Available Abx by Pathogen - URI
|B. Pertussis||Azithromycin, Clarithromycin, Erythromycin||Centers for Disease Control and Prevention (CDC): Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 65 years and older - Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep 61:468, 2012,[PMID:22739778]
Comment: New recommendations that advise to give Tdap x 1 all adults including those over age 65. Boostrix recommended if available as best studied with higher antibody responses in this population.
Centers for Disease Control and Prevention (CDC): Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months --- Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep 60:1424, 2011,[PMID:22012116]
Comment: Summary of recommendations targeting pregnant women to protect infants as well as their household members/caregivers.
Centers for Disease Control and Prevention (CDC): Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR Morb Mortal Wkly Rep 60:13, 2011,[PMID:21228763]
Comment:,Basis for updated immunization recommendations expanding Tdap including safety and efficacy data.
Tiwari T et al: Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC Guidelines. MMWR Recomm Rep 54:1, 2005,[PMID:16340941]
Comment: Basis for drug recommendations for treatment and prophylaxis used in this module.
|C. Pneumoniae||Erythromycin, Clarithromycin, Azithromycin, Doxycycline, Levofloxacin, Moxifloxacin||Kohlhoff SA, Hammerschlag MR: Treatment of Chlamydial infections: 2014 update. Expert Opin Pharmacother 16:205, 2015,[PMID:25579069]
Comment: Although diagnostics have improved for C. pneumoniae, little has changed regarding treatment recommendations over the last decade +.
|H. Influenzae||Amoxicillin/clavulanate, Amoxicillin, Cefuroxime, Moxifloxacin, Levofloxacin||Briere EC et al: Prevention and control of haemophilus influenzae type b disease: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep 63:1, 2014,[PMID:24572654]
Comment: Practice guideline is comprehensive and offers no new recommendations from previous guidance, but has compiled signficant data on effect of Hib conjugate vaccine.
Murphy, TF; Haemophilus infections; Principles and Practice of Infectious Diseases, 7th ed.; Vol. Chap 225; 2009.
Comment: Overview of diagnosis and management of all haemophilus infections including H. influenzae.
|L. Pneumophila||Levofloxacin, Moxifloxacin, Azithromycin, Erythromycin, Ciprofloxacin||Mandell LA et al: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44 Suppl 2:S27, 2007,[PMID:17278083]|
|M. Catarrhalis||Trimethoprim/sulfamethoxazole, Clarithromycin, Azithromycin, Doxycycline, Cefprozil, Cefpodoxime, Cefuroxime, Cefdinir||Verhagen LM, de Groot R: Recurrent, protracted and persistent lower respiratory tract infection: A neglected clinical entity. J Infect 71 Suppl 1:S106, 2015,[PMID:25917807]
Comment: M. catharrlis along with H. influenzae and S. pneumoniae may be seen in chronic lower tract infectiona and bronchiectasis. Rates are higher especially in some indigenous populations of children in Australia, Alaska and New Zealand.
Bandet T et al: Susceptibility of clinical Moraxella catarrhalis isolates in British Columbia to six empirically prescribed antibiotic agents. Can J Infect Dis Med Microbiol 25:155, 2014,[PMID:25285112]
Comment: Study of 117 clinical isolates found the following: all isolates susceptible to amox/clav, doxyycline, clarithromycin, levofloxacin and TMP/SMX. One isolate was intermediately resistant to cefuroxime. Authors state that isolates often were at the higher range of MIC 50 and MIC90 for cefuroxime but that all agents tested continue to be reasonable to prescribe.
Parameswaran GI, Sethi S, Murphy TF: Effects of bacterial infection on airway antimicrobial peptides and proteins in COPD. Chest 140:611, 2011,[PMID:21349930]
Comment: Review of bacteria in exacerbation of chronic bronchitis showing reduced levels of secretory leukocyte protease inhibitor with exacerbations due to M. catarrhalis and with S. pneumoniae. the sugestion is that this reflects reduced pathogen clearance capacity.
Aebi C: Moraxella catarrhalis - pathogen or commensal? Adv Exp Med Biol 697:107, 2011,[PMID:21120723]
Comment: Summary of pathogenicity highlights the role of M. catarrhalis in otitis media and COLD, but also comments on "cold shock." This is defined as a 3 hour airway exposure to 26°C temperature with inhalation of cold air. The result is an enhanced proinflammatory response causing symptoms that resemble the common cold.
