| Antimicrobial Agent |
 |
|
| Drug Class |
|
|
| Coverage |
|
|
| Place in Therapy |
|
|
| Adverse Effects |
|
|
| MOA |
|
|
| Penicillin G |
beta-lactam |
G+ (strep and staph)
VERY limited G- |
Tx of syphilis
(endocarditis, neurosyphilis, susceptible OB-Gyn infections) |
Rash, anaphylactic shock |
Binds PBP (transpeptidase) |
| Penicillin V |
beta-lactam |
Good G+, limited G- |
Strep throat, dental infections |
rash, anaphylaxis |
binds PBP (transpeptidase); PO only; don't give with food; renal/fecal excretion |
| Nafcillin/Oxacillin |
beta-lactam |
Penicillinase resistant; antistaphylococcal |
Staph infections (not for MRSA), (endocarditis, bacteremia, cellulitis, osteomyelitis) |
rash, anaphylaxis, neutropenia |
alteration of b-lactam ring protects against b-lactamase; IV (PO possible), metabolized in liver; adjust for liver fxn |
| Dicloxacillin/Cloxacillin |
beta-lactam |
G+ (non-MRSA) |
Staph infections (not for MRSA), (endocarditis, bacteremia, cellulitis, osteomyelitis) |
rash, anaphylaxis, neutropenia |
Altered b-lactam ring, binds PBP; PO only; renal excretion; no adjustments |
| Amoxicillin |
aminopenicillin b-lactam |
G+ |
(blank) |
(blank) |
(blank) |
| Ampicillin |
(blank) |
(blank) |
(blank) |
(blank) |
(blank) |
| Unasyn (ampicillin + sulbactam) |
b-lactams penicillin |
G+s (staph/strep), Lesser G-s, most anaerobes, B. fragilis, peptostreptococcus |
bacteremia, cellulitis, osteomyelitis, HEENT infx, pneumonia |
(blank) |
IV only |
| Augmentin (amoxicillin + clauvulanic acid) |
b-lactams penicillin |
(blank) |
PO drug of choice when switching from IV unasyn |
(blank) |
PO only |
| Zosyn (Piperacillin + Tazobactam) |
b-lactam extended spectrum penicillin |
PSEUDOMONAS!!, G+ (non-MRSA), G-s, anaerobes |
Nosocomial pneumonia, cellulitis/osteomyelitis, diabetic foot, intra-abdominal, bacteremia, complicated UTI, febrile neutropenia |
(blank) |
IV only, renal excretion, dose modification needed |
| Timentin (Ticarcillin + Clauvulanic Acid) |
b-lactam extended spectrum penicillin |
PSEUDOMONAS!!, G+ (non-MRSA), G-s, anaerobes |
Nosocomial pneumonia, cellulitis/osteomyelitis, diabetic foot, intra-abdominal, bacteremia, complicated UTI, febrile neutropenia |
(blank) |
IV only, renal excretion, dose modification needed |
| Imipenem-Cilastatin (Primaxin) |
b-lactam; carbapenem |
PSEUDOMONAS, Greater G-s |
nosocomial pneumonia, bacteremia, febrile neutropenia, intra-abdominal infx, complicated UTI |
seizures, don't use in ped. CNS infx, infusion-related hypersensitivity |
IV (gastric acid destroys it); cleared renally, dose adjust |
| Meropenem (Merrem) |
b-lactam; carbapenem |
PSEUDOMONAS, Greater G-s |
nosocomial pneumonia, bacteremia, febrile neutropenia, intra-abdominal infx, complicated UTI |
seizures, don't use in ped. CNS infx, infusion-related hypersensitivity, hepatotoxicity |
IV (gastric acid destroys it); cleared renally, dose adjust |
| Ertapenam (Invanz) |
b-lactam; carbapenem |
G+ (strep, staph, non-MRSA), G-s (not pseudomonas) |
intra-abdominal infx, cSSSI, complicated UTI |
seizures, don't use in ped. CNS infx, infusion-related hypersensitivity |
IV (gastric acid destroys it); cleared renally, dose adjust; Once daily IM available (allows for outpt tx) |
| Aztreonam |
b-lactam; monobactam |
PSEUDOMONAS!!, G-s (except Acinetobacter); stable against b-lactamase |
Good for b-lactam allergic pts |
hypersensitivity, hepatotoxicity |
IV or IM, cleared renally, needs adjustment |
