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EscherichiaColiInfectionsMedication:Antibiotics

EscherichiaColiInfectionsMedication
Author:TarunMadappa,MD,MPHChiefEditor:MichaelStuartBronze,MDmore...
Updated:Aug19,2014

Antibiotics
ClassSummary
Empiricantimicrobialtherapymustbecomprehensiveandcoveralllikelypathogensinthecontextoftheclinical
setting.However,giventhebroaduseofantibioticsinhospitals,astudywasperformedtodeterminethe
relationshipbetweenhospitaluseof16classesofantibacterialagentsandtheincidenceofquinoloneresistantE
coliisolates.Theresultsrevealedthatalthoughthelevelofhospitaluseofquinolonesinfluencedtheincidenceof
quinoloneresistanceinEcolihospitalisolates,theconsumptionof2otherclassesofantibiotics,cephalosporinsand
tetracyclines,isalsoassociatedwithquinoloneresistance. [10]
RecentdatafromtheCanadiannationalsurveillancestudy,CANWARD,revealedthat868urineisolatesofEcoli
collectedfrom20102013weresensitivetofosfomycinusingtheClinicalandLaboratoryStandardsInstitute(CLSI)
agardilutionmethod,withminimuminhibitoryconcentrations(MICs)interpretedusingCLSIM100S23(2013)
criteria.Theconcentrationsoffosfomycininhibiting50%(MIC50)and90%(MIC90)ofisolateswere1orlessand
4g/mL,respectivelyl99.4%ofisolatesweresusceptibletofosfomycin. [11]
Viewfulldruginformation

Doxycycline(Vibramycin)
Doxycyclineinhibitsproteinsynthesisandthus,bacterialgrowth,bybindingtothe30Sandpossibly50Sribosomal
subunitsofsusceptiblebacteria.Itisusedtotreattraveler'sdiarrhea.
Viewfulldruginformation

Trimethoprim/sulfamethoxazole(BactrimDS,Septra)
Trimethoprim/sulfamethoxazoleinhibitsbacterialgrowthbyinhibitingthesynthesisofdihydrofolicacid.Itisusedto
treattraveler'sdiarrheafor5days,uncomplicatedUTIfor3days,complicatedUTIfor1014days,andacute
prostatitisfor612weeks.
Viewfulldruginformation

Ciprofloxacin(Cipro)
CiprofloxacinisafluoroquinolonethatinhibitsbacterialDNAsynthesisand,consequently,growth.Itisusedtotreat
mildtomoderateUTIfor714days,acuteuncomplicatedcystitisfor3days,severetocomplicatedUTIfor714
days,infectiousdiarrheafor57days,andchronicbacterialprostatitisfor46weeks.
Viewfulldruginformation

Levofloxacin(Levaquin)
Levofloxacinisusedforinfectionsduetomultidrugresistantgramnegativeorganisms.Itisusedtotreat
communityacquiredpneumoniafor714days,acutepyelonephritisandcomplicatedUTIfor10days,andtraveler's
diarrheafor5days.
Viewfulldruginformation

Amoxicillin(Amoxil,Trimox)
Amoxicillininterfereswiththesynthesisofcellwallmucopeptidesduringactivemultiplication,resultingin
bactericidalactivityagainstsusceptiblebacteria.ItisusedtotreatuncomplicatedUTIfor7daysandcomplicated
UTIorpyelonephritisfor1014days.
Viewfulldruginformation

Aztreonam(Azactam)
Aztreonamisamonobactamthatinhibitscellwallsynthesisduringbacterialgrowth.Itisactiveagainstaerobic
gramnegativebacilli.ItisusedtotreatcomplicatedUTIs/pyelonephritisandbacteremiafor714days,intra
abdominalinfectionsfor1421days,andpneumoniafor14days.
Viewfulldruginformation

Ampicillinandsulbactam(Unasyn)
Ampicillinandsulbactamisadrugcombinationofabetalactamaseinhibitorwithampicillin.Itisusedtotreatintra
abdominalinfectionsfor1421days.
Viewfulldruginformation

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Nitrofurantoin(Macrodantin)
Nitrofurantoinissyntheticnitrofuranandinterfereswithbacterialcarbohydratemetabolismbyinhibiting
acetylcoenzymeA.ItisusedtotreatuncomplicatedUTIsfor7daysorfor3daysafterurineissterile.
Viewfulldruginformation

Meropenem(MerremIV)
Meropenemisabactericidalbroadspectrumcarbapenemantibioticthatinhibitscellwallsynthesis.Itiseffective
againstmostgrampositiveandgramnegativebacteria.Itisusedtotreatintraabdominalinfectionsfor1421days.
Viewfulldruginformation

Ceftriaxone(Rocephin)
Ceftriaxoneisathirdgenerationcephalosporinthatarrestsbacterialgrowthbybindingtooneormorepenicillin
bindingproteins.Itisusedtotreatmeningitisandbacteremiafor1421daysandpneumonia,complicatedUTI,or
pyelonephritisfor14days.
Viewfulldruginformation

