Clinical Use of Anti-infective Agents: A Guide on How to Prescribe Drugs Used to Treat Infections

194 Pages·2012·1.82 MB·English

by  Robert W. Finberg

Clinical Use of Anti-infective Agents

Robert W. Finberg Roy Guharoy
●
Clinical Use of Anti-infective
Agents
A Guide on How to Prescribe Drugs
Used to Treat Infections
Robert W. Finberg Roy Guharoy
Richard Haidack Professor and Chair Chief Pharmacy Offi cer
Department of Medicine UMass Memorial Health Care
University of Massachusetts Clinical Professor of Medicine
Medical School University of Massachusetts
Worcester, MA, USA Medical School
[email protected] Worcester, MA, USA
[email protected]
ISBN 978-1-4614-1067-6 e-ISBN 978-1-4614-1068-3
DOI 10.1007/978-1-4614-1068-3
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011942229
© Springer Science+Business Media, LLC 2012
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Contents
Part I Introduction to Anti-infective Therapy, Structures
and Mechanisms of Action of Commonly Used
Antibacterial Agents
1 Introduction and History ....................................................................... 3
2 Basic Principles of Drug Delivery and Dosing...................................... 5
Mechanism of Actions of Anti-bacterial Agents ...................................... 5
Role of Pharmacokinetics and Pharmacodynamics
in the Management of Bacterial Infectious Diseases ................................ 5
PK/PD Profi les of Anti-microbial Agents ................................................. 9
Time-Dependent Agents (Duration of Exposure to
a Specifi c MIC) ..................................................................................... 9
Concentration-Dependent Killing ............................................................. 9
Pharmacokinetic Variability ...................................................................... 10
Renal Impairment ...................................................................................... 10
Hepatic Impairment .................................................................................. 10
Critically Ill Patients ................................................................................. 11
Tissue Concentrations ............................................................................... 12
Bacteriostatic Versus Bactericidal Drugs .................................................. 12
Conclusion ................................................................................................ 13
Further Reading ........................................................................................ 13
3 Sulfonamides............................................................................................ 15
Introduction ............................................................................................... 15
Mechanism of Action ................................................................................ 15
Trimethoprim ............................................................................................ 16
Trimethoprim–Sulfamethoxazole Combinations ...................................... 17
Spectrum of Activity ................................................................................. 18
Common Uses ........................................................................................... 18
Adverse Effects ......................................................................................... 18
Further Reading ........................................................................................ 19
v
vi Contents
4 Penicillins ................................................................................................. 21
Introduction ............................................................................................... 21
Mechanism of Action ................................................................................ 21
Classes of Penicillins ................................................................................ 22
Natural Penicillins (Penicillin G and Penicillin V) ............................... 22
Spectrum of Activity ................................................................................. 23
Common Uses ........................................................................................... 23
Anti-staphylococcal Penicillins: Methicillin, Oxacillin,
and Nafcillin .............................................................................................. 24
Common Uses for Anti-staphylococcal Penicillins .................................. 25
Aminopenicillins ....................................................................................... 25
Spectrum of Activity of Aminopenicillins ................................................ 26
Common Uses of Aminopenicillins .......................................................... 26
Combinations of Aminopenicillins with Beta-Lactamase Inhibitors ........ 26
Spectrum of Activity of Aminopenicillin/Beta-Lactamase
Combinations ............................................................................................ 27
Common Uses for Aminopenicillin/Beta-Lactamase
Combinations ............................................................................................ 27
Extended-Spectrum Penicillins ................................................................. 27
Spectrum of Activity of Extended-Spectrum Penicillins .......................... 28
Common Uses of Extended-Spectrum Penicillins .................................... 28
Extended-Spectrum Penicillins Combined with Beta-Lactamase
Inhibitors ................................................................................................... 28
Spectrum of Activity of Extended-Spectrum Penicillins Combined
with Beta-Lactamases ............................................................................... 29
Common Uses of Extended-Spectrum Penicillin Combined
with Beta-Lactamases ............................................................................... 29
Adverse Effects and Toxicities of Penicillins ........................................... 29
Further Reading ........................................................................................ 30
5 Cephalosporins ........................................................................................ 31
Introduction ............................................................................................... 31
Mechanism of Action ................................................................................ 31
Classes of Cephalosporins ........................................................................ 32
Adverse Effects ......................................................................................... 35
Common Uses of Cephalosporins (Table 5.2) .......................................... 36
Further Reading ........................................................................................ 36
6 Monobactams .......................................................................................... 37
Aztreonam ................................................................................................. 37
Introduction ........................................................................................... 37
Mechanism of Action ................................................................................ 37
Spectrum of Activity ................................................................................. 37
Common Uses ........................................................................................... 38
Adverse Effects ......................................................................................... 38
Further Reading ........................................................................................ 39
Contents vii
7 Carbapenems ........................................................................................... 41
Introduction ............................................................................................... 41
Mechanism of Action ................................................................................ 41
Spectrum of Activity ................................................................................. 41
Common Uses ........................................................................................... 42
Adverse Effects ......................................................................................... 43
Imipenem .................................................................................................. 43
Meropenem ............................................................................................... 43
Ertapenem ................................................................................................. 43
Doripenem ................................................................................................. 43
Summary ................................................................................................... 44
Further Reading ........................................................................................ 44
8 Glycopeptides and Other Agents Used to Treat
Gram-Positive Cocci ............................................................................... 45
Introduction ............................................................................................... 45
Vancomycin ............................................................................................... 45
Mechanism of Action ................................................................................ 45
Spectrum of Activity ................................................................................. 46
Common Uses ........................................................................................... 46
Adverse Effects ......................................................................................... 47
Teicoplanin ................................................................................................ 47
Dalbavancin and Telavancin ..................................................................... 48
