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NTUH Ri 2016.11.

27
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Penicillin
()

Penicillin

1st generation nature Penicillin


1. Penicillin(PCN) cover S(Streptococcus Staphylococcus)
Staphylococcus Penicillin Streptococcus
Staphylococcus Oxacillin
2. Penicillin-G
3. Penicillin-G Procaine Group A streptococcus(pharyngitis)
Penicillin-G Benzathine Syphilis
> 90% Staphylococci penicillinase PCN resistant Oxacillin

MSSA Oxacillin(CellulitisSeptic arthritis )


Ampicillin Oxacillin BBBMeningitis with wild type Listeria AmpicillinMeningitis with wild type SA Oxacillin
Empirical Abx UnasynTazocin

PSSP(Penicillin sensitive Streptococcus Pneumoniae) : Penicillin or Ampicillin or Cefazolin


PRSP(Penicillin resistant Streptococcus Pneumoniae) : Vancomycin or Ceftriaxone(Rocephin)
Oxacillin
Methicillin

1st generation Penicillin


GPC Cellulitis AbxGNB(-)PsA(-)Ana(-)
1. Oxacillin SA( MSSA Cefa Augmentin/Unasyn )
2. anti-PCNase PCN -lactamase renal dose
3.
2g IV Q6H soft tissue infection
2g IV Q4H max dose for bacterial meningitis, bacterial endocarditis, osteomyelitis, bacteremia, septic arthritis
4. ( slowly push)
MSSA ( Methicillin Sensitive Staphylococcus Aureus )Oxacillin(1st)Cefazolin(2nd)Vancomycin(3rd)
MRSA ( Methicillin Resistant Staphylococcus Aureus )Vancomycin or TeicoplaninDaptomycinLinezolidTigecycline
*VRSA ( Vancomycin Resistant Staphylococcus Aureus )DaptomycinLinezolid
OSSA=MSSAORSA=MRSA Methicillin Oxacillin

Amoxicillin

2nd generation PenicillinAminopenicillin

Ampicillin

Aminopenicillin -lactam 1st generation Penicillin Pathogen Spectrum


cover EnterococcusListeriaShigella -lactamase inhibitor Spectrum (GPC+GNB+Ana)
Ampicillin Wild type EnterococcusMeningitis with ListeriaShingellosis( Ampicillin Amoxicillin )
Amoxicillin H. pyloriN. gonorrhoeae infection
HP cocktail()PPI + Amoxicillin + Clarithromycin
-lactamase inhibitor
Sulbactam -lactamase AB
Tazobactam -lactamase
Clavulanate
AugmentinAmoxicillin +Clavulanate
G(+) MRSAPRSPAmpicillin-resistant enterococci(ARE)MycobacteriaAtypical
G(-) cover PECK(Proteus, E.coli, Klebsiella) ,H. influenza, Salmonella, Moraxella catarrhalis
( Augmentin )
Antibiotic treatment course
UnasynAmpicillin+Sulbactam cover Acinetobacter baumannii (AB )
Augmentin AB ( high dose Unasyn for AB treatment)
Empirical treatmentmainly for community-acquired pathogens
KP Unasyn Augmentin 1st 2nd Cefa KP pneumonia Rocephin
TazocinPiperacillin + Tazobactam cover Pseudomonas aeruginosa (PsA)
G(+) MRSAPRSPAREMycobacteriaAtypical
G(-) Unasyn cover EnterobacterCitrobacter Serratia PsA
Empirical treatmentmainly for hospital-acquired pathogens ( cover PsA )
Piperacillin 4th generation Ureido-Penicillin cover PsA

1. CAP(Community Acquired Pneumonia) Augmentin Unasyn atypical pathogen Azithromycin


2.
3.

