Antibiotics From ancient Greek, antiviotika also called antibacterials, are a type of antimicrobial drug used in the treatment and prevention. Looking for online definition of pneumonia in the Medical Dictionary pneumonia explanation free. What is pneumonia Meaning of pneumonia medical term. What does. Review Article. Primary Care. Aspiration Pneumonitis and Aspiration Pneumonia. Paul E. Marik, M. B., B. Ch. N Engl J Med 2001 344665671 March 1, 2001 DOI 10. 1056. WARNING Clostridium difficile associated diarrhea CDAD has been reported with use of nearly all antibacterial agents, including CLEOCIN PHOSPHATE and may. Carbapenem Wikipedia. Core structure of the carbapenem molecules. Carbapenems are antibiotics used for the treatment of infections known or suspected to be caused by multidrug resistant MDR bacteria. Their use is primarily in people who are hospitalized. Like the penicillins and cephalosporins, they are members of the beta lactam class of antibiotics, which kill bacteria by binding to penicillin binding proteins and inhibiting cell wall synthesis. They exhibit a broader spectrum of activity compared to cephalosporins and penicillins. Their effectiveness is less affected by many common mechanisms of antibiotic resistance than other beta lactams. Carbapenem antibiotics were originally developed at Merck Co. Streptomyces cattleya. 12 Concern has arisen in recent years over increasing rates of resistance to carbapenems, as there are few therapeutic options for treating infections caused by carbapenem resistant bacteria such as the carbapenem resistant Enterobacteriaceae and Klebsiella pneumoniae3. 456Medical useseditAbdominal infectionseditThe carbapenem ertapenem is one of several first line agents recommended by the Infectious Disease Society of America for the empiric treatment of community acquired intra abdominal infections of mild to moderate severity. Agents with anti pseudomonal activity, including doripenem, imipenem, and meropenem are not recommended in this population. Doripenem, imipenem, and meropenem are recommended for high risk community acquired abdominal infections and for abdominal infections that are hospital acquired. 7Complicated urinary tract infectionseditA 2. E. coli infections. 8PneumoniaeditThe carbapenems imipenem and meropenem are recommended by the American Thoracic Society and the Infectious Disease Society of America as one of several first line therapy options for people with late onset hospital acquired or ventilator associated pneumonia, especially when Pseudomonas, Acinetobacter, or extended spectrum beta lactamase producing Enterobactericeace are suspected pathogens. Combination therapy, typically with an aminoglycoside, is recommended for Pseudomonas infections to avoid resistance development during treatment. 9Carbapenems are less commonly used in the treatment of community acquired pneumonia, as community acquired strains of the most common responsible pathogens Streptocuccus pneumoniae, Haemophilus influenazae, atypical bacteria, and Enterobactericeace are typically susceptible to narrower spectrum andor orally administered agents such as fluoroquinolones, amoxicillin, or azithromycin. Imipenem and meropenem are useful in cases in which P. Bloodstream InfectionseditA 2. In 2. 01. 5, the National Institute for Health and Care Excellence recommended piperacillin tazobactam as first line therapy for the treatment of bloodstream infections in neutropenic cancer patients. 1. For bloodstream infections known to be due to extended spectrum beta lactamase producing Enterobacteriaceace, carbapenems are superior to alternative treatments. 1. Spectrum of activityeditCarbapenems exhibit broad spectrum activity against gram negative bacteria and somewhat narrower activity against gram positive bacteria. For empiric therapy treatment of infections prior to identification of the responsible pathogen they are often combined with a second drug having broader spectrum gram positive activity. Gram negative pathogenseditThe spectrum of activity of the carbapenems imipenem, doripenem, and meropenem includes most Enterobacteriaceace species, including Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Citrobacter freundii, Proteus mirabilis, and Serratia marcescens. Activity is maintained against most strains of E. K. pneumoniae that are resistant to cephalosporins due to the production of extended spectrum beta lactamases. Imipenem, doripenem, and meropenem also exhibit good activity against most strains of Pseudomonas aeruginosa and Acinetobacter species. The observed activity against these pathogens is especially valued as they are intrinsically resistant to many other antibiotic classes. 