Pneumonia antibiotic of choice

The Infectious Diseases Society of America has developed guidelines for the management of community-acquired pneumonia in adults The panel endorsed the use of parenteral penicillin G or oral amoxicillin as preferred agents for pneumococcal isolates susceptible to penicillin.

For strains with intermediate susceptibility to penicillin, parenteral penicillin or amoxicillin or the alternative agents were preferred. The MICs of extended-spectrum cephalosporins above which treatment failure would be expected is not clear. Concentrations of cefotaxime and ceftriaxone in pleural fluid have been determined following doses of 1 g every 12 h and 1 g once daily, respectively, in adults with chest tubes placed for drainage of empyemas One could expect to adequately treat pneumococcal pneumonia with cefotaxime or ceftriaxime when the extended-spectrum cephalosporins have an MIC of up to 4.

When the MICs are higher, alternate agents such as vancomycin, clindamycin, or a carbapenem may be needed. Additional studies are required before more specific recommendations can be made. For critically ill patients or patients with an immunocompromising condition, consideration should be given to including vancomycin in the initial treatment regimen when S. Trovafloxacin is an alternative choice in adults.

Modifications of therapy are then made based on antimicrobial susceptibility data as outlined above. Animal models of pneumococcal pneumonia have been used to evaluate the efficacy of penicillin, extended-spectrum cephalosporins, carbapenems, vancomycin, and selected fluoroquinolones in the treatment of infection due to penicillin-resistant strains.

Different conditions such as induction of leukopenia, use of a bacterial inoculum in agar, or infection of different species of rodents were used in these studies 136097, In general, higher doses of penicillin are superior to lower doses in clearing bacteria from the lungs and in decreasing the mortality.

Vancomycin and imipenem were the most active agents in one study. Sparfloxacin was more effective than ciprofloxacin or amoxicillin in decreasing mortality in a leukopenic-mouse model. These results also demonstrated that the time for which the antibiotic concentration in serum was above the MIC for the infecting strain of pneumococcus correlated with the outcome.

These models help to confirm that the present approach to treatment of pneumococcal pneumonia due to antibiotic-resistant strains is reasonable and allow comparisons among new antibiotics for isolates with greater resistance to the traditional agents such as cefuroxime or the extended-spectrum cephalosporins. Except for bacteremia and pneumonia, a limited number of other systemic non-central nervous system infections due to antibiotic-resistant S.

Infective endocarditis, aortitis, and endophthalmitis are other infections documented in single-case reports. Since a variety of antimicrobial regimens were used in these patients, it is very difficult to draw any conclusions regarding single-agent therapy.

However, most of the antibiotics administered to these patients were shown to achieve concentrations in synovial fluid, peritoneal fluid, or bone in excess of their MICs for penicillin-resistant isolates 21267298, The average vancomycin concentration in synovial fluid was 5.

In ascitic fluid, the average vancomycin level was 8. Thus, with standard doses of the extended-spectrum cephalosporins or clindamycin, successful treatment of peritonitis or septic arthritis due to penicillin-resistant S. Vancomycin may be required for infections due to isolates with high-level resistance to these antibiotics.

Some authors recommend adopting empirical therapy for pneumococcal endocarditis that parallels the therapy suggested for pneumococcal meningitis extended-spectrum cephalosporin plus vancomycin Miscellaneous infections reported due to S. Of all the infections caused by S. Since virtually all comment perdre du ventre rapidement nostale 2014 dealing with antibiotic-resistant S.

Presumably these data are also relevant for sinusitis. By using these criteria, it is possible to predict which antibiotics are likely to be efficacious or poorly effective in the treatment of acute otitis media due to S. Since the levels in the middle ear are often achieved in patients with chronic otitis media undergoing pressure equalization tube placement, they may not reflect the levels achieved in patients with acute otitis media.

Nevertheless, it is apparent that certain antibiotics would be expected to be more efficacious than others when treating pneumococcal otitis media due to resistant strains.

