The ABCs of Choosing the Right Antibacterial Agent

Antibiotic Basics for Clinicians:

S E C O N D E D I T I O N

Hauser2e_FM.indd iHauser2e_FM.indd i 12/14/11 11:35 PM12/14/11 11:35 PM

Hauser2e_FM.indd iiHauser2e_FM.indd ii 12/14/11 11:35 PM12/14/11 11:35 PM

Antibiotic Basics for Clinicians:The ABCs of Choosing the Right Antibacterial Agent

Alan R. Hauser, MD, PhDDepartments of Microbiology/Immunology and MedicineNorthwestern University, Chicago, Illinois

S E C O N D E D I T I O N

Hauser2e_FM.indd iiiHauser2e_FM.indd iii 12/14/11 11:35 PM12/14/11 11:35 PM

Acquisitions Editor: Susan RhynerDevelopment Editor: Kathleen ScognaProduction Manager: Steve BoehmMarketing Manager: Joy Fisher-WilliamsDesigner: Stephen DrudingCompositor: Absolute Service, Inc.

Second Edition

Copyright © 2013, 2007 Lippincott Williams & Wilkins, a Wolters Kluwer business.

351 West Camden Street Two Commerce SquareBaltimore, MD 21201 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 offi cial 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).

9 8 7 6 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

Hauser, Alan R., 1959- Antibiotic 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: 1. Bacterial Infections—drug therapy—Examination Questions. 2. Bacterial Infections—drug therapy—Outlines. 3. Anti-Bacterial Agents—therapeutic use—Examination Questions. 4. Anti-Bacterial Agents—therapeutic use—Outlines. WC 18.2]

615.3'29—dc232011037815

DISCLAIMER

Care has been taken to confi rm 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 conse-quences 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 fl ow 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 ascer-tain 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 cus-tomer service representatives are available from 8:30 am to 6:00 pm, EST.

Hauser2e_FM.indd ivHauser2e_FM.indd iv 12/14/11 11:35 PM12/14/11 11:35 PM

■ ■ ■

Dedicated to Anne, Grace, and John

■ ■ ■

Hauser2e_FM.indd vHauser2e_FM.indd v 12/14/11 11:35 PM12/14/11 11:35 PM

Hauser2e_FM.indd viHauser2e_FM.indd vi 12/14/11 11:35 PM12/14/11 11:35 PM

vii

P R E F A C E

Which is more diffi cult: 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 do both. Most health care training programs consist of an initial phase of classroom lectures and small group sessions in which the intricacies of cra-nial 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 com-plaints of a cough, a painful lower back, or a fever. As an infectious disease subspecial-ist, 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 insuffi cient 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 tech-nologists, 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 refl exive prescribing habits of experienced practitioners. Just as the initial bewildering complexities of electrocardiograms and chest radiographs dis-appear when the fi rst principles underlying these tests are appreciated and understood, so too do the diffi culties of antibiotic selection. By supplying the rationale behind anti-biotic selection for many common bacterial pathogens and infectious disease presenta-tions, 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 1 or 2 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 fi ll 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 oversimplifi cation 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 com-plex and frequently encountered antibiotics that must be mastered by health care prac-titioners. 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 3 years. In addition, several old-er 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 carbapenemase-producing bacteria have been incorporated. Likewise, sections have been updated to refl ect recent changes in treatment guidelines, such as those pertaining to Clostridium diffi cile colitis and urinary tract infections.

Hauser2e_FM.indd viiHauser2e_FM.indd vii 12/14/11 11:35 PM12/14/11 11:35 PM

viii Preface

After completing this book, it is hoped that the reader will view antibiotics as valuable friends in the fi ght 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 por-tions 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 ad-vice 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 fi nally, I wish to thank my wife, Anne, who made this whole project possible.

Hauser2e_FM.indd viiiHauser2e_FM.indd viii 12/14/11 11:35 PM12/14/11 11:35 PM

Preface vii

I Bacterial Basics 1

1. Cell Envelope 3 2. Protein Production 6 3. Reproduction 9 4. Measuring Susceptibility to Antibiotics 13

II Antibacterial Agents 15

5. Antibiotics that Target the Cell Envelope 17�-Lactam Antibiotics 18Glycopeptides 45Daptomycin 49Colistin 51

6. Antibiotics that Block Protein Production 53Rifamycins 54Aminoglycosides 57Macrolides and Ketolides 61Tetracyclines and Glycylcyclines 66Chloramphenicol 70Clindamycin 72Streptogramins 74Linezolid 77Nitrofurantoin 79

7. Antibiotics that Target DNA and Replication 81Sulfa Drugs 82Quinolones 87Metronidazole 91

8. Antimycobacterial Agents 93 9. Summary of Antibacterial Agents 96

C O N T E N T S

ix

Hauser2e_FM.indd ixHauser2e_FM.indd ix 12/14/11 11:35 PM12/14/11 11:35 PM

x

III Defi nitive Therapy 101

10. Gram-Positive Bacteria 103Staphylococci 104Pneumococci 108Other Streptococci 111Enterococci 113Other Gram-Positive Bacteria 117

11. Gram-Negative Bacteria 121Enterobacteriaceae 122Pseudomonas 128Neisseria 132Curved Gram-Negative Bacteria 134Other Gram-Negative Bacteria 139

12. Anaerobic Bacteria 145Clostridia 146Anaerobic Gram-Negative Bacilli 149

13. Atypical Bacteria 151Chlamydia 152Mycoplasma 154Legionella 156Brucella 158Francisella tularensis 160Rickettsia 162

14. Spirochetes 164Treponema pallidum 165Borrelia burgdorferi 167Leptospira interrogans 169

15. Mycobacteria 171Mycobacterium tuberculosis 172Mycobacterium avium Complex 175Mycobacterium leprae 177

IV Empiric Therapy 179

16. Pneumonia 181 17. Urinary Tract Infections 189 18. Pelvic Infl ammatory Disease 194

Contents

Hauser2e_FM.indd xHauser2e_FM.indd x 12/14/11 11:35 PM12/14/11 11:35 PM

xi

19. Meningitis 197 20. Cellulitis 202 21. Otitis Media 205 22. Infective Endocarditis 208 23. Intravascular-Related Catheter Infections 215 24. Intra-abdominal Infections 218

V Clinical Cases 221

VI Review Questions and Answers 241

Appendices 253

1. Dosing of Antibacterial Agents in Adults 253 2. Dosing of Antibacterial Agents in Children 258 3. Dosing of Antibacterial Agents in Adults with Renal

Insuffi ciency 264 4. Antibacterial Agents in Pregnancy 271 5. Generic and Trade Names of Commonly Used

Antibacterial Agents 275 6. Treatment of Infections Caused by Bacterial Agents of

Bioterrorism 279 7. Medical References 281 8. Literary References 282 9. Answers to Chapter Questions 283

Index 287

Contents

Hauser2e_FM.indd xiHauser2e_FM.indd xi 12/14/11 11:35 PM12/14/11 11:35 PM

Hauser2e_FM.indd xiiHauser2e_FM.indd xii 12/14/11 11:35 PM12/14/11 11:35 PM