Pneumonia - Surgery

(Page 4)

Telithromycin is still approved for the treatment of CAP, but the drug carries a black box warning noting the potentially serious side effects, including:

• Liver failure
• Loss of consciousness
• Nerve and muscle (neuromuscular) problems
• Vision problems

Because of these side effects, telithromycin is only approved for patients with mild-to-moderate community-acquired pneumonia caused by penicillin- or macrolide-resistant S. pneumoniae. Other treatments are as effective, and are safer.

Tetracyclines

Tetracyclines inhibit the growth of bacteria. They include doxycycline, tetracycline, and minocycline. They can be effective against S. pneumoniae and M. catarrhalis, but bacteria that are resistant to penicillin are also often resistant to doxycycline. The side effects of tetracyclines include:

---

---

• Burning in the throat
• Skin reactions to sunlight
• Tooth discoloration

Aminoglycosides

Aminoglycosides (gentamicin, kanamycin, tobramycin, amikacin) are given by injection for very serious bacterial infections. They can be given only in combination with other antibiotics. Some are available in inhaled forms or by applying a solution directly to mucus membranes, skin, or body cavities. They can have very serious side effects, including:

• Balance problems
• Hearing damage
• Kidney damage

Lincosamides

Lincosamides prevent bacteria from reproducing. The most common lincosamide is clindamycin (Cleocin). This antibiotic is useful against S. pneumoniae and S. aureus, but not against H. influenzae.

Glycopeptides

Glycopeptides (vancomycin, teicoplanin) are used for Staphylococcus aureu s infections that have become resistant to standard antibiotics. The drug can be taken by mouth or given intravenously. The latest generation of glycopeptides, a derivative of vancomycin, is called telavancin. In studies of hospital-acquired pneumonia, it has shown promise for the treatment of Gram-positive pneumonia.

Trimethoprim-Sulfamethoxazole

Trimethoprim-sulfamethoxazole (Bactrim, Cotrim, Septra) is less expensive than amoxicillin. It is particularly useful for adults with mild bacterial upper respiratory infections who are allergic to penicillin. The drug is no longer effective against certain streptococcal strains. It should not be used in patients whose infections occur after dental work, or in people who are allergic to sulfa drugs. Allergic reactions can be very serious.

Oxazolidinone

Linezolid (Zyvox) is the first antibacterial drug in a new class of man-made antibiotics called oxazolidinones. It has been shown to work against certain aerobic Gram-positive bacteria.

Other Medications

Inhaled polymyxin, a drug used in cystic fibrosis patients, is showing some effectiveness against pneumonia caused by multidrug-resistant Gram-negative bacteria, including pseudomonas and klebsiella.

Review Date: 04/13/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).