PENICILLINS
Natural Penicillins
Name
Gram +
Gram -
Anaerobes
Atypicals
Penicillin G
Penicillin VK
(PO)
 DOC: Groups A, B, C, G
Streptococcus
 Strep Pneumoniae
 Neisseria Meningitis
 DOC: Clostridium NON-difficile
 DOC: Propionibacterium
 Oral Anaerobes
 Pastuerella
 DOC: Treponema Pallidum
(Syphilis)
Benzathine Penicillin
(Depo Formulation)
Anti-Staphylococcal Penicillins
Name
Oxacillin
Nafcillin
Dicloxacillin
(PO)
Gram +
Gram -
Anaerobes
Atypicals
Gram -
Anaerobes
Atypicals
 Staphylococcus Aureus
(MSSA)
 CoNS
 Streptococcus
Aminopenicillins
Name
Ampicillin
(PO/IV)
Amoxicillin
(PO)
Gram +
 DOC: Streptococcus
 DOC: Enterococcus
 DOC w/ Gentamycin:
Listeria
 Strep. Pneumonia




DOC (if no BL): H.
Influenza
Neisseria Meningitis
E. Coli
Proteus Mirabilis
 DOC: Pasteurella Multicoda
 Oral Anaerobes
 Propionibacterium
Anti-Pseudomonal Penicillins
Name
Gram +
Piperacillin
Carbenicillin
Ticarcillin
 Streptococcus
 Strep. Pneumoniae
 Enterococcus
Gram 




H. Influenzae
Neisseria Meningitis
Enterobacteriaceae
SPACE-M
Psuedomonas
Anaerobes


Oral Anaerobes
Propionibacterium
Atypicals
Beta-Lactamase Inhibitors




Avibactam
Clavulanic Acid
Sulbactam
Tazobactam
Aminopenicillins + B-Lactamase Inhibitors
Name
Gram +
Ampicillin
+
Sulbactam (Unasyn)
(IV)
 Staphylcoccus Aureus
(MSSA) ←added
 Strep. Pneumoniae
 Streptococcus
Amoxicillin
 Enterococcus
+
Clavulanate (Augmentin)  Listeria
(PO)
Gram ADDED
 DOC (BL): H. Influenzae
 Moraxella Catarrhalis
 Enterobacteriaceae
 Acinetobacter
(Sulbactam only)
--------------------- Neisseria Meiningitis
 Proteus
 H. Influenzae (no BL)
Anaerobes
 DOC: Eikenella ←added
 Bacteriodes ←added
 Oral Anaerobes
 Prevotella ←added
 Fusobacterium
 Propionbacterium
Anti-Pseudomonal Penicillins + B-Lactamase Inhibitors
 SPACE-M
 Enterobacteriaceae
 Stenotrophomonas
Ticarcillin
+
Clavulanic Acid
(Timentin)
 Streptococcus
 Staphylcoccus Aureus
 Strep. Pneumoniae
 Listeria
Maltophilia ←added
 Pseudomonas
 H. Influenzae
 Neisseria
Piperacillin
+
Tazobactam (Zosyn)
 Streptococcus
 Staphylcoccus Aureus
 SPACE-M
 Enterobacteriaceae
 Pseudomonas
 H. Influenzae
 Neisseria
(MSSA)
(MSSA)
 Enterococcus ←added
 Strep. Pneumoniae
 Listeria
 Bacteriodes ←added
 Oral anaerobes
 Propionbacterium
 Prevotella
 Fusobacteria
 Bacteriodes ←added
 Oral anaerobes
 Propionbacterium
 Prevotella
 Fusobacteria
Atypicals
CEPHALOSPORINS
 Covers Staph including MSSA
 Streptococcus
 NONE COVER ENTEROCOCCI!!!
st
1 Generation
Uses: Skin infections, UTI
Name
Cefazolin (ANCEF)
(IV)
Cephalexin (KEFLEX)
(PO)
Gram +
Gram -
Anaerobes
Atypicals
Anaerobes
Atypicals
 DOC: Staph Aureus
(MSSA)←Ancef but not
for meningitis. No BBB
 CoNS
 Streptococcus
 Strep. Pneumoniae
PEcK
 Proteus Mirabilis
 E. Coli
 Klebsiella
Cefadroxil (DURICEF)
(PO)
2nd Generation
Uses: Skin infections, UTI
Name
Gram +
Gram -
Cefuroxime
(IV/PO)
Cefoxitin
(IV)
Cefotetan
(IV)
Cefprozil
(PO)
 Staphylococcus Aureus
(MSSA)
 Streptococcus
 Strep. Pneumoniae