Murphy TF, Parameswaran GI: Moraxella catarrhalis, a human respiratory tract pathogen. Clin Infect Dis 49:124, 2009,[PMID:19480579]
Comment: Often part of normal flora, colonization rates highest in infants and children but decreases in adult years. Most often thought to be a player in otitis media in children and for adults AECB.
Iyer Parameswaran G, Murphy TF: Chronic obstructive pulmonary disease: role of bacteria and updated guide to antibacterial selection in the older patient. Drugs Aging 26:985, 2009,[PMID:19929027]
Comment: Pathogens in acute exacerbation of chronic bronchitis are M. catarrhalis, nontypable H. influenzae and S. pneumoniae. Authors recommendations for antibiotics when indicated: Avoid: penicillin, ampicillin, TMP-SMX and doxycycline. Preferred: 2nd generation cephalosporins, amox-clavulanate, azithromycin or a respiratory quinolone.
Gracia M et al: Antimicrobial susceptibility of Haemophilus influenzae and Moraxella catarrhalis isolates in eight Central, East and Baltic European countries in 2005-06: results of the Cefditoren Surveillance Study. J Antimicrob Chemother 61:1180, 2008,[PMID:18316820]
Comment: Review of 133 clinical isolates of M. catarrhalis -- 96% produced beta-lactamase. All were sensitive to amoxicillin-clavulanate, cefixime, cefpodoxime, cefuroxime, clarithromycin and levofloxacin.
Sethi S et al: Airway bacterial concentrations and exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 176:356, 2007,[PMID:17478618]
Comment: Rank order of bacterial pathogens in patients with acute exacerbations of chronic bronchitis are H. influenzae>> M. catarrhalis > S. pneumoniae
Das S et al: Moraxella keratitis: predisposing factors and clinical review of 95 cases. Br J Ophthalmol 90:1236, 2006,[PMID:16825274]
Comment: Review of 95 cases of M. catarrhalis. keratitis.,Rating: Important
Lieberman D et al: Nasopharyngeal versus oropharyngeal sampling for isolation of potential respiratory pathogens in adults. J Clin Microbiol 44:525, 2006,[PMID:16455908]
Comment: Colonization rates in upper airways using oropharyngeal swabs of 200 healthy adults is 15%.
Murphy TF et al: Identification of surface antigens of Moraxella catarrhalis as targets of human serum antibody responses in chronic obstructive pulmonary disease. Infect Immun 73:3471, 2005,[PMID:15908376]
Comment: Analysis of new antibody production to M. catarrhalis showed that during exacerbations of COPD, five types of antibodies appeared important for microbial clearance.
Murphy TF et al: Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response. Am J Respir Crit Care Med 172:195, 2005,[PMID:15805178]
Comment: Longitudinal study of 104 patients with COPD showed M. catarrhalis was cause of about 10% of exacerbations. Patients developed strain-specific antibody response. The organism is cleared after short duration of carriage.
Beekmann SE et al: Antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and group A beta-haemolytic streptococci in 2002-2003. Results of the multinational GRASP Surveillance Program. Int J Antimicrob Agents 25:148, 2005,[PMID:15664485]
Comment: Tests of 1047 clinical isolates of M. catarrhalis from 20 countries showed 80-100% produced beta-lactamases.,Rating: Important
Walsh F et al: Comparative in vitro activity of telithromycin against macrolide-resistant and -susceptible Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae. J Antimicrob Chemother 53:793, 2004,[PMID:15056640]
Comment: Telithromycin was consistently active against M. catarrhalis including strains that showed reduced sensitivity to macrolides.
Jacobs MR et al: Susceptibility of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis to 17 oral antimicrobial agents based on pharmacodynamic parameters: 1998-2001 U S Surveillance Study. Clin Lab Med 24:503, 2004,[PMID:15177851]
Comment: Clinical isolates of M. catarrhalis were usually resistant to amoxicillin, cefaclor, cefprozil and TMP-SMX.
Olivieri I et al: Septic arthritis caused by Moraxella catarrhalis associated with infliximab treatment in a patient with undifferentiated spondarthritis. Ann Rheum Dis 63:105, 2004,[PMID:14672904]
Comment: Case report of septic arthritis caused by M. catarrhalis in an immunosuppressed host.
