lOMoARcPSD|27034002

ANTIBIOTICS CHEAT SHEET

Mechanisms of action of antimicrobial agents.
Beta-lactams- penicillins, cephalosporins, carbapenems, bacitracin, vancomycin, monobactam,
Cell wall synthesis
lipoglycopeptides, lipopeptides
Protein synthesis chloramphenicol, tetracyclines, aminoglycosides, macrolides, lincosamides, oxazolidinones
Cell membrane polymyxins
Nucleic acid function quinolones
Intermediary metabolism sulfonamides, trimethoprim

Inhibitors of Folate Synthesis:

 Sulfonamides- alteration of dihydropteroate

synthase
 Trimthoprim- inhibition of dihydrofolate
reductase.

Downloaded by Razvan Rosca (rosca.razvan.2011@gmail.com)

 lOMoARcPSD|27034002

ANTIBIOTICS CHEAT SHEET

Spectrum of Activity

Broad Spectrum- ex: tetracyclines, carbapenems, 3rd gen quinolones, 2nd/3rd/4th gen cephalosporins, chloramphenicol,
PCN w/beta-lactamase inhibitors

Narrow Spectrum- ex: glycopeptides, bacitracin, aminoglycosides, sulfonamides, penicillin, lincosamides, macrolides,
vancomycin, aztreonam

*Think about what the ABX covers and the more it covers, the broader it is when treating infections.

Atypical Coverage: Pseudomonas Coverage:

Macrolides Ciprofloxacin, Levofloxacin

Tetracyclines Aminoglycosides
Quinolones Some 3rd Gen Cephalosporins
Chloramphenicol Cefepime (4th Gen Cephalosporin)
Ampicillin Broad Spectrum PCN (Ticarcillin,
Piperacillin)

Overview of Antibiotics

PCN Spectrum

Ticarcillin/clavulanate Amoxicillin & Ampicillin Amoxicillin Nafcillin Pen V (Natural)

Piperacillin/tazobactum (w/ beta-lactamase inhibitor) Ampicillin Oxacillin
Cloxacillin *Gm +
*Gm +/-, ESBL, Pseudomonas *Gm +/-, MSSA, Gm- anaerobes *Gm +/- Dicloxacillin

Penicillins *Gm +, MSSA

 Time-dependent killing and are bactericidal, except

against Enterococci species. No atypical coverage.
 Coverage:
o Natural PCN- Gram +, Enterococcus and anaerobes, Little Gram -
o Aminopenicillins- Adds activity against Gram – (HNPEK) *Haemophilus, Neisseria,
Proteus, E.coli, Klebsiella

Narrow
o Additional of beta lactamase inhibitor- Adds activity against MSSA, more Gram -, Gram – Anaerobes
o Antipseudomonal PCN (extended-spectrum PCN)- very broad coverage with expanded Gram -, Pseudomonas aeruginosa
o Antistaphylococcal PCN- enhanced activity with MSSA, lack Enterococcus activity
 DDI:
o Probenecid can ↑ levels of PCN
o Bacteriostatic antibiotics (ex: tetracyclines) can ↓ effectiveness of PCN
o ↑ levels of methotrexate
o ↓ levels of mycophenolate active metabolites
o Nafcillin is a moderate CYP3A4 inhibitor
o Dicloxacillin & nafcillin can ↓ INR through ↑ metabolism of warfarin

Downloaded by Razvan Rosca (rosca.razvan.2011@gmail.com)

 lOMoARcPSD|27034002

ANTIBIOTICS CHEAT SHEET

Cephalosporins
 Time-dependent killing and are bactericidal. Not active against Enterococcus, atypicals, Listeria, MRSA (except 5th Generation (LAME).
 Coverage:
o 1st- Excel against Gram + (preferred cephalosporin against MSSA)
2nd- Split into 2 groups 1) Cefuroxime like agents cover more resistant S.pneumoniae, HNPEK; 2) Cephamycin drugs (Cefotetan,
Cefoxitin) have added anaerobic coverage
o 3rd- Ceftriaxone, Cefotaxime and oral drugs cover more resistant Streptococci and more Gram -; Ceftazidime lacks Gram + and covers
Pseudomonas
o 3rd w/beta lactamase inhibitor combo- added activity against MDR Pseudomonas and Gram -
o 4th- broad Gram -, including Pseudomonas, Gram +
o 5th- only beta-lactam with MRSA activity
 DDI:
o Probenecid can ↑ levels of cephalosporins
o Enhance anticoagulant effect of warfarin by inhibiting production of clotting factors
o Drugs that ↓ stomach acid can ↓ bioavailability of some cephalosporins

