NTUH Ri 2016.11.

27
Ref
Penicillin MSSA Oxacillin(CellulitisSeptic arthritis )
() Ampicillin Oxacillin BBBMeningitis with wild type Listeria AmpicillinMeningitis with wild type SA Oxacillin
Empirical Abx UnasynTazocin
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
PSSP(Penicillin sensitive Streptococcus Pneumoniae) : Penicillin or Ampicillin or Cefazolin
PRSP(Penicillin resistant Streptococcus Pneumoniae) : Vancomycin or Ceftriaxone(Rocephin)
Oxacillin 1st generation Penicillin
Methicillin 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. HAP(Hospital Acquired Pneumonia) Tazocin cover PsA
3. 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 GPC 2nd Cefa GNB PsA(-)Ana (+)
Cefamycin 1. Cefamycin NMTT side chain GPC coveragecover GNB and Anaerobe better
*Flumarin GPC Cefuroxime cover SASP (SA/SP)(SA)
GNB 2nd Cefacover PECK+HM
Anaerobes( Bacteroides Metronidazole B. fragilis )
2. 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 GPC GNB PsA(+)Ana (+) BBB
Cefamycin 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
2. GPC cover Streptococcus Pneumoniae MSSA
GNB cover Amp-C -lactamase GNB + PsA Amp-C -lactamase
Cefepime(Maxipime)Neutropenia GPCGNBPsA ESBL
ESBL Carbapenem
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 Macrolide Erythromycin better PK, less ADR (esp. GI side effect)
Clarithromycin 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. GNB Enterobacter aerogenes, Citrobacter freundii, Actinobacter sp.
2. lactam allergy induce AmpC beta-lactamase
3. 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. kidney function (Vanco )
2. IV drip(IF) Redman syndrome
3. MSSA OxacillinMRSA ( Teicoplanin)
4. Clostridium difficile colitis
Teicoplanin 1. kidney function
2. (Loading dose )

Daptomycin GPC GNB(-)PsA(-)Anerobics(-)

MRSA 1. Vancomycin serious, invasive infection
2. IndicationMRSA, VISA, VRSA, VRE, PRSP
3. Rapidly bactericidal, concentration dependent
4. ( Surfactant ) Pneumonia Bacteremia bioflim
5. myopathy CK
Linezolid(Zyvox) GPC GNB(-)PsA(-)Anerobics(-) BBB
Anti-HA-MRSA 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. Bacteriostatic agent, bactericidal for pneumococci & H. influenza
2. 3P1B Pseudomonas aeruginosa Proteus spp. Providencia spp.Burkholderia cepacia
Tigecycline Ceftazidime(Fortum)
3. Volume of distribution morbidity combine
4. cover PsA Tigecycline + Ceftazidime combine therapy
5. Thrombocytopenia, abnormal liver function, diarrhea