Merino LA et al: Bacteriologic findings in patients with chronic sinusitis. Ear Nose Throat J 82:798, 2003,[PMID:14606178]
Comment: M. catarrhalis accounted for 38/659 (6.6%) isolates from sinus endoscopy aspirates.
Lieberman D et al: Infectious etiologies in acute exacerbation of COPD. Diagn Microbiol Infect Dis 40:95, 2001,[PMID:11502375]
Comment: Review of 240 hospitalizations for AECB. Viral etiology detected in 117 (49% of these tested), atypical agents in 72 (30%), S. pneumoniae in 48 (20%) and M. catarrhalis in 9 (4%).
Kilpi T et al: Bacteriology of acute otitis media in a cohort of Finnish children followed for the first two years of life. Pediatr Infect Dis J 20:654, 2001,[PMID:11465836]
Comment: Middle ear aspirates in 772 AOM events - S. pneumo in 201 (26%) M. catarrhalis in 177 (23%), H. flu in 177 (23%). Conclusion is that M. catarrhalis is common and increasing.
Biedenbach DJ et al: Activity of BMS284756 against 2,681 recent clinical isolates of Haemophilus influenzae and Moraxella catarrhalis: Report from The SENTRY Antimicrobial Surveillance Program (2000) in Europe, Canada and the United States. Diagn Microbiol Infect Dis 39:245, 2001,[PMID:11404068]
Comment: There were 810 strains of M. catarrhalis tested. All strains were susceptible to respiratory quinolones.
Manfredi R et al: Moraxella catarrhalis pneumonia during HIV disease. J Chemother 12:406, 2000,[PMID:11128560]
Comment: Review of clinic records of 2,123 consecutive HIV infected pts over 9 yrs. There were 4 cases - 3 in pts with CD4 counts <60 and a fourth in a newborn. The total reported cases in the literature (HIV infected pts with M. catarrhalis pneumonia) is 8.
Stefanou J et al: Moraxella catarrhalis endocarditis: case report and review of the literature. Scand J Infect Dis 32:217, 2000,[PMID:10826914]
Comment: Rare cause of endocarditis. Mortality rate is high - only form of M. catarrhalis infection with poor prognosis.
Abuhammour WM et al: Moraxella catarrhalis bacteremia: a 10-year experience. South Med J 92:1071, 1999,[PMID:10586832]
Comment: There were 11 cases including 4 with sickle cell disease, 1 with AIDS and 1 with leukopenia. All were peds & all respiratory tract portals of entry - 10 acute otitis, 5 sinusitis & 3 pneumonia.
Thórsson B, Haraldsdóttir V, Kristjánsson M: Moraxella catarrhalis bacteraemia. A report on 3 cases and a review of the literature. Scand J Infect Dis 30:105, 1998,[PMID:9730292]
Comment: There were 58 cases reported in 3 categories: compromised host, underlying respiratory disease or normal host. Immunocompromised hosts often had no identified portal of entry. Prognosis was good except with endocarditis.
Ioannidis JP et al: Spectrum and significance of bacteremia due to Moraxella catarrhalis. Clin Infect Dis 21:390, 1995,[PMID:8562749]
Comment: There were 58 cases reviewed - pneumonia in patients with chronic respiratory disease, neutropenia with no clear portal of entry and healthy host with upper airway entry.
Collazos J, de Miguel J, Ayarza R: Moraxella catarrhalis bacteremic pneumonia in adults: two cases and review of the literature. Eur J Clin Microbiol Infect Dis 11:237, 1992,[PMID:1597200]
Comment: Total reported experience with M. catarrhalis bacteremic pneumonia was 13 cases - 7 in adults and 6 in children. There was one death for a mortality rate of 13%.,Rating: Important
|M. Pneumoniae||Doxycycline, Azithromycin, Clarithromycin, Erythromycin, Levofloxacin, Moxifloxacin||Mandell LA et al: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44 Suppl 2:S27, 2007,[PMID:17278083]
Comment: Guideline states atypical agents of pneumonia a common cause, especially of outpatient pneumonia, but acknowledge that except for Legionella, agents such as Mycoplasma are hard to diagnose in routine practice. Doxycycline or macrolide therapy advocated for outpatient CAP without risk factors for drug-resistant S. pneumoniae. Fluoroquinolones are listed as an alternative if M. pneumoniae specifically identified as the causal pathogen.