HAP(Hospital Acquired Pneumonia) Tazocin cover PsA


HAP wild type AB Carbapenem Unasyn
Steno(Stenotrophomonas maltophilia) Quinolone ()MonocyclineTigecyclinePolymyxin

Cephalosporin

GPC coverage1st>2nd>3rdGNB coverage3rd>2nd>1st4th GPC GNB

()

Anti-PsA Cefa3rd Ceftazidime(Fortum)3.5th Brosym4th Cefepime(Maxipime)5th Ceftobiprole


3rd3.5th4th Cefa BBB
Cefamycin (2.5th3.5th) NMTT side chain Ana prolonged PTPTT
Cefamycin Ana 1~4th Cefa Ana
Cefa (Enterococcus)(Listeria)

1st generation

GPC GNB cover E.coliKPProteus()PsA(-)Ana (-)


1. GPC MSSA Streptococcus( SP)
GNB cover PECKE. coliKlebsiellaProteus
2. URI UTICellulitisSeptic arthritis (CellulitisUTI )
Cefazolin (IV form)Cephalexin ()

2nd generation

1st GPC GNB coverage cover PECK+HMPsA(-)Ana (-)


1. GPC MSSA Streptococcus( SP)
GNB PECK HM(H. influenza , Moraxella)
2. Cefa AOMSinusitisPneumonia(CAP and COPD AE)BTI()UTIBacteremia
Cefuroxime (Zinnat/Ceflour )

2.5th generation
Cefamycin

GPC 2nd Cefa GNB PsA(-)Ana (+)


1.

*Flumarin

2.

Cefamycin NMTT side chain GPC coveragecover GNB and Anaerobe better
GPC Cefuroxime cover SASP (SA/SP)(SA)
GNB 2nd Cefacover PECK+HM
Anaerobes( Bacteroides Metronidazole B. fragilis )
Intra-abdominal Infection(IAI)Pelvic inflammatory disease(PID)

Cefamycin ( CefoxitinCefmetazole )Flumarin


*Flumarin(Flomoxef) G(-) Anerobics PsA BBB( 3rd Cefa 3rd )
1. GPC Cefamycin cover MSSA Strep. SP
GNB Ana Cefamycin Cefamycin
2. NMTTHTT side chain NMTT side chain side chain prolonged PT & PTT
liver function IAI
3. IAI, PID( Cefamycin) UTI, Mixed infection, LRTI(Low Respiratory Tract Infection)

3rd generation

GNB PsA(- Ceftazidime Anti-PsA)Ana (-) BBB


1. 3rd Cefa BBB GNB Bacterial meningitis Ceftriaxone(Rocephin)
2. (osteomyelitis) UTI
Non Anti-PsA agent
GPC cover MSSA Strep.( SP)
GNB PECK+HMN Enterobacter, Citrobacter, Providencia spp, Leptospira spp.
PsA GNB infectionSalmonellosisGonorrheaLeptosipirosis
*Ceftriaxone(Rocephin) SP Bacterial meningitis moniter LFT (T-Bil )
Cefotaxime(Claforan)For Rocephin(Neonate )GI Cefotaxime Rocephin
Cefixime(Cefspan)3rd Cefa SP Gonorrhea Typhoid feverShigellosis
Ceftibuten(Seftem)3rd Cefa Cefixime
Anti-PsA agent
GPC cover Strep. SP MSSA GNB Rocephin cover PsA
Ceftazidime(Fortum)GNB cover PsA( cover PsA)
PsA Hospital Acquired(HA)/Health-Center Acquired(HCA) infection( PsA )

3.5th generation
Cefamycin

GPC GNB PsA(+)Ana (+) BBB


Cefoperazone(CPZ)
* BrosymCefoperazone(3.5th)+Sulbactam G(+)G(-)PsAAnaAB
1. BTI, PID
2. AB Sulbactam CPZ+sulbactam CRAB (high dose Unasyn CRAB )

4th generation

GPC GNB PsA(+)Ana (-) BBB


1. G(+)G(-) MSSA PsA MRSA Enterococcus
GPC cover Streptococcus Pneumoniae MSSA
GNB cover Amp-C -lactamase GNB + PsA Amp-C -lactamase
Cefepime(Maxipime)Neutropenia GPCGNBPsA ESBL
ESBL Carbapenem
2.

5th generation

GPC GNB PsA(+)Ana (-)


GPCGNBPsA
Ceftobiprole(anti-PsA), Ceftaroline(non anti-PsA)

Carbapenem

PenicillinCefa CarbapenemESBLAmpC Infection Carbapenem ESBL

()

GPC+GNB+Ana+PsA( Ertapenem ) MRSA, E. faecium, S. maltophilia, B. cepacia.


