Clusters (Staph)

1.  Coagulase positive (1)

2.  Gram ?

1.  S. aureus 

2.  Positive

Clusters (Staph)

1.  Coagulase negative (3)

2.  Gram?

1.  S. epidermidis

2.  S.  saprophytcus

3.  S. hominis

*Gram Positive

Pairs or Chains (Streptococcus)

1.  Beta-hemolytic (2 with groups)

2.  Alpha-hemolytic

3.  Gram?

1.  S. pyogenese; S. agalactiae (Groups C, F, and G)

2.  Viridans strep; S. pneumoniae

3.  Positive

Pairs or Chains (Enterococcus)  

1.  Gram?

2.  Spp (2)

1.  Positive

2.  E. facaelis; E. faecium

Gram Negative Cocci

1.  spp (2)

1.  Neisseria meningitidis

2.  N. gonhorrea

Gram Negative Bacilli

1.  Lactose fermenters (3)

2.  Which ones are enterobacteriaceae

1.  E. coli; Kelbsiella sp; Enterobacter sp

2.  ALL are enterobacteriaceae

Gram Negative Bacilli

1.  Non-lactose fermenters (9)

2.  Which ones are enterobacteriaceae (Bold)

1.  Pseudomonas aeruginosa

2.  Moraxella sp

3.  Serratia sp

4.  Morganella sp

5.  Salmonella sp

6.  Shigella sp.

7.  Proteus sp.

8.  Stenotrophomonas

9.  Acinetobacter sp

1.  Peptostreptococcus

2.  Clostridium sp

1.  Mycoplasma sp

2.  Legoinella sp

3.  Chlamydophilia sp

Beta-lactams

1.  MOA

2.  ADE (4)

3.  Drug interaction (1)

1.  Bind PCN binding proteins causing cell lysis

2.  Hypersensitivity rxns

GI disturbances (oral)

CNS toxicity (particularly renal dysfunction)

Nephrotoxicity

3.  Probenacid

Penicillin VK

1.  Brand

2.  Route

3.  Spectrum (3)

4.  Category

1.  Veetids

2.  PO

3.  Streptococcus sp

Mouth Anaerobes

T. pallidum (syphillis, all stages)

4.  Natrual PCN

Penicillin G Sodium

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Pfizerpen

2.  IV/IM

3.  3.  Streptococcus sp

Mouth Anaerobes

T. pallidum (syphillis, all stages)

4.  Natural Penicillin

Penicillin G Procaine

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Wycillin

2.  IM

3.  3.  Streptococcus sp

Mouth Anaerobes

T. pallidum (syphillis, all stages)

4.  Natural PCN

Penicillin G benzathine 

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Bicillin-LA

2.  IM

3.  Streptococcus sp

Mouth Anaerobes

T. pallidum (syphillis, all stages)

4.  Natrual PCN

Nafcillin

1.  Brand

2.  Route

3.  Spectrum 

4.  Category

5.  Renal dosing?

1.  Nafcil

2.  IV

3.  DOC for MSSA

4.  Penicillinase-resistant PCN

5.  No...biliary excretion so NO renal adjustment

Oxacillin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

5.  Renal dosing?

1.  Bactocil

2.  IV

3.  DOC MSSA

4.  Penicillinase-resistant penicillins

5.  No, biliary excretion

Dicloxacillin 

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Dynapen

2.  PO

3.  DOC for MSSA

4.  Penicillinase=Resistant Penicillins

Amoxicillin

1.  Brand

2.  Spectrum

1.  Amoxil

2.  Gm +:  Streptocossu, enterococcus (DOC), listeria, anaerobes

GM -:  E. coli, H. inflenzae, Proteus

Ampicillin

1.  Brand

2.  Spectrum

1.  Principen

2.  Gm +:  Streptocossu, enterococcus (DOC), listeria, anaerobes

GM -:  E. coli, H. inflenzae, Proteus

Piperacillin

1.  Brand

2.  Spectrum

1.  Pipracil

2.  Gm +:  Strep; Enterococcus

Gm -:  Aminopenicllin spectrum (E. coli, H. inflenzae, Proteus) + Enterobacteriaceae, P. aeruginoa, Acinetobacter sp

