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Research Article| Volume 14, ISSUE 4, P483-496, July 1996

Antibiotic use in the emergency department. III. The quinolones, new beta lactams, beta lactam combination agents, and miscellaneous antibiotics

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      Abstract

      This article reviews several new, relatively broad-spectrum antibiotics that have utility in the emergency department (ED). The quinolones have excellent activity against gram-negative organisms, including gonococcus, and are characterized by very high bioavailability after oral administration. The new beta-lactams aztreonam and imipenem have broad spectra but limited usefulness to the emergency physician, and should be reserved for judicious use in severe infections, particularly those involving Pseudomonas. Clavulanate, sulbactam, and tazobactam are themselves antimicrobials that have been combined with beta-lactams such as ampicillin and ticarcillin to produce agents with significant potential utility in the ED; these are typically not first-line agents, however, and their use should be governed by both clinical and cost concerns. Finally, three older antibiotics—vancomycin, metronidazole, and clindamycin—are reviewed with respect to updated indications for their use in the ED.

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      References

        • Walker RC
        • Wright AJ
        The fluoroquinolones.
        in: Symposium on antimicrobial agents. Part IV. revised edition. Mayo Clin Proc. 66. 1991: 1249-1259
      1. Med Lett Drugs Ther. 1992; 34 (Anon): 103-105
        • Neu HC
        Quinolone antimicrobial agents.
        Ann Rev Med. 1992; 43: 465-486
      2. MMWR. 1994; 43 (Anon): 325-327
        • Bitar N
        • Claes R
        • Van der Auwera P
        Concentrations of ofloxacin in serum and cerebrospinal fluid of patients without meningitis receiving the drug intravenously and orally.
        Antimicrob Agents Chemother. 1989; 33: 1686-1690
        • Modai J
        Potential role of fluoroquinolones in the treatment of bacterial meningitis.
        Eur J Clin Microbiol Infect Dis. 1991; 10: 291-295
      3. Med Lett Drugs Ther. 1992; 34 (Anon): 58-60
        • Lode H
        • Hoffken G
        • Borner K
        • Koeppe P
        Unique aspects of quinolone pharmacokinetics.
        Clin Pharm. 1989; 16: S1-S4
        • Grubbs NC
        • Schultz HJ
        • Henry WK
        • et al.
        Ciprofloxacin vs. trimethoprim-sulfamethoxazole: treatment of community-acquired urinary tract infections in a prospective, controlled, double-blind comparison.
        in: revised edition. Mayo Clin Proc. 67. 1992: 1163-1168
        • Guibert J
        • Capron MH
        Uncomplicated urinary tract infections: lomefloxacin vs. trimethoprim/sulfamethoxazole.
        J Int Med Res. 1992; 20: 467-474
        • Andriole VT
        Use of quinolones in treatment of prostatitis and lower urinary tract infections.
        Eur J Clin Microbiol Infect Dis. 1991; 10: 342-350
        • Naber KG
        Use of quinolones in urinary tract infections and prostatitis.
        Rev Infect Dis. 1989; 11: S1321-S1337
        • Hooper DC
        • Wolfson JS
        Fluoroquinolone antimicrobial agents.
        N Engl J Med. 1991; 324: 384-394
        • Mogabgab WJ
        • Holmes B
        • Murray M
        • et al.
        Randomized comparison of ofloxacin and doxycycline for chlamydia and ureaplasma urethritis and cervicitis.
        Chemotherapy. 1990; 36: 70-76
      4. CDC Sexually transmitted disease treatment guidelines, 1993. Natl Center for Prevention Svcs, CDC, 1993: 54-80
        • Gentry LO
        Therapy with newer oral β-lactam and quinolone agents for infections of the skin and skin structures: a review.
        Clin Infect Dis. 1992; 14: 285-297
        • Simon HB
        • Swartz MN
        Chemotherapy for microbial diseases.
        in: Rubenstein E Federman DD revised edition. Scientific American medicine. 7. Scientific American, New York1992: 1-54 (XIV)
      5. Med Lett Drugs Ther. 1991; 33 (Anon): 52-53
        • Leibowitz HM
        Antibacterial effectiveness of ciprofloxacin 0.3% ophthalmic solution in the treatment of bacterial conjunctivitis.
