Module 2.2 Medication Spectrums Matching

Natural Penicillins

• Anaerobes: +/-

• Miscellaneous:

- T. pallidum (Syphilis)

- B. burgdorferi (Lyme)

• Very little coverage - only covers Streptococcus spp, S. pneumonia. E. faecalis and Nesseria spp

Antistaphacoccal Penicillins: Oxacillin, Nafcillin, Dicloxacillin

• Added some coverage - Added MSSA/MSSE but got rid of E. faecalis and Neisseria, they were made to add Staph coverage/penicillinase

• NOT RENALLY ADJUSTED since it has biliary excretion

Ampicillin & Amoxicillin

• Anaerobes: +/- (oral anaerobes)

• Miscellaneous:

- L. monocytogenes

- H. pylori

- Salmonella spp.

- Shigella spp.

• Coverage - Looks just like Penicillin G/VK, with same coverage + light coverage for E. faecium, E. coli, H. influenzae and P. mirabilis and E. faecium

What is Xacduro (Sulbactam/durlobactam) specifically used for?

Acinetobacter baumannii

Spectrum: Aminopencillin + Inhibitor

• Anaerobes: +/+ (oral anaerobes/gut anaerobes)

• Miscellaneous:

- Similar. to ampicillin (M. listeria + H. Pylori)

- Sulbactam for Acinetobacter

• Coverage - Looks like Ampicillin, but now H. influenzae, , E. coli and P. mirabiis has full coverage + MSSA/MSSE, M. catarrhaslis, Klebsiella spp was added and there is now with P. mirabilis with light coverage + works on gut anaerobes

Spectrum: Piperacillin + Tazobactam (Zosyn)

• Anaerobes: +/+ (oral anaerobes/gut anaerobes)

• Miscellaneous:

- Variable activity against ESBL and AmpC

• Coverage - Covers basically everything except doesn’t fully cover Viridans strep, E. faecalis, Enterobacter, Citrobacter and acinetobacter spp and does not cover MRSA /MRSE at all + works on gut anaerobes

How to remember Cephalosporin coverage (for me).

• 1st Gen: PEK (Proteus, E. Coli, Klebsiella) + first 4 w/o pneumoniae

• 2nd Gen: HMPEK + first 4

• 3rd Gen: Start with Neisseria and end with morganella + first 3

• *Ceftazidime: Start with Influenza and end with morganella + Pseudomonas (no gram negative)

• *Cefepime: Start with Nesseria and end with Pseudomonas + first 4 with less coverage for viridians

• *Ceftazidime/avibactam (Avycaz): Start with influenza and end with pseudomonas (basically ceftazidime but you complete it)

• *Ceftazolane/Taxobactam (Zerbaxa): Start with influenza and end with morganella + Pseudomonas + 1st Streptococcus species (just like Ceftazidime except is has the coverage of Streptococcus spp.)

• *Cefepime/Enmetazobactam (Exblifep): Same coverage as plain old cefepime

• *Cefiderocol (Fentroja): Start with influenza all the way to Acinetobacter (no gram positives)

• Ceftaroline, Ceftobiprole: Start with Neisseria till morganella + first 5

- Ceftobiprole also has Pseudomonas coverage

*All of the starred have basically at least 30% coverage of all the gram negatives

Spectrum: Pivmecillinam

• Anaerobes: -

• Miscellaneous:

- Staphylococcus saprophyticus

- Salmonella spp.

- Shigella spp

• Coverage Mostly gram negative, covers E. Coli, Klebsiella and P. mirabillis, Enterobacter spp and Citrobacter spp

• Should NOT be used in heart failure patients since it contains sodium

• Can cause cholestatic jaundice

Spectrum: 1st Gen Cephalosporins (Cefazolin, Cephalexin, Cefadroxil)

• Anaerobes: +/- (oral anaerobes)

• Coverage - Covers Streptococcus spp (NOT S. pneumoniae), MSSA, E. coli, Kebsiella and P. mirabilis

Spectrum: 2nd Gen Cephalosporins (Cefprozil, Cefaclor, Cefuroxime)

• Anaerobes: +/- (oral anaerobes)

• Coverage - Covers same as 1st Gen + S. pneumoniae, H. influenzae, M catarrhalis and some coverage of Neisseria spp and Morganella spp

Spectrum: 2nd Gen Cephamycins (Cefoxitin and Cefotecan)

• Anaerobes: +/+ (oral/gut anaerobes)

• Miscellaneous:

- Active against most anaerobes

- Some resistance observed in B. fragilis.

