Antibiotics of Choice

Infecting Organism

Medication of Choice

Alternative Medications

I. AEROBIC BACTERIA

A. Gram Positive

1. Staphylococci

   a. Non-penicillinase producing

PRP

 

Parenteral Cephaloporins, Vancomycin, Clindamycin

   b. Penicillinase producing

Vancomycin

TMP/SMX

2. Streptococci

   a. Pyogenic groups A, B, C

Penicillin G –or– Penicillin V± Gentamicin

Beta Lactams (Penicillins, Cephalosporins), Erythromicin, Azithromycin

   b. Viridans

Amoxicillin/Clavulanate –or–Penicillin ± Streptomicin

Clindamycin + Ciprofloxacin,

TMP/SMX

   c. Enterococci (Group D)

Amoxicillin/Clavulanate –or–Penicillin ± Streptomicin

Clindamycin + Ciprofloxacin,

TMP/SMX

3. Pseudomonas (Strep. Pneumoniae)

Penicillin G –or–

Vancomycin ± Rifampin

Amoxicillin

B. Gram-negative cocci

1. Neisseria catarralis

Penicillin G

Ceftriaxone, Cefuroxime, Cefotaxime

2. Neisseria gonorrhoeae

Ceftriaxone –or– Cefixime –or– Cefpodoxime

Oxfloxacin, other FQs

C. Gram-negative bacilli

1.  Escherichia coli

Cephalosporin –or– FQ –or– TMP/SMX –or– APA –or– Imipenem/Cilastatin

Cephalosporin, FQ, TMP/SMX, APA, Imipenem/Cilastatin

2. Enterobacter aerogenes

Imipenem/Cilastatin –or– Meropenem –or– APP + APA

 

3. Klebsiella species

Parenteral 3rd Gen Cephalosporin –or– FQ

APA, Ticarcillin/Clavulanate, Ampicillin/Sulbactam, Piperacillin/Tazobactam

4. Pseudomonas aeruginosa

APP –or– Anti-pseudomonal Cephalosporin

 

5. Proteus

   a. P. mirabilis

Ampicillin

TMP/SMX

   b. other Proteus species

Parenteral 3rd Gen Cephalosporin –or– FQ

APA

6. Serratia species

Parenteral 3rd Gen Cephalosporin –or– Imipenem/Cilastatin –or– Meropenem –or– FQ

Aztreonam, Gentamicin

7. Salmonella typhi

FQ –or– Ceftriaxone

Chloramphenicol, Amoxicillin, TMP/SMX, Azithromycin

8. Hemophilus species

   a. H influenzae

Cefotaxime –or– Ceftriaxone

TMP/SMX, Imipenem/Cilastatin, Meropenem, FQ

   b. H. ducreyi

Azithromycin –or– Ceftriaxone

Erythromycin, Ciprofloxacin

9. Brucella species

Doxycycline

Doxycycline

10. Pasteurella species

   a. Francisella tularensis (tularemia)

Streptomycin –or– Gentamicin

Doxycycline

   b. Yersinia pestis

Streptomycin –or– Gentamicin

Doxycycline

D. Gram-positive bacteria

1. Bacillus anthracis

Penicillin G –or– Ciprofloxacin –or–  Doxycycline

Erythromycin, Chloramphenicol

2. Corynebacterium species

Vancomycin

Penicillin G + APA

3. Diphtheroid species

Antitoxin + Erythromycin

Benzyl Penicillin G, followed by Penicillin VK

4. Mycobacterium tuberculosis

Isoniazid + Rifampin + Pyrazinamide

Add Ethambutol + FQ + Amikacin

5. Listeria monocytogenes

Ampicillin

TMP/SMX

II.  ANAEROBIC BACTERIA

A. Gram-positive cocci

1. Streptococcus species

Penicillin G

Clindamycin

B. Gram-positive bacilli

1. Clostridium species

   a. C. perfringens

Penicillin G ± Clindamycin

Doxycycline

   b. C. novyi

Penicillin G ± Clindamycin

Doxycycline

   c. C. histolyticum

Penicillin G ± Clindamycin

Doxycycline

   d. C. septicum

Penicillin G ± Clindamycin

Doxycycline

   e. C. sordellii

Penicillin G ± Clindamycin

Doxycycline

   f. C. sporogenes

Penicillin G ± Clindamycin

Doxycycline

   g. C. tetani

Metronidazole –or– Penicillin G

Doxycycline

C. Bacteroides species

Metronidazole

Clindamycin, Trovafloxacin

III.  MISCELLANEOUS

A. Nocardia species

TMP/SMX –or–  Sulfonamide

Minocycline, Amoxicillin/Clavulanate

B. Fusobacterium fusiforme

Penicillin G

Clindamycin

C. Calymmatobacterium granulomatis

Doxycycline –or– TMP/SMX

Erythromycin, Ciprofloxacin

IV. ACID FAST BACILLI
A. Mycobacterium species

1. M. tuberculosis

Isoniazid + Rifampin + Pyrazinamide

 

2. M. kansasii

Isoniazid + Rifampin + Ethambutol

Isoniazid + Pyridoxine + Ethambutol + Sulfamethoxazole

3. M. avium intracellulare complex

Clarithromycin + Ethambutol + Streptomycin + Clofazimine

Clarithromycin + Rifabutin + Ethambutol

4. M. fortuitum

Surgical excision

Amikacin + Cefoxitin + Probenecid, followd by Doxycycline or TMP/SMX

5. M. marinum (balnei)

Clarithromycin

 

