Antibiotic use in the emergency department. III. The quinolones, new beta lactams, beta lactam combination agents, and miscellaneous antibiotics.
This article reviews several new, relatively broad-spectrum antibiotics that have utility in the emergency department (ED). The quinolones have excellent activity against gram-negative organisms, including gonococcus, and are characterized by very high bioavailability after oral administration. The new beta-lactams aztreonam and imipenem have broad spectra but limited usefulness to the emergency physician, and should be reserved for judicious use in severe infections, particularly those involving Pseudomonas. Clavulanate, sulbactam, and tazobactam are themselves antimicrobials that have been combined with beta-lactams such as ampicillin and ticarcillin to produce agents with significant potential utility in the ED; these are typically not first-line agents, however, and their use should be governed by both clinical and cost concerns. Finally, three older antibiotics--vancomycin, metronidazole, and clindamycin--are reviewed with respect to updated indications for their use in the ED.
Schmidt
J
J
Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona 85008, USA.
Pollack
C V
CV
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D015363:Quinolones / Q000494:pharmacology / Q000627:therapeutic use; D065093:beta-Lactamase Inhibitors; D001618:beta-Lactamases / Q000494:pharmacology; D047090:beta-Lactams
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D015363:Quinolones; D065093:beta-Lactamase Inhibitors; D047090:beta-Lactams; D001618:beta-Lactamases