Infectious Disease Compendium

Comparison of Antibacterials

Gram positive cocci, Gram postive rods, Gram negative cocci/coccobacillus, Gram negative rods, Anaerobes and misc. bugs

Gram Positive Cocci 3= great. Use an antibiotic empirically if it is a 3. 2.5 = the best we got, but I sure wish we had better. OK to use empirically as we do not have any other choice. 2= adequate if susceptible, use with caution (ie know what you are doing and local susceptibility patterns) but do not rely on it empirically if you do not have susceptibilities. 1.5 = if it is susceptible its great, but is almost never susceptible. 1= no way dude. You want a dead patient? "?" = looks good in a test tube "." = placeholder pending data

Penicillins
VRE
penicillin
2 (1)
3
2 (2)
2
1
1.5 (3)
1
1
ampicillin/amoxicillin
2
3
3
3
1
1
1
1
amoxicillin/clavulanate
2
no strep
make a beta
lactamse
1
2
1
1
ampicillin/sulbactam
2
.
.
.
.
2
1
1
nafcillin/oxacillin /dicloxacillin
2
3
2
1
1
3
1
1.5
mezlocillin/ piperacillin
2
3
3
2
2
1
1
1
ticarcillin/clavulanate
2
3
2
2
1
1
1
1
piperacillin/tazobactam
2
3
2
2
1
1
1
1
Cephlosporins
---
---
---
---
---
---
---
---
cefazolin / cephalexin
2
3
3
1
1
3
1
1.5
2nd genration: eg cefuroxime
2
3
3
1
1
2
1
1
cefotaxime / ceftriaxone
3
3
3
1
1
2
1
1
ceftazadime
3
3
3
1
1
2
1
1
cefepime
2
3
3
1
1
2
1
1
Aminoglycosides
---
---
---
---
---
---
---
---
gentamicin / tobramycin
.
.
synergy only
synergy only
.
synergy only
synergy
synergy
amikacin
.
.
.
.
.
.
.
.
Macrolides
---
---
---
---
---
---
---
---
erythromycin
2
2 (4)
2 (2)
1
1
1.5
1
1
clarithromycin
2
2
2
1
1
1.5
1
1
azithromycin
2
2
2
1
1
1.5
1
1
dirithromycin
2
2
2
1
1
.
.
.
telithromycin
2
2
2
1
1
2
1
.
clindamycin
2
2
2
1
1
2(9)
2
2
Tetracyclines
---
---
---
---
---
---
---
---
tetracycline / doxycycline
2
3
2
1
1
2
2
2.5
tigecycline
3
3
2
2.5
2.5
2.5
2.5
2.5
Carbapenems
---
---
---
---
---
---
---
---
ertapenem
3
3
3
2
1
3
1
1.5
doripenam
3
3
3
2
1
3
1
1
meropenem
3
3
3
2
1
3
1
1.5
imipenem
3
3
3
2
1
3
1
1.5
Misc.
---
---
---
---
---
---
---
---
metronidazole
1
1
1
1
1
1
1
1
aztreonam
1
1
1
1
1
1
1
1
colistin
.
.
.
.
.
.
.
.
rifampin
.
.
.
.
.
synergy
synergy
synergy
rifaximin
.
.
.
.
.
.
.
.
trimethoprim/sulfamethoxisole
2
2
2
1
1
2 (9)
1.5
1
vancomycin
3
3
2.5
2
2.5
2.5
2.5
2.5
quinupristin/dalfopristin
3
3
2
2
2
2.5
2.5
2.5
linezolid
3
3
2.5
2.5
2.5
2.5
2.5
2.5
daptomycin
3
3
2.5
2.5
2.5
2.5
2.5
2.5
Quinolones
---
---
---
---
---
---
---
---
levofloxacin
2
2
2
urine only
1
2
2
1
moxifloxacin /gatifloxacin
3
3
2
1
1
2.5
2.5
2.5
ciprofloxacin
1
1
1
urine only
1
1
1
1
VRE

Notes:

(1) 14% I and 7% R to penicillin, the resistant strains often resistant to tetracyclines, macrolides, tmp/sulfa and quinolones.

(2) 30% R or I to penicillin and 30% R to clindamycin.

