Antibiotics
Penicillins
Penicillin
Forms: VK(PO), G(IV), benzathine(IM)
Coverage: syphilis , leptospirosis , clostridium, oral anaerobes , group A strep, strep viridans
2nd generation and its forms: amoxicillin(PO) and ampicillin(IV,IM)
2nd generation coverage: same as penicillin + E.coli, listeria, Lyme, enterococcus
Mx of entrococcus and listeria : ampicillin+ gentamicin
When to use amoxicillin
1. OM
2. Dental infections
3. Endocarditis
4. UTI in preg as alternative to nitrofurantoin
5. Uncomplicated Lyme
Penicillinase resistant penicillins (PRPs)
IV: oxacillin , nafcillin
PO: cloxacillin and dicloxacillin
Use: MSSA
Anti pseudomonas penicillins
Form and drugs: IV pipracillin , ticracillin , azlocillin, mezlocillin
Use and coverage: all gram neg including pseudomonas
1. Cholecystitis and cholangitis
2. Pyelonephritis
3. Bactermia
4. VAP
5. Neutropenia fever
Cephalosporins
Which cephalosporins cover
G+: 1st and 2nd generation
G-: 3rd and 4th generations
MRSA: 5th generation
Anaerobes: cefoxitin and cefotetan
Pseudomonas: ceftazidime and cefepime
Cephalosporins dont cover: LAME
• listeria
• Atypicals
• MRSA
• Entrococcus
Should you use cephalosporins in case of penicillin allergy:
• if only rash you can use
• If anaphylaxis you cant use
,1st generation cephalosporins
IV: cefazolin
PO: cephalxin, cefadroxil
Coverage: same as PRP + E.coli, proteus, klibsella
2nd generation
IV and when to use : cefotetan , cefoxitin : in PID
PO: cefuroxime and cefprozil : bonchitis, sinusitis and otitis
Coverage: more G- coverage
3rd generation
IV: ceftriaxone , cefoxatime and ceftazidime
PO: cefixime , cefopodaxime
Ceftriaxone is first line in : pneumococcus coverage
1. Meningitis
2. Gonorrhea
3. CAP
4. Complicated Lyme disease
Cefotaxime use
1. In neonates
2. In SPB
4th generation
Drug and its form: IV,IM cefepime
Use: pseudomonas neutropenia fever and VAP
5th generation
Drug: ceftaroline
Use: MRSA
Adverse effects
Cefoxitin and cefotetan : inc risk of bleeding
Ceftriaxone: inadequate biliary metabolism , so it cant be used in neonates
Carbapenems
Forms and drugs: all IV Imipenem and meropenem
Coverage: everything except MRSA and entrococcus
Best mx for: EBSL
Which one doesnt cover pseudomonas: Ertapenem
Aztreonam
Use: only G-
Cross reactivity with penicillin: no
,Quinilones
Old quinilone and its coverge:
• PO ciprofloxacin
• Gram negative including pseudomonas
• No gram positive coverage
• Cystitis, pyelonephritis and VAP
New quinilones and their coverage:
• IV/PO moxifloxacin, gemifloxacin, levofloxacin
• Gram +,- and atypicals
Which one cover anaerobes: moxiflxacin
Which one cover MRSA: delafloxacin
Which one doesnt cause QT prolongation: delafloxacin
How can quinilones cover GI infection
1. Use moxifloxacin alone
2. Use other quinilone + metronidazole
Side effects
1. QT prolongation
2. Bone growth ab in children and preg
3. Tendinitis and Achilles’ tendon. Rupture
TMP/SMX
Form: IV/PO
Use
1. PCP
2. Cystitis
3. MRSA skin infection
Side effects
1. Rash
2. Hemolytic anemia with G6PD
3. BM suppression
Aminoglycoside
Drugs and forms IV gentamicin, amikacin , tobramycin
Coverage: all gram negatives
Synergistic with B lactams to cover staph and entrococcus
Side effects
1. Ototoxicity
2. Nephrotoxicity
, Doxycycline
Form: PO
Use
1. Rickettsia
2. Bronchitis
3. Lyme disease
4. Atypicals
5. Syphilis if penicillin allergy
6. Skin MRSA
Side effects
1. Tooth discoloration
2. Fanconi syndrome (type 2 RTA)
3. Esophagitis / ulcer
4. Photosensitivity
Macrolides
Form PO
Use:
1. Mild gram + infection
2. Atypicals (chlamydia, mycoplasma, uroplasama)
Erythromycin: campylobacter jejuni , legionella
Azithromycin: sinusitis, otitis, MAC complex
Clarithromycin: H.pylori , MAC complex
Clindamycin
Form: PO/IV
Use
1. Oral anaerobes
2. Weak gram + coverage
Metronidazole
Form: PO/IV
Use: GET and anaerobes
• Giardiasis
• Entameba
• Trichomonas
