Which medications in the drug class Antibiotics, Other are used in the treatment of Multiple Organ Dysfunction Syndrome in Sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH, FACP, FCCP, FCCM; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Antibiotics, Other

Besides resuscitation fluids, empiric antibiotics that cover the infecting organism and are started early are the only other proven medical treatment for septic shock. Administer all initial antibiotics intravenously (IV) in patients with septic shock.

The necessary coverage is achieved by giving a single broad-spectrum agent or multiple antibiotics. In adults who are not immunocompromised, monotherapy with either an antipseudomonal penicillin or a carbapenem is possible. Combination therapy in adults involves either a third-generation cephalosporin plus anaerobic coverage (clindamycin or metronidazole) or a fluoroquinolone plus clindamycin.

Cefotaxime (Claforan)

Cefotaxime is used for treatment of bloodstream infection (BSI), as well as for treatment of gynecologic infections caused by susceptible organisms. It is a third-generation cephalosporin with enhanced gram-negative coverage, especially of Escherichia coli, Proteus species, and Klebsiella species. It has variable activity against Pseudomonas species.

Ceftriaxone (Rocephin)

Ceftriaxone is used because of the increasing prevalence of penicillinase-producing microorganisms. It inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins. Bacteria eventually lyse as a consequence of the ongoing activity of cell wall autolytic enzymes while cell wall assembly is arrested.

Cefuroxime (Zinacef, Ceftin)

Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of the first-generation cephalosporins and adds activity against E coli, Klebsiella pneumoniae, Proteus mirabilis, Haemophilus influenzae, and Moraxella catarrhalis. The condition of the patient, the severity of the infection, and the susceptibility of the microorganism determine the proper dose and route of administration.

Ticarcillin-clavulanate (Timentin)

Ticarcillin-clavulanate is a combination of an antipseudomonal penicillin with a beta-lactamase inhibitor that provides coverage against most gram-positive organisms (variable coverage against Staphylococcus epidermidis and none against methicillin-resistant Staphylococcus aureus [MRSA]), most gram-negative organisms, and most anaerobes.

Piperacillin-tazobactam (Zosyn)

Piperacillin-tazobactam inhibits the biosynthesis of cell wall mucopeptide and is effective during the stage of active multiplication. It has antipseudomonal activity.

Imipenem-cilastatin (Primaxin)

Imipenem cilastatin is a carbapenem with activity against most gram-positive organisms (except MRSA), gram-negative organisms, and anaerobes. It is used for treatment of polymicrobial infections in which other agents do not have wide-spectrum coverage or are contraindicated because of their potential for toxicity.

Meropenem (Merrem)

Meropenem is a carbapenem that, compared with imipenem, has slightly increased activity against gram-negative organisms and slightly decreased activity against staphylococci and streptococci.

Clindamycin (Cleocin)

Clindamycin is primarily used for its activity against anaerobes. It has some activity against streptococcus and methicillin-sensitive S aureus (MSSA).

Metronidazole (Flagyl)

Metronidazole is an imidazole ring-based antibiotic that is active against various anaerobic bacteria and protozoa. It is usually employed in combination with other antimicrobial agents, except when it is used for Clostridium difficile enterocolitis, in which case monotherapy is appropriate.

Ciprofloxacin (Cipro)

Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Ciprofloxacin has no activity against anaerobes. Continue treatment for at least 2 days (typically, 7-14 days) after signs and symptoms have disappeared.


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