(3) if your S. aureus is S to pencillin G (and that is akin to finding a ceolocanth), then pencillin G is a great drug.

(4) resistance to macrolides has been reported as high as 30%.

(9) high dose po Bactrim 1 ---2 ds po tid or Clindamycin 600---900 po q 8 for boils from MRSA not unreasonable. Never use either for bacteremia, unless, of course, you just so happen to be dumb as a box of rocks.

Gram positive cocci, Gram postive rods, Gram negative cocci/coccobacillus, Gram negative rods, Anaerobes and misc. bugs

Gram Positive Rods 3= great. Use an antibiotic empirically if it is a 3. 2.5 = the best we got, but I sure wish we had better. OK to use empirically as we do not have any other choice. 2= adequate if susceptible, use with caution (ie know what you are doing and local susceptibility patterns) but do not rely on it empirically if you do not have susceptibilities. 1.5 = if it is susceptible its great, but is almost never susceptible. 1= no way dude. You want a dead patient? "?" = looks good in a test tube"." = placeholder pending data

Penicillins
penicillin
2
1
.
.
3
1
3
2
ampicillin/amoxicillin
3
3
.
.
2
1
2
2
amoxicillin/clavulanate
3
3
.
.
2
1
2
2
ampicillin/sulbactam
3
3
.
.
2
1
2
2
nafcillin/oxacillin /dicloxacillin
1
1
.
.
1
1
1
1
mezlocillin/ piperacillin
2.5
1
.
.
1
1
1
2
ticarcillin/clavulanate
1
1
.
.
1
1
1
2
piperacillin/tazobactam
2.5
1
.
.
2
1
1
1
Cephlosporins
---
---
---
---
---
---
---
---
cefazolin / cephalexin
1
1
.
.
1
1
1
1
2nd genration: eg cefuroxime
1
1
.
.
1
1
1
1
cefotaxime / ceftriaxone
1
1
.
.
1
1
1
2
ceftazadime
1
1
.
.
1
1
1
2
cefepime
1
1
.
.
1
1
1
2
Aminoglycosides
---
---
---
---
---
---
---
---
gentamicin / tobramycin
synergy
synergy
synergy
.
1
1
1
2
amikacin
.
.
.
.
1
1
1
2
Macrolides
---
---
---
---
---
---
---
---
erythromycin
1
.
.
.
1
1
1
2
clarithromycin
1
.
.
.
1
1
1
2
azithromycin
1
.
.
.
1
1
1
2
dirithromycin
1
.
.
.
1
1
1
2
telithromycin
1
.
.
.
1
1
1
2
clindamycin
1
.
3
.
3
1
3
2
Tetracyclines
---
---
---
---
---
---
---
---
tetracycline / doxycycline
1
3
2
3
1
1
2
2
tigecycline
1
.
.
.
.
1
.
.
Carbapenems
---
---
---
---
---
---
---
---
ertapenem
1
.
3
.
3(?)
.
?
.
meropenem
2.5
.
3
.
3(?)
.
?
.
imipenem
2.5
.
3
.
3(?)
.
?
.
Misc.
---
---
---
---
---
---
---
---
metronidazole
1
.
1
1
3
3
?
1
aztreonam
1
1
1
1
1
1
1
1
colistin
.
.
.
.
1
.
1
.
rifampin
.
.
.
.
.
1
.
rifaximin
.
.
.
.
1
.
1
.
trimethoprim/sulfamethoxisole
.
.
.
1
.
1
.
vancomycin
2
.
3
.
1
3
1
.
quinupristin/dalfopristin
2
.
.
.
1
.
.
.
linezolid
2
.
.
.
1
?
.
.
daptomycin
2
.
.
.
1
.
.
.
Quinolones
---
---
---
---
---
---
---
---
levofloxacin
1
2
2
2
1
1
.
.
moxifloxacin /gatifloxacin
1
2
2
2
1
1
.
.
ciprofloxacin
1
2
3
3
1
1
.
.

