Antibiotic basics for clinicians

ANTIBIOTIC BASICS FOR CLINICIANS THE ABCs OF CHOOSING THE RIGHT ANTIBACTERIAL AGENT, Second Edition The ABCs of Choosing the Right Antibacterial Agent Antibiotic Basics for Clinicians S E C O N D E D.ANTIBIOTIC BASICS FOR CLINICIANS THE ABCs OF CHOOSING THE RIGHT ANTIBACTERIAL AGENT, Second Edition The ABCs of Choosing the Right Antibacterial Agent Antibiotic Basics for Clinicians S E C O N D E D.

Antibiotic Basics for Clinicians: The ABCs of Choosing the Right Antibacterial Agent SECOND EDITION Hauser2e_FM.indd i 12/14/11 11:35 PM Hauser2e_FM.indd ii 12/14/11 11:35 PM Antibiotic Basics for Clinicians: The ABCs of Choosing the Right Antibacterial Agent SECOND EDITION Alan R Hauser, MD, PhD Departments of Microbiology/Immunology and Medicine Northwestern University, Chicago, Illinois Hauser2e_FM.indd iii 12/14/11 11:35 PM Acquisitions Editor: Susan Rhyner Development Editor: Kathleen Scogna Production Manager: Steve Boehm Marketing Manager: Joy Fisher-Williams Designer: Stephen Druding Compositor: Absolute Service, Inc Second Edition Copyright © 2013, 2007 Lippincott Williams & Wilkins, a Wolters Kluwer business 351 West Camden Street Baltimore, MD 21201 Two Commerce Square 2001 Market Street Philadelphia, PA 19103 Printed in People’s Republic of China All rights reserved This book is protected by copyright No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright To request permission, please contact Lippincott Williams & Wilkins at 2001 Market Street, Philadelphia, PA 19103, via e-mail at permissions@lww.com, or via website at lww.com (products and services) Library of Congress Cataloging-in-Publication Data Hauser, Alan R., 1959Antibiotic basics for clinicians : the ABCs of choosing the right antibacterial agent / Alan R Hauser — 2nd ed p ; cm Includes bibliographical references and index ISBN 978-1-4511-1221-4 I Title [DNLM: Bacterial Infections—drug therapy—Examination Questions Bacterial Infections—drug therapy—Outlines Anti-Bacterial Agents—therapeutic use—Examination Questions Anti-Bacterial Agents—therapeutic use—Outlines WC 18.2] 615.3'29—dc23 2011037815 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST Hauser2e_FM.indd iv 12/14/11 11:35 PM ■■■ Dedicated to Anne, Grace, and John ■■■ Hauser2e_FM.indd v 12/14/11 11:35 PM Hauser2e_FM.indd vi 12/14/11 11:35 PM PREFACE Which is more difficult: learning a large body of information or applying the newly learned information? Although the answer is debatable, it is clear that health care professionals must both Most health care training programs consist of an initial phase of classroom lectures and small group sessions in which the intricacies of cranial nerves, the Krebs cycle, and renal physiology are mastered Following this phase, trainees suddenly are immersed in the real world of patients who present with complaints of a cough, a painful lower back, or a fever As an infectious disease subspecialist, I have often seen this culture shock expressed as the blank look of a medical student when asked, “So, what antibiotic should we start this patient on?” Obviously, a basic understanding of the principles of pharmacology and microbiology is insufficient for most trainees when suddenly faced with the complexities of an infected patient This book is meant to be a guide to antibiotics not only for students studying to be physicians, nurse practitioners, physician assistants, pharmacologists, or medical technologists, but will also prove useful for residents, fellows, and practicing clinicians It is designed to serve as a bridge between the book knowledge acquired during the initial phase of training and the reflexive prescribing habits of experienced practitioners Just as the initial bewildering complexities of electrocardiograms and chest radiographs disappear when the first principles underlying these tests are appreciated and understood, so too the difficulties of antibiotic selection By supplying the rationale behind antibiotic selection for many common bacterial pathogens and infectious disease presentations, much of the memorization (and magic and mystery) that usually accompanies proper prescribing of antibiotics is eliminated Where memorization is unavoidable, learning aids are presented that will make the process as painless as possible This book can be easily read and comprehended in or weeks by a busy student or practitioner As a result, it is not a comprehensive guide to the antibiotic metropolis but merely an outline of the major thoroughfares of antibiotic therapy so that readers can more easily fill in the residential streets and alleys as they gain experience In terms of the war analogy used throughout the book, the emphasis is on strategy, not tactics Thus, only commonly used antibiotics are mentioned, and some oversimplification and omissions are unavoidable It is hoped that the reader will be able to master the major concepts and rules so that with subsequent clinical exposure and