Antibiotics

Authors: Prof. Dr. med. Peter Altmeyer, Anonymous User

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Last updated on: 29.10.2020

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Definition
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Natural or synthetic substances which have a killing (bactericidal) or inhibiting (bacteriostatic) effect on pathogenic micro-organisms, usually bacteria. Antibiotics attack the microbes e.g. at the cell wall ( penicillins, cephalosporins), the cell membrane permeability(polymyxins), the nucleus and protein synthesis ( tetracyclines, gyrase inhibitors, pleuromutilins, oxazolidinone, chloramphenicol, aminoglycosides, lincosamides, macrolides, glycylclines). Cyclic lipopeptides penetrate the bacterial cytoplasmic membrane via lipid side chains and form pores (ion channels) in the presence of calcium, which lead to cytolysis of the pathogens (see also daptomycin).

Some antibiotics are also used as cytostatics, sometimes also as immunosuppressants, because of their inhibition of nucleic acid and protein synthesis (e.g. Adria-, Dauno-, Mito-, Actinomycin).

Topical antibiotics are mostly used for the treatment of wounds or for eradication in case of colonization with MRSA/ORSA (e.g. mupirocin). Topical antibiotics also play a role in acne therapy (e.g. erythromycin)

The following active ingredients play a role in dermatology (see also active ingredients, dermatological):

Preparations
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Overview of the most important antibiotics

Penicillin

  • Penicillin
  • Benzypencillin (Pencillin G)
  • Phenoxypenicillin (Penicillin V)
  • Aminopenicillins
  • Amoxipenicillin
  • Ampicillin
  • Aminopenicillins/Betalactamase inhibitors
  • Amoxicillin/Clavulanic acid
  • Ampcilllin/Sulbactam
  • Acylamiopenicillins
  • Mezlocillin
  • Piperacillin
  • Acylaminopenicillins/betactamase inhibitors
  • piperacillin/tacobactam
  • Isoxyzylpenicillins
  • Flucloxacillin

Cephalosporins

  • Group1
  • Cefazolin
  • Cefalexin
  • Cefadroxil
  • Cefaclor
  • Group 2
  • Cefuroxime
  • Cefotiam
  • Group 3a
  • Cefotaxime
  • Ceftibuten
  • Cefotriaxone
  • Cefexim
  • Cefpodoxime
  • Group 3b
  • Ceftazidem
  • Group 4
  • Cefepim
  • Group 5
  • Ceftarolin
  • Ceftobiprole

Carbapenems

  • imipenem/cilastatin

Glycopeptides

  • Vancomycin
  • Teicoplanin

Fluoroquinolones

  • Group 1
  • norfloxacin
  • Group 2
  • Ofloxacin
  • Ciprofloxacin
  • Group 3
  • Lefloxacin
  • Group 4
  • Moxifloxacin

Macrolides

  • Older macrolides
  • Erythromycin
  • Newer macrolides
  • Azithromycin
  • Clarithromycin
  • Roxithromycin
  • Telithromycin

Aminoglycosides

  • Amikacin
  • Gentamycin
  • Tobramycin

Tetracyclines

  • Tetracycline
  • Chlortetracycline
  • Oxytetracycline
  • Doxycycline
  • Minocycline

Trimethroprim

  • trimethroprime/co-trimooxazole

Note(s)
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See below for information on the targeted therapeutic use of antibiotics:

Literature
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  1. DGI: Definition Antibiotic Stewardship: https://www.dgi-net.de/fort-und-weiterbildung/antibiotic-stewardship-abs/

  2. Dyar OJ et al.(2017) What is antimicrobial stewardship? Clin Microbiol Infect 23: 793-798

  3. Gelmetti C et al (2008) Local antibiotics in dermatology. Dermatologic Therapy 21: 187-195

  4. Lloyd D et al (2018) Antimicrobial Stewardship in Veterinary Medicine. Microbiology spectrum 6: 10.1128/microbiolspec ARBA-0023-2017.

  5. Rittenhouse S et al (2006) Selection of retapamulin, a novel pleuromutilin for topical use. Antimicrob Agents Chemother 50: 3882-3885

Tables
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Pathogen

Therapy options (in vitro efficacy of the antibiotic used and the combination partner must be proven)

staph. aureus

Doxycycline (+ rifampicin), cotrimoxazole + rifampicin

Staph. aureus ("MRSA")

Vancomycin or teicoplanin (+ rifampicin or fosfomycin)

linezolid (+ rifampicin for endocarditis), tigecycline

Enterococci, ß-lactam resistant

Teicoplanin, linezolid, in case of urinary tract infections possibly also nitrofurantoin or fosfomycin

Pneumococcus, penicillin tolerant

cefotaxime, ceftriaxone, ampicillin, moxifloxacin

Pneumococcus, penicillin-resistant

vancomycin + rifampicin, linezolid, moxifloxacin

Enterobacteriaceae, multi-resistant

meropenem, imipenem, ertapenem, ciprofloxacin, levofloxacin, cotrimoxazole, piperacillin/tazobactam, tigecyclin, for urinary tract infections also nitrofurantoin or fosfomycin

Pseudomonas aeruginosa, multi-resistant

Amikacin, Colistin


Pathogen

Therapy option

Alternatives

Staph. aureus; haemolytic streptococci

Clindamycin

cefadroxil, cefazolin, moxifloxacin, ampicillin/sulbactam, amoxicillin/clavulanic acid


Pathogen

Therapy option

Alternatives

Staph. aureus, haemolytic streptococci, enterobacteria, anaerobes, Pseudomonas aeruginosa

slight wound infections: Clindamycin

cefadroxil, ampicillin/sulbactam, amoxicillin/clavulanic acid, moxifloxacin

severe wound infection: cefotiam (+ metronidazole)

Clindamycin (+ gentamicin), moxifloxacin

Infections after bite wounds: Ampicillin/Sulbactam, Amoxicillin/Clavulanic acid

Moxifloxacin


Pathogen

Therapy options

Alternatives

Staph. aureus, streptococci, anaerobes, enterobacteria, Pseudomonas aeruginosa

Clindamycin (+ ciprofloxacin)

Piperacillin/Tazobactam, Ampicillin/Sulbactam, Amoxicillin/Clavulanic acid, Moxifloxacin, Doxycycline


Largely harmless

After risk-benefit analysis

Contraindicated

Pregnancy

Penicillins, cephalosporins, erythromycin (except estolate), fusidic acid

Clavulanic acid, sulbactam, tazobactam, meropenem, imipenem, ertapenem, azithromycin, roxithromycin, clindamycin, vancomycin, teicoplanin, linezolid, fosfomycin

Tetracyclines, chloramphenicol, clarithromycin, TMP/sulfonamides (1st trimester and from 28th week), metronidazole, aminoglycosides, fluoroquinolones, nitrofurantoin, rifampicin, telithromycin, tigecyclin

Breastfeeding period

penicillins, cephalosporins

Clavulanic acid, sulbactam, tazobactam, meropenem, imipenem, ertapenem, azithromycin, roxithromycin, clindamycin, vancomycin, teicoplanin, linezolid, aminoglycosides, fosfomycin

Tetracyclines, chloramphenicol, TMP/sulfonamides, erythromycin, metronidazole, fluoroquinolones, nitrofurantoin, rifampicin, telithromycin, ertapenem, tigecyclin

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Last updated on: 29.10.2020