Antimicrobial therapy

242 Pages·2011·0.95 MB·English

Handbook of
Antimicrobial
Therapy
Selected Articles fromTreatment Guidelines
with updates fromThe Medical Letter®
Published by
The Medical Letter, Inc.
145 Huguenot St.
New Rochelle, New York 10801-7537
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www.medicalletter.org
19th Edition
Contents
Summary................................................................................................. 1
Pathogens in Specific Organs and Tissues........................................... 27
Bacterial Infections................................................................................ 39
Ceftaroline Fosamil (Teflaro)........................................................... 84
Treatment of Clostridium Difficile Infection................................... 89
Drugs for MRSA with Reduced Susceptibility to Vancomycin...... 94
Copyright 2011
Vancomycin Dosing and Monitoring............................................... 96
(ISSN 0190-3454)
(ISBN 978-0-9815278-2-6) Tuberculosis........................................................................................ 99
The Medical Letter Inc. Antimicrobial Prophylaxis for Surgery........................................... 119
145 Huguenot St., Ste 312 Why Not Ertapenem for Surgical Prophylaxis?.............................. 135
New Rochelle, New York 10801-7537 Recommendation for Earlier Antibiotic Prophylaxis for
Cesarean Delivery.......................................................................... 136
Fungal Infections.................................................................................... 137
Miconazole (Oravig)for Oropharyngeal Candidiasis..................... 157
No part of the material may be reproduced or transmitted by any process in HIV Infection.......................................................................................... 161
whole or in part without prior permission in writing. The editors and pub- Viral Infections (Non-HIV)................................................................... 191
lisher do not warrant that all the material in this publication is accurate and
Parasitic Infections................................................................................. 221
complete in every respect. The editors and publisher shall not be held respon-
Sexually Transmitted Infections........................................................... 279
sible for any damage resulting from any error, inaccuracy or omission.
Immunization (Adult)............................................................................ 301
Permissions: To reproduce any portion of this handbook, please e-mail your Cervarix— A Second HPV Vaccine................................................... 327
request to [email protected] Pneumococcal Vaccination of Adults: Polysaccharide or Conjugate?... 330
Advice for Travelers............................................................................... 333
Adverse Effects of Antimicrobial Drugs................................................ 365
Pregnancy, Safety in............................................................................... 381
Dosage of Antimicrobial Drugs............................................................... 397
Trade Names........................................................................................... 429
Index........................................................................................................ 453
Table Index.......................................................................................... 476
EDITOR IN CHIEF: Mark Abramowicz, M.D.
EXECUTIVE EDITOR: Gianna Zuccotti, M.D., M.P.H., F.A.C.P., Introduction
Harvard Medical School
EDITOR: Jean-Marie Pflomm, Pharm.D.
ASSISTANT EDITORS, DRUG INFORMATION: Susan M. Daron, Pharm.D.,
The Medical Letter, Inc. is a nonprofit company founded in 1958 by
Blaine M. Houst, Pharm.D., Corinne E. Zanone, Pharm.D.
Arthur Kallet, the co-founder of Consumers Union, and Dr. Harold
CONSULTING EDITOR: Brinda M. Shah, Pharm.D.
Aaron, with the goal of providing healthcare professionals with objective,
CONTRIBUTING EDITORS: independent analyses of both prescription and over-the-counter drugs.
Carl W. Bazil, M.D., Ph.D., Columbia University College of Physicians and Surgeons In addition to its newsletters, The Medical Letter on Drugs and
Vanessa K. Dalton, M.D., M.P.H., University of Michigan Medical School Therapeutics and Treatment Guidelines from The Medical Letter, the
Eric J. Epstein, M.D., Albert Einstein College of Medicine company also publishes handbooks and software on topics such as
Jules Hirsch, M.D., Rockefeller University antimicrobial therapy and adverse drug interactions. It is supported solely
David N. Juurlink, BPhm, M.D., PhD, Sunnybrook Health Sciences Centre by subscription fees and accepts no advertising, grants or donations.