4Gram positive pathogenseditThe spectrum of activity of the carbapenems against gram positive bacteria is fairly broad, but not as exceptionally so as in the case of gram negative bacteria. Good activity is seen against methicillin sensitive strains of Staphylococcus species, but many other antibiotics provide coverage for such infections. Good activity is also observed for most Streptococcus species, including penicillin resistant strains. Carbapenems are not highly active against methicillin resistant Staphyloccus aureus or most enterococcal infections because carbapenems do not bind to the penicillin binding protein used by these pathogens. 4Carbapenems generally exhibit good activity against anaerobes such as Bacteriodes fragilis. Like other beta lactam antibiotics, they lack activity against atypical bacteria, which do not have a cell wall and are thus not affected by cell wall synthesis inhibitors. 4ContraindicationseditCarbapenems are contraindicated in patients with prior allergic reactions to beta lactam antibiotics. In addition, as the intramuscular formulations of ertapenem and imipenem are formulated with lidocaine, the intramuscular formulation of these two drugs are contraindicated in patients with prior adverse reactions to lidocaine. 1. Adverse effectseditSerious and occasionally fatal allergic reactions can occur in people treated with carbapenems. 1. Seizures are a dose limiting toxicity for both imipenem and meropenem. 1. Clostridium difficile related diarrhea may occur in people treated with carbapenems or other broad spectrum antibiotics. 1. Those with an allergy to penicillin may develop a cross sensitivity to carbapenems. 1. ExampleseditApproved for clinical useeditImipenem, the first clinically used carbapenem, was developed at Merck and Co. It was approved for use in the United States in 1. Imipenem is hydrolyzed in the mammalian kidney by a dehydropeptidase enzyme to a nephrotoxic intermediate, and thus is co formulated with the dehydropeptidase inhibitor cilastatin. 5 Imipenem is available in both intravenous2. Meropenem is stable to mammalian dehydropeptidases and does not require co administration of cilastatin. It was approved for use in the United States in 1. In most indications it is somewhat more convenient to administer than imipenem, 3 times a day rather than 4. Doses of less than one gram may be administered as an IV bolus, whereas imipenem is usually administered as a 2. Meropenem is somewhat less potent than imipenem against gram positive pathogens, and somewhat more potent against gram negative infections. Unlike imipenem, which produced an unacceptable rate of seizures in a phase 2 trial, meropenem is effective for the treatment of bacterial meningitis. 2. A systematic review performed by an employee of the company that markets meropenem concluded that it provides a higher bacterial response and lower adverse event rates than imipenem in people with severe infections, but no difference in mortality rate. 2. Ertapenem is administered once daily as an intravenous infusion or intramuscular injection. It lacks useful activity against the P. Acetinobacter species, both of which are important causes of hospital acquired infections. 2. Doripenem has a spectrum of activity very similar to that of meropenem. Its greater stability in solution allows the use of prolonged infusions and it is somewhat less likely to produce seizures than other carbapenems. 2. Panipenembetamipron Japanese approval 1. Biapenem Japanese approval 2. Tebipenem Japanese approval 2. UnapprovedexperimentaleditRazupenem PZ 6. PZ 6. 01 is a carbapenem antibiotic currently being tested as having a broad spectrum of activity including strains resistant to other carbapenems. Despite early Phase II promise, Novartis who acquired PZ 6. Protez Pharmaceuticals recently dropped PZ 6. Lenapenem. Tomopenem. Thienamycin thienpenem the first discovered carbapenem. Bacterial resistanceeditEnterobacteriaceaeeditEnterobacteriaceae are common pathogens responsible for urinary tract infections,3. Beta lactam resistance in these pathogens is most commonly due to the expression of beta lactamase enzymes. 3. Between 2. 00. 7 and 2. Escherichia coli isolates from Canadian hospitals that produce extended spectrum beta lactamases ESBL increased from 3.
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