Antibiotics Cheat Sheet (Table)

ANTIBIOTICS CHEAT SHEET CLASS Natural Penicillin Anti-staphylococcal penicillin Extended spectrum penicillin Penicillin Beta Lactams Bactericidal CELL WALL SYNTHESIS INHIBITORS Cephalosporins DRUGS Penicillin G: benzyl penicillin Methicillin Nafcillin Ampicillin Penicillin V Oxacillin Dicloxacillin Amoxicillin Amoxicillin/Clavulanic acid Broad spectrum+β-lactamase inhibitor Ampicillin/sulbactam (Co-Amoxiclav) Piperacillin Ticarcillin Anti-Pseudomonal penicillin + β-lactamase inhibitor → Pipercillin/tazobactam Ticarcillin/Clavulanic acid st Cefazolin Cefalexin Cefadroxil Cefradine 1 generation Cefaclor Cefoxitin Cefotetan Cefuroxime 2 nd generation Cefixime Cefotaxime Ceftriaxone Ceftazidime 3rd generation 4th generation Cefepime IV Monobactams Non β lactam Others CELL MEMBRANE Tetracyclines 30s Glycylcyclines Macrolides 50s PROTEIN SYNTHESIS INHIBITORS Aminoglycosides Oxazolidinone Streptogramins Lincosamide Chloramphenicol 2 nd generation 3rd generation 4th generation Sulfonamides Anti folates Nucleic Acid synthesis Fluoroquinolones 1st generation DHFR inhibitor Combinations SPECTRUM and USE/DRUG OF CHOICE Gram+ cocci, Gram+ bacilli, Gram- cocci, Spirochetes Syphilis: Treponema palidum Gas gangrene Clostridium perfringens Penicillinase producing Staphylococci, MSSA. MRSA identification test [Pen. G.] Gram- Bacilli Ampicillin: Enterococcal, Respiratory inf. Gram+ bacillus Listeria monocytogenes Amoxicillin: prophylactically by dentist- bacterial endocarditis Pseudomonas aeruginosa, Gram- bacilli. X Klebsilla Penicillinase producing Enterobacteriaceae and Bacteroides sp. Good gram+, moderate gram- Proteus mirabilis, E.coli, K.pneumoniae. Covers MRSA Moderate gram+, good gram- : Enterobacter aerogenes, Neisseria sp. Cefotetan/Cefoxitin anaerobe Bacteroides fragilis too Weak gram+, good gram- Bacilli, enteric org, S. marcescens. Ceftriaxone/Cefotaxime: Meningitis, Ceftazidime: P. aeruginosa Extended gram+, good gram- Streptococci, staphylococci (only methicillin susceptible) and gram- Enterobacter, P. mirabilis, K. pneumoniae, E. coli, P. aeruginosa Broad gram+. MRSA. Complicated skin and skin structure infection, Community acquired Pneumonia [3rd gen gram-] X P.aeruginosa ESBL Ceftaroline fosamil ✓ Advanced generation Carbapenems Cefpirome Aztreonam Imipenem/Cilastatin Meropenem Doripenem Ertapenem Gram+, MDR: MRSA, enterococci ✓ Vancomycin (glycopeptide) fosfomycin Bacitracin ✓ Daptomycin (cyclic lipopeptide) Bactericidal Colistin (polymyxin) X=No activity against Gram+. […]=that activity along with … ✓ = Cover MRSA MOA ADRs Inhibit transpeptidation or cross-linkage (last step) → exposure of osmotically less stable membrane. Cell lysis by: 1. Osmotic pressure 2. Activation of auto-lysins Hypersensitivity, Diarrhea, Nephritis, Hematologic toxicities, Neurotoxicity Same as penicillins Binds PBP2a MRSA, PBP2x Streptococcus pneumoniae Cross-sensitivity: penicillin-1st gen Hypersensitivity reactions: anaphylaxis, skin rash, granulocytopenia, fever, hemolytic anemia. Renal toxicity: interstitial nephritis, tubular necrosis, Local irritation: pain--IM, thrombophlebitis--IV Non-toxic but phlebitis, skin rash, abnormal LFTs. Eosinophilia, neutropenia, Imipenem: N/V/D, ↑dose: seizures Aerobes: gram- Enterobacteriaceae, P. aeruginosa X gram+, anaerobes. Bind PBPs. Resistant to β -lactamase except ESBLs. Safe in penicillin allergy. β -lactamase producing gram+, gram-, anaerobes, P. aeruginosa. Enter Gram- through porins → permanently acylate PBPs Ertapenem: X P. aeruginosa, Enterococcus sp., Acinetobacter sp. - Sepsis+endocarditis caused by MRSA Bactericidal - Enterococcal carditis (vanco+gentamicin) 1. inhibit cell wall phospholipid synthesis Fever, chills, flushing, phelebitis - Meningitis by highly penicillin resistant pneumococcus (vanco+cefotaxime, ceftriaxone, rifampin) 2. inhibits Peptidoglycan polymerization - Antibiotic associated colitis - Clostridium difficile diarrhea IV reconstitute 125mg PO 4X/d 10day by preventing transglycosylation step Interfere with dephosphorylation in cycling of lipid carrier that transfers peptidoglycan subunits to growing wall. Nephrotoxic systemically, use topical on surface lesion Bind 30s subunit → GI discomfort, effect calcified tissues, growth Bacteriostatic. Gram+, gram-, protozoa, Acne. Chlamydia inf. (doxycycline). Rickettsiae: rickettsialpox, spirochetes, mycobacteria, atypical sp. Q fever, Rocky Mountain spotted fever, murine/epidemic/scrub typhus no protein synthesis stunting, tooth discoloration, Hepato+Phototoxicity -Mycin streptomyces Streptomycin