Gram positive cocci, Gram postive rods, Gram negative cocci/coccobacillus, Gram negative rods, Anaerobes and misc. bugs

Gram Negative Cocci/Coccobacillus 3= great. Use an antibiotic empirically if it is a 3. 2.5 = the best we got, but I sure wish we had better. OK to use empirically as we do not have any other choice. 2= adequate if susceptible, use with caution (ie know what you are doing and local susceptibility patterns) but do not rely on it empirically if you do not have susceptibilities. 1.5 = if it is susceptible its great, but is almost never susceptible. 1= no way dude. You want a dead patient? "?" = looks good in a test tube "." = placeholder pending data.

Penicillins
penicillin
2
3
3
1
1
1
3
2
2
2
2
ampicillin/amoxicillin
2
3
3
2
2
3
3
3
3
3
3
amoxicillin/clavulanate
2
3
3
3
2
3
3
3
3
3(?)
3
ampicillin/sulbactam
2
3
3
3
3
3
3
3(?)
3(?)
3(?)
3(?)
nafcillin/oxacillin /dicloxacillin
1
1
1
1
1
1
1
1
1
1
1
mezlocillin/ piperacillin
2
3
3
3
3
3
3
3
3(?)
3(?)
3
ticarcillin/clavulanate
2
3
3
3
3
3
3
3
3(?)
3(?)
3
piperacillin/tazobactam
2
3
3
3
3
3
3
3
3(?)
3(?)
3
Cephlosporins
---
---
---
---
---
---
---
---
---
---
---
cefazolin / cephalexin
1
2
2
2
1
1
1
1
1
3
1
2nd genration: eg cefuroxime
1
3
3
3
3
1
1
1
1
1
1
cefotaxime / ceftriaxone
3
3
3
3
3
3
3
3(?)
3(?)
3(?)
3
ceftazadime
3
3
3
3
3
3
3
3(?)
3(?)
3(?)
3
cefepime
3
3
3
3
3
3
3
3(?)
3(?)
3(?)
3
Aminoglycosides
---
---
---
---
---
---
---
---
---
---
---
gentamicin / tobramycin
2
2
2
2
2
2
3
3
3
3
3
amikacin
2
2
2
2
2
2
3
3
3
3
3
Macrolides
---
---
---
---
---
---
---
---
---
---
---
erythromycin
1
1
1
1
1
1
1
1
1
1
1
clarithromycin
2
2
2
2
2
2
1
1
1
1
1
azithromycin
2
2
2
2
3
2
1
1
1
1
1
dirithromycin
1
1
1
2
2
1
1
1
1
1
1
telithromycin
1
1
2
3
3
1
1
1
1
1
1
clindamycin
1
1
1
1
1
1
1
1
1
1
1
Tetracyclines
---
---
---
---
---
---
---
---
---
---
---
tetracycline / doxycycline
2
2
2
2
2
2
3
3
3
3
3
tigecycline
.
.
.
.
.
.
.
.
.
.
.
Carbapenems
---
---
---
---
---
---
---
---
---
---
---
ertapenem
3
3
3
3
3
3
3
3?
3?
3?
3?
meropenem
3
3
3
3
3
3
3
3?
3?
3?
3?
imipenem
3
3
3
3
3
3
3
3?
3?
3?
3?
Misc.
---
---
---
---
---
---
---
---
---
---
---
metronidazole
1
1
1
1
1
1
1
1
1
1
1
aztreonam
3
3
3
3
3
3
3
3?
3?
3?
3
colistin
.
.
.
.
.
.
.
.
.
.
.
rifampin
.
prophylaxis
.
.
.
.
.
.
synergy
.
.
rifaximin
.
.
.
.
.
.
.
.
.
.
.
trimethoprim/sulfamethoxisole
1
2
2
2
2
2
2
1
1
1
1
vancomycin
1
1
1
1
1
1
1
1
1
1
1
quinupristin/dalfopristin
1
1
1
1
1
1
1
1
1
1
1
linezolid
1
1
1
1
1
1
1
1
1
1
1
daptomycin
1
1
1
1
1
1
1
1
1
1
1
Quinolones
(8)
1
 
levofloxacin
2
3
3
3
3
3
3?
3?
3?
3?
3?
moxifloxacin /gatifloxacin
2
3
3
3
3
3
3?
3?
3?
3?
3?
ciprofloxacin
2
3
3
3
3
3
3?
3?
3?
3?
3?

Notes:

(7) Use spectinomycin.

(8) Not endocarditis.

