Imipenem
Carbapenem (P) (Needs to be paired with Cilastatin to inhibit dehydropeptidase)
G+:
G-:
Anaerobes:
SMAC are RESISTANT
Spirochete, MRSA, Atypicals, C diff
Meropenem
Carbapenem (P)
G+:
G-:
Anaerobes:
SMAC are RESISTANT
Spirochete, MRSA, Atypicals, C diff
Ertapenem
Carbapenem (P)
G+:
G-:
Anaerobes:
SMAC APE are RESISTANT
Spirochete, MRSA, Atypicals, C diff, Acinetobacter, Pseudomonas, Enterococcus
Aztreonam
Monobactam (P)
G- (ONLY):
Alternative for AG’s in G- infections
NO GRAM POS OR ANAEROBE ACTIVITY
Vancomycin
Vancomycin (P) (ORAL FORMULATION FOR C DIFF)
Bacteriocidal: Prevent Transglycosylation and subsequent transpeptidation reaction
G+:
Anaerobes:
Televancin
Televancin (P) (reserve for resistant gram positives)
Bacteriocidal: Like vancomycin (prevents transglycosylation) but also disrupts bacterial membane
G+:
Anaerobes:
Bacitracin
Bacitracin (T) (often combined with Neomycin or Polymixin topically)
Topically for Skin and Occular (Oral for C Diff Colitis RARELY)
Block step 2 of CWS with Blocking Bactoprenol Phosphate
G+:
G-:
Anaerobes:
Fosfomycin
Fosfomycin (O)
Similar to Phosphoenolpyruvate structurally; ireversibly inhibits Enolpyruvate transferase- blocks synthesis of UDP MurNAc (step 1)
Used Primarily for UTIs (good distribution to bladder, kidneys, prostate and seminal vess)
Tobramycin
Aminoglycoside (poorly absorbed in stomach and intestines) (more expensive then Genta)
Bactericidal: Irreversible binding to the 30S subunit to inhibit INITIATION
Reserved for serious G- infections resistant to less toxic drugs (Aminoglycosides have best action against aerobic gram - but are also often more toxic)
G+:
G-:
INEFECTIVE AGAINST ANAEROBES and ENTEROCOCCI
Amikicin
Aminoglycoside
Reserved for organisms resistant to other AGs (more resistant to drug modifying enz)
G+:
G-:
INEFECTIVE AGAINST ANAEROBES and ENTEROCOCCI
Neomycin
Aminoglycoside (T) (Most Nephrotoxic so limited to Topical use w/ bacitracin and polymixin)
Used as PROPHYLAXIS FOR COLORECTAL SURGERY (HSR with long term use)
Gram + and Gram -
BUT NO ANAEROBES
Gentamicin
Aminoglycoside
G+:
G-:
INEFFECTIVE AGAINST ANAEROBES
Streptomycin
Aminoglycoside
Least toxiv but also least active against G- and resistance is developed quickly
G+:
G-:
INEFFECTIVE AGAINST ANAEROBES AND PSEUDOMONAS
Tetracycline
Tetracyclines (O) (food decreases absorption)
Broad Spectrum
Bacteriostatic: reversibly binds to the a site of 3Os inhibiting ELONGATION
Absorption is decreased by Polyvalent cations
G+:
G-:
Anaerobes:
Biological Warfare:
Spirochetes:
Atypicals
Rickettsiae:
Mycobacteria:
PSEUDOMONAS AERUGINOSA (HAS INTRINSIC RESISTANCE)
Doxycycline
Tetracyclines (O,P) (Hepatic) (Food does NOT decrease absorption)
Broad Spectrum
Bacteriostatic: reversibly binds to the a site of 3Os inhibiting ELONGATION
Absorption is decreased by Polyvalent cations
G+:
G-:
Anaerobes:
Biological Warfare:
Spirochetes:
Atypicals
Rickettsiae:
Mycobacteria:
PSEUDOMONAS AERUGINOSA (HAS INTRINSIC RESISTANCE)
Minocycline
Tetracyclines (O,P) (food does NOT decrease absorption)
Broad Spectrum
Bacteriostatic: reversibly binds to the a site of 3Os inhibiting ELONGATION
Absorption is decreased by Polyvalent cations
G+:
G-:
Anaerobes:
Biological Warfare:
Spirochetes:
Atypicals
Rickettsiae:
Mycobacteria:
PSEUDOMONAS AERUGINOSA (HAS INTRINSIC RESISTANCE)
Tigecycline
Tetracyclines (P) (Biliary)
Broad Spectrum
Bacteriostatic: reversibly binds to the a site of 3Os inhibiting ELONGATION BUT IT BINDS WITH 5X THE AFFINITY OF TETS
Additional coverage to tetracyclines
SAME AS TETRACYCLINES BELOW
G+:
G-:
Anaerobes:
Biological Warfare:
Spirochetes:
Atypicals
Rickettsiae:
Mycobacteria:
PSEUDOMONAS AERUGINOSA (HAS INTRINSIC RESISTANCE)
Erythromycin
Macrolides (absorption dec by food) (all macrolides billiary)
Bacteriostatic: Binds 50S and blocks translocation (macro slide prevents sliding)
G+:
G-:
Atypicals:
Rickettsieae
Spirochetes:
Anaerobes:
Azitromycin
Macrolides (absorption dec by food) (all macrolides billiary)
Bacteriostatic: Binds 50S and blocks translocation (macro slide prevents sliding)
ERythro (seen below) Plus
G+:
G-:
Atypicals:
Rickettsieae
Spirochetes:
Anaerobes:
Clarithromycin
Macrolides (absorption IS DELAYED BY FOOD NOT DEC) (all macrolides billiary)
Bacteriostatic: Binds 50S and blocks translocation (macro slide prevents sliding)
ERythro (seen below) Plus
G+:
G-:
Atypicals:
Rickettsieae
Spirochetes:
Anaerobes:
Clindamycin
Lincosamide (absorption not affected by food) (Unchanged when renally excreted)
Bacteriostatic: binds 50S to block Initiation complex AND block translocation step
G+:
Anaerobes:
NO GRAM NEGATIVE EFFECT DUE TO INEFFICIET PORIN PENETRATION
Chloramphenicol
Chloramphenicol (P) (inactivated by glucuronosyl transferase host enzyme) abosrbed well in gut (last resort drug rarely used in US)
Bacteriostatic: binds to 50S to block Petidyl transferase and prevent peptide bond formation
chloRAMPHEnicol
Sulfamethoxazole
Sulfonamide (O) (broad spectrum) (almost always combo therapy with DHFI) (low solubitiy=Crystalluria)
Competitively inhibits Dihydropteroate Synthase as a structural anolog of PABA to block folate synthesis (needed to synth purines to incorporate into DNA
G+:
G-
Sulfisoxazole
Sulfonamide (O) (broad spectrum) (almost always combo therapy with DHFI) (Highly soluble little renal toxicity)
Competitively inhibits Dihydropteroate Synthase as a structural anolog of PABA to block folate synthesis (needed to synth purines to incorporate into DNA
(COMBO WITH ERYTHROMYCIN FOR OTITIS MEDIA IN KIDS)
G+:
G-