Tobramycin Kanamycin Neomycin Paromomycin Aerobic gram- bacilli MDR P. aeruginosa, K. pneumonia, Enterobacter sp Bactericidal TDM. Nephrotoxicity, ototoxicity, Kanamycin, streptomycin: X Serratia, P. aeruginosa Prevent assembly of ribosomal apparatus, inhibit -Micin paralysis, skin rash Amikacin Gentamicin Netilmicin Verdamicin - Enterococcus faecalis, enterococcus faecium infective endocarditis (+β-lactam) binding of 30s to 50s or cause 30s to miss-read code micromonospores Tigecycline ✓ Bacteriostatic Erythromycin: [pen. G]. Azithromycin: respiratory inf. and urethritis by Chlamydia trachomatis Bacteriostatic. Bind 50s subunit, block Cholestatic jaundice, Ototoxicity, Gastric Erythromycin Clarithromycin Azithromycin Telithromycin (ketolide) Clarithromycin: [higher than E] intracellular pathogens: Chlamydia, legionella, Moraxella, H. pylori translocation and transpeptidation distress and motility: used therapeutically for gastroparesis or post-operative ileus Mycobactrium avium (Clarithromycin/Azithromycin) reaction Linezolid ✓ Tedizolid ✓ Gram+. Bacterial pneumonia, VRE, skin and skin structure inf. Primary place: alternate to vancomycin Bacteriostatic. Inhibit formation of 70s complex Quinapristin/Dalfopristin both bind separate site on 50s subunit → ternary complex, synergistically interrupt protein synthesis Inhibit CYP3A4, linezolid is always better Bactericidal VRE, VRSA Clindamycin ✓ Bacteroides fragilis (anaerobes) Bacteriostatic Broad spectrum, restricted to life-threatening inf. w no alternative. Bacteriostatic, but Inhibits peptide chain by Blurred vision, digital paresthesia, encephalography, Chloramphenicol bactericidal depend: dose+organism. Chlamydiae, rickettsiae, spirochetes, anaerobe Bacteroide sp. interrupting transpeptidation Anemia, Gray baby syndrome, cardiomyopathy Nalidixic acid (Quinolone) Gram- X Pseudomonas sp. UTI by P. aeruginosa. Bactericidal. Inhibit bacterial: GI: N/V/D, antibiotic associated Gram- (including pseudomonas sp.) colitis. CNS: confusion, insomnia, Bacterial diarrhea by 1. topoisomerase IV – interferes with separation of replicated chromosomal Norfloxacin Ciprofloxacin Enoxacin Ofloxacin Gram+ (s. aureus), Atypicals dizziness, anxiety, seizures (GABA Shigella, Salmonella, DNA into respective daughter cells nd displacement). CVS: Prolong QT toxigenic E. coli, 2. DNA gyrase – prevents relaxation of positively supercoiled DNA required Levofloxacin Sparfloxacin [2 gen.] Extended Gram+ and atypical coverage rd interval. Cipro: tendon rupture for normal transcription + replication Camphylobacter Delafloxacin ✓ Trovafloxacin Moxifloxacin Gemifloxacin [3 gen.] broad anaerobic coverage Tetracycline Sulfasalazine Oxytetracycline Sulfacetamide Doxycycline Sulfadiazine Silver sulfadiazine Trimethoprim Sulfamethoxazole + trimethoprim (co-trimoxazole) ✓ Minocycline Sulfamethoxazole Pyrimethamine Sulfadiazine + pyrimethamine Sulfadoxine + pyrimethamine Bactericidal. Gram+ Staphylococcus sp. Gram- enteric bacteria: K. pneumoniae, E.coli, Salmonella, shigella, Enterobacter sp., Nocardia sp. Chlamydia trachomatis and some protozoa. Bacterial inf.: pneumonia, bronchitis, UTI, ear, intestine - Traveler’s diarrhea (co-trimoxazole) - 1st line in Acute toxoplasmosis (sulfadiazine + pyrimethamine) - 2nd line in Malaria (sulfadoxine + pyrimethamine) Megaloblastic anemia, leukopenia, N/V/D, drug fever, granulocytopenia, vasculitis, renal damage. In AIDS & pneumocystis pneumonia: rash, leukopenia, hyperkalemia, hyponatremia, ↑hepatic aminotransferases. Nitroimidazoles Metronidazole Tinidazole Dimetridazole Bactericidal. 1st line in Clostridium difficile diarrhea Mixed amebicide. Cause loss of helical DNA structure and strand breakage. Inhibit DNA replication Nausea, GI disturbance, metallic taste Acid fast Mycobacterium tuberculosis Nocardia Other: Treponema pallidum Spirochetes Atypical: Rickettsiae, Legionella, Chlamydia, Mycoplasma Gram+ Streptococci sp., (pneumoniae, epidermis) Staphylococcus sp., (aureus) MSSA, MRSA, VRSA Clostridium. Listeria monocytogenes. Bacillus anthracis Corynebacterium Gram- Acinetobacter sp. Brucella sp. Chlamydiae E. coli Haemophilus influenzae H. pylori Klebsiella pneumoniae Legionella pneumophila Moraxella catarrhalis Neisseria gonorrhoeae Pseudomonas aeruginosa Proteus mirabilis Salmonella typhi Serratia marcescens Shigella sp. Ureaplasma sp.Vibrio cholerae. Yersinia pestis Anaerobes: Bacteroides fragilis Clostridium (difficile, perfringe, tetani) Enterococcus sp. (faecalis, faecium) VRE Enterobacter sp. Peptostreptococcus sp Providancia sp Toxoplasma gondii