GPCI>D=MGNBD=M>I PsAD>M>I ABI>D>B
Ertapenem PsAwild type AB ImipenemMeropenemDoripenem
BBB Seizure Brain lesion ( Imipenem)

PsA

Seizure

Ertapenem

Invanz

IF

Carbapenem ESBL PsAAB

Imipenem

Tienam

+++

IF

brain lesion Cilastin

Meropenem

Mepem

IVIF

IV push Carbapenem N/S Burkho. cepacia

Doripenem

Finibax

++

+/-

IF

Carbapenem PsA PNA Off label use PNACNS(<1%)

FQ

Fluoroquinolone DNA topoisomerase Anti-TB


GPC(Ciproxin )+GNB+Atypical+Mycobacterium(Factive )+PsA(2nd, 3rd FQ)/Ana(4thFQ)
Concentration dependent post-antibiotics effect once daily ()
Resistance FQ ( FQ Sensitive )
FQ

FQ TB masking TB () CAP
PNA, IAI, Soft tissue/bone, UTI, prostatitis, STD, Mycobacteria infection
2+, 3+(), QT prolongation side effect
2nd FQCiproxinGPC Cover GNB PsA Ana
3rd FQCravitGPC PsA Ana
4th FQAveloxFactive PsA GPC ( SP ) Ana GNB

GPC

GNB

PsA

Ana

Ciprofloxacin(2nd)

Ciproxin

+/-

++

GNB cover PsA Streptococcus partial effect to MSSA


() Anti-PsA FQ Anti-PsA

Levofloxacin(3rd)

Cravit

Ciproxin : PsA GPC MSSA, PRSP


() Anti-PsA

Moxifloxacin(4th)

Avelox

++

For CA pathogen, mixed infection Steno

Gemifloxacin(4th)

Factive

++

++

for CA Pathogen cover PsA & TBSkin rash 8~10

AG

Aminoglycoside Resistance

GNB PsA(+)Ana(-) -Lactam GPC spectrum(Synergistic effect)


Indication: GNB GPC-related Endocarditis( -lactam)Mycobacteria infection
Concentration dependent post-antibiotics effect once daily
(esp.)(Peak level & Trough level)
AG PNA,BTI,CNS infection, Ana infection

Amikacin
Gentamicin

1. GPC infection Gentamicin -lactam (Synergistic effect)

Streptomycin

Amipcillin+Gentamicin newborn meningitis( AG )


2. TB Streptomycin Amikacin Streptomycin
3. MAI(Mycobacterium avium intracellulare) Amikacin
4. PsA infection Amikacin Amikacin AG-Resistant PsA
Loading/Maintenance dose
50% Aminoglycoside

Macrolide

Erythromycin

GI side effect Diarrhea side-effect paralytic ileus()

Azithromycin
Clarithromycin

Macrolide Erythromycin better PK, less ADR (esp. GI side effect)


Macrolide
1. Atypical pathogen: Mycoplasma, Chlamydia, Legionella, Rickettsiae, diphtheria, pertussis( atypical PNA )
Helicobacter pylori (Clarithromycin)
2. NTM infection
3. Syphilis
Azithromycin Empirical treatment for atypical pathogen infection
PK = Pharmacokinetics ADR = Adverse Drug Reaction

Monobactam
Aztreonam

GNB PsA(+)Fail to all GPC and Ana


1.
2.
3.

GNB Enterobacter aerogenes, Citrobacter freundii, Actinobacter sp.


lactam allergy induce AmpC beta-lactamase
allergy to PCN or Cefa

MRSA

VancomycinTeicoplaininDaptomycinLinezolid(Zyvox)TigecyclineRifampin(combine )Cravit( MIC)

Glycopeptide

Ampicillin resistant EnterococcusMRSA( GPC C. Difficile OKGNB )


Loading dose CCRT dose Renal dose

Vancomycin

1.
2.
3.
4.

kidney function (Vanco )


IV drip(IF) Redman syndrome
MSSA OxacillinMRSA ( Teicoplanin)
Clostridium difficile colitis

Teicoplanin

1.

kidney function

2.