        Am J Opthalmol. 1991; 112: 29S-33S
        • Wadworth AN
        • Goa KL
        Lomefloxacin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic use.
        Drugs. 1991; 42: 1018-1060
        • Norrby SR
        Side effects of quinolones: comparisons between quinolones and other antibiotics.
        Eur J Clin Microbiol Infect Dis. 1991; 10: 378-383
      6. AMA Drug Evaluations. 1993; 8: 1-14
        • Neu HC
        Aztreonam activity, pharmacology, and clinical uses.
        Am J Med. 1990; 88: 2S-6S
        • Sykes RB
        • Bonner DP
        Aztreonam: the first monobactam.
        Am J Med. 1985; 78: 2-10
        • Modai J
        • Vittecoq D
        • Decazes JM
        • Wolff M
        • Meulemans A
        Penetration of aztreonam into cerebrospinal fluid of patients with bacterial meningitis.
        Antimicrob Agents Chemother. 1986; 29: 281-283
        • Brewer NS
        • Hellinger WC
        The monobactams.
        in: revised edition. Mayo Clin Proc. 66. 1991: 1152-1157
        • Cunha BA
        Aztreonam.
        Urology. 1993; 41: 249-258
        • Lentnek AL
        • Williams RR
        Aztreonam in the treatment of gram-negative bacterial meningitis.
        Rev Infect Dis. 1991; 13: S586-S590
        • Cook JL
        Gram-negative bacillary pneumonia in the nosocomial setting: role of aztreonam therapy.
        Am J Med. 1990; 88: 34S-37S
        • Sion ML
        • Pyrpasopoulos M
        • Nicolaidis P
        • Papagianni C
        • Tsurutsoglu C
        Efficacy and safety of aztreonam in the treatment of patients with renal failure.
        Rev of Infect Dis. 1991; 13: S652-S654
      7. AMA Drug Evaluations. 1993; 3 (Anon): 1-4
        • Hellinger WC
        • Brewer NS
        Imipenem.
        in: revised edition. Mayo Clin Proc. 66. 1991: 1074-1081
        • Neu HC
        Other β-lactam antibiotics.
        in: Mandell R Douglas Jr, GR Bennet JE Principles and Practice of Infectious Disease. Churchill Livingston, New York1990: 264-271
        • Modai J
        • Vittecoq D
        • Decazes JM
        • Meulemans A
        Penetration of imipenem and cilastatin into cerebrospinal fluid of patients with bacterial meningitis.
        Antimicrob Chemother. 1985; 16: 751-755
        • Haimi-Cohen Y
        • Amir J
        • Weinstock A
        • Varsano I
        The use of imipenem-cilastatin in neonatal meningitis caused by Citrobacter diverusu.
        Acta Paediatr. 1993; 82: 530-532
        • Wong VK
        • Wright HT
        • Ross LA
        • et al.
        Imipenem-cilastatin treatment of bacterial meningitis in children.
        Pediatr Infect Dis J. 1991; 10: 122-125
        • Rolston KVI
        • Berkey P
        • Boday GP
        • et al.
        A comparison of imipenem to ceftazidine with or without amikacin as empiric therapy in febrile neutropenic patients.
        Arch Intern Med. 1992; 152: 283-291
        • Solomkin JS
        • Dellinger EP
        • Christou NV
        • Busuttil RW
        Results of a multicenter trial comparing imipenem/cilastatin to tobramycin/clindamycin for intra-abdominal infections.
        Ann Surg. 1990; 212: 581-591
        • Calandra G
        • Lydick E
        • Carrigan J
        • Weiss L
        • Guess H
        Factors predisposing to seizures in seriously ill infected patients receiving antibiotics: experience with imipenem/cilastatin.
        Am J Med. 1988; 84: 911-918
        • Rolinson GN
        Evolution of β-lactamase inhibitors.
