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Infections
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Both vancomycin and teicoplanin are only active against Gram-positive organisms. They are mainly used for the treatment of infections caused by Gram-positive cocci and Gram-positive rods that are resistant to beta-lactam drugs, or in patients who are allergic to beta-lactams. Oral administration is used for the treatment of Clostridium difficile in antibiotic-associated colitis.
Allergic Diseases
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Adam Fox, George Du Toit, Stephan Strobel
It is the large group of beta-lactam antibiotics that are commonly used to treat bacterial infections and are most commonly associated with allergic reactions. In 80–90% adverse drug reactions affect the skin. Cutaneus presentations classically occur at the time of viral infections and so it can be very difficult to determine whether associated rashes (drug allergies usually present with cutaneous manifestations) arise due to the index infection for which the antibiotic was administrated or due to the antibiotic itself. If such a diagnosis is not taken forward this may cause unnecessary patient anxiety and compromise health care in the future.
The Pharmacist Role in Antimicrobial Stewardship and Interpreting Microbiology Laboratory Results
Published in Nancy Khardori, Bench to Bedside, 2018
Stephanie Crosby, Mark DeAngelo, Nancy Khardori
The mechanism of action or activity of the agent being initiated also needs to be considered. Some antibiotics are bactericidal whereas some may be bacteriostatic. Bactericidal agents will kill the bacteria by disrupting the cell membrane, cell wall or the cellular DNA (Nemeth et al. 2015). Examples of antibiotics in the category include beta-lactams, fluoroquinolones and glycopeptides. Agents that prevent further bacterial replication versus killing the organism are considered bacteriostatic. Antibiotics that are bacteriostatic include macrolides and lincosamides. In severe infections, such as meningitis or endocarditis a bacteriostatic agent would not be ideal as more aggressive killing would favor a better clinical outcome.
Oral step-down therapy in patients with uncomplicated Staphylococcus aureus primary bacteremia and catheter-related bloodstream infections
Published in Journal of Chemotherapy, 2022
Seok Jun Mun, Si-Ho Kim, Kyungmin Huh, Sun Young Cho, Cheol-In Kang, Doo Ryeon Chung, Kyong Ran Peck
In 32 patients with OAT, 24 patients (75%) received oral beta-lactams. This result is similar to the those of recent studies that treated with mostly oral beta-lactams [9,10]. However, other studies have tried oral antibiotics with high oral availability including linezolid, quinolones, and TMP/SMX [6–8,11,16]. Oral beta-lactams have relatively low bioavailability and lower tolerable doses than intravenous antibiotics, and may be difficult to attain therapeutic tissue concentration [17]. Nevertheless, the studies that used mostly oral beta-lactams showed favorable outcomes of OAT, including the current study [9,10]. This may be due to the fact that only patients with MSSA bacteremia were treated with oral beta-lactams. Before the switch to OAT, these patients were mostly treated with intravenous beta-lactams, which are more bactericidal than vancomycin, and this factor might have offset the disadvantages of oral beta-lactams in OAT [1].
An expert opinion on respiratory delivery of high dose powders for lung infections
Published in Expert Opinion on Drug Delivery, 2022
Bishal Raj Adhikari, Jack Dummer, Keith C. Gordon, Shyamal C. Das
The antimicrobial efficacy of different drugs has been described as concentration and time dependent. For example, aminoglycosides such as tobramycin and fluoroquinolone such as ciprofloxacin primarily exhibit concentration dependent killing [113]. However, antimicrobial efficacy of beta lactam antibiotics is primarily time dependent. In case of inhalation, the concentration and time factors reflect pharmacokinetics of drugs upon inhalation. Following inhalation, the drugs are cleared via diffusion into blood within minutes to hours depending upon multiple factors such as hydrophilicity/lipophilicity and molecular mass, effectively reducing the drug concentration in the lung tissue/fluids negating the very reason inhalation route was selected to treat lung infections [114,115]. Strategies are being investigated to improve residence time of the drugs in lungs. Inhalable liposomes containing ciprofloxacin have been reported with the aim to potentially improve the half-time of the drug in the lungs [74]. Similarly, a crystalline adduct of moxifloxacin, an antitubercular drug, was prepared with cinnamic acid to reduce its dissolution rate to improve its residence time in the lungs to potentially improve its localized anti-tubercular action in the lungs [116].
Antibiotic treatment in patients with sepsis: a narrative review
Published in Hospital Practice, 2022
Erika P. Plata-Menchaca, Ricard Ferrer, Juan Carlos Ruiz Rodríguez, Rui Morais, Pedro Póvoa
Sepsis is a life-threatening condition with high mortality and adverse outcomes. An appropriate and timely antimicrobial administration is one of the mainstays of therapy. The administration of broad-spectrum antimicrobials should be done as soon as possible, preferably within the first hour from the time of presentation. Extended infusions of beta-lactams may be considered for most patients, and higher loading doses can be needed for some antibiotics. To ensure a successful outcome and reduce adverse drug effects, it is crucial to individualize and optimize maintenance doses of antibiotics. Antimicrobial stewardship is an essential part of sepsis management. Hospitals should develop, and update periodically, specific protocols for antibiotic prescription according to particular sites of infection, incorporating local and national microbiology and resistance patterns. Appropriate collection of samples for culture allows de-escalation and reducing treatment duration. Biomarker-based antimicrobial stewardship and other new diagnostic stewardship approaches will aid in providing the best management for patients.