What are the preferred antibiotics for specific diseases and their most common indications?

From the Guidelines

For community-acquired pneumonia, the recommended antibiotics are amoxicillin 1g three times daily, doxycycline 100mg twice daily, or a macrolide (azithromycin 500mg on the first day then 250mg daily) 1. When considering the treatment of various diseases, it's essential to prioritize the most recent and highest quality studies to ensure the best outcomes in terms of morbidity, mortality, and quality of life.

Respiratory Tract Infections

• For community-acquired pneumonia, amoxicillin 1g three times daily is a strong recommendation with moderate quality of evidence 1.
• For more severe cases or penicillin-allergic patients, azithromycin (500mg on day 1, then 250mg daily) is effective 1.

Skin and Soft Tissue Infections

• Cephalexin (500mg four times daily for 7-10 days) is preferred for skin and soft tissue infections 1.
• Clindamycin (300-450mg four times daily for 7-10 days) works well for MRSA infections 1.

Urinary Tract Infections

• Nitrofurantoin (100mg twice daily for 5 days) or trimethoprim-sulfamethoxazole (160/800mg twice daily for 3 days) are effective for urinary tract infections 1.

Gastroenteritis

• Ciprofloxacin (500mg twice daily for 3-5 days) may be required for gastroenteritis with bacterial causes 1. It's crucial to note that local resistance patterns may vary, and treatment should be adjusted based on culture results when available. Completing the full course of antibiotics is essential to prevent resistance development, even if symptoms improve earlier.

From the FDA Drug Label

The following adverse reactions are described, or described in greater detail, in other sections: In Phase 3 complicated skin and skin structure infection (cSSSI) trials in adult patients, daptomycin for injection was discontinued in 15/534 (2. 8%) patients due to an adverse reaction, while comparator was discontinued in 17/558 (3. 0%) patients. Table 6: Incidence of Adverse Reactions that Occurred in ≥2% of Adult Patients in the Daptomycin for Injection Treatment Group and ≥ the Comparator Treatment Group in Phase 3 cSSSI Trials Table 7: Incidence of Adverse Reactions that Occurred in ≥5% of Adult Patients in the Daptomycin for Injection Treatment Group and ≥ the Comparator Treatment Group in the S aureus Bacteremia/Endocarditis Trial

The antibiotics preference for certain diseases are as follows:

• Complicated Skin and Skin Structure Infections (cSSSI): Daptomycin for injection is used to treat cSSSI, with a comparator of vancomycin or an anti-staphylococcal semi-synthetic penicillin.
• S. aureus Bacteremia/Endocarditis: Daptomycin for injection is used to treat S. aureus bacteremia/endocarditis, with a comparator of vancomycin or an anti-staphylococcal semi-synthetic penicillin, each with initial low-dose gentamicin. The most common adverse reactions for these diseases are:
• For cSSSI:
  • Diarrhea
  • Headache
  • Dizziness
  • Rash
  • Abnormal liver function tests
  • Elevated CPK
  • Urinary tract infections
  • Hypotension
  • Dyspnea
• For S. aureus Bacteremia/Endocarditis:
  • Sepsis
  • Bacteremia
  • Abdominal pain
  • Chest pain
  • Edema
  • Pharyngolaryngeal pain
  • Pruritus
  • Sweating increased
  • Insomnia
  • Blood creatine phosphokinase increased
  • Hypertension 2

From the Research

Antibiotics Preference for Certain Diseases

• For urinary tract infections (UTIs), the recommended first-line empiric antibiotic therapy includes:
  • Nitrofurantoin 3
  • Fosfomycin tromethamine 3, 4
  • Pivmecillinam 3
• For acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females, a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam is recommended 3
• For UTIs due to AmpC- β-lactamase-producing Enterobacteriales, treatment options include:
  • Nitrofurantoin 3
  • Fosfomycin 3
  • Pivmecillinam 3
  • Fluoroquinolones 3
  • Cefepime 3
  • Piperacillin-tazobactam 3
  • Carbapenems 3
• For UTIs due to ESBLs-E coli, treatment oral options include:
  • Nitrofurantoin 3
  • Fosfomycin 3
  • Pivmecillinam 3
  • Amoxicillin-clavulanate 3
  • Finafloxacin 3
  • Sitafloxacin 3
• For community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), treatment options are not specified in the provided studies, but it is mentioned that pneumonia is a common infection that requires antimicrobial treatment 5

Most Common Studies

• A study published in 2020 found that high rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities 3
• A study published in 2017 discussed the pharmacokinetic characteristics of oral antimicrobial agents for the treatment of uncomplicated UTIs 4
• A study published in 2014 found that trimethoprim-sulfamethoxazole, nitrofurantoin monohydrate/macrocrystals, and fosfomycin trometamol are all appropriate first-line therapies for uncomplicated cystitis 6
• A study published in 2020 found that there is evidence to support shorter courses of antibiotic therapy for many common infections, including community-acquired pneumonia, intraabdominal sepsis, gram-negative bacteraemia, and vertebral osteomyelitis 7