A patients develops an infection of methicillin resistant Staphylococcus aurens. All of the following can be used to treat this infection except:
CEFACLOR: It retains significant activity by the oral route and is more active than the first generation compounds against H. influenzae, E. coli and Pr. mirabilis. COTRIMOXAZOLE: Spectrum of action Antibacterial spectra of trimethoprim and sulfonamides overlap considerably. Additional organisms covered by the combination are-Salmonella typhi, Serratia, Klebsiella, Enterobacter, Yersinia enterocolitica, Pneumocystis jiroveci and many sulfonamide resistant strains of Staph. aureus, Strep. pyogenes, Shigella, enteropathogenic E. coli, H.influenzae, gonococci and meningococci. Ciprofloxacin (prototype): It is the most potent first generation FQ acti\*e against a broad range of bacteria, the most susceptible ones are the aerobic gram-negati\*e bacilli, especially the Enterobacteriaceae and Neisseria. The MIC of ciprofloxacin against these bacteria is usually < 0.1 J.Ig/ml, while grampositive bacteria are inhibited at relatively higher concentrations. The spectrum of action E summarized below: Highly susceptible E. coli K. pneumoniae Enterobacter Salmonella typhi other Salmonella Shigella Proteus Neisseria gonorrhoeae N. meningitidis H. influenzae H. ducreyi Campylobacter jejuni Yersinia enterocolitica Vibrio cholerae Moderately susceptible Pseudomonas aeruginosa Staph. aureus (including few MRSA) Staph. epidermidis Branhamella catarrhalis Legionella Brucella Listeria Bacillus anthracis Mycobact. tuberculosis Organisms which have shown low /variable susceptibility are: Strep. pyogenes, Strep. faecalis, Strep. pneumoniae, Mycoplasma, Chlamydia, Mycobact. kansasii, Mycobact. avium. Vancomycin: It is a glycopeptide antibiotic discovered in 1956 as a penicillin substitute which has assumed special significance due to efficacy against MRSA Strep. viridans, Enterococcus and Cl. difficile. It is bactericidal to gram-positive cocci, Neisseria, Clostridia and diphtheroids. However, in hospitals where it has been extensively used for surgical prophylaxis, etc., vancomycin-resistant Staph. aureus (VRSA) and vancomycin-resistant Enterococcus (VRE) have emerged. These nosocomial bacteria are resistant to methicillin and most other antibiotics as well. REFERENCE: ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:685,688,705,732
Cotrimoxazole
Cefaclor
Ciprofloxacin
Vancomycin
Chemotherapy