• Coverage - Covers same as 1st Gen + S. pneumoniae, H. influenzae, M catarrhalis and some coverage of Neisseria spp and Morganella spp; Mycobacterial

- For intrabdominal cephamycins (Cefoxitin and Cefotetan) it also has + works on gut anaerobes

Spectrum: 3rd Gen Cephalosporins (Cefixime, Cefdinir, Cefpodoxime, Ceftriaxone, Cefotaxime)

• Anaerobes: +/- (oral anaerobes)

• Miscellaneous:

- No activity against ESBL; Poor activity against AmpC

• Coverage - Covers same as 2nd Gen but lost some activity at MSSA/MSSE, gained activity and gained Neisseria spp and Morganella spp

- Ceftrixone can be used once daily and does not require renal adjustment, is CI in neonates less than 29 days old and can increase risk of C. diff

Spectrum: Ceftazidime

• Anaerobes: +/- (oral anaerobes)

• Miscellaneous:

- Achromabacter

- Strenotrophomonas maltophilia

- Unstable against ESBLs and AmpC and carbapenemases

• Coverage- Covers P. aeruginosa and it seems like 3rd generation cephalosporin coverage for gram negatives without Neisseria; it is not stable against enterobacters or Acinetobacter spp.; does not work well for gram positives at all

Spectrum: Cefepime

• Anaerobes: +/- (oral anaerobes)

• Miscellaneous:

- Stable against AmpC

- Poor activity against Steno and Achromabacter (unlike ceftazidime)

• Coverage - Stable against AmpC. and against everything except enterooccuses (like all the other cephalosporins), and MRSA. Also didn’t work as well for viridans strep, and Acinteobacter spp.

Spectrum: Ceftazidime/avibactam (Avycaz)

• Anaerobes: +/- (oral anaerobes)

• Miscellaneous:

- Ceftazidime has poor activity against B. fragilis

- Activity against KPC, ESBLs and AmpC

-Definitive Therapy: KPC producing enterbacterales and DTR/carbapenem resistant Pseudomonas

• Coverage - Works from H. influenzae to P. aeruginosa; same coverage as Caftazidime but now is stable against enterobactales

Spectrum: Ceftolozane/Tazobactam (Zerbaxa)

• Anaerobes: +/- (oral anaerobes)

• Miscellaneous:

- Ceftazidime has poor activity against B. fragilis

- Activity against KPC, ESBLs, AmpC, carbapenem-resistant Pseudomona

- Better activity compared to Avycaz since it has intrinsic Pseudomonas activity

- Definitive Therapy: very resistant DTR P. aeruginosa

• Coverage - Works kinda like Acycaz with coverage from H. influenzae to P. aeruginosa, but it is missing the Enterobactales

Spectrum: Cefepime/Enmetazobactam (Exblifep)

• Anaerobes: +/- (oral anaerobes)

• Miscellaneous:

- Active against ESBLs

- Definitive Therapy: ESBL-producing Enterobacterales

• Coverage - Same as cefepime, but even better and more active against ESBLs

Spectrum: Cefiderocol (Fetroja)

• Anaerobes: -/-

• Miscellaneous: Active against

- Carbapenem-resistant Pseudomonas and Enterobacterales

- Stenotrophomonas maltophilia

- Active against ESBLs, AmpC, and carbapenemases (KPC, OXA-type, MBLs)

• Used for multidrug-resistant Gram-negative infections

• Coverage - Works from H. influenzae to acinetobacter spp with some activity on Neisseria spp (almost all the gram negatives)

Spectrum: Ceftaroline (Teflaro)

• Anaerobes: +/- (oral anaerobes)

• Miscellaneous:

