Moraxella Catarrhalis Infections Medication

  • Author: Michael Constantinescu, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Sep 26, 2011
 

Medication Summary

Approximately 95% of M catarrhalis strains isolated in the United States produce beta-lactamase. Antibiotics such as penicillin, amoxicillin, and ampicillin are only effective against strains that do not produce beta-lactamase.

Topical ciprofloxacin/dexamethasone treatment for acute otitis media with otorrhea via tympanostomy tubes was found to have similar efficacy to that of topical ofloxacin in M catarrhalis infections.[19]

Treatment with oral azithromycin 500 mg once daily for 3 days was found comparable with a 10-day regimen of oral clarithromycin 500 mg twice daily in the treatment of acute exacerbation of chronic bronchitis.[20]

Telithromycin, a ketolide derivative of erythromycin A, demonstrated good in vitro activity against M catarrhalis in acute exacerbation of chronic bronchitis.[21] However, severe liver disease associated with telithromycin use has been reported.[22]

Moxifloxacin, a quinolone, was found to be an effective treatment of M catarrhalis– associated community-acquired pneumonia (400 mg qd).[23]

Among the medicinal plants, garlic, cinnamon, and avocado leaves were found to be antagonistic to M catarrhalis.[24]

The antimicrobial drugs described may be used in M catarrhalis infections, depending on the need for use of oral or parenteral medication, patient age, underlying condition, sensitivity of the organism, and desired spectrum of coverage.

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Antimicrobials

Class Summary

Therapy should cover likely pathogens in the context of this clinical setting. Nearly all M catarrhalis strains produce beta-lactamase.

Amoxicillin-clavulanate, second- and third-generation oral cephalosporins, and trimethoprim-sulfamethoxazole (TMP-SMX) are the most recommended agents. Alternatively, azithromycin, clarithromycin, or dirithromycin can be used. More than 90% of M catarrhalis strains have been shown to resist amoxicillin, and these rates vary by region.[25] All other agents listed below are also effective.

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Erythromycin (E.E.S., E-Mycin, Ery-Tab)

 

Recommended dosing schedule of erythromycin may result in GI upset, causing one to prescribe an alternative macrolide or change to tid dosing. Covers most potential etiologic agents, including Mycoplasma species.

Although 10 d seems to be a standard course of treatment, treating until the patient has been afebrile for 3-5 d seems a more rational approach. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.

In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.

Has the added advantage of being a good anti-inflammatory agent by inhibiting migration of polymorphonuclear leukocytes.

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Cefaclor (Ceclor)

 

Second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods. Determine proper dosage and route based on condition of patient, severity of infection, and susceptibility of causative organism.

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Cefprozil (Cefzil)

 

Binds to 1 or more of the penicillin-binding proteins, which in turn inhibits cell wall synthesis and results in bactericidal activity.

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Cefuroxime (Ceftin, Kefurox, Zinacef)

 

Second-generation cephalosporin maintains gram-positive activity that first-generation cephalosporins have; adds activity against Proteus mirabilis, H influenzae, Escherichia coli, Klebsiella pneumoniae, and M catarrhalis. Condition of patient, severity of infection, and susceptibility of microorganism determine proper dose.

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Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS)

 

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity of TMP-SMX includes common urinary tract pathogens, except Pseudomonas aeruginosa.

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Cefotaxime (Claforan)

 

For septicemia and treatment of gynecologic infections caused by susceptible organisms. Arrests bacterial cell wall synthesis, which in turn inhibits bacterial growth. Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-positive organisms.

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Ceftriaxone (Rocephin)

 

Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

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Cefoperazone (Cefobid)

 

Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins. Presence of piperazine side chain makes it structurally different from other cephalosporins and enhances antipseudomonal activity. Gram-negative spectrum includes M catarrhalis. Dosage depends on severity of infection and susceptibility of organism.

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Ceftazidime (Ceptaz, Fortaz)

 

Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins. Gram-negative spectrum includes M catarrhalis. Dosage depends on severity of infection and susceptibility of organism.

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Ceftizoxime (Cefizox)

 

Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins. Gram-negative spectrum includes M catarrhalis. Dosage depends on severity of infection and susceptibility of organism.

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Ciprofloxacin (Cipro)

 

Fluoroquinolone with activity against most gram-negative organisms, but no activity against anaerobes. Inhibits bacterial DNA synthesis, and consequently, growth.

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Levofloxacin (Levaquin)

 

For pseudomonal infections and infections due to multidrug-resistant gram-negative organisms.

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Azithromycin (Zithromax)

 

Treats mild-to-moderate microbial infections

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Clarithromycin (Biaxin)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

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Dirithromycin (Dynabac)

 

Not available in the United States. Inhibits RNA-dependent protein synthesis by binding to 50S ribosomal subunit. Antimicrobial spectrum includes M catarrhalis. Dosage depends on severity of infection and susceptibility of organism. Dosage depends on severity of infection and susceptibility of organism. In children, age, weight, and severity of infection determine proper dosage.

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Moxifloxacin (Avelox)

 

Inhibits the A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription.

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Contributor Information and Disclosures
Author

Michael Constantinescu, MD  Staff Pathologist, Overton Brooks Veterans Affairs Medical Center

Michael Constantinescu, MD is a member of the following medical societies: American Society for Clinical Pathology, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph A Bocchini Jr, MD  Medical Director of Children's Hospital; Chief of Infectious Disease Section, Director of Clinical Virology Laboratory, Chairman, Professor, Department of Pediatrics, Louisiana State University School of Medicine in Shreveport

Joseph A Bocchini Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Ronald Silberman, PhD  Director of Clinical Microbiology Laboratory, Louisiana State University Hospital; Professor, Department of Pathology, Louisiana State University Medical Center at Shreveport

Disclosure: Nothing to disclose.

James D Cotelingam, MBBS, MD  Head of Hematopathology, Director of Clinical Laboratories, Professor, Department of Pathology, Louisiana State University at Shreveport

James D Cotelingam, MBBS, MD is a member of the following medical societies: American College of Physician Executives, American Society for Clinical Pathology, Association of Military Surgeons of the US, College of American Pathologists, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Specialty Editor Board

Maria D Mileno, MD  Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University

Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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