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Ceftriaxone and Cefdinir
Ceftriaxone (Omnicef) 300mg has been available generically in Europe since 2002. In 2000, Cubist Pharmaceuticals announced that it had acquired the rights to oral ceftriaxone and was developing an alternate oral formulation.
Carbapenems – Penicillin Derivative
Carbapenems are penicillin derivatives that have good activity against gram-positive and gram-negative aerobic and anaerobic bacteria. They are highly resistant to β-lactamase and have a very favorable spectrum of activity.
Macrolides: Erythromycin, Clarithromycin
Macrolides are a class of drugs that inhibit bacterial protein synthesis. They demonstrate excellent activity against atypical organisms (Mycoplasma, Chlamydia, and Legionella species), but have variable activity against typical pathogens (S. pneumoniae and H. influenzae). Macrolides are indicated for use in mild-to-moderate community-acquired pneumonia and are typically used as first- and second-line agents for this indication.
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Azithromycin (Zithromax) acts by binding to the 50S ribosomal subunit of susceptible microorganisms and interfering with microbial protein synthesis. It demonstrates activity in vitro against a wide range of bacteria, including gram-positive bacteria such as S. aureus, S. pneumoniae, and other streptococci, and gram-negative bacteria such as H. influenzae and H. parainfluenzae.
Ketolides – New Class of Macrolide Derivatives
Ketolides are a new class of macrolide derivatives designed specifically to combat macrolide-resistant respiratory tract pathogens. The ketolides exhibit good activity against gram-positive and some gram-negative organisms and have excellent activity against drug-resistant S. pneumoniae, including macrolide-resistant strains. Spontaneous resistance to the available ketolide, telithromycin, is rare. Ketolides display excellent pharmacokinetics that allow once-daily dose administration and extensive tissue distribution relative to serum.
Fluoroquinolones: Levofloxacin, Moxifloxacin, Gatifloxacin
Earlier generations of fluoroquinolones (e.g., ofloxacin) had limited activity against some respiratory pathogens, such as S. pneumoniae. However, recent fluoroquinolone agents (so-called third-generation agents, or the “respiratory fluoroquinolones”) are active against a broad spectrum of gram-positive and gram-negative bacteria, including atypical organisms. Therefore, they are highly effective in RTIs.
Gatifloxacin (Gatiflo, Tequin and Zymar)
Gatifloxacin has a broad spectrum of activity similar to activity observed in other third-generation fiuoroquinolones. The agent is well absorbed following oral administration (almost 100% bioavailability), and its pharmacodynamic and pharmacokinetic properties (e.g., high volume of distribution, long elimination half-life) allow once-daily administration.
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The widespread use of tetracyclines has resulted in a steady increase in the prevalence of resistance to these agents. Therefore, empiric use of tetracycline is usually restricted to regions where resistance levels remain low or to cases where other appropriate antibiotics are contraindicated. Although some tetracyclines have very low activity against S. pneumoniae, doxycycline maintains good antipneumococcal activity and is the tetracycline most commonly used for treatment of bacterial community-acquired pneumonia.
Aminoglycosides
Aminoglycosides are the preferred agents for treating serious infections caused by aerobic gram-negative bacilli. Aminoglycosides play only a minor role in the treatment of community-acquired pneumonia; their use is typically limited to hospitalized patients with severe or complicated community-acquired pneumonia in which gram-negative infections (particularly P. aeruginosa) are suspected.