HEN-PEcK
H. Influenzae
Enterobacter
DOC: N. Meningitis
Proteus Mirabilis
E. Coli
Klebsiella
**Cephamycins ONLY**
"Tan-Fox"


Bacteroides
Oral Anaerobes
**Cefoxitin ONLY**



Myco. Fortuitum
Myco. Abscessus
Myco. Chelonae
3rd Generation
Uses: CNS infections
Name
Gram +
Gram -
Anaerobes
Atypicals
Ceftriaxone (IV)
(ROCEPHIN)
Ceftazidime
(FORTAZ)
(IV)
Cefpodoxime
(PO)
Cefdinir (OMNICEF)
(PO)



 Resistant Streptococcus
 Strep. Pneumoniae
 Staph. Aureus (MSSA) Ceftriaxone ONLY



Cefixime (SURPAX)
(PO)
DOC: Ceftriaxone: Neisseria
Enterobacteriaceae
SPACE-M (avoid = resistance)
Ceftazidime ONLY
Pseudomonas
Steno. Maltophilia
ESBL, KPC, AMPC - CeftazAvibactam (Avycaz) ONLY.
For UTI's and Intra-ab
infections if combined with
Flagyl.
Cefotaxime
(IV)
4th Generation



Uses: Different pneumoniaes (CAP/HAP/VAP), Intra-ab Infections, UTI, CNS, Skin infections
Less resistance
BBW: Nephrotoxicity at high doses or in elderly.
Name
Cefepime (MAXIPIME)
(IV)
Gram +
 Streptococcus
 Strep. Pneumoniae
(Penicillin Resistant)
 Staph. Aureus (MSSA)
Gram -



Enterobacteriaceae
SPACE-M ←Good for this.
Pseudomonas
Anaerobes
Atypicals
5th Generation

Uses: Skin infections and CAP Pneumoniae, blood stream infections, bone infections
Name
Ceftaroline
(TEFLARO)
(IV)
MOA: Binds to 2a
Protein expressed in
MRSA
Gram +
Gram -
 Streptococcus
 Strep. Pneumoniae
(Penicillin Resistant)
 Staph. Aureus
(MSSA & MRSA)
 CoNS
 Enterobacteriaceae
 SP--CE-M


Anaerobes
Atypicals
CARBAPENEMS
**All IV ONLY**
Uses: against resistant organisms, Pneumoniaes (HAP/HCAP/VAP), Intra-ab infections, UTI, CNS
ADR: Seizures
Name
Gram +
Gram -
Anaerobes
Atypicals
Imipenem-Cilastin
(Primaxin)
(IV)
Meropenem
(Merrem)
(IV)
Doripenem
(Doribax)
(IV)
 Strep. Pneumoniae
(Penicilin Resistant)
 Streptococcus
 DOC: (Imipenem +
SMX): Nocardia
 DOC: ESBL bugs
 Enterobacteriaceae
 SPACE-M
 Pseudomonas (but
not Ertapenem)
 Acinetobacter (not
Ertapenem)
 Bacteroides
 Clostridium (Not C. Diff)
 Oral Anaerobes
 Mycobacterium (Imipenem
ONLY)
Ertapenem
(Invanz)
(IV)
MONOBACTAMS
Name
Aztreonam (Azactam)
(IV)
*Inhalation product
available (Cayston)
Gram +
Gram  Enterobacteriaceae
 Pseudomonas
 SP--CE - M
 H. Influenzae
 Moraxella
 Neisseria
Anaerobes
Atypicals



FLUOROQUINOLONES
MOA: blocks TOPO 4 and DNA gyrase (TOPO 2)
 Topo 4 = separates interlinked DNA
 Topo 2 = supercoils DNA helix
Bacteria-CIDAL
Concentration dependent
100% bioavailable IV to PO….except Dela (60%)

Uses: Pneumonia (CAP and HCAP) **Cipro can NOT be used empirically for Pneumoniae**, UTI, Intra-ab infection.

