Functional class Structural class Examples Coverage Common Side Effects Other Stuff

Cell wall synthesis -lactams Pencillins Natural PCNs – gram + PCNs and Cephalo- 3-10% of people are
inhibitors Semi-synthetic (streptococci, Listeria) sporins: Very high allergic to PCN, 10% of
PCNs Others: Broader spectrum therapeutic index these are also allergic
Cephalosporins Carbepenems: N/V, to cephalosporins
Carbepenems diarrhea, rash, drug
Monobactems fever, seizures
Glycopeptide Vancomycin Staph, Strep, some Telavancin is a vanco
Telavancin (lipo- enterococci, clostridia and derivative that binds
glycopeptide) other gram+ anaerobes more tightly to D-ala,
D-ala PG intermediate
Cyclic Peptide Bacitracin Staph, Strep and other Nephrotoxicity limits Occasionally used to
Gram+ its use to topical treat pneumonia in
application infants
Plasma membrane Lipopeptide Daptomycin Aerobic gram+ including Rash, phlebitis, N/V/D
disruption MRSA, S. pneumoniae, some
VRSE
Cationic peptide Colistin P. aeruginosa, many enterics,
H. influenzae
Protein synthesis Aminoglycosides Neomycin Gram +: Some Staph, Strep, Nephro- and May be used at lower
inhibitors Bind 30S Genatmicin Enterococci, Listeria ototoxicity dose with cell wall
Tobramycin Gram-: H. influenzae, inhibitors, which
Streptomycin enterics, P. aeruginosa increase
Mycobacteria (Mtb, MAC) aminoglycoside uptake

Microlides Erythromycin Gram+: Some S. pyogenes, Erythromycin- N/V/D, E-mycin and C-mycin
Bind 50S Clarithromycin some viridans, some Staph, thrombophlebitis inhbit P450 system so
Azithromycin Some S. pneumoniae when given IV watch out for drug
Gram -: Niesseria, H. Prolonged QT interactions (or use
influenzae, Bordetella, azithromycin)
Atypical: Chlamydia,
Mycoplasma, Legionella,
some rickettsias
Myco: MAC, M. leprae
Spirochetes: Borrelia,
Treponema
Tetracyclines Tetracycline Gram+: S. pneumonia Discolor teeth – do not
Bind 30S Doxycycline Gram –: H. influennzae, N. use in pregnant
Minocycline meningitides women and avoid use
 Anaerobes: Some Clostridia in children
Spirotchetes: Borrelia, Phototoxicity
Treponma
Atypical: rickettsia,
Chlamydia, Mycoplasma
Chloramphenicol Chloramphenicol Reversible bone Don’t use on neonates
Binds 50S marrow suppression Used very little due to
Aplastic anemia toxicity
Lincomycins Clindamycin Gram+:Some Staph and Strep Linked to C. difficile Avoid using; its
Binds 50S Including some CA-MRSA infections binding site overlaps
Some anerobes: Bacteroides with macrolides, so
fragilis, some clostridia use them instead
Streptogramins Quinuprisitin/ MRSA, PCNR S. pneumonia, Pain, inflammation, IV use only
Binds 50S Dalfoprinstin some vanco resistant thrombophlebitis at Each component
combination enterococi site of infusion – give inhibits a different
via central line step in elongation
Oxazolindinones Linezolid Most Gram+ aerobes Contraindicated with Completely synthetic
Binds 50S including MRSA, PCNR S. MAO inhibitors and Don’t use unless you
pneumonia, vanco resistant serotonin receptor have to/keep out of
enterococi inhibitors circulation
Nitrofuran Nitrofurantoin Gram+: Staph saprophyticus N/V, rash, pulmonary Concentrated in urine
Binds 50S (?) and enterococci hypersensitivies, so it the classic anti-
Gram - : Most enterbacteria hepatitis, anemia, UTI drug
peripheral
neuropathies
Anti-metabolites Sulfa drugs Trimethoprim- Gram+: Some staph & strep GI, Stevens-Johnson HIV pts are
Inhibit folic acid sulfamethoxazole Listeria monocytogenes syndrome, leukopenia, particularly prone to
synthesis Dapsone Gram –: Some H. influenza, thrombocytopenia, toxic side effects
some enterbacteria hepatitis,
Dapsone- M. leprae hyperkalemia
Transcription Rifamycins Rifampin Gram+:Staphylococci Potent P-450 inducers Used most commonly
inhibitors Block bacterial Rifabutin Gram- H. influenza, N/V?/D, hepatitis, rash in combination with
RNA polymerase Rifapentine N. meningitides Tears and urine turn anti-mycobacterial
Myco: Mtb, MAC, M. leprae red (warn pts!) drugs
Replication Quinolones and Ciprofloxacin Very broad spectrum: N/V/D Cipro should not be
inhibitors Fluroquinolones Levofloxacin Most Gram+ strep and staph Cause cartilage used to treat S.