Carbapenems
 Time-dependent killing and are bactericidal. Not active against atypical, MRSA, VRE.
 Coverage:
o VERY BROAD COVERAGE “BIG GUN”, generally used for MDR Gram -, most Gram +, Gram – (including ESBL producing bacteria),
anaerobes
o Ertapenem is different and has NO activity against Pseudomonas, Acinetobacter or Enterococcus
 DDI:
o Probenecid can ↑ levels of cephalosporins
o ↓ levels of valproic acid leading to a loss of seizure control
o Use in caution in patients at risk for seizures

Monobactam
 Aztreonam (similar to ceftazidime); acts like a beta-lactam, but it’s not…like splenda to sugar
 Structure makes cross-reactivity with beta-lactam allergy unlikely, primarily used when beta-lactam allergy is present.
 Coverage:
o Similar to Ceftazidime lacks Gram +, covers Gram - and covers Pseudomonas

Aminoglycosides
 Concertation dependent killing and has post-antibiotic effect. Can use extended dose interval nomograms.
 Coverage:
o Gram -, Pseudomonas
 DDI:
o Use in caution with patients with impaired renal function

Quinolones
 Concertation dependent killing and are bactericidal.
 Coverage:
o Broad spectrum (Gram +, Gram -, Atypicals)

Downloaded by Razvan Rosca (rosca.razvan.2011@gmail.com)

 lOMoARcPSD|27034002

ANTIBIOTICS CHEAT SHEET

o Gemifloxacin, Levofloxacin, Moxifloxacin (GLM)- respiratory quinolones due to enhanced coverage of S.pneumoniae and atypical
coverage
o Ciprofloxacin, Levofloxacin- enhanced Gram -, including Pseudomonas
o Moxifloxacin- enhanced Gram + and anaerobic
 DDI:
o Products contained multivalent cations (ex: antacids, vitamins, calcium rich foods) can chelate and inhibit absorption
o ↑ effects of warfarin, sulfonylureas/insulin and QT-prolonging drugs (moxifloxacin prolongs QT interval the most)
o Probenecid and NSAIDs can ↑ quinolone levels
o Ciprofloxacin is a P-gp substrate, strong 1A2 inhibitor and weak 3A4 inhibitor

Macrolides
 Bacteriostatic activity related to total exposure of the drug (AUC/MIC).
 Coverage:
o Good Atypical activity
 DDI:
o Erythromycin and clarithromycin are 3A4 inhibitors and substrates
o Azithromycin is a substrate for 3A4 and inhibitor of 1A2 and P-gp; it has fewer drug interactions
o ALL MACROLIDES: DO NOT USE WITH AGENTS THAT CAN PROLONG THE QT INTERVAL

Tetracyclines
 Bacteriostatic activity related to total exposure of the drug (AUC/MIC).
 Coverage:
o Many Gram +, Gram -, including respiratory flora
o Doxy- used in mild MRSA skin infections, VRE in UTI
o Mino- enhanced Gram + and preferred for skin infections (acne)
o Tetra- rarely used, can be used in H.pylori regimens
 DDI:
o Absorption is impaired by medications that contain divalent cations
o Tetracycline is a substrate of 3A4 and an inhibitor
o Doxycycline is a weak 3A4 inhibitor
o Enhance the anticoagulant effect with warfarin

Sulfonamides
 Individually they are bacteriostatic, but collectively they are bactericidal. Lacks Pseudomonas, Enterococci, atypical or anaerobic coverage.
 Coverage:
o Gram +, including Staphylococci/MRSA, many Gram –
 DDI:
o Inhibitors of 2C8/9
o Cause ↑ INR with warfarin
o ↑ levels of sulfonylureas, metformin, phenytoin, dofetilide, azathioprine, methotrexate and mercaptopurine
o Levels of SMX/TMP can be ↓ by 2C8/9 inducers
o ↑ in hyperkalemia when used with ACE inhibitors, ARBs, aliskiren, potassium-sparing diuretics, cyclosporine, tacrolimus and more

Glycopeptide
 Vancomycin
 Coverage:
o Gram +, MRSA, Streptococci, Enterococci (not VRE), C.difficile
 DDI:
o ↑ toxicity of other nephrotoxic drugs and ototoxic drugs

Lipoglycopeptide
 Concentration-dependent killing and are bactericidal; (similar to Vancomycin, but have extended MOA)
 Coverage:

Downloaded by Razvan Rosca (rosca.razvan.2011@gmail.com)

 lOMoARcPSD|27034002

ANTIBIOTICS CHEAT SHEET

o Gram +, MRSA, Streptococci, Enterococci (not VRE), C.difficile
 DDI:
o Telavancin- cause QT prolongation

