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Bugs-to-Drugs Cheat Sheet by

Matching Antibiotics to susceptible bacteria

Beta-L­actams: Penicillin Family

Antibi­otics
Bacteria
Notes
Natural Penicillin
(PCN G / PCN V)
↦ Strep
↦ Staph (non-β­-la­cta­mase)
↦ Treponema pallidum (syphilis)
DOC for Syphilis
Anti-S­taph. Penicillin
(Nafcillin / Diclox­aci­llin)
↦ Staph. aureus (penic­ill­ina­se-­pro­ducing)
↦ Some Strep
DOC for MSSA infections
Aminop­eni­cillins
(Ampic­illin / Amoxic­illin)
↦ Strept­ococcus spp.
↦ Entero­coccus faecalis
↦ Entero­bac­ter­iaceae (some)
↦ Listeria monocy­togenes
DOC for suscep­tible Entero­coccus and Listeria infections
Amoxic­ill­in/­cla­vul­anate (Augme­ntin®)
↦ Strep + Staph. aureus
↦ E. coli + Klebsiella
↦ H. flu + Moraxella catarr­halis
↦ Anaerobes
Mixed infect­ions:
(GP+GN­+an­aer­obes) such as Diabetic Foot Ulcers
Ampici­lli­n/s­ulb­actam (Unasyn®)
Similar to Amoxic­ill­in/­cla­vul­anate + broader activity against anaerobes
(sulbactam = acinet­oba­cter)
Mixed infect­ions:
(GP+GN­+an­aer­obes) such as Diabetic Foot Ulcers
Pipera­cil­lin­/ta­zob­actam (Zosyn®)
Similar to Amoxic­ill­in/­cla­vul­anate + Pseudo­monas aeruginosa
Same as above PLUS Pseudo­monas
Mechanism of Action:
1. Binds to Penicillin Binding Proteins (PBPs) located on the bacterial cell wall
2. PBPs catalyze peptid­oglycan synthesize which interferes with bacterial cell wall
constr­uction → Bacteria lysis and death
3. Number and type of PBPs vary between different bacteria
4. Time Dependent killing

Beta-L­actam: Cephal­osporin

Antibi­otics
Bacteria
Drug-o­f-C­hoice
1st Generation
(Cefazolin / Cephal­exin)
↦ Strept­ococcus + Staph (including some MSSA)
↦ PEK: Proteus, E. coli, Klebsiella pneumoniae
SSTI
Surgical prophy­laxis
2nd Generation
(Cefoxitin / Cefotetan)
Enhanced activity against gram (–) bacteria including
↦ Some anaerobes (B. fragilis)
↦ Strept­ococcus + Staph (including some MSSA)
↦ H. flu + Entero­bacter aerogenes
Intra-­abd­ominal infections
Prophy­laxis pre-su­rgery
2nd Generation
(Cefur­oxime / Cefaclor)
↦ Strept­ococcus + Staph (including some MSSA)
↦ H. influenzae + M. catarr­halis + Neisseria (some)
↦ E. coli + K. pneumoniae
URT infections
3rd Generation
(Ceftr­iaxone / Ceftaz­idime)
Broad spectrum including
↦ Many gram (–) bacteria
↦ Strept­ococcus + Staph (including some MSSA)
↦ H. influenzae + M. catarr­halis + Neisseria
↦ (Cefta­zidime = Pseudo­monas)
Meningitis
Gonorrhea (Ceftr­iaxone)
3rd Generation
(Cefixime / Cefpod­oxime / Cefdinir)
↦ Strept­ococcus + Staph (including some MSSA)
↦ H. influenzae + M. catarr­halis
↦ Entero­bac­ter­iaceae: E. coli + K. pneumoniae
Commun­ity­-ac­quired infections
4th Generation
(Cefepime)
Broad-­spe­ctrum activity including
↦ Pseudo­monas aeruginosa
↦ Many gram (–) bacteria
↦ Strept­ococcus + Staph (including some MSSA)
HAP
Febrile neutro­penia
5th Genera­tio­n/A­nti­-MRSA
(Cefta­roline)
Broad spectrum including
↦ MRSA + Strept­ococcus spp
↦ Some gram (–) bacteria
SSTI
CAP
Very safe antibi­otics
Less frequent dosing compared to PCNs
Cephal­osp­orins are intrin­sically resistant to ALL Entero­cocci and Listeria species
All agents are metabo­lized by the kidneys EXCEPT Ceftri­axone (hepatic metabo­lism; hepati­c/renal excretion)

