Antibiotics community-acquired pneumonia

Ertapenem (Invanz) [Anti infective/Carbapenem] Uses Complicated intra-abd, acute pelvic, skin Infxns, pyelonepluitis, community-acquired pneumonia Action A carbapenem p-lactam antibiotic, cell wall synth Dose Adults. 1 g IM/IV daily 500 mg/d in CrCl <30 mL/min Peds. 3 mo-12 y ... 

Patients with a CURB-65 score of 3 or more should be managed as severe community-acquired pneumonia with appropriate antibiotics, whereas those with a CURB-65 score of 2 or less should be managed as non-severe community-acquired pneumonia. 

Studies of community-acquired pneumonia in the UK indicate that no organism is isolated in over 30% of cases (British Thoracic Society, 200f). Viruses are isolated in approximately f 3% of patients. Of the bacterial pathogens associated with community-acquired pneumonia, Streptococcus pneumoniae is the most important (isolated in almost 40% of cases), typically sensitive to benzylpeni-cillin and cephalosporin antibiotics. 

So-called atypical bacteria such as Chlamydia pneumoniae and Mycoplasma pneumoniae are the next most important group of community-acquired pneumonia pathogens, accounting for around one case in every eight in hospitalised patients. Atypical bacteria are not sensitive to beta-lactam antibiotics such as penicillins and cephalosporins and the treatment of choice is a macrolide such as erythromycin. 

The patient s vital signs provide the most sensitive indicator of response to therapy and normalisation of heart rate, respiratory rate, oxygenation, blood pressure and temperature should be confirmed. Laboratory markers of infection such as CRP and WCC should be monitored to ensure normalisation. Failure to improve may indicate an incorrect diagnosis, a resistant pathogen, poor absorption of antibiotic, immunocompromise or local or distant complications of community-acquired pneumonia such as lung abscess. 

Trade names Spara Sparlox Torospar Zagam Indications Community-acquired pneumonia Category Antibiotic, quinolone Half-life 16-30 hours... 

Indications Community-acquired pneumonia, chronic bronchitis Category Antibiotic, macrolide Half-life 10-13 hours... 

High use/high volume Those medications used most frequently, as well as the most common procedures and disease states. Incremental improvements made in these areas will impact the greatest number of patients (e.g., antibiotic use, pain management, acetaminophen, community-acquired pneumonia, otitis media, and patient counseling). 

The treatment of community-acquired pneumonia may consist of humidified oxygen for hypoxemia, bronchodilators (albuterol) when bronchospasm is present, rehydration fluids, and chest physiotherapy for marked accumulation of retained respiratory secretions. Antibiotic regimens should be selected based on presumed causative pathogens and pulmonary distribution characteristics and should be adjusted to provide optimal activity against pathogens identified by culture (sputum or blood). 

With no comorbidity, the most common organisms associated with a community-acquired pneumonia are At. pneumonia, C. pneumoniae, and viruses. In smokers, the pneumococcus becomes a more frequent pathogen, Macrolide antibiotics have activity against most strains of these organisms (other than viruses) and are therefore commonly used in the treatment of a community-acquired pneumonia. 

Azithromycin, an azalide macrolide antibiotic (500 mg p.o. as a single dose on day 1, followed by 250 mg daily on days 2 to 5 total accumulation dose is 1.5 g), is indicated in the treatment of acute bacterial exacerbations of chronic obstructive pulmonary disease caused by Haemophilus influenzae, Moraxella (Branhamella) catarrhalis, or Streptococcus pneumoniae mild community-acquired pneumonia caused by H. influenzae or S. pneumoniae uncomplicated skin and skin-structure infections caused by Staphylococcus aureus, Streptococcus pyogenes, or S. agalactiae second-line therapy of pharyngitis or tonsillitis caused by S. pyogenes and in nongonococcal urethritis or cervicitis caused by Chlamydia trachomatis. 

Levofloxacin is a fluoroquinolone/ophthalmic/antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, nosocomial pneumonia, community-acquired pneumonia, skin and skin structure infections, chronic bacterial prostatitis, urinary tract infection (UTI), inhalational anthrax (postexposure), and acute pyelonephritis caused by susceptible strains of specific microorganisms. Ophthalmic use is for the treatment of conjunctivitis caused by susceptible strains of aerobic Gram-positive and aerobic Gram-negative microorganisms. 

Erythromycin A, the major fermentation component of S. erythraea, is a 14-membered ring macrolide that is used by medicinal chemists as the foundation for building semisynthetic derivatives of erythromycin antibiotics. (Macrohdes inhibit bacteria by interfering with microbial protein biosynthesis.) Semisynthetic macrolides are popular with clinicians because they can be administered orally and have relatively low toxicity. They are often used to treat respiratory tract infections, and have been especially effective against conditions such as Legionnaires disease and community-acquired pneumonia. Erythromycin therapy is often prescribed for individuals allergic to penicillin. One of the most widely used macrohde antibiotics... 

Organisms that cause community-acquired pneumonia will be susceptible to broad-spectrum jd-lactam antibiotics, macrolides, or a fluoroquinolone, and usually it is not necessary to add an aminoglycoside. Gentamicin (or other aminoglycosides) never should be used as the sole agent to treat pneumonia acquired in the community or as the initial treatment for pneumonia acquired in... 

Nelson 8, Belknap 8M, Carlson RW, et al. A randomized controlled trial of filgrastim as an adjunct to antibiotics for treatment of hospitalized patients with community-acquired pneumonia. CAP 8tudy Group. J Infect Dis 1998 178 1075-1080. 

Antiviral drug therapy has not been proven to be effective. Treatment is supportive, although appropriate antibiotic therapy for community-acquired pneumonia should be initiated according to local guidelines in case SAKS is later ruled out. 

Solithromycin (CEM-101, Figure 44.8) is a ketolide antibiotic undergoing clinical development for the treatment of community-acquired pneumonia. It is another example of semi-synthetic antimicrobial agents derived from erythromycin, which was designed to overcome erythromycin resistance in Streptococcus pneumoniae. The synthesis of solithromycin involves the introduction of the fluorine atom on the (3-keto ester moiety with Selectfluor in the presence of potassium tert-butoxide in tetrahydrofuran (THF). Solithromycin shows the greatest potency and widest spectrum of activity against respiratory tract... 

The need for new antibiotics is driven by the recent rise in the incidence of resistance to commonly used antibiotics. The emergence of multiple-drug resistance to community-acquired infections, such as those caused by Streptococcus pneumoniae, is particularly alarming due to the ease of transmission [1-4], Recent reports show that methicillin-resistant Staphylococcus aureus, the common cause of hospital-acquired infections, has also moved into the community [5],... 

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