A Few Antibiotics to Know: Difference between revisions

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* '''Cloxacillin''' (and oxacillin and others) is great against methicillin-sensitive ''Staphylococcus aureus'' (MSSA)
 
* '''Cloxacillin''' (and oxacillin and others) is great against methicillin-sensitive ''Staphylococcus aureus'' (MSSA)
 
* '''Amoxicillin/clavulanic acid''' (PO) is broad-spectrum, and works against most Gram-positives and Gram-negatives, as well as some anaerobes
 
* '''Amoxicillin/clavulanic acid''' (PO) is broad-spectrum, and works against most Gram-positives and Gram-negatives, as well as some anaerobes
* '''Piperacillin'''/tazobactam (IV) adds even better anaerobic coverage, as well as anti-pseudomonal activity
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* '''Piperacillin'''-tazobactam (IV) adds even better anaerobic coverage, as well as anti-pseudomonal activity
   
 
=== Cephalosporins ===
 
=== Cephalosporins ===

Revision as of 10:17, 29 October 2019

Beta-lactams

  • Our gold-standard class of antibiotics that are extremely effective and very well tolerated

Penicillins +/- Beta-lactamase Inhibitors

  • Amoxicillin (PO) and ampicillin (IV) are great against most streptococci, and a few Gram-negatives
  • Cloxacillin (and oxacillin and others) is great against methicillin-sensitive Staphylococcus aureus (MSSA)
  • Amoxicillin/clavulanic acid (PO) is broad-spectrum, and works against most Gram-positives and Gram-negatives, as well as some anaerobes
  • Piperacillin-tazobactam (IV) adds even better anaerobic coverage, as well as anti-pseudomonal activity

Cephalosporins

  • Cephalexin (PO) and cefazolin (IV) are first-generation cephalosporins that are fantastic against most Gram-positives, including streptococci and MSSA, as well as many non-resistant Gram-negatives
  • Ceftriaxone (IV) is worse for Staph. aureus, but maintains excellent streptococcal coverage and improves the Gram-negative coverage significantly
  • Ceftazidime (IV) is like ceftriaxone but adds anti-pseudomonal activity

Carbapenems

  • Ertapenem (IV) covers essentially everything except MRSA and some very resistant Gram-negatives
  • Meropenem (IV) adds anti-pseudomonal activity

Fluoroquinolones

  • Broad-spectrum and great oral bioavailability (PO ~= IV), but low barrier to resistance and many side effects
  • Levofloxacin (PO/IV) and moxifloxacin (PO/IV) cover Gram-positives that includes staph. aureus and Gram-negatives
  • Ciprofloxacin (PO/IV) has less good Gram-positive coverage but better Gram-negative coverage, including anti-pseudomonal activity

Vancomycin/Daptomycin/Linezolid

  • Vancomycin (IV) and daptomycin (IV) work only against Gram-positives, and are reserved for resistant infections such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE)
    • Vancomycin has renal toxicity and possibly ototoxicity
    • Daptomycin doesn't work for pneumonia (inactivated by surfactant)
  • Vancomycin (PO) is not absorbed, and is used only for Clostridium difficile-associated diarrhea
  • Linezolid (PO/IV) is another antibiotic that treats only Gram-positives, including MRSA

Aminoglycosides

  • Tobramycin (IV) and gentamicin (IV) are reserved for very resistant Gram-negative infections, and have side effects of renal toxicity and ototoxicity

Miscellaneous

  • Septra (TMP-SMX) (PO/IV) has good Gram-negative coverage, including many resistant Gram-negatives, as well as MRSA coverage
  • Azithromycin (PO) is used for community-acquired pneumonia, covering Strep. pneumoniae and atypicals like Chlamydia, Mycoplasma, and Legionella
  • Clindamycin (PO/IV) is used for Gram-positives (including MRSA) and oral anaerobes, as well as streptococcal toxic shock syndrome
  • Doxycycline (PO) is used for weird infections, but also includes MRSA coverage
  • Metronidazole (PO/IV) treats gut anaerobes and C. difficile