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
orPenicillin
Streptomicin
Clindamycin +
Ciprofloxacin,
TMP/SMX
c. Enterococci (Group D) Amoxicillin/Clavulanate
orPenicillin
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 3
rd
Gen
Cephalosporin or FQ
APA,
Ticarcillin/Clavulanate,
Ampicillin/Sulbactam,
Piperacillin/Tazobactam
4. Pseudomonas APP or Anti-
aeruginosa pseudomonal
Cephalosporin
5. Proteus
a. P. mirabilis Ampicillin TMP/SMX
b. other Proteus species
Parenteral 3
rd
Gen
Cephalosporin or FQ
APA
6. Serratia species
Parenteral 3
rd
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 3
rd
Gen
Cephalosporin +
Azithromycin
B. Chlamydia trachomatis Doxycyclineor Erythromycin, Ofloxacin
Azithromycin
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);
Doxycycline Chloramphenicol
tick bite fever; typhus,
scrub typhus; Q fever
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,
1
st
Gen Cephalosporins:
Parenteral: Cefazolin
Oral: Cefadroxil, Cephalexin
2
nd
Gen Cephalosporins:
Parenteral: Cefoxitin, Cefuroxime
Oral: Cefaclor, Cefprozil, Cefuroxime acetil, Loracarbef (carbacephem classified
as a cephalosporin)
3
rd
Gen Cephalosporins:
Parenteral: Cefepime (sometimes classified as a 4
th
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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