Activity of the Newer Oral Extended-Spectrum Antimicrobials against Resistant Respiratory Pathogens

Publisher Website
Google Scholar
Abstract
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis, Staphylococcus aureus, and Streptococcus pyogenes resistant to multiple antimicrobials cause upper and lower respiratory infections in children. Amoxicillin and trimethoprim-sulfamethoxazole remain useful first line antibiotics, however, they are increasingly ineffective for patients with otitis media, sinusitis, and lower respiratory infections. Newer, extended-spectrum antimicrobials that may be advantageous in selected patients include amoxicillin/clavulanate, cephalosporins (cefprozil, cefuroxime axetil, loracarbef, cefixime, cefpodoxime proxetil, and ceftibuten), and the extended-spectrum macrolides (clarithromycin and azithromycin). These newer antibiotics are differentiated from each other by their activity against penicillin-resistant pneumococci, relative β-lactamase stability, and pharmacokinetic properties. Monitoring local patterns of bacterial susceptibility among respiratory isolates is important in tracking the problem of resistant pathogens. Use of the newer, extended-spectrum antibiotics should take into account their differing spectrum of activity, adverse events profile, cost, and the risks of escalating the pressure on selecting new more resistant bacterial strains.