Gram Positive Gram Negative Anaerobes Other Empiric Therapy Adverse Effects (precautions)

MSSA MRSA S. epi GABS GBBS S. pneu E. faec L. mono P. aerug Serr. Citrob. Enterob. P. mira E. coli Kleb. H. influ M. catar Neiss. B. frag Prevo. C. diff PSC Actino. 'Oral'
GPC GPC GPC GPC GPC GPC GPC GPR GNR GNR GNR GNR GNR GNR GNR GNCB GNDC GNDC GNR GNR GPR GPC GPR
fac fac fac fac fac fac aerotol fac fac fac fac fac fac fac fac fac ob ob ob ob fac
Syphilis, Necrotizing faciitis (S.
b-lactam penicillin G/V - - - +* + +* + + - - - - - - - - - - - + +* Syphilis Rash, dec. seizure threshold
pyogenes)
MSSA bacteremia, MSSA endocarditis,
anti-staph pen oxacillin, nafcillin +* - + + + + - - - - - - - - - - - - AIN (urine eosinophils)
OM, CNS ifns
Urticarial, mobiliform rash, angioedema, Stevens
amino-penicllin ampicillin, amoxicillin - - - + + + +* +* - - - - - - - + + +* ENT favorite
Johnson
Urticarial, mobiliform rash, angioedema, Stevens
amino-penicllin amp-sulb, amox/clav + - - + + + +* +* - - - - + +* +* + + + + + + +* ENT favorite
Johnson
ticarcillin/clavulanate, HCAP (w/ levaquin), aspiration CAP,
anti-pseudo pen + - + + + + + tic, pip +* + + + + +* + + + + + + + D, C, N
piperacillin/tazobactam unknown sepsis
Meningitis, sepsis, brain abscess, VP
carbapenams meropenam + - + + + + + +* + + + + + + + + + + + + + shunts, ab ifn, HCAP (prevent resistance, N, D
anaerobes)
Lower URI, UTI, ab ifn, sepsis,
carbapenams imipenem + - + + + + + + +* + + +* + + + + + + + + + + + Nocardia PNA alternative endocarditis, VP shunts, HCAP (prevent Lower seizure threshold
resistance, anaerobes)
carbapenams ertapenam + - + + + + - - + + + + + + + + + + + + + + Pelvic ifns, CAP, ab ifn, complicated UTI D
Upper and lower RTI, sepsis, SSTI, gyn, Rash, TEN, D, N, V, neutropenia, transaminitis,
monobactam aztreonam - - - - - - - - +* +* +* +* +* +* +* +* +* +* - - - - -
GN w/ pen allergy little cross-reactivity with pens
Rash (<10% cross-reactive), cytopenias (CBC), mild
1st-gen ceph cefazolin, cephalexin +* - - + + + - - - + + + + SSTI, perioperatively
cholestasis (alk phos)
Rash (<10% cross-reactive), cytopenias (CBC), mild
2nd-gen ceph cefoxitin, cefuroxime + - - + + + - - - + + + + + + Borrelia URI, OM, GU
cholestasis (alk phos)
Rash (<10% cross-reactive), cytopenias (CBC), mild
3rd-gen ceph cefotaxime + + + + - - + + + + + + + + + + Resistance-prone (SPAICE) Sepsis, meningitis, ab ifn, UTI, CAP
cholestasis (alk phos)
Rash (<10% cross-reactive), cytopenias (CBC), mild
3rd-gen ceph ceftazidime + + +* - - + + + + + + + + + + + Resistance-prone (SPAICE) Sepsis, meningitis, ab ifn, UTI, CAP
cholestasis (alk phos)
Meningitis, ab ifn, UTI, CAP, gonorrhea, Rash (<10% cross-reactive), cytopenias (CBC), mild
3rd-gen ceph ceftriaxone +* + + + - - + + + + + + + + + + + Resistance-prone (SPAICE)
pyelo, AOM cholestasis (alk phos)
adv-gen ceph ceftaroline +* +* + + + + + - + + + + + + + + + + CAP, SSTI Positive Coombs (without hemolysis)
BMT patients (febrile neutropenia -
4th-gen ceph cefepime + + + + - - +* + + +* + + + + + + - + ab ifn, CAP, SSTI, pyelo Positive Coombs (without hemolysis)
Pseudomonas)