(Loading dose )

Daptomycin
MRSA

GPC GNB(-)PsA(-)Anerobics(-)
1. Vancomycin serious, invasive infection
2. IndicationMRSA, VISA, VRSA, VRE, PRSP
3.
4.

Rapidly bactericidal, concentration dependent


( Surfactant ) Pneumonia Bacteremia bioflim

5.

myopathy CK

Linezolid(Zyvox)
Anti-HA-MRSA

GPC GNB(-)PsA(-)Anerobics(-) BBB


1. Vancomycin Resistance TB ()
2. IndicationMRSA, VRSA, VRE, PRSP, NTM, mycobacterium (Vancomycin Resistance TB )
3. Bacteriostatic
4. Pneumonia BBBCSF 70%
5. Thormbocytopenia()

Tigecycline

(GPC + GNB + Ana + NTM)PsA(-)


1.
2.

Bacteriostatic agent, bactericidal for pneumococci & H. influenza


3P1B Pseudomonas aeruginosa Proteus spp. Providencia spp.Burkholderia cepacia

3.

Tigecycline Ceftazidime(Fortum)
Volume of distribution morbidity combine

4.
5.

cover PsA Tigecycline + Ceftazidime combine therapy


Thrombocytopenia, abnormal liver function, diarrhea


Clindamycin

Baktar
PJP

GPC Ana GNB(-)PsA(-)


1. MSSA (>60%)Strep.(>40%)Viridans strep.(>20%)SP(>70%)Ana(>50%)
2. Toxin(Esp. endotoxin)
3. GPC, Ana ( CefmetazoleFlumarin )
4. for PCN or Cefa allergy ( MSSA beta-lactam )
5. SSSS(Staphylococcal Scalded Skin Syndrome) Vancomycin + Clindamycin Clindamycin toxin
6. GPC combine therapy Ana infection
7.

GI upsetSkin rashDrug fever

1.

Trimethorpim/Sulfamethoxazole (TMP/SMX)

2.
3.

Indication: Simple UTI, PJP, Salmonella infection, Travelers diarrhea, Toxoplasmosis, Norcardiosis

A.
B.
C.

Colistine

Burkholderia cepacia
Burkholderia pseudomallei(melioidosis)
Stenotrophomonas maltophilia

4.

D. Norcardiosis
E. PJP(Pneumocystitis jirovecii pneumonia)
GI upset, Skin rash, neutropenia, hyperkalemia, psychosis

1.
2.
3.
4.

(1947 )/MDRABMDRPA
QQ
Proteus spp.ProvidenciaBurkholderiaSerretia speciesS.mElizabethChryseobacteriumMoraxella
(neuromascular blockade)

MDRABMultiple-Drug-Resistant AB MDRPAMultiple-Drug-Resistant Pseudomonas aeruginosa


Metronidazole

Ana Parasite(Amebiasis, Giardiasis, Trichomoniasis) Garderella vaginalis H. pylori


1. IndicationAnaerobic infection, Pseudomembranous colitis, Parasite infection, Bacterial vaginosis, H. pylori infection
2. MNZ 98%
3. ( BBB Abcess )
4. Rocephin+MNZ for GI infection
5. GI upset() alcohol Disulfiram-like reaction

Anti-TB
Rifampin

GPCGNBMycobacteriaRickettsia
1. Anti-TB (deep infection, prosthetic joint infection, biofilm )
2. biofilm Teicoplanin Deep infection of SA
3. Combine therapy
4. SA Rifampim Baktar Clindamycin
5. ( 36%)
6. (Hepatocellular hepatitisGOT/GPTCholestatic hepatitisALP/GGTT-BIL)()

Tetracycline

IntervalTetracycline (Q6H), Minocycline (Q12H), Doxycycline (Q12H)

Tetracycline
Minocycline
Doxycycline

Atypical(Chlamydia, Mycoplasma, Rickettsia, Brucella)Typical(Vibrio, B. pseudomallei)Spirochetes


1.
2.
3.

Indication: Atypical infection, Mycoplasma, Chlamydia, Rickettsia (Scrub Typhus), Q fever


Mino>Doxy>Tetra Mino Neisseria meningitidis Doxy Tetra
Tetracycline

4.

