall implement a comprehensive outpatient 1) Five (5) ex officio members, namely: the Secretary of
benefit, including outpatient drug benefit and Health, Secretary of Social Welfare and Development,
emergency medical services in accordance with the Secretary of Budget and Management, Secretary of
recommendations of the Health Technology Finance, Secretary of Labor and Employment
Assessment Council (HTAC) created under Section 34 2) Three (3) expert panel members with expertise in public
hereof; health, management, finance, and health economics
3) The DOH and the local government units (LGUs) shall 3) Five (5) sectoral panel members, representing the direct
endeavor to provide a health care delivery system that contributors, indirect contributors, employers group,
will afford every Filipino a primary care provider that health care providers to be endorsed by their national
would act as the navigator, coordinator, and initial and associations of health care institutions and health care
continuing point of contact in the health care delivery professionals, and representative of the elected local
system: Provided, That except in emergency or serious chief executives to be endorsed by the League of
cases and when proximity is a concern, access to higher Provinces of the Philippines, League of Cities of the
levels of care shall be coordinated by the primary care Philippines and League of Municipalities of the
provider; and Philippines: Provided, That at least one (1) of the expert
4) Every Filipino shall register with a public or private panel members and at least two (2) of the sectoral panel
primary care provider of choice. The DOH shall members are women.
promulgate the guidelines on the licensing of primary
care providers and the registration of every Filipino to a • An ex officio member is a member of a body (notably a
primary care provider. board, committee, council) who is part of it by virtue of
holding another office
FINANCIAL COVERAGE • The term ex officio is Latin, meaning literally ‘from the
1) Population-based health services shall be financed by office’, and the sense intended is ’by right of office’
the National Government through the DOH and
provided free of charge at point of service for all The sectoral and expert panel members must be Filipino
Filipinos. citizens and of good moral character.
The National Government shall support LGUs in the
financing of capital investments and provision of THE EXPERT PANEL MEMBERS MUST:
population based interventions. 1) Be of recognized probity and independence and must
2) Individual-based health services shall be financed have distinguished themselves professionally in public,
primarily through prepayment mechanisms such as civic or academic service
social health insurance, private health insurance, and 2) Be in the active practice of their professions for at least
HMO plans to ensure predictability of health seven (7) years
expenditures. 3) Not be appointed within one (1) year after losing in the
immediately preceding elections, whether regular or
NATIONAL HEALTH INSURANCE PROGRAM special.
PROGRAM MEMBERSHIP
Membership into the Program shall be simplified into two (2) The Secretary of Health shall be an ex officio nonvoting
types, direct contributors and indirect contributors Chairperson of the Board. All appointive members of the
1) DIRECT CONTRIBUTORS refer to those who have the Board shall be required to undergo training in health care
capacity to pay premiums, are gainfully employed and financing, health systems, costing health services and Health
are bound by an employer-employee relationship, or Technology Assessment (HTA) prior to the start of their term.
are self-earning, professional practitioners, migrant Noncompliance shall be a ground for dismissal.
workers, including their qualified dependents, and
lifetime members ADDITIONAL POWERS AND FUNCTIONS OF PHILHEALTH
2) INDIRECT CONTRIBUTORS refer to all others not 1) To fix the reasonable compensation, allowances and
included as direct contributors, as well as their qualified other benefits of all positions, including its President and
dependents, whose premium shall be subsidized by the CEO, based on a comprehensive job analysis and audit
national government including those who are of actual duties and responsibilities, subject to the
subsidized as a result of special laws. approval of the President of the Philippines.
2) To establish the organizational structure and staffing
pattern of PhilHealth’s central and regional offices to
cover as many provinces, cities and legislative districts,

