• Staphylococcus
  • aureus
  • epidermis
• Streptococcus
  • pyogenes (groupA)
  • group B
  • group D (enterococcus)
  • pneumoniae
  • viridans

• Bacillus antracis
• Corynebacterium
  • diphtheriae
  • jeikeium
• Listeria monocytogenes

• Moraxella catarrhalis
• Neisseria meningitidis

Gram Negative Aerobes

• Enteric bacilli
• Enterobacteraciae
• Lactose Positive
• Fermenters

• E. coli - lactose positive
  
• Klebsiella pneumoniae
• Proteus/ Morganella - lactose (-) oxidase (-)
• Enterobacter - oxidase (-)
  
• Salmonella
• Serratia

• Acinetobacter
• H. influenzae
• Psuedomonas aeruginosa - lactose (-) oxidase (+)
  
• Stenotrophomonas maltophilia- lactose (-) odxidase (-)

• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Legionella

• Clostridum
  • perfiringes
  • dificille
• Peptococcus
• Peptostreptococcus

Beta-Lactam Antibiotics - Penicillin

MOA?

Spectrum?

MOA: bactericidal inhibitors of cell wall synthesis.  Bind to penicillin binding proteins, inhibiting cell wall formation.

Spectrum: active against susceptible bacteria in cardiovascular, musculoskeletal, CNS, renal, skin, and respiratory

5 groups

Group 1 Penicillin - Beta-lactamase susceptible

Penicillin K

• Renall excretion
• Spectrum:
  • streptococci
  • neisseria
  • listeria
  • gram-positive anaerobes

Group 2 Penicillin- Penicillinase resistant

Methicillin

Nafcillin (IV)

Oxacillin (IV)

Dicloxacillin (po)

Cloxacillin (po)

• Hepatic metabolism except for methicillin
• Spectrum:
  • Staphylococcus (not MRSA or MRSE)
  • Streptococcus

Group 3 Penicillin - Aminopenicillins

Amoxicillin (po)

Ampicillin (IV)

• Penicillinase susceptible
• Renally excreted
• Spectrum:
  • Group 1 (strep, neisseria, listeria, gram-positive anerobe)
  • H. influenza
  • enteric bacteria

Group 4 Pencicillin- Extended Spectrum Penicillin

Piperacillin

Ticarcillin

• Penicillinase susceptible
• Renal Excretion
• Spectrum
  • Group 3 (strep, gram-positive anaerobe, H influenza, enterics)
  • Pseudomonas aeruginosa
• Ticarcillin does NOT cover enterococcus and pseudomonas
  

Group 5 Pennicillins

- Beta-Lactam + Beta-Lactamase Inhibitor

Beta-lactamase Inhibitors- Clavulanic acid, Tazobactam, Sulbactam

Group 5a

• Amoxicillin/clavulanic acid (Augmentin)
• Ampicillin/Sulbactam (Unasyn)

Group 5b

• Piperacillin/tazobactam (Zosyn)
• Ticarcillin/clavulanic acid (Timentin)

• Inhibits activity of penicillinase(beta lactamase)
• Renally  excreted

Group 5a spectrum:

• Group 3 plus Staph, H. influenzae, enterics, bacteroides

Group 5b spectrum:

• Group 5a plus Pseudomonas aeruginosa

• Bactericidal inhibitors of cell wall synthesis
• Binds to penicillin binding proteins
• Spectrum
  • Cardio, musculoskelatal, CNS, renal, skin, respitroy
  • 4 genrations
    1. Staph, Strep, [H.flu, enterics (community acquired gram neg)][no enterococcus coverage]
    2. Staph, Strep, H.flu, enterics, B.frag
    3. a.2nd gen no bacteroides.   b.diminished gram positive, covers gram negative including pseudomonas
    4. combo of 3a and b.