Daptomycin (Cubicin)
 Concentration-dependent killing and are bactericidal.
 Coverage:
o Gram +, MRSA, Streptococci, Enterococci, including VRE, *same coverage as Vancomycin but covers more organisms
 DDI:
o Additive risk of muscle toxicity with statins

Oxazolidinones
 Bacteriostatic activity.
 Coverage:
o Gram +, MRSA, Streptococci, Enterococci, including VRE, *same coverage as Vancomycin but covers more organisms
 DDI:
o Weak MAOI (caution in patients taking concurrent serotonergic or adrenergic drugs
o Avoid tyramine-containing foods
o Can exacerbate hypoglycemic episodes

Polymyxins
 Concentration-dependent killing and bactericidal. Use in combo with another antibiotic due to the emergence of resistance.
 Coverage:
o Gram -, Pseudomonas, used primarily with MDR Gram – pathogens
 DDI:
o Other nephrotoxic agents can enhance nephrotoxicity

Chloramphenicol
 Bactericidal
 Coverage:
o Gram +, Gram -, anaerobes and atypicals

Lincosamides
 Bacteriostatic
 Coverage:
o Most aerobic and anaerobic Gram +, some MRSA, does not cover Enterococcus

Urinary Agents
 Fosfomycin (Monurol)- inhibits bacterial cell wall synthesis by inactivating the enzyme pyruval transferase; bactericidal
 Coverage:
o E.coli (including ESBLs) and E.faecalis (including VRE)
 Nitrofurantoin (Macrodantin, Macrobid, Furadantin)- bacterial cell wall inhibitor; bactericidal
 Coverage:
o E.coli, Klebsiella, Enterobacter, S.aureus, Enterococcus (VRE)

Downloaded by Razvan Rosca (rosca.razvan.2011@gmail.com)

 lOMoARcPSD|27034002

ANTIBIOTICS CHEAT SHEET

Side Effect Chart (list not all inclusive)

PCN Caution w/ anaphylaxis allergy, GI upset, diarrhea, rash, ↑ LFTs, seizures w/accumulation
Cephalosporins (Pregnancy B)
Carbapenems
Monobactam Similar to PCN (N/V/D, rash and ↑ LFTs) (Pregnancy B)
Aminoglycosides Nephrotoxicity, Ototoxicity (Pregnancy D)
Quinolones GI upset/diarrhea, QT prolongation, peripheral neuropathy, CNS effects,
Hypoglycemia/hyperglycemia, ↑ LFTs, photosensitivity, crystalluria, Boxed warning: tendon
inflammation and/or rupture, muscle weakness (Pregnancy C)
Macrolides QT prolongation, hepatotoxicity, GI upset, taste perversion, ↑ LFTs (Pregnancy B/C)
Tetracyclines Rash, ↑BUN, photosensitivity, N/V/D (Pregnancy D)
Sulfonamides Caution w/G6PD deficiency, N/V/D, anorexia, skin reactions, crystalluria, photosensitivity, ↑K,
hypoglycemia, ↓ folate, ↑LFTs (Pregnancy C/D)
Vancomycin GI upset, infusion reaction (red man syndrome), nephrotoxicity, myelosuppression, fever, ototoxicity
(Pregnancy B-oral/C-IV)
Lipoglycopeptides Metallic taste, N/V, QT prolongation (Pregnancy C)
(Telavancin)
Daptomycin N/V/D, ↑CPK and myopathy (Pregnancy B)
Oxazolidinones Thrombocytopenia, headache, N/D, anemia, myelosuppression (Pregnancy C)
Polymyxins Nephrotoxicity, neurologic disturbances (Pregnancy C)
Chloramphenicol Gray syndrome, myelosuppression, dermatologic (angioedema, rash, Uticaria) *rarely used due to
side effects
Lincosamides C.diff, Severe or fatal skin reactions (SJS), N/V/D, rash, urticaria (Pregnancy B)
Fosfomycin (urinary) Peripheral edema, dizziness, headache, flatulence, nausea, rash (Pregnancy C)
Nitrofurantoin Optic neuritis, hepatoxicity, pulmonary toxicity, anemia, GI upset, headache, rash, brown urine
discoloration (harmless)

Storage
Refrigeration after reconstitution Refrigeration Recommended
Pen VK, Ampicillin, Augmentin, Cephalexin, Cefpodoxime, Amoxicillin (improves taste)
Cefprozil, Cefuroxime, Vancomycin (oral)
*all other do not refrigerate

No Renal Dose Dicloxacillin, oxacillin, nafcillin

Adjustment Ceftriaxone
Moxifloxacin
*not all inclusive Azithromycin, erythromycin
Doxycycline, minocycline, tigecycline
Linezolid
Clindamycin
Chloramphenicol

Downloaded by Razvan Rosca (rosca.razvan.2011@gmail.com)