Lung Abscess Medication

Updated: Jun 15, 2017
  • Author: Nader Kamangar, MD, FACP, FCCP, FCCM; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Medication

Medication Summary

Most abscesses develop secondary to aspiration and are caused by anaerobes. A history suggestive of community acquired pneumonia or a history of development of abscess in a hospitalized patient is important in deciding the appropriate antibiotic coverage.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens suspected in this clinical setting.

Clindamycin (Cleocin)

Lincosamides are used for the treatment of serious skin and soft tissue staphylococcal infections. They are slso effective against aerobic and anaerobic streptococci, except enterococci. Clindamycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Cefoxitin (Mefoxin)

Cefoxitin is a second-generation cephalosporin indicated for gram-positive cocci and gram-negative rod infections. Infections caused by cephalosporin- or penicillin-resistant gram-negative bacteria may respond to cefoxitin.

Penicillin G (Pfizerpen)

Penicillin G interferes with the synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

Metronidazole (Flagyl, Flagyl ER, Metro)

Metronidazole is an imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. It is used in combination with other antimicrobial agents (except for Clostridium difficile enterocolitis). It is not standard practice to use metronidazole alone because some anaerobic cocci and most microaerophilic streptococci are resistant.

Sulfamethoxazole and Trimethoprim (Bactrim, Bactrim DS, Septra DS, Sulfatrim)

This is a synthetic combination antibiotic. It is rapidly absorbed after oral administration. The mechanism of action involves blockage of two consecutive steps in biosynthesis of nucleic acids and proteins needed by many microorganisms. It provides coverage for common forms of both gram-positive and gram-negative organisms.

Ciprofloxacin (Cipro, Cipro XR)

Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Ciprofloxacin has no activity against anaerobes. Continue treatment for at least 2 days (7-14 d typical) after signs and symptoms have disappeared.

Moxifloxacin (Avelox)

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

Ampicillin and sulbactam (Unasyn)

This is a drug combination of a beta-lactamase inhibitor with ampicillin. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. It covers skin, enteric flora, and anaerobes. It is not ideal for nosocomial pathogens.

Linezolid (Zyvox)

Linezolid prevents the formation of functional 70S initiation complex, which is essential for the bacterial translation process. It is bacteriostatic against enterococci and staphylococci and bactericidal against most strains of streptococci. It is used as an alternative in patients allergic to vancomycin and for the treatment of vancomycin-resistant enterococci.

Vancomycin

Vancomycin is used in prophylaxis. It is a potent antibiotic directed against gram-positive organisms and active against Enterococcus species. It is useful in the treatment of septicemia and skin structure infections. Vancomycin is indicated for patients who cannot receive, or have failed to respond to, penicillins and cephalosporins or have infections with resistant staphylococci. For abdominal penetrating injuries, it is combined with an agent active against enteric flora and/or anaerobes.

To avoid toxicity, the current recommendation is to assay vancomycin trough levels after the third dose drawn 0.5 hour prior to the next dosing. Use creatinine clearance to adjust dose in patients diagnosed with renal impairment.

Vancomycin is used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing gastrointestinal or genitourinary procedures.

Imipenem/cilastatin (Primaxin)

This combination is for the treatment of multiple-organism infections in which other agents do not have wide-spectrum coverage or are contraindicated because of a potential for toxicity.

Amikacin

Amikacin irreversibly binds to the 30S subunit of bacterial ribosomes; it blocks the recognition step in protein synthesis and causes growth inhibition. It is for gram-negative bacterial coverage of infections resistant to gentamicin and tobramycin. Amikacin is effective against Pseudomonas aeruginosa. Use the patient's ideal body weight for dosage calculation. The same principles of drug monitoring for gentamicin apply to amikacin.

Ceftaroline (Teflaro)

Ceftaroline is a fifth-generation cephalosporin indicated for community-acquired bacterial pneumonia and for acute bacterial skin and skin structure infections, including MRSA. This agent is a beta-lactam cephalosporin with activity against aerobic and anaerobic gram-positive and aerobic gram-negative bacteria. It demonstrates activity in vivo against resistant MRSA strains and activity in vitro against vancomycin-resistant and linezolid-resistant S aureus.

Meropenem (Merrem IV)

Meropenem is a bactericidal broad-spectrum carbapenem antibiotic that inhibits the A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription, and inhibits cell wall synthesis. Meropenem is effective against most gram-positive and gram-negative bacteria and has slightly increased activity against gram-negatives and slightly decreased activity against staphylococci and streptococci compared with imipenem.

Doripenem (Doribax)

Doripenem is a carbapenem antibiotic. It has a spectrum of activity similar to that of imipenem and meropenem. It elicits activity against a wide range of gram-positive and gram-negative bacteria.

Ertapenem (Invanz)

Ertapenem is a carbapenem antibiotic that has bactericidal activity resulting from inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin-binding proteins. Ertapenem is stable against hydrolysis by a variety of beta-lactamases, including penicillinases, cephalosporinases, and extended-spectrum beta-lactamases. It is hydrolyzed by metallo-beta-lactamases.

Levofloxacin (Levaquin, Levofloxacin Systemic)

Levofloxacin is a fluoroquinolone. It is the L stereoisomer of the D/L parent compound ofloxacin, the D form being inactive. It has good monotherapy with extended coverage against pseudomonal species and excellent activity against pneumococcal species. Levofloxacin acts by inhibition of DNA gyrase activity. The oral form has a bioavailability that is reportedly 99%.

Telavancin (Vibativ)

Telavancin is a lipoglycopeptide antibacterial that is a synthetic derivative of vancomycin. This agent is reserved for use when alternative treatments are not suitable.

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