Antibiotic Spectrum Flashcards
Gram positive bacteria
Staph aureus
Coag negative staphylococcus
Streptococci (S. pneumoniae, s. viridans, group A = s. pyogenes, group B streptococci)
Enterococcus (faecais & faecium), listeria monocytogenes
Gram negative
Proteus spp, E. Coli, Klebsiella spp (PEcK)
H. Influenzae
Moraxella catarrhalis, neiserria gonorrhoeae, N. meningitidis
Seratia, Pseudomonas, Acinetobacter, Citrobacter, Enterobacter (SPACE)
Providencia spp, Indole-positive Proteus spp. (SPICE)
Atypicals?
Legionella
Mycoplasma
Chlamydia
Anaerobes?
Oral: peptostreptococcus, fusobacterium, prevotella
Gut: bacteroides fragilis, clostridium species
Example of time-dependent killing abx
Beta lactams
Macrolides
Vancomycin
Example of concentration-dependent killing abx
Quinolones
Aminoglycosides
Example of post-ABX effect (PAE)
Aminoglycosides
Drugs to avoid in P/L
“Safe Fetus Means Avoid These Now”
Septra - CI near term, avoid 1st/3rd tri
Fluoroquinolones - CI all tris
Metronidazole/macrolides - avoid in 1st tri
Aminoglycosides - avoid in all tri’s
Tetracyclines - CI all tri’s
Nitrofurantoin - CI at term and during labor
Community acquired pneumonia bugs
S. Pneumoniae Respiratory viruses M. Pneumoniae C. Pneumoniae H. Influenzae
CAP drugs
Macrolides
Beta lactams (eg high dose amoxi) +- macrolide
Respiratory fluoroquinolone
Acute otitis media bugs
S. Pneumoniae
H. Influenzae
M. Catarrhalis
Acute OM drugs
Amoxicillin
Amoxi/clav
2nd gen cephalosporins
UTI bugs
E.coli
Proteus spp.
S. saprophyticus
Penicillin spectrum
Aerobic gram positive: beta henolytic streptococci, E. faecalis, and S. viridans (if sensitive)
Neisseria meningitidis (if sens), treponema palladium (if sens)
Oral anaerobes
Gut anaerobes: clostridium spp (C. Tetani, C. perfringens)
NO longer s. aureus or n. gonorrhoeae
Aminopenicillins coverage
Everything penicillin covers PLUS:
Gram negative: H. influenzae (beta-lactamase -ve), proteus mirabillis, E. coli, streptococci
Listeria monocytogenes, E. facalis
Oral anaerobes (no gut)
NO COVERAGE: Kleb, s. aureus, atypicals
Amoxi/clav coverage
Everything amoxi covers PLUS
BL producing H. Influenzae, PEcK, M. Catarrhalis,
E. Faecalis, staphylococcus (MSSA), stretococcus
SOME coverage of gut (B. fragilis)
Pip/taz coverage
Everything amoxi covers PLUS
BL producing H. Influenzae, PEcK, M. Catarrhalis,
E. Faecalis, staphylococcus (MSSA), stretococcus
Gut and oral anaerobes
PSEUDOMONAS COVERAGE
DO NOT us for definitive SPACE/SPICE therapy even tho beta-lactam-i added
1st gen cephalosporin coverage
Gram positive cocci, MSSA, streptococci (very good)
S. epidermidis
Oral anaerobes
NO activity against H. influenzae, M. catarrhalis, anerobes, SPACE, listeria, MRSA, MRSE, atypicals
2nd gen cephalosporins coverage
Cefuroxime/cefaclor: H. influenzae (incl. BL producing), M. catarrhalis, oral anaerobes, streptococci
Cefoxitin: PEcK plus gut anaerobes (B. fragilis)
NO activity against MRSA/MRSE, Enterococcus spp., listeria spp., anaerobes (except cefoxitin, atypicals)
Cefaclor/cefuroxime: URTI
Cefoxitin: uncomplicated intra-abdo infections, PID & surgical procedures, infections due to gram -ve plus anaerobes
3rd gen cephalosporins coverage
PEck, H. influenzae, M. catarrhalis, oral anaerobes
Ceftriaxone: good strep coverage including penicilin resistant S. pneumoniae
Ceftazidime: some gram -ve activity compared to ceftriaxone but NO gram +ve activity, use if concern for pseudomonas and not if concern for gram +ve
Cefixime: good activity for N. gonorrhoeae (poor activity against streptococcus or staphylococcus)
NOT recommended for SPICE infections
No activity against MRSA/MRSE, Enterococci, Listeria spp, gut anaerobes, legionella,
4th gen cephalosporin coverage
Evergthing ceftriaxone covers,
Improved gram +ve (staphylococcus/streptococcus) coverage, good gram -ve coverage (incl pseudomonas)
Retains activity for SPACE organisms (eg. has activity against broad spectrum BL producing gram -ve (Amp C betalactamase, and maybe Class A ESBLs)
NO activity against gut anaerobes
Carbapenems coverage
For difficult to treat organisms with multi-resistance such as SPACE/SPICE, ESBLs; good for mixed infections (G-ve, G+ve, pseudomonas)
DO NOT use ertapenem for pseudomonas spp or acinetobacte spp (no/unreliable coverage)
Covers: G-ve (PEcK, SPACE/SPICE), G+ve (streptococcus/staphylococcus), anaerobes (gut/oral)
Some E. faecalis with imipenem (but increase failure rate)
NO ACTIVITY: MRSA, atypical organism (mycoplasma spp, chlamydia spp), C. difficile
Macrolides coverage
G+ve incl streptococcus spp (S. Pneumoniae), weak staphylococcus spp.,
H. influenzae and M. catarrhalis (not erythromycin)
Excellent attpical coverage: Chlamydophila, legionella, mycoplasma pneumoniae;
N. gonorrhea, B. pertussis, Campylobacter, Lyme, H. pylori, MAC
NO ACTIVITY: MRSA, Enterococcus spp, gut anaerobes, most G-ve.
