Drug Name

Clindamycin (Cleocin) -- Lincosamide effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Adult Dose

600 mg IV q6-8h

Pediatric Dose

25-40 mg/kg/d IV divided tid/qid

Contraindications

Documented hypersensitivity; regional enteritis; ulcerative colitis; hepatic impairment; antibiotic-associated colitis

Interactions

Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects of clindamycin; antidiarrheals may delay absorption of clindamycin

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis

Drug Name

Cefoxitin (Mefoxin) -- Second-generation cephalosporin indicated for gram-positive cocci and gram-negative rod infections. Infections caused by cephalosporin-resistant or penicillin-resistant gram-negative bacteria may respond to cefoxitin.

Adult Dose

2 g IV q6-8h

Pediatric Dose

80-160 mg/kg/d IV in 4-6 divided doses

Contraindications

Documented hypersensitivity

Interactions

Probenecid may increase effects of cefoxitin; coadministration with aminoglycosides or furosemide may increase nephrotoxicity (closely monitor renal function)

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged use or repeated treatment; caution in patients with previously diagnosed colitis

Drug Name

Penicillin G (Pfizerpen) -- Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

Adult Dose

2 million U IV q4h

Pediatric Dose

150,000 U/kg/d IV q4h

Contraindications

Documented hypersensitivity

Interactions

Probenecid can increase penicillin effectiveness by decreasing its clearance; tetracyclines can decrease penicillin effectiveness

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Traditional drug for treatment of lung abscess, but spectrum of activity is narrow; use with caution in patients with impaired renal function

Drug Name

Azithromycin (Zithromax) -- These agents are replacing erythromycin as therapy for community-acquired pneumonia. They cover most potential etiologic agents, including Mycoplasma species. The newer macrolides offer decreased GI upset and the potential for improved compliance through reduced dosing frequency. They also afford more improved action against Haemophilus influenzae than erythromycin.

Adult Dose

Day 1: 500 mg PO
Days 2-5: 250 mg/d PO; alternatively, 500 mg/d IV

Pediatric Dose

Day 1: 10 mg/kg PO
Days 2-5: 5 mg/kg PO

Contraindications

Documented hypersensitivity; hepatic impairment; do not administer with pimozide

Interactions

May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Site reactions can occur with IV route; bacterial or fungal overgrowth may result with prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals, or pneumonia; caution in patients who are hospitalized, geriatric, or debilitated

Drug Name

Clarithromycin (Biaxin) -- Another antibiotic used during initial therapy in otherwise uncomplicated pneumonia. More GI symptoms appear to occur than with azithromycin (eg, gastric upset, metallic taste). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Adult Dose

500 mg PO bid for 10 d

Pediatric Dose

<6 months: Not recommended
>6 months: 7.5 mg/kg PO bid for 10 d; not to exceed 1 g/d

Contraindications

Documented hypersensitivity; coadministration with pimozide

Interactions

Toxicity increases with coadministration of fluconazole, astemizole, and pimozide; clarithromycin effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole, carbamazepine, ergot alkaloids, triazolam, and HMG CoA-reductase inhibitors; serious cardiac arrhythmias may occur with coadministration of cisapride; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; administer one-half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be a sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies

Drug Name

Erythromycin (E.E.S., Erythrocin, Ery-Tab) -- Recommended dosing schedule of erythromycin may result in GI upset, causing one to prescribe an alternative macrolide or change to tid dosing. Covers most potential etiologic agents, including Mycoplasma species. Oral dosing regimen may be insufficient to adequately treat Legionella species. Erythromycin is less active against H influenzae. Although 10 d seems to be a standard course of treatment, treating until the patient has been afebrile for 3-5 d seems a more rational approach. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.

Adult Dose

250 mg stearate/base (or 400 mg ethylsuccinate) PO q6h 1 h ac or 500 mg q12h; alternatively, use 333 mg q8h and increase up to 4 g/d depending on severity of infection
Hospitalized with severe pneumonia: 1 g IV q6h; alternatively, administer 15-20 mg/kg/d IV in divided doses q6h

Pediatric Dose

In children, age, weight, and severity of infection determine proper dosage; when bid dosing is desired, one-half total daily dose may be taken q12h; for more severe infections, double the dose
7.5 mg/kg/d PO divided bid; alternatively, 20-40 mg/kg/d IV divided q6h or by constant infusion; not to exceed 4 g/d

Contraindications

Documented hypersensitivity; hepatic impairment

Interactions

Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (administer doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occurs

Drug Name

Amoxicillin-clavulanate (Augmentin) -- An alternative antibiotic for patients allergic or intolerant to the macrolide class. Usually is well tolerated and provides good coverage to most infectious agents. Not effective against Mycoplasma and Legionella species. Cost is a major problem. Drug combination treats bacteria resistant to beta-lactam antibiotics.

