Viral

Gram Positive Cocci

• Clusters
• -coag. positive

diff. MSSA/MRSA

Gram positive cocci

• Clusters
• -coag. negative

diff. MSSA/MRSA

Gram positive cocci

Chains or pairs

gram positive cocci

chains or pairs

diff. VRE

gram positive rod

Gram negative cocci

Gram negative cocci

respiratory pathogen

Gram negative rods/bacilli

lactose fermenting

gram negative rod/bacilli

non-lactose fermenting

gram negative rod/bacilli

non-lactose fermenting

gram negative

respiratory pathogen

Gram positive mouth anaerobes

cocci

Gram positive mouth anaerobes

cocci

Gram positive gut anaerobe

bacilli

Gram negative gut anaerobes

Atypical respiratory pathogen

Atypical respiratory pathogen

Atypical respiratory pathogen

DOC: streptococcus

some enterococcus coverage

mouth anaerobes

Probenecid administered shortly before or w/ PCN will increase PCN levels

susceptible to degradation by beta-lactamases

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

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

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

• 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

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

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

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

very broad spectrum

enterobacteriacease

peudomonas

1st cephalosporin with activity against MRSA

Broad spectrum bactericidal activity against gram (+) & gram (-) pathogens

dose adjustment if CrCl <50 ml/min

• Gram Negative ONLY
• -incl. Pseudomonas

mono-bactam

no cross-senstivity with PCN

no nephrotoxicity

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 T_1/2
• Doripenem
• -no neurotoxicity

• ADRs:
• -cross-sensitivity to PCN
• -mental status changes & seizures

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

• 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

• 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

• 5-HT syndrome

• 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

• Broad Gram-Positive Spectrum
• -Staphylcoccus (MRSA)
• -Streptococcus (incl. resistant species)
• -E. Faecalis

Renally excreted

high PPB -- DI!!!

• ADRs:
• -myopathy; increases CPK levels

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

ANAEROBES

• Mouth anaerobes - poor activity
• Bacteroides fragilis (gut)
• DOC: C. diff

• hepatically eliminated
• ADRs:
• -metallic taste (chew gum, hard candy)
• -Disulfiram rxn
• -can induce seizures (rarely)
• DI:
• coumadin, carbamazepine, cyclosporin

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)

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

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

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

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

Vanocomycin (1st line)

Zyvox (2nd line)

Synercid (3rd line)

Cubicin

Minocycline

Tigecycline

Zyvox

Cubicin

Synercid

Clindamycin

Metronidazole

Tigecycline

tetracycline

bactrim

macrolide

quinolone

tetracycline

tigecycline

bactrim

quinolones

aminoglycosides

vancomycin

Vancomycin (PO)

Metronidazole (PO)

Metronidazole

Carbapenems

Quinolones

Penicillinase-resistant penicillin

Synercid

Clindamycin

Metronidazole

Moxifloxacin