Comparison of in vitro activity of oral antibiotics for S. Trimethoprim-sulfamethoxazole does not penetrate into middle ear effusions adequately to predict efficacy for penicillin-intermediate isolates, since there is such considerable cross-resistance for this combination and penicillin. For clindamycin, the mean level in the middle ear mucosa is 3.

Whether this level correlates with those in middle ear effusion is not clear. Clindamycin remains quite active for most pneumococcal isolates resistant to penicillin and would be considered an alternative agent for treating otitis media caused by such strains In most areas, pneumococcal isolates resistant to macrolides generally remain susceptible to clindamycin.

As is generally the case, otoscopic evaluation of the tympanic membrane and clinical condition define the outcome measures. Thus, the results are somewhat subjective, especially in nonrandomized, investigator-unblinded studies. All the studies included an initial tympanocentesis for culture of middle ear fluid.

[Community-acquired pneumonia in children: etiology and treatment].

Cefuroxime, cefprozil, and amoxicillin-clavulanate were found to be efficacious in most of the children evaluated in these studies; cefaclor and cefixime have not been as effective as some of these other agents. Although only a small number of children were treated in one study, cefpodoxime did not appear to be particularly effective despite having reasonable in vitro activity against S. This lack of effectiveness might possibly be related to the relatively low concentrations achieved in the middle ear.

In a second study of cefpodoxime for otitis media, the outcome in all four children with penicillin-nonsusceptible strains mainly intermediate was satisfactory Outcome of treatment for otitis media due to S. In several studies, a single intramuscular dose of ceftriaxone was comparable to a standard day course of amoxicillin or trimethoprim-sulfamethoxazole for treatment of acute otitis media 15 However, efficacy for antibiotic-resistant pneumococci was not assessed.

Block et al. In a preliminary study, Leibovitz et al.

Pneumonia antibiotic for cattle

Tympanocentesis for middle ear cultures was performed on the day of enrollment and on days 4 to 10 and if clinical relapse occurred. Bacteriological relapse occurred in two children with isolates intermediate to penicillin. In a similar study, Gehanno et al. Thirty-six children had S. One day after ceftriaxone therapy was completed, 24 of 27 had negative repeat cultures of the middle ear. Together, these two studies establish ceftriaxone as an important alternative agent for the treatment of acute otitis media unresponsive to first-line agents.

However, three intramuscular doses probably are required, and the treatment is expensive. Clindamycin and azithromycin have not been evaluated adequately to assess their role in the treatment of pneumococcal otitis media. In studies conducted in Israel, azithromycin was effective if the middle ear pneumococcal isolate was susceptible to azithromycin eradicated in 12 of 12 patients but totally ineffective when the isolate was azithromycin resistant eradicated in 0 of 6 patients In a chinchilla model of acute otitis media, penicillin-resistant pneumococci remaining susceptible to clarithromycin were eradicated from middle ear cultures following clarithromycin treatment 4.

Taken together, data from these studies suggest that the macrolides may provide effective therapy for treatment of acute otitis media due to penicillin-nonsusceptible strains remaining susceptible to the macrolides. However, since more than half of the obese tight clothes tumblr isolates nonsusceptible to penicillin will be nonsusceptible to macrolides, it is not likely that azithromycin or clarithromycin will be highly effective in treating acute otitis media due to such strains Another approach has been to increase the dose of amoxicillin for the treatment of acute otitis media in order to increase the concentration of amoxicillin in serum and thus the level in the middle ear fluid.

In the chinchilla model, an amoxicillin dose fold greater than that necessary to eradicate penicillin-susceptible strains was effective in clearing penicillin-resistant S. In children with acute otitis media, levels of amoxicillin in middle ear fluid exceeded 1. The estimated mean peak concentration in middle ear fluid occurred 3. If the MIC 90 of amoxicillin is 4. It is unclear if treatment failures for acute otitis media are occurring more frequently now than 10 years ago in association with the rise in the incidence of antibiotic-resistant S.

Most of these children were 6 to 36 months old. Tympanocentesis was performed in children whose acute otitis media had not responded after one or two empirical antimicrobial treatment courses. Only one-third of the isolates were tested for penicillin susceptibility; 2 of 11 were nonsusceptible to penicillin.

