Penicillins
Pen + B lactamase inhib
(adds MSSA)
Penicillin
IV/PO
G+ only, All GAS/GBS, syphilis, oral anaerobes (but not gut),
clostridium
exudative pharyngitis, erysipelias
Nafcillin (IV)/oxacillin(po)/dicloxacillin(po)
IV/PO
G+ only DOC MSSA, can use for strep, (no MRSA), no G neg
Cellulitis, s. aureus cutaneous abscess
B lactamase resistant penicillins
Ampicillin(IV)/amoxicillin(po)
IV/PO
G+ and some G- DOC for enterococcus, strep like pen, no
staph, only a little G neg (some H.flu, some e. coli), listeria
1st line acute otitis media, acute sinusitis, neonatoal
meningitis with gentamicin
aminopenicillins
Piperacillin
IV
Like amp + G-, so good for strep, enterococcus and G neg incl
pseudomonas + anaerobes, but NO MSSA
Amp/sulbactam (unasyn) IV
IV
Like amp + MSSA and anaerobes, NO MRSA, H.flu, most
anaerobes, listeria
Amox/clavulanate (augmentin) po
PO
Pipercillin/tazobactam (zosyn)
IV
All except MRSA, including pseudomonas and enteric G-
IV
No enterococci, NO MRSA, no listeria
Staph and strep in pen allergic pt (10% cross react), G pos,
few G neg (ex ecoli), few anaerobes
Failed tx of otitis media
Ticarcillin/tazo? (Timentin)
Cephalosporin
All
1st gen: Cefazolin (ancef) IV
Cephalexin (Keflex) PO
PO
2nd gen: Cefoxitan (Mefoxin) iv
IV
PO
Above + H.flu, more G neg, anaerobes
gut surg prophylaxis, otitis failed augmentin,
IV
A lot of G neg (no pseudomonas), not as good for staph as first
and second gen, still good for GAS/GBS and s.pneumo
Comm acquired Meningitis in all except neonates – crosses
BBB, also for pyelo in kids and adults
Rocephin, bad in neonates – biliary sludging/Ca++
precipitation, can use cefotaxime
Omnicef – otitis failed augmentin
IV
G pos, most G neg, incl pseudomonas, limited anaerobes, no
enterococcus
Cefpodoxime (Vantin) iv
Cefuroxime (Ceftin) po/iv
3rd gen: Ceftriaxone (Rocephin) im/iv
Cefotaxime (Omnicef) po
4th gen: Cefipime
Ceftazidime
Carbapenem
Meropenem (kids)
Nosocomial meningitis, pseudomonas
IV
Gram pos incl. entero, gram neg, pseudomonas, anaerobes,
ESBL gram neg, NO MRSA, no acinetobacter
Imipenem – decreases seizure threshold
IV
Like imipenem but no pseudomonas
Q day, no CNS penetration
Erythromycin
IV/PO
Gram pos, some anaerobes, atypicals, NO gram neg
Can cause pyloric stenosis so CI in neonates
Azithromycin
IV/PO
Above + H.flu, MAC tx, prophylaxis, more G- than erythro
Pretty good resp drug, Pen allergic for strep throat, otitis
media, DOC outpatient community acquired pneumonia in
teenagers/adults, pertussis
Imipenem (Primaxin)
Ertapenem (Invanz)
Macrolides
Clarithromycin (Biaxin)
Tetracycline
PO
Some gram neg, gram pos, SOME MRSA, some anaerobes,
atypicals - Kill some of everything
Use if MRSA or e. coli known to be sensitive b/c cheap
Relative CI in kids <8yo
Lyme, rickettsial, erlichiosis
Tetracyclines
Doxycycline
IV/PO
Glycylcyclines
Tigecycline RESTRICTED
IV
Drug resistant gram pos/neg (acinetobacter, VRE), NO
pseudomonas
Aminoglycosides
Gentamicin, tobramycin, amikacin
IV
Aerobic gram neg only, incl pseudomonas, no anaerobes,
only good at bloodstream pH, so no good in abscesses
Can do qday dosing
Quinolones
Ciprofloxacin
IV/PO
G neg, most pseudomonas, atypicals, NO anaerobes
Moxifloxacin (Avelax)
IV/PO
Above plus G pos including PRSP, less pseudomonas
PRSP – pneumonia (with azithro inpt), sinusitis
Highly oto/nephrotoxic. Gent – often used in r.o sepsis in
neonates, Amikacin/torbra – better nosocomial g- coverage,
tobra least nephrotoxic, best agains pseudomonas, nebs for
CF,
Levofloxacin (levaquin)
Lincosamide
Clindamycin (Cleocin)
IV/PO
G pos, anaerobes, NO enterococc, will cover many community
acquired MRSA (not nosocomial), good tissue, bone
penetration, has antitoxin activity
Comm aquired MRSA, infxns involving toxin production
Metronidazone
Metronidazole (flagyl)
IV/PO
Best for strict anaerobes
B. fragilis, C. dif
Sulfa
Trimethoprim/sulfamethoxazole (Bactrim)
IV/PO
Many gram pos incl comm. aq MRSA, many gram neg, PCP, no
pseudomonas, no enterococcus
Cystits, PCP tx/prophy, COPD exac w/infxn
Polymyxin
Colistin RESTRICTED
IV
Very resistant G neg, no stenotrophomonas, causes renal
failure, periph neuropathy, CNS problems
When nothing else works for acinetobacter
Rifampin
Rifambin
G+ incl staph, g- incl pseudomonas, TB, NEVER alone except
for prophylazis, pregnancy category D
Adjunctively for bad staph infection, TB/meningitis
prophylazis
Monobactam
Aztreonam – RESTRICTED
IV
Only aerobic gram neg (just like aminoglycosides)
for severe pen allergies (can’t use piper or zosyn)
Glycopeptide
Vancomycin
IV/PO
Gram pos, enterococci, IV – MRSA, MRSE, PO for c. dif,
resistant strep pneumo, not oto/nephrotoxic
Enterococc if pen allergic
C. diff resistant to metronidazole
Oxazolidinone
Linezolid (Zyvox)
IV/PO
Gram +, enterococci, MRSA, MRSE, VRE
VRE
Linopeptide
Daptomycin (Cubicin) RESTRICTED
IV
Gram + (MRSA, VRE, MRSE)
VRE