Drugs

Common Antibiotics:

• penicillin V (PO)

• penicillin G (IV, IM)

• ampicillin (PO, IV, IM)

• amoxicillin (PO)

Gram [-] Organisms

• Escherichia coli

• Haemophilus influenzae (beta-lactamase negative)

• Proteus mirabilis

• Neisseria meningitidis

Gram [+] Organisms

• Staphylococcus aureus (MSSA)

• Staphylococcus epidermidis (MSSE)

• Streptococcus pneumoniae

• Streptococcus pyogenes

• Streptococcus sp., Viridans group

• Enterococcus faecalis

Anaerobes

• Peptostreptococcus sp.

• Clostridium sp.

Mode of Action: Disrupt bacterial cell wall synthesis

Pros:

• Safe in pregnancy

• Enters cerebrospinal fluid

Cons:

• Hypersensitivity

• High incidence of diarrhea

• Urticaria/Anaphylaxis

• Nausea / Vomiting

• Superinfections

• Can cause candidiasis

Common Antibiotics:

• Augmentin (Amoxicillin-clavulanic acid)

Gram [-] Organisms

• Salmonella, Shigella species

• Proteus mirabilis, vulgaris

• Pasteurella multocida

• Moraxella catarrhalis

• Klebsiella species

• Haemophilus influenzae

• Escherichia coli (E.coli)

• Bacteroides fragilis

Gram [+] Organisms

• Streptococcus pneumoniae

• Streptococcal (A,B,C,F, & G groups)

• Listeria monocytogenes

• Enterococcus faecalis

• Peptostreptococcus

• Clostridium

• Actinomyces

Mode of Action: Clavulanic acid binds and inhibits beta-lactamases that inactivate amoxicillin, amoxicillin disrupts cell wall synthesis

Pros:

• More broad spectrum

• Relatively safe

Cons:

• Growing resisitance to penicillins

• DIARRHEA

Common Antibiotics:

• Duricef (Cefadroxill)- PO

• Keflex (Cephalexin)- PO

• Ancef (Cefazolin)- IV

Gram [-] Organisms:

NONE

Gram [+] Organisms:

Most Gram + organisms

• Staphylococcus aureus

• Streptococcal Groups A, B, C, F, G

• Streptococcus pneumonia

Mode of Action: Inhibits bacterial cell wall synthesis

Pros:

• Inexpensive

• Good for skin infections d/t strep and staph coverage

• Commonly used for 24 hours for surgical prophylaxis

Cons: 

• Does not cross blood-brain barrier

• Cross sensitivity with PCN

Common Antibiotics:

• Cefuroxime (PO,IV)

• Cefoxitin (IV, IM)

• Cefotetan (IV, IM)

Gram [-] Organisms:

• Escherichia coli

• Haemophilus influenzae

• Klebsiella sp.

• Moraxella catarrhalis

• Proteus mirabilis

Gram [+] Organisms:

• Peptostreptococcus

• Staphylococcus aureus

• Streptococcal Groups A, B, C, F, G

• Streptococcus pneumonia

Mode of Action: Inhibits bacterial cell wall synthesis

Pros:

• Generally considered safe in pregnancy

• First-line for PID

• Good for URIs, CAP, gonorrhea, surgical prophylaxis

Cons:

• Inhibits Vitamin K production- increased bleeding risk

• Has a disulfiram-like reaction with alcohol

• Does not cross the blood-brain barrier

• Expensive

• Cross sensitivity with PCN

Common Antibiotics:

• Ceftriaxone (IV)

• Cefotaxime

• Ceftazidime

Gram [-] Organisms:

• Citrobacter freundii

• Citrobacter sp.

• Escherichia coli

• Haemophilus influenzae

• Klebsiella sp

• Pasteurella multocida

• Proteus mirabilis, vulgaris

• Moraxella catarrhalis

• Salmonella

• Shigella

Gram [+] Organisms:

• Staphylococcus aureus

• Streptococcal Groups A, B, C, F. G

• Streptococcus pneumonia

Mode of Action: Inhibits bacterial cell wall synthesis

Pros:

• Crosses BBB

• No need for renal adjustments for Ceftriaxone

Cons:

• Associated strongly with C. diff infections

• Cross sensitivity with PCN

Common Antibiotics:

• Cefepime (IV, IM)

Gram [-] Organisms:

