ANTIBIOTICS
AMINOGLYCOSIDES
Drug
Treatment
amikacin
(Amikin)
gentamicin
(Garamycin)
kanamycin
(generic)
neomycin
(Mycifradin)
streptomycin
(generic)
tobramycin
(TOBI, Tobrex)
serious gramnegative
infections
Pseudomonas
infection
hepatic coma
and decrease
GI normal flora
suppression of
GI normal flora
tuberculosis
Pharmacokinetics
Adverse
Effects
Poorly absorbed in
the GI tract but is
rapidly absorbed
after intramuscular
injections,
reaching peak
levels of 1 hour.
Half-life of 2 to 3
hours.
-effects in CNS
include
ototoxicity,
deafness,
vestibular
paralysis,
depression, and
weakness.
ocular infections
Clinically Important
Interactions
-synergistic
bactericidal effects
when given with
penicillin or
cephalosporins
- avoid combining
diuretics
-renal toxicity
- GI effects
include nausea,
vomiting,
diarrhea, weight
loss, stomatitis,
and hepatic
toxicity
-palpitations,
hypotension,
and
hypertension
Contraindications
and Cautions
contraindicated in
patients with known
allergy to
aminoglycosides;
renal or hepatic
disease
caution is necessary in
pregnancy
amikacin is very high,
use only as long as
necessary
streptomycin is very
toxic to eighth cranial
nerve and kidney, to
be use only in special
situations
CARBAPENEMS
Drug
doripenem
(Doribax)
ertapenem
(Invanz)
imipenemcilastatin
(Primaxin)
meropenem
(Merrrem IV)
Treatment
Pharmacokinetics
complicated intraabdominal
infections or
complicated UTIs
communityacquired
pneumonia, acute
pelvic infections,
intra-abdominal
infections
serious respiratory
infections,
septicemia, bone
and joint infections
endocarditis, and
polymicrobic
infections
bacterial
meningitis,
complicated skin
and skin infection
-rapidly absorbed if
given
intramuscularly
and reach peak
levels at the end of
the infusion if
given
intravenously
-excreted
unchanged in the
urine
-half-life of 1 to 4
hours
Adverse Effects
-superinfections
can occur
-headache,
dizziness, and
altered mental
state
-seizures are
reported with
combined with
other drugs
Clinically
Important
Interactions
-consider
alternative
treatment if patient
is on valproic acid
Contraindication
and Cautions
-known allergy to
carbapenem or
beta-lactam
CEPHALOSPORINS
Drug
Treatment
cefadroxil
(generic)
cephalexin
(Keflex)
Pharmacokinetics
UTIs, pharyngitis,
and tonsilitis
respiratory, skin,
bone, and GU
infections
-well absorbed in
GI tract
Adverse Effects
-nausea, vomiting,
diarrhea, anorexia
-primarily
metabolized in liver
Clinically
Important
Interactions
-patients receiving
this drug
aminoglycoside
are at risk for
nephrotoxicity
Contraindication
and Cautions
-known allergies to
cephalosporins
-use with caution
in pregnant women
-those who receive
with anticoagulants
are at risk for
bleeding
- avoid alcohol for
72 hours after
discontinuation of
the drug
SECOND-GENERATION CEPHALOSPORINS
Drug
Treatment
cefaclor (Ceclor)
cefoxitin
(generic)
cefprozil
(generic)
cefuroxime
(Zinacef)
Pharmacokinetics
Adverse Effects
Clinically
Important
Interactions
Contraindication
and Cautions
respiratory
infections, UTIs,
otitis media,
typhoid fever,
anthrax infection
preoperative
prophylaxis for
cesarian section
and abdominal or
colorectal surgery
pharyngitis.
