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2005-2006 Field Guide
to Antibiotic Therapy
I N T R O D U C T I O N
Proper antibiotic selection requires a knowledge of host rosyphilis because of limited penetration into the central factors (e.g., immune function, comorbid diseases, and nervous system. Similarly, cefotaxime has activity against age); pharmacologic factors (e.g., pharmacokinetics, phar- Enterobacter, but would rarely be used as monotherapy for macodynamics, adverse effects, and drug interactions); serious infections, because of high rates of resistance and and microbial factors (e.g., resistance patterns and patho- the emergence of resistance during therapy.
genicity). The accompanying chart can serve as a quick ref- erence to general therapeutic use of antibiotics for selected This chart is a compilation of data and recommendations organisms. One must be careful not to use this or any presented in the primary literature, review articles, and other generalized reference in the absence of sound clinical textbooks that are well-recognized in the field of infectious judgment, as it cannot account for all host, drug, and diseases. Because many antibiotics have overlapping spec- microbial factors in each specific clinical scenario. In partic- trums of activity, it is difficult to assign a drug of choice ular, an antibiotic may be listed as having activity against for each specific pathogen. Therefore, the table is divided an organism in general but may be ineffective in certain into first-line, second-line, and third-line agents; a (+) clinical settings. For example, doxycycline is active against to indicate some in vitro or clinical activity; and (i) for an Treponema pallidum, but is not used for treatment of neu- AUTHOR: Jeffrey J. Kuper, Pharm.D., BCPS, Clinical Associate
This chart is designed to be a quick reference on antibiotic drugs and was based bythe author on recommendations in review articles and textbooks. Drug Topics neither Professor, Rutgers School of Pharmacy and Department of Phar- affirms nor denies the accuracy of the information contained herein. macy, Robert Wood Johnson University Hospital, No liability will be assumed for the use of the chart. Readers are strongly urged to consult the complete manufacturer’s literature on the drugs in question. 1 = first-line agent for typical infections caused by this
§ = combination of antipseudomonal beta-lactam plus
pathogen (e.g., strong in vivo efficacy data).
aminoglycoside generally recommended for severe 2 = second-line agent for typical infections caused by this
pathogen (e.g., less documented clinical data, more toxi- # = multiple antibiotics plus antisecretory therapy recom-
city, or higher cost compared to first-line agent).
mended for gastrointestinal ulcers caused by this organ- 3 = third-line agent for typical infections caused by this
pathogen (e.g., lack of in vivo clinical data, emerging ** = quinupristin/dalfopristin has not shown activity against
resistance patterns, toxicity risk, or high cost compared Enterococcus faecalis and should be considered only for infections caused by Enterococcus faecium. + = agent displaying in vitro or in vivo activity against this
* = resistance may be a problem; because of varying sus-
organism but not used clinically for specific infections ceptibilities among geographic areas, susceptibility i = an investigational drug that has shown in vitro or in
†† = rifampin is to be used in conjunction with other anti-
vivo activity against this organism but is not yet infective agents and not as a single agent except in the prophylactic therapy of Haemophilus influenzae and ‡ = anaerobe
† = combination therapy with a penicillin and aminoglyco-
ii = streptomycin is to be used in combination with other
side recommended for enterococcal endocarditis.
antiinfective agents for the treatment of streptococcal orenterococcal endocarditis, mycobacterial infections, †‡ = this agent is not indicated for streptococcal otitis media.
Il = agent indicated only for urinary tract infections.
A N T I B I O T I C T A B L E
P E N I C I L L I N S
CEPHALOSPORINS
Gram-positive cocci
Staphylococcus aureus* (MRSA) Gram-positive rods
Gram-negative cocci
Spirochetes
A N T I B I O T I C T A B L E
CEPHALOSPORINS
Gram-positive cocci
Staphylococcus aureus* (MRSA) Gram-positive rods
Gram-negative cocci
Spirochetes
A N T I B I O T I C T A B L E
Gram-positive cocci
Staphylococcus aureus* (MRSA) Gram-positive rods
Gram-negative cocci
Spirochetes
A N T I B I O T I C T A B L E
P E N I C I L L I N S
CEPHALOSPORINS
Spirochetes
Atypical organisms
Gram-negative coccobacillary
Gram-negative rods
A N T I B I O T I C T A B L E
CEPHALOSPORINS
Spirochetes
Atypical organisms
Gram-negative coccobacillary
Gram-negative rods
A N T I B I O T I C T A B L E
Spirochetes
Atypical organisms
Gram-negative coccobacillary
Gram-negative rods
P E N I C I L L I N S
CEPHALOSPORINS
A N T I B I O T I C T A B L E
Gram-negative rods
R E F E R E N C E S
Mandell GL, Bennett JE, Dolin R. (eds.). Mandell, Douglas and Bennett’s Principles TAP pharmaceuticals. Spectracef (cefdinir) package insert. Lake Forest, IL: August 2001.
