Infectious Disease Compendium

Comparison of Antibacterials

Gram-positive cocci

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.