Tonsilitis and
secondary
bronchial
infections
wide range of
infections
THIRD-GENERATION CEPHALOSPORINS
Drug
Treatment
cefdinir
(generic; a
suspension
form is
available for
children)
respiratory
infections
Pharmacokinetics
Adverse Effects
Clinically Important
Interactions
Contraindications and
Cautions
cefotaxime
(Claforan)
moderatesevere
infections,
peritonitis,
septicemia,
bone infections
cefpodoxime
(Vantin)
gonorrhea
ceftazidime
(Ceptaz,
Tazicef)
CNS infections
ceftibuten
(Cedax; a
suspension
form is
available for
children)
exacerbations
of bronchitis
ceftriaxone
(Rocephin)
Lyme disease
FOURTH-GENERATION CEPHALOSPORINS
Drug
Treatment
cefditoren
(Spectracef)
acute
exacerbations
of bronchitis
cefepime
(Maxipime)
skin, urinary,
and respiratory
infections
communityacquired
pneumonia
ceftaroline (Tefl
aro)
Pharmacokinetics
Adverse Effects
Pharmacokinetics
Adverse
Effects
Clinically Important
Interactions
Contraindications and
Cautions
FLUOROQUINOLONES
Drug
ciprofloxacin
(Cipro)
gemifloxacin
(Xtoro)
Treatment
wide spectrum
of gramnegative
bacteria
otitis media
absorbed from the
GI tract,
metabolized in the
liver, and excreted
most common
are headache,
dizziness,
insomnia, and
depression
Clinically Important
Interactions
Contraindications
and Cautions
taken concurrently
with iron
salts, sucralfate,
mineral supplements,
or antacids, the
contraindicated in
patients with
known allergy to any
fluoroquinolone and in
pregnant
or lactating patients
levofloxacin
(Levaquin)
moxifloxacin
(Avelox)
ofloxacin
(Floxin,
Ocuflox)
respiratory,
urinary tract,
skin, and sinus
infections
adults with
sinusitis,
bronchitis, or
communityacquired
pneumonia
f respiratory,
skin, and
urinary tract
infections;
pelvic
inflammatory
disease
in the urine and
feces.
Because of its
parenteral
availability, it may
be preferred for
severe infections
or for use when
the patient cannot
take oral drugs
related to
possible effects
on the CNS
membranes.
vomiting,
diarrhea, and
dry mouth,
related to direct
drug effect on
the GI tract
therapeutic effect of
the fl uoroquinolone is
decreased
are taken with drugs
that increase the QTc
interval or cause
torsade de pointes
severe-to-fatal
cardiac reactions are
possible
not recommended for
use in children
younger than 18 years
of ag
fever, rash, and
photosensitivity,
a potentially
serious adverse
effect that can
cause severe
skin reactions.
PENICILLINS AND PENICILLINASE-RESITANT
Drug
Treatment
Pharmacokinetics
Adverse
Effects
Clinically Important
Interactions
Contraindications
and Cautions
penicillin G
benzathine
(Bicillin,
Permapen)
Severe
infections
caused by
sensitive
organisms;
treatment of
syphilis and
erysipeloid
infections
-rapidly absorbed
-The major
adverse effects
of penicillin
therapy involve
the GI tract
-taken concurrently
patients with allergies
to penicillin or
cephalosporins or
other allergens
-Pain and
inflammation at
the injection
site can occur
with injectable
forms of the
drugs.
Hypersensitivity
reactions may
include rash,
fever, wheezing,
and, with
repeated
exposure,
anaphylaxis that
can progress to
anaphylactic
shock and death
-combination with
penicillin G
potassium
(Pfizerpen)
severe
infections; used
for several days
in some cases
penicillin G
procaine
(Wycillin)
moderately
severe
infections
penicillin V
(Veetids)
prophylaxis for
bacterial
endocarditis;
Lyme disease,
urinary tract
infections
from the GI tract,
reaching peak
levels in 1 hour
-sensitive to the
gastric acid levels
in the stomach
and should be
taken on an empty
stomach to ensure
adequate
absorption.
with tetracyclines, a
decrease in the
effectiveness of the
penicillin results.
any of the parenteral
aminoglycosides,
inactivation of the
aminoglycosides
occurs.
