Right Middle Lobe Syndrome Medication

Updated: May 16, 2018
  • Author: Nemr S Eid, MD, FAAP, FCCP; Chief Editor: Denise Serebrisky, MD  more...
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Medication Summary

The role of antibiotic therapy in the treatment of right middle lobe syndrome (RMLS) is not well studied. Antibiotics are usually administered during acute exacerbations and when bronchiectasis is well established. In this latter instance, long-term rotation of antibiotics (ie, 3 weeks on and 1 week off, then change antibiotic) is advocated. Base the choice of antibiotic on culture and sensitivity results of either sputum or bronchoalveolar lavage (BAL) fluid. When this is not available, select a broad-spectrum antibiotic to cover S pneumoniae, other streptococci, H influenzae, and Moraxella catarrhalis. Antibiotics can be orally or intravenously administered. The use of nebulized antibiotics has not been studied in right middle lobe syndrome. Also see Asthma for relevant treatment information. From the authors experience, the use of Azithromycin given three times per week can be helpful in the treatment of established bronchiectasis. 



Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Cefuroxime (Ceftin, 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.

Cefpodoxime proxetil (Vantin)

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins; bacteria eventually lyse because of ongoing activity of cell wall autolytic enzymes while cell wall assembly is arrested.

Cefprozil (Cefzil)

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

Erythromycin and sulfisoxazole (Pediazole)

Erythromycin is a macrolide antibiotic with a large spectrum of activity. Erythromycin binds to the 50S ribosomal subunit of the bacteria, which inhibits protein synthesis.

Sulfisoxazole expands erythromycin's coverage to include gram-negative bacteria. Sulfisoxazole inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid.

Azithromycin (Zithromax)

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

Clarithromycin (Biaxin)

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

Amoxicillin and clavulanic acid (Augmentin)

Drug combination treats bacteria resistant to beta-lactam antibiotics. For children >3 months, base dosing protocol on amoxicillin content. Due to different amoxicillin/clavulanic acid ratios in 250-mg tab (250/125) vs 250 mg chewable-tab (250/62.5), do not use 250-mg tab until child weighs >40 kg.

Sulfamethoxazole and trimethoprim (Bactrim, Septra, Cotrim)

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.