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