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 including foreign countries, whenever and wherever it systems. The Provincial and City Health Boards shall oversee
may be expedient, necessary and feasible and to and coordinate the integration of health services for
inspect or cause to be inspected periodically such province-wide and city-wide health systems, to be
offices, subject to the approval by the Board; composed of municipal and component city health systems,
3) To maintain a Provident Fund which consists of and citywide health systems in highly urbanized and
contributions made by both PhilHealth and its officials independent component cities, respectively. The Provincial
and employees and earnings thereon, for the payment and City Health Boards shall manage the Special Health Fund
of benefits to such officials and employees or their referred to in Section 20 of this Act and shall exercise
dependents or heirs under such terms and conditions as administrative and technical supervision over health facilities
may be prescribed by the Board, subject to the approval and health human resources within their respective territorial
of the President of the Philippines jurisdiction: Provided, That municipalities and cities included
4) To adopt or approve the annual and supplemental in the province-wide and city-wide health systems shall be
budget of receipts and expenditures including salaries, entitled to a representative in the Provincial or City Health
allowances and early retirement of PhilHealth personnel Board, as the case may be.
and to authorize such capital and operating
expenditures and disbursements as may be necessary HUMAN RESOURCES FOR HEALTH
and proper for the effective management and operation NATIONAL HEALTH HUMAN RESOURCE MASTER PLAN
of PhilHealth The DOH, together with stakeholders, shall ensure the
formulation and implementation of a National Health Human
HEALTH SERVICES DELIVERY Resource Master Plan that will provide policies and strategies
POPULATION-BASED HEALTH SERVICES for the appropriate generation, recruitment, retraining,
The DOH shall endeavor to contract province-wide and city- regulation, retention and reassessment of health workforce
wide health systems for the delivery of population based based on population health needs.
health services. Province-wide and city-wide health systems
shall have the following minimum components: To ensure continuity in the provision of the health programs
1) Primary care provider network with patient records and services, all health professionals and health care workers
accessible throughout the health system shall be guaranteed permanent employment and
1) Accurate, sensitive, and timely epidemiologic competitive salaries.
surveillance systems
2) Proactive and effective health promotion programs or NATIONAL HEALTH WORKFORCE SUPPORT SYSTEM
campaigns A national health workforce (NHW) support system shall be
created to support local public health systems in addressing
INDIVIDUAL-BASED HEALTH SERVICES their human resource needs:
1) PhilHealth shall endeavor to contract public, private, or Provided, That deployment to Geographically Isolated and
mixed health care provider networks for the delivery of Disadvantaged Areas (GIDAs) shall be prioritized.
individual-based health services:
Provided, That member access to services shall not be SCHOLARSHIP AND TRAINING PROGRAM
compromised: 1) The Commission on Higher Education (CHED), Technical
Provided, further, That these networks agree to service Education and Skills Development Authority (TESDA),
quality, co-payment/co-insurance, and data submission Professional Regulation Commission (PRC) and the DOH
standards: Provided, furthermore, That during the shall develop and plan the expansion of existing and
transition, PhilHealth and DOH shall incentivize health new allied and health related degree and training
care providers that form networks: Provided, finally, That programs including those for community-based health
apex or end-referral hospitals, as determined by the care workers and regulate the number of enrollees in
DOH, may be contracted as stand-alone health care each program based on the health needs of the
providers by PhilHealth. population especially those in underserved areas.
2) PhilHealth shall endeavor to shift to paying providers 2) The CHED and the DOH shall expand scholarship grants
using performance driven, close-end, prospective for allied and health-related undergraduate and
payments based on disease or diagnosis related graduate programs: Provided, That scholarships shall be
groupings and validated costing methodologies and based on the needed cadre of national and local health
without differentiating facility and professional fees; managers and health professionals: Provided, further,
develop differential payment schemes that give due That scholarships for bona fide residents of unserved or
consideration to service quality, efficiency and equity; underserved areas or members of indigenous peoples
and institute strong surveillance and audit mechanisms shall be given priority.
to ensure networks’ compliance to contractual 3) The PRC and the DOH, in coordination with duly
obligations registered medical and allied health professional
societies, shall set up a registry of medical and allied
ORGANIZATION OF LOCAL HEALTH SYSTEMS health professionals, indicating, among others, their
INTEGRATION OF LOCAL HEALTH SYSTEMS INTO current number of practitioners and location of practice.
PROVINCE-WIDE AND CITY-WIDE HEALTH SYSTEM 4) The CHED, PRC, and DOH, in coordination with duly
The DOH, Department of the Interior and Local Government registered medical and allied professional societies,
(DILG), PhilHealth and the LGUs shall endeavor to integrate shall reorient medical and allied medical professional
health systems into province-wide and city-wide health education, and health professional certification and

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 regulation towards producing health workers with EQUITY
competencies in the provision of primary care services. 1) The DOH shall annually update its list of underserved
areas, which shall be the basis for preferential licensing
RETURN SERVICE AGREEMENT of health facilities and contracting of health services.
All graduates of allied and health-related courses who are The DOH shall develop the framework and guidelines to
recipients of government-funded scholarship programs shall determine the appropriate bed capacity and number of
be required to serve in priority areas in the public sector for at health care professionals of public health facilities.
least three (3) full years, with compensation, and under the 2) The government shall guarantee that the distribution of
supervision of the DOH: Provided, further, That those who will health services and benefits provided for in this Act shall
serve for additional two (2) years shall be provided with be equitable by prioritizing Geographically Isolated and
additional incentives as determined by the DOH: Provided, Disadvantaged Areas (GIDAs) in the provision of
further, That graduates of allied and health related courses assistance and support.
from state universities and colleges and private schools shall 3) All government hospitals are required to operate not
be encouraged to serve in these areas. The DOH shall less than ninety percent (90%) of their bed capacity as
coordinate with the CHED and PRC for the effective basic or ward accommodation:
implementation of this section including the establishment of Provided, That specialty hospitals are required to
guidelines for noncompliance. operate not less than seventy percent (70%) of then bed
capacity as basic or ward accommodation: Provided,
SAFETY AND QUALITY further, That private hospitals are required to operate
1) PhilHealth shall establish a rating system under an not less than ten percent (10%) of then bed capacity as
incentive scheme to acknowledge and reward health basic or ward accommodation: Provided, finally, That all
facilities that provide better service quality, efficiency government hospitals, specialty hospitals and private
and equity: Provided, That PhilHealth shall recognize hospitals shall regularly submit a report on the allotment
third party accreditation mechanisms and may use or percentage of their bed capacity to basic or ward
these as basis for granting incentives. accommodation to DOH, which shall issue the
2) The DOH shall institute a licensing and regulatory necessary guidelines for the immediate implementation
system for stand-alone health facilities, including those of this provision.
providing ambulatory and primary care services, and
other modes of health service provision. APPROPRIATIONS
3) The DOH shall set standards for clinical care through the THE AMOUNT NECESSARY TO IMPLEMENT THIS ACT
development, appraisal, and use of clinical practice SHALL BE SOURCED FROM THE FOLLOWING:
guidelines in cooperation with professional societies 1) Total incremental sin tax collections as provided for in
Republic Act No. 10351, otherwise known as the "Sin Tax
AFFORDABILITY Reform Law“
1) DOH-owned health care providers shall procure drugs 2) Fifty percent (50%) of the National Government share
and devices guided by price reference indices, from the income of the Philippine Amusement Gaming
following centrally negotiated prices, sell them Corporation (PAGCOR) as provided for in Presidential
following the prescribed maximum mark-ups, and Decree No. 1869
submit to DOH a price list of all drugs and devices 3) Forty percent (40%) of the Charity Fund, net of
procured and sold by the health care provider. Documentary Stamp Tax Payments, and mandatory
2) An independent price negotiation board, composed of contributions of the Philippine Charity Sweepstakes
representatives from the DOH, PhilHealth and the Office (PCSO) as provided for in Republic Act No. 1169
Department of Trade and Industry (DTI), among others, 4) Premium contributions of members;
shall be constituted to negotiate prices on behalf of the 5) Annual appropriations of the DOH included in the
DOH and PhilHealth, guided by certain parameters General Appropriations Act (GAA)
including new technology, innovator drugs, and sourced 6) National Government subsidy to PhilHealth included in
from a single supplies the GAA
3) Health care providers and facilities shall be required to
make readily accessible to the public and submit to DOH PENAL PROVISIONS
and PhilHealth, all pertinent, relevant, and up-to-date 1) A health care provider of population-based health
information regarding the prices of health services, and services who violates any of the provision in its
all goods and services being offered. respective contract shall be subject to sanctions and
4) Drug outlets shall be required at all times to carry the penalties under its respective contracts without
generic equivalent of all drugs in the Primary Care prejudice to the right of the government to institute any
Formulary and shall be required to provide customers criminal or civil action before the proper judicial body.
with a list of therapeutic equivalents and then’ 2) A health care provider contracted for the provision of
corresponding prices when fulfilling prescriptions or in individual based health services who commits an
any transaction. unethical act, abuses the authority vested upon the
5) The DOH, PhilHealth, HMOs, life and non-life private health care provider, or performs a fraudulent act shall
health insurance (PHIs) shall develop standard policies be punished by a fine of Two hundred thousand pesos
and plans that complement the Program’s benefit (₱200,000.00) for each count, or suspension of contract
schedule up to three (3) months or the remaining period of its
contract or accreditation whichever is shorter, or both, at