Gram positive cocci, Gram postive rods, Gram negative cocci/coccobacillus, Gram negative rods, Anaerobes and misc. bugs

Gram Negative Rods (given the large variability in gram negative susceptabilties know your local susceptability pattern.) 3= great. Use an antibiotic empirically if it is a 3. 2.5 = the best we got, but I sure wish we had better. OK to use empirically as we do not have any other choice. 2= adequate if susceptible, use with caution (ie know what you are doing and local susceptibility patterns) but do not rely on it empirically if you do not have susceptibilities. 1.5 = if it is susceptible its great, but is almost never susceptible. 1= no way dude. You want a dead patient? "?" = looks good in a test tube "." = placeholder pending data

Penicillins
penicillin
1
1
1
1
1
1
1
1
1
1
ampicillin/amoxicillin
2
2
2
2
2
2
2
2
2
2
amoxicillin/clavulanate
2
2
2
2
2
2
2
2
2
2
ampicillin/sulbactam
2
2
2
2
2
2
2
2
2
2
nafcillin/oxacillin /dicloxacillin
1
1
1
1
1
1
1
1
1
1
mezlocillin/ piperacillin
2
2
2
2
2
2
2
2
2
2
ticarcillin/clavulanate
2
2
2
2
2
2
2
2
2
2
piperacillin/tazobactam
2
2
2
2
2
2
2
2
2
2
Cephlosporins
---
---
---
---
---
---
---
---
---
---
cefazolin / cephalexin
1
3
1
1
1
1
1
1
1
1
2nd genration: eg cefuroxime
2
2
1
1
1
1
1
1
1
1
cefotaxime / ceftriaxone
3
3
3
3
2
2
2
1
1
1
ceftazadime
3
3
3
3
3
3
3
3
3
3
cefepime
3
3
3
3
3
3
3
3
3
3
Aminoglycosides
---
---
---
---
---
---
---
---
---
---
gentamicin / tobramycin
3
3
3
3
3
3
3
3
3
3
amikacin
3
3
3
3
3
3
3
3
3
3
Macrolides
---
---
---
---
---
---
---
---
---
---
erythromycin
1
1
1
1
1
1
1
1
1
1
clarithromycin
1
1
1
1
1
1
1
1
1
1
azithromycin
1
1
1
1
1
1
1
1
1
1
dirithromycin
1
1
1
1
1
1
1
1
1
1
telithromycin
1
1
1
1
1
1
1
1
1
1
clindamycin
1
1
1
1
1
1
1
1
1
1
Tetracyclines
---
---
---
---
---
---
---
---
---
---
tetracycline / doxycycline
2
1
1
1
1
1
1
1
1
1
tigecycline
2.5
2.5
.
.
.
.
.
.
.
.
Carbapenems
---
---
---
---
---
---
---
---
---
---
ertapenem
3
3
3
3
3
3
3
1
1
1
doripenam
3
3
3
3
3
1.5
3
3
   
meropenem
3
3
3
3
3
3
3
3
2
2
imipenem
3
3
3
3
3
3
3
3
2
2
Misc.
---
---
---
---
---
---
---
---
---
---
metronidazole
1
1
1
1
1
1
1
1
1
1
aztreonam
3
3
3
3
3
3
3
3
3
3
colistin
2
2
2
2
2
2
1
2
2
1
rifampin
.
.
.
.
.
.
.
.
.
.
rifaximin
3(10)
.
.
.
.
.
.
.
.
.
trimethoprim/sulfamethoxisole
2
2
2
2
1
1
1
1
2
1
vancomycin
1
1
1
1
1
1
1
1
1
1
quinupristin/dalfopristin
1
1
1
1
1
1
1
1
1
1
linezolid
1
1
1
1
1
1
1
1
1
1
daptomycin
1
1
1
1
1
1
1
1
1
1
Quinolones
---
---
---
---
---
---
---
---
---
---
levofloxacin
3
3
3
1.5
3
3
3
2
3
3
moxifloxacin /gatifloxacin
3
3
3
1.5
2
2
2
2
3
3
ciprofloxacin
3
3
3
1.5
3
3
3
3
3
3

Notes:

(10) No systemic absorbtion, use for GI illness only.