amoxicillin
(Amoxil,
Trimox)
Broad spectrum
of uses
ampicillin
(Principen)
Broad spectrum
of activity;
Infections by
penicillinaseproducing
staphylococci
Infections by
penicillinaseproducing
staphylococci
nafcillin
oxacillin
SULFANAMIDES
Drug
Treatment
Pharmacokinetics
Adverse
Effects
sulfadiazine
(generic)
sulfasalazine
(Azulfidine)
broad spectrum
of infections
-are teratogenic
- given orally, are
-GI effects
ulcerative colitis
and Crohn’s
disease;
rheumatoid
arthritis
cotrimoxazole
(Septra,
Bactrim)
otitis media,
bronchitis,
urinary tract
infections, and
pneumonitis
caused by P.
carinii
absorbed from the
GI tract,
metabolized in the
liver, and excreted
in the urine.
photosensitivity
and rash related
to direct effects
on the dermal
cell effects
Pharmacokinetics
Adverse
Effects
Clinically Important
Interactions
Contraindications
and Cautions
taken with
tolbutamide,
tolazamide, glyburide,
glipizide, or
chlorpropamide, the
risk of hypoglycemia
increases.
-contraindicated with
Clinically Important
Interactions
Contraindications
and Cautions
penicillin G and
tetracyclines are
taken concurrently,
the effectiveness of
penicillin G decreases
contraindicated in
patients with known
allergy to tetracyclines
or to tartrazine
any known allergy to
any sulfonamide, to
sulfonylureas, or to
thiazide diuretics
because crosssensitivities occur;
TETRACYLINES
Drug
Treatment
demeclocycline
(generic)
wide variety of
infections when
penicillin
cannot be used
traveler’s
diarrhea and
sexually
transmitted
diseases;
periodontal
disease
doxycycline
(Doryx,
Vibramycin)
absorbed
adequately, but
not completely,
from the GI tract.
half-life ranging
from 12-25 hours
administered on
an empty stomach
1 hour before or 2
direct irritation
of the GI tract
Fatal
hepatotoxicity
related to the
drug’s irritating
effect on the
liver has also
been reported.
oral contraceptives
are taken with
tetracyclines, the
effectiveness of the
contraceptives
should be used with
caution in children
younger than 8 years
of age
minocycline
(Arestin,
Minocin)
meningococcal
carriers and of
various
uncomplicated
genitourinary
and
gynecological
infections
acne vulgaris
and minor skin
infections
caused by
susceptible
organisms
tetracycline
(generic)
to 3 hours after
any meal or other
medication
decreases, and
patients who take
oral contraceptives
should be advised to
use an additional
form of birth control
while receiving the
tetracycline
ANTIMYCOBACTERIALS
Drug
Treatment
Pharmacokinetics
Adverse
Effects
Clinically Important
Interactions
Contraindications
and Cautions
ethambutol
(Myambutol)
isoniazid
(Nydrazid)
pyrazinamide
(generic)
rifampin
(Rifadin,
Rimactane)
M. tuberculosis
contraindicated for
patients with any
known allergy to
these agents; in those
with severe renal or
hepatic failure
M. tuberculosis
neuritis,
dizziness,
headache,
malaise,
drowsiness, and
hallucinations,
are often
reported and
are related to
direct effects of
the drugs on
neurons.
rifampin and INH are
used in combination,
the possibility of toxic
liver reactions
increases
rifapentine
(Priftin)
Streptomycin
(generic)
cycloserine
(Seromycin)
capreomycin
(Capastat)
ethionamide
(Trecator-SC)
rifabutin
(Mycobutin)
dapsone
(generic)
M. tuberculosis
generally, well
absorbed from the
GI tract. These
drugs, given orally,
are metabolized in
the liver and
excreted in the
urine; they cross
the placenta and
enter breast milk,
placing the fetus
or child at risk for
adverse reactions
M. tuberculosis
M. tuberculosis
M. tuberculosis
M. tuberculosis
M. tuberculosis
M. tuberculosis
M. tuberculosis
leprosy, P.
carinii
pneumonia in
AIDS patients
cause
discoloration of
body fluids from
urine to sweat
and tears.
KETOLIDE
Drug
Treatment
telithromycin
(Ketek)
mild to
moderate
communityacquired
pneumonia
caused by
susceptible
bacteria
Pharmacokinetics
rapidly absorbed
through the GI
tract, reaching
peak levels in 1
hour.
