PCN’s G+ G- A MRSA PsA Inhibit peptidoglycan cross linking in cell walls

PCN + Not staph

Amp/Amox + ?
Oxacillin/Diclox + Sensitive staph

1st gen Cephalosporins Less susceptible to B lactamases

Cefazolin/Cephelexin + + Sensitive staph. Gram - ESBL are resistant
2nd gen
Cephalosporins
Cefuroxime + + +
3rd gen
Ceftriaxone + + +
Cefotaxime + + +
Cefpodoxime PO + +
Ceftazadime + + ? +
4th gen
Cefepime + + +

Carbapenems Highly resistant to B lactamases;Lowers seizure threshold

Imipenem + ++ + +
Ertapenem + ++ + No PsA!
Meropenem + ++ + +

Combinations Combo with B lactamase inhibitor

Amox/Clavulanate + + +
(Augmentin)
Amp/Sulbactam + + +
(Unasyn)
Pip/Tazo (Zosyn) + + + +

Aztreonam + + Binds only Gram – penicillin binding proteins

Macrolides Inhibits bacterial tRNA and ribosome translocation
Azithromycin + + atypicals
Clarithromycin + +
Erythromycin +? +

Quinolones Inhibit bacterial DNA gyrase and topoisomerase. Watch INR. CDif.
Levofloxacin + ++ + And atypicals
Ciprofloxacin + ++ +
Moxifloxacin + ++
Gatifloxacin + ++ +

Tetracyclines Binds ribosome, inhibits tRNA binding. Photosensitivity!

Doxycycline + + + + And most atypical (not Legionella)

Aminoglycosides Binds ribosome, inhibis protein synthesis. Nephrotoxic, ototoxic

Gent + +
Tobra + +
Neomycin Not absorbed

Vancomycin ++ ? + Inhibits cell wall synthesis. 15mg/kg bid (less if renal insuff); Redman
Clindamycin + + ? Binds ribosome, inhibits tRNA and ribosomes (like macrolides).
Metronidazole + Taken up by anerobes, forms toxic metabolites. Peripheral neuropathy
Linezolid ++ ? + Prevents initiation complex of ribosomes. Marrow toxicity
Daptomycin ++ + Binds to cell membranes, depolarizes, cell death. VRE.
Tigecycline ++ + + + Binds ribosome, prevents translocation.
Nitrofurantoin + + Toxic metabolites. e. coli only
Rifampin + + Inhibits bacterial RNA polymerase. Neiserria
Trimethoprim/Sulfa + + + Inhibits successive steps in folate synthesis. Increases Cr but not
nephrotoxic