6. M. leprae (leprosy)

Dapsone + Rifampin

 

V. ACTINOMYCETES

A. Actinomyces israelii (actinomycosis)

Ampicillin –or– Penicillin G

Doxycycline

B. Nocardia

TMP/SMX –or– Sulfonamide (in high doses)

Minocycline

VI.  CHLAMYDIA

A. Chlamydia psittaci (psittacosis, ornithosis)

Azithromycin –or– Clarithromycin

Parenteral 3rd Gen Cephalosporin + Azithromycin

B. Chlamydia trachomatis

Doxycycline–or– Azithromycin

Erythromycin, Ofloxacin

1. (trachoma)

Azithromycin

Doxycycline, Tetracycline

2. (inclusion conjunctivitis)

Doxycycline

Erythromycin

3. (pneumonia)

Doxycycline

Erythromycin, FQ

4. (urethritis)

Doxycycline

Azithromycin

C. Lymphogranuloma venereum

Doxycycline

Erythromycin

VII.  FUNGI

A. Aspergillus

Amphotericin B –or– Itraconazole

 

B. Blastomyces dermatitidis

Amphotericin B –or– Itraconazole

Fluconazole

C. Candida species

Amphotericin B –or– Fluconazole

Increase dosages of first line agents

D. Chromomycosis

Surgical excision, then Itraconazole

Itraconazole

E. Coccidioides immitis

Amphotericin B –or– Itraconazole  Fluconazole

 

F. Cryptococcus neoformans

Amphotericin B –or– Fluconazole

Amphotericin B + Flucytosine

G. Dermatophytes (tinea)

1. Tinea infections

Erythromycin –or– Terbinifine   –or– Itraconazole –or– Fluconazole

Clindamycin 2% topical

2. Tinea versicolor

Ketoconazole

 

H. Histoplasma capulatum

1. Minor infections

Itraconazole

 

2. Severe infections

Amphotericin B

 

I. Mucor

Amphotericin B

 

J. Paracoccidioides brasiliensis

Itraconazole –or– Ketoconazole

Amphotericin B, Sulfonamide

K. Sporothrix schenckii

Itraconazole

Cutaneous: SSKI

Extracutaneous: Amphotericin B

VIII. MYCOPLASMA
Mycoplasma pneumoniae

Erythromycin –or– Azithromycin –or– Clarithromycin –or– FQ

Doxycycline

IX. RICKETTSIA

Rocky Mtn spotted fever; endemic typhus (murine); tick bite fever; typhus, scrub typhus; Q fever

Doxycycline

Chloramphenicol

X. PNEUMOCYSTIS CARINII

TMP/SMX –or– Dapsone

Clindamycin + Primaquine, Pentamidine

XI. SPIROCHETES
A. Borrelia recurrentis

(relapsing fever)

Doxycycline

Erythromycin, Penicillin G

B. Leptospira

Penicillin G

Doxycycline

C. Treponema pallidum (syphilis)

Benzathine Penicillin G

Doxycycline, Tetracycline, Ceftriaxone

D. Treponema pertenue (Yaws)

Benzathine Penicillin G

Tetracycline

XII. VIRUSES
A. Herpes simplex

Acyclovir

Famciclovir, Valacyclovir

B. Herpes zoster

Acyclovir

Famciclovir, Valacyclovir

C. Influenza A

Zanamivir

Rimantidine, Amantadine

D. Hepatitis B

Interferon Alfa

Lamivudine

E. Hepatitis C

Ribaviran

Interferon Alfa-2B

 Abbreviations / Classifications:

 APA (Anti-pseudomonal Aminoglycoside)

  •  Amikacin, Gentamicin, Netilmicin, Tobramycin

APP (Anti-pseudomonal Penicillins)

  • Piperacillin, Mezlocillin, Ticarcillin, Pipercillin/Tazobactam, Ticarcillin/Clavulanate

 FQ (Fluoroquinolones)

  •  Ciprofloxacin, Gatifloxacin, Levofloxacin, Lomefloxacin, Moxifloxacin, Ofloxacin, Pefloxacin, Sparfloxacin, Trovafloxacin

PRP (Penicillinase-Resistant Penicillins)

  • Cloxacillin, Dicloxacillin, Methlocillin, Nafcillin, Oxacillin,

1st Gen Cephalosporins:

  • Parenteral: Cefazolin

  • Oral: Cefadroxil, Cephalexin

2nd Gen Cephalosporins:

  • Parenteral: Cefoxitin, Cefuroxime

  • Oral: Cefaclor, Cefprozil, Cefuroxime acetil, Loracarbef (carbacephem classified as a cephalosporin)

 3rd Gen Cephalosporins:

  • Parenteral: Cefepime (sometimes classified as a 4th Generation), Cefoperazone, Cefotaxime, Ceftazadime, Ceftizoxime, Ceftriaxone

  • Oral: Cefdinir, Cefixime, Cefpodoxime proxetil, Ceftibuten

 SSKI: Super saturated Potassium Iodide solution

 TMP/SMX: Trimethoprim and Sulfamethoxazole

 
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