Burke A Cunha MDab

AState University of New York School of Medicine, Stony Brook, NY, USA bInfectious Disease Division, Winthrop-University Hospital, Mineola, NY 11501, USA Antibiotics have been an important part of the therapeutic armamentarium against infectious diseases for decades. Although most practitioners have a penchant for using newer antimicrobials, some older antibiotics remain highly effective and underused. The side effects and drug interactions of older antibiotics are well known. Importantly,...

Box 1 Nitrofurantoin

Serum half-life (normal end-stage renal disease) 0.5 1 h Plasma protein binding 40 Volume of distribution (Vd) 0.8 L kg For urinary tract infections only, not systemic infection. Gastrointestinal upset minimal with microcrystalline preparations. No transplacental transfer. Chronic toxicities associated with prolonged use and renal insufficiency avoid in renal insufficiency if CrCl < 30 mL min. Gram-negative cystitis catheter-associated bacteriuria (CAB) (not due to Proteus spp or P...

Ch

Erythromycin, has a 15-membered ring structure as a result of the insertion of a methyl-substituted nitrogen atom between the C-9 and C-10 positions of erythromycin in addition, the ketone group at the C-9 position of erythromycin has been removed. The principal consequences of these changes are increased acid stability and a longer elimination half-life for azithromycin 1 . The ketolide antibiotic, telithromycin, is also depicted in Fig. 1. It has a 14-membered ring structure similar to...

Elsevier

0025-7125 06 - see front matter 2006 Elsevier Inc. All rights reserved. cellulitis. If, however, the patient's history suggests any other potential causative organisms, these should be treated as well. Classically, cellulitis involves erythema, warmth, tenderness, and swelling that is usually localized. Many patients present with symptoms as outpatients. These individuals may be managed in the outpatient setting as clinical judgment warrants. The decision to hospitalize patients should be based...

The hope of altering these gloomy prospects

For any hope to materialize, there is an absolute need for cooperation between health administrations, health care agencies, scientists, practicing physicians, the public, and the industry, particularly the agricultural and pharmaceutical industries. What medical science has to offer is summarized in the section on ''The Future of Antibiotic Therapy.'' Molecular genetics and drug modeling may help produce engineered drugs designed to inhibit new bacterial targets. Bacteria-carrying engineered...

S

Saccharomyces boulardii, for Clostridium difficile-associated diarrhea, 1150 Serious systemic infections, oral antibiotics for, 1197-1222 absorption in, 1198 advantages of, 1200-1201 bioavailability of, 1198 1209-1210, 1215 endocarditis, 1212-1214, 1216 febrile neutropenia, 1208, 1215 intravenous equivalence of, 1199 nosocomial pneumonia, 1210-1212, 1215 overview of, 1198-1200 requirements for, 1199 selection of, 1202-1207 switching from intravenous therapy to, 1199-1200 Staphylococcal...

Box 1 If and when we must use antibiotics

Have a working knowledge of the spectrum of pathogens involved in common infections and the spectrum of activity of commonly used antibiotics. Treat early and treat aggressively. In the absence of a microbiologic diagnosis, treat the most resistant of possible pathogens. This is particularly important in patients with serious, life-threatening infection. If and when the infection is microbiologically documented, use the most narrow-spectrum agent possible. Use combination antibiotic therapy...

For Helicobacter pylori

Jason Collins, MD, Amira Ali-Ibrahim, MD, Duane T. Smoot, MD, FACP, FACG* Gastroenterology Section, Department of Medicine, Howard University College of Medicine, Washington, DC 20059, USA Helicobacter pylori has been one of the most studied pathogens in recent times. Literature searches will yield nearly 22,000 results for studies and papers published on the subject. The excitement began in 1983, the year Drs. J.R. Warren and B. Marshall published their findings concerning an ''unidentified...

