1

Introduction to ID
Pharmacotherapy III-Spring 2004
Joanne J. Orrick, PharmD, BCPS

NOMENCLATURE FOR COMMON AEROBIC AND ANAEROBIC BACTERIA

Gram-positive cocci (aerobic) Gram-negative bacilli (aerobic)

Staphylococci Enterobacteriaceae
Coagulase-positive Citrobacter koseri
Staphylococcus aureus Citrobacter freundii
Coagulase-negative Enterobacter cloacae
Staphylococcus epidermidis Enterobacter aerogenes
Staphylococcus saprophyticus Escherichia coli
Streptococci Klebsiella oxytoca
Streptococcus pneumoniae Klebsiella pneumoniae
Streptococcus pyogenes (Group A) Serratia marscescens
Streptococcus agalactiae (Group B) Morganella morganii
Streptococcus dysgalactiae (Group C,G) Proteus mirabilis (indole-negative)
Streptococcus bovis (Group D) Proteus vulgaris (indole-positive)
Viridans streptococci Salmonella sp.
Enterococci Shigella sp.
Enterococcus faecalis Yersinia pestis
Enterococcus faecium Pasteurella multocida
Vibrio cholerae
Gram-positive cocci (anaerobic) Acinetobacter sp.
Streptococci Burkholderia cepacia
Peptostreptococcus sp. Pseudomonas aeruginosa
Peptococcus sp. Stenotrophomonas maltophilia
Haemophilus influenzae
Gram-positive bacilli (aerobic)
Bacillus cereus Gram-negative coccobacilli (aerobic)
Bacillus anthracis Bartonella sp.
Corynebacterium diphtheriae Eikenella corrodens
Listeria monocytogenes Campylobacter jejuni
Lactobacillus acidophilus Helicobacter pylori
Gardnerella vaginalis
Nocardia asteroides
Gram-negative cocci (aerobic)
Gram-positive bacilli (anaerobic) Neisseria gonorrhoeae
Clostridium difficile Neisseria meningitides
Clostridium perfringens Moraxella catarrhalis
Clostridium tetani
Clostridium botulinum Gram-negative bacilli (anaerobic)
Bacteroides fragilis
.

“Atypical Pathogens”
Chlamydia trachomatis
Chlamydia pneumoniae
Legionella pneumophila
Mycoplasma pneumoniae
Rickettsia rickettsii
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DRUG(S) OF CHOICE FOR COMMON PATHOGENS AND ALTERNATIVES

Infecting Organism Drug(s) of first choice Alternatives

GRAM-POSITIVE COCCI
Enterococcus faecalis/faecium
endocarditis or other Ampicillin + gentamicin Vancomycin + gentamicin;
severe infections Synercid*, linezolid

UTI Ampicillin or amoxicillin Nitrofurantoin, fosfomycin

Staphylococcus aureus
penicillinase producing Penicillinase-resistant 1GC†, clinidamycin, vancomycin,
penicillin (nafcillin, oxacillin) BLIC‡, carbapenem, macrolide, FQ§,
linezolid, Synercid

methicillin-resistant Vancomycin linezolid, Synercid ,minocycline,

TMP/SMX, daptomycin

Staphylococcus epidermidis Vancomycin ± rifampin Rifampin + (TMP/SMX or FQ)

Streptococcus pyogenes Penicillin G or V Macrolide, any β-lactam

(group A)
Streptococcus pneumoniae
pen-susceptible Penicillin G or V, amoxicillin Cephalosporin, macrolide, FQ-
GP**, TMP/SMX, a tetracycline,
clindamycin
pen-intermediate High dose amoxicillin, FQ-GP**, vancomycin
penicillin G IV, ceftriaxone,
cefotaxime
pen-resistant Non-meningitis: Carbapenem
3GC††, FQ-GP**
Meningitis:
Vancomycin + (ceftriaxone
or cefotaxime) ± rifampin
GRAM-POSITIVE BACILLI

Bacillus anthracis Ciprofloxacin or Amoxicillin (if susceptible)

doxycycline (+ rifampin or
clindamycin for systemic
infections)

Clostridium perfringens Penicillin G ± clindamycin Doxycycine, carbapenem

*
Not active vs. E. faecalis
†
First generation cephalosporin
‡
Beta lactam/Beta-lactamase inhibitor combo: Augmentin, Timentin, Unasyn, Zosyn
§
Fluoroquinolone
**
Fluoroquinolone with enhanced gram-positive activity: Gatifloxacin, Levofloxacin, Moxifloxacin
††
Third generation cephalosporin
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Clostridium difficile Metronidazole Vancomycin (oral)

Listeria monocytogenes Ampicillin ± gentamicin TMP-SMX

GRAM-NEGATIVE COCCI
Neisseria gonorrhoeae Ceftriaxone, cefixime, FQ
cefpodoxime
Neisseria meningitidis Penicillin G Cefotaxime, ceftriaxone,
cefuroxime, a sulfonamide

GRAM-NEGATIVE BACILLI
Bacteroides fragilis Metronidazole Clindamycin, BLIC, carbapenem,
cefoxitin, cefotetan
Enterobacter sp. Carbapenem ± Timentin, Zosyn, cefepime,
aminoglycoside ciprofloxacin

Escherichia coli Systemic infections: Systemic infections: 1GC, 2GC,

3GC cefepime, FQ, BLIC, carbapenem,
aztreonam
UTI: TMP/SMX UTI: Ampicillin, Augmentin, FQ

Haemophilus influenzae Serious infections: Serious infections: Carbapenem

Cefotaxime or ceftriaxone

URI and bronchitis: URI and bronchitis: Azithromycin,

TMP/SMX, Augmentin, Oral clarithromycin, FQ, ampicillin (if β-
2GC or oral 3GC lactamase negative)

Legionella sp. Erythromycin or Doxycycline, TMP/SMX

azithromcyin or FQ (all ±
rifampin)
Pseudomonas aeruginosa
Urinary tract infection Ciprofloxacin AP β-lactam‡‡, aminoglycoside,
aztreonam

Other infections AP β-lactam (All usually + Imipenem, meropenem,

aminoglycoside or ciprofloxacin, aztreonam
ciprofloxacin for serious (Ertapenem not active)
infections)
Stenotrophomonas TMP/SMX Timentin, ceftazidime, minocycline
(Xanthomonas, Pseudomonas)
maltophilia
Chart adapted from 1) DiPiro et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 5th ed.,
2001 and 2) Gilbert et al, eds. The Sanford Guide to Antimicrobial Therapy, 2003

‡‡
Anti-pseudomonal beta-lactam: Timentin, Zosyn, Ceftazidime, cefepime