• Pseudomonas aeruginosa

• Enterobacter

Gram [+] Organisms:

• Streptococcal (A,B, C.F, & G groups)

• Streptococcus pneumoniae

• Staphylococcus aureus

Mode of Action: Inhibits bacterial cell wall synthesis

Pros:

• Most broad of the cephalosporins

• Covers Pseudomonas

• Good for nosocomial infections

Cons:

• Can cause CNS toxicity

• Associated with C. diff

• Cross-sensitivity with PCN

Common Antibiotics:

• Doxycycline (PO)

• Minocycline (PO)

• Tetracycline (PO)

Gram [-] Organisms:

• Rickettsia species

• Mycoplasma pneumoniae

• Moraxella catarrhalis

• Haemophilus influenzae

• Chlamydophila species

• Good for atypicals

Gram [+] Organisms:

• Staphylococcus aureus, MRSA

• Listeria monocytogenes

• Peptostreptococcus

• Actinomyces

• Clostridium

Mode of Action: Prevents protein synthesis from bacteria, inhibiting bacteria to grow

Pros:

• Good coverage for atypicals, rickettsia, spirochetes (e.g., B. burgdorferi, Helicobacter pylori), Plasmodium species (malaria) 

• Moderate coverage for staphylococci (including MRSA), S. pneumonia 

• Drugs of choice for tick-borne diseases

• Alternative to ciprofloxacin in bioterrorism scenarios

• Use for malaria prophylaxis 

Cons:

• Can cause esophageal irritation (take with water standing up); 

• Often causes photosensitivity

• Can cause discoloration of developing teeth (C/I in pregnant women and children less than 8 yo) 

• Drug interactions: Chelate cations (separate by at least two hours)

Common Antibiotics:

• Sulfamethoxazole/Trimethoprim (PO, IV)

Gram [-] Organisms:

• Morganella morganii

• Enterobacter species

• Klebsiella species

• Haemophilus influenzae

• Legionella species

• Proteus mirabilis, vulgaris

Gram [+] Organisms:

• MRSA

• Staphylococcus aureus

• Listeria monocytogenes

Mode of Action: inhibit enzyme systems involved in the bacterial synthesis of tetrahydrofolic acid

Pros:

• First line for Pneumocystis jirovecii pneumonia in patients with HIV

Cons:

• Frequently causes rash 

• Dose-dependent bone marrow suppression 

• Risk for SJS

• Can cause both true and “pseudo renal” failure seen as a rise in SCr 

• Trimethoprim component can cause hyperkalemia 

• IV formulation requires considerable amounts of volume 

• Drug interaction: warfarin (increases INR)

Common Antibiotics:

• Ciprofloxacin (PO, IV, Otic, Ophthalmic) 

• Levofloxacin (PO, IV, ophthalmic) 

• Moxifloxacin (PO, IV, ophthalmic, intraocular)

Gram [-] Organisms:

• Chlamydophila sp.

• Escherichia coli

• Enterobacter sp.

• Haemophilus influenzae, 

• Klebsiella sp.

• Legionella sp.

• Moraxella catarrhalis

• Mycoplasma pneumoniae,

• Pasteurella multocida

• Proteus mirabilis /vulgaris

• Salmonella

• Shigella

• Serratia sp.

Gram [+] Organisms:

• Enterococcus faecalis 

• Listeria monocytogenes 

• Peptostreptococcus 

• Staphylococcus aureus 

• Streptococcal Groups A, B, C, F, G S

• Streptococcus pneumoniae

Mode of Action: Inhibits bacterial DNA synthesis by inhibiting the DNA gyrase enzyme

Pros: 

• Can cover drug-resistant strep pneumoniae

• Well oral absorption

• Broad spectrum

• Covers atypical, pseudomonas & anerobes

• Optic solution options

Cons:

• Do not take with cations (aluminum, calcium, magnesium); separate by at least 2 hours

• Risk of QTc prolongation 

• Diarrhea a large side effect (can lead to C. difficile)

Common Antibiotics:

• Metronidazole (PO, IV)

Gram [-] Organisms:

• Fusobacterium species

• Bacteroides species

• Helicobacter pylori

Gram [+] Organisms:

• Peptostreptococcus

• Clostridium species

• Clostridium difficile

ANAEROBES

Mode of Action: Inhibits DNA synthesis

Pros:

•  1:1 IV to PO conversion

• Useful in anaerobic infections

• Can be used in treatment for C diff.