Penicillins
Penicillin
Forms: VK(PO), G(IV), benzathine(IM)
Coverage: syphilis , leptospirosis , clostridium, oral anaerobes , group A strep, strep viridans
2nd generation and its forms: amoxicillin(PO) and ampicillin(IV,IM)
2nd generation coverage: same as penicillin + E.coli, listeria, Lyme, enterococcus
Mx of entrococcus and listeria : ampicillin+ gentamicin
When to use amoxicillin
1. OM
2. Dental infections
3. Endocarditis
4. UTI in preg as alternative to nitrofurantoin
5. Uncomplicated Lyme
Penicillinase resistant penicillins (PRPs)
IV: oxacillin , nafcillin
PO: cloxacillin and dicloxacillin
Use: MSSA
Anti pseudomonas penicillins
Form and drugs: IV pipracillin , ticracillin , azlocillin, mezlocillin
Use and coverage: all gram neg including pseudomonas
1. Cholecystitis and cholangitis
2. Pyelonephritis
3. Bactermia
4. VAP
5. Neutropenia fever
Cephalosporins
Which cephalosporins cover
G+: 1st and 2nd generation
G-: 3rd and 4th generations
MRSA: 5th generation
Anaerobes: cefoxitin and cefotetan
Pseudomonas: ceftazidime and cefepime
Cephalosporins dont cover: LAME
• listeria
• Atypicals
• MRSA
• Entrococcus
Should you use cephalosporins in case of penicillin allergy:
• if only rash you can use
• If anaphylaxis you cant use
,1st generation cephalosporins
IV: cefazolin
PO: cephalxin, cefadroxil
Coverage: same as PRP + E.coli, proteus, klibsella
2nd generation
IV and when to use : cefotetan , cefoxitin : in PID
PO: cefuroxime and cefprozil : bonchitis, sinusitis and otitis
Coverage: more G- coverage
3rd generation
IV: ceftriaxone , cefoxatime and ceftazidime
PO: cefixime , cefopodaxime
Ceftriaxone is first line in : pneumococcus coverage
1. Meningitis
2. Gonorrhea
3. CAP
4. Complicated Lyme disease
Cefotaxime use
1. In neonates
2. In SPB
4th generation
Drug and its form: IV,IM cefepime
Use: pseudomonas neutropenia fever and VAP
5th generation
Drug: ceftaroline
Use: MRSA
Adverse effects
Cefoxitin and cefotetan : inc risk of bleeding
Ceftriaxone: inadequate biliary metabolism , so it cant be used in neonates
Carbapenems
Forms and drugs: all IV Imipenem and meropenem
Coverage: everything except MRSA and entrococcus
Best mx for: EBSL
Which one doesnt cover pseudomonas: Ertapenem
Aztreonam
Use: only G-
Cross reactivity with penicillin: no
,Quinilones
Old quinilone and its coverge:
• PO ciprofloxacin
• Gram negative including pseudomonas
• No gram positive coverage
• Cystitis, pyelonephritis and VAP
New quinilones and their coverage:
• IV/PO moxifloxacin, gemifloxacin, levofloxacin
• Gram +,- and atypicals
Which one cover anaerobes: moxiflxacin
Which one cover MRSA: delafloxacin
Which one doesnt cause QT prolongation: delafloxacin
How can quinilones cover GI infection
1. Use moxifloxacin alone
2. Use other quinilone + metronidazole
Side effects
1. QT prolongation
2. Bone growth ab in children and preg
3. Tendinitis and Achilles’ tendon. Rupture
TMP/SMX
Form: IV/PO
Use
1. PCP
2. Cystitis
3. MRSA skin infection
Side effects
1. Rash
2. Hemolytic anemia with G6PD
3. BM suppression
Aminoglycoside
Drugs and forms IV gentamicin, amikacin , tobramycin
Coverage: all gram negatives
Synergistic with B lactams to cover staph and entrococcus
Side effects
1. Ototoxicity
2. Nephrotoxicity
, Doxycycline
Form: PO
Use
1. Rickettsia
2. Bronchitis
3. Lyme disease
4. Atypicals
5. Syphilis if penicillin allergy
6. Skin MRSA
Side effects
1. Tooth discoloration
2. Fanconi syndrome (type 2 RTA)
3. Esophagitis / ulcer
4. Photosensitivity
Macrolides
Form PO
Use:
1. Mild gram + infection
2. Atypicals (chlamydia, mycoplasma, uroplasama)
Erythromycin: campylobacter jejuni , legionella
Azithromycin: sinusitis, otitis, MAC complex
Clarithromycin: H.pylori , MAC complex
Clindamycin
Form: PO/IV
Use
1. Oral anaerobes
2. Weak gram + coverage
Metronidazole
Form: PO/IV
Use: GET and anaerobes
• Giardiasis
• Entameba
• Trichomonas
