• cefoperazone (3rd gen)
• ceftriaxone (3rd gen)
• cefotaxime (3rd gen)

natural penicillin

natural penicillin

oral, poor bioavailability

mild infections of throat, respiratory tract, soft tisse

penicillinase-resistant penicillin

no longer used because of nephrotoxicity

penicillinase-resistant penicillin

IV

drug of choice for MSSA staphylcoccal infections

penicillinase-resistant penicillin

oral

mild infections of skin and soft tissue (i.e. cellulitis)

• aminopenicillins
• carboxypenicillins
• ureidopenicillins

aminopenicillin

IV/PO

drug of choice for enterococci

serious infections caused by anaerobes, Listeria, Gram-negative rods (community)

rash in infectious mononucleosis patients

aminopenicillin

PO, better absorption

sinusitis, otitis, lower respiratory tract infection

prophylaxis for endocarditis prior to dental procedures

carboxypenicillins

IV

works on Pseudomonas and Enterbacter, not Klebsiella or enterococci

prolonged bleeding time due to platelet dysfunction and hypokalemia

Ureidopenicillin

IV

Klebsiella, *Pseudomonas* (+aminoglycosides)

pneumonia, bacteremia, UTIs, osteomyelitis, soft tissue infections

neutropenia

beta-lactamase inhibitor + carboxypenicillin

IV

Klebsiella, Stenotrophomonas maltophilia, not improved Pseudomonas

cephalosporins are

• more stable against beta-lactamases
• broader spectrum
• not active against enterococci, Listeria, and atypicals (i.e. Mycoplasma, Chlamydia)

first generation cephalosporin

IV

Pneumococci, streptococci, MSSA, E. coli, Klebsiella, Proteus, peptostreptococci

Pseudomonas, Enterobacter, Serratia, Acinetobacter, Bacteroides

drug of choice for surgical prophylaxis

first generation cephalosporin

oral

Pneumococci, streptococci, MSSA, E. coli, Klebsiella, Proteus, peptostreptococci

Pseudomonas, Enterobacter, Serratia, Acinetobacter, Bacteroides

UTIs, minor cellulitis, soft tissue abscesses

second generation cephalosporin

IV, PO

less Gram (+), extended Gram (-): Klebsiella, H. influenzae

Pseudomonas

community-acquired pneumonia

second generation cephalosporin

PO

less Gram (+), extended Gram (-): Klebsiella, H. influenzae

Pseudomonas

sinusitis, otitis, lower respiratory tract

second generation cephalosporin *cephamycin

IV

less Gram (+), extended Gram (-): Klebsiella, H. influenzae, Bacteroides fragilis

Pseudomonas

peritonitis, diverticulitis

third generation cephalosporin

IV

E. coli, Klebsiella, Proteus, H. influenza, Neisseria

staphylcocci, Enterobacter, Citrovacter, Serratia, Providencia

penicillin resistant pneumococci

ceftazidime

third generation cephalosporin

IV

E. coli, Klebsiella, Proteus, H. influenza, Neisseria, Pseudomonas

staphylcocci, Enterobacter, Citrovacter, Serratia, Providencia

sepsis, Pseudomonas infections and febrile neutropenia (+ aminoglycosides)

third generation cephalosporin

IV

E. coli, Klebsiella, Proteus, H. influenza, Neisseria

staphylcocci, Enterobacter, Citrovacter, Serratia, Providencia

penicillin resistant Gonorrhea/Pneumococci, meningitis

biliary sludge and gallstones - avoid in children

third generation cephalosporin

oral

E. coli, Klebsiella, Proteus, H. influenza, Neisseria

staphylcocci, Enterobacter, Citrovacter, Serratia, Providencia

fourth generation cephalosporin

IV

Pseudomonas, Enterbacteriaceae, Haemophilus, Neisseria, Staphylcoccus, Streptococcus

meningitis, sepsis, febrile neutropenia

* penetrates CSF well; more resistant to beta-lactamases

• dermatologic
• hematologic (bleeding disorders, thrombocytopenia, leukopenia)
• superinfection (by MRSA or enterocci)

monobactam

IV

Gram-negatives only (including Pseudomonas)

penicillin-allergic patients with nosocomial infections

skin rash, nausea, vomiting, diarrhea, elevated serum aminotransferases

IV only; penetrate CSF well

Citrobacter, Enterobacter, Serratia, Acinetobacter, extended-spectrum beta-lactamase (ESBL) producing E. coli and Klebsiella

resistant to most beta-lactamases, except metallo-beta-lactamases, Entercococcus faecium, and Pseudomonas

carbapenem + renal dihydropeptidase inhibitor

Gram-negative rods, Gram-positive cocci, and anaerobes

Enterococcus faecium, MRSA, Clostridium difficile, Burkholderia, Stenotrophomonas, Chlamydia, Mycoplasma

nausea, vomiting, diarrhea, skin rash, reactions at infusion sites, seizures

meropenem

carbapenem

more Gram-neg and less Gram-pos than imipenem

*less likely to cause seizures*- meningitis

carbapenem

Gram-pos, Gram-neg, anaerobic

Pseudomonas, MRSA, Enterococci

seizures, pseudomembranous colitis, nausea, vomiting, diarrhea, infused vein rxns

intra-abdominal infections, community acquired pneumonia, skin and soft tissue infections

*once-daily dosing*

carbapenem

Gram-negative bacilli (including Pseudomonas), Gram-pos cocci, anaerobes

seizures, nausea, vulvomycotic infection, rash

intra-abdominal infections, complicated UTIs

• lesions of the central nervous system
• prior history of seizures
• compromised renal function

glycopeptide

Gram-positive only- esp. staphylcocci

MRSA, meningitis caused by penicillin-resistant pneumococci (+ceftriaxone), surgical prophylaxis in penicillin-allergic pts, coag. neg staph infections, Corynebacterium, Bacillus, Beta-hemolytic strep, strep viridans, anaerobic cocci, Listeria

phlebitis, ototoxicity (w/ aminoglycosides), nephrotoxicity, "red neck" syndrome, rash