Thus, at least during this period, treatment failures of acute otitis media were not often a result of S. However, similar data from to are not available, and these presumably would show higher rates of antimicrobial resistance among S. Amoxicillin is still considered the agent of choice in treating acute otitis media.

Certain risk factors have been identified as associated with an increased likelihood of treatment failure: a history of recurrent otitis media and treatment during the winter months are two of the strongest Younger age and day care attendance might be considered additional risk features.

Modifying this initial approach would be reasonable when faced with a younger child with these risk factors. If a child is nonresponsive to this higher dosing level of amoxicillin, alternative agents to consider include amoxicillin-clavulanate, cefuroxime axetil, and cefprozil.

Parenteral administration of ceftriaxone for at least three consecutive days is another option 2362 After a period when relatively few new antibiotics were introduced, the emergence of strains of antibiotic-resistant bacteria has spurred research into new antimicrobial compounds.

Some of the preparations belong to creme anti rides matifiante unifiante antimicrobial classes, while others represent refinements of older antibiotics. Those that are being tested and appear useful against S. The streptogramins are inhibitors of cell wall synthesis at the ribosomal level and have been used in Europe since They are active against most gram-positive bacteria, including all pneumococcal strains, regardless of penicillin or macrolide susceptibility.

RP Synercid is a semisynthetic injectable combination of quinupristin and dalfopristin. Separately, these agents are active but bacteristatic for pneumococci, while the combination has synergistic activity and is rapidly bactericidal for all pneumococci 22 RP Pyostacinea single oral streptogramin that has been licensed in France and Belgium for more than 20 years, is very active against strains of S.

Cefditoren is a pivaloyloxymethyl ester of the parent cephalosporin molecule and is intended for oral treatment This antimicrobial agent is inhibitory and bactericidal at concentrations between 0. Pharmacokinetic studies in human volunteers found maximum levels of sanfetrinem in serum of 2. These levels suggest this agent should be effective in treating acute otitis media in pediatric patients.

LY is a semisynthetic glycopeptide that is active against vancomycin-resistant enterococci and other gram-positive bacteria, including S. It is highly protein bound but rapidly bactericidal against both pneumococci and enterococci. Sparfloxacin has a structure similar to clinafloxacin Trovafloxacin is a novel fluoroquinolone with enhanced activity for gram-positive bacteria over the earlier quinolones Trovafloxacin may be the first quinolone actually studied in children for possible licensure.

DUa is probably the most active of the newer fluoroquinolones in vitro BAY is an experimental oral broad-spectrum 8-methoxyquinolone The oxazolidinones, represented by Linezolid U and Eperezolid Uare a new class of antimicrobial agent with a unique structure and good activity against gram-positive bacteria Studies with penicillin and ceftriaxone non susceptible S.

Both compounds inhibit bacterial protein synthesis and are bactericidal for pneumococci but not for other gram-positive organisms. Rifabutin is a lipophilic antibacterial that inhibits DNA-dependent RNA polymerase and is rapidly bactericidal for many bacteria, including S.

Penicillin-intermediate strains were inhibited by concentrations between 0. The management of infection due to antibiotic-resistant S. Unless there is a dramatic change in the antibiotic-prescribing habits of physicians and other health care workers, it is unlikely that the upward trend in antibiotic resistance will be halted. A number of organizations, especially the Centers for Disease Control and Prevention, are initiating efforts to educate health care workers and the public about the proper and wise use of antibiotics.

Different dosing schemes of available agents and discovery of newer agents with different mechanisms of action remain important approaches to the development of new strategies for treating these infections. Perhaps the development of conjugate pneumococcal vaccines provides the greatest promise for controlling antibiotic-resistant S. National Center for Biotechnology InformationU. Journal List Clin Microbiol Rev v. Clin Microbiol Rev. Sheldon L.

