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 toconsult 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
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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
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