Antibiotic, Antifungal, Antiviral Drugs

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.

Amikacin is a semisynthetic aminoglycoside antibiotic. Amikacin sulfate is administered by IM injection or IV infusion. Dosage of amikacin sulfate is expressed in terms of amikacin and is identical for either route of administration.