Author: Brian Holtry

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.

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.

Cephalosporins are semisynthetic b-lactam antibiotics that are structurally and pharmacologically related to penicillins, carbacephems (e.g., loracarbef), and cephamycins (e.g., cefotetan, cefoxitin). Cephalosporins generally are divided into 4 groups (“generations”) based on their spectra of activity. Cefaclor, cefadroxil, cefdinir, cefditoren pivoxil, cefpodoxime proxetil, cefprozil, ceftibuten, cefuroxime axetil, cephalexin, and cephradine also are used orally for the treatment of mild to moderate skin and skin structure infections caused by susceptible staphylococci or streptococci.

Commercially available tobramycin solution for oral inhalation is administered via nebulization in the management of bronchopulmonary Pseudomonas aeruginosa infections in cystic fibrosis patients 6 years of age or older. Use of tobramycin oral inhalation solution can be considered for suppressive therapy in cystic fibrosis patients colonized with Ps. aeruginosa if they are 6 years of age or older and have a forced expiratory volume in 1 second (FEV1) that is 25-75% of the predicted value. At baseline, the FEV1 in all study patients was 25-75% of the predicted value.

Streptomycin is used in conjunction with other antituberculosis agents in the treatment of clinical tuberculosis. The American Thoracic Society (ATS), US Centers for Disease Control and Prevention (CDC), and Infectious Diseases Society of America (IDSA) currently recommend several possible multiple-drug regimens for the treatment of culture-positive pulmonary tuberculosis. These regimens have a minimum duration of 6 months (26 weeks), and consist of an initial intensive phase (2 months) and a continuation phase (usually either 4 or 7 months).

Neomycin sulfate is usually administered orally. In patients with hepatic encephalopathy who are unable to take oral medication, the drug has also been given as a retention enema.

IM and IV dosage are identical and should be based on an estimate of ideal body weight. The manufacturers state that dosage by all routes of administration should not exceed 1.5 g daily. A causal relationship between maintenance of certain peak or trough serum concentrations or other pharmacodynamic endpoints and clinical response or toxicity has not been established to date for aminoglycoside dosing regimens. However, in general, desirable peak serum concentrations of kanamycin for systemic infections are 15-30 mcg/mL and trough concentrations of the drug should not exceed 5-10 mcg/mL.