Renal Corticomedullary Abscess Medication

Updated: Aug 18, 2021
  • Author: Aaron Benson, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications. Initial empirical choices for intravenous antibiotic therapy include a penicillin derivative, a cephalosporin, an aminoglycoside, or a fluoroquinolone; for combination therapy, a beta-lactam antibiotic plus an aminoglycoside can be given.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Piperacillin and tazobactam sodium (Zosyn)

Antipseudomonal penicillin plus beta-lactamase inhibitor. Inhibits biosynthesis of cell wall mucopeptide and is effective during active multiplication stage.

Ticarcillin and clavulanate (Timentin)

Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active growth. Antipseudomonal penicillin plus beta-lactamase inhibitor that provides coverage against most gram-positive organisms, most gram-negative organisms, and most anaerobes.

Nafcillin (Nafcil, Nallpen, Unipen)

Initial therapy for suspected penicillin G–resistant streptococcal or staphylococcal infections.

Use parenteral therapy initially in severe infections. Change to PO therapy as condition warrants.

Because of thrombophlebitis, particularly in the elderly, administer parenterally only for short term (1-2 d); change to PO route as clinically indicated.

Ceftazidime (Fortaz)

Third-generation cephalosporin with broad-spectrum, gram-negative activity, including Pseudomonas species; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins, which, in turn, inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall synthesis, thus inhibiting cell wall biosynthesis. The condition of the patient, severity of the infection, and susceptibility of the microorganism should determine the proper dose and route of administration.

Cefepime (Maxipime)

Fourth-generation cephalosporin. Gram-negative coverage comparable to that of ceftazidime but has better gram-positive coverage (comparable to ceftriaxone). Cefepime is a zwitter ion; rapidly penetrates gram-negative cells. Best beta-lactam drug for IM administration. Poor capacity to cross blood-brain barrier precludes use for treatment of meningitis.

Ciprofloxacin (Cipro)

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. Has no activity against anaerobes. Continue treatment for at least 2 d (7-14 d typical) after signs and symptoms have disappeared.

Levofloxacin (Levaquin)

For pseudomonal infections and infections due to multidrug-resistant gram-negative organisms.

Gentamicin (Garamycin)

Aminoglycoside antibiotic for gram-negative coverage bacteria, including Pseudomonas species. Synergistic drug with beta-lactamase against enterococci. Interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits.

Dosing regimens are numerous and are adjusted based on CrCl and changes in volume of distribution, as well as body space into which agent needs to distribute. Dose of gentamicin may be given IV/IM. Each regimen must be followed by at least trough level drawn on third or fourth dose, 0.5 h before dosing; may draw peak level 0.5 h after 30-min infusion.

Amikacin (Amikin)

Irreversibly binds to 30S subunit of bacterial ribosomes; blocks recognition step in protein synthesis; causes growth inhibition. For gram-negative bacterial coverage of infections resistant to gentamicin and tobramycin. Effective against Pseudomonas aeruginosa.

Use patient's IBW for dosage calculation. The same principles of drug monitoring for gentamicin apply to amikacin.

Tobramycin (Nebcin)

Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes.

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