Beta-L­actam: Carbap­enems Family

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Imipen­em/­Cil­astatin
Meropenem
↦ Gram (+) – Not Entero­coccus faecium
↦ Gram (–) & Pseudo­monas
↦ Anaerobes
↦ DOC for Entero­bacter, Serratia and ESBL
↦ Severe hospit­al-­acq­uired infections
↦ Compli­cated infections
Ertapenem
↦ Gram (+) cocci
↦ Many Gram (–) rods
↦ Anaerobes
↦ Less active against Pseudo­monas and Acinet­obacter
↦ CAP
↦ Compli­cated intra-­abd­ominal infections
Merope­nem­/Va­bor­bactam
Imipen­em/­Cil­ast­ati­n/R­ele­bactam
Same as ABOVE PLUS
↦ Resistant gram (–) such as CRE
↦ Compli­cated UTIs
↦ HAP/VAP
Carbap­enems are very broad spectrum (similar in activity to Pipera­cil­lin­/Ta­zob­actam) and usually used for hospital acquir­ed/­ser­iou­s/r­esi­stant infections
1) Usually used for hospital acquired organisms that have developed resistance to other cell wall inhibitors (aka, Extended Spectrum Beta Lactamase Producers)
2) Reserve to use for resistant infections

Beta-L­actam: Monobactam Family

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Aztreonam
↦ ONLY Gram (–) including Neisseria, H. flu, Entero­bac­ter­iaceae, and Pseudo­monas
↦ No anaerobes
↦ Altern­ative agent for GRAM (-) infections in those with PCN allergies
↦ Mainly for hospital related infect­ions, critically ill, or sepsis.
Narrower spectrum of activity compared to other beta-l­actams
1) ONLY Gram (-) activity, no anaerobes
2) No cross reactivity with other beta-l­actams
3) Can be used safely in those with PCN allergies

Vancomycin and Glycop­eptides

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Vancomycin
↦ ONLY gram (+) including MRSA and sensitive Entero­cocci
↦ PO for C. diff
↦ For either resistant infections or beta-L­actam allergies
↦ Must monitor levels: AUC/MIC ratio
↦ PO can be used for C. diff infections
Televancin
↦ Only Gram (+) including MRSA and sensitive Entero­cocci
↦ DOES NOT cover VRE
↦ Potent­ially can be used for Vancom­yci­n-r­esi­stant S. aureus (VRSA)
↦ Increase mortality when used for HAP with renal impairment
↦ Contra­ind­icated in pregnancy
Dalbav­ancin
↦ Only Gram (+) including MRSA and sensitive Entero­cocci
↦ Skin/Soft Tissue Infections (SSTIs)
Oritav­ancin
↦ Only Gram (+) including MRSA and sensitive Entero­cocci
↦ COVERS VRE
↦ Skin/Soft Tissue Infections (SSTIs)
1) Only has Gram (+) Activity
2) Mainly used to cover either Beta-L­actam Resistant Infections (MRSA, PCN resistant Strep pneumo, Amp resistant Entero­coccus) OR
3) Altern­ative for Gram (+) infections in those with Beta-L­actam allergies

Daptomycin vs. Polymyxin (Colistin)

Daptomycin
ONLY Gram (+) and for resistance infection including
↦ MRSA/M­SSA­/VI­SA/VRSA
↦ Entero­cocci (include VRE)
↦ Strept­ococcus
↦ Altern­ative agent for GRAM (-) infections in those with PCN allergies
↦ Mainly for hospital related infect­ions, critically ill, or sepsis.
Colistin
Resistant Gram (–) infections including Pseudo­monas
For resistant Gram (-) infections
Daptom­ycin: Cannot use for pneumonia due to inacti­vation by lung surfactant
Polymyxin: Old class of drugs that have gained new popularity for resistant Gram (-) infections

Macrolide Family

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Erythr­omycin
↦ Gram (+)
↦ Gram (–)
↦ Atypical organisms
↦ Mycoba­cterium sp.
↦ CAP / Sinusitis / Otitis Media
↦ Atypical infections
↦ Lyme’s disease
Clarit­hro­mycin
↦ Gram (+)
↦ Gram (–)
↦ Atypical organisms
↦ Mycoba­cterium sp.
↦ BETTER H.flu coverage
↦ CAP / Sinusitis / Otitis Media
↦ Atypical infections
↦ Lyme’s disease ↦ Mycoba­cterial infections
Azithr­omycin
↦ Gram (+), but less activity
↦ Gram (–)
↦ Atypical organisms
↦ Mycoba­cterium sp.
↦ BETTER H.flu coverage
↦ CAP / Sinusitis / Otitis Media
↦ Atypical infections
↦ Lyme’s disease
↦ Mycoba­cterial infections
↦ Frequently used as one time dose (1 g) for Chlamydia treatment.
Can be used safely with PCN allergies

