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Staphylococcus Aureus
Gram Positive Cocci
diff. MSSA/MRSA
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Staphylococcus epidermidis
Gram positive cocci
diff. MSSA/MRSA
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Streptococcus
(S. Pneumoniae, S. Pyogenes)
Gram positive cocci
Chains or pairs
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Enterococcus
(E. faecalis, E. faecium)
gram positive cocci
chains or pairs
diff. VRE
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Listeria meningitidis
gram positive rod
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Neisseria species
(N. meningitidis, N. gonorrhoeae)
Gram negative cocci
-
Moraxella catarrhalis
Gram negative cocci
respiratory pathogen
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Enterobacteriaceae
(E. coli, enterobacter, klebsiella, proteus, serratia, citrobacter, salmonella, shigella)
Gram negative rods/bacilli
lactose fermenting
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Acinetobacter
gram negative rod/bacilli
non-lactose fermenting
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Pseudomonas
gram negative rod/bacilli
non-lactose fermenting
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Hemophilus influenzae
gram negative
respiratory pathogen
-
Peptococcus
Gram positive mouth anaerobes
cocci
-
Peptostreptococcus
Gram positive mouth anaerobes
cocci
-
Clostridium
(C. difficile, C. sp.)
Gram positive gut anaerobe
bacilli
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Bacteroides fragilis
Gram negative gut anaerobes
-
Mycoplasma pneumoniae
Atypical respiratory pathogen
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Chlamydia pneumoniae
Atypical respiratory pathogen
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Legionella pneumoniae
Atypical respiratory pathogen
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Natural Penicillins
Penicillin G (IV)
Penicillin V (po)
DOC: streptococcus
some enterococcus coverage
mouth anaerobes
Probenecid administered shortly before or w/ PCN will increase PCN levels
susceptible to degradation by beta-lactamases
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Penicillinase Resistant PCNs
Nafcillin, Oxacillin (IV)
Dicloxacillin, Cloxacillin (PO)
DOC: staphylcoccus
streptococcus
hepatically eliminated
may elevate liver enzymes; potential for hepatitis
avoid extravasation
DI: warfarin, nifedipine (naficillin): increases metabolism
Do not administer together with aminoglycosides in the same compartment
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Amino-penicillins
Ampicillin (IV;PO)
Amoxicillin (PO)
some gram-negative activity
streptococcus
enterococcus (only ampicillin)
- enterobacteriaceae (limited)-E. coli, Proteus
H. influenzae
Mouth flora
Major ADR: hypersensitivity rxn (rash)
- DIs:
- OC;
- methotrexate (increases methotrexate toxicity);
- venlafaxine,
- warfarin (increase INR, risk of bleeding)
- Do not administer together with aminoglycosides in the same compartment
Ampicillin causes C. diff colitis
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Extended-Spectrum Penicillins (IV)
Ticarcillin (Carboxy-penicillins)
Piperacillin (Ureido-penicillins)
Piperacillin (broader spectrum than Ticarcillin)
- Streptococcus
- Enterococcus (Piperacillin only)
- Enterobacteriaceae
- Pseudomonas aeruginose (P>T)
H. Influenzae (variable)
- Mouth & Gut anaerobe (only some coverage; cannot rely upon)
ADRs: thrombophlebitis, injection site pain
Do not administer together with aminoglycosides in the same compartment
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Penicillin plus B-lactamase inhibitors
Augmentin (Amoxicillin/clavulanate) PO
Unasyn (Ampicillin/sulbactam) IV
Timentin (Ticarcillin/clavulanate) IV
Zosyn (Piperacillin/tazobactam) IV
- MAO:
- 1) high-affinity & irreversible binding to B-lactamase preventing hydrolyses on penicillin
2) directly bidning to penicillin-binding proteins of bacteria increasing antibacterial activity of penicillin
inhibitors have no or little antibacterial activity
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1st Generation Cephaloporins
Cefazolin (IV)
Cephalexin (PO)
