Antibiotic | ||||||||
---|---|---|---|---|---|---|---|---|
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 |
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?
R = resistant
"?" = looks good in a test tube
"." = placeholder pending data
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.