Richard B. Kim, M.D., University of Western Ontario
Hans Meinertz, M.D., University Hospital, Copenhagen The Medical Letter on Drugs and Therapeutics offers comprehensive
Sandip K. Mukherjee, M.D., F.A.C.C., Yale School of Medicine drug evaluations of virtually all new drugs and reviews of older drugs
Dan M. Roden, M.D., Vanderbilt University School of Medicine when important new information becomes available on their usefulness
F. Estelle R. Simons, M.D., University of Manitoba or adverse effects. Occasionally, The Medical Letterpublishes an article
Jordan W. Smoller, M.D., Sc.D., Harvard Medical School on a new non-drug treatment or a diagnostic aid. Treatment Guidelines
Neal H. Steigbigel, M.D., New York University School of Medicine from The Medical Letterconsists of review articles of drug classes for
Arthur M. F. Yee, M.D., Ph.D., F.A.C.R., Weil Medical College of Cornell University treatment of major indications. A typical issue contains recommenda-
tions for first choice and alternative drugs with assessments of the drugs’
SENIOR ASSOCIATE EDITORS: Donna Goodstein, Amy Faucard effectiveness and safety. The Medical Letter is published every other
ASSOCIATE EDITOR: Cynthia Macapagal Covey week and Treatment Guidelines is published once a month. Both are
EDITORIAL FELLOW: Esperance A. K. Schaefer, M.D., M.P.H.,
intended to meet the needs of the busy healthcare professional who
Massachusetts General Hospital, Harvard Medical School
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MANAGING EDITOR: Susie Wong
publications help healthcare professionals make decisions based on the
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best interests of their patients, rather than the commercial interests of the
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Antibacterial Drugs: A Brief Summary for Quick Reference
The editorial process used for Medical Letter publications relies on a con- ANTIBACTERIAL DRUGS:
sensus of experts to develop prescribing recommendations. An expert con- A BRIEF SUMMARY FOR QUICK REFERENCE
sultant, one of our editors or a contributing editor prepares the preliminary
report on a drug (for The Medical Letter) or drugs for common disorders AMINOGLYCOSIDES — Aminoglycosides are effective against
(for Treatment Guidelines) in terms of their effectiveness, adverse many gram-negative bacteria and mycobacteria. They may be ototoxic
effects and possible alternatives. Both published and available unpub- and nephrotoxic, especially in patients with diminished renal function.
lished studies are carefully examined, paying special attention to the They are often used together with penicillin or ampicillin in treatment of
results of controlled clinical trials. The preliminary draft is edited and enterococcal endocarditis in order to achieve synergy. They are some-
sent to our contributing editors, to 10-20 other reviewers who have clin- times used empirically in septic patients or in those with serious gram-
ical and experimental experience with the drug or type of drug or dis- negative pneumonia together with ß-lactam antibiotics. When there is
ease under review, to the FDA and CDC, and to the first authors of all resistance to other safer antibiotics they are sometimes used to treat uri-
the articles cited in the text. nary tract infections.
Amikacin (Amikin, and others)—Amikacin is often effective for
treatment of infections caused by gram-negative strains resistant to gen-
Many critical observations, suggestions and questions are received from
tamicin and tobramycin, including some strains of Pseudomonas aerugi-
the reviewers and are incorporated into the article during the revision
nosa and Acinetobacter. It is generally reserved for treatment of serious
process. Further communication as needed is followed by checking and
infections caused by amikacin-susceptible gram-negative bacteria
editing to make sure the final appraisal is not only accurate, but also
known or suspected to be resistant to the other aminoglycosides. Like
easy to read.
other aminoglycosides, its distribution to the lungs is limited and when
used to treat gram-negative bacilli that cause pneumonia it should be
combined with another agent to which the organism is susceptible, such
The Medical Letter, Inc., is based in New Rochelle, NY. For more infor-
as a ß-lactam. It has also been used concurrently with other drugs for
mation go to www.medicalletter.org or call [phone].
treatment of some mycobacterial infections.
