Antibiotic Chart 2

Lefamulin Brand

Xenleta

IV, PO

Lefamulin Spectrum/Niche

Narrow

respiratory pathogens only

gram (+) cocci

Atypicals,

H. Influence

Lefamulin Pharmacology

Dose adjust in Hepatic Disease

mix IV only in the citrate buffered NS bag provided

Take PO on an empty stomach

Lefamulin Safety

BBW - None

Common ADR - injection-site reaction

diarrhea

increased AST/ALT

Serious ADR - QT prolongation

CDAD

Lefamulin Precautions, pregnancy, and interactions

Sensitive CYP3A4 substrate that also prolong the QT interval.

Other QT Prolonging drugs are a caution, not an absolute CI

Pregnancy - no human data; however, fetal risk cannot be ruled out

Polymyxin B Sulfate Spectrum/Niche

Narrow

Gram (-) bacilli only (MDR GNR included)

Acinetobacter and pseudomonas are the reason this class survives despite its toxicity

Polymyxin B Sulfate Pharmacology

Poor oral absorption

excellent tissue penetration, except CNS, synovial, pleural, and pericardial

Available as generic injectable (Hikma;Fresenius Kabi)

Polymyxin Safety

BBW - (Polymyxin B) Nephrtoxicity, Neruotoxicity, Respiratory muscle paralysis

Neurotoxicity - parenthesis, confusion, coma, psychosis, seizures

Bronchoconstriction (inhalation)

Polymyxin Precautions, Pregnancy and Interactions

Pregnancy - fetal and infant risk cannot be ruled out.

IM/Intrathecal - Hospital use only

Avoid other Nephrotoxins

Polymyxin Other Information

Reserved for severe, Life-Threatening infections because of toxicity

Rifaximin Brand

Xifaxan PO

Fidaxomicin Brand

Dificid PO

Rifaximin Spectrum and niche

Narrow

for GI Disease (not orally absorbed)

Not for systemic infection

Gram (-) bacilli (esp E. coli)

anaerobes

C. diff

Cryptosporidium

Giardia

Salmonella

Shigella

NOT Campylobacter

Fidaxomicin Spectrum and Niche

Narrow

Structurally similar to Microlides

Not absorbed orally

C. diff only

Rifamycin Pharmacology

Rifaxamin/Fidaxomicin: no renal adjustment/ These are eliminated hepatically

Rifamixin Safety

Traveler’s diarrhea

Hepatic Encephalopathy (decreased ammonia producing bacteria

ADR GI (Flatulence, abdominal pain, urgency)

dizzines

headache

Fidaxomicin Safety

CDAD

ADR GI (flatulence, Abdominal pain, Urgency)

dizziness

headache

Rifomycin CI

hypersensitivity to any rifamycin class agent

Fosfomycin Brand

Monurol PO

Contepo IV