Adverse Effects/Disadvantages:
 Induction of Resistance - MRSA, MDR acinetobacter, ESBLs
 BBW: Tendon rupture, peripheral neuropathy, CNS
 Dysglycemia
 GI = N/V/D
 QT Prolongation = Torsades
 Phototoxicity
 AVOID in children <8 and Pregnant women
 Drug-Drug Interactions (PO)  binds to zinc, iron, calcium aluminum, antacids, sucralafate, enteral feedings. Separate 2
hours before or 4 after.

Name
Ciprofloxacin
(IV/PO)
Delafloxacin (Baxdela)
(IV/PO)
Levofloxacin
(Levaquin)
(IV/PO)
Gram +
Gram -
 DOC: Salmonella
 DOC (CIPRO): Anthrax
 DOC: Shigella
 Strep. Pneumoniae (NOT
 Pseudomonas (Not
CIPRO)
 Streptococcus
 Listeria
 MRSA (Dela ONLY)
Moxi)
 SPACE-M
 H. Influenzae
 M. Catarrhalis
Anaerobes
 Oral Anaerobes (Moxi only)
Atypicals
 DOC: Atypicals
 Ureaplasma
 MDR-TB (Moxi only)
Moxifloxacin (Avelox)
(IV/PO)
PROTEIN SYNTHESIS INHIBITORS
Clindamycin
 MOA: CLEAN TAG - 50s subunit
 Bacterio-STATIC
 Time dependent
 Excellent bioavailability. Oral doses less than IV to help GI.
 Not used for Intra-ab infection due to anaerobic resistance
 D-Test = if positive do not use. Erm gene and resistance is present.
 NO renal adjustment needed.

Uses: Toxin suppression for Strep. A group (necrotizing fasciitis)

Adverse Effects:
 GI very common: C. diff. Monitor for diarrhea
 Rash
 Increased LFT's
Name
Gram +
Gram -
Clindamycin (Cleocin)
(IV/PO)
 Staph. Aureus (MRSA
and MSSA)
 Strep. Pneumoniae
 Streptococcus
Anaerobes
 Oral anaerobes
 Clostridium (with PCN)
 Gardnerella Vaginalis
Atypicals
 Chlamydia Trachomatis
 Some Protozoa
 Malaria (combo)
 PCP
 Toxoplasmosis
PROTEIN SYNTHESIS INHIBITORS
Macrolides
 MOA: CLEAN TAG - 50s subunit
 Bacterio-STATIC
 Time dependent
 Zithroxmax Only: NO renal adjustment needed.

Uses:
 Zithromax: CAP, sinusitis, Mycobacteria Avium, Chlamydia. Anti-inflammatory properties for Cystic Fibrosis pts who have
Pseudomonas and Burkholderia.
 Cleocin: H. Pylori, Mycobacteria Avium

Adverse Effects:
 Erythromycin: diarrhea cuz it’s a motilin agonist. Biaxin also gives diarrhea.
 QT prolongation
 Jaundice
 Ototoxicity
Name
Gram +
Azithromycin
(Zithromax)
(PO/IV)
Clarithromycin (Biaxin)
(PO)
Erythromycin
(PO/IV)
 Strep. Pneumoniae
 Listeria
Gram  DOC: Shigella
 DOC: Camp. Jejuni
 H. Influenzae
 M. Catarrhalis
 H. Pylori (Biaxin)
 Salmonella
 E. Coli
Anaerobes
 Oral anaerobes
Atypicals
 DOC: Atypicals
 Urea Urea
 "MAC" Myco. Avium (Zithro
and Biaxin)
PROTEIN SYNTHESIS INHIBITORS
Tetracyclines
 MOA: CLEAN TAG - 30s subunit
 Bacterio-STATIC
 Time dependent