Ticarcillin

1.  Brand

2.  Spectrum

1.  Ticar

2.  Gm +:  Strep; Enterococcus

Gm -:  Aminopenicllin spectrum (E. coli, H. inflenzae, Proteus) + Enterobacteriaceae, P. aeruginoa, Acinetobacter sp

Beta-lactamases

Identify the generic of:

1.  Augmentin

2.  Unasyn

3.  Zosyn

4.  Timentin

5.  Spectrum

1.  Amoxicillin/clavulanic acid

2.  Ampicillin/sulbactam

3.  Piperacillin/tazobactam

4.  Ticarcillin/clavulanate

5.  Increased gram - and anaerobic coverage

**Unasyn also covers Acinetobacter spp

Cephalosproins

1.  Trend in spectrum from first to third gen

2.  Cefepime spectrum

3 ADEs (3)

1.  Decreased gram + and increased Gm -/CNS penetration

2.  Covers all three classes minus anaerobes

3.  H/S (<1% cross-sensitivity)

GI effects

Pain at injection site (particularly IM)

Cefazolin 

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Ancef

2.  IV/IM

3.  GM +:  Streptococcus and MSSA

4.  1st Gen Cephalosporin

Cephalexin 

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Keflex

2.  PO

3.  GM +:  Streptococcus, MSSA

4.  1st Gen Cephalosporin

Cefadroxil

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Duricef

2.  PO

3.  GM +:  Streptococcus, MSSA

4.  1st Gen Cephalosporin

Cefotetan

1.  Brand

2.  Route

3.  Spectrum

4.  Category

5.  Special thing to remember

1.  Cefotan 

2.  IV

3.  Increased GM - (E. coli, H flu, P. mirabilis)

4.  2nd Gen Cephalosporin

5.  Tiomethyltetrazole (MTT) side chain that can cause bleeding/hyperprothrombinemia...disulfiram-like reactions may increase warfarin effects; Also has anaerobic activity

Cefoxitin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

5.  Specail thing about it

1.  Mefoxin

2.  IV

3.  Increased GM - (E. coli, H flu, P. mirabilis)

4.  2nd Gen Cephalosporin

5.  Anaerobic activity

Cefprozil 

1.  Brand

2.  Route

3.  Spectrum

4.  Category

5.  What is special about it

1.  Cefzil

2.  PO

3.  Increased GM - (E. coli, H flu, P. mirabilis)

4.  2nd Gen Cephalosporin

5.  Anaerobic Activity

Cefaclor

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Raniclor

2.  PO

3.  Increased GM - (E. coli, H flu, P. mirabilis)

4.  2nd Gen Cephalosporin

Cefuroxime

1.  Brand (2)

2.  Route

3.  Spectrum

4.  Category

1.  Ceftin; Zinacef

2.  PO

3.  Increased GM - (E. coli, H flu, P. mirabilis)

4.  2nd Gen Cephalosporin

Cefotetan (Cefotan)*#

Cefoxitin (Mefoxin)*

Cefprozil (Cefzil)*

Cefaclor (Raniclor)

Cefuroxime (Ceftin, Zinacef)

1.  Cefazolin (Ancef)

2.  Cephalexin (Keflex)

3.  Cefadroxil (Duricef)

Cefdinir

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Omnicef

2.  PO

3.  GM + (EXCEPT Ceftazidime)

GM-:  Enterobacteriaceae (Ceftaz = P. aeruginosa)

4.  3rd Gen Cephalosporin

Cefpodoxime 

1.  Brand

2.  Route

3.  Spectrum

4.  Category

5.  What is special

1.  Vantin

2.  PO

3.  GM + (EXCEPT Ceftazidime)

GM-:  Enterobacteriaceae (Ceftaz = P. aeruginosa)

