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Vibrio Infections Medication

  • Author: Hoi Ho, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Sep 25, 2014
 

Medication Summary

In adults with noncholera Vibrio infections other than gastroenteritis, the combination of a third-generation cephalosporin (eg, ceftazidime, cefotaxime, ceftriaxone) and tetracycline or one of its analogues (eg, doxycycline) or a single-agent regimen with a fluoroquinolone (eg, levofloxacin, ciprofloxacin) is the therapy of choice.[32, 33]

Among children with serious noncholera Vibrio infections in whom tetracycline and fluoroquinolone are contraindicated, trimethoprim-sulfamethoxazole plus an aminoglycoside (eg, gentamicin) is recommended.[32]

Analyzing the efficacy of 3 antibiotic regimens (group 1, a third-generation cephalosporin; group 2, a third-generation cephalosporin plus minocycline; group 3, a fluoroquinolone with or without minocycline) in terms of patient outcomes in the treatment of 89 cases of V vulnificus necrotizing fasciitis, authors reported that a fluoroquinolone or the combination of a third-generation cephalosporin plus minocycline are antibiotics of choice in lowering mortality rates (61% in group 1 vs 14% in group 2, P = 0.0003; 61% in group 1 vs 14% in group 3, P = 0.00027).[34]

Another alternative regimen with documented synergism in vivo study on mice is cefotaxime and minocycline.[35]

In a retrospective chart review of 93 patients hospitalized with serious Vibrio infections, the combination of a third-generation cephalosporin and tetracycline or its analogue was an independent factor for lower mortality (OR, 0.337; 95% CI, 0.007-0.192; P < .001).[28]

Tigecycline, a novel glycylcycline, has a potent in vitro antimicrobial effect against Vibrio species. Other newer antibiotics such as daptomycin and linezolid that were approved for the treatment of serious skin and soft-tissue infections have not been studied in serious Vibrio infections. Therefore, the authors do not currently recommend the use of these antibiotics in the treatment of serious Vibrio infections.

Adjuvant therapy: Recombinant human activated protein C (drotrecogin alfa activated) has been used as an adjuvant therapy in patients with severe sepsis who scored 25 or more on the Acute Physiology and Chronic Health Evaluation (APACHE II). A few patients with V vulnificus sepsis who were successfully treated with antibiotics, surgical debridement, and recombinant human activated protein C were reported. In view of serious bleeding associated with the continuous infusion of recombinant human activated protein C and the potential requirement for repeated surgical debridement in patients with V vulnificus sepsis, routine use of this adjuvant therapy is not recommended.[36]

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Antibiotic combinations are usually recommended for serious gram-negative bacillary infections. This approach ensures coverage for a broad range of organisms and polymicrobial infections. In addition, resistance from bacterial subpopulations is prevented, and additive or synergistic effects are provided. Once organisms and sensitivities are known, the use of antibiotic monotherapy is recommended.

Doxycycline (Bio-Tab, Doryx, Vibramycin, Doxy)

 

Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Piperacillin and tazobactam (Zosyn)

 

Antipseudomonal penicillin plus beta-lactamase inhibitor. Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active multiplication.

Ticarcillin and clavulanate (Timentin)

 

Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active growth. Antipseudomonal penicillin plus beta-lactamase inhibitor provides coverage against most gram-positive, gram-negative, and anaerobic bacteria.

Ciprofloxacin (Cipro, Ciloxan)

 

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

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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Contributor Information and Disclosures
Author

Hoi Ho, MD Associate Dean for Faculty Affairs and Development, Professor, Department of Internal Medicine, Director, Center for Advanced Teaching and Assessment in Clinical Simulation (ATACS), Paul L Foster School of Medicine, Texas Tech University Health Sciences Center; Consulting Physician, University Medical Center

Hoi Ho, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American College of Forensic Examiners Institute, American College of Physicians, American Society for Microbiology, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Thong Huy Do, MD Staff Physician, Department of Internal Medicine, Thomason Hospital, Texas Tech University

Thong Huy Do, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Ogechika Karl Alozie, MBBS, MPH, AAHIVS Assistant Professor of Infectious Diseases/Internal Medicine, Texas Tech University Health Sciences Center, Paul L Foster School Of Medicine

Ogechika Karl Alozie, MBBS, MPH, AAHIVS is a member of the following medical societies: American Academy of HIV Medicine

Disclosure: Received honoraria from AbbVie for speaking and teaching; Received honoraria from GSK for speaking and teaching.

Sun-Yu Tran Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine

Sun-Yu Tran is a member of the following medical societies: American College of Physicians, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Mary D Nettleman, MD, MS MACP, Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical and Translational Research, Infectious Diseases Society of America, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Tony Tran Ho, MS Texas Tech University School of Medicine

Tony Tran Ho, MS is a member of the following medical societies: American Medical Association and Texas Medical Association

Disclosure: Nothing to disclose.

Wei-I (Vickie) Wu, MS Texas Tech University School of Medicine

Disclosure: Nothing to disclose.

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Vibrio infections. Early bullous lesions appear over the dorsum of the foot of a patient with cirrhosis.
Vibrio infections. In a patient with cirrhosis, skin lesion rapidly becomes necrotic.
Vibrio infections. Bullous lesions in a patient with cirrhosis continue to progress, and the patient rapidly develops hypotension and shock despite aggressive medical therapy.
Table 1. Noncholera Vibrio Species and Associated Clinical Presentations
Infection Type Noncholera Vibrio Species Cytotoxins/Enzymes
Gastroenteritis V parahaemolyticus



Non-01 V cholerae



Vibrio fluvialis



V mimicus



Vibrio furnissii



Vibrio hollisae



Vibrio alginolyticus



V vulnificus



Cytotoxin



Hemolysin



Wound infection V alginolyticus



V vulnificus



Non-01 V cholerae



Vibrio damsela



Vibrio carchariae



V fluvialis



V parahaemolyticus



V mimicus



Protease



Hemolysin



Lipase



DNAase



Cytolysin



Septicemia V vulnificus



V fluvialis



V damsela



Non-01 V cholerae



Vibrio cincinnatiensis



Proteases



Endotoxic lipopolysaccharide



Table 2. Clinical Presentation Rates of Pathogenic Vibrio Infections
Vibrio Species Gastroenteritis



(%)



Wound Infection



(%)



Septicemia



(%)



Miscellaneous



(%)



V parahaemolyticus 59 34 5 2
V vulnificus 5 45 43 7
Non-01 V cholerae 67 9 15
V alginolyticus 5-12 71 1 10-15
V mimicus 85 3 3
V fluvialis 73 10 6
V damsela Rare >95 Rare
V furnissii >90 Rare Rare
Vibrio metschnikovii Common Rare Rare
V hollisae 85 7 5
V cincinnatiensis Rare Rare Rare Meningitis
Table 3. Clinical Signs and Symptoms of Vibrio Infections
Clinical Presentation Symptoms (Frequency)
Gastroenteritis Diarrhea (100%)



Abdominal cramps (89%)



Nausea (76%)



Vomiting (55%)



Fever (47%)



Bloody stools (29%)



Headache (24%)



Myalgia (24%)



Wound infection Swelling (100%)



Pain (100%)



Erythema (100%)



Bullae (30-50%)



Necrosis (30-50%)



Gangrene (< 10%)



Septicemia Fever (>90%)



Hypothermia (< 10%)



Hypotension (100%)



Tachycardia (80-90%)



Shock (50-70%)



Bullae (80-100%)



Acute respiratory distress syndrome (< 5%)



Multiple organ dysfunction (30-50%)



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