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Penicillin Spectrum
- B-lactamase negative GPC(S.pneumoniae, S.pyrogens, VGS)- oral anaerobes (GPs) (actinomyces, peptococcus, petptostretococcus)- N. meningitis (GN)- syphilis * GRAM POSITIVES**
Penicillin Gaps
- atypical organisms- B-lactamase (+) GPCs - Staph- aerobic GNB- anaerobic GN
Amoxicillin/Ampicillin Spectrum
PCN + gram positives including enterococcus some gram negatives
Amoxicillin/Ampicillin Gaps
susceptible to B-lactamases
Piperacillin Spectrum
more GN activity- harder to treat GN pseudomonas & enterococcus
Gaps in Coverage:- susceptible to B-lactamases
Piperacillin + Tazobactam Spectrum
Useful for where there is resistance! LARGE spect.- oral anaerobes - GP in general (inc. MSSA)- GN in general
Cephalosporins 1st (cefazolin, cephalexin) gen spectrum
Coverage: PCN PLUS- easy to kill GN: E.coli, proteus spp., klebsiella sppRetain:- aerobic GPC- oral anaerobes
Cephalosporins 2nd ( cefoxitin cefaclor cefuroxime) gen spectrum
Coverage: PCN + 1GC PLUS- gut anaerobes: B. fragillis sp (but resistance high so not often used)cefuroxime: H.influenza and Moraxella catarrhalis (respiratory organisms)
Cephalosporins 3rd gen (Ceftriaxone Cefotaxime Ceftazidime) spectrum
Ceftriaxone: 1st GC PLUS broader GNB Gaps in Coverage: LOSE: Staph activity & anaerobic coverageCeftazidime: PCN PLUS broader GNB than 2nd GC (b/c of sidechain which inc. penetration of GN membrane) and Pseudomonas
Gaps in Coverage: LOSE GP coverage** NO strep or staph coverage
Cephalosporins 4th gen (cefepime) spectrum
Coverage: 3GC plus more GNs, AmpCRetain:- GP similar to ceftriaxone (3GC)- PsA similar to ceftazidime (3Gc)Gaps in Coverage:- ESBL
Carbapenems: Meropenem and Imipenem
Coverage: added to Pip/tazo OR 3GC- oral & gut anaerobes - GP in general (inc. MSSA)- GN in general - ESBL - ampC- Pseudomonas (M&I)
Carbapenems: Ertapenem
- less activity than mero/imipen against GN-
LOSE: pseudomonas, enterococci, acinetobacter
Vancomycin
Coverage:- GPs only (b/c too large & polar to cross GN CM)- C. difficile (po)- MSSA, MRSA- PCN resistant strep meningitis - enterococcus“drug of last choice”
Use when:- B-lactam allergy, B-lactam resistance (MRSA, CoNS)
Daptomycin
Coverage:- GPs (inc. MRSA, MRSE, VRE)
Gaps in Coverage:- no GNs- no anaerobes
Ciprofloxacin (early fluroquinolone)
Spectrum:- aerobic GN activity- poor GP activity (no staph/strep)