A. Chlamydial infection
B. Rickettsail infection
C. Vibrio infection()
Doxycycline

5.

A. Malaria
B. Mycoplasma pneumoniae Macrolide Doxycycline
C. Tetra Mino Tetra Doxycycline
(Esp. Doxycycline)(Esp. MinoN/V)

SA

Staphylococcus aureus

PNA

Pneumonia

SP

Streptococcus pneumoniae

BTI

Biliary tract infection

PsA

Pseudomonas aeruginosa

IAI

Intra-abdominal infection

Ana
AB

Anaerobes
Acinetobacter baumannii

N/V
CA

Nausea/Vomiting
Community-Acquired

Steno

Stenotrophomonas maltophilia

HCA

Health-Care-Aquired

PJP( PCP)

Pneumocystitis jirovecii pneumonia

HA

Hospital-Acquired

Antifungal

Polyene
Amphotericin B

Candida spp.( C. lusitaniae )Aspergillus spp.Cryptococcus neoformans Zygomycetes


(Candidemia, Aspergillosis, Cryptococcal meningitis)Candida UTI

Liposomal
Amphotericin-B
(Ambisome)

IV drip 4 hrs D5W ( N/S )


Yeast, Dimorphic cover Aspergillus(A. terreus ) partial cover Mucorale, Fusarium
( CVC )( 75%)()
BUNCreKMgHb
Ampho-B Ambisome CNS lung penetration
For (CCr < 30)
AmBisome 3 Ampho-B 1200

Triazole

Azole QTc prolongation (Fluconazole )


CandidiasisAspergillosisCryptococcus Fluconazole (Aspergillosis)

Itraconazole

CandidiasisAspergillosisDermatophytoses
1.
2. Aspergillosis Voriconazole Voriconazole Itraconazole Aspergillosis
3. CNS fungal meningitis candidal UTI
4. (negative inotropic effect)

Fluconazole

Candidiasis(systemic candidal infection, mucocutaneous candidiasis, candidal UTI)


1.
2.

Cryptococcosis( Cryptococcal meningitis)Dermatophytes


C. glabrata (partially sensitive MIC) C. krusei Cryptococcus neoformans
90% IV Fluconazole AntacidH2 blockerPPI
IV
A.
B.
C.

3.
4.
5.
Voriconazole

Severe fungal infection loading dose( maintanace dose)


CSF 60~80% fungal meningitis Candidal UTI

CandidiasisAspergillosis Neutropenic fever fungal infection


1.

2.
3.
4.

96% IV IV
A. ( Neutropenic fever)
B.
C.
Voriconazole
CSF 30~68% fungal meningitis Candidal UTI

IV C. albicans, C. tropicalis, C. parapsilosisFluconazole()C. glabrata, C. kruseiEchinocandin()


PO Fluconazole C. krusei, voriconazole-sensitive C. galbrata

5.

Visual disturbance()LFTQTc prolongation

Posaconazole

CandidiasisAspergillosisMucormycosisFusariosisZygomycosis
1.

2.
Sertaconazole
Echinocandin

Caspofungin

Micafungin
Anidulafungin

azole Mucormycosis (systemic fungal infection)


A.
B. IV Posaconazole
C.
QTc prolongation QTc prolongation ( Torsades de pointes)

CandidiasisAspergillosis Neutropenic fever fungal infection

Candida Azole-resistant Candida spp.


BBB CNS infection UTI

C. krusei C. glabrata Candida C. krusei C. glabrata infection


Cytochrome P450 QTc prolongation (Azole QTc prolongation)

()histamine-mediated symptoms()LFTN/V
Echinocandin
Caspofungin 10000 NTD/dayMicafungin 4000 NTD/dayAnidulafungin 4500 NTD/day

1.
2.

IV drip > 1hr glucose Child BC Renal dose


Loading dose PJP

3.
4.
5.

Biofilm ( Triazole Voriconazole biofilm bioflim Candida)


endophthalmitis
(Remarkably non-toxic) Drug-Drug interaction(D-D)Esp. Cyclosporine

1.

IV drip > 1hr LiverRenal dose Child C

2.
1.
2.
3.