Sepsis, HCAP, lower RTI, skin, bone, C. Anaphylaxis, Redman syndrome (IgE), AKI, Linear
vancomycin +^ +* +* + + +* + + - - - - - - - - - - - + + +
diff (PO, if Flagyl-unresponsive) IgA Bullous Dematosis
SSTI, R-sided endocarditis (aureus), VRE, HTN, edema, Rhabdomyolysis (check CK, not with
lincopeptide daptomycin + +* + + + + VRE - - - - - - - - - - - + +
PNA (surfactant inactivation) statins)
CA-MRSA, necrotizing faciitis, cellulitis,
clindamycin + (CA) - + + + - - - - - - - - - - - + + + + Anaerobes above diaphragm Pseudomembranous colitis, metallic taste
TSS, dental ifn
Resistance (MRSA PNA, VRE, HAP, HA, D, N, optic n. damage, peripheral neuropathy,
linezolid + +* + + + +* VRE + - - - - - - - - - MDR TB, Nocardia
CAP) serotonin syndrome, BM suppression (2+ weeks)
MRSA SSTI, PCP, UTI, Nocardia, Toxo, Hyperkalemia, Stevens-Johnson, pancytopenia,
TMP-SMX + +* - + - +* - + - + PCP, Nocardia (1), Toxo
Listeria meningitis (pen allergy) crystaluria, AKI, G6PD hemolysis, pancreatitis
Rikketsia, Chlamydia, Lyme, non-TB Lyme disease, Malaria PPx (clq Photosensitivity, pill esophagitis, grey teeth, no
tetracycline doxycycline + - + + + - + - - - - + + + +
myco, Q fever, 2 Syphilis resistance), acne urine penetration (doxy)
Meningitis, Q fever, Rikketsia, Penicillin back-up, Malaria PPx (clq Photosensitivity, pill esophagitis, grey teeth, blue
tetracycline minocycline + - + + + - + - - - - + + + +
Chlamydia, RMSF, Syphilis resistance), acne discoloration (mino)
Strep/Staph, Legionella, Chlamydia,
Macrolide erythromycin - - + + - + - - - - - - - + + + Gonorrhea, M. pneumoniae, Colorectal decontamination QTc prolongation, heartburn/GI upset/D (prokinetic)
Bartonella
azithromycin Chlamydia, Gonorrhea, Mycoplasma AOM, atypical pneumonia, PID, GU ifns,
Macrolide + - - + + - + - - - - - - - + + + + QTc prolongation, heartburn/GI upset/D (prokinetic)
clarithromycin pneumoniae, MAC, Bartonella MAC
HCAP (w/ Zosyn), GU, prostatitis, Tendonitis/rupture, QTc prolongation, neuropathy,
Fluroquinolone moxifloxacin, levo + + +* +* +* +* + + + + + + + + + + Legionella, M. pneumoniae
pyelonephritis, OM (Hgb SS) G6PD hemolysis
HCAP, GU, prostatitis, pyelonephritis, OM Tendonitis/rupture, QTc prolongation (less),
Fluroquinolone ciprofloxacin + + + + + + + + + + + + + Legionella, M. pneumoniae
(Hgb SS) neuropathy, G6PD hemolysis
MDR, important 2 agent for G- bacilli and
Aminoglycoside amikacin + + + +* + +* + - - - - - - Mycobacteria, MDR TB, Nocardia Nephrotoxicity, ototoxicity
some G+
Bone ifns, RTI, SSTI, abdominal ifns,
Aminoglycoside gentamicin + + + + + +* + - - - - - - Mycobacteria, MDR TB, Nocardia Nephrotoxicity, ototoxicity
UTIs, endocarditis
rifampin + + + + + + + + + + + Biofilms Active TB, never use alone Orange urine, OCPs don't work
nitrofurantoin + + + + + + - + + + Increased activity in urine UTIs ( ESRD) N, V, pulmonary fibrosis, hepatitis, G6PD hemolysis
Anaerobes below diaphragm Disulfiram-like rxn, metallic taste, neuropathy, N,
metronidazole - - - - - - - - - - - - - - - - - - + + + + - BV, trich, PID, Giardia, C. diff (severe)
(+ CNS), protozoa V, QTc prolongation