and Practices of Infectious Diseases, 6th Edition. New York, NY: Churchill Livingstone Inc; 2004.
Centers for Disease Control and Prevention. Public Health Emergency Preparedness & The choice of antibacterial drugs. Med Lett Drugs Ther 2001; 43:69-78.
Response. 2005 April [cited 2005 April 11]. Available from URL: http://www.bt.cdc.gov/.
Benson KK, Raddatz JK, Rotschafer JC. Stenotrophomonas maltophilia: A clinical perspective. 13. Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug Information Handbook. J Infect Dis Pharmacother 1996;2:1-14.
13th Edition. Hudson, Ohio:Lexi-Comp, Inc.; 2005.
Fish DN, Singletary TJ. Meropenem, a new carbapenem antibiotic. Pharmacotherapy 14. Edwards JR. Meropenem: a Microbiological Review. Journal of Antimicrobial Chemotherapy Finegold SM, Wexler HM. Present status of therapy for anaerobic infections. Clin Infect Dis 15. Wiseman LR, Wagstaff AJ, Brogden RN, Bryson HM. Meropenem: A Review ofIts Antibacterial Activity, Pharmacokinetic Properties, and Clinical Efficacy. Drugs 1995; Gilbert DN, Moellering RC, Sande MA. The Sanford Guide to Antimicrobial Therapy. 35th Edition. Hyde Park, VT: Antimicrobial Therapy, Inc.; 2005.
16. Kayacan SM, Turkmen A, Alis H, et al. Successful Therapy Combined with Surgery for Nightingale CH. Moxifloxacin, a new antibiotic designed to treat community-acquired Severe Post-Transplant Nocardiosis. Journal Nephrol 2001; 14:304-306.
respiratory tract infections: A review of microbiologic and pharmacokinetic-pharmacodynamic 17. Eliopoulos GM. Quinupristin/dalforpristin and linezolid: Evidence and opinion. Clinical characteristics. Pharmacotherapy 2000;20:245-256.
Infectious Diseases 2003; 36:473-481.
Perry CM, Barman Balfour JA, Lamb HM. Gatifloxacin. Drugs 1999;58:683-696.
Lowemn, Lamb HM. Gemifloxacin. Drugs 2000; 59:1137-1147.
Jones RN, Biedenbach DJ, Croco MA, et al. In vitro evaluation of a novel orally administered Curran MP, Simpson D, Perry CM. Ertapenam: A review in its use in the management cephalosporin (cefditoren) tested against 1249 recent clinical isolates of Haemophilus of bacterial infections. Drugs 2003; 63:1855-78.
influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Diagn Microbiol Tedesco KL, Ryback MJ. Daptomycin. Pharmacotherapy. 2004; 24:41-57 Preston SL, Drusano Gl. Telithromycin: A once-daily, broad-spectrum ketolide for treatment of various respiratory infections. Formulary 2001;36:101-110.
Gram-negative rods
COMMON PATHOGENS BY DISEASE
MENINGITIS/BRAIN TISSUE
ENDOCARDITIS/
BLOODSTREAM
UPPER RESPIRATORY TRACT
HOSPITAL-ACQUIRED
LUNG INFECTION
LIVER/PANCREAS
LOWER RESPIRATORY TRACT
Gram-negative rods
COMMON PATHOGENS BY DISEASE
BONE/JOINTS
URINARY TRACT
SKIN/SOFT TISSUE
PELVIC INFLAMMATORY
INTRA-ABDOMINAL

Source: http://www.zubnistranky.cz/atb.pdf

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