Impact of Guidelines on Antimicrobial Treatment of Respiratory Tract Infections
Robert C. Owens, Lautenbach Ebbing in Antimicrobial Resistance, 2007
First-line therapy for adult patients with mild disease and no antibiotic therapy during the previous 4 to 6 weeks are limited to high-dose amoxicillin, amoxicillin-clavulanate, cefpodoxime proxetil, and cefuroxime axetil. The guidelines note that cefprozil may have a bacterial failure rate of up to 25%. Similarly, while clarithromycin, trimethoprim-sulfamethoxazole, doxycycline, azithromycin, or erythromycin may be considered for patients with beta-lactam allergies, they are generally less active for DRSP. The use of trimethoprim-sulfamethoxazole also has been associated with potentially fatal toxic epidermal necrolysis. For adults with mild disease who have had recent antibiotic therapy or for those with moderate disease with no recent antibiotic therapy, first-line treatment recommendations include amoxicillin-clavulanate, high-dose amoxicillin, cefpodoxime proxetil, and cefuroxime axetil. Appropriate agents for beta-lactam-allergic or -intolerant patients include gatifloxacin, levofloxacin, and moxifloxacin. In adult patients with moderate disease and recent antibiotic use, the indicated agents are amoxicillin-clavulanate, gatifloxacin, levofloxacin, moxifloxacin, or combination therapy—amoxicillin or clindamycin for Gram-positive coverage plus cefixime or cefpodoxime proxetil for Gram-negative coverage.
Impact of Guidelines on Antimicrobial Treatment of Respiratory Tract Infections
Robert C. Owens, Paul G. Ambrose, Charles H. Nightingale in Antibiotic Optimization, 2004
First-line therapy for adult patients with mild disease and no antibiotic therapy during the previous 4 to 6 weeks is limited to high-dose amoxicillin, amoxicillin-clavulanate, cefpodoxime proxetil, and cefuroxime axetil. The guidelines note that cefprozil may have a bacterial failure rate of up to 25%. Similarly, although clarithromycin, trimethoprim-sulfamethoxazole, doxycycline, azithromycin, or erythromycin may be considered for patients with beta-lactam allergies, they are generally less active for DRSP. The use of trimethoprim-sulfamethoxazole also has been associated with potentially fatal toxic epidermal necrolysis. For adults with mild disease who have had recent antibiotic therapy or for those with moderate disease with no recent antibiotic therapy, first-line treatment recommendations include amoxicillin-clavulanate, high-dose amoxicillin, cefpodoxime proxetil, and cefuroxime axetil. Appropriate agents for beta-lactam-allergic or -intolerant patients include gatifloxacin, levofloxacin, and moxifloxacin. In adult patients with moderate disease and recent antibiotic use, the indicated agents are amoxicillin-clavulanate, gatifloxacin, levofloxacin, moxifloxacin, or combination therapy B3/4 amoxicillin or clindamycin for gram-positive coverage plus cefixime or cefpodoxime proxetil for gram-negative coverage.
Cefaclor, Cefprozil, and Loracarbef
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Cefprozil is active against S. aureus, including beta-lactamase-producing strains. S. epidermidis is typically susceptible to cefprozil, but S. haemolyticus and S. hominis are often resistant. Streptococcus pyogenes and groups B, C, F, and G streptococci are susceptible. S. pneumoniae is quite susceptible to cefprozil, and penicillin-resistant strains tend to have a lower minimum inhibitory concentration (MIC) of cefprozil than penicillin. S. viridans is typically susceptible, but strains with high-level penicillin resistance are also cefprozil resistant (MIC 32 μg/ml).