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 the discretion of the PhilHealth, taking into consideration less than six (6) months but not more than one (1) year,
the gravity of the offense. or both such fine and imprisonment, at the discretion of
the court.
The same shall also constitute a criminal violation punishable
by imprisonment for six (6) months and one (1) day up to six If the unlawful deduction is committed by an association,
(6) years, upon discretion of the court without prejudice to partnership, corporation or any other institution, its managing
criminal liability defined under the Revised Penal Code. directors or partners or president or general manager, or
other persons responsible for the commission of the act shall
If the health care provider is a juridical person, its officers and be liable for the penalties provided for in this Act.
employees or other representatives found to be responsible,
who acted negligently or with intent, or have directly or ANY DIRECTOR, OFFICER OR EMPLOYEE OF PHILHEALTH
indirectly caused the commission of the violation, shall be WHO:
liable. Recidivists may no longer be contracted as participants 1) Without prior authority or contrary to the provisions of
of the Program. this Act or its IRR, wrongfully receives or keeps funds or
property payable or deliverable to the PhilHealth, and
3) A member who commits any violation of this Act or who appropriates and applies such fund or property for
knowingly and deliberately cooperates or agrees, personal use, or shall willingly or negligently consents
whether explicitly or implicitly, to the commission of a either expressly or implicitly to the misappropriation of
violation by a contracted health care provider or funds or property without objecting to the same and
employer as defined in this section, including the filing promptly reporting the. matter to proper authority, shall
of a fraudulent claim for benefits or entitlement under be liable for misappropriation of funds under this Act
this Act, shall be punished by a fine of Fifty thousand and shall be punished with a fine equivalent to triple the
pesos (₱50,000.00) for each count or suspension from amount misappropriated per count and suspension for
availment of the benefits of the Program for not less three (3) months without pay.
than three (3) months but not more than six (6) months, 2) Commits an unethical act, abuse of authority, or
or both, at the discretion of PhilHealth. performs a fraudulent act shall be punished by a fine of
Two hundred thousand pesos (₱200,000.00) or
ANY EMPLOYER WHO: suspension for three (3) months without pay, or both, at
1) Deliberately or through inexcusable negligence, fails or the discretion of PhilHealth, taking into consideration the
refuses to register employees regardless of their gravity of the offense. The same shall also constitute a
employment status, accurately and timely deduct criminal violation punishable by imprisonment for six (6)
contributions from the employee’s compensation or to months and one (1) day up to six (6) years, upon
accurately and timely remit or submit the report of the discretion of the court without prejudice to criminal
same to PhilHealth shall be punished with a fine of Fifty liability defined under the Revised Penal Code.
thousand pesos (₱50,000.00) for every violation per
affected employee, or imprisonment of not less than six Other violations of the provisions of this Act or of the rules and
(6) months but not more than one (1) year, or both such regulations promulgated by PhilHealth shall be punished with
fine and imprisonment, at the discretion of the court. a fine of not less than Five thousand pesos (₱5,000.00) but
not more than Twenty thousand pesos (₱20,000.00). All other
Any employer or any officer authorized to collect violations involving funds of PhilHealth shall be governed by
contributions under this Act who, after collecting or the applicable provisions of the Revised Penal Code or other
deducting the monthly contributions from the employee’s laws, taking into consideration the rules on collection,
compensation, fails or refuses for whatever reason to remittances, and investment of funds as may be promulgated
accurately and timely remit the contributions to PhilHealth by PhilHealth.
within thirty (30) days from due date shall be presumed prima
facie to have misappropriated the same and is obligated to PhilHealth may enumerate circumstances that will mitigate or
hold the same in trust for and in behalf of the employees and aggravate the liability of the offender or erring health care
PhilHealth, and is immediately obligated to return or remit the provider, member or employer. Despite the cessation of
amount. operation by a health care provider or termination of practice
of an independent health care professional while the
If the employer is a juridical person, its officers and complaint is being heard, the proceeding shall continue until
employees or other representatives found to be responsible, the resolution of the case.
whether they acted negligently or with intent, or have directly
or indirectly caused the commission of the violation, PERFORMANCE MONITORING DIVISION
The DOH shall establish a Performance Monitoring Division to
2) Deducts, directly or indirectly, from the compensation of monitor and evaluate the proper and effective
the covered employees or otherwise recover from them implementation of the provisions of this Act. The office in
the employer’s own contribution on behalf of such charge of field implementation performance of the DOH shall
employees shall be punished with a fine of Five comprise the core personnel of the office which shall be
thousand pesos (₱5,000.00) multiplied by the total augmented by the DOH Secretary, as may be deemed
number of affected employees or imprisonment of not necessary.

