Antibiotic Utilization Highlights
Methicillin-Resistant Staphylococcus aureus (MRSA)
HA-MRSA
CA-MRSA
Vancomycin
1
Agent
Ticarcillin/Clavulanate
Piperacillin/Tazobactam
Ceftriaxone
Ceftazidime
Ceftazidime/Avibactam7
Cefepime
Ceftolozane/Tazobactam7
Cefiderocol7, 11
Carbapenems
Aztreonam
Ciprofloxacin
Delafloxacin6, 8
Levofloxacin
Aminoglycosides
Colistin
Sulfamethoxazole/Trimethoprim
Daptomycin2
Doxycycline
3
Linezolid
Minocycline
Tedizolid
Clindamycin
Ceftaroline
Linezolid
Telavancin
Tedizolid
Dalbavancin
Moxifloxacin4
Oritavancin
Delafloxacin6
Tigecycline
Gram Negative Rods
Serratia, Pseudomonas, Acinetobacter, Citrobacter, E. coli
2
Teicoplanin
Quinupristin/Dalfopristin
Chloramphenicol
Rifampin5
Delafloxacin6
1
PO form only for C.diff
2
Not for pneumo
3
1:1 IV/PO conversion
4
Technically, but probably not
5
Not monotherapy
Indicated for ABSSSI and CABP
6
Pseudomonas Coverage
√
√
√
√ (Possibly also MDR)
√
√ (Possibly also MDR)
√
√ (Except ertapenem)
√
√
√
√
√
√
Tigecycline
Cilastatin/Imipenem/Relebactam13
√
Atypicals (Chlamydia, Mycoplasma, Legionella)
Agent
Notes
12
Lefamulin
7
Only in select serious cases, only labeled for complicated UTI
8
Only P & E (and Enterobacter cloacae and Klebsiella pneumoniae)
9
QT prolongation
10
E. faecium only
11
Only P & E (and Proteus mirabilis and Enterobacter cloacae and Klebsiella pneumoniae)
12
Indicated for CABP, novel class (pleuromutilin)
13
Indicated for complicated UTI and complicated intra-abdominal infections
Non-VRE
Penicillin
Quinupristin/Dalfopristin10
Ampicillin/Sulbactam
Piperacillin/Tazobactam
VRE
Linezolid3
Tedizolid
Daptomycin2
Oritavancin
Vancomycin
Tigecycline2
Agent
Notes
Metronidazole3
Also used in C. diff, STIs, GI parasites
Clindamycin
No gm(-) coverage, highest assoc. w/ C. diff
Not for UTIs
Tigecycline
Piperacillin/Tazobactam
10
Ticarcillin/Clavulanate
Ampicillin/Sulbactam
Telavancin
Macrolides
CI in pregnancy
Moxifloxacin3, 9
Teicoplanin
Beta-lactams
CI in pregnancy
Carbapenems
Quinupristin/Dalfopristin
Lipophilic
Moxifloxacin
Mino/Doxycycline
Anaerobes
Enterococcus
Hydrophilic
Also MSSA and S. pneumoniae
Macrolides9
Amoxicillin/Clavulanate
NOT Renally-Adjusted
Agents
Aminoglycosides
Fluoroquinolones
Ceftriaxone
Daptomycin
Tetracyclines
Nafcillin/Oxacillin
Vancomycin
Linezolid
Rifampin
Clindamycin
Liphophilic – Distributes to tissues
Doxycycline
Moxifloxacin
Hydrophilic – Distributes in blood
Erythromycin
Azithromycin
Time-Dependent
Concentration-Dependent
Beta-lactams (PCNs, Cephs, Carbapenem, Aztreonam)
Fluoroquinolones (Ciprofloxacin, Moxifloxacin)
Vancomycin
Aminoglycosides (Gentamicin, Amikacin)
Renal Adjustments:
Time-Dependent – Lower dose; Same dosing interval
Concentration-Dependent – Same dose; Extended dosing interval
Distribution of Select Agents
Lung
CSF
Macrolides
Bactrim
Blood
Beta-lactams
Bone
Tetracyclines
Urine
Beta-lactams
Aminoglycosides
Fluoroquinolones
Fluoroquinolones
Fluoroquinolones
Fluoroquinolones (not Moxi)
Daptomycin
Vancomycin
Rifampin
Macrolides
Linezolid
Beta-lactams
Metronidazole
Beta-lactams
Aminoglyclosides
Daptomycin