Gentamicin (Garamycin, and others) — Gentamicin is useful for
treatment of many hospital-acquired infections caused by gram-negative
bacteria. Strains of gram-negative bacilli resistant to gentamicin are
often susceptible to amikacin or to one of the third-generation
cephalosporins, cefepime, or imipenem or meropenem. Gentamicin is
also used with penicillin G, ampicillin or vancomycin for treatment of
endocarditis caused by susceptible enterococci.
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Antibacterial Drugs: A Brief Summary for Quick Reference Antibacterial Drugs: A Brief Summary for Quick Reference
Kanamycin (Kantrex, and others) — Active against some gram- AMPICILLIN(Principen, and others) — See Penicillins
negative bacilli (except Pseudomonas or anaerobes), but most centers
now use gentamicin, tobramycin or amikacin instead. Kanamycin can be AMPICILLIN /SULBACTAM(Unasyn, and others)— See Penicillins
useful concurrently with other drugs for treatment of tuberculosis.
AZITHROMYCIN (Zithromax, and others)— See Macrolides
Neomycin— A drug that can cause severe damage to hearing and
renal function and has the same antibacterial spectrum as kanamycin.
AZTREONAM (Azactam, and others)— A parenteral monobactam (ß-
Parenteral formulations have no rationale for use because of their toxic-
lactam) antibiotic active against most aerobic gram-negative bacilli,
ity. Deafness has also followed topical use over large areas of skin, injec-
including Pseudomonas aeruginosa, but not against gram-positive
tion into cavities such as joints, and oral administration, especially in
organisms or anaerobes. Aztreonam has little cross-allergenicity with
patients with renal insufficiency.
penicillins and cephalosporins. Aztreonam is also available in a solution
for inhalation (Cayston)for use in patients with cystic fibrosis who are
Streptomycin — Streptomycin has been displaced by gentamicin
colonized with Pseudomonas aeruginosa.
for treatment of gram-negative infections, but it is still sometimes used
concurrently with other drugs for treatment of tuberculosis, tularemia
BACITRACIN — A nephrotoxic drug used in the past to treat severe
and plague and is occasionally used with penicillin, ampicillin or van-
systemic infections caused by staphylococci resistant to penicillin G. Its
comycin to treat enterococcal endocarditis.
use is now restricted mainly to topical application.
Tobramycin (Nebcin, and others) — Similar to gentamicin but
with greater activity in vitro against Pseudomonas aeruginosa and less CAPREOMYCIN (Capastat) — A second-line antituberculosis drug.
activity against Serratia. In clinical use, it is not certain that it is signifi-
cantly less nephrotoxic than gentamicin. CARBAPENEMS — There has been an emergence of gram-negative
bacteria, especially in hospitalized patients that can produce carbapene-
AMINOSALICYLIC ACID (PAS) — Used in antituberculosis regi- mase enzymes enabling them to be resistant to the carbapenems, peni-
mens for many years, its distressing gastrointestinal effects caused many cillins and cephalosporins.
patients to stop taking it prematurely. An enteric-coated oral formulation
(Paser) is more tolerable, and is used occasionally in combination with Imipenem/Cilastatin (Primaxin) — The first carbapenem,
other drugs in treating tuberculosis due to organisms resistant to first- imipenem, has an especially broad antibacterial spectrum. Cilastatin
line drugs. sodium inhibits renal tubular metabolism of imipenem. This combina-
tion may be especially useful for treatment of serious infections in which
AMOXICILLIN(Amoxil, and others) — See Penicillins aerobic gram-negative bacilli, anaerobes, and Staphylococcus aureus
(but not methicillin-resistant strains) might all be involved. It is active
AMOXICILLIN/CLAVULANIC ACID (Augmentin, and others) — against many gram-negative bacilli that are resistant to third- and fourth-
See Penicillins generation cephalosporins, aztreonam and aminoglycosides. Resistance
2 3
Antibacterial Drugs: A Brief Summary for Quick Reference Antibacterial Drugs: A Brief Summary for Quick Reference
to imipenem in Pseudomonas aeruginosa occasionally develops during tially fatal immune-mediated hemolysis has been reported, particularly
therapy. It has been rarely associated with seizures particularly with high with ceftriaxone and cefotetan.
doses in elderly patients.
