Antibiotic Spectrum of Activity: Venn Diagram

This visual representation provides a concise overview of the general coverage of various classes of antibiotics.
Please note that while this diagram offers valuable insights, it is not exhaustive and should be used as a quick reference rather than a comprehensive resource.

Penicillins: Cephalosporins:
Gram Positive
Natural PCNs: Anti-staphylococcal PCNs: 1st Generation: 2nd Generation:
Penicillin G Dicloxacillin Cefazolin Cefuroxime
Natural PCNs Oxazolidinones
Penicillin V Nafcillin Cephalexin Cefoxitin
Oxacillin Anti-staphylococcal PCNs Glycopeptides
Cefadroxil Cefotetan
Aminopenicillins: Daptomycin Cefprozil
Amoxicillin Cefaclor
Ampicillin
3rd Generation:
Aminopenicillin + BLIs: Ceftriaxone
Amoxicillin-clavulanate Aminopenicillins Cefotaxime
Ampicillin-sulbactam
Cefazolin (G+ >>> G-) Clindamycin Ceftazidime
Piperacillin-tazobactam Cefdinir
Ceftriaxone (G+ = G-)
Macrolides:† Cefepime (G- >>> G+) Cefpodoxime
Azithromycin † Cefixime
Levofloxacin
Clarithromycin † 4th Generation:
Macrolides
Glycopeptides: † Cefepime
Tetracyclines
Vancomycin Nitrofurantoin Carbapenems:
Dalbavancin Aminopenicillins + BLIs
Oritavancin Gram TMP-SMX Ertapenem

Telavancin
Carbapenems
Anaerobic Meropenem

Tetracyclines:† Negative Delafloxacin† Imipenem-cilastatin

Moxifloxacin† Oxazolidinones:
Doxycycline Linezolid
Modified tetracyclines
Minocycline Tedizolid
Modified tetracyclines:
Tigecycline Aztreonam Metronidazole
Eravacycline Aminoglycosides
Omadacycline Polymyxins
Ciprofloxacin†
Fosfomycin^

BLI: beta-lactamase inhibitor

PCN: penicillin
TMP-SMX: trimethoprim-sulfamethoxazole

† Indicates activity against atypical organisms More clinical pearls at pyrls.com

^ While fosfomycin has reported coverage against Gram positive
- and Gram negative organisms, in clinical practice said activity is ® 2023 Cosmas Health, Inc. and/or its affiliates. All rights reserved.
- questionable (especially for Gram positive infections)
Antibiotic Spectrum of Activity
P. aeruginosa MRSA MRSA
Amikacin (Amikin)* Delafloxacin (Baxdela) Ceftaroline (Teflaro) Minocycline (Minocin)
Aztreonam (Azactam) Imipenem-cilastatin (Primaxin) Clindamycin (Cleocin) Omadacycline (Nuzyra)**
Cefepime (Maxipime) Imipenem-cilastatin-relebactam (Recarbrio) Daptomycin (Cubicin)** Oritavancin (Kimyrsa, Orbactiv)
Cefiderocol Fetroja) Levofloxacin (Levaquin) Dalbavancin (Dalvance) Tedizolid (Sivextro)**
Ceftazidime (Fortaz) Meropenem (Merrem) Delafloxacin (Baxdela) Telavancin (Vibativ)
Ceftazidime-avibactam (Avycaz) Meropenem-vaboractam (Vabomere) Doxycycline (Vibramycin) Tigecycline (Tygacil)**
Ceftolozane-tazobactam (Zerbaxa) Piperacillin-tazobactam (Zosyn) Eravacycline (Xerava)** TMP-SMX (Bactrim, Bactrim DS)
Ciprofloxacin (Cipro) Polymyxin B Linezolid (Zyvox)** Vancomycin (Vancocin)
Colistimethate (Coly-Mycin C) Tobramycin (Tobi)

ESBL-E CRE
Uncomplicated cystitis: Uncomplicated cystitis:
Nitrofurantoin, TMP-SMX, aminoglycosides^ Nitrofurantoin, TMP-SMX, ciprofloxacin, levofloxacin, aminoglycosides^

Complicated UTIs or pyelonephritis: Complicated UTIs or pyelonephritis: Infections outside the urinary tract:
TMP-SMX, ciprofloxacin or levofloxacin Ceftazidime-avibactam (Avycaz) Ceftazidime-avibactam (Avycaz)
Use carbapenem initially if a patient is critically ill or if resistance/toxicities Meropenem-vaboractam (Vabomere) Meropenem-vaboractam (Vabomere)
prevent the use of TMP-SMX, ciprofloxacin or levofloxacin
Imipenem-cilastatin-relebactam (Recarbrio) Imipenem-cilastatin-relebactam (Recarbrio)
Infections outside the urinary tract: Cefiderocol (Fetroja) Cefiderocol (Fetroja)
Meropenem, imipenem-cilastatin or ertapenem TMP-SMX, ciprofloxacin or levofloxacin may be used if susceptibility is noted

CRE: carbapenem-resistant Enterobacterales * = breakpoints are limited to urinary isolates

ESBL-E: extended-spectrum β-lactamase-producing Enterobacterales ** = expected activity against VRE

More clinical pearls at pyrls.com
VRE: vancomycin-resistant enterococci ^ = for aminoglycosides single dose therapy is recommended
® 2023 Cosmas Health, Inc. and/or its affiliates. All rights reserved.