Uses: As alternative NOT monotherapy
 Skin infections (ABSSSI's, MRSA)
 "For lots of things that you would get outdoors"
 H. Pylori (in combo)
 Prostatitis
 Pneumonia (CAP)

Adverse Effects:
 Avoid in children <8 or pregnancy: Tooth discoloration, enamel hypoplasia
 Doxycycline: NO RENAL adjustment.
 Avoid use with antacids and/or milk
 Phototoxicity
 Vertigo
Name
Gram +
Doxycycline
(Vibramycin)
 Staph. Aureus (MSSA
Minocycline
Tetracycline
and MRSA)
 CoNS
 Strep. Pneumoniae
 Listeria
Gram -
Anaerobes
 DOC (Doxy): Rickettsia - Rocky
 DOC (Doxy): Vibrio 



cholera
Acineto Baumannii Minocycline
Enterobacteriaceae
M. Catarrhallis
H. Influenzae
Atypicals
mountain fever
 Clostridium (NOT C. Diff)
 Spirochetes
 H. Pylori
 T. Pallidium (Syphillis) Only
if PCN allergy
 DOC (Doxy): Borrelia
Burgdorferi - Lyme disease
 Atypicals
 Plamodium - malaria
PROTEIN SYNTHESIS INHIBITORS
Tigecycline - IV ONLY
 MOA: 30s subunit
 Similar to Tetracyclines
 Bacterio-STATIC
 Time dependent

Uses:
 2nd or 3rd line….NEVER 1st line.
 Intra-ab infections, ABSSSI's, Pneumonia (CAP), ESBL, Klebsiella organisms.
 Excellent tissue penetration but LOW blood levels.
 NOT FOR BACTEREMIA!!
 Doesn't cover MP3: Morganella, Proteus, Providencia, Pseudomonas

Adverse Effects:
 BBW: increased mortality
 N/V  Very high!!
 Diarrhea
Name
Gram +
 Staph Aureus (MSSA
Tigecycline (Tygacil)
(IV)




and MRSA)
Enterococcus (VRE)
Strep. Pneumoniae
Streptococcus
Listeria
Gram -
Anaerobes
Atypicals
 Enterobaceteriacae
(NOT morganella,
Providencia, Proteus,
Psuedomonas)
 ESBL's
 Klebsiella
 Acineto Baumannii
 Oral anaerobes
 Bacteriodes
 Clostridium (C.Diff)
 Atypicals (not used a lot for
this. You have less toxic
agents.)
PROTEIN SYNTHESIS INHIBITORS
Aminoglycosides
 MOA: CLEAN TAG - 30s subunit

Uses:
 NOT monotherapy for Gram+ or Lung infection
 Streptomycin  used in multi-drug resistant TB
 Neomycin  used as prep to sterilize gut for procedures
Name
Gram +
Gram -
Anaerobes
Atypicals
Gentamicin
Streptomycin
Tobramycin
Amikacin
Neomycin
(Topical/PO)
Kanamycin
 Enterobactericeae
 ESBL producing
 Klebsiella
Agalactiae
 SPACE-M
 Add On w/ Amp: Listeria
 Yersinia (plague)
 Add On: Enterococus
 Add On: Strep.
 Non-TB Myco.:
 Amikacin
 Streptomycin
 Myco. TB
 Streptomycin





ZOLIDS
MOA: inhibits 23s ribsomal RNA of 50s subunit = interrupts bacterial translation
Bacterio-STATIC.
 Is bacterio-CIDAL with most Streptococcus
Time dependent
100% bioavailable IV or PO.
NO renal adjustment

Uses:
 VRE bacteremia -- NOT MRSA bacteremia
 MRSA pneumonia
 ABSSSI
 Resistant Streptococcus
 Multi-drug resistant Myco. including TB.