4.  3rd Gen Cephalosporin

5.  Anaerobic Activity

Cefixime

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Suprax

2.  PO

3.  GM + (EXCEPT Ceftazidime)

GM-:  Enterobacteriaceae (Ceftaz = P. aeruginosa)

4.  3rd Gen Cephalosporin

Cefditoren

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Spectracef

2.  PO

3.  GM + (EXCEPT Ceftazidime)

GM-:  Enterobacteriaceae (Ceftaz = P. aeruginosa)

4.  3rd Gen Cephalosporin

Ceftibutin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Cedax

2.  PO

3.  GM + (EXCEPT Ceftazidime)

GM-:  Enterobacteriaceae (Ceftaz = P. aeruginosa)

4.  3rd Gen Cephalosporin

Ceftriaxone 

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Rocephin

2.  IV/IM

3.  GM + (EXCEPT Ceftazidime)

GM-:  Enterobacteriaceae (Ceftaz = P. aeruginosa)

4.  3rd Gen Cephalosporin

Ceftazidime

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Fortaz

2.  IV/IM

3.  GM + (EXCEPT Ceftazidime)

GM-:  Enterobacteriaceae (Ceftaz = P. aeruginosa)

4.  3rd Gen Cephalosporin

**ANTI-pseudomonal

Cefotaxime

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Claforan

2.  IV/IM

3.  GM + (EXCEPT Ceftazidime)

GM-:  Enterobacteriaceae (Ceftaz = P. aeruginosa)

4.  3rd Gen Cephalosporin

Ceftizoxime

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Cefizox

2.  IV

3.  GM + (EXCEPT Ceftazidime)

GM-:  Enterobacteriaceae (Ceftaz = P. aeruginosa)

4.  3rd Gen Cephalosporin

1.  Cefdinir (Omnicef)

2.  Cefpodoxime (Vantin)

3.  Cefixime (Suprax)

4.  Cefditoren (Spectracef)

5.  Ceftibutin (Cedax)

6.  Ceftriaxone (Recephin)

7.  Ceftazidime (Fortaz)

8.  Cefotaxime (Claforan)

9.  Ceftizoxime (Cefizox)

Cefepime

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Maxipime 

2.  IV

3.  GM + (Strep, MSSA)

Excellent GM -:  P aeruginosa and Acinetobacter

**NO anaerobic activity

4.  4th Gen Cephalosporin

Ceftaroline 

1.  Brand

2.  Route

3.  Spectrum

4.  Classification

1.  Teflaro

2.  IV

3.  GM+:  MSSA, MRSA, Streptococcus

GM-:  Limited:  E. coli, Klebsiella, H. flu

4.  Anti-MRSA Cephalosporin

Carbapenems

1.  ADEs

2.  DDIs

1.  H/S (1% cross-reactivity with PCNs)

Seizures (particularly with h/o seizure disorder or renal dysfunction)

