Pneumonia antimicrobials

Olsen, K.M., Gentry-Nielsen, M., Yue, M., Snitily, M.U. and Preheim, L.C. (2006) Effect of ethanol on fluoroquinolone efficacy in a rat model of pneumococcal pneumonia. Antimicrobial Agents and Chemotherapy, 50, 210-219. 

Marrer, E., Schad, K, Satoh, A.T, Page, M.G., Johnson, M.M., and Piddock, L.J. (2006) Involvement of the putative ATP-dependent efflux proteins PatA and PatB in fluoroquinolone resistance of a multidrug-resistant mutant of Streptococcus pneumoniae. Antimicrobial Agents and Chemotherapy, 50 (2), 685-693. 

Cill, M.J., Brenwald, N.P., and Wise, R. (1999) Identification of an efflux piunp gene, pmrA, associated with fluoroquinolone resistance in Streptococcus pneumoniae. Antimicrobial Agents and Chemotherapy. 43 (1), 187-189. 

Recognizing the presumed site of infection and most common pathogens associated with the infectious source should guide antimicrobial choice, dose, and route of administration. For example, community-acquired pneumonia is caused most commonly by S. pneumoniae, E. coli is the primary cause of uncomplicated UTIs, and staphylococci and streptococci are implicated most frequently in skin and skin-structure infections (e.g., cellulitis). 

The patient was admitted to the hospital with a presumptive diagnosis of health care-associated pneumonia (based on the recent hospitalization). He received intravenous hydration with normal saline, 5 L oxygen via face mask, an insulin infusion to control his glucose, and empirical antimicrobial therapy with piperacillin-tazobactam 2.25 g intravenously every 6 hours and vancomycin 1 g intravenously every 24 hours. All other medications are continued with the exception of the diabetes medications. 

Design an appropriate empirical antimicrobial regimen based on patient-specific data for an individual with community-acquired pneumonia, aspiration pneumonia, and ventilator-... 

Empirical selection of antimicrobial therapy for ventilator-associated, health care-associated, and hospital-associated pneumonia is broad spectrum however, once culture and susceptibility information are available, the therapy should be narrowed (deescalation) to cover the identified pathogen(s). 

Resistance to commonly prescribed antimicrobials such as the penicillins and macrolides/azalides increased dramatically in the late 1980s through the middle to late 1990s. Table 68-2 provides resistance information collected nationally from 1999 to 2004 using the Tracking Resistance in the US Today (TRUST) surveillance database.26 In 2004, the average national rate of resistance to penicillin and macrolides was approximately 18% and 25%, respectively. Susceptibility results alone do not account for clinical success or failures when treating pneumonia. 

TABLE 68-2. Percentage of Resistance for Various Antimicrobials Against S. pneumoniae... 

Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001 163 1730-1754. 

The CSFs should not be used routinely for treatment of febrile neutropenia in conjunction with antimicrobial therapy.5 However, the use of CSFs in certain high-risk patients with hypotension, documented fungal infection, pneumonia, or sepsis is reasonable. A recent meta-analysis demonstrated that hospitalization and neutrophil recovery are shortened and that infection-related mortality is marginally improved.14 As with prophylactic use of these agents, cost considerations limit their use to high-risk patients. 

Jones, M. E. Blosser-Middleton, R. S. Thornsberry, C. Karlowsky, J. A. Sahm, D. F. The activity of levofloxacin and other antimicrobials against clinical isolates of Streptococcus pneumoniae collected worldwide during 1999-2002. Diagn. Microbiol. Infect. Dis. 2003,47,579-586. 

Generally very resistant to all antimicrobials check sensitivities to ceftazidime 6 ticarcillinChlamydia pneumoniae Doxycyclinee... 

TABLE 43-6 1 Empirical Antimicrobial Therapy for Pneumonia in Adults ... 

These infections are predominantly caused by E. coli, and antimicrobial therapy should be directed against this organism initially. Other causes include S. saprophyticus and occasionally K. pneumoniae and Proteus mirabilis. 

Selection of empiric antimicrobial therapy should be based on the most likely organisms. The most common organisms for acute exacerbation of COPD are Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, and H. parainfluenzae. 

Sporadic clinical reports, without the support of data from controlled studies, repeatedly indicate the effectiveness of intratracheal administration of parenteral antimicrobial preparations in the treatment of tracheobronchitis and pneumonia in cattle. The expectation when using this route of administration is that a greater therapeutic effect will be achieved when the drug is placed as close to the infection site as possible, rather than relying on the systemic circulation for drug delivery. 

Antimicrobial prophylaxis Cases of Pneumocystis carinii pneumonia (PCP) have been reported in patients not receiving antimicrobial prophylaxis. Therefore, administer antimicrobial prophylaxis for PCP for 1 year following transplantation. Cytomegalovirus (CMV) prophylaxis is recommended for 3 months after transplantation, particularly for patients at increased risk for CMV disease. 

The spectrum of respiratory tract infections (RTI) can vary from the common cold to acute or chronic bronchitis to community-acquired pneumonia to nosocomial pneumonia and aspiration pneumonia to ventilator-associated pneumonia to chronic pneumonia (in cystic fibrosis, histoplasmosis, tuberculosis, etc.). Important complications are lung abscess and pleural empyema that will often need drainage and prolonged antimicrobial treatment (>6 weeks). 

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