N/Vtransient LFTUN/CreD-D with Sirolimus, nifedipine, Itraconazole( Voriconazole)


< 1.1mg/min LiverRenal dose
Loding dose
Red man syndromeN/VD-D with Cyclosporin

Flucytosine(5-FC)

Candida spp.Cryptococcus neoformans


1.

Cryptococcal meningitis( BBB Amphotericin B )

2.

BM suppression( GI 5-FU BMS)()LFT


1.
2.
3.
4.

(De-Escalation therapy) Abx culture


GPC G(+)GNB G(-)( G(+) GPCG(-) GNB)
-lactam PenicillinCefasporinCarbapenemMonobactam
-lactamase PCN Cefa -lactamase inhibitor eg. Unasyn, Augmentin, Tazocin
ESBL PCN CefaUnasynTazocin -lactamase inhibitor Carbapenem
AmpC -lactamase 1~3 Cefa -lactamase inhibitor (UnasynTazocin )4th Cefepime
AmpC -lactamase induced Tazocin AmpC -lactamase Tazocin
AmpC PathogenSPICE

5.
6.
7.

8.

9.

Serratia, "Indole-positive" PsA, "Indole-positive" Providencia, "Indole-positive" Proteus vulgaris, Citrobacter, and Enterobacter species
(Cefamycin)NMTT side chain effectNMTT chain vitamin K dependent carboxylase vitamin K 2,3-epoxide reductase
(competitive antagonist) prolonged PT & PTT liver function

A. Bactericidal
B. Bacteriostatic

A. Concentration dependent post-antibiotics effect(PAE) once daily AG FQ


B. Time dependent MIC

A. S(Sensitive)
B. I(Intermediate)

C. R(Resistant)
10.
A. Peak level()Peak level 30
B. Trough level()Trough level
11. Liver doseRenal dose CCRT dose Loading dose Maintenance dose
Loading dose Maintenance dose
12. IV form AmoxicillinIV=1.25*PO

Streptococcus Pneumonia
PSSP(Penicillin sensitive Streptococcus Pneumoniae) : Penicillin or Ampicillin or Cefazolin
PRSP(Penicillin resistant Streptococcus Pneumoniae) : Vancomycin or Ceftriaxone(Rocephin)
PRSP meningits Vanco+Rocephin
Staphylococcus Aureus
MSSA ( Methicillin Sensitive Staphylococcus Aureus )Oxacillin(1st)Cefazolin(2nd)Vancomycin(3rd)
MRSA ( Methicillin Resistant Staphylococcus Aureus )Vancomycin or Teicoplanin DaptomycinLinezolidTigecycline
VRSA ( Vancomycin Resistant Staphylococcus Aureus )DaptomycinLinezolid
Enterococcus(E. faecalis E. faecium Vancomycin Ampicillin )
ASE(Ampicillin Susceptible Enterococcus) Ampicillin PCN OxacillinUnasyn Penicillin
ARE(Ampicillin Resistance Enterococcus)Vancomycin or Teicoplanin
VRE(Vancomycin Resistance Enterococcus)DaptomycinLinezolidTigecycline
Anaerobes(Bacteroides Clostridium )
CefamycinCefoxitinCefmetazoleFlumarinBrosym
-lactam+-lactamase inhibitorUnasynAugmentinTazocin
CarbapenemErtapenemImipenemMeropenemDoripenem
Other agent: MetronidazoleTigecyclinClindamycin
IAI(Intra-Abdominal Infection)
Cefa Cefamycin(CefoxitinCefmetazole)FlumarinBrosym
FQ AveloxFactive
ESBL
CarbapenemTigecyclineColistin
AmpC CarbapenemTigecyclineFQ AG Cefepime
CRAB ColistinSulbactam ( BrosymUnasyn)Tigecycline

CoNSCoagulase negative staphylococcus

GPC

Staphylcocci

Coagulase(+):
Staphylcoccus aureus
Coagulase(-):
CONS Staphylcoccus epidemis ()

GNC

Nesseria

N. meningitis
N. gonorrhea

Moraxella

Moraxella catarrhalis (Pneumonia)

-hemolytic()
GASS. pyogenes ( pharyngitis &

GNB

Enterobacteriaceae

Fermenting GNB
1. PECK(Proteus, E.coli, Klebsiella spp.)