The cephalosporins can be classified into four ‘‘generations’’based on
Meropenem (Merrem, and others)—A carbapenem for parenteral their activity against gram-negative organisms. All first-generation drugs
use similar to imipenem/cilastatin. It may have less potential than have a similar spectrum, including many gram-positive cocci (but not
imipenem for causing seizures. enterococci or methicillin-resistant Staphylococcus aureus), Escherichia
coli, Klebsiella pneumoniae and Proteus mirabilis. Among the first-
Doripenem (Doribax) — Doripenem has a spectrum of activity generation parenteral cephalosporins, cefazolin (Ancef, and others) is
similar to imipenem/cilastatin. In vitro, it is more active than imipenem less painful on intramuscular injection than cephapirin (Cefadyl; no
and meropenem against Pseudomonas aeruginosaand is active against longer available in the US). The first-generation parenteral
some pseudomonal isolates resistant to the other carbapenems; the clini- cephalosporins are usually given intravenously, and cefazolin is most
cal significance of this in vitro activity is unknown. It may have less frequently used because of its longer half-life.
potential than imipenem for causing seizures.
The second-generation cephalosporins have broader in vitro activity
Ertapenem (Invanz) — Ertapenem has a longer half-life, but nar- against gram-negative bacteria. Cefamandole (Mandol; no longer avail-
rower antibacterial spectrum than imipenem, meropenem and doripenem. able in the US)has increased activity against Haemophilus influenzae and
It is more active against some extended-spectrum ß-lactamase-producing some gram-negative bacilli, but is occasionally associated with prothrom-
gram-negative bacilli, but less active against gram-positive cocci, bin deficiency and bleeding. Cefoxitin (Mefoxin, and others) has
Pseudomonas aeruginosa and Acinetobacter spp. For empiric treatment improved activity against Bacteroides fragilis, Neisseria gonorrhoeae
of intra-abdominal, pelvic and urinary tract infections and community- and some aerobic gram-negative bacilli. Cefotetan (Cefotan, and others)
acquired pneumonia, it offers no advantage over older drugs other than has a spectrum of activity similar to that of cefoxitin; it has a side chain
once-daily dosing. that has rarely been associated with prothrombin deficiency and bleeding.
Cefuroxime (Zinacef, and others), another second-generation
CARBENICILLIN — See Penicillins cephalosporin, has a spectrum of activity similar to cefamandole.
Cefuroxime and cefamandole are less active than third-generation
CEPHALOSPORINS — All cephalosporins except ceftazidime have cephalosporins against penicillin-resistant strains of Streptococcus pneu-
good activity against most gram-positive cocci, and all cephalosporins are moniae. Cefonicid (Monocid; no longer available in the US)has a longer
active against many strains of gram-negative bacilli. All currently FDA- half-life than the other second-generation cephalosporins, but is less
approved cephalosporins are inactive against enterococci and all but cef- active against gram-positive organisms and less active than cefoxitin
taroline are not active against methicillin-resistant staphylococci. These against anaerobes.