Macrolide Family

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Erythr­omycin
↦ Gram (+)
↦ Gram (–)
↦ Atypical organisms
↦ Mycoba­cterium sp.
↦ CAP / Sinusitis / Otitis Media
↦ Atypical infections
↦ Lyme’s disease
Clarit­hro­mycin
↦ Gram (+)
↦ Gram (–)
↦ Atypical organisms
↦ Mycoba­cterium sp.
↦ BETTER H.flu coverage
↦ CAP / Sinusitis / Otitis Media
↦ Atypical infections
↦ Lyme’s disease ↦ Mycoba­cterial infections
Azithr­omycin
↦ Gram (+), but less activity
↦ Gram (–)
↦ Atypical organisms
↦ Mycoba­cterium sp.
↦ BETTER H.flu coverage
↦ CAP / Sinusitis / Otitis Media
↦ Atypical infections
↦ Lyme’s disease
↦ Mycoba­cterial infections
↦ Frequently used as one time dose (1 g) for Chlamydia treatment.
Can be used safely with PCN allergies

Tetrac­yclines Family

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Tetrac­ycline
Doxycy­cline
Minocy­cline
Gram (+)
↦ MRSA & Strept­ococcus
Some Gram (-)
↦ Atypical infections
↦ Chlamy­dia­/go­norrhea
↦ Tick borne disease
↦ Tick or spider bites
↦ Lyme’s Disease
↦ CAP
↦ SSTI, esp. MRSA
↦ Atypical respir­atory infections
Tigecy­cline
Gram (+)
↦ MRSA & Strept­ococcus
↦ VRE
Some Gram (-)
Some Anaerobe
Atypical infections
↦ Chlamy­dia­/go­norrhea
↦ Tick borne disease
↦ Compli­cated IAI
↦ Skin/soft tissue infections
↦ MRSA/VRE infections
Eravac­ycline
Omadac­ycline
Gram (+)
↦ MRSA & Strept­ococcus
↦ VRE
Some Gram (-)
Some Anaerobe
Atypical infections
↦ SSTI
↦ CAP
↦ Compli­cated intra-­abd­ominal infection (IAI)
Spectrum of Activity: Very Broad- Gram-p­ositive (including MRSA), Gram-n­ega­tive, Rickettsia and other Tick borne diseases, Chlamydia, some protozoa
Omadac­ycline, Eravac­ycline, and Tigecy­cline also cover entero­cocci (including VRE)

Aminog­lyc­osides Family

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Tobramycin
Gentamicin
Amikacin
↦ Gram (-) + Pseudo­monas
↦ Gram (+) → Synergy dosing for Entero­coccal infective Endoca­rditis
↦ Amikacin only covers mycoba­cterium sp.
↦ Resistant G- infections
↦ Synergy with beta-l­act­am/­gly­cop­eptide in entero­coccal endoca­rditis
Plazomicin
↦ Gram (-) + Pseudo­monas
↦ Gram (+) → Synergy w/ with a beta-l­act­am/­gly­cop­eptide for Entero­coccal infective Endoca­rditis
↦ CRE
↦ Resistant G- infect­ions, including UTI
↦ Plague
Spectrum of Activity
1) Mostly Gram (-), mycoba­cte­rium, synergy for Gram + infections when used with a beta-l­actam or glycop­eptide
2) Most frequently used now for resistant gram – infections or in combin­ation with an extended spectrum beta-l­actam (addit­ional coverage for resistant Gram (-) infect­ions) in serious infections such as neutro­penic fever or sepsis

Oxazol­idi­nones Family

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Linezolid
ALL Gram (+) organisms
↦ MsSA/M­RSA­/VI­SA/VRSA
↦ Entero­cocci (VRE)
↦ Strept­ococcus
Some Atypicals
↦ SSTIs
↦ Suspected MRSA / VRE infections
Tedizolid
Same as ABOVE PLUS
↦ Gram (-) anaerobes
↦ SSTIs
Spectrum of Activity: Gram + (MRSA + VRE) , some atypical organisms, Mycoba­cterium sp., and Nocardia