Adverse Effects:
 Thrombocytopenia
 Peripheral Neuropathy
 Optic Neuritis
 GI: N/V/D
 Rare: serotonin syndrome: Avoid MAOI's, SSRI's, triptans, tyramine foods.
 No SS syndrome with Tedzolid
Name
Gram +
Gram Anaerobes
Linezolid (Zyvox)
(IV/PO)
BID
 Staph Aureus (MRSA)
 Enterococcus (VRE)
 Streptococcus
 Listeria
 CoNS
 Oral anaerobes
 Propionibacterium
 Clostridium (NOT C.Diff)
Atypicals
 Myco TB  Zyvox
Tedzolid (Sivextro)
(IV/PO)
QD
 Coryn. Jeikium
 Bacillus
STREPTOGRAMINS



MOA: blocks synthesis at 50s subunit
Bacterio-STATIC
Time dependent

Uses:
 LAST LINE for VRE Faceium……….NOT faecalis.
 LAST LINE for MRSA
 Very rarely used.

Adverse Effects:
 Venous irritation. Inufsion site pain and inflammation.
 Myalgia…a lot!!
 Hyperbilirubinemia…a lot!!
Name
Gram +
Gram -
Anaerobes
 Staph Aureus (VRSA


Dalfopristin/Quinupristin

(Synercid)

(IV)


and MRSA)
CoNS
Strep. Pneumoniae
Streptococcus
Listeria
Coryn. Jeikium
Bacillus
 Oral anaerobes
 Propionibacterium
 Clostridium
Atypicals
GLYCOPEPTIDE


MOA: binds D-Ala-D-Ala
Adverse Effects:
 Nephrotoxicity
 Ototoxicity
 Red man syndrome
Name
Gram +
Gram -
Anaerobes
 DOC: Staph Aureus
Vancomycin
(Vancocin)







(MRSA)
Enterococcus
Strep. Pneumoniae
Streptococcus
Listeria
Coryn. Jeikium
Bacillus
CoNS
 DOC: C. Diff (PO only)
 Oral anaerobes
 Propionibacterium
 Clostridium
Atypicals



LIPOPEPTIDE
MOA: binds to cell membrane  rapid depolarization.
Bacteri-CIDAL……..Bacterio-STATIC for Enterococcus
Concentration dependent

Uses:
 ABSSSI
 Bacteremia MRSA
 NEVER for Pneumonia. It is deactivated in the lungs.

Adverse Effects:
 CPK elevation = myopathy and rhabdo
 GI
Name
Gram +
Gram -
Anaerobes
 Staph Aureus (MRSA)
 Enterococcus (VRE in
Daptomycin (Cubicin)
(IV)






blood)
Strep. Pneumoniae
Streptococcus
Listeria
CoNS
Coryn. Jeikium
Bacillus
 Oral anaerobes
 Propionibacterium
 Clostridium
Atypicals



LIPOGLYCOPEPTIDE = "VANCINS"
MOA: 1). blocks D-Ala-D-Ala and 2). Rapid depolarization
Bacteri-CIDAL
Concentration dependent

Uses:
 ABSSSI
 Hospital acquired pneumonia (MRSA)

Adverse Effects:
 Foamy urine
 Nausea
 Metallic Taste
 QT prolongation
 Preg: C…possible teratogen
 Red man Syndrome  Dalvance and Orbactive
 Caution with Warfarin (Orbactive) = increased bleeding
Name
Gram +
Gram -
Anaerobes
 Staph Aureus (MRSA
Telavancin (Vibativ)
(IV)
"TV"
and VRSA)
 Enterococcus (NOT
VRE)
 Strep. Pneumoniae
 Streptococcus
 Oral anaerobes
 Propionibacterium
 Clostridium
Atypicals
Dalbavancin
(Dalvance)
(IV)
 Listeria
 CoNS
 Coryn. Jeikium
 Bacillus
T1/2 = 346 hours
Infuse = 30 min
$$$$
Oritvancin (Orbactive)
(IV)
T1/2 = 245 hours
Infuse = 3 hours
FOLATE ANTAGONISTS



MOA: blocks folate synthesis
Bacteri-STATIC
Time dependent but also Concentration dependent against Gram+

Uses:
 ABSSSI
 UTI's
 Dosed based on TMP.
 Good bioavailabilty.
 IV ONLY in D5W. If not excess free water  Hyponatremia