drugs are often prescribed for patients allergic to penicillin, but such
patients may also have allergic reactions to cephalosporins. Rare, poten- The third-generation cephalosporins, cefotaxime (Claforan, and others),
cefoperazone (Cefobid; no longer available in the US), ceftizoxime
4 5
Antibacterial Drugs: A Brief Summary for Quick Reference Antibacterial Drugs: A Brief Summary for Quick Reference
(Cefizox; no longer available in the US), ceftriaxone (Rocephin, and oth- against them. Gram-negative bacilli that produce carbapenemase
ers) and ceftazidime (Fortaz, and others), and the fourth-generation enzymes are resistant to all cephalosporins. Cefotaxime and ceftriaxone
cephalosporin, cefepime (Maxipime, and others), are more active than the are often used for treatment of meningitis. Ceftriaxone has been widely
second-generation cephalosporins against enteric gram-negative bacilli, used for single-dose treatment of gonorrhea, but resistance to it has
including nosocomially acquired strains resistant to multiple antibiotics. increased.
These agents are highly active against Haemophilus influenzae and
Neisseria gonorrhoeae, including penicillinase-producing strains. Except Cephalexin (Keflex, and others), cephradine (Velosef; no longer
for ceftazidime, they are moderately active against anaerobes, but often available in the US), and cefadroxil (Duricef, and others) are well-absorbed
less so than metronidazole, chloramphenicol, clindamycin, cefoxitin, oral cephalosporins with first-generation antimicrobial activity; cephradine
cefotetan, ampicillin/sulbactram, piperacillin/tazobactam, ticarcillin/ is also available for parenteral use. Cefaclor (Ceclor, Raniclor, and others),
clavulanic acid, or carbapenems. Ceftazidime has poor activity against cefuroxime axetil (Ceftin, and others), cefprozil (Cefzil, and others)and
gram-positive organisms and anaerobes. Cefotaxime, ceftizoxime, ceftri- loracarbef (Lorabid; no longer available in the US)are oral second-gener-
axone and cefepime are the most active in vitro against gram-positive ation agents with increased activity against Haemophilus influenzae and
organisms, but ceftizoxime has poor activity against Streptococcus pneu- Moraxella catarrhalis. Cefixime (Suprax), an oral cephalosporin with
moniae that are intermediate or highly resistant to penicillin. activity against gram-positive organisms similar to that of first-generation
Cefoperazone, which can cause bleeding, is less active than other third- cephalosporins except for its poor activity against staphylococci; against
generation cephalosporins against many gram-negative bacilli, but more gram-negative bacteria, it has greater activity than second-generation
active than cefotaxime, ceftizoxime or ceftriaxone against Pseudomonas cephalosporins. It is useful for single-dose oral treatment of gonorrhea.
aeruginosa. Ceftazidime and cefepime have the greatest activity among Cefpodoxime proxetil (Vantin, and others), cefdinir (Omnicef, and others)
the cephalosporins against Pseudomonas aeruginosa. Cefepime has and cefditoren pivoxil (Spectracef) are oral cephalosporins similar to
somewhat greater activity against enteric gram-negative bacilli than the cefixime, but with greater activity against methicillin-susceptible staphylo-
third-generation cephalosporins. The third-generation cephalosporins and cocci. Ceftibuten (Cedax) is an oral cephalosporin similar to cefixime in its
cefepime are expensive, but are useful for treatment of serious hospital- gram-negative activity and poor activity against staphylococci, but it has
associated gram-negative infections when used alone or in combination only inconsistent activity against Streptococcus pneumoniae.
with aminoglycosides such as gentamicin, tobramycin or amikacin.
Gram-negative bacteria that produce “broad spectrum” ß-lactamases are Ceftaroline (Teflaro) is an intravenous cephalosporin FDA-
resistant to first-generation cephalosporins, but are usually sensitive to approved in 2010. It is similar to ceftriaxone in its gram-negative activ-
second and third generation cephalosporins. However, gram-negative ity, but its gram-positive activity is better than that of ceftriaxone and
bacilli that produce “extended spectrum ß-lactamases”, particularly some includes methicillin-resistant Staphylococcus aureus. It has some anero-
Klebsiella strains and those that produce chromosomally-encoded ß-lac- bic activity, but not against Bacteroides.
tamases, are usually resistant to first, second and third-generation
cephalosporins. These organisms are often hospital-associated. Cefipime Ceftobiprole is an investigational broad-spectrum parenterally
may be more active than the third-generation cephalosporin against these administrated cephalosporin with activity against MRSA. It may soon
strains, but imipenem and meropenem are most consistently active become available.