Cefadroxil (PO)
SPEcK
Gram positive: Staphylocci, Streptococci
Gram negative: Proteus, E. coli, Klebsiella
- 5-8% cross-sensitivity with PCN allergy
- -used as an alternative in pts with mild PCN allergy
- -dont give in pts with anaphylatic rxn
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2nd Generation Cephalosporins
Cefuroxime (IV)
Cefonicid (IV)
Cefuroxime axetil (PO)
Cefaclor (PO)
Cefprozil, Loracarbef (PO)
Cefoxitin, Cefotetan (IV)
HNM-SPEcK
Gram positive: Streptococci
Gram negative: Hemophilus influenzae, Neisseria gonorrhoeae, Moraxella catarrhalis, Proteus, E. Coli, Klebsiella
- Cefoxitin, Cefotetan (IV)
- -anaerobic activity: bacteroides fragilis
- -SPEcK (no HNM)
Cefotetan has MTT side chain: may interfere with prothrombin synthesis
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3rd Generation Cephalosporins
Cefotaxime, Ceftriaxone, Ceftizoxime, Ceftazidime (IV)
Cefixime, Cefpodoxime proxetil, Ceftibuten, Cefdinir, Cefditoren pivoxil (PO)
have expanded gram negative activity
less gram positve activity
- IV have good CSF penetration -used in meningitis
- ceftriaxone
- -hepatically eliminated
- -shouldnt be given within 48hrs of IV soln that contains Ca2+
- -nephrotoxicity
- -used for lyme disease, gonorrhoea & pneumonia
- ceftazidime -pseudomonas
-
4th Generation Cephalosporins
Cefepime (IV)
very broad spectrum
enterobacteriacease
peudomonas
-
5th Generation Cephalosporins
Ceftraoline fosamil (IV)
1st cephalosporin with activity against MRSA
Broad spectrum bactericidal activity against gram (+) & gram (-) pathogens
dose adjustment if CrCl <50 ml/min
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Aztreonam IV
- Gram Negative ONLY
- -incl. Pseudomonas
mono-bactam
no cross-senstivity with PCN
no nephrotoxicity
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Carbapenems (IV)
Imipenem-cilastatin
Meropenem
Ertapenem
Doripenem
Staphylococcus & Streptococcus
E. Faecalis
Gram-Neg (incl. Pseudomonas)
Anaerobes ( no C. Diff)
Cilastatin prevents the degradation of imipenem in the renal tract
Imipenem causes seizures
Meropenem -gram (-) > gram (+) - -less ADRs with increased dosed
- -lower incidence of seizures
- Ertapenem -narrower spectrum (no pseudomonas)
- -good anerobic activity
- -longest T1/2
- Doripenem
- -no neurotoxicity
- ADRs:
- -cross-sensitivity to PCN
- -mental status changes & seizures
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Aminoglycosides
Gentamicin, Tobramycin, Amikacin, Streptomycin, Capreomycin (IV,IM)
Primarily Gram Negative
- Staphylococcus (Gentamicin)
- w. penicillinase-resistant PCN, cefazolin, or vanco
- Streptococcus
Enterococcus (w/ ampicillin & vanco)
Gram-Neg (incl. Pseudomonas)
Concentration Dependent Killer
- ADR:nephrotoxicity (reversible)
- ototoxicity (not reversible)
- neuromuscular blockade
- Gent, Tobra:
- -trough <2
- -peak: for synergy=3-4; infections=6-10
- Amikacin:
- -trough <10
- -peak: 15-30
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Vancomycin
- GRAM-POSITIVE
- -Staphylococcus (incl. MRSA)
- -Streptococcus
- -Enterococcus (bacteriostatic)
C. difficile (only P.O use)
- DOC: MRSA
- alt. in pts with PCN allergic rxn
- ADRs:-"red man" syndrome
- -ototoxicity (irreversible)
- -nephrotoxicity
- -neutropenia (reversible)
- -hypersensitivity rxn
monitor trough in only for pt w/ renal impairment
-
Linezolid (Zyvox)
- broadest gram-positive abx spectrum
- -bacteriostatic
staphyococcus (incl. MRSA)
streptococcus
enterococcus
- hepatically eliminated
- excellent bioavailability
- -IV & PO
ADRs:- myelosuppression (reversible)
- -usually occur after 2 weeks
- -thrombocytopenia
weak & reversible inhibitors of MAO
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Synercid
quinupristin/dalfopristin
- Gram-Positive
- -Staphylcoccus (MRSA - bactericidal)
- -Streptococcus
- -E. faecium only (bacteriostatic)
- -VRSA
reserved for life-threatening or serious infections
incompatible w/ normal saline
hepatically eliminated
- ADRs:
- -arthralgias
- -myalgias
- -increases bilirubin
inhibits cyp450 3A4
-
Daptomicin (IV)
(Cubicin)
- Broad Gram-Positive Spectrum
- -Staphylcoccus (MRSA)
- -Streptococcus (incl. resistant species)
- -E. Faecalis
Renally excreted
high PPB -- DI!!!
