1. Penicillin

2. cephalosporin

3. carbapenems & monobactams

4. Vancomycin

5. Vancomycin Alternatives: Linezolid, quinupristin/dalfopristin, daptomycin, telavancin 

6. Fluroquinolones

-narrow spectrum penicillin (natural penicillins)

-Penicilinase-Resistant penicillins

 (Anti-staph penicillins)

-Extended spectrum penicillins

(Amino-penicillins, anti-pseudomonal penicillin, B-lactamase inhibitor combinations)

-

Penicillin G-IV, IM, PO

Penicillin V-PO

Gram + (Steptococcus, Enterococcus)

Gram - (Neisseria meningitidis)

Anaerobes (peptostreptococcis, clostridiium non-deficil)

Other (troponema pallidum, listeria)

1. Step pharynitis

2. strep pneumoniae infections

3. endocarditis due to strept viridans

4. endocarditis prophylaxis

5. meningitis due to neisseria meningtidis

6. Syphilis=DOC

7. Lymes disease (carditis, meningitis, arthritis, high dose)

benzathine pen

procaine pen

benzathine/procaine penicillin

Penicillin G potassium or sodium

Penicillin V potassium

Methicillin

nafcillin

oxacillin

Dicloxacillin

cloxacillin

G+ (MSSA, streptococcus, MSSE)

Anaerobes (Peptostreptococcus)

1.Skin and skin structures infections due to stap areus (MSSA, or MSSE)

2.osteomyelitis dues to MSSA or MSSE

3.Infection of prosthetic joint due to MSSA or MSSE

4.Line infections due to staph

Nafcillin and oxacillin

dicloxacillin

Amoxicillin

Ampicillin

Extended Spectrum Penicillins

Amino-penicillins

G+ = streptococcus, enterococcus

G- = H.flu, Neisseria, proteus

Anaerobes = Peptostreptococcus, clostridium (non deficil)

Other = listeria, H.pylori

1.Upper respiratory tract infections

-otitis media (amoxicillin DOC)

-Strep pharyngitis (strep pyogenes)

2. enterococcus infection

3. UTI

4. Meningtits due to listeria monocytogenes

5. H. pylori (with PPI and other abx)

6. Lymes disease

Amoxicillin

ampicillin

Amino-penicillins

Amoxicillin/clavulanate (augmentin)

Ampicillin/sulbactam (Unasyn)

G+ = Staph, Strep, Enterococcus

G- = H.flu, neisseria, m.cat, E.coli, Klbsiella, proteus

anaerobes = peptostreptococcus, clostridium, B.fragilis

Otitis media

Sinusitis

aspiration pneumonia

Bites (cat, dog, human)

Urinary tract infections

Anearobic infections (abscess)

Amoxicillin/clavulanate (augmentin)

Ampicillin Ampicillin/sulbactam

Ticarcillin

Piperacillin

Carbenicillin

Mezlocillin

G+ = Staph, Step, enterococcus

G- = h. flu, neisseria, m.cat, e.coli, klebsiella, proteus, pseudomonas

Anaerobes = peptostreptocuccus, clostridium, B. fragilis

Broadest spectrum

1. Ticacillin and piperacillin are rarely used w/out B-lactamase inhibitors

2. Empiric broad spectrum coverage +/- other antimicrobials

-Gi organisms: ruptured appy, gi surgery, diverticulitis

-nosocomial pneumonia (hospital aquired)

3. Pseudomonas infections

4. febrile neutropenia

Zosyn (piperacillin/tozobactam)

timentin (ticarcillin/clavulanate)

Generally well tolerated

Allergic rxn: rash, anaphylaxis, increased LFts, interstitial nephritis

Amox/Amp: Maculopapular rash with mono infection, CLLL, allopurinol= not true allergy

diarrhea

seizures with high doses

neutropenia, thrombocytopnia

thrombophlebitis

1. Dose changed for renal dysfunction

2. strep pneumo more resistant to pen

3. time above MIC is critical to penicillins success

-frequent doses

-continues infusion pen have to be used

-B-lactamase production

(Cephs are more stable with b-lactamse)

-PEn binding protein alteration

Separated into 3 generations

1st generation = G+ best (G-worst) no anaerobes

3rd generation = G- best (G+worst)

All cephalosporins dont work against MRSA and enterococcus

Cephalexin (keflex)

Cefazolin (ancef, kefzol)

Skin and skin structure infections

bone infections

surgical prophylaxis

uncomplicated UTI (EKP)

cefuroxime (ceftin)

cefoxitin (mefoxin)

2nd generation cephalosporins

Spectrum of activity in the middle

g+ g- anaerobes

Respiratory tract infections

otitis media

UTI, cystitis, pyelonephritis

cefoxitin & cefotetan only-GI, GU, GYN, procedures, and tx pelvic inflammatory disease w/doxycycline

PO:  Cefpodoxime (vantin)

cefdinir (omnicef)

Iv: Ceftriaxone (rocephin), cefotamime (claforan), cefizoxime (cefizox), ceftazidime (fortaz), cefipime (maxipime)

