Bugs and Drugs Cheat Sheet

Bugs & Drugs Study Cheat Sheet When You See… Consider Using… GRAM POSITIVES Oral: cephalexin, cefadroxil, amox/clav; IV: cefazolin, oxacillin, nafcillin MSSA Oral: SMX/TMP, doxycycline, clindamycin, linezolid, tedizolid, omadacycline, delafloxacin; IV: vancomycin, daptomycin, telavancin, dalbavancin, oritavancin, ceftaroline, tigecycline, eravacycline; all oral options also come as IV Ampicillin, then vancomycin; if VRE: linezolid, daptomycin, oritavancin, tigecycline, omadacycline, eravacycline, nitrofurantoin (UTI only), Fosfomycin (UTI only) MRSA Enterococci Strep. pyogenes or Strep. agalactiae Penicillin, amoxicillin, clindamycin Ceftriaxone, levofloxacin, amoxicillin, amoxicillinclavulanic acid ( beware penicillin & macrolide resistance) Ampicillin Strep. pneumoniae or Viridans group Streptococci Listeria monocytogenes GRAM NEGATIVES Oral: ciprofloxacin, levofloxacin, delafloxacin; IV: pip/taz, ceftazidime, ceftazidime-avibactam, cefepime, ceftolozane-tazobactam, cefiderocol, imipenem-cilastatin +/- relebactam, meropenem, aztreonam, aminoglycosides, polymyxins Oral: cephalexin, amoxicillin-clavulanic acid, SMX/TMP, nitrofurantoin (cystitis only), fosfomycin, ciprofloxacin, levofloxacin, delafloxacin IV: ceftriaxone, ampicillin-sulbactam ( resistance), cefepime, piperacillin-tazobactam, carbapenems! Carbapenems, ceftolozane-tazobactam, ceftazidimeavibactam, meropenem-vaborbactam, imipenemcilastatin-relebactam, cefiderocol, polymyxins, aminoglycosides, fosfomycin, nitrofurantoin (cystitis only), tigecycline, omadacycline, eravacycline ESBL-producer drug list minus carbapenem alone Aztreonam + (MERO/VAB or CAZ/AVI) SMX/TMP, levofloxacin, minocycline Fluoroquinolone, SMX/TMP, ceftriaxone FUNGI Fluconazole Echinocandin, but can use fluconazole if susceptible Micafungin, anidulafungin, or caspofungin Micafungin, anidulafungin, or caspofungin Voriconazole VIRUSES Valganciclovir, letermovir, ganciclovir, foscarnet PO: acyclovir, famciclovir, valacyclovir; IV: acyclovir Valacyclovir (PO), famciclovir (PO), acyclovir (IV/PO) PO: oseltamivir, baloxavir marboxil; IV: peramivir Remdesivir; monoclonal antibodies Pseudomonas aeruginosa E. coli, Klebsiella ESBL-producer / Drug-Resistant GNR Carbapenem resistant GNR NDM producer Stenotrophomonas Salmonella typhi Candida albicans Candida glabrata Candida krusei Candida auris Aspergillus Cytomegalovirus (CMV) Herpes Simplex Virus (HSV) Varicella Zoster Virus (VZV) Influenza SARS-CoV-2 (COVID-19) MISCELLANEOUS Anaerobes Clostridioides difficile (formerly Clostridium difficile) Atypical organisms Cryptosporidium parvum Cystoisospora sp. (Isospora) Leishmania sp. Borrelia burgdorferi (Lyme dz) Treponema pallidum (Syphilis) Mycobacterium tuberculosis Mycobacterium avium (MAC) Pneumocystis Pneumonia (PCP) Toxoplasma gondii Oral: metronidazole, clindamycin, amoxicillinclavulanic acid, moxifloxacin IV: ampicillin-sulbactam, piperacillin-tazobactam, cefoxitin, cefotetan, ertapenem, tigecycline Oral vancomycin or fidaxomicin ! Metronidazole no longer preferred Macrolides, fluoroquinolones, tetracyclines, lefamulin Nitazoxanide SMX/TMP Amphotericin B Doxycycline Penicillin Rifampin + isoniazid + pyrazinamide + pyridoxine + ethambutol – “RIPPE” Clarithromycin+ ethambutol (tx), azithromycin (px) SMX/TMP (tx or px) Pyrimethamine +sulfadiazine +leucovorin (tx); SMX/TMP (px) ABBREVIATIONS: Amox/clav = amoxicillin/clavulanic acid, CAZ/AVI = ceftazidime/avibactam, ESBL = extended-spectrum beta-lactamase, GNR = Gram negative rod, IV = intravenous, MERO/VAB = meropenem/vaborbactam, MRSA = methicillin-resistant S. aureus, MSSA =methicillin-susceptible S. aureus, NDM = New Delhi metallo-beta-lactamase, PIP/TAZ = piperacillin/tazobactam, PO = oral, SMX/TMP = sulfamethoxazole/trimethoprim, VRE = vancomycin resistant Enterococci