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ORIGINS OF ANTIBIOTICS HERBAL REMEDIES BACTERIOSTATIC VS. BACTERICIDAL
1. Allium cepa (Liliaceae) BACTERIOSTATIC BACTERICIDAL
• Onion − Arrest the growth and − Kills bacteria
• Sibuyas replication of bacteria − Total number of viable
• Quercetin organisms decreases
2. Curcuma longa (Zingiberaceae)
• Chloramphenicol • Aminoglycosides
• Turmeric • Nitrofurantoin • Quinolones
• Luyang dilaw • Clindamycin • Cycloserine
• Curcumin • Tetracycline • Vancomycin
3. Allium sativum (Liliaceae) • Erythromycin • Carbapenems
• Garlic • Trimethoprim • Pencillin
• Bawang • Lincomycin • Cephalosporin
• Allicin
4. Piper nigrum (Piperaceae) CHEMOTHERAPEUTIC SPECTRUM
• Pepper 1. Narrow spectrum
• Paminta 2. Extended spectrum
• Peperine 3. Broad spectrum

ORIGINS OF ANTIBIOTICS ANTIMICROBIAL DRUGS ACCORDING TO MECHANISM OF

1. Paul Ehrlich (1854-1915) ACTION
− Pioneered the development of antibiotics with his 1. Cell wall synthesis inhibitors
work on “606” or Salvarsan, a treatment for syphilis 2. Protein synthesis inhibitors
3. Nucleic acid synthesis inhibitors
2. Alexander Fleming (1881-1955) 4. Cell membrane disrupters
− Isolation of an antibiotic substance penicillin from
Penicillium notatum COMBINATION OF ANTIMICROBIAL DRUGS
• Advantages
DESIRED PROPERTIES OF A NEW ANTIMICROBIAL AGENT • Disadvantages

ANTIMICROBIAL PHARMACOLOGICAL DRUG RESISTANCE

PROPERTIES PROPERTIES − ability of a microorganism to withstand a drug that was
previously toxic to it
• Selectively for • Non-toxic to the host
microbial rather than • Long plasma half-life ➢ Basic Mechanism by which Microorganisms can
mammalian targets • Good tissue distribution
become Resistant to Antimicrobial Drugs
• Broad spectrum of • Low plasma-protein
1. Production of drug-activating enzyme
activity binding
• Cidal activity 2. Changes to drug penetration
• Oral and parenteral
(antibacterial and 3. Changes in receptor structure
dosing forms
antifungal agents) • No interference with 4. Alteration of metabolic pathways
other drugs
EMPIRIC THERAPY
CRITICAL FACTORS THAT DETERMINE THE SELECTION OF − Early intervention through the use of antibiotic before a
AN ANTOMICROBIAL DRUG pathogen is identified
1. Organism’s identity and its sensitivity to a particular
agent ➢ Benefits:
2. Site of infection 1. Helps improve the outcome of an infection
3. Safety of the agent 2. Physicians use information from history, physical
4. Patient’s factor exams and other completed diagnostics tests to
5. Cost of Therapy determine which antibiotic to use

CLASSIFICATION OF ANTIMICROBIAL DRUGS ANTIMICROBIAL PROPHYLAXIS

1. Activity against particular types of organisms − Use of antibiotic to prevent disease
2. Mechanism of action
3. Chemical structure COMMON COMPLICATIONS OF ANTIBIOTIC THERAPY
1. Hypersensitivity
2. Direct toxicity
3. Super infections

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A. CELL WALL SYNTHESIS INHIBITORS 2. Seizure
ẞ-lactam antibiotics Other antibiotics 3. GIT disturbances
Penicillin Vancomycin 4. Hemolytic anemia
Cephalosporin Bacitracin 5. Cation toxicity
Carbapenem
Monobactam 2. Anti-staphylococcal penicillin (Penicillinase
Resistant Penicillin)
PENICILLIN a. Methicillin
b. Nafcillin
c. Oxacillin
d. Dicloxacillin
e. Cloxacillin