| Cefazolin (Ancef/Kefzol) |
b-lactam; 1st gen. cephalosporin |
G+s (staph, strep, non-MRSA); SS-PEK (staph, strep, proteus, e. coli, klebsiella) |
cellulitis, puncture wounds, bacteremia, surgical prophylaxis, G- UTIs |
allergies similar to penicillin, thrombocytopenia, neutropenia, hemolysis, hepatotoxicity |
IV, short 1/2-life, renal clearance, dose adjust |
| Cephalexin (Keflex) |
b-lactam; 1st gen. cephalosporin |
G+s (staph, strep, non-MRSA); SS-PEK (staph, strep, proteus, e. coli, klebsiella) |
PO drug of choice when switching from IV Cefazolin; cellulitis, puncture wounds, bacteremia, surgical prophylaxis, G- UTIs |
allergies similar to penicillin, thrombocytopenia, neutropenia, hemolysis, hepatotoxicity |
PO, short 1/2-life, renal clearance, dose adjust |
| Cefoxitin (Mefoxin), Cefotetan (Cefotan) |
b-lactam; 2nd generation cephalosporin |
Weaker G+, but Expanded G-; HNM-PEK (H. influenzae, e. coli, n. gonorrhea, proteus, klebsiella, m. catarhalis); anaerobic (B.fragilis) |
intra-abdominal, pelvic inflam. disease, surgical prophylaxis |
(blank) |
IV |
| Cefuroxime (Ceftin, Zinacef) |
b-lactam; 2nd generation cephalosporin |
Weaker G+, but Expanded G-; HNM-PEK (H. influenzae, e. coli, n. gonorrhea, proteus, klebsiella, m. catarhalis); anaerobic (B.fragilis) |
Pulmonary/HEENT infx, (otitis media, pneumonia, pharyngitis, tonsilitis, bronchitis) |
(blank) |
PO and IV, stable against b-lactamase |
| Cefotaxime (Claforan), Ceftriaxone (Rocephin), Ceftazidime (Fortaz) |
b-lactam, 3rd gen. cephalosporin |
Ceftazidime has PSEUDOMONAS coverage; HENS PECK MA (h. influenza, e. coli, n. meningitides, salmonella, serratia, proteus, enterobacter, citrobacter, klebsiella, m. catarrhalis, acinetobacter) |
meningitis, pneumonia, bacteremia, intra-abdominal infx |
ceftriaxone - sludging of bladder |
IV, biliary excretion |
| Cefixime (Suprax), Cefpodoxime (Vantin) |
b-lactam, 3rd gen. cephalosporin |
HENS PECK MA (h. influenza, e. coli, n. meningitides, salmonella, serratia, proteus, enterobacter, citrobacter, klebsiella, m. catarrhalis, acinetobacter) |
PO drug of choice when switching from IV cephalosporin |
(blank) |
PO, renally cleared, dose adjust |
| Cefepime (Maxipime) |
b-lactam, 4th gen. cephalosporin |
PSEUDOMONAS and expanded G- goverage |
**Reserve for resistant infections |
(blank) |
IV only, renally adjust |
| Vancomycin |
glycopeptide |
MRSA/MRSE!!, G+s ONLY, enterococcus, listeria |
nosocomial pneumonia, bacteremia, cellulitis/osteomyelitis, meningitis, endocarditis; b-lactam allergic pts |
OTOTOXICITY, neprhotoxicity, Red Man's syndrome (1g/hr max) |
blocks glycosidic bond (PBP; transglycosidase) and peptide bond (transpeptidase); causes weak cell wall and bacterial lysis; IV (po given only for colitis), DOSE DEPENDENT on total body weight, dose adjust, Narrow therapeutic index (monitor troughs) |
| Daptomycin |
b-lactam; cyclic lipopetide |
MRSA G+ (strep, staph aureus), enterococcus faecalis and faecium, including VRE |
Complicated skin and skin structure infx (cSSSI), surgical sites, traumatic wounds, ulcers, abscesses, cellulitis...NEVER for PNEUMONIA |
Muscle pain and weakness, CPK elevations (monitor weekly) |
IV only, renal excretion, dose adjust; binds and depolarizes cell causing efflux of K+ and cell death; low risk of cross-resistance with other b-lactams b/c of unique mechanism |
| Azithromycin |
Macrolides |
S. pneumonia, "atypical G-s" Chlamidia 1xdose |