        Rev Infect Dis. 1991; 13: S727-S732
        • Todd PA
        • Benfield P
        Amoxicillin/clavulanic acid: an update of its antibacterial activity, pharmacokinetic properties and therapeutic use.
        Drugs. 1990; 39: 264-307
        • Pichichero M
        • Aronovitz GH
        • Gooch WM
        • et al.
        Comparison of cefuroxime axetil, cefaclor, and amoxicillin-clavulanate potassium suspensions in acute otitis media in infants and children.
        South Med J. 1990; 83: 1174-1177
        • Wright AJ
        • Wilkowske CJ
        The penicillins.
        in: revised edition. Mayo Clin Proc. 66. 1991: 1047-1063
        • Abramowicz M
        revised edition. Handbook of antimicrobial therapy. Med Lett Drugs Ther, New Rochelle, New York1992
        • Roselle GA
        • Bode R
        • Hamilton B
        • et al.
        Clinical trial of the efficacy and safety of ticarcillin and clavulanic acid.
        Antimicrob Agents Chemother. 1985; 27: 291-296
        • Pankey GA
        Diagnosis and treatment of skin and soft tissue infections: clinical experience with ticarcillin disodium-clavulanate potassium.
        Pharmacotherapy. 1991; 11: 90S-98S
        • Pastorek JG
        • Sanders Jr, CV
        Antibiotic therapy for post cesarean endomyometritis.
        Rev Infect Dis. 1991; 13: S752-S757
        • Faro S
        • Hammill HA
        • Maccato M
        • Martens M
        Ticarcillin/clavulanate for treatment of postpartum endometritis.
        Rev Infect Dis. 1991; 13: S758-S762
        • Lucas MJ
        • Cox SM
        • Roark ML
        • Cunningham FG
        Ticarcillin/clavulanate in the treatment of pelvic infections.
        J Reprod Med. 1990; 35: 343-347
        • Meunier F
        • Snoeck R
        • Lagast H
        • Woussen F
        • Klastersky J
        Empirical antimicrobial therapy with Timentin plus amikacin in febrile granulocytopenic cancer patients.
        J Antimicrob Chemother. 1986; 17: 195-201
        • Segreti J
        • Kapell KS
        • Trenholme GM
        In vitro activity of betalactam drugs and sulbactam against Chlamydia trachomatis.
        Diagn Microbiol Infect Dis. 1992; 15: 371-373
        • Crombleholme WR
        • Ohm-Smith M
        • Robbie MO
        • DeKay V
        • Sweet RL
        Ampicillin/sulbactam vs. metronidazole-gentamicin in the treatment of soft tissue pelvic infection.
        Am J Obstet Gynecol. 1987; 156: 507-512
        • Wald E
        • Reilly JS
        • Bluestone CD
        • Chiponis D
        Sulbactam/ampicillin in treatment of acute epiglottis in children.
        Rev Infect Dis. 1986; 8: S617-S619
      8. Med Lett Drugs Ther. 1987; 29 (Anon): 79-81
        • Tan JS
        • Wishnow RM
        • Talan DA
        • Duncanson FP
        • Norden CW
        Treatment of hospitalized patients with complicated skin and skin structure infections: double-blind, randomized, multicenter study of piperacillin-tazobactam vs. ticarcillin-clavulanate.
        Antimicrob Agents Chermother. 1993; 37: 1580-1586
      9. Med Lett Drugs Ther. 1994; 36 (Anon): 7-9
        • Reeves DS
        • Holt HA
        • Bywater MJ
        • MacGowan AP
        The activity of piperacillin/tazobactam against clinical isolates collected in 20 UK centers and the design of a disc test for susceptibility testing.
        J Antimicrob Chemother. 1993; 32: 51-61
        • Sweet RL
        • Roy S
        • Faro S
        • et al.
        Piperacillin and tazobactam vs. clindamycin and gentamicin in the treatment of hospitalized women with pelvic infection.
        Obstet Gynecol. 1994; 83: 280-286
        • Polk HC
        • Fink MP
        • Laverdiere M
        • et al.
