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MHTEXT1.PRG
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1986-07-06
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* MHTEXT1 DB3 PLUS REVISION 10/10/85
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CEPHALOSPORINS
Third-generation cephalosporins primarily are more resistant to beta-
lactamases that are produced by a wide variety of gram-negative organisms and,
therefore, have a broader spectrum of activity.
None of these agents are very effective against enterococcus or
Pseudomonas. Neither should they be considered primary drugs for the treatment
of Bacteroides fragilis infections unless the sensitivity is known, because a
significant number of B. fragilis organisms are resistant to the newer
cephalosporins. None of the second or third-generation drugs are primarily
indicated for treating infections caused by gram-positive organisms.
An advantage over aminoglycosides is that cephalosporins are relative-
ly non-toxic, therefore there is a fair margin for error in terms of over-
dosing. Activity against a broad spectrum of gram-negative bacilli, however,
does not come anywhere close to the aminoglycosides.
It is recommended that none of the third-generation cephalosporins be
used for prophylaxis over first or second-generation drugs in order to prevent
emergence of resistant strains.
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REFERENCE (cephalosporins)
Eickhoff, M.D., Theodore
Finegold, M.D., Sydney M.
Moellering, Jr., M.D., Robert C.
Remington, M.D., Jack S.
Sabath, M.D., Lee D.
"A Rational Approach to the Selection of Antibiotics in Seriously Ill
Patients: New Agents Versus Standard Regimens," The Upjohn Company, 1982.
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AMINOGLYCOSIDES
Despite developments of newer beta-lactam antibiotics, aminoglyco-
sides remain the "gold standard" of therapy for gram-negative bacillary
infections. Bacteria resistant to gentamicin and tobramycin are usually
susceptible to amikacin. Tobramycin is the most reliable against Pseudo-
monas aeruginosa. Gentamicin is the most cost-effective aminoglycoside and
is the first choice in most clinical situations. Aminoglycoside use has
been limited by side effects including nephrotoxicity and ototoxicity,
which may be minimized through careful patient monitoring and adjusting
dosages by measuring serum drug levels.
Aminoglycosides can be inactivated by broad-spectrum penicillins.
Carbenicillin, ticarcillin, and to a lesser degree, mezlocillin, azlocil-
lin, and piperacillin in high concentrations slowly inactivate aminoglyco-
sides in vitro. In vivo, this interaction may significantly shorten the
aminoglycoside half-life in patients with significant renal insufficiency.
Serum aminoglycoside levels must therefore be monitored. Amikacin is the
most stable aminoglycoside when exposed to the higher penicillin concentra-
tions.
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REFERENCE (aminoglycosides)
Le Frock, M.D., Jack L.
Molavi, M.D., Abdolghader
Smith, Pharm.D., Bruce R.
Rittase, Pharm.D., Robert
"Current Use of Amnioglycosides," Infections in Surgery, Vol. 3, No. 1.,
January, 1984.
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