Pneumonia - Surgery

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Cephalosporins. Most of these antibiotics are not very effective against bacteria that have developed resistance to penicillin. They are classed according to their generation:

• First generation includes cephalexin (Keflex), cefadroxil (Duricef, Ultracef), and cephradine (Velosef).
• Second generation includes cefaclor (Ceclor), cefuroxime (Ceftin), cefprozil (Cefzil), and loracarbef (Lorabid).
• Third generation includes cefpodoxime (Vantin), cefdinir (Omnicef) cefditoren (Sprectracef), cefixime (Suprax), and ceftibuten (Cedex). Ceftriaxone (Rocephin) is an injected cephalosporin. These are effective against a wide range of Gram-negative bacteria.

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Other Beta-Lactam Agents. Carbapenems include meropenem (Merrem), biapenem, faropenem, ertapenem (Invanz) and combinations [imipenem/cilastatin [Primaxin)]. These drugs are used to treat a wide variety of bacteria. They are now used for serious hospital-acquired infections and for bacteria that have become resistant to other beta-lactams. Imipenem has serious side effects when used alone, so it is given in combination with cilastatin to offset these adverse effects. The newer drugs are less toxic, although they may not be as effective.

Sanfetrinem, a new beta-lactam antibiotic known as a trinem, is proving to be effective against S. pneumoniae, H. influenzae, and M. catarrhalis.

Ceftobiprole is an investigational beta-lactam for methicillin-resistant Staphylococcus aureus (MRSA), penicillin-resistant streptococci, and other Gram-negative bacteria. Other anti-MRSA beta-lactams in development include:

• CS-023/RO-4908463, a carbapenem
• Ceftaroline, a cephalosporin (PPI-0903)

Fluoroquinolones

Fluoroquinolones (quinolones) interfere with bacteria's genetic material to prevent them from reproducing.

• Ciprofloxacin (Cipro), a second-generation quinolone, remains the most potent quinolone against Pseudomonas aeruginosa. It is not very effective against Gram-positive bacteria such as Streptococcus pneumoniae.
• "Respiratory" quinolones are currently the most effective drugs available for a wide range of bacteria. Such drugs include levofloxacin (Levaquin) and gemifloxacin (Factive). Some of the newer fluoroquinolones only need to be taken once a day.
• The fourth-generation quinolones moxifloxacin (Avelox) and clinafloxacin (which is still under development) are proving to be effective against anaerobic bacteria.