Adverse Effects
Clinically
Important
Interactions
Contraindications
and Cautions
half-life of 10 hours
nausea, vomiting,
taste alterations,
and the potential
for
pseudomembranous
colitis.
risk of increased
serum levels of
telithromycin and
potentially serious
adverse effects if it
is combined with
pimozide,
simvastatin,
lovastatin, or
atorvastatin
contraindicated with
known allergy to any
component of the
drug or to macrolide,
with known
congenital prolonged
QT interval,
bradycardia, or any
proarrhythmic
condition such as
hypokalemia
Clinically
Important
Interactions
Contraindications
and Cautions
LINCOSAMIDES
Drug
Treatment
Pharmacokinetics
Adverse Effects
clindamycin
(Cleocin)
severe
infections
lincomycin
(Lincocin)
severe
infections
rapidly absorbed
from the GI tract
or from IM
injections and are
metabolized in the
liver and excreted
in the urine and
feces.
Severe GI reactions,
including fatal
pseudomembranous
colitis, have
occurred, limiting
the usefulness of
lincosamides
caution in patients
with hepatic or renal
impairment, which
could interfere with
the metabolism and
excretion of the drug.
Use during pregnancy
and lactation only if
the benefi t clearly
outweighs the risk to
the fetus or neonate
LIPOGLYCOPEPTIDES
Drug
Treatment
Pharmacokinetics
Adverse
Effects
Clinically Important
Interactions
Contraindications
and Cautions
televancin
(Vibativ)
complicated
skin and skinstructure
infections
It is rapidly
absorbed with
peak levels
occurring at the
end of the infusion
toxic effects on
the GI tract
increased risk of
prolonged QT interval
and resultant
arrhythmias if
telavancin is
combined with other
drugs known to
prolong the QT
interval;
contraindicated with
known allergy to any
component of the
drug
oritavancin
(Orbitiv)
telavancin
(Vibativ)
complicated
skin and skinstructure
infections
complicated
skin and skinstructure
infections
half-life of 8 to 9
hours
A transfusion
reaction called
red man
syndrome with
flushing,
sweating, and
hypotension can
occur with rapid
infusion
OXAZOLIDIZONES
Drug
Treatment
linezolid
(Zyvox)
pneumonia
tedizolid
(Sivextro)
acute skin
infections
Pharmacokinetics
Adverse Effects
Clinically Important
Interactions
available in oral or
IV use. Tedizolid
has a half-life of 12
hours, linezolid
has 5 hours
CNS effects,
thrombocytopenia
risk for hypertension
increased risk of
bleeding when
combined with
NSAIDs
Contraindications
and Cautions
contraindicated with
known allergy to the
drug components, with
PKU
avoid foods
containing tyramine
MACROLIDES
Drug
Treatment
azithromycin
(Zithromax)
clarithromycin
(Biaxin)
erythromycin
(Ery-Tab, Eryc)
mild to
moderate
respiratory
infections
various
respiratory,
skin, sinus, and
maxillary
infections
Pharmacokinetics
widely distributed
throughout the
body
treatment of
Legionnaire’s
disease
Adverse
Effects
most frequent
ones, which
involve the
direct effects of
the drug on the
GI tract, are
often
uncomfortable
enough to limit
the use of the
drug.
Clinically Important
Interactions
Contraindications
and Cautions
increased serum
levels of digoxin occur
when digoxin is taken
concurrently with
macrolides
contraindicated in
patients with a known
allergy to any
macrolide
should be taken on an
empty stomach with a
full, 8-oz glass of
water 1 hour before
or at least 2 to 3
hours after meals
MONOBACTAM
Drug
aztreonam
(Azactam)
Treatment
gram-negative
enterobacterial
infections
Pharmacokinetics
Adverse
Effects
Clinically Important
Interactions
Contraindications
and Cautions
available for IV
and IM use only
and reaches peak
effect levels in 1 to
1.5 hours. Its halflife is 1.5 to 2
hours
GI effects
include nausea,
GI upset,
vomiting, and
diarrhea.
Aztreonam is
incompatible in
solution with nafcillin,
cephradine, and
metronidazole.
contraindicated with
any known allergy to
aztreonam