Bugs and Drugs

Natural Penicillins

Natural Penicillins

Penicillin G

Penicillin G coverage

• other strep

• E. faecalis

• oral anaerobes

aminopenicillins

• ampicillin

• amoxicillin

• augmentin

• Unasyn

Ampicillin and Amoxicillin coverage

• other strep

• E. faecalis

• respiratory gram negatives (CA)

• oral anaerobes

• listeria monocytogenes, N. meningitidis

Augmentin coverage

• other strep

• MSSA/MSSE

• E. faecalis

• gram negatives (CA)

• anaerobes

• listeria monocytogenes, N. meningitidis, Neisseria gonorrhoeae

Unasyn coverage

• other strep

• MSSA/MSSE

• E. faecalis

• gram negatives (CA)

• anaerobes

• listeria monocytogenes, N. meningitidis, Neisseria gonorrhoeae, acinetobacter

Anti-staph (penicillinase-resistant) penicillins

• nafcillin

• dicloxacillin

Nafcillin coverage

• S. pneumo

• other strep

• MSSA/MSSE

Hepatic Elimination

Dicloxacillin coverage

• S. pneumo

• other strep

• MSSA/MSSE

Extended Spectrum (anti-pseudomonal) penicillins

Zosyn

Zosyn Coverage

• S. pneumo

• other strep

• MSSA/MSSE

• E. faecalis

• gram negatives (CA, HA)

• Anaerobes

• Clostridium species (not diff.)

Carbapenems

• doripenem

• ertapenem

• imipenem-cilastatin

• meropenem

• vabomere

Doripenem coverage

• S. pneumo

• other strep

• MSSA/MSSE

• gram negs. (CA, HA)

• Anaerobes

Ertapenem coverage

• S. pneumo

• other strep

• MSSA/MSSE

• gram negs. (CA)

• Anaerobes

• NOT pseudomonas

• acinetobacter

imipenen-cilastatin coverage

• S. pneumo

• other strep

• MSSA/MSSE

• gram negs. (CA, HA)

• Anaerobes

• norcardia, acinetobacter

meropenem coverage

• S. pneumo

• other strep

• MSSA/MSSE

• gram negs. (CA, HA)

• Anaerobes

• L. monocytogenes, norcardia, acinetobacter

vabomere coverage

• S. pneumo

• other strep

• MSSA/MSSE

• gram negs. (CA, HA)

• Anaerobes

• L. monocytogenes, nocardia, acinetobacter (ESBL coverage + KPC strains)

Monobactams

aztreonam

Aztreonam coverage

• gram negs (CA, HA)

• use against carbapenemase-producing organisms

Aminoglycosides

• gentamicin

• tobramycin

• amikacin

Gentamicin coverage

• gram neg. (CA)

• F. tularensis

• least pseudomonas/ acinetobacter coverage

Tobracymin coverage

• gram negs. (CA, HA)

Amikacin coverage

• gram negs. (CA, HA)

• BEST pseudomonas/ acinetobacter coverage

1st Gen. Cephalosporins

• cefazolin

• cephalexin

Cefazolin and Cephalexin coverage

• other strep

• MSSA/MSSE

• respiratory gram negs. (CA)

• oral anaerobes

• mainly respiratory gram neg + some E. coli

• PEK (P. mirabilis, E. coli, K. pneumoniae)

2nd Gen. Cephalosporins

• cefotetan disodium

• cefuroxime

Cefotetan disodium coverage

• other strep

• MSSA/MSSE

• gram neg. (CA)

• anaerobes

• ± B. frag.

Cefuroxime coverage

• other strep

• MSSA/ MSSE

• gram neg. (CA)

• oral anaerobes

3rd Gen Cephalosporins

• Cefotaxime

• Ceftazidime

• Ceftazidime/ Avibactam

• Ceftriaxone

• Ceftolozane/Tazobactam

• Cefdinir

• Cefixime

Cefotaxime coverage

• S. pneumo

• other strep

• MSSA/MSSE

• gram negs. (CA)

• oral anaerobes

• Neisseria meningitidis

Ceftazidime coverage

• other strep

• gram negs. (CA, HA)

• oral anaerobes

• anti-pseudomonal Ceph

Ceftazidime/ Avibactam coverage

• other strep

• gram negs. (CA, HA)

• oral anaerobes

• intra-abdominal and UTIs (ESBL coverage + KPC strains)

Ceftriaxone coverage

• S. pneumo

• other strep

• MSSA/ MSSE

• gram neg. (CA)