Mechanism of Action ................................................................................ 48
Spectrum of Activity ................................................................................. 48
Common Uses ........................................................................................... 49
Adverse Effects ......................................................................................... 49
Miscellaneous Non-glycopeptide Agents ................................................. 49
Streptogramins ...................................................................................... 49
Quinupristin/Dalfopristin ...................................................................... 49
Mechanism of Action ................................................................................ 49
Spectrum of Activity ................................................................................. 50
Adverse Effects ......................................................................................... 50
Oxazolidinones ......................................................................................... 51
Linezolid ................................................................................................... 51
Mechanism of Action ................................................................................ 51
Spectrum of Activity ................................................................................. 52
Common Uses ........................................................................................... 52
Adverse Effects ......................................................................................... 52
Daptomycin ............................................................................................... 52
Mechanism of Action ................................................................................ 52
Spectrum of Activity ................................................................................. 53
Common Uses ........................................................................................... 53
viii Contents
Adverse Effects ......................................................................................... 53
Fidaxomicin .............................................................................................. 54
Mechanism of Action ................................................................................ 54
Spectrum of Activity ................................................................................. 54
Common Uses ........................................................................................... 55
Adverse Effects ......................................................................................... 55
Further Reading ........................................................................................ 55
9 Aminoglycosides ...................................................................................... 57
Introduction ............................................................................................... 57
Mechanism of Action ................................................................................ 57
Spectrum of Activity ................................................................................. 57
Pharmacokinetics ...................................................................................... 58
Traditional Multiple Daily Dosing ............................................................ 58
Single Daily Dose ..................................................................................... 59
Adverse Effects ......................................................................................... 61
Common Uses ........................................................................................... 61
Further Reading ........................................................................................ 62
10 Macrolides................................................................................................ 63
Introduction ............................................................................................... 63
Mechanism of Action ................................................................................ 63
Spectrum of Activity ................................................................................. 63
Erythromycin ........................................................................................ 63
Azithromycin ........................................................................................ 64
Clarithromycin ...................................................................................... 64
Resistance ................................................................................................. 65
Common Uses ........................................................................................... 65
Adverse Effects ......................................................................................... 65
Further Reading ........................................................................................ 66
11 Metronidazole and Clindamycin ........................................................... 67
Introduction ............................................................................................... 67
Mechanism of Action ................................................................................ 67
Spectrum of Activity ................................................................................. 67
Common Uses ........................................................................................... 68
Adverse Effects ......................................................................................... 68
Clindamycin .............................................................................................. 68
Mechanism of Action ................................................................................ 69
Spectrum of Activity ................................................................................. 69
Common Uses ........................................................................................... 69
Adverse Effects ......................................................................................... 70
Further Reading ........................................................................................ 70
Contents ix
12 Quinolones ............................................................................................... 71
Introduction ............................................................................................... 71
Mechanism of Action ................................................................................ 71
Spectrum of Activity ................................................................................. 71
Common Uses ........................................................................................... 73
Adverse Effects ......................................................................................... 73
Conclusion ................................................................................................ 74
Further Reading ........................................................................................ 74
13 Tetracyclines ............................................................................................ 75
Introduction ............................................................................................... 75
Mechanism of Action ................................................................................ 75
Spectrum of Activity ................................................................................. 76
Common Uses ........................................................................................... 77
Adverse Effects ......................................................................................... 77
Further Reading ........................................................................................ 78
Part II The Clinician Approaches a Patient with an Infectious Disease
14 Clinical Approach to the Treatment of Infectious Diseases ................ 81
The Four Questions ................................................................................... 81
Asking the Four Questions .................................................................... 82
The Remainder of the History ................................................................... 83
Specifi c Issues in the Physical Examination ............................................. 83
Use of the Laboratory ............................................................................... 83
15 Understanding Drug Allergies and Drug Toxicities ............................. 85
Antibiotic Allergy ..................................................................................... 85
Classifi cation of Antibiotic Allergy .......................................................... 85
Clinical Features ....................................................................................... 86
Diagnosis of Antibiotic Allergy ................................................................ 86
Other Methods .......................................................................................... 87
Differential Diagnosis ............................................................................... 88
Cross-Reactivity Between Cephalosporins and Penicillins ...................... 88
Cross-Reactivity Among Cephalosporins ................................................. 88
Penicillin Allergy and Carbapenems......................................................... 90
Penicillin and Monobactams ..................................................................... 90
Sulfonamide Allergy ................................................................................. 91
Nonsulfonylarylamines ......................................................................... 91
Drugs in Which the Sulfonamide Moiety Is Not Connected
to the Benzene Ring .............................................................................. 91
Sulfonylarylamine Drugs ...................................................................... 92