| PENICILLINS | CEPHALOSPORINS | FLUOROQUINOLONES | AMINOGLYCOSIDES | MONOBACTAMS | CARBAPENEMS | MACROLIDES | OTHER |
|---|---|---|---|---|---|---|---|
| Natural Penicillin G Penicillin | First generation Cephalothin Cefazolin (Ancef, Kefzol) Cephapririn Cephalexin (Keflex) | Ciprofloxacin (Cipro) Levofloxacin (Levaguin) Moxifloxacin (Avelox) Norfloxacin | Amikacin Gentamicin Kanamycin Neomycin Tobramycin | Aztreonam | Ertapenem Imienem Meropenem | Azithromycin Clarithromycin Dirithromycin Erythromycin Clindamycin | Vancomycin Rifampin Doxycycline Linezolid Tetracycline Trimethoprim/ sulfamethoxacole |
| Penicillinase Resistant Methicillin Nafcillin Oxacillin other | Second Generation Cefacor Cefotetan (Cefotan) other | ||||||
| Aminopenicillins Ampicillin | Third Generation Ceftriaxone (Rocephin) other | ||||||
| Fourth Generation Cefpirome Cefepime |
Grouping by Mechanism
| Cell Wall Synthesis | Penicillins Cephalosporins Vancomycin Beta-lactamase Inhibitors Carbapenems Aztreonam Polymycin Bacitracin |
| Protein Synthesis Inhibitors | Inhibit 30s Subunit Aminoglycosides (gentamicin) Tetracyclines Inhibit 50s Subunit Macrolides Chloramphenicol Clindamycin Linezolid Streptogramins |
| DNA Synthesis Inhibitors | Fluoroquinolones Metronidazole |
| RNA synthesis Inhibitors | Rifampin |
| Mycolic Acid synthesis inhibitors | Isoniazid |
| Folic Acid synthesis inhibitors | Sulfonamides Trimethoprim |
Cell wall synthesis (beta-lactams)
Penicillins
(bactericidal: blocks cross linking via competitive inhibition of the transpeptidase enzyme)
| Class/Mechanism | Drugs | Indications (**Drug of Choice) | Toxicity |
|---|---|---|---|
| Penicillin | Penicillin G Aqueous penicillin G Procaine penicillin G Benzathine penicillin G Penicillin V | Strep. pyogenes (Grp.A)** Step. agalactiae (Grp.B)** C. perfringens(Bacilli)** | Hypersensitivity reaction Hemolytic anemia |
| Aminopenicillins | Ampicillin Amoxicillin | Above + ? Gram-negative: E. faecalis** E. Coli** | Above |
| Penicillinase-resistant-penicillins | Methicillin Nafcillin Oxacillin Cloxacillin Dicloxacillin | Above + PCNase-producingStaph. aureus | Above + Interstitial nephritis |
| Antipseudomonal penicillins | Carbenicillin Ticarcillin Piperacillin | Above + Pseudomonas aeruginosa** | Above |
| Cephalosporins | |||
| (bactericidal: inhibits bacterial cell wall synthesis via competitive inhibition of the transpeptidase enzyme) |
| Class/Mechanism | Drugs | Indications (**Drug of Choice) | Toxicity |
|---|---|---|---|
1st generation | Cefazolin Cephalexin | Staph. aureus** Staph. epidermidis** Some Gram-negatives: E. Coli Klebsiella | Allergic reaction Coombs-positive anemia (3%) |
| 2nd generation | Cefoxitin Cefaclor Cefuroxime | Above + ? Gram-negative | Allergic Reaction ETOH Disulfiram reaction |
| 3rd generation | Ceftriaxone Cefotaxime Ceftazidime Cefepime (4th generation) | Above + ? Gram-negative Pseudomonas | Allergic Reaction ETOH Disulfiram reaction |
| Other Cell Wall Inhibitors |
| Indications (**Drug of Choice) | Toxicity | ||
|---|---|---|---|
| Vancomycin (bactericidal: disrupts peptioglycan cross-linkage) | Vancomycin | MRSA** PCN/Ceph allegies** S. aureus S. epidermidis | Red man syndrome Nephrotoxicity Ototoxicity |