Clindamycin 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
Baktar 1. Trimethorpim/Sulfamethoxazole (TMP/SMX)
PJP 2. Indication: Simple UTI, PJP, Salmonella infection, Travelers diarrhea, Toxoplasmosis, Norcardiosis
3.
A. Burkholderia cepacia
B. Burkholderia pseudomallei(melioidosis)
C. Stenotrophomonas maltophilia
D. Norcardiosis
E. PJP(Pneumocystitis jirovecii pneumonia)
4. GI upset, Skin rash, neutropenia, hyperkalemia, psychosis
Colistine 1. (1947 )/MDRABMDRPA
2. QQ
3. Proteus spp.ProvidenciaBurkholderiaSerretia speciesS.mElizabethChryseobacteriumMoraxella
4. (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 Atypical(Chlamydia, Mycoplasma, Rickettsia, Brucella)Typical(Vibrio, B. pseudomallei)Spirochetes
Minocycline 1. Indication: Atypical infection, Mycoplasma, Chlamydia, Rickettsia (Scrub Typhus), Q fever
Doxycycline 2. Mino>Doxy>Tetra Mino Neisseria meningitidis Doxy Tetra
3. Tetracycline
A. Chlamydial infection
B. Rickettsail infection
C. Vibrio infection()
4. Doxycycline
A. Malaria
B. Mycoplasma pneumoniae Macrolide Doxycycline
C. Tetra Mino Tetra Doxycycline
5. (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 Anaerobes N/V Nausea/Vomiting
AB Acinetobacter baumannii CA 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
IV drip 4 hrs D5W ( N/S )
Yeast, Dimorphic cover Aspergillus(A. terreus ) partial cover Mucorale, Fusarium
( CVC )( 75%)()
BUNCreKMgHb
Liposomal Ampho-B Ambisome CNS lung penetration
Amphotericin-B For (CCr < 30)
(Ambisome) 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)
Cryptococcosis( Cryptococcal meningitis)Dermatophytes
1. C. glabrata (partially sensitive MIC) C. krusei Cryptococcus neoformans
2. 90% IV Fluconazole AntacidH2 blockerPPI
IV
A.
B.
C.
3. Severe fungal infection loading dose( maintanace dose)
4. CSF 60~80% fungal meningitis Candidal UTI
5.
Voriconazole CandidiasisAspergillosis Neutropenic fever fungal infection
1. 96% IV IV
A. ( Neutropenic fever)
B.
C.
2. Voriconazole
3. CSF 30~68% fungal meningitis Candidal UTI
4.
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. azole Mucormycosis (systemic fungal infection)
A.
B. IV Posaconazole
C.
2. QTc prolongation QTc prolongation ( Torsades de pointes)
Sertaconazole
Echinocandin 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
Caspofungin 1. IV drip > 1hr glucose Child BC Renal dose
2. Loading dose PJP
3. Biofilm ( Triazole Voriconazole biofilm bioflim Candida)
4. endophthalmitis
5. (Remarkably non-toxic) Drug-Drug interaction(D-D)Esp. Cyclosporine
Micafungin 1. IV drip > 1hr LiverRenal dose Child C
2. N/Vtransient LFTUN/CreD-D with Sirolimus, nifedipine, Itraconazole( Voriconazole)
Anidulafungin 1. < 1.1mg/min LiverRenal dose
2. Loding dose
3. 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. (De-Escalation therapy) Abx culture
2. GPC G(+)GNB G(-)( G(+) GPCG(-) GNB)
3. -lactam PenicillinCefasporinCarbapenemMonobactam
4. -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
Serratia, "Indole-positive" PsA, "Indole-positive" Providencia, "Indole-positive" Proteus vulgaris, Citrobacter, and Enterobacter species
5. (Cefamycin)NMTT side chain effectNMTT chain vitamin K dependent carboxylase vitamin K 2,3-epoxide reductase
(competitive antagonist) prolonged PT & PTT liver function
6.
7.
A. Bactericidal
B. Bacteriostatic
8.
A. Concentration dependent post-antibiotics effect(PAE) once daily AG FQ
B. Time dependent MIC
9.
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(+): GNC Nesseria N. meningitis
Staphylcoccus aureus N. gonorrhea
Coagulase(-): Moraxella Moraxella catarrhalis (Pneumonia)
CONS Staphylcoccus epidemis ()
Streptococci -hemolytic() GNB Enterobacteriaceae Fermenting GNB
GASS. pyogenes ( pharyngitis & 1. PECK(Proteus, E.coli, Klebsiella spp.)
tonsillitis, necrotizing fascilitis PCN 2. Enterobacter spp. / Citrobacter spp.
) 3. Salmonella spp. / shigella spp.
GBSS. agalactiae ( normal flora, Non-fermenting GNBABPS( MDR)
neonatal meningitis) 1. Acinetobacter baumannii
-hemolytic() 2. Burkholderia spp.
S. viridans( IE ) 3. Pseudomonas aureus
S. pneumonia 4. Stenotrophomonas maltophilia
S. bovis (Group D, endocarditis) Fastidious GNB
H. influenza
Enterococcus faecalis()
Enterococcus Atypical Mycoplasma, Chlamydia, Legionella
() Enterococcus faecium( VRE) Rickettsia, scrub typhus
GPB Aerobes Listeria () Mycobacteria Mycobacterium tuberculosis(tuberculosis)
() Corynebacterium dipheriae() Mycobacterium leprae(leprosy)
Nocardia (, )
Bacillus anthracis ()
Anaerobes Clostridium (, ) Anaerobes peptostreptococcus
C. difficile() Bacteroides fragilis
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 Cephalosporin Zithromax Azithromycin Macrolide
Ceflour Cefuroxime() 2nd Cephalosporin Targocid Teicoplanin Glycopeptide
Cetazone Cefmetazole 2.5th Cephalosporin Cubicin Daptomycin Lipopeptides
Cexitin Cefoxitin 2.5th Cephalosporin Zyvox Linezolid Oxazolidinones
Flumarin Flomoxef 2.5th Cephalosporin Tygacil Tigecycline Glycylcycline
Rocephin Ceftriaxone 3rd Cephalosporin Clincin/Lindacin Clindamycin Lincosamide
Claforan Cefotaxime 3rd Cephalosporin Baktar/Sevatrim Trimethoprim-sulfamethoxazole Sulfonamide
Co-trimoxazole
Fortum/Tatumcef Ceftazidime 3rd Cephalosporin Borymycin Monocycline Tetracycline
Cefspan Cefixime() 3rd Cephalosporin Colimycin Colistin Polymixin
Seftem Ceftibuten() 3rd Cephalosporin Anegyn/Flagyl Metronidazole Nitroimidazole
Brosym CPZ+sulbactam 3.5th Cephalosporin Fungizone Amphotericin B Polyene
Maxipime Cefepime 4th Cephalosporin 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