• When do you use Penicillinase-Resistant

− Most widely effective antibiotic and among the least Penicillin?
toxic drugs known − These drugs have a very narrow spectrum
− Major adverse reaction: hypersensitivity − They were developed solely for the purpose
of killing staphylococci that produce
➢ Mechanisms of action: penicillinase
1. Penicillin-binding protein
2. Inhibition of transpeptidase • What other Toxicity is Associated with these
3. Autolysis Drugs?
− Methicillin, nafcillin and some penicillins
➢ Classifications: occasionally cause Granulocytopenia in
1. Natural penicillin children
a. Penicillin G
b. Penicillin V 3. Anti-pseudomonal penicillin
c. Penicillin G procaine a. Mezlocillin
d. Penicillin G benzathine b. Piperacillin
c. Azlocillin
• Various natural penicillin drugs all work the same d. Carbenicillin
ways. They differ in their route of administration e. Ticarcillin
and stability to gastric acid
• Has a large spectrum; however, it affects gram • Extremely unstable in gastric acid; must be given
positive organisms the most IV or IM
• Inactivated by penicillinase
• Clinical indications include: • Effective against gram-negative bacilli except
✓ Streptococci Klebsiella
✓ Meningococci • Adverse effect: platelet dysfunction
✓ Enterococci
✓ Clostridia 4. Extended spectrum penicillin
✓ Listeria a. Amoxicillin
✓ Bacteroides species b. Ampicillin
✓ Spirochetes
✓ Syphilis • Effective against all organisms affected by natural
✓ Diphtheria penicillins and some gram-negative organisms:
✓ Anthrax ✓ E. coli
✓ Actinomycosis ✓ Proteus mirabilis
✓ Anaerobic organism that do not produce ẞ- ✓ Salmonella
lactamase ✓ Shigella
✓ Haemophilus influenza
• Absorption depends on their acid stability and ✓ Listeria monocytogenes
protein binding • Inactivated by ẞ-lactamase
• Absorption of most penicillin is affected by food • Potential side effect of ampicillin:
• Mostly unchanged when they are excreted in the Pseudomembranous colitis
urine • Can be given with a ẞ-lactamase inhibitors:
• Renal tubular secretion can be delayed by co- ✓ Clavulanic acid
administration of probenecid (inhibits organic acid ✓ Sulbactam
secretion system) ✓ Tazobactam
RESISTANCE
• Most Common Adverse Effects of Penicillin − Alteration in target penicillin-binding proteins (PBP)
1. Hypersensitivity reactions

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 − Decreased cell permeability which prevents penetration ➢ In general, how do the characteristics of Cephalosporins
of antibiotic to its target change from first to fourth generation agents?
✓ A decrease in gram-positive coverage
TO WHICH DRUGS ARE ẞ-LACTAMASE INHIBITORS ARE ✓ An increase in gram-negative coverage
PAIRED WITH? ✓ An increase in CNS penetration
✓ Clavulanic acid with amoxicillin or ticarcillin ✓ Increase in resistance in ẞ-lactamase
✓ Sulbactam with ampicillin
✓ Tazobactam with piperacillin OTHER CELL WALL SYNTHESIS INHIBITORS:
MONOBACTAM (AZTREONAM)
CEPHALOSPORINS − Disrupt bacterial cell wall synthesis by binding to
penicillin-binding protein and inhibiting peptidoglycan
synthesis
− Administered IV or IM (excreted in the urine)
− Indicated for gram-negative rods

− ẞ-lactam antibiotics that are closely related both ➢ Adverse effects:

structurally and functionally to penicillin a. Skin rash
− Most be administered IV due to poor oral absorption b. Elevated liver enzymes
− Bactericidal c. GIT distress

➢ Adverse effects: CARBAPENEMS

a. Allergic manifestation − Synthetic ẞ-lactamase antibiotics and resistant to ẞ-
b. Disulfram-like effect lactamase
c. Bleeding − E.g., Imipenem (combined with cilastatin)
− Active against virtually all gram-positive, gram-negative,
➢ Analogous to penicillin in: and anaerobic organisms
✓ Binding to specific penicillin-binding proteins − Methicillin-resistant Staphylococcus and Clostridium
✓ Inhibition of cell wall synthesis by blocking the difficile are exceptions
transpeptidase step of peptidoglycan synthesis
✓ Activation of autolytic enzyme ➢ Adverse effects:
a. Seizure
➢ Classifications: b. GIT distress
1. First generation c. Eosinophilia
• Cefazolin d. Neutropenia
• Cafadroxil
• Cephalexin VANCOMYCIN
• Cephalothin − Binds to D-alanyl-D-alanine portion of cell precursors
• Cephapirin − Inhibits peptidoglycan polymerization
• Cephradine − Effective against all gram-positive organisms
− Reserved for treating severe infection caused by:
2. Second generation ✓ methicillin-resistant Staphylococci
• Cefaclor ✓ serious gram-positive infection in penicillin-allergic
• Cefamandole patients
• Cafonicid − Slow IV injection is employed for the treatment of
• Cefametazole systemic infections or for prophylaxis
• Cefotetan − Resistance is due to:
• Cefoxitin ✓ plasmid-mediated changes in permeability
• Cefuroxime ✓ decrease binding to receptor molecules
• Cefuroxime Axetil
➢ Adverse effects:
3. Third generation a. Fever
b. Chills
• Cefixime
c. Shock
• Cefoperazone
d. Dose-related ototoxicity
• Cefotaxime
e. Nephrotoxicity
• Ceftazidime
f. Redman’s syndrome
• Ceftizoxime
• Ceftriaxone BACITRACIN
− Mixture of polypeptide that inhibit cell wall synthesis by
4. Fourth generation blocking the transfer of peptidoglycan subunits to a
• Cefepime growing cell wall
• Cefpirome