Baum, S; Mycoplasma pneumoniae and Atypical Pneumonia; Chap 185, Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases, 9th ed., Churchill Livingstone, 2015.
Comment: Latest overview of Mycoplasma pneumoniae regarding clinical presentations, diagnosis and treatment.
|S. Pneumoniae||Penicillin V, Amoxicillin, Cefpodoxime, Cefprozil, Cefditoren, Cefdinir, Doxycycline||Tomczyk S et al: Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 63:822, 2014,[PMID:25233284]
Comment: Updated recommendations regarding introducing PCV-13 as routine administration to adults aged 65 years or older. ACIP will revist recommendation in 2018. Use of PCV-13 in special populations under age 65 remains unchanged.
Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices: Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep 59:1102, 2010,[PMID:20814406]
Comment: Update on 1997 ACIP recommendations include: 1) the indications for which PPSV23 vaccination is recommended now include smoking and asthma, and 2) routine use of PPSV23 is no longer recommended for Alaska Natives or American Indians aged < 65 years unless they have medical or other indications for PPSV23. ACIP recommendations for revaccination with PPSV23 among the adult patient groups at greatest risk for IPD (i.e., persons with functional or anatomic asplenia and persons with immunocompromising conditions) remain unchanged.
Nuorti JP, Whitney CG, Centers for Disease Control and Prevention (CDC): Prevention of pneumococcal disease among infants and children - use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine - recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 59:1, 2010,[PMID:21150868]
Comment: Guidelines for 13-valent polysaccharide-protein conjugate vaccine covers all of prior PCV-7 with addition of 1, 3, 5, 6A, 7F, and 19A.
Mandell LA et al: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44 Suppl 2:S27, 2007,[PMID:17278083]
Comment: IDSA guidelines for community acquired pneumonia used here.
Tunkel AR et al: Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39:1267, 2004,[PMID:15494903]
Comment: IDSA guidelines for pyogenic meningitis used here.
Snow V et al: Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 134:595, 2001,[PMID:11281744]
Comment: This is the ACP/ASIM 2001 recommendations for treatment of EXACERBATIONS OF ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS. S. pneumoniae and H. influenzae are commonly implicated, but most studies do not provide convincing evidence that bacterial infections account for a substantial number; most are viral infections, allergies, smoking, etc. There is marginal support for antibiotic treatment of severe exacerbations and the recommended agents are amoxicillin, doxycycline and TMP-SMX.
|S. Pyogenes||Benzathine Penicillin, Penicillin VK, Amoxicillin, Cefpodoxime Proxetil, Cefdinir, Cefadroxil, Loracarbef, Erythromycin, Azithromycin, Clarithromycin, Clindamycin||Shulman ST et al: Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 55:1279, 2012,[PMID:23091044]
Comment: Current IDSA guideline for GAS pharyngitis.
Gerber MA et al: Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 119:1541, 2009,[PMID:19246689]
Comment: Official recommendations of strep infections and sequelae including rheumatic fever.
Stevens DL et al: Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 41:1373, 2005,[PMID:16231249]
Comment: Skin/soft tissue infection guidelines from IDSA include impetigo, cellulitis and necrotizing fasciitis.
Bisno AL et al: Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America. Clin Infect Dis 35:113, 2002,[PMID:12087516]
Comment: Guidelines for managing pharyngitis in adults from IDSA. The main difference with the ACP/CDC guidelines is that the IDSA guidelines accept only group A strep as the cause only if it is detected by culture or rapid antigen test. The concern with the more liberal ACP/CDC guidelines which accept clinical criteria that appear to overtreat about 50% of cases. The authors argue that overtreating is unnecessary & undertreating is not terrible because: 1)Rheumatic fever has nearly disappeared; 2)clinical response is modest/nil; 3)adults do not pose a public health problem; 4) quincy has become rare.
Stevens DL, Madaras-Kelly KJ, Richards DM: In vitro antimicrobial effects of various combinations of penicillin and clindamycin against four strains of Streptococcus pyogenes. Antimicrob Agents Chemother 42:1266, 1998,[PMID:9593164]
Comment: The authors show the absence of antagonism with CLINDAMYCIN PLUS PENICILLIN vs. Strep pyogenesin vitro. The relevance is for the use of this combination in deep strep infections.