| Beta-lactamase Inhibitors (bactericidal: blocking cross linking) | Clavulanic Acid Sulbactam Tazobactam | S aureus** S epidermis** E.Coli** Klebsiella** | Hypersensitivity Reaction Hemolytic anemia |
| Carbapenems | Imipenem (+ cilastatin) Meropenem Doripenem Ertapenem | Broadest activity of any antibiotic (except MRSA, Mycoplasma) | |
| Aztreonam | Aztreonam | Gram-negative rods Aerobes Hospital-acquired infections | |
| Polymyxins | Polymyxin B Polymyxin E | Topical Gram-negative infections | |
| Bacitracin | Bacitracin | Topical Gram-positive infections | |
| Protein Synthesis Inhibition |
Protein synthesis inhibition
Anti-30S ribosomal subunit
| Indications (**Drug of Choice) | Toxicity | ||
|---|---|---|---|
| Aminoglycosides (bactericidal: irreversible binding to 30S) | Gentamicin Neomycin Amikacin Tobramycin Streptomycin | Aerobic Gram-negatives Enterobacteriaceae Pseudomonas | Nephrotoxicity Ototoxicity |
| Tetracyclines (bacteriostatic: blocks tRNA) | Tetracycline Doxycycline Minocycline Demeclocycline | Rickettsia Mycoplasma Spirochetes(Lyme’s disease) | Hepatotoxicity Tooth discoloration Impaired growth Avoid in children < 12 years of age |
| Anti-50S ribosomal subunit |
| Indications (**Drug of Choice) | Toxicity | ||
|---|---|---|---|
| Macrolides (bacteriostatic: reversibly binds 50S) | Erythromycin Azithromycin Clarithromycin | Streptococcus H. influenzae Mycoplamsa pneumonia | Coumadin Interaction (cytochrome P450) |
| Chloramphenicol (bacteriostatic) | Chloramphenicol | H influenzae Bacterial Meningitis Brain absces | Aplastic Anemia Gray Baby Syndrome |
| Lincosamide (bacteriostatic: inhibits peptidyl transferase by interfering with amino acyl-tRNA complex) | Clindamycin | Bacteroides fragilis S aureus Coagulase-negative Staph & Strep Excellent Bone Penetration | Pseudomembranous colitis Hypersensitivity Reaction |
| Linezolid (variable) | Linezolid | Resistant Gram-positives | |
| Streptogramins | Quinupristin Dalfopristin | VRE GAS and S. aureus skin infections |
DNA Synthesis Inhibitors
Fluoroquinolones
(bactericidal: inhibit DNA gyrase enzyme, inhibiting DNA synthesis)
| Indications | Toxicity | ||
|---|---|---|---|
| **1st generation | Nalidixic acid | Steptococcus Mycoplasma Aerobic Gram + | Phototoxicity Achilles tendon rupture Impaired fracture healing |
| 2nd generation | Ciprofloxacin Norfloxacin Enoxacin Ofloxacin Levofloxacin | As Above +Pseudomonas | as above |
| 3rd generation | Gatifloxacin | As above + Gram-positives | as above |
| 4th generation | Moxifloxacin Gemifloxacin | As above + Gram-positives + anaerobes | as above |
| Other DNA Inhibitors |
| Indications | Toxicity | ||
|---|---|---|---|
| Metronidazole(bacteridical: metabolic biproducts disrupt DNA) | Metronidazole (Flagyl) | Anaerobics | Seizures Crebelar dysfunction ETOH disulfram reaction |
RNA Synthesis Inhibitors
| Rifampin(bactericidal: inhibits RNA transcription by inhibiting RNA polymerase) | Rifampin | Staphylococcus Mycobacterium(TB) | Body fluid discoloration Hepatoxicity (with INH) |
Mycolic Acids Synthesis Inhibitors
| Isoniazid | Isoniazidz | TB Latent TB |
Folic acid Synthesis Inhibitors
| Trimethoprim/Sulfonamides (bacteriostatic: inhibition with PABA) | Trimethoprim/Sulfamethoxazole (SMX) Sulfisoxazole Sulfadiazine | UTI organisms Proteus Enterobacter | Thrombocytopenia Avoid in third trimester of pregnancy |
| Pyrimethamine | Pyrimethamine | Malaria T. gondii |