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Antibacterial Drugs: A Brief Summary for Quick Reference Antibacterial Drugs: A Brief Summary for Quick Reference
CHLORAMPHENICOL (Chloromycetin, and others) — An effective COLISTIMETHATE (Coly-Mycin M, and others)— See Polymyxins
drug for treatment of meningitis, epiglottitis, or other serious infections
caused by Haemophilus influenzae, severe infections with Salmonella CYCLOSERINE (Seromycin)— A second-line antituberculosis drug.
typhi, for some severe infections caused by Bacteroides (especially those
in the central nervous system), and for treatment of vancomycin-resistant DAPTOMYCIN (Cubicin) — A cyclic lipopeptide antibiotic that is
Enterococcus. Chloramphenicol is often an effective alternative for treat- effective for treating complicated skin and soft tissue infections and
ment of pneumococcal or meningococcal meningitis in patients allergic methicillin-sensitive and methicillin-resistant S. aureus bacteremia,
to penicillin, but some strains of Streptococcus pneumoniae are resistant including right-sided endocarditis. It is rapidly bactericidal against
to it. Because it can cause fatal blood dyscrasias, chloramphenicol gram-positive bacteria by causing membrane depolarization. Its anti-
should be used only for serious infections caused by susceptible bacteria bacterial activity includes methicillin-sensitive and -resistant, and van-
that cannot be treated effectively with less toxic agents. comycin-sensitive and -resistant S. aureus and coagulase-negative
staphylococci, streptococci and vancomycin-sensitive and -resistant
CINOXACIN (Cinobac, and others) — See Quinolones enterococci. Rarely, S. aureus strains with decreased susceptibility to
daptomycin have emerged during treatment of S. aureus endocarditis
CIPROFLOXACIN (Cipro, and others)— See Fluoroquinolones with daptomycin. Some strains of S. aureus that have emerged with
reduced susceptibility to vancomycin during treament with vancomycin,
CLARITHROMYCIN (Biaxin, and others)— See Macrolides have shown reduced susceptibility to daptomycin. It is administered
intravenously once daily and is excreted unchanged in urine; dose
CLINDAMYCIN (Cleocin, and others) — A derivative of lincomycin adjustments are required when given to individuals with severe renal
with a similar antibacterial spectrum, clindamycin can cause severe diar- insufficiency. Adverse effects include the potential for skeletal muscle
rhea and pseudomembranous colitis caused by Clostidiumdifficile. It is damage, with rare reversible CPK elevations. More severe muscle
one of the alternative drugs for anaerobic infections outside the central effects, which were seen in preclinical studies, do not seem to occur with
nervous system, and can also be used as an alternative for treatment of the currently approved doses; higher doses may increase the potential for
some staphylococcal infections in patients allergic to penicillins. Strains rhabdomyolysis. Daptomycin should not be used to treat pneumonia
of S. aureusthat are sensitive to clindamycin, but resistant to erythromy- because it is inactivated by surfactant.
cin become rapidly resistant to clindamycin when it is used.
Clindamycin is also used concurrently with other drugs to treat DEMECLOCYCLINE (Declomycin, and others)— See Tetracyclines
Pneumocystis carinii pneumonia and toxoplasmosis. Clindamycin may
be beneficial in treatment of necrotizing fasciitis due to Group A strepto- DICLOXACILLIN (Dycill, and others) — See Penicillinase-resistant
coccus but, because of the possibility of resistance to clindamycin, it Penicillins
should be used in combination with penicillin G.