practice, the nuances and exceptions to these rules may be assimilated The scope of this volume is limited to antibacterial agents, arguably the most complex and frequently encountered antibiotics that must be mastered by health care practitioners Future volumes will address antiviral, antifungal, and antiparasitic agents The second edition of this book has been updated and expanded to include newer antibiotics that have become available during the past years In addition, several older antibiotics that have enjoyed renewed popularity (e.g., colistin and nitrofurantoin) are now also discussed Emerging resistant organisms such as community-acquired methicillin-resistant Staphylococcus aureus and Klebsiella pneumoniae carbapenemaseproducing bacteria have been incorporated Likewise, sections have been updated to reflect recent changes in treatment guidelines, such as those pertaining to Clostridium difficile colitis and urinary tract infections vii Hauser2e_FM.indd vii 12/14/11 11:35 PM viii Preface After completing this book, it is hoped that the reader will view antibiotics as valuable friends in the fight against infectious diseases and not as incomprehensible foes blocking his or her progress toward clinical competency In addition, the reader will obtain a foundation that can be built upon throughout his or her career, as new antibiotics become available I am indebted to many people who have contributed in large and small ways to this book but would especially like to acknowledge a few individuals Many thanks to Mike Postelnick, Kristin Darin, and Marc Scheetz for advice and for reviewing portions of this book; Andy Rabin for providing quotes from the medieval literature; and Joe Welch for invaluable advice Thank you to Kathleen Scogna, Michael Brown, and Steve Boehm at Lippincott Williams & Wilkins for their assistance, patience, and advice throughout the process of putting together the second edition of this book I am grateful to the intelligent and inquisitive medical students at Northwestern University who asked the many questions that inspired this book And finally, I wish to thank my wife, Anne, who made this whole project possible Hauser2e_FM.indd viii 12/14/11 11:35 PM CONTENTS Preface I vii Bacterial Basics II Cell Envelope Protein Production Reproduction Measuring Susceptibility to Antibiotics 13 Antibacterial Agents 15 Antibiotics that Target the Cell Envelope 17 ␤-Lactam Antibiotics 18 Glycopeptides 45 Daptomycin 49 Colistin 51 Antibiotics that Block Protein Production 53 Rifamycins 54 Aminoglycosides 57 Macrolides and Ketolides 61 Tetracyclines and Glycylcyclines 66 Chloramphenicol 70 Clindamycin 72 Streptogramins 74 Linezolid 77 Nitrofurantoin 79 Antibiotics that Target DNA and Replication 81 Sulfa Drugs 82 Quinolones 87 Metronidazole 91 Antimycobacterial Agents 93 Summary of Antibacterial Agents 96 ix Hauser2e_FM.indd ix 12/14/11 11:35 PM x Contents III Definitive Therapy 101 10 Gram-Positive Bacteria 103 Staphylococci 104 Pneumococci 108 Other Streptococci 111 Enterococci 113 Other Gram-Positive Bacteria 117 11 Gram-Negative Bacteria 121 Enterobacteriaceae 122 Pseudomonas 128 Neisseria 132 Curved Gram-Negative Bacteria 134 Other Gram-Negative Bacteria 139 12 Anaerobic Bacteria 145 Clostridia 146 Anaerobic Gram-Negative Bacilli 149 13 Atypical Bacteria 151 Chlamydia 152 Mycoplasma 154 Legionella 156 Brucella 158 Francisella tularensis 160 Rickettsia 162 14 Spirochetes 164 Treponema pallidum 165 Borrelia burgdorferi 167 Leptospira interrogans 169 15 Mycobacteria 171 Mycobacterium tuberculosis 172 Mycobacterium avium Complex 175 Mycobacterium leprae 177 IV Empiric Therapy 179 16 Pneumonia 181 17 Urinary Tract Infections 189 18 Pelvic Inflammatory Disease 194 Hauser2e_FM.indd x 12/14/11 11:35 PM Contents 19 20 21 22 23 24 V Meningitis 197 Cellulitis 202 Otitis Media 205 Infective Endocarditis 208 Intravascular-Related Catheter Infections Intra-abdominal Infections 218 xi 215 Clinical Cases VI Review Questions and Answers Appendices 221 241 253 Dosing of Antibacterial Agents in Adults 253 Dosing of Antibacterial Agents in Children 258 Dosing of Antibacterial Agents in Adults with Renal Insufficiency 264 Antibacterial Agents in Pregnancy 271 Generic and Trade Names of Commonly Used Index Hauser2e_FM.indd xi Antibacterial Agents 275 Treatment of Infections Caused by Bacterial Agents of Bioterrorism 279 Medical References 281 Literary References 282 Answers to Chapter Questions 283 287 12/14/11 11:35 PM Hauser2e_FM.indd xii 12/14/11 11:35 PM ... Antibiotic Basics for Clinicians: The ABCs of Choosing the Right Antibacterial Agent SECOND EDITION Hauser2e_FM.indd i 12/14/11 11:35 PM Hauser2e_FM.indd ii 12/14/11 11:35 PM Antibiotic Basics. .. and services) Library of Congress Cataloging-in-Publication Data Hauser, Alan R., 195 9Antibiotic basics for clinicians : the ABCs of choosing the right antibacterial agent / Alan R Hauser — 2nd... constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings