[SPECTRUM , EFFECTS AND USES]

Antibiotics
Antibiotic spectrum according
to class
1. Penicillin :
Strept. Except viridans
MSSA(Methicillin-sensitive Staphylococcus aureus)
Enterococcus
2. Ampicillin and amoxicillin :
MSSA but only with added clav. Acid/sulbactam
Strept. Except viridans
Enterococcus
Anaerobes
Gm ve but only with clav. Acid /sulbactam
3. Anti-staph penicillin (naficillin/dicloxacillin)
MSSA
Strept. Except viridans
4. Anti-pseudomonas penicillin (pipracillin/tazobactam)
MSSA
Strept. Except viridans
Enterococcus
Gm ve
Anaerobes
Pseudomonas
5. Cephalosporins 1st gen:
Gm +ve except enterococci
Gm ve
Anaerobes
6. Cephalosporins 2nd gen:
Gm +ve except enterococci
Gm ve
Anaerobes
1

Summary of classes of antibiotics in clinical use | Stanford school

of medicine

[SPECTRUM , EFFECTS AND USES]

7. Cephalosporins 3rd gen :

Gm +ve except enterococcus
Gm ve
Anaerobes
Pseudomonas : only ceftazidime(fortum)
8. Cephalosporins 4th gen:
Gm +ve except enterococci
Gm ve
Anaerobes
Pseudomonas
9. Cephalosporins 5th gen (Ceftaroline ) :
Gm +ve except enterococcus
Gm ve
MRSA
10.
Carbapenems (imipenem
/meropenem/ertapenem):
They cover all organisms except
MRSA
Vancomycin resistant enterococcus (VRE)
Acinetobacter
Atypicals
Stenotrophomonas
11.
Quinolones (ciprofloxacin)
MSSA
Gm ve
Pseudomonas
Atypicals
12.
Quinolones (levofloxacin)
Gm +ve
Gm ve
Atypicals
Anaerobes
13.
Quinolones (moxifloxacin)
Gm +ve
Gm ve
2

Summary of classes of antibiotics in clinical use | Stanford school

of medicine

[SPECTRUM , EFFECTS AND USES]

Atypicals
Anaerobes
MRSA
14.
Aminoglycosides
Used for serious aerobic gm ve infections including
pseudomonas , used with vancomycin/ lactams in
cases of endocarditis
Contraindicated in renal failure and myasthenia gravis
Ototoxic-nephrotoxic : tobramycin is the safest

Summary and notes

- Main use for cephalosporins in summary
1. 1st gen : gm +ve except MRSA
2. 2nd gen : anaerobes
3. 3rd gen : gm ve + pseudomonas (fortum only)
4. 4th gen : pseudomonas
5. 5th gen : MRSA
- Cephalosporins do not cover enterococci
- Fortum is the only 3rd gen against pseudomonas

- Imipenem and meropenem active against pseudomonas

- Imipenem doesnt cross BBB
- Imipenem is always combined with cilstatin that inhibit
human dehydropeptidas enzyme
- Carbapenems only IV route
- Ertapenem is not active against enterococcus fecalis

- Penicillin G : strept A/B, strept pneumonia

- Ampicillin/amoxicillin : strept A/B , strept pneumonia ,
enterococcus fecalis, listeria
- Ampicillin/amoxicillin + clav. Acid/sulbactam: MSSA, strept
A/B, strept pneumonia , enterococcus fecalis, listeria
3

Summary of classes of antibiotics in clinical use | Stanford school

of medicine

[SPECTRUM , EFFECTS AND USES]

- Anti-staph penicillins : MSSA mostly

- Anti-pseudomonal penicillins : MSSA, strept A/B, strept
pneumonia, enterococcus fecalis
- Quinolones : strept A/B, strept pneumonia , enterococcus
fecalis
- Quinolones are bactericidal antibiotics mostly and dont
cross BBB

- Macrolides : weak cover for strept A/B , pneumonia , listeria

- Tetracyclines : strept pneumonia
- Sulpha : MSSA, strept A/B, strept pneumonia , strept viridans
, listeria
- Clindamycin : strept A/B, strept pneumonia , anaerobes

Generally preferred drugs for gm

+ve organisms
MSSA
Coagulase-ve
staph
Strept A/B
Strept
pneumonia
Strept viridans
Enterococcus
fecalis
Enterococcus
4

Naficillin
Cefazolin
Vanco
Naficilli
Vanco
Carbapenems
Penicillin + clindamycin for A
Any lactams
Vanco
Penicillin G
Any lactams
Vanco
Penicillin G
Ceftriaxone
Vanco
Ampicillin
Penicillin G
Vanco
Ampicillin

Summary of classes of antibiotics in clinical use | Stanford school

of medicine

[SPECTRUM , EFFECTS AND USES]

facium
listeria

NB:
-

Penicillin G
Vanco
Ampicillin gentamicin
Sulpha
Carbapenems

Staph = naficillin (except MRSA)

Strept = penicillin G / ceftriaxone
Enterococcus/listeria = ampicillin
For cases of severe allergy against ampicillin , vanco is a
good choice

Resistant bacteria
Risk factors:
- Recent excess use of cephalosporins/quinolones for MRSA or
vanco for VRE
- Longterm hospitalization
- Hemodialysis
Drug of choice:
- Vancomycin :
MRSA
Side effects: red man syndrome , nephrotoxic ,
ototoxic ,neutropenia
Poor BBB crossing
- Daptomycin:

MRSA

VRE

Side effects : myopathy , neuropathy , esinophilia

- Linezolid:
MRSA
VRE
5

Summary of classes of antibiotics in clinical use | Stanford school

of medicine

[SPECTRUM , EFFECTS AND USES]

Side effects : lactic acidosis , serotonin syndrome

,neuropathy, optic neuritis
- Ceftaroline

Generally preferred drugs for gm ve

organisms
2nd gen cephalosporins

3rd gen cephalosporins

4th gen cephalosporins

Amoxicillin/ampicillin+ clav.
Acid/sulbactam
Anti-spseudomonal penicillins
Carbapenems
Aztreonam
Quinolones
Aminoglycosides

E-coli
H.influenza
Klebsiella
Proteus
The same+
Neisseria
- The same
+citrobacteria and
neisseria
- As 3rd gen
-

As 4th gen
As 4th gen
As 2nd gen
All except Neisseria
All except neisseria

Resistant negative
strains
Pseudomonas mainly
Others: stenotrophomonas ,ESBL

Drug of choice:
6

Summary of classes of antibiotics in clinical use | Stanford school

of medicine

[SPECTRUM , EFFECTS AND USES]

Ceftazidime : pseudomonas , only one in 3rd gen

Cefipime: pseudomonas , false +ve coombs test
Pipracillin/tazobactam: pseudomonas , PLT
Carbapenems except ertapenem : pseudomonas and ESBL

- Aztreonam : weak anti-pseudomonal

- Aminoglycosides : pseudomonas , poor lung
penetration , ototoxic , nephrotoxic
NB:
1. Ciprofloxacin & levofloxacin have good anti-pseudomonal
activity
2. Ampicillin sulbactam has good cover for acinetobacter
3. Sulpha is good for stenotrophomonas and can be used if no
contraindications

Generally preferred drugs for

anaerobic infections
When should we cover anaerobes even if theres no growth?
-

periodontal infections
Infections of deep spaces of neck
Aspiration pneumonia
Lung abscess
Empyema
Intra-abdominal abscess
Secondary peritonitis

metronidazole
carbapenems
lactams + clav.
Acid/sulbactam
7

Bacteroids
Clostridia
Metallic taste
Fair for all organisms but
ertapenem is not preferred
- Fair against all organisms
- PLT

Summary of classes of antibiotics in clinical use | Stanford school

of medicine

[SPECTRUM , EFFECTS AND USES]

clindamycin
2nd gen cephalosporins
moxifloxacin

chloramphenicol

Fair for all organisms

Q 6hrs compliance
Fair against all
Fair against actinomyces
QT prolongation
Not recommended for
pediatrics
- Excellent against all except
c. difficile

NB:
- If infection above diaphragm use clindamycin
- If infection below diaphragm use metronidazole
- If generalized use lactams + clav. Acid/sulbactams
&moxifloxacin
- Metronidazole should never be used as monotherapy except
for c. difficile that is the most common cause for infection
colitis due to antibiotic use
- Most gut flora is gm ve
- Vanco can be used for TTT of c. difficile but only oral because
IV route is poorly absorbed in GIT

Generally preferred drugs for

atypical organisms
Mycoplasma pneumonia
Chlamydia trachomatis

Chlamydophila pneumonia
Chlamydophila pisittaci
rickettsia
legionella
8

Atypical pneumonia
PID
Urethritis
Prostatitis
Pneumonia in neonates
Atypical pneumonia
Bird transmission
Typhus
Atypical pnemonia

Summary of classes of antibiotics in clinical use | Stanford school

of medicine

[SPECTRUM , EFFECTS AND USES]

Drug of choice:
1. Macrolides :
all except rickettsia
Side effects : QT prolongation , hepatic injury ,
exacerbate myasthenia gravis
2. Tetracycline :
all except legionella
Side effects: esophagitis , hyperpigmentation
Should be taken with plenty of fluids
3. Quinolones:
for all except rickettsia
Side effects : QT prolongations , exacerbate myasthenia
gravis
4. Chloramphenicol:
for all except legionella
Side effects : aplastic anemia

mycoplasma

chlamydia

rickettsia

legionella

Doxycycline
Azithromycin
Quinolones
Doxycycline
Azithromycin
Levofloxacin
Doxycycline
Azithromycin
Quinolones
Levofloxacin
Moxifloxacin
Azithromycin

Summary of classes of antibiotics in clinical use | Stanford school

of medicine

[SPECTRUM , EFFECTS AND USES]

Key
means
excellent
activity
means good
activity
means not
always active

1
0

Summary of classes of antibiotics in clinical use | Stanford school

of medicine