Adult Dose

500 mg PO bid or 875 mg PO bid for 10 d or until afebrile for 3-5 d

Pediatric Dose

<3 months: Base dosing protocol on amoxicillin content
<40 kg: 20-40 mg/kg/d (based on amoxicillin content) divided bid; do not use 250-mg tab until child weighs >40 kg
>40 kg: Administer as in adults

Contraindications

Documented hypersensitivity

Interactions

Coadministration with warfarin or heparin increases risk of bleeding

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Administer for a minimum of 10 d to eliminate organism and prevent sequelae (eg, endocarditis, rheumatic fever); following treatment, perform cultures to confirm eradication of streptococci

Drug Name

Levofloxacin (Levaquin) -- Rapidly becoming a popular choice in pneumonia. A good monotherapy for pseudomonal infections and infections due to multidrug-resistant gram-negative organisms.

Adult Dose

500 mg/d PO/IV for 7-14 d

Pediatric Dose

<18 years: Not recommended
>18 years: Administer as in adults

Contraindications

Documented hypersensitivity

Interactions

Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; levofloxacin reduces therapeutic effects of phenytoin; probenecid may increase levofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)

Pregnancy

C - Safety for use during pregnancy has not been established.

Precautions

In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy

Drug Name

Cefaclor (Ceclor) -- Second-generation cephalosporin that binds to one or more of the penicillin-binding proteins, which in turn inhibits cell wall synthesis and results in bactericidal activity. Has gram-positive activity that first-generation cephalosporins have and adds activity against Proteus mirabilis, H influenzae, Escherichia coli, Klebsiella pneumoniae, and Moraxella catarrhalis. The condition of the patient, severity of the infection, and susceptibility of the microorganism should determine the proper dose and route of administration.

Adult Dose

500 mg PO q8h for 10 d

Pediatric Dose

20-40 mg/kg/d PO divided q8-12h; not to exceed 2 g/d

Contraindications

Documented hypersensitivity

Interactions

Alcoholic beverages consumed <72 h after taking cefaclor may produce disulfiramlike reactions; may increase hypoprothrombinemic effects of anticoagulants; coadministration with potent diuretics and aminoglycosides (eg, loop diuretics) may increase nephrotoxicity

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Reduce dosage by one half if CrCl is 10-30 mL/min and by one fourth if <10 mL/min; bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy

Drug Name

Cefprozil (Cefzil) -- Second-generation cephalosporin that binds to one or more of the penicillin-binding proteins, which in turn inhibits cell wall synthesis and results in bactericidal activity. Has gram-positive activity that first-generation cephalosporins have and adds activity against P mirabilis, H influenzae, E coli, K pneumoniae, and M catarrhalis. The condition of the patient, severity of the infection, and susceptibility of the microorganism should determine the proper dose and route of administration.

Adult Dose

500 mg/d PO for 10 d

Pediatric Dose

<12 years: 30 mg/kg/d PO divided q12h for 10 d
>12 years: Administer as in adults

Contraindications

Documented hypersensitivity

Interactions

Probenecid increases effect of cefprozil; coadministration with furosemide and aminoglycosides increases nephrotoxic effects of cefprozil

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Adjust dosage in renal impairment

Drug Name

Cefuroxime (Ceftin) -- Second-generation cephalosporin that binds to one or more of the penicillin-binding proteins, which in turn inhibits cell wall synthesis and results in bactericidal activity. Has gram-positive activity that first-generation cephalosporins have and adds activity against P mirabilis, H influenzae, E coli, K pneumoniae, and M catarrhalis. The condition of the patient, severity of the infection, and susceptibility of the microorganism should determine the proper dose and route of administration.

Adult Dose

250 mg PO bid for 10 d

Pediatric Dose

Neonates: 20-50 mg/kg/d IV divided q12h
Infants and children: 75-150 mg/kg/d IV divided q8h; not to exceed 6 g/d
<13 years: 250 mg PO bid for 20 d
>13 years: Administer as in adults

Contraindications

Documented hypersensitivity

Interactions

Disulfiramlike reactions may occur when alcohol is consumed within 72 h after taking cefuroxime; may increase hypoprothrombinemic effects of anticoagulants; may increase nephrotoxicity in patients receiving potent diuretics such as loop diuretics; coadministration with aminoglycosides increases nephrotoxic potential

Pregnancy

C - Safety for use during pregnancy has not been established.