G

Ganciclovir, drug interactions with, 1247-1248 Gastric mucosa-associated lymphoid tissue lymphomas, Helicobacter pylori in, 1127 Gastroesophageal reflux disease, Helicobacter pylori in, 1127 Gastrointestinal flora, antibiotic-induced alterations of, 1229, 1232 for serious systemic infections, 1204, 1209-1210, 1215 for Streptococcus pneumoniae infections, 1171 drug interactions with, 1235 for Streptococcus pneumoniae infections, 1171 1235-1236 for endocarditis, 1188, 1190 for serious systemic...

Susceptibility testing and the clinical microbiology laboratory

Susceptibility testing remains one of the principal functions of the clinical microbiology laboratory. If the results of in vitro susceptibility testing did not correlate with in vivo clinical effectiveness, clinicians would have no use for this information. In fact, today the clinician considers the results of susceptibility testing as being of utmost importance in directing proper antimicrobial therapy, particularly in the current era of increasing resistance. Indeed, detection of resistance...

Tmpsmx

750 mg (PO) q24h Moxifloxacin 400 mg (PO) q24h 750 mg (PO) q24h Ciprofloxacin 750 mg (PO) ql2h 750 mg (PO) ql2h Ciprofloxacin 750 mg (PO) q24h 750 mg (PO) ql2h Moxifloxacin 400 mg (PO) q24h 500 mg (IV) q6h Ertapenem 1 g (IV) q24h MRSA antibiotics Vancomycin 1 g (IV) 12h Quinupristin dalfopristin 100 mg (IV) x 1 dose then 50 mg (IV) ql2h Antipseudomonal Penicillins Ticarcillin 100 mg (IV) x 1 dose then 50 mg (IV) ql2h MSSA, MRSA, VSE, VRE MSSA, MRSA, VRE MSSA, MRSA, VSE, VRE MSSA, MRSA, VSE, VRE

Info

A S. aureus (MSSA MRSA) pneumonia suggested by rapid cavitation (< 72 h on CXR), cyanosis, and MSSA MRSA bacteremia of lung origin. Abbreviations MRSA, methicillin-resistant S aureus MSSA, methicillin-sensitive S aureus. Adapted from Cunha BA. Antibiotic essentials. 5th edition. Royal Oak (MI) Physicians' Press 2006. a S. aureus (MSSA MRSA) pneumonia suggested by rapid cavitation (< 72 h on CXR), cyanosis, and MSSA MRSA bacteremia of lung origin. Abbreviations MRSA, methicillin-resistant S...

Gramnegative bacillary meningitis

* In adults with normal hepatic renal function, not intolerant allergic to the drug. Adapted from Cunha BA, editor. Antibiotic essentials. 5th edition. Royal Oak (MI) Physicians' Press 2006. in several important respects 1,81 . In contrast to tetracycline, doxycycline is highly active against S pneumoniae, including PRSP, Hemophilus influenzae, Moraxella catarrhalis, and Legionella. Doxycycline is effective monotherapy for community-acquired pneumonia 15,82-87 . It has good antistaphylococ-cal...

Charles W Stratton MD

Room 4525-TVC, 21st and Edgehill Road, Vanderbilt University School of Medicine Nashville, TN 37232, USA In vitro susceptibility testing is widely done and relied on for the antimicrobial therapy of infectious diseases. Yet the clinical relevance of such testing has been questioned partly because of the difficulty of correlating in vitro susceptibility testing with in vivo clinical effectiveness. It is useful to review this issue periodically and update the clinical relevance of susceptibility...

Hostpathogen factors that influence the effectiveness of antimicrobial therapy

There are many host pathogen factors that influence the effectiveness of antimicrobial therapy. Many of these factors are well known 7-7b , but some are worth reviewing in brief. The first and most important of these host pathogen factors is the host immune system 7-7b,8 . The immune system today is recognized as a complex collection of defenses that include the innate immune system and the adaptive immune system 8 . The innate immune system uses multiple families of pattern-recognition...

