Tags: Primaxin

Specific Anti-Infective Agents

Antibiotics Before prescribing a specific antibiotic, clinicians should be able to answer these questions: •  How does the antibiotic kill or inhibit bacterial growth? •  What are the antibiotic’s toxicities and how should they be monitored? •  How is the drug metabolized, and what are the dosing recommendations? Does the dosing schedule need to be modified in patients with renal dysfunction? •  What are the indications for using each specific antibiotic? •  How broad is the antibiotic’s antimicrobial spectrum? •  How much does the antibiotic cost? Clinicians should be familiar with the general classes of antibiotics, their mechanisms of action, and their major toxicities. The differences between the specific antibiotics in …

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Antimicrobial therapy: general principles

A wide variety of antimicrobial agents is available to treat established infections caused by bacteria, fungi, viruses, or parasites. This section will cover the general principles of antimicrobial therapy and will also include illustrative clinical problems to emphasize proper decision-making in using antimicrobials. Determinants of Antimicrobial Efficacy Measurement of antimicrobial activity in vitro Susceptibility testing is indicated for any bacterial pathogen warranting chemotherapy. Drugs that irreversibly destroy the ability of an organism to replicate, and perhaps in the process destroy the structural integrity of the organism, are microbicidal. Drugs that reversibly impair replicating ability, with this function being restored when drug concentrations fall below critical inhibitory levels, are microbiostatic. In quantitative …

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Management of Bacterial Meningitis

Central nervous system infections, especially bacterial meningitis, are frequently life-threatening and usually constitute medical emergencies that require accurate and prompt treatment. (Portions of this section about meningitis have previously been published [Swartz and O'Hanley 1987] and are reproduced with permission of the publisher, Scientific American Medicine, New York. [Send permission to section editor.]) Fortunately, advances in methods of diagnosis and treatment developed during the past 15 years have significantly improved the prognosis associated with many of these illnesses. New diagnostic methods (such as latex agglutination and polymerase chain reaction) supplement rather than supplant cerebrospinal fluid studies. The cerebrospinal fluid studies frequently provide important initial information needed for clinical and microbiologic diagnosis; …

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Imipenem and Cilastatin

C12H17N3O4S•H2 • Imipenem and cilastatin sodium is a fixed combination of imipenem monohydrate (a semisynthetic carbapenem b-lactam antibiotic) and cilastatin sodium, 1, 35 which prevents renal metabolism of imipenem by dehydropeptidase I (DHP I). Uses Imipenem and cilastatin sodium solution is used IV in the treatment of serious infections caused by susceptible organisms including lower respiratory tract, skin and skin structure, intra-abdominal, gynecologic, or bone and joint infections. The drug also is used IV in the treatment of serious complicated or uncomplicated urinary tract infections, septicemia, or endocarditis caused by susceptible organisms. If IM therapy is considered appropriate, imipenem and cilastatin sodium for injectable suspension can be used IM in the …

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Community-Acquired Pneumonia: Current Therapies

Overview Many highly effective agents are available for the treatment of bacterial community-acquired pneumonia (community-acquired pneumonia) and other community-acquire respiratory tract infections (RTIs). Currently marketed antibiotics for community-acquired pneumonia demonstrate similar efficacy rates in clinical trials, and these agents have generally achieved clinical symptom resolution in 85-95% of trial participants. The drugs differ mainly in their spectrum of activity (the organisms against which the agent is effective), side-effect profiles, dosing schedules, and dose form availability. Broad-spectrum antibiotics are effective against a wide range of pathogens; narrow-spectrum antibiotics tend to be efficacious against a narrower range of bacterial species, generally either gram-positive or gram-negative organisms.TABLE:Mechanisms of Resistance Against Select Antibacterial Classes, 2004 …

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Carbapenems – Penicillin Derivative

