Empiric therapy for severe infections in adults

Article Abstract:

Empiric therapy attempts to rapidly treat the most likely causes of an infection, while at the same time avoiding the cost and dangers associated with a 'shotgun' approach. For example, community-acquired pneumonia, has a 40 to 80 percent chance of being caused by Streptococcus pneumoniae, while Hemophilus influenzae is on the rise among adults, particularly in those with chronic obstructive pulmonary disease. Staphylococcus aureus accounts for up to 10 percent of pneumonia in nursing homes, and is a major cause of pneumonia following flu epidemics. Since streptococcus pneumoniae is the most likely pathogen in community-acquired pneumonia, penicillin G would be chosen over the cephalosporins because it is more effective against this organism. In cases of nosocomial pneumonia, pneumonia contracted in the hospital, a greater variety of organisms are suspect. Empiric therapy should include a combination of either a semisynthetic penicillin or a cephalosporin with an aminoglycoside. In otherwise healthy patients with meningitis, the majority of cases are caused by pneumococci or meningococci, and penicillin G is the agent of choice. However, if the meningitis is acquired from septicemia, head trauma, or a neurosurgical procedure, the range of potential causative organisms widens, and third-generation cephalosporins become a possible choice. Urinary tract infections (UTIs) are among the most common of all infections both in the community, and in the hospital where they account for about 40 percent of nosocomial infections. At least one percent of urinary tract infections are associated with bacteremia and are potentially life-threatening. Escherichia coli accounts for roughly 80 percent of uncomplicated urinary tract infections, but is responsible for only 30 percent of the infections acquired in hospitals, where most UTIs are complicated. Although cephalosporins achieve high concentrations in the urine, they should not be used to treat community-acquired UTIs, which are likely to be caused by organisms responding to older and less expensive agents. When enterococcus is suspected in a hospital-acquired infection, penicillin should be tried; other infections are likely to respond well to cephalosporins. The majority of infections of the skin and soft tissues are caused by Staphylococcus aureus, for which penicillin is the treatment of choice. However, many gram-negative bacilli and anaerobes are resistant to many antibacterial agents; a significant advantage of the third-generation cephalosporins is their effectiveness against gram-negative bacteria which are resistant to other antibiotics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Conferences, meetings and seminars

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Pathophysiologic basic for the use of third-generation cephalosporins

Article Abstract:

Third-generation cephalosporins have been used for a decade, and their widespread application has established their efficacy and safety. They continue to have superior effectiveness against gram-positive cocci, including several streptococcal species. They also show superior activity against gram-negative aerobic strains such as Hemophilus, Neisseria, Branhamella, and some less common gram-negative aerobes. Enterococci, like Listeria and Corynebacterium jekeium, and methicillin-resistant streptococci are resistant to all cephalosporins. It is less widely appreciated that the spectrum of activity of cephalosporins includes oral anaerobes and Bacteroides and Clostridium species. Infected patients with normal kidney function may be treated three times a day; the dose or frequency may be reduced for those with impaired kidney function. A useful and important feature of the newer cephalosporins is that they enter the cerebrospinal fluid in concentrations eight to ten times greater than that necessary to kill several important agents of meningitis. Cefotaxime and ceftriaxone are the most widely used for meningitis, but ceftazidime also achieves adequate concentrations in the cerebrospinal fluid. When cephalosporins are properly targeted to appropriate organisms they continue to be effective and safe, and will probably be used successfully in the next decade. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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A decade of progress in cephalosporin use: summary

Article Abstract:

The wide range of the effectiveness of cephalosporins make them an ideal first choice for the treatment of suspected infections. They have been shown to be useful in treating many respiratory infections acquired in the hospital, numerous urinary tract infections, and the more common forms of meningitis, particularly bacterial meningitis in children. There are also a number of rare infections, such as some brain abscesses, which have been reported to respond well to cephalosporin treatment. New cephalosporins are constantly being developed and tested. One of these, cefpirome, has shown activity against organisms such as the Enterobacteriaceae, Listeria, methicillin-resistant strains of Staphylococcus aureus, and Pseudomonas aeruginosa, organisms that have been resistant to older cephalosporins. It is tempting to speculate that this compound may be the prototype of a new 'fourth-generation' of cephalosporins which will find even greater application in the coming decade. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research

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