(respiratory infx, pneumonia, bronchitis, pharyngitis, sinusitis, otitis media, MAC) |
(blank) |
(blank) |
| Clarithromycin |
Macrolides |
S. pneumonia, "atypical G-s", H. pylori |
S. pneumonia, "atypical G-s" (respiratory infx, pneumonia, bronchitis, pharyngitis, sinusitis, otitis media, MAC) |
(blank) |
(blank) |
| Telithromycin |
Ketolides |
S. pneumonia, "atypical G-s" |
(blank) |
drug interactions d/t -3A4 interactions |
overcame macrolide resistance |
| Clindamycin |
Clindamycin |
G+s, anaerobics |
common choice for penicillin allergic pts (bacteremia, cellulitis/osteomyelitis, aspiration pneumonia (anaerobes), dental infx, endocarditis prophylaxis, diabetic foot - mixed infx) |
(blank) |
(blank) |
| Linezolid |
Oxazolidinones |
MRSA, VRE |
1st line agent for MRSA; pneumonia, bacteremia, cellulitis/osteomyelitis, diabetic foot |
(blank) |
PO, high bioavailability, |
| Synercid (Quinupristin + dalfopristin; 2 drugs in 1) |
Streptogramins |
G+ VRE enterococcus faecium (not E. faecalis) |
endocarditis, peritonitis, pneumonia, bacteremia, cellulitis/osteomyelitis, UTIs |
(blank) |
(blank) |
| Tetracycline |
Tetracyclines |
H. pylori |
acne |
(blank) |
Don't give w/milk products (binds Ca) |
| Doxycycline |
Tetracyclines |
"atypicals," rickettsial infx |
better choice w/poor kidney fxn; Lyme disease, Q Fever, Rocky mountain spotted fever, ehrlichiosis; 2nd line agent for CAP and COPD exacerbations, acne |
(blank) |
(blank) |
| Minocycline |
Tetracyclines |
Staph |
Rheumatoid arthritis |
limited use d/t side effects |
(blank) |
| Tigecycline |
Glycycyclines |
(blank) |
cSSSI, intra-abdominal infx |
(blank) |
recently approved |
| Chloramphenicol |
Chloramphenicol |
(blank) |
CNS infx, rickettsial infx in children as last resort |
aplastic anemia, Gray Baby syndrome |
(blank) |
| Gentamicin |
Aminoglycosides |
G-s (best for serratia mercasens); pseudomonas |
Extended interval of 1qd high peak with low trough |
(similar to Vancomycin) OTOTOXICITY and Nephrotoxicity (related to dose/duration of therapy; low peaks and high troughs increase risk) |
synergistic with b-lactams against enterococcus |
| Tobramycin |
Aminoglycosides |
G-s (best for PSEUDOMONAS and acinetobacter) |
(blank) |
(similar to Vancomycin) OTOTOXICITY and Nephrotoxicity (related to dose/duration of therapy; low peaks and high troughs increase risk) |
synergistic with b-lactams against enterococcus |
| Amikacin |
Aminoglycosides |
G-s (Useful in Gentra/Tobra-resistant strains) |
(blank) |
(similar to Vancomycin) OTOTOXICITY and Nephrotoxicity (related to dose/duration of therapy; low peaks and high troughs increase risk) |
synergistic with b-lactams against enterococcus |
| Gemifloxacin, Moxifloxacin, Gatifloxacin, Levofloxacin |
3rd gen. Fluoroquinolones |
G+ (staph non-MRSA, strep/s. pneumoniae, E. faecalis), G-s (Levofloxacin for PSEUDOMONAS); some anaerobes (not C. dificile), "atypicals" |
Pneumonia; respiratory "above the waist" infx; ok for UTIs, STDs |
must separate from food w/complex metallic ions; hypo/hyperglycemia, CNS, QT prolongation, tendon rupture; Gemifloxacin - rash |
IV, PO (gemifloxacin only PO); inhibit topoisomerase (DNA gyrase) preventing supercoiling of DNA; resistance by target site modification and efflux pump; Mefloxacin hepatically metabolized; the rest need renal adjustment |
| Ciprofloxacin |
2nd gen. Fluoroquinolones |
1st choice FQ for PSEUDOMONAS; G-s, "atypicals" |
Anthrax; "below the waist" UTIs, STDs (gonnorrhea); poor S. pneumonia coverage |
