Antibacterial drugs

Prior to initiation of cefoperazone therapy, appropriate specimens should be obtained for identification of the causative organism and in vitro susceptibility tests. Cefoperazone may be started pending results of susceptibility tests but should be discontinued if the causative organism is found to be resistant to the drug. In serious infections when the causative organism is unknown, concomitant therapy with an aminoglycoside may be indicated pending results of in vitro susceptibility tests. However, in vitro studies indicate that cefoperazone is less active on a weight basis than cefotaxime, ceftizoxime, and ceftriaxone against susceptible Enterobacteriaceae, and other cephalosporins (e.g., cefepime, cefotaxime, ceftazidime, ceftriaxone, ceftizoxime) generally are preferred when a parenteral cephalosporin is indicated for the treatment of infections known or suspected to be caused by Enterobacteriaceae.

The drug also is used for the treatment of uncomplicated gonorrhea and has been used in the treatment of infections caused by susceptible Salmonella or Shigella. Because cefixime has a long serum half-life and can be administered once or twice daily, some clinicians suggest that the drug may be particularly useful when patient compliance is a concern (e.g., in the treatment of otitis media). Although cefixime is an effective alternative to other anti-infective agents for the treatment of many infections, the drug offers no clear advantage (except for a convenient dosage regimen) over other equally effective, less expensive anti-infectives available for the treatment of uncomplicated urinary tract infections or upper and lower respiratory tract infections.

Cefditoren pivoxil is a semisynthetic cephalosporin antibiotic. The drug is an oral aminothiazolyl cephalosporin with a methylthiazolyl group at position 3 of the cephalosporin nucleus. Cefditoren pivoxil is a prodrug and has little, if any, antibacterial activity until hydrolyzed in vivo to cefditoren.

Cefdinir is used orally for the treatment of mild to moderate upper and lower respiratory tract infections (i.e., acute maxillary sinusitis, acute exacerbations of chronic bronchitis, community-acquired pneumonia) caused by susceptible bacteria. The drug also is used orally for the treatment of acute bacterial otitis media, streptococcal pharyngitis and tonsillitis, and mild to moderate, uncomplicated skin and skin structure infections caused by susceptible bacteria.

The manufacturer of Ceftin® (cefuroxime axetil) oral suspension states that safety and efficacy of the suspension have been established only for the treatment of pharyngitis and tonsillitis, acute otitis media, and impetigo caused by susceptible bacteria. Cefuroxime sodium is used parenterally in the treatment of lower respiratory tract infections (including pneumonia), serious skin and skin structure infections, genitourinary tract infections, bone and joint infections, septicemia, and meningitis caused by susceptible organisms.

Cefprozil is used orally for the treatment of mild to moderate respiratory tract infections (i.e., acute sinusitis, secondary bacterial infections of acute bronchitis, acute exacerbations of chronic bronchitis, community-acquired pneumonia) caused by susceptible bacteria.

Cefaclor capsules and oral suspension are used for the treatment of lower respiratory tract infections (including pneumonia) caused by susceptible S. pneumoniae, H. influenzae, or S. pyogenes. Cefaclor extended-release tablets are used for the treatment of mild to moderate acute exacerbations of chronic bronchitis or secondary infections of acute bronchitis caused by susceptible Haemophilus influenzae (non-b-lactamase-producing strains only), Moraxella (formerly Branhamella) catarrhalis (including b-lactamase-producing strains), or Streptococcus pneumoniae.

Cephradine is administered orally. Cephradine also has been administered by IM or IV injection and by IV infusion, but a parenteral dosage form no longer is commercially available in the US. For lobar pneumonia and serious urinary tract infections (including prostatitis), the usual adult oral dosage is 500 mg every 6 hours or 1 g every 12 hours. For severe or chronic infections, dosage may be increased up to 1 g every 6 hours.

For severe infections or those caused by less susceptible organisms, higher dosages may be needed (up to 4 g daily in adults). If a dosage greater than 4 g daily is required, initial therapy with a parenteral cephalosporin should be considered.

Cefazolin is used for the treatment of respiratory tract infections, urinary tract infections, skin and skin structure infections, biliary tract infections, bone and joint infections, genital infections, septicemia, and endocarditis caused by susceptible bacteria.