Emilio Bouza MD PhDa Almudena Burillo MD PhDb Patricia Muoz MD PhDa

ADepartment of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Mara n, Universidad Complutense, Dr. Esquerdo 46, 28007 Madrid, Spain bServicio de Microbiolog a Cl nica, Hospital de Madrid-Monteprincipe, Avda, Monteprincipe, 25, 28660 Madrid, Spain Clostridium difficile-associated diarrhea (CDAD) is the most common etiologically defined cause of hospital-acquired diarrhea. Caused by the toxins of certain strains of C difficile, CDAD represents a growing...

In case of the status quo prospects for the future

The antimicrobial resistance that emerged in the last century will continue into the current one. The number of multiresistant bacteria for which no effective antibiotics exist at this point will expand. Breeding grounds of resistance in communities, hospitals, nursing homes, and ultimately homes will make both the current and future treatment of infectious diseases ineffective. The patients in hospitals who cannot be treated will become reservoirs of resistant bacteria, leading to further...

Origin of resistance genes

At the time antibiotics were first introduced, the biochemical and molecular basis of resistance was not known. Bacteria collected between 1914 and 1950 (the Murray Collection) were found to be completely sensitive to antimicrobial agents, including sulfanamides that had been introduced in the mid-1930s 38 . However, they contained a large number of plasmids capable of conjugative transfer. Antimicrobial resistance was reported in the early 1940s in streptococci, gonococci, and staphylococci....

Intrinsic factors that influence the effectiveness of antimicrobial therapy

There are many factors that are intrinsic to the antimicrobial agents themselves that determine their therapeutic effectiveness 6 . The understanding of these factors continues to evolve in line with new scientific information and collectively can be viewed as the standards of antibacterial performance 26 . These factors include the effect of the agent on the microorganism, which is what most clinicians think of when considering the results of in vitro susceptibility testing. Actually, it is...

N

For serious systemic infections, 1204 Necrotizing pneumonitis, Staphylococcus aureus, 1079-1080 Neutropenic fever, 1186-1187, 1208, 1215 Nitazoxanide, for Clostridium difficile-associated diarrhea, 1146, 1148 for enterococcal infections, 1173 new uses for, 1092-1093 Nonsteroidal anti-inflammatory drugs, peptic ulcer disease due to, 1126-1127 Norfloxacin, drug interactions with, 1234 Clostridium difficile, 1141-1163 pneumonia, 1210-1212 Staphylococcus aureus, 1176-1178

David Schlossberg Md Facpab

ATemple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA hTuberculosis Control Program, Department of Health, 500 South Broad Street, Philadelphia, PA 19146, USA Sometimes antibiotics fail or appear to fail, and the clinician must determine the reasons for a suboptimal response. However, before concluding that an antibiotic has failed, it is important to remember that, even when antibiotics have their desired effect, the patient's response may not be...

Staphylococcus aureus Burke A Cunha MDab

AState University of New York School of Medicine, Stony Brook, NY, USA bInfectious Disease Division, Winthrop-University Hospital, Mineola, NY 11501, USA Antibiotic resistance is natural and intrinsic or it is acquired. Intrinsic or natural resistance refers to the inactivity of an antibiotic beyond its usual spectrum of activity (eg, clindamycin has no activity naturally and intrinsically against aerobic gram-negative bacilli). Acquired resistance is limited to relatively few gram-positive and...

References

1 Capasso L. 5300 years ago, the Ice Man used natural laxatives and antibiotics. Lancet 1998 352(9143) 1864. 2 Hoel D, Williams DN. Antibiotics past, present, and future. Unearthing nature's magic bullets. Postgrad Med 1997 101(1) 114-8, 121-2. 3 Alexander Fleming medicine's accidental hero. US News World Rep 1998 58-63. 4 Goldsworthy PD, McFarlane AC. Howard Florey, Alexander Fleming and the fairy tale of penicillin. Med J Aust 2002 176(4) 176-8. 5 Raper K. The penicillin saga remembered. ASM...

