Pharmacology for Anaesthesia and Intensive Care

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22 Antimicrobials

Table 22.2.Summary of some antibacterial drugs.

Drug Main uses Notes

Benzylpenicillin Streptococcal, Neisseria and

Clostridia infection. Used in

anthrax, leptospirosis, Lyme,

tetanus and necrotising fasciitis.

Established resistance to some

Pneumococcal, Gonococcal

and Meningococcal

infection. No longer drug of

first choice in

Meningococcal meningitis.

Flucloxacillin Staphylococcal infection (joint,

soft tissue, endocarditis, toxic

shock syndrome).

Maycause cholestatic

jaundice.

Amoxycillin Enterococcal infection and

first-line treatment for

Listeriosis. Useful agent for

sensitive urological sepsis.

90% ofStaphylococci,50%E.

coliand 15%H. influenzae

resistant (less with

co-amoxiclav). May cause

cholestatic jaundice.

Piperacillin Pseudomonal infection. Blind

broad spectrum ICU cover

(Tazocin).

Synergy with

aminoglycosides, rarely

used in isolation against

Pseudomonas.

Cefradine

(1stgeneration

cephalosporin)

Surgical prophylaxis where

predominant gram-positive

cover required (orthopaedics).

E.faecalisandH. influenzae

resistant.

Cefuroxime

(2ndgeneration

cephalosporin)

General surgery prophylaxis,

peritonitis, pneumonia, joint

infection, urinary sepsis.

Resistant toβ-lactamase

action. Improved cover

againstH. influenzae,

Proteus,N. gonorrhoeaand

Klebsiella.

Cefotaxime (3rd

generation

cephalosporin)

Meningitis, nosocomial

pneumonia, biliary infection,

wound sepsis, urinary sepsis.

Less gram-positive cover than

cefuroxime. Excellent CSF

penetration.E.faecalisand

listeria resistant. Improved

cover for Pseudomonas,

Serratia, Citrobacter and

Acinetobacter.

Imipenem Very broad antimicrobial

spectrum. Role in blind

treatment of severe sepsis in

ICU. Used in neutropaenic

sepsis.

Poor CNS penetration. Some

MRSA insensitive. Synergy

with aminoglycosides

againstPseudomonas.

Combined with Cilastatin.

Aztreonam ‘Third’-line agent, reserved for use

against multi-resistant

organisms.

Gram-negative aerobic cover

only. Hepatotoxic, rare

cause of toxic epidermal

necrolysis.

(cont.)