Block gyrase/ Moxifloxacin Gram -: H. influenza, Neisseria damage – avoid use in pneumoniae
topoisomerase Gemifloxacin spp. P. aeruginosa, some children, and elderly; Levo has enhanced
enterobacteria do not use in pregnant activity again aerobic
 Anaerobes: Some Clostridia women Gram + but less active
and Bacteroides Prolonged QT interval against Gram -
Atypical: Chlamydia and
Chlamydiophila, Mycoplasma
pneumoniae, Legionella
Myco: Mtb, MAC, M. leprae
Free radical Metronidazole Metronidazole Anaerobic bacteria- B. Unpleasant metallic Active only when
generator fragilis, Clostridium spp. & taste reduced; can only be
most other anaerobes, Alcohol should be reduced by ferredoxin
including protozoa avoided (leads to of anaerobic protozoa
(Trichomonas) N/V/D) and bacteria
Anti-mycobacterial Numerous Isoniazid Isoniazid/pyrazinamide/ Isoniazid- rash, fever,
Rifampin (see ethambutol- thought to block hepatoxicity,
above) mycolic acid synthesis neuropathies (give B6)
Pyrazinamide
Ethambutol
Clarithromycin
and azithromycin
(see above)
-lactam class Example Coverage Resistance mechanisms Other Stuff
Natural PCN-G, PCN-V Streptococcus pyogenes (GAS) The 6 P’s: Pumps, Porins, PCN-G is parenteral
Pencillins Viridans group streptococci Penetration, PG, PBPs PCN-V is po
Some enterococci Penicillinases (-
Listeria monocytogenes lactamases)
Anti-Staph PCNs: Nafcillin, S. aureus and S. epidermidis -lactamases Bulky R groups prevent PBP
oxacillin, Does NOT cover MRSE or MRSA, Bulky R group limits binding by Staph -lactamases
dicloxacillin & most other bacteria penetration through gram
neg outer membrane
AminoPCNs: ampicillin Same as Natural PCNs + -lactamases Increased R group polarity allows
amoxicillin Some gram – (N. meningitides, H. influenza, passage through porins
Proteus), Borrelia, Anaerobes: Clostridium
spp.
AminoPCN- Amoxicillin- Same as AminoPCNs + some Bacteroides Clavulanate and Sulbactam are
-lactamases clavulanate (anaerobe) without suicide inhibitors -lactamases
inhibitor combos Ampicillin- -lactamase inhibitor; less likely to encounter
sulbactam resistance
Extended Piperacillin Same as Natural PCNs + AminoPCNs + -lactamases, but less so R group even more polor than
spectrum PCNs Ticarcillin Pseudomonas aeruginosa than other PCNs aminopenicillins
Extended Piperacillin- Same as Extended spectrum PCNs + most Piperacillin- tazobactam has a
spectrum PCNs – tazobactam aerobic gram+ and gram-, nearly all broader spectrum than Ticarcillin-
-lactamases Ticarcillin- anaerobes EXCEPT C. difficile clavulanate
inhibitor combos clavulanate
1st Generation Cefazolin Aerobic gram+ cocci (Staph, strep) Because coverage of gram negs is
Cephalosporins Cefadroxil Gram-: some E. coli, some Klebsiella spotty, used primarily for gram +
cefalexin pneumonia, some Proteus mirabilis
NOT MRSA or MRSE
2nd Generation Cefuroxime Same as 1st gen + Neisseria spp., Haemophilus
Cephalosporins influennzae
3rd Generation Cefotaxime, Same as 2nd gen + Borrelia Long half-life so can be taken once
Cephalosporins Ceftriaxone, per day
4th Generation Cefepime Same as 2nd gen + more enterics + not effective against Borrelia
Cephalosporins P. aeruginosa
5th Generation Ceftaraline Same as 2nd gen + Clostridium, MRSA Only cephalosporin effective
Cephalosporins against anaerobes
Carbepenems Imipenem Most aerobic gram pos and gram neg, many -lactamases Not active against C. difficile
Meropenem anaerobes including Bacteroides altered PBP (MRSA) or MRSA or Enterococcus faecium.
Doripenem
Erapenem
Monobactems Aztreonam Aerobic gram negative bacteria (eg H.
influenza, Neisseria, many pseudomonads)