Antibiotic basics for clinicians

ANTIBIOTIC BASICS FOR CLINICIANS THE ABCs OF CHOOSING THE RIGHT ANTIBACTERIAL AGENT, Second Edition The ABCs of Choosing the Right Antibacterial Agent Antibiotic Basics for Clinicians S E C O N D E D.ANTIBIOTIC BASICS FOR CLINICIANS THE ABCs OF CHOOSING THE RIGHT ANTIBACTERIAL AGENT, Second Edition The ABCs of Choosing the Right Antibacterial Agent Antibiotic Basics for Clinicians S E C O N D E D.

The ABCs of Choosing the Right Antibacterial Agent

Antibiotic Basics for Clinicians:

S E C O N D E D I T I O N

Antibiotic Basics

for Clinicians:

The ABCs of

Choosing the Right

Antibacterial Agent

Alan R Hauser, MD, PhD

Departments of Microbiology/Immunology and Medicine

Northwestern University, Chicago, Illinois

S E C O N D E D I T I O N

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Second Edition

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9 8 7 6 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

Hauser, Alan R.,

Antibiotic basics for clinicians : the ABCs of choosing the right antibacterial agent / Alan R Hauser — 2nd ed.

p ; cm.

Includes bibliographical references and index.

ISBN 978-1-4511-1221-4

I Title

[DNLM: 1 Bacterial Infections—drug therapy—Examination Questions 2 Bacterial Infections—drug

therapy—Outlines 3 Anti-Bacterial Agents—therapeutic use—Examination Questions 4 Anti-Bacterial

Agents—therapeutic use—Outlines WC 18.2]

615.3'29—dc23

2011037815 DISCLAIMER

Care has been taken to confi rm the accuracy of the information present and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any

conse-quences from application of the information in this book and make no warranty, expressed or implied, with respect

to the currency, completeness, or accuracy of the contents of the publication Application of this information in a

particular situation remains the professional responsibility of the practitioner; the clinical treatments described and

recommended may not be considered absolute and universal recommendations.

The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication

However, in view of ongoing research, changes in government regulations, and the constant fl ow of information

relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any

change in indications and dosage and for added warnings and precautions This is particularly important when the

recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to

ascer-tain the FDA status of each drug or device planned for use in their clinical practice.

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■ ■ ■

Dedicated to Anne, Grace, and John

■ ■ ■

P R E F A C E

Which is more diffi cult: learning a large body of information or applying the newly

learned information? Although the answer is debatable, it is clear that health care

professionals must do both Most health care training programs consist of an initial

phase of classroom lectures and small group sessions in which the intricacies of

cra-nial nerves, the Krebs cycle, and renal physiology are mastered Following this phase,

trainees suddenly are immersed in the real world of patients who present with

com-plaints of a cough, a painful lower back, or a fever As an infectious disease

subspecial-ist, I have often seen this culture shock expressed as the blank look of a medical student

when asked, “So, what antibiotic should we start this patient on?” Obviously, a basic

understanding of the principles of pharmacology and microbiology is insuffi cient for

most trainees when suddenly faced with the complexities of an infected patient

This book is meant to be a guide to antibiotics not only for students studying to be physicians, nurse practitioners, physician assistants, pharmacologists, or medical

tech-nologists, but will also prove useful for residents, fellows, and practicing clinicians It is

designed to serve as a bridge between the book knowledge acquired during the initial

phase of training and the refl exive prescribing habits of experienced practitioners Just

as the initial bewildering complexities of electrocardiograms and chest radiographs

dis-appear when the fi rst principles underlying these tests are appreciated and understood,

so too do the diffi culties of antibiotic selection By supplying the rationale behind

anti-biotic selection for many common bacterial pathogens and infectious disease

presenta-tions, much of the memorization (and magic and mystery) that usually accompanies

proper prescribing of antibiotics is eliminated Where memorization is unavoidable,

learning aids are presented that will make the process as painless as possible

This book can be easily read and comprehended in 1 or 2 weeks by a busy student

or practitioner As a result, it is not a comprehensive guide to the antibiotic metropolis

but merely an outline of the major thoroughfares of antibiotic therapy so that readers

can more easily fi ll in the residential streets and alleys as they gain experience In terms

of the war analogy used throughout the book, the emphasis is on strategy, not tactics

