Pneumonia - Surgery

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S. pneumoniae -- strains resistant to the "respiratory" quinolones are uncommon in the U.S., but resistance is dramatically increasing.

Many quinolones cause side effects, including:

• Nervous system, mental, and heart problems
• Sensitivity to light

Pregnant women should not take these medications. The drugs also enhance the potency of oral anti-clotting drugs.

Macrolides, Azalides, and Ketolides

Macrolides and azalides also affect the genetics of bacteria. These medications include:

• Azithromycin (Zithromax, Zmax)
• Clarithromycin (Biaxin)
• Erythromycin
• Roxithromycin (Rulid)

These antibiotics are effective against atypical bacteria such as mycoplasma and chlamydia. Macrolides are also used in some cases for S. pneumoniae and M. catarrhalis, but there is increasing bacterial resistance to these antibiotics. All but erythromycin are effective against H. influenzae. Macrolide-resistance rates doubled between 1995 and 1999 as more and more children were being treated with these antibiotics. Some research suggests these drugs may reduce the risk of a first heart attack in some patients by reducing inflammation in the blood vessels.

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Extended-release (ER) azithromycin (Zmax) is the first anti-pneumonia antibiotic that can be given in a single dose. It is effective against Gram-positive, Gram-negative, and atypical bacteria. Studies have shown the results to be equal to those achieved with 7 days of levofloxacin or clarithromycin ER in patients with CAP. A single-dose antibiotic decreases the likelihood that a patient will stop taking the antibiotic early, which rapidly contributes to the development of drug-resistant bacteria.

Ketolides. Ketolides are a new class of antibiotic drugs. They are derived from erythromycin and were developed to combat bacteria that have become resistant to macrolides. Telithromycin (Ketek), the first antibiotic in the ketolide class, was approved by the FDA in 2004 for treating community-acquired pneumonia (CAP).

In February 2007, the FDA withdrew approval of Ketek for the treatment of acute bacterial sinusitis. The agency decided that the serious risks of telithromycin outweigh its benefits for sinusitis treatment. The decision followed several 2006 reports of patient deaths due to severe liver damage.