Gram positive cocci, Gram postive rods, Gram negative cocci/coccobacillus, Gram negative rods, Anaerobes and misc. bugs Anaerobes and Misc. 3= great. Use an antibiotic empirically if it is a 3. 2.5 = the best we got, but I sure wish we had better. OK to use empirically as we do not have any other choice. 2= adequate if susceptible, use with caution (ie know what you are doing and local susceptibility patterns) but do not rely on it empirically if you do not have susceptibilities. 1.5 = if it is susceptible its great, but is almost never susceptible. 1= no way dude. You want a dead patient? "?" = looks good in a test tube "." = placeholder pending data

Penicillins
penicillin
2
3
.
1
1
1
1
1
1
ampicillin/amoxicillin
2
3
.
1
1
1
1
1
1
amoxicillin/clavulanate
3
3
.
1
1
1
1
1
1
ampicillin/sulbactam
3
3
.
1
1
1
1
1
1
nafcillin/oxacillin /dicloxacillin
1
1
1
1
1
1
1
1
1
mezlocillin/ piperacillin
2
.
.
1
1
1
1
1
1
ticarcillin/clavulanate
3
.
.
1
1
1
1
1
1
piperacillin/tazobactam
3
.
.
1
1
1
1
1
1
Cephlosporins
---
---
---
---
---
---
---
---
---
cefazolin / cephalexin
1
.
1
1
1
1
1
1
1
2nd genration: eg cefuroxime
2(5)
.
1
1
1
1
1
1
1
cefotaxime / ceftriaxone
1
.
3
1
1
1
1
1
1
ceftazadime
1
.
2
1
1
1
1
1
1
cefepime
1
.
2
1
1
1
1
1
1
Aminoglycosides
---
---
---
---
---
---
---
---
---
gentamicin / tobramycin
1
.
2
.
.
.
.
.
.
amikacin
1
.
3
.
.
.
.
.
.
Macrolides
---
---
---
---
---
---
---
---
---
erythromycin
1
.
.
3
3
3
2
2
2
clarithromycin
1
.
.
3
3
3
2
2
3
azithromycin
1
.
.
3
3
3
2
2
3
dirithromycin
1
.
.
.
.
.
.
.
.
telithromycin
.
.
.
.
.
.
.
.
.
clindamycin
2 (6)
3
.
1
1
1
1
1
1
Tetracyclines
---
---
---
---
---
---
---
---
---
tetracycline / doxycycline
2
3
.
2
3
3
3
3
3
tigecycline
.
.
.
.
.
.
.
.
.
Carbapenems
---
---
---
---
---
---
---
---
---
ertapenem
3
3
3
1
1
1
1
1
1
doripenam
2
. . . . . . . .
meropenem
3
3
3
1
1
1
1
1
1
imipenem
3
3
3
1
1
1
1
1
1
Misc.
---
---
---
---
---
---
---
---
---
metronidazole
3
1
1
1
1
1
1
1
1
aztreonam
1
1
.
1
1
1
1
1
1
colistin
1
1
1
1
1
1
1
1
1
rifampin
1
1
.
synergy
.
.
.
.
.
rifaximin
1
1
1
1
1
1
1
1
1
trimethoprim/sulfamethoxisole
1
.
3
2
2
2
2
2
2
vancomycin
1
.
1
1
1
1
1
1
1
quinupristin/dalfopristin
1
.
.
.
.
.
.
.
.
linezolid
1
.
.
.
.
.
.
.
.
daptomycin
1
.
.
.
.
.
.
.
.
Quinolones
---
---
---
---
---
---
---
---
---
levofloxacin
1
.
2
3
3
3
3
3
3
moxifloxacin /gatifloxacin
1
.
2
3
3
3
3
3
3
ciprofloxacin
1
.
2
3
3
3
3
3
3

Notes

(5) cefoxitin, cefotetan, cefmetazole are no longer are soon to be no longer available in the US, the latter two do not get the dot group of Bacteroides.

(6) 30% resistance of Bacteroides reported.

Gram positive cocci, Gram postive rods, Gram negative cocci/coccobacillus, Gram negative rods, Anaerobes and misc. bugs

This page dedicated to Dr. Kevin Winthrop, who refused to use this compendium until these tables were available. Hope you like it Kevin. Bastard. He still doesn't use it.