Streptococcus pneumoniae infection treatment

Clotrimazole is an imidazole antifungal agent indicated for the treatment of fungal infections caused by Candida albicans. The administration of clotrimazole would be of no use in the treatment of infections caused by Chlamydia trachomatis, Neisseria gonorrhoea, Staphylcoccus aureus and Streptococcus pneumoniae. 

Aminomethyl- cyclines Amino- methyl- cycline MK-2764 (PTK-0796 BAY 73-7388) (153) Antibacterial (broad spectrum antibiotic against MRS A, MDR Streptococcus pneumoniae and vancomycin-resistant enterococci) Inhibits bacterial protein synthesis Phase III (treatment of hospital infections in both oral and i.v. injectable formulations) Paratek/Novartis 810... 

Levofloxacin (1), the levo-isomer or the (5)-enantiomer of ofloxacin, received FDA approval in 1996 (Fish, 2003 Hurst et al., 2002 Mascaretti, 2003 Norrby, 1999 North et al., 1998). The initial approval covered community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, uncomplicated skin and skin structure infections, acute pyelonephritis, and complicated urinary tract infections (North et al., 1998). Four years later, the levofloxacin indication list grew to include community-acquired pneumonia caused by penicillin-resistant Streptococcus pneumoniae. In addition, in 2002, nosocomial (hospital-acquired) pneumonia caused by methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Kliebsella pneumoniae, and Escherichia coli was added (Hurst et al., 2002). Finally in 2004, LVX was approved as a post-exposure treatment for individuals exposed to Bacillus anthracis, the microbe that causes anthrax, via inhalation (FDA, 2004). 

Tetracyclines no longer can be entirely relied on in the treatment of streptococcal infections up to 40% of Streptococcus pyogenes and 10% of Streptococcus pneumoniae are resistant. 

Within the last few years, some new sulfa drugs have been introduced, including tnmethoprim-sulfamethoxazole. This drug has broadened the scope in treatment of urinary tract infections derived from species in addition to E. coli, namely, Klebsiella, Enterobacter, and Porteus species. This drug also is used for the treatment of acute otitis media in children, particularly those instances where strains uf H. influenzae and streptococcus pneumoniae may be suspected. The drug is also used to treat systemic infections that may arise from chloramphenicol- and ampicillin-rcsistant Salmonella as well as infections attributed to Pneumocystis carinii. 

Tumour necrosis factor-a (TNFa) accumulates in the brain after trauma. This cytokine is known to be an important factor in delayed CNS damage. It was found that, in addition to its anti-NMDA effect, HU-211 causes up to 90% inhibition of the TNFa surge after closed head injury in rats [195], Bacterial and viral infections of the CNS are known to cause secretion of the TNFa as well as interleukin-1 and other cytokines which are involved in the inflammatory process and may cause secondary damage. Such infections may result in high mortality. It was found that rats infected with Streptococcus pneumoniae suffered less cerebral oedema on treatment with a combination of a suitable antibiotic with HU-211 than the antibiotic alone [196],... 

Cefeclor is nsed to treat bacterial infections of the middle ear, limg, and urinary tract. Oral cefeclor can also be used to treat mild preseptal celluUtis. Parenteral administration of cefuroxime along with ampicillin/snlbactam is a recommended treatment for severe or imresponsive preseptal cellulitis (see Table 11-1). However, with the increase of penicillin-resistant isolates of Streptococcus pneumoniae, the effectiveness of empirically treating this condition with p-lactam dmgs needs to be carefully considered. 

Because of its potential toxicity, vancomycin is reserved for serious infections in which less toxic antibiotics are ineffective or not tolerated. Generally, vancomycin is administered intravenously because of poor intestinal absorption. It is the drug of choice for treating infections caused by methicillin-resistant staphylococci and penicillin-resistant Streptococcus pneumoniae. Vancomycin has been used to treat enterococcal infections because of their resistance to the P-lactam antibiotics, but most enterococci are now also resistant to vancomycin. Oral administration of rancomycin is important for treatment of some gastrointestinal infections such as pseudomembranous colitis caused by C. difficile. 