Lincosamides coverage (clindamycin)
G+ve: Staphylococci, streptococcus viridans, strep pyogenes, strep pneumoniae, MRSA Gut anaerobes (B. Fragilis, Clostridium spp.) Oral anaerobes (peptostreptococcus, fusobacterium, clostridia)
NO ACTIVITY: Enterococcus, most G-ve
Aminoglycosides coverage
Pseudomonas,
Enterobacter
Mycobacterium tuberculosis,
G-ve (SPACE organisms): gentamicin best activity for Serratia & Klebsiella, tobramycin best for pseudomonas, Amikacin usually lower resistance rates
NO ACTIVITY: G+ve, atypical organism, anaerobes
Genatmicin used for synergy with Penicillin or vancomycin for MSSA/MRSA and enterococcus;
Useful for difficult to treat G-ve organisms such as pseudomonas & urosepsis, bacteremis, in combination with other drugs for multi-resistant organisms
Tetracyclines coverage
G+ve (S. aureus, some MRSA, streptococci incl. S. pneumoniae) G-ve (H. Influenzae, M. catarrhalis) B. anthracis, Mycoplasma, Chlamydophila sp., Lyme disease, Rickettsia, Helicobacter pylori
NO ACTIVITY: anaerobes, hard to kill G-ve
Tigecycline coverage
Useful for MRSA when vanco/dapto/linezolid is not an option
G+ve (S. aureus, MRSA, Streptococci, Enterococcus incl. VRE)
G-ve (H. influenzae, M. catarrhalis, E. coli)
Excellt Atypical (Mycoplasma, Chlamydia, Legionella)
Gut anaerobes
NO ACTIVITY: proteus, providencia, and pseudomonas
Fluoroquinolones coverage
G-ve (PEcK, H. influenzae, M. catarrhalis, SPACE/SPICE, Neisseria gonorrhoeae, Salmonella, Shigella)
Atypical (Mycoplasma pneumoniae, Chlamydia pneumonia, Legionella pneumophilia)
G+ve streptococci incl. penicillin-resistant strains (only respiratory FQ: levo, moxi, gem)
Moxifloxacin also covers anaerobes (only quinolone with anaerobic coverage)
Moxi DOES NOT penetrate urine (not for UTI)
NO ACTIVITY: MRSA, Pseudomonas spp (escrpt cipro/levo), G+ve (unless respiratory FQ); variable against enterococcus
Metronidazole coverage
oral anaerobes (Peptostreptococcus spp, Fusobacterium spp,)
Gut anaerobes (B. fragilis, Clostridium spp.)
Other protozoa
H. pylori
NO ACTIVITY: G+ve, most G-ve, atypical
Septra coverage
G+ve: Staphylococcus, Streptococcus, (S. aureus possibly including MRSA);
Listeria, Nocardia;
G-ve: PEcK, H. influenzae, M. catarrhalis, SPACE/SPICE but NOT pseudomonas
Strenotrophomonas maltophilia, PCP and toxiplasmosis (in HIV pt)
NO ACTIVITY: Enterococci, atypicals, anaerobes, Pseudomonas; poor against S. pneumoniae
Vancomycin coverage
G+ve (S. aureus, MRSA, S. epidermidis, Streptococcus spp, Enterococcus spp, Listeria)
C. difficile (when used PO)
NO ACTIVITY: G-ve (except Neisseria), atypical, anaerobes
Daptomycin coverage
G+ve (S. aureus, MRSA, Streptococcus spp, Enterococcus spp incl. VRE (both faecium and faecalis)
NO ACTIVITY: G-ve, atypical, anaerobes
Linezolid coverage
G+ve (S. aureus, MRSA, Streptococcus spp incl. penicillin-resistant S. pneumoniae (PRSP), Enterococcus spp incl. VRE (both faecium and faecalis)
NO ACTIVITY: G-ve, atypical, anaerobes
Nitrofurantoin covers?
PEcK, S. aureus, S. saprophyticus, S. agalactiae, Enterococcus spp & faecalis
NO ACTIVITY: atypical, anaerobes, pseudomonas
Fosfomycin
G+ve: Staphylococcus spp., S. aureus (MRSA), Enterococcus spp.;
G-ve: E. coli, Enterobacter spp., Citrobacter spp., Klebsiella spp., Proteus spp., Providencia spp., P. aeruginosa
NO ACTIVITY: atypical, anaerobes