- ADRs:
- -myopathy; increases CPK levels
-
Clindamycin
Gram positive & anaerobes
- Staphylococcus (no MRSA)
- Streptococcus
- Mouth anaerobes
- Bacteroides fragilis
100% bioavailability
good alternative for PCN in staph/strep infections
hepatically eliminated
ADRs:-diarrhea (may be the cause for c. diff) - -bitter taste
-
Metronidazole
ANAEROBES
Mouth anaerobes - poor activity - Bacteroides fragilis (gut)
- DOC:
C. diff
ADRs:-metallic taste (chew gum, hard candy)- -Disulfiram rxn
- -can induce seizures (rarely)
- DI:
- coumadin, carbamazepine, cyclosporin
-
Tetracyclines
Tetracycline (PO)
Minocycline (IV/PO)
Doxycycline (IV/PO)
RESPIRATORY MOs
Strep pneumoniae
- Staph. aureus & epidermidis
- -incl. MRSA
- -only minocycline
Resp. MOs
- Atypical MOs:
- -chlamydia pneumoniae/trachomatis
- -mycoplasma pneumoniae
- -legionella pneumoniae
bacteriostatic
ADR:- photosensitivity
- tooth discoloration
- DI:
- -chelation (2 hrs apart)
-
Tigecycline
Broad Spectrum
staphlyococcus ( MRSA)
streptococcus (incl. resistant species)
enterococcus ( VSRA)
gram-neg (no pseudo)
Mouth anaerobes, bacteroides sp., clostridium sp.
bacteriostatic
adjust dose in severe hepatic impairment
ADRs:- -photosensitivity
- -tooth discoloration
-
Bactrim
trimethoprim/sulfamethoxazole
strep. pneumoniae
enterobacteriaceae (variable)
resp. MOs
decrease dose by 50% if CrCl<50mL/min
- ADRs:
- -photosensitivity
- -hypersensitivity rxns (SJS)
- -bone marrow supression
- -crystalluria (drink alot of fluid)
- DIs:
- -potentiate warfarin
- -phenytoin
-
Macrolides
erythromycin, azithromycin, clarithromycin, roxithromycin, dirithromycin
resp. & HIV
staph (no MRSA) - strep
resp. MOs
atypical & AIDs MOs
H. pylori
only Azithromycin should be taken w/o food
- A --> least ADRs
- E --> most ADRs
- ADRs:
- -VT, QT prolongation
- All (except A) inhibit cyp450 3A
-
-
Quinolones
ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin
Staph & Strep (except C)
Enterococci (except C)
Enterobacteriaceae
Pseudomonas (only C & L)
Resp. MOs
Anaerobes (only M)
atypical MOs (except C)
- only Moxifloxacin is hepatically eliminated
- concentration dependent killer
- ADRs:-seizures
- -photosensitivity
- -tendonitis
- -QT prolongation (torsades)
- -dysglycemias
- DIs:
- -antacids & cations (space out 3-4hrs)
- -NSAIDs
- -anticoags
-
MRSA tx
Vanocomycin (1st line)
Zyvox (2nd line)
Synercid (3rd line)
Cubicin
Minocycline
Tigecycline
-
VRSA tx
Zyvox
Cubicin
Synercid
-
Anaerobes tx
Clindamycin
Metronidazole
Tigecycline
-
Resp. Anaerobes tx
tetracycline
bactrim
macrolide
quinolone
-
Abx that causes photosensitivity
tetracycline
tigecycline
bactrim
quinolones
-
Nephrotox abx
aminoglycosides
vancomycin
-
C. Diff tx
Vancomycin (PO)
Metronidazole (PO)
-
Abx that can induce seizures
Metronidazole
Carbapenems
Quinolones
-
Hepatically eliminated abx
Penicillinase-resistant penicillin
Synercid
Clindamycin
Metronidazole
Moxifloxacin
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