Antibiotic Drug-Bug

Streptococcus spp.

Pen G/Pen VK
Amoxicillin

Ampicillin

Cefazolin

Ceftriaxone

Macrolides (for when there is a penicillin allergy)

MSSA (methicillin-susceptible Staphylococcus aureus)

Nafcillin/Oxacillin
Cefazolin

Cephalexin

Dicloxacillin

Amoxicillin-clavulanate

MRSA

Vancomycin
Linezolid

Daptomycin (not for pneumonia)

Ceftaroline

SMX-TMP

Doxycycline

Clindamycin (if it is susceptible)

Enterococcus faecalis

Ampicillin

Vancomycin

Linezolid

Daptomycin

Enterococcus faecium/VRE

Linezolid

Daptomycin

Uncomplicated E. coli/Klebsiella (Gram -)

Ceftriaxone

Pip-Taz

Fluroquinolones

SMX-TMP

ESBL (Extended Spectrum Beta Lactamase)-producing E.coli or Klebsiella (sepsis/bactremia)

Meropenem

Imipenem

ESBL cystitis

Nitrofurantoin

SMX-TMP

Fluroquinolones

AmpC organism (HECK-Yes) (H. alviae, Enterobacter cloacae, Citrobacter freundii, Klebsiella aerogenes, Yersinia enterolytica)

Cefepime

Carbapenems

Pseudomonas aeruginosa

Pip-Taz

Cefepime

Ceftazidime

Imipinem/Meropenem/Doripenem

Aztreonam

Ciprofloxacin

Levofloxacin

Tobramycin

Anaerobes (Bacteroides fragilis)

Metronidazole

Pip-Taz

Ampicillin-sulbactam

Carbapenems

Cefoxitin

Cefotetan

C. diff

Fidaxomicin

Oral vancomycin

Atypicals (Mycoplasma, Chalmydia, Legionella)

Azithromycin

Doxycycline

Levofloxacin

Moxifloxacin

Which carbapenem does NOT cover Pseudomonas?

Ertapenem

Which cephalosporin covers MRSA?

Ceftaroline

What is the best drug for AmpC organisms?

Cefepime

What is the big contraindication for Daptomycin?

It does not treat pneumonia

What is the first line medication for MSSA bacteremia?

Cefazolin or nafcillin

What is the best oral MRSA options for SSTI?

SMX-TMP

Doxycycline

Clindamycin

What is the best anaerobe add-on when coverage is missing?

Metronidazole?

Community-Acquired Pneumonia (CAP) - outpatient, healthy adult

Amoxicillin

Doxycycline

Azithromycin

CAP - comorbidities or inpatient

Ceftriaxone + azithromycin

Levofloxacin or moxifloxacin

Severe CAP/ ICU

Ceftriaxone + azithromycin

Ceftriaxone + levofloxacin

Add vancomycin or linezolid if MRSA risk

Hospital-Acquired Pneumonia (HAP)

Cefepime

Pip-Taz

Meropenem

Add vanco or linezolid if MRSA risk

Ventiolator-Associated Pneumonia (VAP) / high MDR

Cefepime OR pip-taz OR meropenem

PLUS vanco or linezolid

Consider double Pseudomonas coverage if severe

Uncomplicated UTI (cystitis)

Nitrofurantoin

SMX-TMP

Fosfomycin

Complicated UTI/ Pyleonephritis

Ceftriaxone

Pip-Taz

Fluoroquinolones

ESBL UTI

Nitrofurantoin (cystitis only)

SMX-TMP

Ciprofloxacin or levofloxacin

ESBL bacteremia from urinary source

Carbapenem (mero or imi)

Sepsis (empiric)

Vancomycin

PLUS pip-taz OR cefepime OR meropenem

MSSA bacteremia

Cefazolin

Nafcillin or oxacillin

MRSA bacteremia

Vanco

Dapto

Non-purulent cellulitis (step > MRSA)

Cephalexin

Cefazolin

Augmentin

Purulent SSTI (Soft Skin and Tissue Infection) / abcess (MRSA concern)

SMX-TMP

Doxycycline

Clindamycin

Vanco

Necrotizing fasciitis

Vanco

PLUS pip-taz or carbapenem

PLUS clindamycin

Adult bacterial meningitis (empiric)

Ceftriaxone

PLUS vanco

Add ampicillin if >50 years or immunocompromised

Native valve endocarditis

Vanco

PLUS cefepime or ceftriaxone

Enterococcus endocarditis (synergy required)

Ampicillin + gentamicin

OR ampicillin + ceftriaxone

Intra-abdominal infection/perforation

Ceftriaxone + metronidazole

Pip-taz

Carbapenem

C. Diff

Fidaxomicin

Oral Vanco

MRSA pneumonia

Vanco

Linezolid

Pseudomonas infection

Cefepime

Pip-Taz

Meropenem

Ceftazidime

When should you NEVER use dapto?

Pneumonia

What is a carbapenem that does NOT cover pseudomnas?

Invanz

Amoxicllin

CAP

Strep infections

Otitis media/ sinusitis

Augmentin

CAP with comorbidities
Sinusitis / otitis

SSTI

Bite wounds

Ampicilin

E. faecalis

Listeria

Meningitis

Cefazolin

MSSA Infections

Surgical prophylaxis

SSTI

MSSA bacteremia

Ceftriaxone

CAP

Meningitis

Pyelonephritis

Intra-abdominal infection

Cefepime

HAP

Pseudomonas aeruginosa

AmpC organisms

Severe sepsis

Pip-taz

Sepsis

Intra-abdominal infections

HAP

Pseudomonas coverage

Anaerobic infections

Meropenem

ESBL infections

Severe sepsis/ septic shock

Intra-abdominal infections

Meningitis

Ertapenem

ESBL infections (NOT pseudomonas)

Intra-abdominal infections

Complicated UTIs

Aztreonam

Gram negative infections in severe beta-lactam allergy

Pseudomonas aeruginosa

Vancomycin

MRSA infections

Severe sepsis

Endocarditis

Oral form for C. diff

Linezolid

MRSA pneumonia

VRE infections

SSTI

Daptomycin

MRSA bacteremia

VRE bacteremia

NOT pneumonia

Azithromycin

Atypical pneumonia (mycoplasma, chalmydia, legionella)

CAP

Doxycycline

MRSA skin infections

Atypical pneumonia

Tick-borne illnesses

STIs

TMP-SMX

MRSA skin infections

Uncomplicated UTI

PJP prophylaxis

Strenotrophomonas

Ciprofloxacin

Complication UTI

Pyelonephritis

Pseudomonas infections

Levofloxacin

CAP

Complicated UTI

Pseudomonas

Metronidazole

Anaerobic infections

Intra-abdominal infections

C. diff

Clindamycin

SSTI

Anaerobes

Necrotizing fasciitis

Fidaxomicin

C. diff

Nitrofurantoin

Uncomplicated cystitis ONLY

No pyelo, no sepsis

Fosfomycin

Uncomplicated cystitis

Tobramycin

Pseudomonas infections

Severe gram negative infections

Gentamicin

Synergy for enterococcal endocarditis

Severe gram negative infections