Inhibit cell wall synthesis - Doesn’t work for organisms that LACK a cell wall (i.e, mycoplasma, pertussis)

RNA protein synthesis inhubition

Disrupts cell wall

Protein synthesis inhibitor

Inhibit folic acid pathway

Inhibits protein synthesis by binding at the 50S/30S ribosome

Agents suppress RNA synthesis

Interacts with electron transport mechanism resulting in DNA synthesis disruption

Inhibits metabolism of nucleic acids

Inhibits protein synthesis/DNA synthesis

Inhibits protein synthesis at the 50S ribosome

Ca+ dependent; depolarizes electronic cell membrane

Group A and B streptococcus, syphilis drug of choice

Neutropenia with prolonged use, allergy

Methicillin susceptible S. aureus produces a beta lactamase most often for this so doesn’t cover this organism and also does not cover for methicillin resistant S. aureus

Best drug for methicillin-susceptible Staphylococcus aureus (MSSA); superior drug than vancomycin for documented MSSA

Neutropenia with prolonged use, allergy, thrombophlebitis

Doesn’t cover enterococcus and methicillin resistant S. aureus (MRSA)

Check local antibiogram for E. coli to amoxicillin and amoxicillin/ clavulanate; E. faecalis, S. pneumoniae, Group A and B streptococcus

Neutropenia with prolonged use, allergy. Amoxicillin/clavalanate is associated with more diarrhea

Amoxicillin alone does NOT cover S. aureus, need beta-lactamase inhibitor!

This class (without beta-lactamase inhibitors) does not cover enteric gram negatives other than a select few

Doesn’t cover methicillin resistant S. aureus

Better anaerobic coverage including gut flora with amoxicillin/clavulanate and ampicillin/sulbactam

beta-lactamase inhibitors (clavulanate, sulbactam, tazobactam) do not cross the blood brain barrier

Pseudomonas, and other routine enteric gram negatives and anaerobes including Bacteroides

Neutropenia with prolonged use, allergy

Good coverage for anaerobes, enteric gram negatives. Avoid prolonged use if possible, as can cause drug fevers, hepatitis. Piperacillin-tazobactam does not have good central nervous system penetration

Doesn’t cover methicillin resistant S. aureus

beta-lactamase inhibitors (clavulanate, sulbactam, tazobactam) do not cross the blood brain barrier

activity against MSSA and Group A streptococcus NOT MRSA; some enteric Gram negative rods

NO cephalosporins have activity against Enterococcus or Listeria.

Doesn’t penetrate the central nervous system.

do not cross blood brain barrier, doesn’t penetrate the central nervous system.

Good enteric gram negative coverage; ceftazidime adds Pseudomonoas coverage but in exchange has no S. aureus coverage and likely less S. pneumoniae coverage than ceftriaxone).

NO cephalosporins have activity against Enterococcus or Listeria

Ceftriaxone can cause biliary sludging in neonates and can react with calcium in TPN formulations causing a solid precipitant in neonates

Because cefotaxime is not routinely available now, some centers are using ceftriaxone in term neonates with a normal bilirubin starting at day 14 of life.

ceftriaxone: dose dependent central nervous system penetration

Cefoxitin and Cefotetan cover anaerobes. Activity for MSSA and Group A Stretptococcus and a bit more E. coli and Klebsiella species than first generation cephalosporins

NO cephalosporins have activity against Enterococcus or Listeria: resistance is via. Cefoxitin and Cefotetan cover anaerobes

Typically will cover enteric gram negatives but in addition acceptable for Enterobacter spp, Citrobacter and Serratia spp; typically does including Pseudomonas coverage, but retains MSSA coverage. No anaerobic coverage!

NO cephalosporins have activity against Enterococcus or Listeria

No anaerobic coverage; good central nervous system penetration

Does cover for MRSA skin/soft tissue infections and pneumonia.

Think of ceftriaxone + vancomycin in one

NO cephalosporins have activity against Enterococcus or Listeria

Does not have significant anaerobic coverage

Gram negative aerobic bacteria only. Basically nothing else

Less cross-allergy with other b-lactam. No gram positive coverage and no anaerobic coverage

Gram + and negative organisms, anaerobes, very broad but often overused

Use sparingly! Drug of choice for an extended spectrum beta lactamase (ESBL) producing gram negative in the bloodstream.

dose dependent central nervous system penetration

Aerobic gram negatives (including some pseudomonas). Sometimes used in Tuberculosis treatment

Main role in therapy is for urinary tract infection, neonatal sepsis, and adjunct therapy for MDRO Gram negative rod infections

Not good for treating an abscess

Oto and nephrotoxic

poor central nervous system penetration, poor lung penetration

excellent urinary tract penetration

Gram + aerobic cocci, anaerobic organisms

Oral anaerobes

no Enterococcus, no gram negatives

High rates of C. difficile in the adult population, less in kids.

irrelevant central nervous system and urinary tract penetration

Gram positive bacteria

Drug of choice for MRSA sepsis

Plasmid mediated gene (van A) carried by Enterococcus species confers vancomycin resistance

*Less bactericidal than b-lactams

dose dependent central nervous system penetration, poor lung penetration (potentially treatment limiting in pneumonia)

Mycoplasma, Chlamydophila, Legionella, Bordatella, GAS, H. pylori, and some and some gram negative.

Not good for **azithro with more gram negative activity (h. pylori, salmonella, shigella)

Some strains of staphylococci (MSSA, MRSA), streptococci, Nocardia

Drug of choice for Stenotrophomonas

Useful oral option for ESBL-producing Gram negative bacteria

salmonella/shigella.

*Causes hypersensitivity reactions, occasionally agranulocytosis and/or thrombocytopenia

Rickettsia, Chlamydia, Ehrlichia, B. burgdorferi, mycoplasma

MSSA/MRSA

many gram negative organisms

Decreased permeability

*Generally not used (unless needed) in those under 8

MTB, S. aureus, N. meningitidis, H. influenzae, Legionella, Pseudomonas

Only needs one step to develop resistance; don’t use it alone!

Anaerobic bacteria and some protozoa (Entamoeba histolytica, Trichomonas, Giardia)

Peripheral neuropathy, GI complaints, metallic taste

Don’t use with EtOH

Gram negative organisms, including Pseudomonas (only PO option), less activity against gram + organisms; new gen more S. pneumoniae coverage

Mutations of DNA gyrase

Only po treatment of pseudomonas

Arthralgias, achilles heel rupture, peripheral neuropathy

Bacteriostatic: used mainly for prophylactic UTI

Can be used for ESBL-producing Gram negative rods

Can only use for treatment of cystitis, not a pyelonephritis

irrelevant penetration outside of urine

Gram + organisms

drug of choice for VRE, PO option for clinda-resistant MRSA

Liver toxicity, thrombocytopenia, peripheral neuropathy

Resistant gram + organisms, including for SSTI, endocarditis due to MRSA

Once-daily dosing

**elevated CPK

**caution with tobramycin, anticoagulant treatment

no activity in lung tissue, do not use for penumonia

Cryptosporidium parvum and Giardia lamblia

in vitro/ in vivo against C. difficile

3 day treatment

**GI upset main SE

Approved in children!