        Prospective randomized study of piperacillin/tazobactam therapy of surgically treated intra-abdominal infection.
        Am Surg. 1993; 59: 598-605
        • Brismar B
        • Malmborg AS
        • Tunevall G
        • et al.
        Piperacillin-tazobactam vs. imipenem-cilastatin for treatment of intra-abdominal infection.
        Antimicrob Agents Chemother. 1992; 36: 2766-2773
        • Niinikoski J
        • Havia T
        • Alhava E
        • et al.
        Piperacillin/tazobactam vs. imipenem/cilastatin in the treatment of intra-abdominal infections.
        Surg Gynecol Obstet. 1993; 176: 255-261
        • Wilhelm MP
        Vancomycin.
        in: Mayo Clin Proc. 66. 1991: 1165-1170
        • Fekety R
        Vancomycin and teicoplanin.
        in: Mandell R Douglas Jr., GR Bennet JE Principles and Practice of Infectious Disease. Churchill Livingston Inc, New York1990: 317-323
        • Levine JF
        Vancomycin: a review.
        Med Clin N Am. 1987; 71: 1135-1145
      10. AMA Drug Evaluations. 1993; 9 (Anon): 1-23
        • Watanakunakorn C
        Treatment of infections due to methicillin-resistant Staphylococcus aureus.
        Ann Intern Med. 1982; 97: 376-378
        • Gump DW
        Vancomycin for treatment of bacterial meningitis.
        Rev Infect Dis. 1981; : S289-S292
        • Viladrich PF
        • Gudiol F
        • Linares J
        • et al.
        Evaluation of vancomycin for therapy of adult pneumococcal meningitis.
        Antimicrob Agents Chemother. 1991; 35: 2467-2472
        • Dajani AS
        • Bisno AL
        • Chung KJ
        • et al.
        Prevention of bacterial endocarditis: recommendations by the American Heart Association.
        JAMA. 1990; 264: 2919-2922
      11. Med Lett Drugs Ther. 1992; 34 (Anon): 49-56
        • European Organization for Research and Treatment of Cancer
        Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients.
        J Infect Dis. 1991; 163: 951-958
        • Oliva SL
        • Gugliemlmo BJ
        • Jacobs R
        • Pons VG
        Failure of intravenous vancomycin and intravenous metronidazole to prevent or treat antibiotic-associated pseudomembranous colitis.
        J Infect Dis. 1989; 159: 1154-1155
        • Sahai J
        • Healy DP
        • Garris R
        • Berry A
        • Polk RE
        Influence of antihistamine pretreatment on vancomycin-induced red-man syndrome.
        J Infect Dis. 1989; 160: 876-881
        • Gatterer G
        Spasmodic low back pain in a patient receiving intravenous vancomycin during continuous ambulatory peritoneal dialysis.
        Clin Pharm. 1984; 3: 87-89
        • Goldman P
        Metronidazole.
        N Eng J Med. 1980; 303: 1212-1218
        • Finegold SM
        • Mathisen GE
        Metronidazole.
        in: Mandell R Douglas Jr., GR Bennett JE Principles and Practice of Infectious Disease. Churchill Livingston, New York1990: 303-307
        • Smilack JD
        • Wilson WR
        • Cockerill FR
        Tetracyclines, chloramphenicol, erythromycin, clindamycin, and metronidazole.
        in: Mayo Clin Proc. 66. 1991: 1270-1280
        • Hamed KA
        • Studemeister AE
        Successful response of metronidazole-resistant trichmonal vaginitis to tinidazole. A case report.
        Sex Trans Dis. 1992; 19: 339-340
        • Schmadel LK
        • McEvoy GK
        Topical metronidazole: a new therapy for rosacea.
        Clin Pharm. 1990; 9: 94-101
        • Stoltze K
        • Stellfeld M
        Systemic absorption of metronidazole after application of a metronidazole 25% dental gel.
        J Clin Periodont. 1992; 19: 693-697
      12. Med Lett Drugs Ther. 1992; 34 (Anon): 17-26
        • Sweet RL
        New approaches for the treatment of bacterial vaginosis.