Mason, Jr. Author information Copyright and License information Disclaimer. Phone: Fax: E-mail: ude. This article has been cited by other articles in PMC. Abstract Antibiotic-resistant strains of Streptococcus pneumoniae are becoming more prevalent throughout the world; this has resulted in modifications of treatment approaches. Open in a separate window.

Dexamethasone The use of adjunctive dexamethasone in addition to antibiotics for the treatment of pneumococcal meningitis remains somewhat controversial Implications It is unclear if treatment failures for acute otitis media are occurring more frequently now than 10 years ago in association with the rise in the incidence of antibiotic-resistant S.

Antibiotic no. Streptogramins The streptogramins are inhibitors of cell wall synthesis at the ribosomal level and have been used in Europe since Cephalosporins Cefditoren is a pivaloyloxymethyl ester of the parent cephalosporin molecule and is intended for oral treatment Glycopeptides LY is a semisynthetic glycopeptide that is active against vancomycin-resistant enterococci and other gram-positive bacteria, including S.

Fluoroquinolones Sparfloxacin has a structure similar to clinafloxacin Oxazolidinones The oxazolidinones, represented by Linezolid U and Eperezolid Uare a new class of antimicrobial agent with a unique structure and good activity against gram-positive bacteria Rifabutin Rifabutin is a lipophilic antibacterial that inhibits DNA-dependent RNA polymerase and is rapidly bactericidal for many bacteria, including S.

Pediatr Infect Dis J. Penicillin-insensitive pneumococci. Case report and review. Am J Dis Child. Recurrent meningitis from a multiply resistant Streptococcus pneumoniae strain treated with erythromycin. Efficacy of clarithromycin treatment of acute otitis media caused by infection with penicillin-susceptible, -intermediate, and -resistant Streptococcus pneumoniae in the chinchilla.

Antimicrob Agents Chemother. American Academy of Pediatrics. Dexamethasone therapy for bacterial meningitis. In: Peter G, editor. Red book: Report of the Committee on Infectious Diseases. Tables of antimicrobial agent pharmacology. Principles and practice of infectious diseases. New York, N. Y: Churchill Livingstone, Inc. Applebaum P C. Epidemiology and in vitro susceptibility of drug-resistant Streptococcus pneumoniae.

Washington, D. C: American Society for Microbiology; Arditi, M. Bradley, T. Tan, W. Barson, G. Schutze, E. Wald, L. Givner, K. Kim, R. Yogev, and S. Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics and outcome related to penicillin susceptibility and dexamethasone use.

Pediatrics in press. Aronin, S. Mukherjee, J. West, and E. Review of pneumococcal endocarditis in adults in the penicillin era. J Chemother. Imipenem-cilastatin therapy in a child with meningitis caused by a multiply resistant pneumococcus.

In vivo efficacy of a new fluoroquinolone, sparfloxacin, against penicillin-susceptible, and -resistant and multiresistant strains of Streptococcus pneumoniae in a mouse model of pneumonia. Pyogenic bacterial pneumonia in human immunodeficiency virus-infected inpatients: a clinical radiological, microbiological, and epidemiological study.

Clin Infect Dis. Comparison of ceftriaxone and trimethoprim-sulfamethoxazole for acute otitis media. Antimicrobial activity and spectrum of sparfloxacillin tested against erythromycin-resistant Streptococcus pneumoniae isolates. Diagn Microbiol Infect Dis. In vitro activities of five fluoroquinolone compounds against strains of Streptococcus pneumoniae with resistance to other antimicrobial agents. Efficacy of single-dose ceftriaxone in experimental otitis media induced by penicillin- and cephalosporin-resistant Streptococcus pneumoniae.

Effect of increased dosage of amoxicillin in the treatment of experimental middle ear otitis due to penicillin-resistant Streptococcus pneumoniae. Penetration of third-generation cephalosporins into human peritoneal tissue. J Antimicrob Chemother. Penicillin-resistant Streptococcus pneumoniae in acute otitis media: risk factors, susceptibility patterns and antimicrobial management.