Cons:

• Dose-related peripheral neuropathies (potentially reversible), 

• N/V/D, metallic taste

• Serious side effects include hepatitis, pancreatitis, and seizures 

• Causes disulfiram-like reaction with consumption of alcohol 

Common Antibiotics:

• Azithromycin (PO, IV, ophthalmic)

• Clarithromycin (PO)

• Erythromycin (PO, IV, Topical)

Gram [-] Organisms:

• Haemophilus influenzae

• Morazella catarrhalis

• Legionella pneumophila

• Bordaella pertussis

• Mycoplasma pneumoniae

• Bartonella species

• Chlamydophila species

• Helicobactor pylori

Gram [+] Organisms:

• Staphylococcus aureus

• Streptococcus pneumoniae

• Streptococcus pyogenes (Group A)

• Mycobacterium avium

Mode of Action: Inhibits protein synthesis

Pros:

• Prolonged half-life → short course may be adequate for most infections 

• No renal adjustments 

• 1:1 IV to PO

Cons:

• Inhibit CYP450 enzymes (less so with azithromycin)

• Does not enter CSF

Common Antibiotics:

• Gentamicin (IV, ophthalmic, topical)

• Tobramycin (IV, ophthalmic)

• Amikacin (IV, IM)

• Streptomycin (IM)

Gram [-] Organisms:

• Bartonella sp.

• Brodetella pertussis

• Chlamydophila sp.

• Haemophilus influenzae

• Legionella sp.

• Moraxella catarrhalis

• Mycoplasma pneumoniae

Gram [+] Organisms:

• Actinomyces

• Clostridium (not difficile)

• Corynebacterium diphtheria

Mode of Action: Inhibit protein synthesis by bacteria

Pros:

• High potency

• Used in conjunction with β lactams

Cons:

• Nephrotoxicity (see an increase in SCr)

• Irreversible ototoxicity with high doses

• Poor lung and CNS penetration

Common Antibiotics:

• Meropenem (IV)

• Imipenem-Cilastatin (IM or IV)

• Ertapenem (IV)

Gram [-] Organisms:

• Citrobacter freundii 

• Enterobacter cloacae 

• Escherichia coli 

• Klebsiella pneumoniae 

• Proteus mirabilis 

• Serratia marcescens

Gram [+] Organisms:

• Acinetobacter 

• Pseudomonas aeruginosa 

• Staphylococcus 

• Streptococcus

Mode of Action: Binds to bacterial cell wall

Pros:

• Broad spectrum

• Good for intra-abdominal infections

• Can be inhaled

Cons:

• Cross-reactivity with penicillins

• DO NOT USE WITH MENINGITIS

Common Antibiotics:

• Vancomycin (IV, PO) 

Gram [-] Organisms:

NONE

Gram [+] Organisms:

• Arcanobacterium sp. 

• Clostridium difficile 

• Clostridium sp. 

• Enterococcus faecalis 

• Peptostreptococcus 

• Staphylococcus aureus, MRSA 

• Coagulase-negative Staphylococcus 

• Staphylococcus saprophyticus 

• Streptococcal Groups A, B, C, F, G 

• Streptococcus pneumoniae 

• Viridans strep

Mode of Action: Inhibits cell wall synthesis

Pros:

• Useful for MRSA

• Used to treat C. diff

Cons:

• No Gram-negative coverage

• Red Man syndrome

Common Antibiotics:

• Clindamycin (PO, IM, IV) 

Gram [-] Organisms:

• Capnocytophagia sp. 

• Fusobacterium necrophorum 

• Prevotella melaninogenica

Gram [+] Organisms:

• Actinomyces sp. 

• Arcanobacterium sp. 

• Clostridium sp. 

• Corynebacterium diphtheriae 

• Peptostreptococcus 

• Staphylococcus aureus, MRSA 

• Coagulase-negative Staphylococcus 

• Staphylococcus saprophyticus 

• Streptococcal Groups A, B, C, F, G 

• Streptococcus pneumoniae

Mode of Action: Prevent bacterial replication by interfering with synthesis of proteins

Pros:

• 100% bioavailable with oral dosing

• Good option for pts with PCN allergies

Cons:

• Can cause diarrhea, rash

• Liquid form tastes bad