        Am J Obstet Gyn. 1993; 169: 479-482
        • Lugo-Miro VI
        • Green M
        • Mazur L
        Comparison of different metronidazole therapeutic regimens for bacterial vaginosis. A meta-analysis.
        JAMA. 1992; 268: 92-95
        • Sutherland L
        • Singleton J
        • Sessions J
        • et al.
        Double blind, placebo controlled trial of metronidazole in Crohn's disease.
        Gut. 1991; 32: 1071-1075
        • Motta GJ
        Topical metronidazole. Part I.
        Ostomy Wound Management. 1992; 38: 35-38
        • Dhawan VK
        • Thadepalli H
        Clindamycin: a review of fifteen years of experience.
        Rev Infect Dis. 1982; 4: 1133-1153
        • Steigbigel NH
        Erythromycin, lincomycin, and clindamycin.
        in: Mandell R Douglas Jr., GR Bennet JE Principles and Practice of Infectious Disease. Churchill Livingston Inc, New York1990: 308-317
        • Dannemann B
        • McCutchan JA
        • Israelski D
        • et al.
        Treatment of toxoplasmic encephalitis in patients with AIDS.
        Ann Intern Med. 1992; 116: 33-43
        • Kay R
        • DuBois RE
        Clindamycin/primaquine therapy and secondary prophylaxis against Pnuemocystis carinii pneumonia in patients with AIDS.
        South Med J. 1990; 83: 403-404
        • Noskin GA
        • Murphy RL
        • Black JR
        • et al.
        Salvage therapy with clindamycin/primaquine for Pneumocystis pneumonia.
        Clin Infect Dis. 1992; 14: 183-188
        • Musial CE
        • Rosenblatt JE
        Antimicrobial susceptibilities of anaerobic bacteria isolated at the Mayo Clinic during 1982 through 1987: comparison from 1977 through 1981.
        in: Mayo Clin Proc. 64. 1989: 392-399
        • Cuchural Jr, GJ
        • Tally FP
        • Jacobus NV
        • et al.
        Susceptibility of the Bacteroides fragilis group in the United States: analysis by site of isolation.
        Antimicrob Agents Chemother. 1988; 32: 717-722
        • Yee MH
        • Guiney DG
        • Hasegawa P
        • Davis CE
        Clinical significance of clindamycin-resistant Bacteroides fragilis.
        JAMA. 1982; 248: 1860-1863
        • Levison ME
        • Manfura CT
        • Lorber B
        • et al.
        Clindamycin compared with penicillin for the treatment of anaerobic lung abscess.
        Ann Intern Med. 1983; 98: 466-471
        • Gudiol F
        • Manresa F
        • Pallares R
        • et al.
        Clindamycin vs. penicillin for anaerobic lung infections: high rate of penicillin failures associated with penicillin-resistant Bacteroides melaninogenicus.
        Ann Intern Med. 1990; 150: 2525-2529
        • Bartlett JG
        • Gorbach SL
        Penicillin or clindamycin for primary lung abscess? (editorial).
        Ann Intern Med. 1983; 98: 546-548
        • Alger LS
        • Lovchik JC
        Comparative efficacy of clindamycin vs. erythromycin in eradication of antenatal Chlamydia trachomatis.
        Am J Obstet Gynecol. 1991; 165: 375-381
      13. Med Lett Drugs Ther. 1992; 34 (Anon): 109
        • Schmitt C
        • Sobel JD
        • Meriwether C
        Bacterial vaginosis: treatment with clindamycin cream vs. oral metronidazole.
        Obstet Gynecol. 1992; 79: 1020-1023
        • Leyden JJ
        • Shalita AR
        • Saathuan GD
        • et al.
        Erythromycin 2% gel in comparison with clindamycin phosphate 1% solution in acne vulgaris.
        Am J Am Acad Dermatol. 1987; 16: 822-827
      14. Med Lett Drugs Ther. 1989; 31 (Anon): 94-95