Adverse Effects:
 Bone marrow suppression  seen in Higher doses.
 Rash  SJS
 Photosensitivity
 GI upset
 Hyperkalemia
 Crystalluria/Nephrotoxicity
 Pregnancy = Avoid in 1st and 3rd trimester.
 Avoid in neonates = Kernicterus
Name
Gram +
Gram -
Anaerobes
Atypicals
SMX/TMP (Bactrim,
Spetra)
(IV)
Dapsone
Pyrimethamine
Sulfadiazine
Sulfadoxine
 DOC w/ Imipenem:
Nocardia
 Staph Aureus (MRSA
and MSSA)
 Strep. Pneumoniae
 Listeria
 CoNS
 DOC: Stenotrophomonas
 Enterobacteriaceae
 H. Influenzae
 M. Catarrhalis
 Providencia
 DOC: PCP
 Legionella
NITROIMADAZOLES




MOA: loss of helical DNA structure = cell death.
Bacteri-CIDAL
Concentration dependent
High bioavailability.

Uses:
 Anaerobic infections ONLY!
 Brain abscess
 Skin/soft tissue, bone/joint infections

Adverse Effects:
 Metallic taste
 GI upset
 Dizziness
 Headache
 Dark urine
 Peripheral neuropathy/seizures = only in prolonged cases.
 Renal Adjustment: CrCl < 10ml/min
 Avoid Alcohol  Disulfram reaction
Name
Gram +
Gram -
Anaerobes
Atypicals
Metronidazole (Flagyl)
(IV/PO)
Gut Anaerobes
 DOC: Bacteroides
 DOC: Gardnerella Vaginalis
 C. Diff
 Fusobacterium
 Clostridium
Tinidazole


MOA: blocks RNA polymerase interfering w/ protein synthesis = cell death
Bacteri-CIDAL

Uses:
 C. Diff ONLY!!

Adverse Effects:
 Nausea is most significant
Name
Fidaxomicin (Dificid)
Tinidazole
Gram +
Gram -
Anaerobes
 C. Diff
$$$$$

NITROFURANS
MOA: blocks coenzyme A = interferes with metabolism, damages proteins and DNA/RNA

Uses:
Protozoa
 DOC: Entamoeba Histolytica
 Trichomonas
 Giardia Lambia
 Bastocysts
Atypicals



Cystitis
UTI prophylaxis
Adverse Effects:
 CI in pregnancy after 38 weeks  anemia and jaundice in neonates.
 GI upset
 Pulmonay fibrosis
 Renal Adjustment: CI if CrCl <60
Name
Nitrofurantoin
(Macrobid)
(PO)
Gram +
 S. Saphrophyticus
 Staph Aureus (MSSA and
MRSA)
 Enterococcus
 Streptococcus



MOA: inactivates pyruvyl transferase
Bacteri-CIDAL
Time dependent

Uses:
 UTIs
Name
Fosfomycin (Monurol)
(PO)
Gram +
 Staph Aureus (MSSA
and MRSA)
 Enterococcus (VRE)
Gram -
Anaerobes
Atypicals
 E. Coli
 Klebsiella
 Enterobacter
 Citrobacter
Gram  Pseudomonas
 SPACE-M
 ESBL and KPC
producing
 KPC
 Proteus
 E. Coli
 Klebsiella
Anaerobes
Atypicals





POLYMYXINS
MOA: cationic detergent  leakage of intracellular substances
Bacteri-CIDAL
Concentration dependent
Last Line Drug.
Adverse Effects:
 Nephrotoxic!!!!!
Name
Gram +
Gram -
Anaerobes
Atypicals
Anaerobes
Atypicals
 Pseudomonas
 Acinetobacter
 E. Coli (including ESBL's)
 Klebsiella (including KPC's)
Polymyxin E (Colistin)
Polymyxin B
RIFAMYCINS

MOA: blocks RNA synthesis, RNA transcription

Uses
 Rarely used alone.
 Penetrates biofilms - sticks to hardware like catheters
 CYP450 inducer
Name
Rifampin
(IV/PO)
Gram +
Gram -