Antimicrobials
Class Summary
Intravenous antibiotics should be directed against the most likely bacterial pathogens, including S aureus and S pneumoniae. Other considerations should include antibiotic coverage for K pneumoniae,E coli, and group A streptococci. Most often, an appropriate single agent can be used, but combined antibiotic therapy can be considered, especially if a specific organism is not identified. As community-associated methicillin-resistant S aureus (MRSA) has increasingly been identified, reconsideration of empiric choice of antistaph beta-lactam for seriously ill patients with suspected MRSA should be carefully considered. [18] The following antimicrobials may be used to target an underlying pneumonia.
Oxacillin (Bactocill)
A very effective antibiotic for treating S aureus as well as S pneumoniae.
Ampicillin and sulbactam (Unasyn)
Drug combination of beta-lactamase inhibitor with ampicillin. A very effective antibiotic for treating S aureus as well as S pneumoniae. Also effective for many anaerobic infections.
Cefuroxime (Zinacef)
Very effective antibiotic for treating S aureus and S pneumoniae.
Vancomycin (Lyphocin, Vancocin, Vancoled)
Very effective antibiotic for treating methicillin-resistant S aureus as well as for treating penicillin-resistant S pneumoniae.
To avoid toxicity, current recommendation is to assay vancomycin trough levels before fourth dose. Use CrCl to adjust dose in patients with renal impairment.
Clindamycin (Cleocin)
Very effective antibiotic for treating S aureus as well as S pneumoniae. Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Ciprofloxacin (Cipro)
Very effective antibiotic for treating S aureus as well as S pneumoniae. A fluoroquinolone with activity against Pseudomonas, streptococci, MRSA, S epidermidis, and most gram-negative organisms but no activity against anaerobes. Inhibits bacterial DNA synthesis and consequently growth.
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Pneumonia with multiple pneumatoceles.
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Pneumonia with pneumatocele (lateral).
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Resolving pneumatocele.
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Chest CT scan of pneumonia with pneumatocele.