1st Generation Cephalosporins

Cefazolin (Ancef)-IV

Cephalexin (Keflex)-po

• Renal elimination
• Spectrum
  • Staph, strep, community H.flu and enterics, peptidococous
  • No MRSA or MRSE

2nd Generation Cephalosporins

Cefotetan (IV)

Cefoxitin (IV)

Cefuroxime (Ceftin)(po)

• Renal clearance
• Group 1, plus better Gram negative coverage
• Still active against gram positive
• Cefotetan and Cefoxitin cover B. fragilis

3rd Generation Cephalosporin

3a. Ceftriaxone (Rocephin) IV

      Cefpodoxime (Vantin) po

3b. Ceftazidime (Fortaz) IV

3a Cephalosporins

• Ceftriaxone dual elimination: renal and biliary
• Cefpodoxime:renal
• Spectrum:
  • 2nd generation, no Bacteroides coverage

3b Cephalosporins

• Renal elimination
• Spectrum
  • Diminished gram positive activity
  • covers gram-negative pathogens including pseudomonas

4th Generation Cephalosporins

Cefipime (maxipime) (IV)

• Renal clearance
• Spectrum:
  • Ceftazidime + Ceftriaxone
  • (Staph, Strep, H.flu, Enterics, Pseudomonas, pepto, Bacteroides)

Carbapenems

Imipenem/cilastatin (Primaxin)

Meropenem (Merrem)

Doripenem (Dorabax)

Ertapenem (Invanz)

• Renal Clearance
• Bactericidal inhibitors of cell wall synthesis by binding to PBPs
• Spectrum
  • Gram-positive: Staph, strep, enterococcus   (NO MRSA, MRSE, and VRE)
  • Gram negative: Pseudomonas
• Ertapenem does NOT cover pseudomonas
• Cilastin prevents breakdown of imipenem matolization by kidney enzymes, but increases CNS SEs (must be reanlly adjusted sooner than others)
  

Monobactams

Aztreonam (Azactam)

• MOA: Bactericidal, binds to PBP
• Renal Clearance
• Spectrum:
  • Aerobic gram-negative including pseudomonas (H.flu, enterics, pseudomonas)

Fluoroquinolones

1. 1st generation - not used
2. 2nd generation- Ciprofloxacin (Cipro) IV,po; Ofloxacin (floxin)po
3. 3rd generation- levofloxacin (IV,po),; Moxifloxacin (avelox)IV,po; Gemifloxacin(factive)po

• MOA: Inhibition of DNA gyrase promoting breakage of DNA strands
• Renal clearance

Quinolone - 2nd Generation

Ciprofloxacin (Cipro) IV and po

Ofloxacin (Ofloxacin) po only

• Spectrum
  • Aerobic gram-negative including pseudomonas (H. flu, enterics, pseudomonas)
  • Weak gram-positive activity

Aminoglycosides

Gentamycin

Tobramycin

Amikacin

Nemycin

• MOA: binds to 30s and 50s rimosomal subunits, interfering with bacterial cell membrane protein synthesis
• Renal clearance
• Spectrum:
  • Gram-negative including Pseudomonas
• Ofen used in combinatin
• Gentamycin and Streptomycin are AGS with Enterococcus activity
• Neomycin and Kanamycin used in oral and topical formulations for superficial infxns of skin or eye

Macrolides / Azalides

Azithromycin

Clarithromycin

Erythromycin

• MOA: binds to 50s ribosomal subunit and inhibits RNA-dependent prtoein synthesis by blockage of transpeptidase
• Spectrum:
  • Respitory tract infxns, STD, oppurtunistic prophylaxis
  • Staph (NOT MRSA/MRSE), Strep, H. flu, and atypicals

Folate Synthesis Inhibitors

Sulfamethoxazole (SMX)

Trimethoprim (TMP)

• Renal clearance
• Spectrum:
  • Gram-positive aerobic bacteria (Staph, Strep)
  • MRSA
  • aerobic upper respiratory
  • enteric gram-negatives
  • Does not cover Enterococcus

Tetracyclines

Tetracycline

Doxycycline

Minocycline

• Spectrum
  • Broad spectrum; bacteriostatic
  • Gram-positive aerobics (Staph, Strep)
  • MRSA
  • Aerobic upper respiratory gram-negative (H.flu, Moraxella cat.)
  • Enteric Gram-negative

Glycopeptides

Vancomycin

• Renal Clearance
• Spectrum
  • Gram-positive aerobes (Staph, Strep)
  • MRSA/MRSE
  • Gram-positive anaerobes (C.diff only oral use)

Oxazolidinones

Linezolid (Zyvox)

• Hepatic clearance
• Bacteriostatic
• Spectrum:
  • Staph
  • Enterococcus
  • MRSA, MRSE, VRE

Lincosimide

Clindamycin

• Hepatic clearance
• Spectrum:
  • Staph
  • Strep (not Group D)
  • Bacteroides
  • Gram-positive mouth anaerobes (pepto)