Ceftriaxone failure in meningitis caused by Streptococcus pneumoniae with reduced susceptibility to beta-lactam antibiotics. Bradley, J. Bradsher R W. Ceftriaxone Ro therapy of serious infections. Breakthrough bacteremia and meningitis during treatment with cephalosporins parenterally for pneumococcal pneumonia.

J Pediatr. J Infect Dis. Influence of dexamethasone on efficacy of ceftriaxone and vancomycin therapy in experimental pneumococcal meningitis. Amoxicillin middle ear fluid penetration and pharmacokinetics in children with acute otitis media.

Treatment of penicillin-resistant pneumococcal bacteremia in neutropenic patients with cancer. Failure of cefotaxime in the treatment of meningitis due to relatively resistant Streptococcus pneumoniae. Penicillin- and cephalosporin-resistant strains of Streptococcus pneumoniae causing sepsis and meningitis in children with sickle cell disease.

Therapy for children with invasive pneumococcal infections. Craig W A, Andes D. Pharmacokinetics and pharmacodynamics of antibiotics in otitis media. Impaired bacteriologic response to oral cephalosporins in acute otitis media caused by pneumococci with intermediate resistance to penicillin. Bacteriologic response in acute otitis media: comparison between azithromycin, cefaclor and amoxicillin, abstr.

Penetration of meropenem into the cerebrospinal fluid of patients with inflamed meninges. Nosocomial epiglottitis associated with penicillin- and cephalosporin-resistant Streptococcus pneumoniae bacteremia. J Clin Microbiol. Dhawan V K.

Clindamycin: a review of fifteen years of experience. Rev Infect Dis. In vitro activity of sanfetrinem GVa new trinem antimicrobial agent, versus Streptococcus pneumoniaeHaemophilus influenzaeand Moraxella catarrhalis.

Bactericidal activity against intermediately cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with bacterial meningitis treated with high doses of cefotaxime and vancomycin.

Penetration of cefpodoxime into middle ear fluid in pediatric patients with acute otitis media. Concerns of secondary fever in Streptococcus pneumoniae meningitis in an era of increasing antibiotic resistance. Arch Pediatr Adolesc Med. Comparative activities of LYa new glycopeptide, against penicillin-susceptible and -resistant pneumococci. Community-acquired pneumonia due to penicillin-resistant pneumococci. N Engl J Med. Comparative in vitro killing activities of meropenem, imipenem, ceftriaxone, and ceftriaxone plus vancomycin at clinically achievable cerebrospinal fluid concentrations against penicillin-resistant Streptococcus pneumoniae isolates from children with meningitis.

Invasive pneumococcal disease: clinical features, serotypes, and antimicrobial resistance patterns in cases involving patients with and without human immunodeficiency virus infection. Human pharmacokinetics and distribution in various tissues of ceftriaxone. Friedland I R. Comparison of the response to antimicrobial therapy of penicillin-resistant and penicillin-susceptible pneumococcal disease.

Failure of chloramphenicol therapy in penicillin-resistant pneumococcal meningitis. Cerebrospinal fluid bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in children with meningitis treated with high-dose cefotaxime. Concentrations of ceftriaxone in cerebrospinal fluid of children with meningitis receiving dexamethasone therapy. Susceptibility of Streptococcus pneumoniae to penicillin: a prospective microbiological and clinical study.

Meningitis from a pneumococcus moderately resistant to penicillin. Treatment of experimental pneumonia due to penicillin-resistant Streptococcus pneumoniae in immunocompetent rats. Scand J Infect Dis. Resolution of clinical failure in acute otitis media confirmed by in vivo bacterial eradication—efficacy and safety of ceftriaxone injected once daily, for 3 days, abstr.

In vivo correlates for Streptococcus pneumoniae penicillin resistance in acute otitis media. Penicillin-resistant pneumococcal vertebral osteomyelitis. George J, Morrissey I. The bactericidal activity of levofloxacin compared with ofloxacin, d -ofloxacin, ciprofloxacin, sparfloxacin and cefotaxime against Streptococcus pneumoniae. Dexamethasone treatment for bacterial meningitis in children and adults. Single-dose intramuscular ceftriaxone for acute otitis media in children.