Methicillin-resistant strains of Staphylococcus aureus and S. epidermidis and penicillin-resistant Streptococcus pneumoniae have been isolated from ocular infections. Therefore treatment of ocular infections caused by these organisms might require use of vancomycin for resolution. Vancomycin is also recommended for empiric intra-vitreal and topical therapy in bacterial endophthalmitis and for parenteral therapy in moderate to severe preseptal cellulitis (see Table 11-1). 

Clarithromycin is indicated for the treatment of mild to moderate upper and lower respiratory tract infections as well as skin infections caused by susceptible strains of Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, H. influenzae, Legionella pneumophila, and Mycoplasma pneumoniae. The usual dosage is 250 to 500 mg twice a day for 7 to 14 days. 

Trimethoprim-polymyxin B is effective for the treatment of blepharitis, conjimctivitis, and blepharoconjunctivitis. Side effects are very rare. Because it is clinically effective against H. influenzae and Streptococcus pneumoniae, which are the most common causes of bacterial pediatric eye infections, it is a drug of choice for treating eye infections in children. 

Disease that is segmental or lobar in its distribution is usually caused by Streptococcus pneumoniae (pneumococcus). Haemophilus influenzae is a rare cause in this group, although it more often leads to exacerbations of chronic bronchitis and does cause pneumonia in patients infected with HIV. Benzyl-penicillin i.v. or amoxicillin p.o. are the treatments of choice if pneumococcal pneumonia is very likely alternatively, use erythromycin/clarithromycin in a penicillin-allergic patient. Seriously ill patients are best given benzylpenicillin (to cover the pneumococcus) plus ciprofloxacin (to cover Haemophilus and atypical pathogens). Where penicillin-resistant pneumococci are prevalent, i.v. cefotaxime is a reasonable best guess choice. 

Moxifloxacin is an 8-methoxyquinolone with enhanced potency against important Gram-positive pathogens, notably Streptococcus pneumoniae (penicillin-resistant and penicillin-susceptible strains), and class activity against Gram-negative bacteria. Its activity is not affected by beta-lactamases. Moxifloxacin may therefore represent a promising alternative for treatment of respiratory tract infections (1). 

Starting in the 1920s, very many different mixed bacterial vaccine products (including inactivated bacteria such as Staphylococcus aureus. Streptococcus species. Streptococcus pneumoniae, Moraxella catarrhalis, Klebsiella pneumoniae, H. influenzae) were marketed worldwide. Currently, there are still several products available in European countries, and one product in the USA. Most vaccines have been used for treatment of recurrent and chronic infections of the respiratory tract. The efficacy of these products is doubtful. Delayed hypersensitivity to bacterial products is common. Delayed reactions, sometimes associated with vague malaise or myalgia, can occur after the administration of maintenance doses for months. If delayed skin reactions are accompanied by any systemic symptoms, administration of the mixed vaccine should be drastically reduced or stopped (87). 

Lomefloxacin has been approved for two primary indica-(ions. First, it is indicated for acute bacterial exacerbations of chronic bronchitis cau.sed by H. influenzae or Moraxella (Branimmella) caiatrhalis. but not if Streptococcus pneumoniae is the causative organism. Second, it is used for prophylaxis of infection following transurethral surgery. Lomefloxacin also finds application in the treatment of acute cys-this and chronic urinary tract infections caused by Gram-negative bacilli. 

Therapeutic Agents Targeting TNF-oc. The Streptococcus pneumoniae host resistance model is also valuable for evaluating the importance of macrophage cytokines on bacterial host resistance. Human biological therapeutics targeting inhibition of TNF-a have been used to treat inflammatory autoimmune diseases such as rheumatoid arthritis. Decreased TNFa as a result of treatment with monoclonal antibodies (mAb) to TNF-a has an effect on several biomarkers of infection (Takashima et al, 1997 van der Poll et al, 1997 Benton et al., 1998 O Brien et al, 1999). These studies have reported that treatment of mice with a mAb to TNF-a results in altered levels of TNF-a in the lungs... 

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. 

Streptococcus pneumoniae, and Haemophilus sp. Suifamethoxazoie, in combination with trimethoprim, is used for treatment of primary uncomplicated urinary tract infections and, occasionally, as a backup to other, normally more preferred agents in speciai situations. 

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