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 − Topical application because of its potential for − Effective against many gram-positive and gram-
nephrotoxicity negative organisms

➢ Adverse effect: ➢ Adverse effects:

a. Nausea a. CNS toxicities
b. Vomiting b. Tremors
c. Skin rashes c. Seizures
d. Confusion
CYCLOSERINE e. Headaches
− Structural analog of D-alanine; therefore, blocks the f. Psychosis
incorporation of D-alanine into peptidoglycan

SUMMARY OF ADVERSE EFFECTS OF CELLWALL SYNTHESIS INHIBITORS

CEPHALOSPHORIN MONOBACTAM CARBAPENEMS VANCOMYCIN BACITRACIN CYCLOSERINE
Fever CNS toxicities
Seizure Chills Tremors
Allergic manifestation Skin rash Nausea
GIT distress Shock Seizures
Disulfram-like effect Elevated liver enzymes Vomiting
Eosinophilia Dose-related ototoxicity Confusion
Bleeding GIT distress Skin rashes
Neutropenia Nephrotoxicity Headaches
Redman’s syndrome Psychosis

B. PROTEIN SYNTHESIS INHIBITORS − Consists of 4-fused rings with a system of conjugated

− Bind to either 30s or 50s ribosomal subunit double bonds
− Interferes with transcription of mRNA to protein − Binds reversibly to the 30s subunit of bacterial ribosome,
blocking aminoacyl transfer RNA from entering the
Inhibits 30s Inhibits 50s acceptor site on the mRNA-ribosomal complex
Aminoglycosides Chloramphenicol − Broad spectrum antibiotics
Tetracycline Macrolides − Bacteriostatic
Spectinomycin Lincosamides − For treatment of gram-positive and gram-negative
facultative organisms and anaerobes
INHIBITS 30S: − Absorbed after oral administration except after
AMINOGLYCOSIDES consumption of:
− Aminoglycosides that are derived from Streptomyces ✓ Dairy foods
have a “mycin” suffix whereas those derived from ✓ Iron-containing preparations
Micromonospora end in “micin” ✓ Antacids that contain calcium, aluminum,
a. Tobramycin magnesium, iron
b. Gentamycin − Excreted in the urine
c. Streptomycin
d. Neomycin ➢ Adverse effects:
e. Amikacin a. Associated with staining of the teeth
f. Netilmicin b. Retardation of bone growth
− Used in the treatment of serious infection due to aerobic c. Liver toxicity
gram-negative bacilli d. Photosensitivity
− Bactericidal e. Vestibular reactions
− Irreversibly bind to 30s ribosomal subunit and inhibit
protein synthesis by blocking the formation of the ➢ Contraindicated to:
initiation complex and the translocation step a. breast-feeding pregnant women
− Poorly absorbed from the GIT b. children below 12 years old

➢ Adverse effects: ➢ How does resistance to tetracycline develop?

a. Ototoxicity • Inability of the drug to accumulate intracellularly
b. Nephrotoxicity either through an increased efflux by an active
c. Neuromuscular toxicity transport protein pump or diminished influx
• Inability of the drug to bind to bacterial ribosome
TETRACYCLINE • Enzymatic destruction of the drug
a. Demeclocycline
b. Doxycycline SPECTINOMYCIN
c. Minocycline − Aminocyclitol antibiotic structurally related to
d. Oxytetracycline aminoglycosides
e. Chlortetracycline
− Binds to 30s ribosomes subunit and inhibits protein
f. Tetracycline
synthesis
− IM injection

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 − Alternative drug for Neisseria gonorrhoeae in patients
who are allergic to ceftriaxone ➢ Used in treating of patients with:
✓ Mycoplasma infection
➢ Common adverse effect: ✓ Legionnaires’ disease
a. Pain at injection site ✓ Chlamydial infections
b. Fever ✓ Diphtheria
c. Nausea ✓ Pertussis
✓ Pneumonia
INHIBITS 50S
CHLORAMPHENICOL ➢ Adverse effects:
− Bacteriostatic broad-spectrum antibiotic a. Epigastric distress
− Binds reversibly to 50s ribosomal subunit b. Cholestatic hepatitis
− Inhibits protein synthesis during the peptidyl transferase c. Ototoxicity
reaction
− Active against both aerobic and anaerobic gram- ➢ Avoid using:
positive and gram-negative organisms as well as:  Erythromycin with theophylline
✓ Rickettsia  Oral coagulant
✓ Haemophilus influenza  Cisapride
✓ Neisserria meningitides * It will increase the serum concentrations
✓ Bacteroides species
➢ How does resistance to macrolides develop?
− Due to its toxicity, its use is restricted to life-threatening • Defective uptake of the drug by the microbes
infections in which there are no alternatives • Bacterial plasmids coding for enzymes that
− Metabolized in the liver inactivate these drugs
− Clinically significant resistance is due to bacterial
production of chloramphenicol acetyl transferase that LINCOSAMIDES (LINCOMYCIN)
inactivates chloramphenicol or decreases penetration − Antibiotic elaborated by Streptomyces lincolnensis that
of the drug resembles erythromycin
− Associated with bone marrow depression and aplastic − Chlorine derivative of lincomycin (clindamycin)
anemia that is usually fatal − Bacteriostatic agent that binds to 50s ribosomal
− Can produce gray baby syndrome subunits
− Inhibits protein synthesis by interfering with aminoacyl
MACROLIDES translocation steps
a. Erythromycin − Metabolized both renal and hepatic routes
b. Clarithromycin − Treat severe infection by anaerobic bacteria such as:
c. Azithromycin ✓ Bacteroides fragilis
✓ Streptococci
− Has macrocyclic structure ✓ Staphylococci
− Alternative to penicillin in individuals who are allergic to ẞ- ✓ Pneumococci
lactam antibiotics
− Binds to 50s ribosome ➢ Adverse effects:
− Inhibits the translocation in step of protein synthesis a. Pseudomembranous colitis
− Some are bacteriostatic, others are bactericidal b. Diarrhea
c. Granulocytopenia
− Oral administration for all
d. Skin rashes
− IV for erythromycin and azithromycin
− Metabolized by cytochrome P450 system