metabolized by CYP-1A2; must separate from food w/complex metallic ions; hypo/hyperglycemia, CNS, QT prolongation, tendon rupture |
inhibit topoisomerase (DNA gyrase) preventing supercoiling of DNA; resistance by target site modification and efflux pump |
| (blank) |
Metronidazole |
(blank) |
(blank) |
(blank) |
(blank) |
| (blank) |
Rifampin |
(blank) |
(blank) |
(blank) |
(blank) |
| Sulfonamides (sulfasalazine, dapsone, silver sulfadiazine) |
Antifolates/bacterial nucleic acid synthesis inhibitors |
(blank) |
(blank)ulderative colitis (Crohn's disease), leprosy and brown recluse spider bite, burns respectively |
(blank) |
blocks THF, a cofactor needed by bacteria to produce nucleotide bases |
| Sulfonamide and Trimethoprim (Diaminopyrimidines) |
Antifolates/bacteiral nucleic acid synthesis inhibitors |
Drug of choice for: stenotropomonas multiphilia nocardia sp.; some lesser G-s (e. coli, klebsiella
(resistance: altered target site AND overproduction of PABA)
First line for: acute cystitis (bladder UTI), traveler's diarrhea, Pneumocystis jiroveci |
rarely used as a single agent b/c of synergistic effects (except TMP in UTIs) |
highly bound ptn displaces unconjugated bilirubin from albumin causes kernicterus
allergies, rash can be fatal if SJS, GI symptoms, myelosuppression, hyperkalemia |
step 1: PABA converted by folic acid sythetase to dihydroflic acid (sulfonamides mimic PABA and compete for enzyme)
step 2: dihydrofolate acid converted to tetrahydrofolic acid by DHA reductase
step 3: tetrahydrofolate helps produce nucleotide |
| Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA), Ethambutol (EMB) |
First line drugs for Active TB |
mycobacterium |
Initial phase (2mo with 4 drugs) then "continuation phase" (4-7mo with 2 drugs) |
(blank) |
(blank) |
| Isoniazid or Rifampin |
Latent TB |
preventative/chemoprophylaxic therapy of walled off/dormant TB |
Isoniazid (9mo, 6mo) or Rifampin (4mo) |
(blank) |
(blank) |
| Isoniazid (INH) |
(blank) |
(blank) |
First line monotherapy for LTBI and 1 of 4 drugs used for first line active TB tx; safe in pregnancy |
liver (asymptomatic elevation of aminotransferases --> clinical hepatitis --> fatal hepatitis) |
PO, (IV); competitive antagonism; inhibits mycolic acid synthesis for cell wall; no renal adj.. avoid liver pts |
| Rifampin |
(blank) |
G+s |
safe in pregnancy |
CYP450 induction...MOST DRUG INTERACTION OF ALL TB agents; hepatotoxicity, discoloration of body fluids! |
inhibits DNA-dependent RNA polymerases |
| Pyrazinimide |
(blank) |
(blank) |
(blank) |
hepatotoxicity, ARTHRALGIAS, Gouty arthritis; contraindicated in gout |
PO only; dependent on presence of pyrazinamidase; renal excretion mostly, adj dose |
| Ethambutol |
(blank) |
(blank) |
best with rapidly dividing M. tuberculosis |
retrobulbar neuritis (visual disturbance with colors: red/green); NO HEPATOTOXICITY |
PO only; renal excretion, adj dose |
| Fluoroquinolones/Aminoglycosides |
ptn synthesis inhibitors |
(blank) |
1. moxifloxacin, levofloxacin gatifloxacin --> resistant to all or none; 2. amikacin/kanamyxin (cross resistance 100%, less vestibular dysf than streptomycin); 3. streptomycin (works w/ strains resistant to amikacin/kanamycin with less nephrotoxicity) |
Pregnancy restrictions |
(blank) |
| Cycloserine |
second line drugs for Active TB |
resistant strains |
try to avoid in pregnancy if possible |
CNS (headache restlessness --> psychosis, seizures) |