Penetration of ceftriaxone into the middle ear fluid of children. Failure of cefotaxime treatment in two children with meningitis caused by highly penicillin-resistant Streptococcus pneumoniae.

Acta Paediatr. Complicated parapneumoniac effusions in children caused by penicillin-nonsusceptible Streptococcus pneumoniae. Middle ear effusion concentrations of cefixime during acute otitis media with effusion and otitis media with effusion. Ceftriaxone therapy in pediatric patients.

A pharmacologic evaluation of penicillin in children with purulent meningitis. John C C. Treatment failure with use of a third-generation cephalosporin for penicillin-resistant pneumococcal meningitis: case report and review. Beneficial effects of dexamethasone in children with pneumococcal meningitis.

Kaplan, S. Barson, E. Wald, M. Arditi, T. Tan, G. Schutze, J. Bradley, L. Kim, and R. Three year multicenter surveillance of systemic pneumococcal infections in children. Pediatrics, in press. Risk factors for mortality from pneumococcal bacteremia, abstr. Trovafloxacin in treatment of rabbits with experimental meningitis caused by high-level penicillin-resistant Streptococcus pneumoniae.

Meningitis with beta-lactam resistant Streptococcus pneumoniae : the need for early repeat lumbar puncture. Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis. Klugman K P. Pneumococcal resistance to antibiotics. Clin Microbial Rev. Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis.

Bacteriologic efficacy of 3-day intramuscular ceftriaxone in non-responsive acute otitis media, abstr. Sanfretrinem pharmacokinetics plasma and middle ear fluid in pediatric patients with acute otitis media, abstr. Meningitis due to ceftriaxone-resistant Streptococcus pneumoniae. Timing of dexamethasone therapy in experimental pneumococcal meningitis, abstr. Efficacy of trovafloxacin in patients with community acquired pneumonia due to penicillin susceptible and resistant S.

In vitro activities of oxazolidinones U and U against penicillin-resistant and cephalosporin-resistant strains of Streptococcus pneumoniae.

Consensus Report: antimicrobial therapy for bacterial meningitis in infants and children. Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomized clinical trials since Pharmacokinetics of vancomycin in normal subjects and in patients with reduced renal function.

In vivo efficacy of a broad-spectrum cephalosporin, ceftriaxone, against penicillin-susceptible and -resistant strains of Streptococcus pneumoniae in a mouse pneumonia model. The penetration of ceftriaxone into synovial fluid of the inflamed joint. Therapy and outcome of meningitis caused by drug-resistant Streptococcus pneumoniae in three US cities —, abstr. Appearance of resistance to beta-lactam antibiotics during therapy for Streptococcus pneumoniae meningitis.

Relapsing pneumococcal meningitis: isolation of an organism with decreased susceptibility to penicillin G. National Committee for Clinical Laboratory Standards. Activity of oral antibiotics in middle ear and sinus infections caused by penicillin-resistant Streptococcus pneumoniae : implications for treatment. Article Article Outline. Access to the text HTML. Access to the PDF text. Recommend this article.

Save as favorites.

Access to the full text of this article requires a subscription. If you are a subscriber, please sign in 'My Account' at the top right of the screen. Antibiothérapie des pneumonies aiguës communautaires PAC dues a des agents atypiques. Casal bP. Gispert aE. Corresponding author. Outline Masquer le plan. From in vitro studies, cellular models and experimental models to the human clinical settings. Q fever. Extrapulmonary manifestations of atypical pathogens: role of antibiotic therapy.

Other agents that may cause atypical pneumonia. Toxicities and interactions. Top of the page - Article Outline. Contact Help Who are we? As per the Law relating to information storage and personal integrity, you have the right to oppose art 26 of that lawaccess art 34 of that law and rectify art 36 of that law your personal data.

You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted. Personal information regarding our website's visitors, including their identity, is confidential. The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.

You can move this window by clicking on the headline. General considerations Coverage of atypical agents in the empiric therapeutic approach of community-acquired pneumonia. LD Antibiotic choice. Masquer le plan.