• oral anaerobes

• neisseria meningitidis/ gonorrhea

Hepatic elimination

Ceftolozane/ Tazobactam coverage

• S. pneumo

• other strep

• gram negs. (CA, HA)

• anaerobes

• intra-abdominal and UTIs (ESBL coverage)

Cefdinir coverage

• other strep

• MSSA/ MSSE

• gram neg. (CA)

• oral anaerobes

• neisseria gonorrhea

cefixime coverage

• other strep

• gram neg. (CA)

• oral anaerobes

• neisseria gonorrhea

4th Gen. Cephalosporins

cefepime

Cefepime coverage

• S. pneumo

• other strep

• MSSA/ MSSE

• gram neg. (CA, HA)

• oral anaerobes

• MOST resistant to carbapenemases; Anti-pseudomonal ceph

5th Gen. Cephalosporins

Ceftaroline fosamil

Ceftaroline fosamil coverage

• S. pneumo

• other strep

• MSSA/ MSSE

• MRSA-CA

• MRSA-HA

• Gram neg. (CA)

• ONLY MRSA cephalosporin

Fluoroquinolones

• ciprofloxacin

• levofloxacin

• moxifloxacin

Ciprofloxacin coverage

• gram negs. (CA, HA)

• atypicals

• anthrax

• BEST pseudomonal coverage in class

• some ESBL coverage

Levofloxacin coverage

• S. pneumo

• other strep

• E. faecalis

• gram negs. (CA, HA)

• atypicals

• oral anaerobes

• Listeria

Moxifloxacin coverage

• S. pneumo

• other strep

• E. faecalis

• gram neg. (CA)

• atypicals

• anaerobes

• Listeria

Hepatic elimination

Macrolides

Azithromycin

Azithromycin coverage

• other strep

• respiratory gram neg. (CA)

• atypicals

• M. avium

• C. trachomatis

• M. genitalium

• Gonococcus

• Listeria

• C. jejuni

No renal adjustment

Tetracyclines

• doxycycline

• minocycline

Doxycycline coverage

• MSSA/ MSSE

• MRSA-CA

• gram neg. (CA)

• atypicals

• oral anaerobes

• borrelia

• brucellosis

• Yersinia

• tularemia

• Vibrio

• Rickettsia

• Anthrax

No renal adjustments

Minocycline coverage

• other strep

• MSSA/ MSSE

• MRSA-CA

• gram neg. (CA)

• atypicals

• oral anaerobes

• rickettsia (lyme)

• nocardia

• listeria

No renal adjustments

Glycylcyclines

Tigecycline

Tigecycline coverage

• S. pneumo

• other strep

• MSSA/ MSSE

• MRSA- CA

• MRSA- HA

• E. faecalis

• gram negs. (CA, HA)

• atypicals

• anaerobes

• ESBL and carbapenemases

• NOT pseudomonas

Hepatic elimination

Folate Antagonists

SMX-TMP

SMX-TMP coverage

• other strep

• MSSA/MSSE

• MRSA-CA

• gram neg. (CA)

• Burkholderia

• Stenotrophomonas

• Pneumocystis

• Nocardia

Lincosamides

clindamycin

Clindamycin coverage

• other strep

• MSSA/ MSSE

• MRSA-CA

• Anaerobes

• acne

• anthrax

No renal adjustments

Nitroimidazoles

• metronidazole

Metronidazole coverage

• Anaerobes

• C. diff

• trichomonas

• entamoeba

• giardiasis

• H. pylori tx

Hepatic elimination

Glyco-, Glycolipo-, Lipopeptides

• daptomycin

• vancomycin

Daptomycin coverage

• S. pneumo

• other strep

• MSSA/ MSSE

• MRSA-CA

• MRSA-HA

• E. faecalis

• E. faecium

• SSTI

• Endocarditis (not pneumonia)

• VRE coverage

Vancomycin coverage

• S. pneumo

• other strep

• MSSA/MSSE

• MRSA-CA

• MRSA-HA

• E. faecalis

• oral anaerobes

• Oral C. diff

• NOT VRE

Oxazolidinones

Linezolid

Linezolid coverage

• S. pneumo

• other strep

• MSSA/MSSE

• MRSA-CA

• MRSA- HA

• E. faecalis

• E. faecium

• oral anaerobes

• VRE Coverage

No renal adjustments

Polymyxins

• Polymyxin B Sulfate

• Colistimethate

Polymyxins Coverage

• gram negs. (CA, HA)

• including ESBL and carbapenemases

Urinary tract agents

Nitrofurantoin

Nitrofurantoin coverage

• E. faecalis

• E. faecium

• Gram neg. (CA)