Thus, only commonly used antibiotics are mentioned, and some oversimplifi cation

and omissions are unavoidable It is hoped that the reader will be able to master the

major concepts and rules so that with subsequent clinical exposure and practice, the

nuances and exceptions to these rules may be assimilated

The scope of this volume is limited to antibacterial agents, arguably the most com-plex and frequently encountered antibiotics that must be mastered by health care

prac-viii Preface

After completing this book, it is hoped that the reader will view antibiotics as valuable friends in the fi ght against infectious diseases and not as incomprehensible

foes blocking his or her progress toward clinical competency In addition, the reader

will obtain a foundation that can be built upon throughout his or her career, as new

antibiotics become available

I am indebted to many people who have contributed in large and small ways to this book but would especially like to acknowledge a few individuals Many thanks to

Mike Postelnick, Kristin Darin, and Marc Scheetz for advice and for reviewing

por-tions of this book; Andy Rabin for providing quotes from the medieval literature; and

Joe Welch for invaluable advice Thank you to Kathleen Scogna, Michael Brown, and

Steve Boehm at Lippincott Williams & Wilkins for their assistance, patience, and

ad-vice throughout the process of putting together the second edition of this book I am

grateful to the intelligent and inquisitive medical students at Northwestern University

who asked the many questions that inspired this book And fi nally, I wish to thank my

wife, Anne, who made this whole project possible

Preface vii

1. Cell Envelope 3

2. Protein Production 6

3. Reproduction 9

4. Measuring Susceptibility to Antibiotics 13

5 Antibiotics that Target the Cell Envelope 17

␤-Lactam Antibiotics 18 Glycopeptides 45

Daptomycin 49 Colistin 51

6 Antibiotics that Block Protein Production 53

Rifamycins 54 Aminoglycosides 57 Macrolides and Ketolides 61 Tetracyclines and Glycylcyclines 66 Chloramphenicol 70

Clindamycin 72 Streptogramins 74 Linezolid 77 Nitrofurantoin 79

7 Antibiotics that Target DNA and Replication 81

C O N T E N T S

10 Gram-Positive Bacteria 103

Staphylococci 104 Pneumococci 108 Other Streptococci 111 Enterococci 113 Other Gram-Positive Bacteria 117

11 Gram-Negative Bacteria 121

Enterobacteriaceae 122 Pseudomonas 128 Neisseria 132 Curved Gram-Negative Bacteria 134 Other Gram-Negative Bacteria 139

12 Anaerobic Bacteria 145

Clostridia 146 Anaerobic Gram-Negative Bacilli 149

13 Atypical Bacteria 151

Chlamydia 152 Mycoplasma 154 Legionella 156 Brucella 158 Francisella tularensis 160 Rickettsia 162

14 Spirochetes 164

Treponema pallidum 165 Borrelia burgdorferi 167 Leptospira interrogans 169

15 Mycobacteria 171

Mycobacterium tuberculosis 172 Mycobacterium avium Complex 175 Mycobacterium leprae 177

16 Pneumonia 181

17 Urinary Tract Infections 189

18 Pelvic Infl ammatory Disease 194

Contents

19 Meningitis 197

20 Cellulitis 202

21 Otitis Media 205

22 Infective Endocarditis 208

23 Intravascular-Related Catheter Infections 215

24 Intra-abdominal Infections 218

1. Dosing of Antibacterial Agents in Adults 253

2. Dosing of Antibacterial Agents in Children 258

3. Dosing of Antibacterial Agents in Adults with Renal Insuffi ciency 264

4. Antibacterial Agents in Pregnancy 271

5. Generic and Trade Names of Commonly Used Antibacterial Agents 275

6. Treatment of Infections Caused by Bacterial Agents of Bioterrorism 279

7. Medical References 281

8. Literary References 282

9. Answers to Chapter Questions 283

Index 287

Contents