DORIPENEM(Doribax)— See Carbapenems
CLOFAZIMINE (Lamprene) — An oral agent used with other drugs
for treatment of leprosy. DOXYCYCLINE (Vibramycin, and others) — See Tetracyclines
8 9
Antibacterial Drugs: A Brief Summary for Quick Reference Antibacterial Drugs: A Brief Summary for Quick Reference
ERTAPENEM (Invanz) — See Carbapenems tions caused by enteric gram-negative bacilli or Pseudomonas aerugi-
nosa. Oral ciprofloxacin has been effective in treating patients with neu-
ERYTHROMYCIN (Erythrocin, and others) — See Macrolides tropenia and fever who are at low risk for mortality. Ciprofloxacin is now
one of the preferred prophylactic agents for contacts of patients with
ERYTHROMYCIN-SULFISOXAZOLE (Pediazole, and others) — meningococcal disease. It is also used for prophylaxis after Bacillus
See Macrolides anthracis (Anthrax) exposure. Emergence of resistance in staphylococcal
and Pseudomonas strains and other gram-negative organisms is increas-
ETHIONAMIDE (Trecator) — A second-line antituberculosis drug. ingly encountered.
ETHAMBUTOL (Myambutol, and others)— Often used in antituber- Levofloxacin (Levaquin), moxifloxacin (Avelox) and gemifloxacin
culosis regimens, it can cause optic neuritis. (Factive) —More active than ciprofloxacin or ofloxacin against gram-
positive organisms, such as Streptococcus pneumoniae, including strains
FLUOROQUINOLONES —Fluoroquinolones are synthetic anti-bac- highly resistant to penicillin, and Staphylococcus aureus. Like other flu-
terial agents with activity against gram-positive and gram-negative oroquinolones, they are active against Legionella pneumophila,
organisms. With the increased use of fluoroquinolones, resistant organ- Chlamydia spp., Mycoplasma pneumoniae, Haemophilus influenzae and
isms have become more frequent, especially among strains of Moraxella catarrhalis. All are effective for many community-acquired
Staphylococcus aureus and Pseudomonas aeruginosa. Resistance respiratory infections. Levofloxacin and moxifloxacin are less active
among Streptococcus pneumoniae strains has begun to emerge but is still than ciprofloxacin in vitro against enteric gram-negative bacilli and
rare, especially in the US. None of these agents is recommended for use Pseudomonas aeruginosa, but have been effective in treating urinary tract
in children or pregnant women. All can cause gastrointestinal distur- infections and other systemic infections caused by these organisms.
bances and, less commonly central nervous system toxicity. Tendon Levofloxacin and moxifloxacin have been used to treat some methicillin-
effects and hypersensitivity reactions, including vasculitis, serum sick- sensitive and methicillin-resistant S. aureusinfections, although resistance
ness-like reactions and anaphylaxis, occur rarely. Hypo- and hyper- is increasing. Levofloxacin, moxifloxacin, ofloxacin or ciprofloxacin are
glycemia can also occur rarely. sometimes used as second-line anti-tuberculous drugs in combination with
other agents. Moxifloxacin has been used more frequently for treatment of
Ciprofloxacin (Cipro, and others)—Used for oral or intravenous tuberculosis than the other fluoroquinolones. Levofloxacin is more effec-
treatment of a wide variety of gram-positive and gram-negative bacterial tive for treatment of Legionella pneumophilathan azithromycin. The use
infections in adults, including those due to methicillin-susceptible and of fluoroquinolones has been associated with the recent increase in severe
resistant staphylococci, Haemophilus influenzae, Neisseria, enteric cases of C. difficile infection. Levofloxacin and moxifloxacin are available
pathogens and other aerobic gram-negative bacilli, and Pseudomonas for both oral and parenteral use. Gemifloxacin is only available for oral
aeruginosa, but not anaerobes. Newer fluoroquinolones such as lev- use. Levofloxacin and moxifloxacin have rarely been associated with tor-
ofloxacin, gemifloxacin and moxifloxacin are preferred for treatment of sades de pointes arrhythmia. Gemifloxacin has produced more rashes than
gram-positive coccal infections such as those caused by S. pneumoniae other fluoroquinolones.
