Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Class Summary

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting. Base selection of antibiotics on blood culture sensitivity whenever feasible. Indicated as an adjunct to decompression/resection of the gallbladder with empyema.

Class Summary

Second-generation cephalosporins have extended coverage against anaerobes and gram-negative bacilli.

Cefuroxime (Ceftin, Zinacef)

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Binds to penicillin-binding proteins and inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell-wall death; resists degradation by beta-lactamase; proper dosing and appropriate route of administration are determined by condition of patient, severity of infection, and susceptibility of microorganism.

Class Summary

Extended-spectrum penicillins are semi-synthetic penicillin analogs used in the treatment of moderate to severe urinary, respiratory, gastrointestinal tract, skin, bone and joint infections. These agents extended activity against garm-negative bacteria and particular activity against Escherichia coli, Hemophilis influenzae, Listeria monocytogenesis, Neisseria gonorrhoeae, Proteus mirabilis, Salmonella, Shigella, Staphylococcus aureus (non-penicillinase producing), Staphylococcus epidermidis, and Streptococcus pneumoniae.

Piperacillin/tazobactam (Zosyn)

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Antipseudomonal penicillin plus beta-lactamase inhibitor; inhibits biosynthesis of cell wall mucopeptide synthesis by binding to 1 or more of the penicillin-binding proteins and is effective during active-multiplication stage.

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Author

Benjamin Pace, MD, FACS Chief, Division of Breast Surgery, Department of Surgery, Queens Hospital Center; Associate Professor of Surgery, Icahn School of Medicine at Mount Sinai

Benjamin Pace, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Coauthor(s)

James T O'Connor, MD Assistant Professor of Surgery, Icahn School of Medicine at Mount Sinai; Director of Surgery, Attending Surgeon, Queens Hospital Center

James T O'Connor, MD is a member of the following medical societies: American Medical Association, American Society of Colon and Rectal Surgeons, New York Society of Colon and Rectal Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons

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.

Chief Editor

Praveen K Roy, MD, AGAF Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine

Praveen K Roy, MD, AGAF is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF Associate Professor of Clinical Medicine, Albert Einstein College of Medicine of Yeshiva University; Associate Professor of Clinical Medicine, Hofstra Medical School

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, New York Society for Gastrointestinal Endoscopy, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Sita Chokhavatia, MD, MBBS Associate Fellowship Director, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, Mount Sinai School of Medicine

Sita Chokhavatia, MD, MBBS is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Bruce Morel, MD, FACS Clinical Assistant Professor, Department of Surgery, Mount Sinai School of Medicine

Bruce Morel, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, and Medical Society of the State of New York

Disclosure: Nothing to disclose.