SUMMARY OF ADVERSE EFFECTS OF PROTEIN SYSNTHESIS INHIBITORS

INHIBITS 30S INHIBITS 50S
AMINOGLYCOSIDES TETRACYCLINE SPECTINOMYCIN CHLORAMPHENICOL MACROLIDES LINCOSAMIDES
Associated with
staining of the teeth Epigastric Pseudomembranous
Ototoxicity
Retardation of bone Pain at injection site distress colitis
Nephrotoxicity
growth Fever Gray baby syndrome Cholestatic Diarrhea
Neuromuscular
Liver toxicity Nausea hepatitis Granulocytopenia
toxicity
Photosensitivity Ototoxicity Skin rashes
Vestibular reactions

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C. DNA SYNTHESIS INHIBITORS ➢ Adverse effects:
a. Quinolones and fluoroquinolones a. Anorexia
− Block nucleic acid synthesis by inhibiting DNA b. Nausea
gyrase c. Vomiting
b. Rifampin d. Neurological disorders
− Inhibits DNA-dependent RNA polymerase e. Hemolytic anemia
c. Sulfonamides f. Pulmonary infiltration
− Inhibit synthesis of folate which is a critical g. Chronic active hepatitis
component of DNA h. Rashes
i. Brown urine
QUINOLONES
Nalidixic acid and cinoxacin Methenamine
− Only useful as urinary antiseptics as they do not reach − Must decompose at an acidic pH of 5 or less in the urine,
the systemic bactericidal levels and they rapidly thus, producing formaldehyde which is toxic to most
develop resistance bacteria
− Have largely been replaced by fluoroquinolones − Used for chronic suppressive therapy of UTIs
− Orally administered
FLUOROQUINOLONES
a. Norfloxacin ➢ Adverse effects:
b. Levofloxacin a. GI distress
c. Ciprofloxacin b. Hematuria
d. Ofloxacin c. Albuminuria
e. Enoxacin d. Rashes at high dose
f. Sparfloxacin
g. Trovafloxacin FOLATE ANTAGONIST
Sulfonamides
− Inhibits DNA gyrase a. Sulfamethoxazole
− Well-absorbed and widely distributed in body fluids and b. Sulfisoxazole
bones, not in the CNS c. Sulfamethizole
− Broad spectrum agents active against aerobic gram- d. Sulfasalazine
negative bacteria and many gram-positive organism e. Sulfacetamide
f. Silver sulfadiazine
➢ Treatment of: g. Mafenide
✓ UTI h. Sulfadiazine
✓ Respiratory tract infection
✓ Prostatitis − Resemble PABA in structure
✓ STDs − Bind and competitively inhibit dihydropteroate synthetase
✓ Skin, bone, soft tissue infections (Osteomyelitis) − Bacteriostatic
− Effective against gram-positive and gram-negative
− Contraindicated for pregnant and nursing women and organisms including: Nocardia, Chlamydia, E. coli,
children Klebsiella & Enterobacter
− Administered IV or PO − Well-absorbed after oral administration
− Increases plasma theophylline levels with concomitant − Contraindicated for pregnant and nursing women
use of fluoroquinolones
➢ Treatment of:
➢ Adverse effects: ✓ UTI
a. Headache ✓ Ulcerative colitis
b. Dizziness ✓ Burn infections
c. Insomnia ✓ Ocular infections
d. Diarrhea ✓ Nocardiosis
e. Nausea ✓ Toxoplasmosis
f. Abnormal liver function tests
g. Photosensitivity ➢ Adverse effects:
a. Hypersensitivity
URINARY ANTISEPTICS b. Stevens-Johnson syndrome
Nitrofurantoin c. Hematoxicity
− Both bacteriostatic and bactericidal in increased doses d. Crystalluria
against gram-positive and gram-negative bacteria e. Hematuria
− Alters various bacterial enzymes and bacterial DNA f. Kernicterus
− Indicated for UTIs
− Administered orally
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 Trimethoprim d. Skin eruptions
− Stops the conversion of dihydrofolate to e. Convulsion
tetrahydrofolate by inhibiting the enzyme dihydrofolate
reductase 2. Rifampin
− Oral administration − Inhibits the ẞ-subunit of DNA-dependent RNA
− Combined with sulfamethoxazole polymerase
− Suppresses RNA synthesis by blocking chain
➢ Treatment of: initiation
✓ Complicated or recurrent UTIs − Metabolizes and induces the cytochrome P450
✓ Bacterial prostatitis system
✓ Gonorrhea − Prophylaxis of meningitis, treatment of leprosy (in
✓ Sinusitis/bronchitis combination of dapsone), and Legionnaires’
✓ Acute otitis media disease
✓ Pneumonia − Urine, sweat, tears, and other secretions may
✓ Toxoplasmosis become red orange in color
− Bactericidal
➢ Adverse effect:
a. Folate deficiency ➢ Adverse effects:
b. Megablostatic anemia a. Rash
c. Leukopenia b. Fever
d. Granulocytopenia c. Nausea
d. Vomiting
Co-Trimoxazole e. Flu-like syndrome with chills, fever, myalgias
• Trimethoprim + sulfamethoxazole
− Greater antimicrobial activity 3. Pyrazinamide (PZA)
− Broad spectrum of activity than the sulfa drugs − For short course treatment of tuberculosis in
combination with INH and rifampin
DRUGS USED TO TREAT TUBERCULOSIS AND LEPROSY − Orally absorbed and distributed to most body
tissues, including CNS
FIRST LINE DRUGS SECOND LINE DRUGS DRUGS FOR
− Bactericidal
FOR TB FOR TB LEPROSY
Amino salicylic acid ➢ Adverse effects:
Capreomycin a. Hepatotoxicity
Isoniazid (INH)
Cycloserine b. Gout
Pyrazinamide (PZA) Dapsone
Ethionamide
Rifampin Clofazimine c. Arthralgia
Kanamycin
Ethambutol Rifampin d. Myalgia
Quinolones
Streptomycin
Rifabutin
Viomycin 4. Ethambutol
− Almost always used against M. tuberculosis but
can be used against M. kansasii as well
Tuberculosis
− Inhibit arabinogalactan, an essential component
− Number 1 cause of death from the infectious diseases
of mycobacterial cell wall
worldwide
− Well absorbed orally and distributes into all cells,
− Caused by the bacterium Mycobacterium tuberculosis
including CNS
− Recommendation for initial treatment of active TB
− The only first line drug that is bacteriostatic
✓ A 2-month regimen of PZA, INH and rifampin
✓ A 4-month regimen of INH and rifampin
➢ Adverse effects:
✓ A total of 6 months
a. Optic neuritis (Lowers visual acuity; Red-
green color blindness
First Line of Drugs for TB
b. Gout
1. Isoniazid (INH)
− Inhibit the synthesis of mycolic acid which are
5. Streptomycin
unique to the mycobacterial cell wall
− Aminoglycoside
− Rapidly absorbed orally and parenterally
− Binds to 30s ribosome subunit, causing and
− Absorption is impaired if INH is taken with
misinterpretation of genetic code
aluminum-containing antacids
− Used for life-threatening TB in combination with
other first line drugs
➢ Adverse effects:
a. Peripheral neuritis (Inactivated by Vitamin B)
➢ Adverse effects:
b. Hepatotoxicity
a. Ototoxicity
c. Rashes
b. Nephrotoxicity
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 Drugs for Leprosy GI irritation
1. Dapsone CLOFAZIMINE
Nausea
Vomiting
− Related to the sulfonamide
Diarrhea
− Inhibits folate biosynthesis by acting as a
LEPROSY
competitive agonist of PABA GI irritation
Methemoglobinemia
− orally administered DAPSONE Hemolysis (Dose related)
− undergoes acetylation in the liver Drug-induced lupus
erythematosus
− Used in combination with rifampin and
clofazimine to treat leprosy (6-24 months) Ototoxicity
STREPTOMYCIN
Nephrotoxicity
➢ Adverse effects:
Optic neuritis (Lowers visual
a. GI irritation acuity; Red-green color
b. Methemoglobinemia ETHAMBUTOL
blindness
c. Hemolysis (Dose related) Gout

