**Table 7.**

#### *Bactericidal and Bacteriostatic Antibiotics DOI: http://dx.doi.org/10.5772/intechopen.99546*

No dosing modification is needed for renal or hepatic impairment. They are teratogenic, and the anticoagulant dose needs adjustment when used concomitantly. A slightly increased mortality was observed in the CABP trial of omadacycline [94].

Azithromycin is an excellent choice for treating CABP caused by atypical organisms such as *Mycoplasma pneumoniae*, *Legionella* spp., *Chlamydia pneumoniae,* and *Coxiella burnetti.* An important fact is to remember the numerous interactions this class has with other medications, and also, it can prolong the QT interval resulting in ventricular tachyarrythmias.

When used in the therapy for staphylococcal infections, it is prudent always to perform a "D" test to identify any chance of inducible resistance. It is recommended not to use clindamycin as an empirical regimen against streptococcal infections due to a higher risk of resistance. Clindamycin can suppress the cyclosporine effect and can cause neuromuscular blockade.

Linezolid is an alternative for vancomycin in MRSA/MSSA pneumonia and is used in combination regimens for nosocomial pneumonia. It is an alternative in Nocardiosis and a part of combination regimens in the therapy of *Mycobacterium tuberculosis*, *Mycobacterium avium complex,* and *Mycobacterium abscessus complex*.

#### **3. Bactericidal antibiotics**

These include glycopeptides in **Table 8** (3A I), lipoglycopeptides in **Table 9** (3A II), lipopeptides in **Table 10** (3A III), aminoglycosides in **Table 11** (3A IV), quinolones in **Table 12** (3A V), penicillin in **Table 13** (3A VI), cephalosporins in **Table 14** (3A VII), beta-lactamase and beta-lactamase inhibitor combinations in **Table 15** (3A VIII), monobactams in **Table 16** (3A IX), carbapenems in **Table 17** (3A X), polymixins in **Table 18** (3A XI), epoxide in **Table 19** (3A XII), pleuromutilin in **Table 20** (3A XIII), rifamycins in **Table 21** (3A XIV) and metronidazole in **Table 22** (3A XV).

An increased risk of renal failure is observed when vancomycin is administered along with aminoglycosides and piperacillin-tazobactam [218, 219]. If a VRE strain susceptibility reveals sensitivity to teicoplanin, it should be avoided due to resistance emergence during therapy. When teicoplanin is used for IE, bone, and joint infections as a monotherapy, the recommendation is to keep serum levels close to 20 μg/mL and, if needed >30 μg/mL [220]. A higher AUC/MIC ratio is related to better clinical outcomes and decreased mortality with vancomycin therapy [221].

The lipoglycopeptides have a longer half-life and are currently undergoing trials for bacteremia, joint infections, osteomyelitis.

Retrospective data indicate higher cure rates and lower mortality when a higher dose (> 8 mg/kg/day) of daptomycin is used [222]. In the therapeutic failure of vancomycin therapy, a suggestion is to use a higher dose of daptomycin or combine it with a beta-lactam or aminoglycoside or TMP-SMX to increase its bactericidal activity. In VRE endocarditis with bacteremia, daptomycin with beta-lactam is an ideal combination to prevent the emergence of resistance [223, 224]. Due to lack of CNS penetration, it should not be used in the therapy for meningitis [225]. Daptomycin is inactivated by the pulmonary surfactant and is rendered ineffective in bronchoalveolar pneumonia but is adequate in hematogenous pneumonia [226]. In patients with chronic kidney disease and on dialysis, more frequent monitoring of CPK is ideal. CPK monitoring is a must if the patient is on statins for hyperlipidemia. It needs to be stopped if the CPK levels are >1000 units/L with clinical features of myopathy or > 2000 (ten times the upper limit) with no myopathy features [123].


## **Table 8.**

*3A I glycopeptides.*

Streptogramins are another class of lipopeptides rarely used currently. They are made up of two macrocyclic lactone peptolide components. They are labeled as streptogramin A, and streptogramin B. Quinupristin-Dalfopristin is a 30: 70 ratio IV formulation available for therapy. These components are bacteriostatic as dalfopristin ends protein synthesis by binding to 50S ribosomal unit and quinupristin prevents peptide elongation. Dalfopristin binding increases the affinity to quinupristin due to structural change resulting in synergistic bactericidal activity. It is currently used as an alternative for MSSA or streptococcal SSTI. It needs a central line for administration as it is an irritant and can cause thrombophlebitis [227].

*Bactericidal and Bacteriostatic Antibiotics DOI: http://dx.doi.org/10.5772/intechopen.99546*


#### **Table 9.**

*3A II lipoglycopeptides.*



#### **Table 10.**

*3A III lipopeptides.*


#### **Table 11.** *3A IV aminoglycosides.*

Due to the lack of active intrinsic electron transport chain and cell membrane potential difference, the anaerobic bacteria are resistant to aminoglycosides. *Enterococci* are intrinsically resistant to aminoglycosides [228]. Once-daily dosing is effective as traditional multiple doses, decreases the risk of ototoxicity and nephrotoxicity, is straightforward, and is economical towards resources and time [229]. This dosing pattern does not decline neuromuscular function in sick intubated patients but needs evaluation in cystic fibrosis, meningitis, and osteomyelitis caused by aerobic gram-negative bacilli [230–232]. The once-daily dose should be used