Precautions

Administer one-half dose if CrCl is 10-30 mL/min and one-fourth dose if <10 mL/min; fungal and microorganism overgrowth may occur with prolonged therapy

Drug Name

Ceftriaxone (Rocephin) -- Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins. The condition of the patient, severity of the infection, and susceptibility of the microorganism should determine the proper dose and route of administration.

Adult Dose

500-1000 mg IV q12h; not to exceed 4 g/d

Pediatric Dose

Neonates >7 d: 25-50 mg/kg/d IV/IM; not to exceed 125 mg/d
Infants and children: 50-75 mg/kg/d IV/IM divided q12h; not to exceed 2 g/d

Contraindications

Documented hypersensitivity

Interactions

Probenecid may increase ceftriaxone levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Adjust dose in renal impairment; caution in women who are breastfeeding and persons with allergy to penicillin

Drug Name

Ceftazidime (Fortaz) -- Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins. The condition of the patient, severity of the infection, and susceptibility of the microorganism should determine the proper dose and route of administration.

Adult Dose

1-2 g IV/IM q8-12h

Pediatric Dose

Neonates: 30 mg/kg IV q12h
Infants and children: 30-50 mg/kg/dose IV q8h; not to exceed 6 g/d
Adolescents: Administer as in adults

Contraindications

Documented hypersensitivity

Interactions

Nephrotoxicity may increase with aminoglycosides, furosemide, and ethacrynic acid; probenecid may increase ceftazidime levels

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Adjust dose in renal impairment

Drug Name

Streptokinase (Kabikinase, Streptase) -- Acts with plasminogen to convert plasminogen to plasmin. Plasmin degrades fibrin clots as well as fibrinogen and other plasma proteins. Increase in fibrinolytic activity that degrades fibrinogen levels for 24-36 h takes place with intravenous infusion of streptokinase. Absorbed from the pleural space.

Adult Dose

250,000 IU IV in 100 mL of normal saline qd or bid is instilled into pleural space for 3-5 d

Pediatric Dose

Not established

Contraindications

Documented hypersensitivity; active internal bleeding; intracranial neoplasm; aneurysm; diathesis; severe uncontrolled arterial hypertension

Interactions

Antifibrinolytic agents may decrease effects of streptokinase; heparin, warfarin, and aspirin may increase risk of bleeding

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Caution in severe hypertension, intramuscular administration of medications, trauma, or surgery in the previous 10 days; measure hematocrit, platelet count, aPTT, TT, PT, or fibrinogen levels before therapy is implemented; either TT or aPTT should be less than twice the normal control value following infusion of streptokinase and before instituting or re-instituting heparin; do not take blood pressure in the lower extremities because it may dislodge a possible deep vein thrombi; PT, aPTT, TT, or fibrinogen should be monitored 4 hours after the initiation of therapy

Drug Name

Urokinase (Abbokinase) -- Direct plasminogen activator that acts on the endogenous fibrinolytic system and converts plasminogen to the enzyme plasmin, which in turn degrades fibrin clots, fibrinogen, and other plasma proteins. Most often used for local fibrinolysis of thrombosed catheters and superficial vessels. Advantage is that agent is nonantigenic; however, more expensive than streptokinase and, thus, limits use. When used for local fibrinolysis, urokinase is administered as local infusion directly into area of thrombus and with no bolus administered. Dose of medication should be adjusted to achieve clot lysis or patency of affected vessel.

Adult Dose

100,000 IU IV in 100 mL of normal saline once or twice a day is instilled into pleural space for 3-5 d

Pediatric Dose

Not established

Contraindications

Documented hypersensitivity; internal bleeding; recent trauma; history of intracranial or intraspinal surgery or trauma; cerebrovascular accident; intracranial neoplasm

Interactions

Thrombolytic enzymes, alone or in combination with anticoagulants and antiplatelets, may increase risk of bleeding complications

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Caution in patients receiving intramuscular administration of medications, severe hypertension, trauma, or surgery in previous 10 days; avoid dislodging a possible deep vein thrombi; do not measure blood pressure in lower extremities; monitor therapy by performing PT, aPTT, TT, or fibrinogen approximately 4 h after initiation of therapy; monitor therapy by performing PT, aPTT, TT, or fibrinogen approximately 4 h after initiation of therapy