Overview 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. A drawback of these agents is that they are available in IV form only. These agents are used in the treatment of severe community-acquired pneumonia when sepsis is a concern. The incidence of this adverse reaction is low (1%) and occurs predominantly in the elderly or in patients with predisposing CNS conditions. Carbapenem antibiotics include imipenem (Merck’s Primaxin), meropenem (AstraZeneca’s Merrem), and ertapenem (Merck’s Invanz). This section reviews only imipenem/cilastatin because this class is generally used only in a small …

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Carbapenems

Overview. 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. A drawback of these agents is that they are available in IV form only. These agents are used in the treatment of severe, complicated acute exacerbations of chronic bronchitis when sepsis is of concern. The incidence of adverse reaction is low (1%) and occurs predominantly among the elderly or patients with predisposing central nervous system conditions. Carbapenem antibiotics include imipenem (Merck’s Primaxin) meropenem (AstraZeneca’s Merrem), and ertapenem (Merck’s Invanz). This section reviews only imipenem/cilastatin, as this class is generally used …

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Acute Exacerbations of Chronic Bronchitis: Current therapies

Overview Numerous highly effective pharmacological agents are available to treat acute exacerbations of chronic bronchitis (acute exacerbations of chronic bronchitis). TABLE:Pharmacological Management of Underlying Disease During an Acute Exacerbation of Chronic Bronchitis summarizes the general pharmacological agents and classes used to manage acute exacerbations of chronic bronchitis. The primary therapies used in acute exacerbations of chronic bronchitis treat the causative infection (antibiotics), relieve symptoms (bronchodilators), and treat the underlying inflammation (corticosteroids). TABLE :Current Therapies Used for Acute Exacerbations of Chronic Bronchitis summarizes the leading antibiotic therapies used to treat the infection. Most acute exacerbations of chronic bronchitis cases require empiric antibiotic therapy because of the difficulty in definitively distinguishing exacerbations of …

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Imipenem

(British Approved Name, US Adopted Name, rINN) Drug Nomenclature International Nonproprietary Names (INNs) in main languages (French, Latin, Russian, and Spanish): Synonyms: N-Formimidoyl Thienamycin; Imipemide; Imipeneemi; Imipenem; Imipenem monohydrát; Imipenemas; Imipenemum; Imipenemum Monohydricum; MK-0787; MK-787 BAN: Imipenem USAN: Imipenem INN: Imipenem [rINN (en)] INN: Imipenem [rINN (es)] INN: Imipénem [rINN (fr)] INN: Imipenemum [rINN (la)] INN: Имипенем [rINN (ru)] Chemical name: (5R,6S)-6-[(R)-1-Hydroxyethyl]-3-(2-iminomethylaminoethylthio)-7-oxo-1-azabicyclo[3.2.0]hept-2-ene-2-carboxylic acid monohydrate Molecular formula: C12H17N3O4S,H2O =317.4 CAS: 64221-86-9 (anhydrous imipenem); 74431-23-5 (imipenem monohydrate) Description. Imipenem is the N-formimidoyl derivative of thienamycin, an antibiotic produced by Streptomyces cattleya. Pharmacopoeias. In Europe, Japan, and US. European Pharmacopoeia, 6th ed., 2008 and Supplements 6.1 and 6.2 (Imipenem). A white, almost white, or …

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Merrem: Carbapenem for Severe Infection

Carbapenem antibiotics were first discovered in the 1970s. The first and only marketed agent in this class was Primaxin, a combination product containing imipenem and the human renal dihyropeptidase-I (DHP-I) antagonist cilastatin. Meropenem (Merrem), similar to imipenem-cilastatin, has been approved by the FDA for the treatment of complicated intra-abdominal infections in adults and children as well as for bacterial meningitis in children. Meropenem is the first carbapenem antibiotic approved in the United States for use in children. Other uses being studied include febrile neutropenia, lower respiratory tract infections, urinary tract infections and skin and skin structure infections. The neurotoxicity associated with imipenem-cilastatin has not been demonstrated with meropenem, which seems to …

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