Which of the following antibiotics are considered sensitive: Cefuroxime (CEFUROXIME), Cotrimoxazole (COTRIMOXAZOLE), Levofloxacin (LEVOFLOXACIN), Tetracycline (TETRACYCLINE), and Ciprofloxacin?

Sensitive Antibiotics: A Comprehensive Review

All the listed antibiotics - Cefuroxime, Cotrimoxazole, Levofloxacin, Tetracycline, and Ciprofloxacin - are considered sensitive antibiotics with broad-spectrum activity against various pathogens, though their specific sensitivity patterns differ based on the target organisms and regional resistance patterns. 1, 2, 3

Individual Antibiotic Profiles

Cefuroxime

• Second-generation cephalosporin with activity against many Gram-positive and Gram-negative bacteria 1, 4
• Effective against Streptococcus pneumoniae (susceptibility rate of 72.6% overall) and Haemophilus influenzae (82.8% susceptibility) 1
• Commonly used for respiratory tract infections, animal bites, and skin/soft tissue infections 1
• Limited activity against anaerobes and no activity against Pseudomonas aeruginosa 4

Cotrimoxazole (Trimethoprim-Sulfamethoxazole)

• Combination antibiotic with activity against many Gram-positive and Gram-negative organisms 1
• Particularly effective against methicillin-resistant Staphylococcus aureus (MRSA) in skin and soft tissue infections 1
• Susceptibility rates against Streptococcus pneumoniae vary (63.7% overall) 1
• Used for urinary tract infections, skin infections, and as an alternative for respiratory infections 1

Levofloxacin

• Fluoroquinolone with broad-spectrum activity against Gram-positive, Gram-negative, and atypical respiratory pathogens 2, 5
• High activity against Streptococcus pneumoniae (99.1% susceptibility), including penicillin-resistant strains 1, 5
• Nearly 100% effective against Haemophilus influenzae and Moraxella catarrhalis 1, 2
• Used for respiratory infections, urinary tract infections, skin infections, and as part of combination therapy for necrotizing fasciitis 1, 5

Tetracycline

• Bacteriostatic antibiotic that inhibits protein synthesis by binding to the 30S ribosomal subunit 3
• Active against a broad range of Gram-positive and Gram-negative organisms, including some atypical pathogens 3
• Doxycycline (a tetracycline) shows good activity against Streptococcus pneumoniae (80.4% susceptibility) 1
• Used for respiratory infections, skin infections, and in combination therapy for specific infections like those caused by Aeromonas hydrophila 1, 3

Ciprofloxacin

• Fluoroquinolone with excellent activity against Gram-negative bacteria 6
• 100% effective against Haemophilus influenzae and Moraxella catarrhalis 1
• Limited activity against Streptococcus pneumoniae compared to newer fluoroquinolones like levofloxacin 1, 5
• Used for urinary tract infections, gastrointestinal infections, and skin/soft tissue infections 1, 6

Clinical Applications Based on Infection Type

Respiratory Tract Infections

• Levofloxacin shows excellent activity against common respiratory pathogens including penicillin-resistant S. pneumoniae 2, 5
• Cefuroxime is effective for community-acquired pneumonia and acute bronchitis 1, 7
• Tetracyclines (particularly doxycycline) are effective for atypical pathogens like Mycoplasma pneumoniae 1, 3
• Ciprofloxacin has limited activity against S. pneumoniae but good activity against H. influenzae 1, 6

Skin and Soft Tissue Infections

• Cotrimoxazole is particularly effective for MRSA infections 1
• Levofloxacin 750mg daily shows comparable efficacy to ticarcillin/clavulanic acid for complicated skin infections 5, 8
• Cefuroxime is effective for uncomplicated skin infections 1, 7
• For necrotizing fasciitis, combination therapy including fluoroquinolones (levofloxacin/ciprofloxacin) with metronidazole is recommended 1

Urinary Tract Infections

• Fluoroquinolones (levofloxacin, ciprofloxacin) show excellent activity against common urinary pathogens 1, 8
• Cotrimoxazole remains effective for uncomplicated UTIs in regions with low resistance 1
• Cefuroxime is effective against many urinary pathogens including E. coli 4, 7

Important Considerations and Caveats

Resistance Patterns

• Local and regional resistance patterns should guide empiric antibiotic selection 1
• Fluoroquinolone resistance in S. pneumoniae remains relatively low for levofloxacin (<1% in the US) 8
• MRSA infections may require specific antibiotics like cotrimoxazole, doxycycline, or vancomycin 1

Special Populations

• Tetracyclines and fluoroquinolones should generally be avoided in children and pregnant women 1, 3
• Dosing adjustments may be needed for patients with renal impairment, particularly for levofloxacin and cotrimoxazole 2, 8

Duration of Therapy

• Shorter courses of high-dose levofloxacin (750mg daily for 5 days) may be as effective as longer courses for community-acquired pneumonia 8
• Duration of therapy varies by infection type and severity, ranging from 5-7 days for uncomplicated infections to 10-14 days for more severe infections 1, 5

Conclusion

When selecting among these sensitive antibiotics, consider:

• The likely pathogens based on infection site and clinical presentation 1
• Local resistance patterns 1
• Patient factors including allergies, comorbidities, and pregnancy status 1, 2
• The pharmacokinetic properties of each agent (e.g., tissue penetration, dosing frequency) 2, 5

Levofloxacin offers the broadest spectrum with excellent activity against respiratory pathogens, while cotrimoxazole may be preferred for suspected MRSA infections. Cefuroxime provides good coverage for many common pathogens with a favorable safety profile, while ciprofloxacin excels against Gram-negative organisms but has limited activity against S. pneumoniae 1, 5, 8, 4.