Others Protein Synthesis Inhibitors

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Lincos­amide
(Clind­amycin)
↦ Gram (+) → MSSA + some MRSA
↦ Anaerobes (esp. mouth) including Peptos­tre­pto­coccus, Bacter­oides, Prevot­ella, and Fusoba­cterium Strep + Staph infections
↦ DOC for Pelvic Inflam­matory Disease (PID)
↦ Used in combo with PCN for toxin producing strains for Clostr­idium perfri­ngens and S. pyogenes; commonly occurs with necrot­izing fasciitis
↦ Altern­ative for G+ infections with PCN allergy
↦ Dental infect­ions, IAI, and Pelvic infections
↦ Can be used topically for acne
Pleuro­mutilin
(Lefam­ulin)
↦ Gram (+) organisms
↦ Gram (-) organisms (limited)
↦ Atypicals
↦ CAP
Strept­ogr­amins
(Quinu­pri­sti­n/D­alf­opr­istin)
↦ Gram (+) organisms
↦ MSSA/MRSA
↦ Strep
↦ Entero­coccus (VRE)

Fluoro­qui­nolones Family

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Ciprof­loxacin
↦ Mostly Gram (+)
↦ Some Gram (–) → Pseudo­monas, but not as good as other agents
↦ Atypical organisms
↦ UTIs
↦ GNR bacter­emia, bone/joint infect­ions, hospital related infections
↦ Altern­ative for GNR infections in those w/ beta-l­actam allergies
↦ DON'T use for respir­atory infections
Levofl­oxacin
↦ Mostly Gram (+)
↦ Some Gram (–) → Pseudo­monas, but not as good as other agents
↦ Atypical organisms
↦ UTIs / CAP / SSTIs / Sinusitis
↦ GNR bacter­emia, bone/joint infect­ions, and hospital related infections
↦ Altern­ative for GNR infections in those w/ beta-l­actam allergies
↦ Altern­ative for mycoba­cterial infections
Delafl­oxacin
↦ Gram (+): MRSA
↦ Some Gram (-) →Pseud­omonas
↦ Atypical organisms
↦ SSTIs
Moxifl­oxacin
↦ Mostly Gram (+)
↦ Some Gram (-) → Not as good as other agents
↦ Atypical organisms
↦ Anaerobic coverage
↦ CAP / SSTIs
Spectrum of Activity: Varies by Agent, but broad spectrum (Gram +, Gram -, Atypical)
1) Respir­atory FQ: Levofl­oxacin, Delafl­oxacin, Moxifl­oxacin ("Let's Do Medita­tio­n")
2) Pseudo­monas: Levofl­oxacin, Ciprof­lox­acin, Delafl­oxacin ("Let's Cancer Die")
3) Anaerobes: Moxifl­oxacin
4) MRSA: Delafl­oxacin ("MR Del is like Modella beer")

Rifamycins Family

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Rifampin
↦ Mycoba­cterium species
↦ Gram (+) → MRSA
↦ Never use as solo agent
Rifabutin
↦ Mycoba­cterium species
↦ Less DDIs → Preferred drug for patients on antire­tro­virals
Rifape­ntine
↦ Mycoba­cterium species
Rifaximin
↦ Gram (+)
↦ Gram (-) → Entero­bac­ter­iaceae
↦ Only active in GI tract
↦ Can’t use to treat systemic infections
Spectrum of Activity
• Rifampin, Rifabutin, Rifape­ntine → Mycoba­cterium species
• Rifampin: Gram + (MRSA); never use ALONE
• Rifaximin: Gram +, Gram – such as Entero­bac­ter­iaceae; ONLY active in the GI tract

Miscel­laneous Nucleic Acid Synthesis Inhibitors

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Metron­idazole
↦ Gram (+)
↦ Gram (–)
↦ Anaerobes
↦ Protozoa
↦ In combo with other agents to cover anaerobes
↦ Bacterial vaginosis
↦ H. pylori treatment
↦ Crohn’s disease
↦ Giardia infections
Nitrof­ura­ntoin
Fosfomycin
↦ Gram (+) → Staph
↦ Gram (–) → Entero­coccus (VRE) + GNR
↦ Fosfomycin covers ESBL
↦ Lower UTIs
Metron­ida­zole: Gram – and + anaerobes and protozoa
Nitrof­ura­ntoin: Staphy­loc­occus, Entero­coccus (including VRE) and GNRs (not pseudo­monas)
Fosfom­ycin: Staphy­loc­occus, Entero­coccus (including VRE) and GNRs including many resistant one such as ESBL

Sulfon­amides Family

Antibi­otics
Bacteria
Drug-o­f-C­hoice
Sulfon­amides
(Sulfa­met­hox­azo­le/­tri­met­hoprim)
↦ Some strept­ococcus sp.
↦ Staphy­loc­occus (MRSA)
↦ Entero­bac­ter­iaceae, Listeria, and Nocardia
↦ Pneumo­cystis jiroveci
↦ DOC for Nocardia and Pneumo­cystis jiroveci
↦ UTIs / SSTIs (MRSA)
↦ Treatment of/pre­vention of infection in immuno­com­pro­mised
 

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  • Published: 7th March, 2024

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