2.  Decreases valproic acid levels

Imipenem/cilastatin

1.  Brand

2.  Route

3.  Spectrum

4.  Classification

1.  Primaxin

2.  IV

3.  Very broad spectrum with most Gm +/- and anerobes covered

***DOES NOT cover P. aeruginosa or A. baumannii

4.  Carbapenem

Meropenem

1.  Brand

2.  Route

3.  Spectrum

4.  Classificaiton

1.  Merrem

2.  IV

3.  Very broad spectrum with most Gm +/- and anerobes covered

***DOES NOT cover P. aeruginosa or A. baumannii

4.  Carbapenem

Doripenem 

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Doribax

2.  IV

3.  Very broad spectrum with most Gm +/- and anerobes covered

***DOES NOT cover P. aeruginosa or A. baumannii

4.  Carbapenem

Ertapenem

1.  Brand

2.  Route

3.  Spectrum

4.  Classification

1.  Invanz

2.  IV

3.  Very broad spectrum with most Gm +/- and anerobes covered

***DOES NOT cover P. aeruginosa or A. baumannii

4.  Carbapenem

Aztreonam

1.  Brand

2.  Route

3.  Spectrum

4.  ADEs

5.  Category

1.  Azactam

2.  IV

3.  Gm - only :  Including SPACE bugs except Acinetobacter

4.  H/S...no reported Cross-reactivity with PCN

5.  Monobactam

Vancomycin

1.  Brand

Daptomycin

1.  Brand

2.  Route

3.  Spectrum

4.  Unique PK

5.  ADEs

6.  Category

1.  Cubicin

2.  IV

3.  Gm + (Including MRSA and VRE)

4.  Inactivated by pulmonary surfactant...no tx for pneumonia

5.  Musculoskeletal (CK weekly monitoring); GI effects; Peripheral effects (paresthesias and neuropathies)

6.  Cyclic glycopeptide

Colistin, polymixin E

1.  Brand

2.  Spectrum

3.  ADEs

1.  Coly-Mycin M

2.  Gm - only:  ONLY for MDR resistant organisms including P. aeruginosa and A. bacumannii

3.  Nephrotoxicity; Neurotoxicity (NMB blockade; paresthesias around lips, tongue, extremeties; peripheral neuropathy)

Polymixin B 

1.  Brand

2.  Spectrum

3.  ADEs

1.  Poly-Rx

2.  Gm - only:  ONLY for MDR resistant organisms including P. aeruginosa and A. bacumannii

3.  Nephrotoxicity; Neurotoxicity (NMB blockade; paresthesias around lips, tongue, extremeties; peripheral neuropathy)

Ciprofloxacin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Cipro

2.  IV, PO

3.  GM -:  Enterobacteriaceae; P. aeruginosa, atypicals

4.  FQN

Levofloxacin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Levaquin

2.  IV, PO

3.  Gm +:  Strep

Gm -:  P. aeruginosa

Atypicals

4.  FQN

Moxifloxacin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Avelox

2.  IV, PO

3.  Gm+:  Strep

Gm -: Enterobacteriaceae (NO pseudomonas)

Atypical

Anaerobic (Moxi only)

4.  FQN

Gemifloxacin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Factive

2.  PO

 3.  Gm+:  Strep

Gm -: Enterobacteriaceae (NO pseudomonas)

Atypical

4.  FQN

Ofloxacin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Floxin

2.  PO

3.  Gm -: Enterobacteriaceae (NO pseudomonas)

Atypical

4.  FQN

FQN

1.  ADEs

2.  Interactions

1.  GI

CNS (more common elderly)

Tendonitis/tendon rupture (BBW)

2.  Absorption decreased with products containing Ca, Mg, Fe, Al, Zn

Use with steroids may increase tendon ruption

May potentiate warfarin

Metronidazole 

1.  Brand

2. Route

3.  Spectrum

1.  Flagyl

2.  IV/PO

3.  Anaerobes only (good coverage of B. fragilis)

Metronidazole

1.  MOA

2.  ADEs

3.  Interactions

1.  DNA helical structure disintegration

2.  GI, CNS, Metallic taste, Potential carcinogen (BBW)

3.  Possible disulfiram-like reaction

May inc effects of warfarin and lithium

Effects may be dec by phenobarb, phenytoin, and Inc by cimetidine

Rifampin

1.  Brand

2.  Route

3.  MOA

4.  Spectrum

5.  Class

1.  Rifadin

2.  PO

3.  Inhibits B-subunity of DNA dep RNA pol

4.  Wide spectrum, but common for:  Staphy, mycobacterium, neisseria (meningitis propylaxis)

5.  Rifamycin

Rifamycins

1.  ADEs

2.  Interactions

1.  GI

Discolored body fluids

Hematologic (thrombocytopenia, leukopenia, granulocytopenia)