3rd generation cephalosporin

Spectrum activity G+ G-

PO agents

-respiratory tract infections

UTI

IV agents

Empiric tx of serious infections

Meningitis DOC w/ vancomycin

W/aminoglycoside for pseudomonas

febrile neutopenia

1.Generally well tolerated

2.hypersensitivity

-cross reactivity with penicillin

-do not use with hives to penicillin

3.diarrhea

4. neutropenia, throbocytopenia

5. platelet dysfunction

DOC for N. gonorrhea

Useful in otitis media

Need double coverage for pseudomonas

imipenem + cilastatin (primaxin)

meropenem (merrem)

doripenem (doribax)

ertapenem (invanz)

generally stable in the presence of most types of b-lactamase

pseudomonas has shown altered permeability to imipenem

antagonism has been seen when imipenem is use with other b-lactams due to inc B-lactamase production

- Serious nosocomial infections (hospital acquired)

-serious polymicrobial infections

-intra-abdominal infections (hospital acquireD)

-pseudomonoas infections

-febrile neutropenia

The other carbapenem

+spectrum of activity

Ertapenem

Similar to imipenem but no psuedomonas or enterococcis coverage

intra-abdominal infections

Skin and skin structures infections

UTI, pyelonephritis

Adverse effects of Carbapenems

Allergy - rash

Seizures-do not use with hx of seizures of meningitis

GI problems

Aztreonam (azactam)

Similar to other B-lactams

binds to PBPs and therefore inhibits call wall formation

considered a g-specialist

good activity against G- aerobes including pseudomonas

G- sepsis

urinary tract infection

G- osteomyelitis

G- pneumonia

intra-abdominal infections

CF (inhaled)

1.Not absorbed from GI

2.Given IV for systemic infections

3.diffuses well into pleural, pericardial, synovial and ascitic fluids

4.therapeutic levels inCSF occur only with inflamed meninges and high doses

5.half-life 6hr with normal renal function upto 7.5 days with renal impairment

6. is not removed by conventional dialysis but is removed by high-flux methods of HD

Vancomycin common uses:

 DOC: HCA-MRSA

MRSE, and enterococci (for PNC-allergy)

serious infections caused by s.aureus, enterococcus, or strep intolerant of b-lactams

infections caused by g+ organisms

clostridiium defficile colitis if metronidazole fails

endocarditid prophylaxis- GU or GI procedures in PEN intolerant pts

Neohrotixicity

ototoxicity

red man/neck syndrome

VRE 15% OF ICU STRAINS

4 serotypes:

1. VanA type- High level resitence

2. VanB type- resistent to vanco

3. VanC type-low level resistance to vanco only

4. VanD type-similar to VanB

Vanco is discouraged in:

-prophylaxis for infection or colonization of vasc catheters

-eradication of MRSA colonization or CA-MSRA

-primary tx for clostridium difficile colitis

-routine prophylaxis for very low birth weight infanst

-routine prophylaxis for peritoneal dialysis

1.Healthcare associated: Vanco =DOC or daptomysin

2. Community-associated MRSA = TMP/SMX, clindamycin, doxyclcline

moa: protein synthesis inhibitor

Spectrum: Staph, strep, enterococcus, resistant organisms

Use: should be strictly reserved to serious infections due to organisms resistant to other therapies

QUINUPRISTIN/DALFOPRISTIN

info:

MOA: protein synthesis inhibitor combo

Spectrum: staph, step, enter, resistant organisms, VRE

Use: should be reserved for serious infections

Telavancin

-info

MOA: inhibits bacterial cell wall synthesis

Spectrum: gram-positive bacteria, including MRSA

Use: strictly reserved to serious infections

1. Linezolid

2. Quinupristin/dalfopristin

3.telavancin

Inhibits topoisomerases II (supercoil DNA) and IV (separates daughter from parent)

Inhibition of topoisomerases results in rapid and lethal cessation of DNA replication

Efflux pump

gene mutation

permeability

ciprofloxacin (cipro)

ofloxacin (floxin)

norfloxacin (norflox)

Second generation Fluoroquinolones

g- best

Moxifloxacin (avelox)

Gemifloxacin (factive)

Fourth generation fluoroquinolones

g+ best

Other bacteria:

-chlamydia

-legionella

-mycoplasma

-mycobacterium TB, Avium

-H. Pylori: with combo

best psuedomonal activity of quinolones, poor s. pneumoniae

Better S. pneumoniae than cipro, but ledd than 4th generation

UTI (pyelonephritis, cystitis, prostatitis)

Osteomyelitis due to gram -

CAP

M. tuberculosis

complicated gram- and anaerobic abdominal and gyn infections

acute exacerbations of chronic bronchitis

chronic sinusitis

travelers diarrhea

limited in children under 18 and avoided in pregnancy

=bone/joint erosion in young animals

-gi problems

-cns -dizzy, headache

chelation (dec absorption)

theophylline (cipro)

warfarin

avoid with meds that prolong QT interval