d. Drug-induced lupus erythematosus Hepatotoxicity

Gout
PZA
2. Clofazimine Arthralgia
Myalgia
− Phenazine dye that binds to DNA and inhibits
TUBERCULOSIS
DNA template function

SUMMARY OF ADVERSE EFFECTS OF DNA SYNTHESIS INHIBITORS

Rash
− Given to patients who are unable to tolerate Fever
Nausea
dapsone RIFAMPIN
Vomiting
− Distinctive reddish-brown Flu-like syndrome with
chills, fever, myalgias

➢ Adverse Effects:
a. GI irritation Peripheral neuritis
(Inactivated by Vitamin B)
• Nausea IINH Hepatotoxicity
• Vomiting Rashes
Skin eruptions
• Diarrhea

Folate deficiency
D. CELL MEMBRANE DISRUPTER Megablostatic anemia
TRIMETHOPRIM
− Polyene antimicrobials Leukopenia
Granulocytopenia

AMPHOTERICIN B FOLATE
ANTAGONISTS Hypersensitivity
− Polyene antibiotic Stevens-Johnson syndrome
− For treating systemic mycotic infections SULFONAMIDES
Hematoxicity
Crystalluria
− Binds to ergosterol and forms pores or channels within Hematuria
the membrane (this allows electrolytes to leak from the Kernicterus
cell membrane, which results in cell death)
− Either fungicidal or fungistatic depending on the GI distress
Hematuria
organism and concentration of the drug METHENAMINE
Albuminuria
Rashes at high dose
➢ Adverse effects:
a. Fever and chills Anorexia
URINARY
Nausea
b. Renal impairment ANTISEPTICS
Vomiting
c. Hypotension Neurological disorders
NITROFURANTOIN Hemolytic anemia
d. Anemia Pulmonary infiltration
e. neurologic effects Chronic active hepatitis
f. thrombophlebitis Rashes
Brown urine

NYSTATIN Headache
Dizziness
− Polyene antibiotic nsomnia
− Its structure, chemistry, mode of action and resistance Diarrhea
FLUOROQUINONES
− Resemble those of amphotericin B Nausea
Abnormal liver function
− Use is restricted to topical treatment of Candida tests
infections because of its systemic toxicity Photosensitivity

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