2.  Strong inducer of CYP 3A4, 1A2, 2C9, and 2C19

Sulfamethoxazole-Trimethoprim 

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Bactrim, Septra

2.  IV/PO

3.  Gm+:  Staphy (including MRSA); Strep (not group A)

Gm-:  Variable activity against (enterobacteriacae, DOC for stenotrophomonas maltophilia)

4.  Folic Acid Inhibitors

Sulfamethoxazole-Trimethoprim

1.  MOA

2.  ADEs

3.  Interactions

1.  Trimethoprim:  DHFR

Sulfamethoxazole:  DHPS

2.  GI, Rash (relatively common causes of SJS or TEN)

3.  Potent CYP 2C9 inhibitor

Potentiates warfarin, methotrexate, antidiabetic drugs

AVOID with G6PD deficiency

Protein inhibitors 

1.  30 S (2)

2.  50S (4)

3.  30 and 50S

1.  Tetracyclines; Glycylcyclines

2.  Macrolides; Lincosamides; Streptogrammins; Oxazolidinones

3.  Aminoglycosides (ONLY CIDAL in this group)

Tetracycline

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  None given

2.  PO

3.  Gm +:  staph (including MRSA) Strep (variable group A)

Gm-:  Variable enterobacteriaceae

Anaerobes (not Bacteroides)

Atypicals

4.  Tetracyclines 

Doxycycline

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Vibramycin

2.  IV/PO

3.  Gm +:  staph (including MRSA) Strep (variable group A)

Gm-:  Variable enterobacteriaceae

Anaerobes (not Bacteroides)

Atypicals

4.  Tetracyclines 

Minocycline 

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Minocin

2.  IV/PO

3.  Gm +:  staph (including MRSA) Strep (variable group A)

Gm-:  Variable enterobacteriaceae

Anaerobes (not Bacteroides)

Atypicals

4.  Tetracyclines 

Tetracyclines

1.  ADEs (6)

2.  Interactions

1.  H/S; Photosensitivity; Skin pigmentation changes; Discoloration of teeth/bones (children, CI in pregnant women and kids up to 8 yo); Vertigo (Minocin); GI (more with tetracycline)

2.  Absorption decreased with Ca, Fe, Mg, Al, Zn; May dec effect of oral contraceptives; May increase effect of warfarin

Tigecycline

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Tygacil

2.  IV

3.  Broad; 

Main hole in coverage:  P. aeruginosa

4.  Glycylcycline

Tigecycline

1.  Unique PK

2.  ADEs 

3.  Interactions

1.  Rapid distribution to periphery

**DO NOT use for bacteremia

2.  GI (up to 30%)

Photosensitivity

3.  May inc warfarin effects

May dec oral contraceptive effects

Erythromycin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Erythrocin

2.  IV/PO

3.  Gm+:  Sterp; Listeria

Gm -:  H flu; Moraxella

Atypicals

4.  Macrolide

Azithromycin

1.  Brand

2.  Route

3. Spectrum

4.  Category

1.  Zithromax

2.  IV/PO

3.  Gm+:  Sterp; Listeria

Gm -:  H flu; Moraxella

Atypicals

4.  Macrolide

Clarithromycin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

1.  Biaxin

2. PO

3.  Gm+:  Sterp; Listeria

Gm -:  H flu; Moraxella

Atypicals

4.  Macrolide

Macrolides

1.  ADEs

2.  Interactions

1.  GI (particularly erythromycin)

H/S

2.  Clarithromycin and erythromycin are major substrates and inhibitors of CYP3A4 and may prolong QT interval

All may increase effects of warfarin

Fidaxomicin

1.  Brand

2.  Route

3.  Sepctrum

4.  Category

1.  Dificid

2.  PO

3.  C. difficilie (cidal)

4.  Classified as a macrolide

Fidaxomicin

1.  MOA

2.  Unique PK

3.  ADEs

1.  Inhibits RNA synthesis via RNA polymerase inhibition 

2.  Minimal systemic absorption

3.  GI effects

Anemia/Neutropenia

Clindamycin

1.  Brand

2.  Route

3.  Spectrum

4.  Category

5.  ADEs

1.  Cleocin

2.  IV/PO

3.  Gm +:  Strep, Staph (including MRSA)

Anaerobes (not reliable against B. fragilis)

