The Antimicrobial Pocket Book

268 Pages·1991·5.79 MB·English

by  Gerald P. Bodey

The
Antimicrobial
Pocket Book
G.P. Bodey
D. Milatovic
I. Braveny
This issue has been made possible
by a grant from Bayer AG, Germany
The
Antimicrobial
Pocket Book
G.P. Bodey
D. Milatovic
I. Braveny
Gerald P. Bodey
Department of Medical Speciallies
Section of lnfectious Oiseases
M.D. Anderson Cancer Center
The University of Texas
Houston, U.S.A.
Danica Milatovic
Oepartment of Medical Microbiology
University Hospital (TU)
Klinikum r. d. lsar
Munich. Germany
llja Braveny
Department of Medical Microbiology
University Hospital (TU)
Klinikum r. d. lsar
Munich, Germany
All rights reserved
©Springer Fachmedien Wiesbaden 1991
Originally published by Friedr. Vieweg & Sohn Verlagsgesellschaft mbH,
Braunschweig/Weisbaden in 1991
Vieweg is a subsidiary company of the
Bertelsmann Publishing Group International.
No part of this publication may be repro
duced. stored in a retrieval system or
transmitted. mechanical, photocopying or
othervvise, without prior permission of
the copyright holder.
Typeset in the Federal Republic of Germany by Vornehm, Munich
ISBN 978-3-663-05257-9 ISBN 978-3-663-05255-5 (eBook)
DOI 10.1007/978-3-663-05255-5
Table of Contents
Page
Guidelines for antibiotic use .
Microscopical examination 8
Antimicrobial agents
List of generic names 14
List of trade names 16
Classification of antimicrobial agents ... 20
Characterization of the antimicrobial agents:
Antibacterial agents 24
Antimycotics 104
Tuberculostatics ......................................................................... 114
Virustatics 125
Empiric therapy of organ system infections 133
Agents against specific bacterial pathogens 162
Specific infections 167
Antibiotic prophylaxis in surgery 226
Endocarditis prophylaxis 230
Antibiotic use during pregnancy 232
Drug monitoring 234
Vaccination and prophylaxis for travelers 236
Regulations for international travel 240
Specimen collection 249
Classification of bacterial pathogens 253
Index . 263
List of abbreviations 270
5
G ie 1PS 1r An 1b11Jt1r Us
1. Suitable bacteriological samples must be obtained before starting antibiotic
treatment, e. g. several blood cultures for suspected sepsis, pneumonia or
osteomyelitis.
2. Except in immunocompromised patients fever alone without further signs of
infection is no indication for antibiotic therapy (antibiotics are not
antipyretics!).
3. Antibiotic therapy should not be prolonged unnecessarily. In many cases
antibiotics can be discontinued three days after defervescence.
4. The following possibilities must be considered if the patient has failed to
respond to antibiotic therapy after two to three days of treatment:
-causative pathogen is resistant to the antimicrobial agent
- insufficient tissue penetration at the site of infection
-antibiotic is ineffective in vivo despite in vitro sensitivity of the pathogen
-abscess, foreign body related infection, impaired immunity
-non-bacterial etiology (drug fever. viral infection, etc.)
5. The initial empiric treatment (usually combination therapy) aims to cover nearly
all potential pathogens and is generally expensive. Less expensive
alternatives which are often even more efficacious should be chosen as soon
as the results of susceptibility testing are available.
6. Topical antibiotics are hardly ever indicated (except in skin and eye infections).
7. When choosing an antibiotic economical aspects should also be considered.
Older. equally efficacious drugs are often much more cost-effective. Expensive
antibiotics should only be applied when strictly indicated.
8. Perioperative prophylaxis should not be prolonged unnecessarily' Usually a
single preoperative dose is sufficient.
9. Drug monitoring is recommended for antibiotics with a narrow therapeutic
range (aminoglycosides, vancomycin) in order to minimize toxicity especially in
patients with impaired renal function (see page 234).
10. Allergic predispositions must be excluded before beginning antimicrobial
chemotherapy.
11. Combination therapy is indicated:
-in polymicrobial infections
-for empiric treatment
-in order to reduce development of resistance of certain species (e. g.
Pseudomonas, Serratia, M. tuberculosis)
6
-in order to take advantage of synergistic effects (e.g. for treatment of
endocarditis or in immunocompromised patients).
12. The antibiotic regimen should be chosen and adjusted individually with regard
to the patient's age, immune status, metabolic condition, nutritional state,
water and electrolyte balance, renal and hepatic function, etc.
13. Selection of an adequate antibiotic agent must also take into consideration the
conditions at the site of infection as for example pH, aerobic/anaerobic milieu
(e. g. aminoglycosides are ineffective at a low pH or under anaerobic
conditions). tissue penetration of the drug, etc.
14. When choosing antibiotics for empiric treatment differentiation between
hospital acquired and communitiy acquired infections is important because of
the different microbial spectrum that needs to be covered.
15. Interactions with other drugs should be taken into account.
7
Microscopic examination of clinical material may be a useful adjunct in certain
clinical situations, particularly for the initial choice of the antibiotic regimen. Unfor
tunately it is too seldom applied. The characteristic appearance of certain bacterial
species in stained smears may allow a presumptive diagnosis.
1. Using a sterile loop or swab smear the material onto a clean glass slide. Dilute
viscous material with a drop of saline.
2. Allow to air-dry completely.
3. Heat-or alcohol-fix the preparation. Heat fixation: pass the slide with the
coated side upwards several times through the flame. Alcohol fixation: flood the
slide with methanol 3 minutes.
Methylene blue stain
1. Flood with methylene blue approximately 2 minutes
2. Rinse with tap water
3. Blot with absorbent paper
Gram stain
1. Flood with crystal violet or carbol-gentian violet and pour off after approximately
1 minute
2. Flood with Gram's iodine and pour off after approximately 1 minute (do not rinse
with water)
3. Decolorize with ethanol-acetone (96% ethanol with 3% acetone) until any
coloration is released
4. Rinse thoroughly with water
5. Counterstain with safranin or carbol-fuchsin for 15-30 seconds
6. Rinse with tap water and blot with absorbent paper
Examine the stained preparation without a cover slip using x 1000 magnification
(x 10 eyepiece, x 100 oil immersion lense). Elevate the condenser and open the
diaphragm completely.
Methylene blue stained smears
Bacteria will stain deep blue and any cellular elements will appear light blue. This
simple staining method is particularly useful in assessing the location of bacteria in
relation to cellular elements (e.g. intracellular microorganisms). above all for
demonstration of intracellular gonococci.
Gram stained smears
Gram-positive bacteria will appear dark blue or purple while gram-negative
bacteria will stain light or deep red. The Gram's stain is useful in differentiation
and identification of bacterial species and can be helpful in initial choice of
antibiotic for the treatment (e.g. CSF and other body fluid preparation).
8
Fig. 1
Streptococcus
pneumoniae in CSF.
Intra-and
extra leukocytic gram
positive diplococci
(pneumococcal
meningitis).
Fig. 2
Neisseria meningitidis in
CSF. Intra-and
extra leukocytic gram
negative diplococci
(meningococcal
meningitis).
Fig 3
Haemophilus influenzae
in CSF. Slender gram
negative rods and
granulocytes
(Haemophilus
meningitis)