Piperacillinandtazobactam(Zosyn)
Piperacillinandtazobactamisanantipseudomonalpenicillinplusbetalactamaseinhibitor.Itinhibitsbiosynthesisof
cellwallmucopeptideandiseffectiveduringthestageofactivemultiplication.Itisusedtotreatintraabdominal
infectionsfor1421days.
Viewfulldruginformation

Imipenemandcilastatin(Primaxin)
Theimipenemandcilastatincombinationisfortreatmentofmultipleorganisminfectionsinwhichotheragentsdo
nothavewidespectrumcoverageorarecontraindicatedduetopotentialfortoxicity.Itisusedtotreatpneumonia
andcomplicatedUTIfor14days,bacteremiafor7days,andintraabdominalabscessfor1421days.
Viewfulldruginformation

Rifaximin(Xifaxan,RedActiv,Flonorm)
Rifaximinisanonabsorbed(<0.4%),broadspectrumantibioticspecificforentericpathogensoftheGItract(ie,
grampositive,gramnegative,aerobic,anaerobic).Itisarifampinstructuralanalog,anditbindstothebetasubunit
ofbacterialDNAdependentRNApolymerase,therebyinhibitingRNAsynthesis.ItisindicatedforEcoli
(enterotoxigenicandenteroaggregativestrains)associatedwithtravelers'diarrhea.

ContributorInformationandDisclosures
Author
TarunMadappa,MD,MPHAttendingPhysician,DepartmentofPulmonaryandCriticalCareMedicine,Christus
SpohnShorelineHospital
TarunMadappa,MD,MPHisamemberofthefollowingmedicalsocieties:AmericanCollegeofChest
Physicians,AmericanThoracicSociety
Disclosure:Nothingtodisclose.
Coauthor(s)
ChiHiongUGo,MDAssistantProfessor,DepartmentofInternalMedicine,TexasTechUniversityHealth
ScienceCenteratOdessa
ChiHiongUGo,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysiciansAmerican
SocietyofInternalMedicine
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:ReceivedsalaryfromMedscapeforemployment.
CharlesVSanders,MDEdgarHullProfessorandChairman,DepartmentofInternalMedicine,Professorof
Microbiology,ImmunologyandParasitology,LouisianaStateUniversitySchoolofMedicineatNewOrleans
MedicalDirector,MedicineHospitalCenter,CharityHospitalandMedicalCenterofLouisianaatNewOrleans
ConsultingStaff,OchsnerMedicalCenter
CharlesVSanders,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,Alliance
forthePrudentUseofAntibiotics,TheFoundationforAIDSResearch,SouthernSocietyforClinical
Investigation,SouthwesternAssociationofClinicalMicrobiology,AssociationofProfessorsofMedicine,
AssociationforProfessionalsinInfectionControlandEpidemiology,AmericanClinicalandClimatological
Association,InfectiousDiseaseSocietyforObstetricsandGynecology,OrleansParishMedicalSociety,
SoutheasternClinicalClub,AmericanAssociationfortheAdvancementofScience,AlphaOmegaAlpha,
AmericanAssociationofUniversityProfessors,AmericanAssociationforPhysicianLeadership,American
FederationforMedicalResearch,AmericanGeriatricsSociety,AmericanLungAssociation,AmericanMedical
Association,AmericanSocietyforMicrobiology,AmericanThoracicSociety,AmericanVenerealDisease
Association,AssociationofAmericanMedicalColleges,AssociationofAmericanPhysicians,InfectiousDiseases
SocietyofAmerica,LouisianaStateMedicalSociety,RoyalSocietyofMedicine,SigmaXi,SocietyofGeneral

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InternalMedicine,SouthernMedicalAssociation
Disclosure:ReceivedroyaltyfromBaxterInternationalforother.
ChiefEditor
MichaelStuartBronze,MDDavidRossBoydProfessorandChairman,DepartmentofMedicine,StewartG
WolfEndowedChairinInternalMedicine,DepartmentofMedicine,UniversityofOklahomaHealthScience
CenterMasteroftheAmericanCollegeofPhysiciansFellow,InfectiousDiseasesSocietyofAmerica
MichaelStuartBronze,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
MedicalAssociation,OklahomaStateMedicalAssociation,SouthernSocietyforClinicalInvestigation,
AssociationofProfessorsofMedicine,AmericanCollegeofPhysicians,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
AdditionalContributors
LarryILutwick,MDProfessorofMedicine,StateUniversityofNewYorkDownstateMedicalSchoolDirector,
InfectiousDiseases,VeteransAffairsNewYorkHarborHealthCareSystem,BrooklynCampus
LarryILutwick,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,Infectious
DiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
Acknowledgements
TheauthorsandeditorsofMedscapeReferencegratefullyacknowledgethecontributionsofpreviousauthor
EleftheriosMylonakis,MD,tothedevelopmentandwritingofthisarticle.

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