The choice of antimicrobial drugs

Article Abstract:

The decision of which drug to use to treat an infection requires an understanding of the characteristics of the drug, such as its activity against the infective microorganism, toxicity, accessibility to a specific site of infection, and financial cost. The patient's clinical condition or characteristics, such as pregnancy, decreased kidney or liver function, suppressed immune or natural defense mechanisms, and allergic reactions to drugs in the past, may also influence the choice of which drug to use for treating an infection. Meningitis, an inflammation of the membranes around the spinal cord and brain, should be treated immediately by antimicrobial agents that are effective against the microorganisms Streptococcus pneumoniae, Neisseria meningitidis or Haemophilus influenzae. The drugs of choice for treating meningitis in adults, children, patients who are allergic to penicillin, and newborns who also have sepsis or infection of the blood, are described. Bacteremia is a bacterial infection of the blood which should also be treated immediately. The choice of antimicrobial agents for treating bacteremia depends on the source of the infection in the body, the results of laboratory tests to identify the bacteria, the immune status of the patient, and patterns of drug resistance in the community or hospital. The antibiotic regimens commonly used for the initial treatment of bacteremia; for infections involving or originating in the heart, abdomen, pelvis, and biliary tract; for patients infected with drug-resistant bacterial strains; and for patients with neutropenia, a decreased number of neutrophils, a type of white blood cell, are described. The first-choice antibiotics and alternatives for treating infections are listed according to the infective organism. (Consumer Summary produced by Reliance Medical Information, Inc.)

Meningitis, Bacterial infections, Bacteremia

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Cefixime - a new oral cephalosporin

Article Abstract:

Cefixime, an oral cephalosporin antibiotic, was recently approved by the United States Food and Drug Administration for the once-a-day treatment of otitis media, or inflammation of the middle ear; pharyngitis, or inflammation of the throat; bronchitis, or inflammation of the bronchi which connect the upper respiratory tract with the lungs; and urinary tract infections. Cefixime prevents the growth of various microorganisms, but is not effective against staphylococci, enterococci, Listeria, anaerobes, Pseudomonas, and many strains of Enterobacter and Acinetobacter. It is slowly and incompletely absorbed in the gastrointestinal tract, and reaches its highest levels in the blood within two to five hours after ingestion. It is not metabolized and 50 percent of absorbed cefixime is eliminated in the urine within 24 hours. In a study of 106 patients with otitis media, cefixime was equally or more effective than the antibiotic amoxicillin in eliminating Branhamella and strains of H. influenzae, but was less effective than amoxicillin against pneumococci and Staphylococcus aureus. In another study of 128 patients with otitis media, cefixime was as effective as cefaclor. Other studies demonstrated that cefixime was as effective as amoxicillin in treating pharyngitis, tonsillitis, bronchitis, and acute urinary tract infections. Adverse side effects of cefixime include gastrointestinal toxicity, such as diarrhea, rashes, increased aminotransferase activity, and vaginal yeast infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cefixime

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Ceftibuten - a new oral cephalosporin

Article Abstract:

Ceftibuten (Cedax) may be a poor choice of treatment for the conditions approved by the FDA, including otitis media, middle-ear infection. Ceftibuten is a new cephalosporin for the treatment of tonsillitis, pharyngitis, and bacterial forms of chronic bronchitis. Clinical research with ceftibuten indicated a therapeutic benefit equivalent to or better than other standard antimicrobial drugs in those diseases, with some exceptions. Ceftibuten is very active against group A streptococci and mildly active against Streptococci pneumoniae, a frequent cause of ear infections. Although most pathogens in otitis media remain unidentified, a recommendation for the use of ceftibuten would be unwise. Side effects are usually limited to diarrhea. The drug is priced at the high end of the scale for both children and adults.

Streptococcal infections, Anti-infective agents, Otitis media

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