celll wall; inhibits alanine racemase preventing peptide bond |
| Ethionamide |
second line drugs for Active TB |
resistant strains |
(blank) |
GI, hepatotoxicity, NEUROTOXICITY (peripheral and optic)!! |
(blank) |
| P-aminosalicylic acid (PAS) |
(blank) |
(blank) |
avoid in pregnancy if possible |
Hypothyroidism, GI, hepatotoxicity |
similar to sulfonamides; competes with PABA; no renal adj |
| Chloroquine |
antiparasitic |
malaria (P. falciparum tx); active against sensitive malarial infections in blood stage |
Prophylaxis/Tx of Malaria |
Screen for G6PD; pruritis, GI |
somehow prevents conversion from heme to hemozoin (buildup kills parasite); PO rapidly absorbed with large vol distribution; 1/2-life 1-2 months; urine excretion; DOES NOT work on hepatic stage |
| Primaquine |
antiparasitic |
Malaria (P. vivax and P. ovale) in hepatic stage |
Mararia prophylaxis/Tx |
Check G6PD - hemolysis; GI; leukopenia |
PO rapidly absorbed large vol distribution; urine excretion; DOES NOT work on blood stage |
| Mefloquine |
antiparasitic |
Mararia (P. falciparum and P. vivax); choroquine resistant strains; blood stage |
Prophylaxis for chloroquine resistant malaria |
Neuropsychiatric toxicity; myelosuppression; GI |
PO good absorption large vol of distribution; terminal 1/2-life is 20days allowing weekly dosing |
| Quinine/Quinidine |
antiparasitic |
Malaria (P. faliparum) blood stage |
Tx only choice for severe P. falciparin (after chloroquine)...no prophylaxis because of adverse effects |
Check G6PD; Cinchonism: visual changes headache, dizziness, tinnitus, flushing; hypersensitivity; myelosuppression; Quinidine - arrhythmias/hypotension |
Quinine: PO only; Quinidine: IV only; not active against hepatic stage |
| Doxycycline/Clindamycin |
antibiotics |
malaria |
Doxycyclin: prophylactic drug of choice in SE Asia for blood stage; usually combined with quinine/quinidine; Clindamycin is safe for children/pregnant/breastfeeding mothers |
(blank) |
not active against hepatic stage |
| Atovaquone-Proguanil (Malarone) |
antifolate agent |
Malaria (P. falciparum only) |
Prophylaxis only |
(blank) |
inhibits bacterial DNA synthesis; expensive; shorter pre/post exposure Tx |
| Sulfadoxine |
antifolate |
malaria (P. falciparum only) |
Standard cost-effective single dose Tx in Africa |
(blank) |
(blank) |
| Iodoquinolol |
(blank) |
trophozoites in bowel lumen |
Amebiasis therapy - luminal agent |
contraindicated for pts with iodine allergy; diarrhea |
PO only; 10% absorbed so it is not active in intestinal wall or extraintestinal tissue; excreted in feces |
| Paromomycin |
aminoglycoside antibiotic |
trophozoites in bowel lumen |
amebiasis therapy - luminal agent |
Caution with renal insufficiency (avoid if serious); diarrhea, GI |
PO only; little absorption; 7-day therapy; better tolerated than iodoquinol |
| Metronidazole (Flagyl) |
nitroimidazole |
C. dificile-associated diarrhea; anaerobics; amebiasis; giardiasis; trichomoniasis; bacterial vaginosis |
amebiasis therapy - tissue agent; anaerobes; parasites; active against intestinal wall and extraintestinal infections |
alcohol intolerance; peripheral neuoropathy; metallic taste; GI |
PO 100% bioavailable; high penetration to most sites; hepatic metabolism/renal elimination |
| Tindazole (Tindamax) |
(blank) |
Giardiasis; trichomoniasis |
amebiasis therapy - tissue agent |
(blank) |
(blank) |
| Stibogluconate sodium (pentavalent antimony) |
(blank) |