4.  Lincosamide 

5.  GI/Pseudomembranous colitis (BBW)

Quinupristin-dalfopristin 

1.  Brand

2.  Spectrum

3.  Category

4.  ADEs

5.  Interactions

1.  Synercid

2.  Gm + only

3.  Streptogrammin

4.  GI; Arthralgia/myalgia; Hyperbilirubinemia

5.  Potent CYP3A4 inhibitor

Linezolid 

1.  Brand

2.  Spectrum

3.  Category

4.  ADEs

5.  Interactions

1.  Zyvox

2.  Gm + only including MRSA and VRE

3.  Oxazolidinone

4.  GI; Myelosuppression (esp if >2 wk duration); Neuropathies (peripheral and optic)

5.  5-HT syndrome wiht SSRI use; Reversible non-selective MAOIs alays cause 5-HT syndrome

NItrofurantoin

1.  Brand

2.  Spectrum

3.  MOA

4.  ADE

1.  Macrobid, Macrodantin

2.  Gm +

Gm -:  some enterobacteriaceae (E. coli and Citrobacter)

3.  Reduced by flavoproteins to active intermediates that damage robisomal proteins, DNA, and RNA (only active in urine so not effective if CrCl<60 mL/min)

4.  GI; Pulmonary reactions

Define

1.  Antimicrobial resistance

2.  MDR Pathogens

1.  The abiliyt of microbes to grow in the presence of a chemical (drug) that would normally kill or limit its growth

2.  Resistant to 3+ drugs commonly used to treat the bug

1.  Enzymes destroy ABX

2.  Mutation at binding site

3.  Downregulation of membrane proteins allowing access to inside

4.  Efflux pump that removes ABX from cell

Define resistance mechanisms for 

1.  B-lactams

2.  AGs

3.  FQNs

4.  Macrolides

5.  Tetracyclines

6.  Vanc

1.  Target alteration, dec perm, enzyme degradation

2.  Reduced perm, enzyme degredation

3.  Efflux; target alteration; reduced perm

4.  Efflux; target alteration

5.  Efflux

6.  Alteration of target

Enterococcus faecium

Staphylococcus aureus

Klebsiella pneumonia

Acinetobacter baumannii

Pseudomonas aeruginosa

Enterobacter sp

1.  Vanc

2.  Dapto

3.  Linezolid

4.  Telavancin

5.  Ceftaroline

6.  Clinda

7.  Tetracyclines (including tigecyl)

8.  Synercid

9.  Bactrim

1.  Ampicillin

2.  Linezolid

3.  Dapto

4.  Nitrofurantoin

5.  Tetracyclines

Extended Spectrum B-lactamase Gm -

1.  Resistant to what

2.  Most common with

3.  TOC

1.  1st, 2nd, 3rd gen cephalosporins (not cefoxitin or cefotetan) and monobactams

2.  K. pneumoniae and E. coli

3.  Carbapenems

AmpC B-lactamases Gm -

1.  Resistant to

2.  Typically occurs in

1.  All B-lactams except carbapenems

2.  Enterobacter, Citrobacter, M. morganii, Serratia, P. aeruginosa

Klebsiella pneumoniae carbapenemase (KPC) Gm-

1.  Resistant to

2.  Occurs in

3.  TOC

1.  All B-lactams INCLUDING carbapenems

2.  K. pneumoniae, E. coli, Citrobacter, Enterobacter, Serratia, P. aeruginosa

3.  AG + Polymixin