and S. aureus. Ciprofloxacin is useful for treatment of urinary tract infec-
10 11
Antibacterial Drugs: A Brief Summary for Quick Reference Antibacterial Drugs: A Brief Summary for Quick Reference
Gatifloxacin — Gatifloxacin has been associated with hypergyl- ISONIAZID (Nydrazid, and others) — A major antituberculosis drug
cemia and hypoglycemia more often than the other fluoroquinolones and that can cause fatal hepatitis. Rifampin-isoniazid-pyrazinamide
it is no longer available for systemic use. (Rifater) and rifampin-isoniazid (Rifamate, and others)are fixed-dose
combinations for treatment of tuberculosis.
Norfloxacin (Noroxin) — An oral fluoroquinolone for treatment of
urinary tract infections due to Enterobacteriaceae, Enterococcus or KANAMYCIN (Kantrex, and others) — See Aminoglycosides
Pseudomonas aeruginosa.
LEVOFLOXACIN (Levaquin) — See Fluoroquinolones
Ofloxacin (Floxin, and others)— An oral and intravenous fluoro-
quinolone similar to ciprofloxacin, but less active against Pseudomonas.
LINCOMYCIN (Lincocin) — Similar to clindamycin in antibacterial
Ofloxacin can be used for single-dose treatment of gonorrhea and for
activity and adverse effects. Rarely indicated for treatment of any infec-
seven-day treatment of chlamydial infections. It is sometimes used as a
tion because it is less active than clindamycin.
second-line anti-tuberculous drug in combination with other agents.
LINEZOLID (Zyvox) — An oxazolidinone bacteriostatic antibiotic
FOSFOMYCIN (Monurol) —Can be used as a single-dose oral agent
available in both an oral and intravenous formulation. It is active against
with moderate effectiveness for treatment of uncomplicated urinary tract
Enterococcus faecium and E. faecalis including vancomycin-resistant
infections caused by many strains of enteric gram-negative bacilli, ente-
enterococcal infections. Linezolid is also active against methicillin-
rococci and some strains of Staphylococcus saphrophyticus, but gener-
resistant Staphylococcus aureus, S. epidermidis and penicillin-resistant
ally not Pseudomonas. It is much more expensive than trimethoprim/
Streptococcus pneumoniae. Reversible thrombocytopenia has occurred,
sulfamethoxazole.
especially with therapy for more than 2 weeks. Peripheral and optic neu-
ropathy may occur with long-term use. A serotonin syndrome has been
FURAZOLIDONE (Furoxone) — An oral nonabsorbable antimicrobial
observed in patients taking linezolid together with a selective serotonin
agent of the nitrofuran group that inhibits monoamine oxidase (MAO).
reuptake inhibitor. Emergence of resistance has been observed with ente-
The manufacturer recommends it for treatment of bacterial diarrhea. Its
rococcal and S. aureusstrains.
safety has been questioned (oral administration induces mammary
tumors in rats) and other more effective drugs are available. It is no
MACROLIDES— These antibiotics have anti-inflammatory activities
longer available in the US.
that may be clinically relevant as well as their anti-bacterial effects.
GATIFLOXACIN (Tequin) — See Fluoroquinolones (has been withdrawn)
Azithromycin (Zithromax, and others) — A macrolide antibiotic
GEMIFLOXACIN (Factive) — See Fluoroquinolones that has much less gastrointestinal toxicity than erythromycin and is not
associated with drug interactions with the CYP3A cytochrome P-450
GENTAMICIN (Garamycin, and others) — See Aminoglycosides enzyme systems. A single dose has been effective for treatment of ure-
thritis and cervicitis caused by Chlamydiaand for treatment of trachoma.
IMIPENEM/CILASTATIN (Primaxin) — See Carbapenems Azithromycin is useful in treating Mycoplasma pneumoniae, Chlamydia
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