The rest is history awakening to the possibilities and confronting the challenges

Subsequently, more broad-spectrum penicillins and other aminoglyco-sides were developed, followed by more antibiotic classes. More than 5000 antibiotics are now known. Approximately a thousand of these have been carefully investigated, and about 100 are currently used to treat infections. Most are produced by actinomycetes and bacteria, many of which are then chemically modified (semisynthetic). Others are completely synthetic. Penicillin, the prototype b-lactam, is a 6-aminopenicillanic acid...

Older antibiotics revisited

The recent interest in rediscovering new applications for older antibiotics has developed because of changes in pathogen distribution and resistance. The use of some older antibiotics has increased because of an increase in infections for which the antibiotic was used, which leads to an increase in usage for some established indications 4,5 . Antibiotic resistance is one of the factors responsible for the resurgence of some older antimicrobials. Among gram-positive organisms, there has been an...

Cyp3a4

The relative proportions of clinically used drug metabolized by cytochrome P450 enzymes. Significant interindividual variability exists in the outcomes of drug interactions. This variability is associated with patient-specific factors such as disease state, other concomitant medications, and genetics. Specifically, there is at least 10-fold interindividual variability in CYP450 content, which is most likely due to a combination of clinical factors and genetics. In addition, certain...

Shilpa M Patel MDa Louis D Saravolatz Md Macpb

ADivision of Infectious Diseases, Department of Internal Medicine, St. John Hospital and Medical Center, 19251 Mack Avenue, Suite 340, Grosse Pointe Woods, MI 48236, USA bDepartment of Medicine, St. John Hospital and Medical Center, 19251 Mack Avenue, Suite 335, Grosse Pointe Woods, MI 48236, USA The science of antibiotic therapy for infectious diseases continues to evolve. In many instances where empiric coverage is necessary, treatment with more than one agent is considered prudent. If an...

The future of antibiotic therapy

The strategies for developing new antibacterial agents will continue to involve inhibition of bacterial growth and multiplication, bacterial death, and interference with cellular attachment. In addition, improving drug delivery systems, reducing side effect profiles, improving antimicrobial susceptibility testing and reporting, and improving antibiotic use in the clinical setting will all play important roles in determining the future of antibacterial therapy 43 . Antibiotics with novel modes...

Manjunath P Pai PharmDa Kathryn M Momary PharmDb Keith A Rodvold Pharm Dbc

A University of New Mexico, College of Pharmacy, MSC09 5360, Albuquerque, NM 87131, USA b University of Illinois at Chicago, College of Pharmacy, Room 164, 833 South Wood Street, m c 886, Chicago, IL 60612, USA c University of Illinois at Chicago, College of Medicine, 833 South Wood Street, m c 886c, Chicago, IL 60612, USA The prescribing of safe and effective drug therapy is becoming increasingly complex. More and more patients are receiving multiple drug therapies for acute and chronic...

New uses for older antibiotics

The combination of increasing resistance among selected gram-positive and gram-negative pathogens has prompted a re-evaluation of the antibiotic armamentarium, because few antimicrobials are effective against previously or newly highly resistant micro-organisms. Among the tetracyclines, doxycy-cline and minocycline maintain their effectiveness in their traditional areas of use (eg, rickettsial infections, ehrlichiosis, Lyme and other spirochetal infections) and against bacterial zoonoses 1,3 ....

F

Febrile neutropenia, 1186-1187, 1208, 1215 antibiotic failure in, 1270 in penicillin allergy, 1258-1259, 1261 Fluoroquinolones, 1057. See also specific agents. diarrhea due to, 1143 drug interactions with, 1232-1235 for cellulitis, 1184 for endocarditis, 1191 for neutropenic fever, 1187 for pneumonia, 1192 Foscarnet, drug interactions with, 1248 Furazolidone, for Helicobacter pylori infections, 1132, 1134 Fusidic acid, for Clostridium difficile-associated diarrhea, 1150