Clinical considerations for oral beta-lactams as step-down therapy for Enterobacteriaceae bloodstream infections
Published in Expert Opinion on Pharmacotherapy, 2019
Bryan T. Mogle, Mario V. Beccari, Jeffrey M. Steele, Tasaduq Fazili, Wesley D. Kufel
In the absence of specific MIC values, the use of wild-type MIC distributions may be considered when selecting an OBL that is predicted to be susceptible based on surrogate susceptibility testing [15]. For example, wild-type MIC values occurring in the highest frequency for amoxicillin, amoxicillin-clavulanate, cephalexin, cefaclor, cefuroxime, and cefpodoxime for E. coli are 4 mg/L, 4 mg/L, 4 mg/L, 1 mg/L, 4 mg/L, and 0.5 mg/L, respectively [16]. Taking these values into consideration with the data presented in Table 3, cephalexin 1000 mg every 6 h appears to offer the highest likelihood of PD target attainment amongst OBL in a patient with normal renal function, however, amoxicillin, amoxicillin-clavulanate (when dosed every 8 h), cefaclor, and cefpodoxime may be suitable options at lower MICs, if known. Cefprozil, cefuroxime, and cefdinir appear to offer a low likelihood of PD target attainment. In patients with renal impairment requiring OBL dose adjustments, the overall exposure and influence on PD target attainment are unclear.
Functional profile of host microbiome indicates Clostridioides difficile infection
Published in Gut Microbes, 2022
Etienne Nzabarushimana, Haixu Tang
Here, we attempted to evaluate the confounding impact of antibiotic treatment on CDI by assessing the predictive power of the LR models on three tasks: 1) the prediction of CDI independent of the antibiotic treatment (Figure 4a,d), 2) the prediction of antibiotic treatment regardless of CDI status (Figure 4c,f), and 3) the classification between CDI+ cases vs antibiotic treated individuals (ABX+; Figure S2 D). For task 2, CDI+ cases and ABX+ cases (taking and after taking antibiotics) form one class (the negative class), while CDI- and ABX- form the positive class. We used data from Palleja et al.,47 where healthy individuals were given a cocktail of the three last resort antibiotics (meropenem, gentamicin, and vancomycin) for 4 days and followed up to 180 days post-intervention. We also used data from the Raymond et al. study50 in which healthy individuals were administered a second-generation cephalosporin, cefprozil for 7 days and followed for up to 3 months.
Bilateral Acute Iris Transillumination (BAIT): A Rare Syndrome Possibly Associated with COVID-19 and Moxifloxacin Use. A Report of 2 Cases
Published in Seminars in Ophthalmology, 2023
Kristina Lončarić, Rašeljka Tadić, Marin Radmilović, Zoran Vatavuk
The exact etiopathogenesis of BAIT is still unclear. Previously published reports suggest an association with preceding upper respiratory tract infections, with or without the use of certain antibiotics. In the majority of cases, the patients were treated with systemic moxifloxacin, but in some cases, the patients developed BAIT after prior ampicillin/sulbactam, amoxicillin/clavulanate/cefixime or penicillin antibiotics administration.2 There are also published reports of BAIT after intracameral moxifloxacin application.3,4 A case of BAIT with no associated infection nor prior antibiotic use has been described.5 A novel epidemic, COVID-19 (coronavirus disease 2019) caused by the severe acute respiratory syndrome coronavirus – 2 (SARS-CoV-2) emerged in December 2019. Yagci et al. reported a first ever case of BAIT in a 44-year-old woman 2 weeks after being discharged for prior COVID-19 pneumonia, who had no history of fluoroquinolone nor other recent antibiotic use.6 Altan et al. reviewed retrospectively the clinical features and course of 12 BAIT and 4 BADI patients following acute COVID 19 infection and found that 9 patients had history of moxifloxacin use, 4 were treated with another antibiotics (including cefuroxime, cefprozil and a combination of a B-lactamase inhibitor with amoxicillin and azithromycin), while 3 patients could not give information whether they used antibiotics or not7 . According to published reports, the most prevalent presumption on the etiopathogenesis of BAIT is a immune dysregulation rather than direct viral invasion, followed by a presumption of a direct toxicity of certain antibiotics (most commonly moxifloxacin), but also apoptotic mechanisms, immune complex-mediated mechanisms and ischemic processes have been suspected.2,6–8
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