Viral


Staphylococcus Aureus


Gram Positive Cocci

Clusters-coag. positive
diff. MSSA/MRSA


Staphylococcus epidermidis


Gram positive cocci

Clusters-coag. negative
diff. MSSA/MRSA


Streptococcus

(S. Pneumoniae, S. Pyogenes)


Gram positive cocci

Chains or pairs


Enterococcus

(E. faecalis, E. faecium)


gram positive cocci

chains or pairs

diff. VRE


Listeria meningitidis


gram positive rod


Neisseria species

(N. meningitidis, N. gonorrhoeae)


Gram negative cocci


Moraxella catarrhalis


Gram negative cocci

respiratory pathogen


Enterobacteriaceae

(E. coli, enterobacter, klebsiella, proteus, serratia, citrobacter, salmonella, shigella)


Gram negative rods/bacilli

lactose fermenting


Acinetobacter


gram negative rod/bacilli

non-lactose fermenting


Pseudomonas


gram negative rod/bacilli

non-lactose fermenting


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


Bacteroides fragilis


Gram negative gut anaerobes


Mycoplasma pneumoniae


Atypical respiratory pathogen


Chlamydia pneumoniae


Atypical respiratory pathogen


Legionella pneumoniae


Atypical respiratory pathogen


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


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


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


Extended-Spectrum Penicillins (IV)

Ticarcillin (Carboxy-penicillins)
Piperacillin (Ureido-penicillins)


Piperacillin (broader spectrum than Ticarcillin)

StreptococcusEnterococcus (Piperacillin only)
EnterobacteriaceaePseudomonas 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


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


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


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


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 & pneumoniaceftazidime -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


Aztreonam IV


Gram Negative ONLY-incl. Pseudomonas
mono-bactam

no cross-senstivity with PCN

no nephrotoxicity


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


Aminoglycosides

Gentamicin, Tobramycin, Amikacin, Streptomycin, Capreomycin (IV,IM)


Primarily Gram Negative

Staphylococcus (Gentamicin)w. penicillinase-resistant PCN, cefazolin, or vancoStreptococcus
Enterococcus (w/ ampicillin & vanco)

Gram-Neg (incl. Pseudomonas)

Concentration Dependent Killer

ADR:nephrotoxicity (reversible)ototoxicity (not reversible)neuromuscular blockadeGent, Tobra: -trough <2-peak: for synergy=3-4; infections=6-10
Amikacin:-trough <10-peak: 15-30


Vancomycin


GRAM-POSITIVE-Staphylococcus (incl. MRSA)-Streptococcus-Enterococcus (bacteriostatic)
C. difficile (only P.O use)

DOC: MRSAalt. 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 eliminatedexcellent bioavailability-IV & POADRs:myelosuppression (reversible)-usually occur after 2 weeks-thrombocytopenia
weak & reversible inhibitors of MAO

5-HT syndrome


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 anaerobesBacteroides 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 activityBacteroides fragilis (gut)DOC: C. diff
hepatically eliminatedADRs:-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:photosensitivitytooth 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 ADRsE --> 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 eliminatedconcentration 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