Leishmaniasis |
First-line for all leishmaniasis infx (except in certain parts of India) |
GI; myalgias/arthralgias; QT prolongation |
IV, (IM) |
| Pentamidine |
(blank) |
Leishmaniasis; African sleeping sickness |
Leishmaniasis; African sleepin sickness; last-line for PCP pneumonia |
Very Toxic; pancreatitis; renal damage; bronchospasm (inhaled) |
IV or inhaled; alternative to Stibogluconate Sodium |
| Albendazole, Mebendazole, Thiabendazole |
Helminth agents |
worms (primarily nematodes) |
nematodes |
short term: GI; long term: increased LFTs, pancytopenia; Thiabendazole rarely used d/t toxicity |
PO only; fatty meals increase absorption; inhibits microtubule synthesis in parasites |
| Praziquantel |
Helminth agent |
Flukes, tapeworms |
primarily tremadotes and cestodes |
headache, dizziness, fatigue |
PO only (swallow tablets whole); excreted renally; increases parasitic cell membrane permeability to Ca |
| bacitracin and gramicidin |
antibacterial |
G+ (strep, pneumo, staph), anaerobic cocci; neisseriae, tetanus bacilli; diptheria bacilli |
"temporary" decrease in staph nares colonization; use in combo with other antibiotics |
allergic contact dermatitis |
inhibits bacterial wall synthesis |
| Mupirocin |
antibacterial |
MRSA G+s; aerobic |
"eradicates" nasal MRSA colonization; Tx of impetigo due to Staph. aureus, Grp a hemolytic strep, S. pyogenes |
irritation of mucous membrane; pruritis; rash; taste perversion; URI |
topical; inhibits ptn synthesis (binds t-RNA); not absorbed into systemic circulation |
| Polymyxin B Sulfate |
antibacterial |
G-s; Pseudomonas, e. coli, enterobacter klebsiella |
prevent infxn in minor cuts/burns; Tx of ocular infx |
Neuorotoxic, Nephrotoxic |
ointment or solution; alters permeability |
| Neomycin and Gentamicin |
antibacterial |
G-s: e.coli, proteus klebsiella, enterobacter (gentamicin is better for Pseudomonas, staph, and GAS) |
Tx of minor skin or eye infx |
Neurotoxic, Nephrotoxic; Ototoxic |
ptn synth (binds 30s); ointment, cream, solution |
| Clindamycin |
antibacterial |
P. acnes |
Tx of acne |
dry skin irritation; BLOODY diarrhea and pseudomembranous colitis |
binds 50s; gel or lotion |
| Erythromycin |
antibacterial |
P.acnes |
Tx of acne vulgaris |
allergies; skin irritation; antibiotic resistance |
gel or topical |
| Metronidazole |
antibacterial |
P. acnes |
Tx of skin infxn and acne rosacea |
dry/burning/stinging skin |
inhibitory effects on neutrophil cellular fxn; gel or cream |
| Sodium sulfacetamide |
antibacterial |
P. acnes |
seborrheic scaling dermatosis; bacterial infx of skin; acne vulgaris/acne rosacea |
local irritation; Risk of SJS, exfoliative dermatitis, toxic epidermal necrolysis; contraindicated in pts w/ hypersensitivity to sulfonamides |
inhibits p.acnes by competitive inhibition of PABA |
| Clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, sulconazole |
imidazoles; antifungal agents |
dermatophytes, candidiasis |
tinea pedis, cruris, corporis, versicolor; Cutaneous candidiasis |
skin irritation |
alters membrane permeability |
| Cilopirox olamine |
antimycotic/antifungal agent |
dermatophytes, candidiasis |
dermatomycosis candidiasis, tinea versicolor; mild to moderate onychomycosis of nails |
skin irritation/worsening; |
inhibits uptake of molecules for cell membrane synth; cream, lotion, nail polish |
| Naftifine and Terbinafine |
allylamine class antifungals |
dermatophytes, candidiasis |
(blank) |
(blank) |
(blank) |