- Not activity against ESBLs

- Poor activity against AmpC

• Used for deep-seated MRSA off label

• Coverage - Basically 3rd generation cephalosproin coverage from Neisseria to Morganells with full coverage for MSSA/MSSE and MRSA/MRSE

Spectrum: Ceftabiprole (Zevtera)

• Anaerobes: +/- (oral anaerobes)

• Miscellaneous:

- Not activity against ESBLs

- Poor activity against AmpC

• FDA approved for MRSA bacteremia and endocarditis

• Coverage - Basically ceftaroline + psuedomonas

Spectrum: Meropenem (Merrem), Imipenem/Cilastatin (Primaxin)

• Anaerobes: +/+ (oral anaerobes/gut anaerobes)

• Miscellaneous:

- Stable against ESBLs and AmpC

- Activity against Mycobacteria

- Inactive against S. maltophilia (causes outbreaks)

• Used last-line since there is resistance forming against this drug

• Coverage - Covers almost everything except MRSA and E. faceium, and low coverage for E. faecalis + works on gut anaerobes

Spectrum: Ertapenem (Ivanz)

• Anaerobes: +/+ (oral anaerobes/gut anaerobes)

• Miscellaneous:

- Stable against ESBL and AmpC

- Inactive against S. maltophilia (causes outbreaks)

• Used if drug is found to be susceptible or need for once daily therapy

• Coverage - Covers almost everything except MRSA, enterococcus, P. aeroguniosa, and Acinetobacter. spp, + works on gut anaerobes

Spectrum: Aztreonam

• Anaerobes: -/-

• Miscellaneous:

- Activity against NDM metallo-beta-lactamases

- Unstable against ESBL and AmpC

• Coverage - Covers only gram -, from H. influenza to P.aeruginosa, but there is variable activity at Enterobactor and P.aeruginosa since it is unstable against ESBL and AmpC

• Used for those with severe beta-lactam allergies

Spectrum: Aminoglycoside

• Anaerobes: -/-

• Miscellaneous:

- Synergy for gram-positives with cell wall active agent

- Amikacin active against Mycobacteria

- Not active against Stenotrophomonas

• Coverage - Everything except S. pneumoniae, and Neisseria spp

Spectrum: Plazomicin

• Anaerobes: -/-

• Miscellaneous:

- Active against GNB (gram - bacteria) with gentamicin resistance, especially carbapenamase producers (KPC)

- Poor activity against Gent resistant Pseudomonas

• Coverage - Includes more resistant strains from H. influenzae to Serratia spp., some activity against P. aeruginosa and Acinetobacter spp. As well as MSSA/MSSE and MRSA/MRSE

Spectrum: Fluoroquinolones

• Atypical:

- Chlamydia spp

- Mycoplasm spp

- Legionella pneumophila

• Miscellaneous:

- Active against: S. maltophilia; Vibrio spp; Yersinia spp; Bacillusanthracis;

- High frequency of FQ resistance in ESBLs GNB

• Coverage - All of them cover strep and at least Neisseria to Serratia and has some resistance from E. Coli; Delafloxacin has the most gram + activity and covers MRSA, and Cipro covers Pseudomonas

Spectrum: Sulfonamides

• Anaerobes: -

• Miscellaneous:

- Active against: Pneumocystis jiroveci; Salmonella, Shigella, Vibrio, Stenotrophomonas, Nocardia, Listeria

- Can be used to treat cellulitis caused by S. pyogenes

• Coverage - Not able to cover the Enterococcus or anything after Morganella (Enterobacter and after)

Spectrum: Fosfamycin

• Anaerobes: -

• Miscellaneous:

- Active against: Salmonella; Shigella, Listeria, Aerococcus, H. pylori (almost same as aminopenicillin)

- Inactive: Stenotrophomonas, Burkholderia, and S. saprophyticus

• Coverage -

Covers the 3 groups of 3 for E. Coli and Enterobacter + what Nitrofuratoin covers

Spectrum: Nitrofurantoin

• Anaerobes: -/-

• Coverage -

Works well for MSSA, MRSA, Enterococcus, E. Coli and Citrobacter