AEROBES GNC CDK, TDK, AUCDK? P. vulgaris (Indole +) P. mirabilis (indole -) GNB Enterococcus faecalis Aceinetobacter spp.

Streptococcus spp. Enterobacter spp. GPC MRSA / MRSE (3%) GPB VRSA, VREF, VRE L. monocytogenes GPB

ANAEROBES GNB Atypical organisms

Salmonella spp.

Citrobacter spp.

MSSA / MSSE

N.meningitidis

P. aeruginosa

M. catarrhalis

H. influenzae

Shigella spp.

Serratia spp.

C. difficile

Klebsiella

Cloxacillin Penicillin Amoxicillin/Ampicillin Amoxicillin-Clavulanate

1 1

C C C C C C C C
2

T T T T T T T T T T T T T T T

25%

30%

B. fragilis

E. coli

PHM321Y ANTIBIOTICS

N. gonorrhoeae

Piperacillin-Tazobactam

Cephalexin/Cefadroxil/Cefazolin
2

Cefuroxime/Cefprozil/Cefaclor
2

Cefoxitin

40%

Ceftriaxone/Cefotaxime
3

C C C C C C C C C C C C C S S S S S S S C

Ceftazidime
3 4

DIM
17%

Cefixime Cefepime

Ceftobiprole

DIM

DIM

30
%

Carbapenems (DIME)
5

Gylcopeptides (VT) Daptomycin

O
3-13%

CO M M

Sulfamethoxazole-Trimethoprim Fluoroquinolones (CON) Resp. Fluoroquinolones (LM) Aminoglycosides (TAG) Metronidazole Clindamycin Macrolides (ACE) Linezolid
3 4

T C A C C T T

C L

C
30-50%

syn syn

syn

Oral anaerobes

Cidal or Static?

AC AC

Nitrofurantoin

syn

syn

Chloramphenicol
6

Tetracyclines (TDM) Tigecycline Rifampin

syn

syn

syn

syn

PO only; IV only, both the drug has weak coverage or there is high resistance (25%) against the drug Risk of resistance given if mentioned in class these bugs have the potential to produce BSBLs (SPACE PEK bugs) and Pip/Tazo is not effective against BSBLs Enterococcus faecium is more resistant than Enterococcus faecalis against these drugs (carbapenems are not effective against E. faecium) DIME = doripenem, imipenem-cilastatin, meropenem, ertapenem CON = ciprofloxacin, ofloxacin, norfloxacin; LM = levofloxacin, moxifloxacin; TAG = tobramycin, amikacin, gentamicin; ACE = azithromycin, clarithromycin, erythromycin TDM = tetracycline, doxycycline, minocycline syn = synergy ( 2x extent of killing compared to best agent alone) GPB = gram-positive bacilli GPC = gram-positive cocci GNB = gram-negative bacilli GNC = gram-negative cocci
1 2 3 5 4 6

Never use as a single agent: combine with aminoglycosides Only Ceftriaxone covers N. gonorrhoeae Only used in cystitis or recurrent UTI prophylaxis Glycopeptides: vancomycin, telavancin cidal against H. influenzae, S. pneumoniae, N. meningitides cidal against S. pnuemoniae, S. epidermis. Does not cover Proteus spp. = drug of choice against species (bold font) Atypical Organisms Stenotrophomonas maltophilia Pneumocystitis carinii (HIV)

weak or unreliable activity against pathogen, do not use as 1st line treatment

Mycoplasma pneumoniae

Legionella pneumoniae

Chlamydia trachomatis

Clamydia pneumoniae

Mycobacterium spp.

Rickettisia spp.

Brucella spp.

ORAL ANAEROBES Peptococcus Peptostreptococcus Fusobacterium Bacteroides spp. GNB THAT CAN PRODUCE BROAD SPECTRUM BETALACTAMASES (BSBLs) SPACE PEK:

Sulfamethoxazole-Trimethoprim Fluoroquinolones (CON) Fluoroquinolones (LM) Macrolides (ACE) Tetracyclines (TDM) Chloramphenicol Rifampin CO O L CO CO

syn

syn

syn

Serratia marcescens Pseudomonas aeruginosa Acinobacter spp. Citrobacter spp. Enterobacter spp.

Proteus spp. Escherichia coli Klebsiella spp. (K. pneumoniae)