Streptococci

tonsillitis, necrotizing fascilitis PCN


)
GBSS. agalactiae ( normal flora,
neonatal meningitis)
-hemolytic()
S. viridans( IE )

2. Enterobacter spp. / Citrobacter spp.


3. Salmonella spp. / shigella spp.
Non-fermenting GNBABPS( MDR)
1.
2.
3.
4.

S. pneumonia
S. bovis (Group D, endocarditis)
Enterococcus faecalis()
() Enterococcus faecium( VRE)
Enterococcus
GPB

Aerobes
()

Listeria ()
Corynebacterium dipheriae()
Nocardia (, )

Acinetobacter baumannii
Burkholderia spp.
Pseudomonas aureus
Stenotrophomonas maltophilia

Fastidious GNB
Atypical

H. influenza
Mycoplasma, Chlamydia, Legionella
Rickettsia, scrub typhus

Mycobacteria

Mycobacterium tuberculosis(tuberculosis)
Mycobacterium leprae(leprosy)

Anaerobes

peptostreptococcus
Bacteroides fragilis

Bacillus anthracis ()
Anaerobes

Clostridium (, )
C. difficile()
C. perfringens()
C. botulinum()
C. tetani()

(Cefasporin=Cephalosporin) Anti-MRSA (Vancomycin )

Ocillina

Oxacillin

1st Penicillin

Amikin

Amikacin

Aminoglycoside

Cefa

Cefazolin

1st Cephalosporin

Gentamycin

Gentamicin

Aminoglycoside

Keflex/Cephalexin/Ulex

Cephalexin()

1st Cephalosporin

Rulid

Erythromycin

Macrolide

Furoxime

Cefuroxime

2nd

Zithromax

Azithromycin

Macrolide

Ceflour

Cefuroxime()

2nd Cephalosporin

Targocid

Teicoplanin

Glycopeptide

Cetazone

Cefmetazole

2.5th Cephalosporin

Cubicin

Daptomycin

Lipopeptides

Cexitin

Cefoxitin

2.5th

Zyvox

Linezolid

Oxazolidinones

Flumarin

Flomoxef

2.5th Cephalosporin

Tygacil

Tigecycline

Glycylcycline

Rocephin

Ceftriaxone

3rd Cephalosporin

Clincin/Lindacin

Clindamycin

Lincosamide

Claforan

Cefotaxime

3rd

Baktar/Sevatrim

Trimethoprim-sulfamethoxazole
Co-trimoxazole

Sulfonamide

Fortum/Tatumcef

3rd Cephalosporin

Borymycin

Monocycline

Tetracycline

Cefspan

Ceftazidime
Cefixime()

3rd

Colimycin

Colistin

Polymixin

Seftem

Ceftibuten()

3rd Cephalosporin

Anegyn/Flagyl

Metronidazole

Nitroimidazole

Brosym

CPZ+sulbactam

3.5th Cephalosporin

Fungizone

Amphotericin B

Polyene

Maxipime

Cefepime

4th

Ambisome

Amphotericin B, Liposomal

Polyene

Ciproxin

Ciprofloxacin

Quinolone

Diflucan

Fluconazole

Triazole

Cravit

Levofloxacin

Quinolone

Sporanox

Itraconazole

Triazole

Avelox

Moxifloxacin

Quinolone

Posanol

Posaconazole

Triazole

Factive

Gemifloxacin

Quinolone

Vfend

Voriconazole

Triazole

Invanz

Ertapenem

Carbapenem

Zalain

Sertaconazole

Triazole

Tienam

Imipenem

Carbapenem

Cancidas

Caspofungin

Echinocandin

Mepem

Meropenem

Carbapenem

Mycamine

Micafungin

Echinocandin

Finibax

Doripenem

Carbapenem

Eraxis

Anidulafungin

Echinocandin

Azactam

Aztreonam

Monobactam

Flusine

Flucytosine

Pyrimidine

Cephalosporin

Cephalosporin

Cephalosporin

Cephalosporin

Cephalosporin