Clarithromycin (Biaxin) | CAP | RA: Oral F: Suspension, tablets, extended release tablets D: 250-500 mg every 12 h; 1000 mg every 24 h (XL) | Inhibits protein synthesis | SE: Headache, rash, abnormal taste, gastrointestinal, C. diff CI: Hypersensitivity to macrolide | E: H & R DI: P450 substrate: 3A4 (major); P450 inhibitor: 3A4 (strong), 1A2 (weak) GI: Pregnancy category C. |
Azithromycin (Zithromax; Z-pac) | CAP | RA: Oral, IV F: Injection, suspension, tablet D: 250-500 mg every 24 h | Inhibits protein synthesis | SE: Headache, rash, gastrointestinal, C. diff CI: Hypersensitivity to macrolide | E: H; use with caution in patients with preexisting liver disease DI: P450 substrate: 3A4 (minor), P450 inhibitor: 3A4 (weak) GI: Pregnancy category B |
Doxycycline (Vibramycin and others) | CAP | RA: Oral, IV F: Capsule, tablet, suspension, syrup, injection D: 100 mg every 12 h | Inhibits protein synthesis | SE: Rash (photosensitivity), GI, C. diff, BMS (rare), hepatotoxicity (rare), autoimmune disease reported CI: Hypersensitivity to doxycycline/tetracyclines, children ≤ 8 years of age | E: R and feces DI: P450 inhibitor 3A4 (moderate), levels decreased by cations GI: Pregnancy category D |
Amoxicillin (Amoxil) | CAP | RA: Oral F: Capsule, tablet, suspension D: 500 mg every 8 h or 875 every 12 h (1000 mg every 8 h for DRSP) | Inhibits bacterial cell wall synthesis | SE: Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to amoxicillin or penicillin compounds | E: R (dose reductions required for renal dysfunction) GI: Pregnancy category B; high percentage of patients with infectious mononucleosis develop rash on amoxicillin. |
Ampicillin (Principen and others) | CAP | RA: Oral, IV F: Capsule, suspension, injection D: 2 g IV every 6 h | Inhibits bacterial cell wall synthesis | SE: Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to amoxicillin or penicillin compounds | E: R (dose reductions required for renal dysfunction) GI: Pregnancy category B; high percentage of patients with infectious mononucleosis develop rash on ampicillin |
Amoxicillin/Clavulanate (Augmentin) | CAP; aspiration | RA: Oral F: Suspension, tablet, XR tablet D: 500 mg every 8 h, 875 mg every 12 h, 2000 mg every 12 h | Inhibits bacterial cell wall synthesis; addition of clavulanate extends coverage of amoxicillin to include beta- lactamase producing bacteriac | SE: Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to amoxicillin or penicillin compounds | E: R (dose reductions required for renal dysfunction) GI: Pregnancy category B; high percentage of patients with infectious mononucleosis develop rash on amoxicillin/clavulanate |
Ampicillin/Sulbactam (Unasyn) | CAP | RA: IV F: Injection D: 1.5-3 g every 6 h | Inhibits bacterial cell wall synthesis; addition of sulbactam extends coverage of ampicillin to include beta lactamase- producing bacteriac | SE: Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to ampicillin or penicillin compounds | E: R (dose reductions required for renal dysfunction) GI: Pregnancy category B; high percentage of patients with infectious mononucleosis develop rash on ampicillin/sulbactam |
Piperacillin/Tazobactam (Zosyn) | HCAP | RA: IV F: Injection D: 3.375-4.5 g every 4-6 h | Inhibits bacterial cell wall synthesis; addition of tazobactam extends coverage of piperacillin to include beta lactamase- producing bacteriac | SE: Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to piperacillin or penicillin compounds | E: R (dose reductions required for renal dysfunction) GI: Pregnancy category B; high percentage of patients with infectious mononucleosis develop rash on piperacillin; bleeding disorders have been observed, particularly in patients with renal dysfunction, discontinue if thrombocytopenia or bleeding occurs; 4.5 g injection contains 11.17 mEq of sodium, 3.375 g contains 8.38 mEq of sodium |
Cefpodoxime (Vantin) | CAP | RA: Oral F: Suspension, tablet D: 200 mg every 12 h | Inhibits bacterial cell wall synthesis | SE: Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to cefpodoxime or cephalosporin compounds; if allergic to penicillin: delayed reaction (rash) 8%-10% chance of cross reactions, immediate reaction (anaphylaxis) do not use | E: R (dose reductions required for renal dysfunction); GI: Pregnancy category B |
Cefuroxime (Ceftin and others) | CAP | RA: Oral, IV F: Tablet, suspension, injection D: 500 mg every 12 h (po), 750 mg every 8 h (IV) | Inhibits bacterial cell wall synthesis | SE: Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to cefuroxime or cephalosporin compounds; if allergic to penicillin: delayed reaction (rash) 8%-10% chance of cross reactions, immediate reaction (anaphylaxis) do not use | E: R (dose reductions required for renal dysfunction) GI: Pregnancy category B; cefuroxime axetil film coated tablets and oral suspension are not bioequivalent and are not substitutable on a mg/mg basis |
Ceftriaxone (Rocephin) | CAP | RA: IV F: Injection D: 1-2 g daily | Inhibits bacterial cell wall synthesis | SE: Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to ceftriaxone or cephalosporin compounds; if allergic to penicillin: delayed reaction (rash) 8%-10% chance of cross reactions, immediate reaction (anaphylaxis) do not use | E: R (dose reductions not required for renal dysfunction), feces GI: Pregnancy category B; do not use in hyperbilirubinemic neonates and concomitant use with calcium containing solutions/products in neonates |
Cefotaxime (Claforan) | CAP | RA: IV F: Injection D: 1-2 g every 8 h | Inhibits bacterial cell wall synthesis | SE: Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to cefotaxime or cephalosporin compounds; if allergic to penicillin: delayed reaction (rash) 8%-10% chance of cross reactions, immediate reaction (anaphylaxis) do not use | E: R (dose reductions required for renal dysfunction) GI: Pregnancy category B |
Cefepime (Maxipime) | HCAP | RA: Injection F: IV D: 1-2 g every 8-12 h | Inhibits bacterial cell wall synthesis | SE: Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash); CI: Hypersensitivity to cefepime or cephalosporin compounds; if allergic to penicillin: delayed reaction (rash) 8%-10% chance of cross reactions, immediate reaction (anaphylaxis) do not use | E: R (dose reductions required for renal dysfunction) GI: Pregnancy category B; may be used for CAP, however since cefepime has activity against Pseudomonas aeruginosa, it should be reserved for HCAP, use ceftriaxone or cefotaxime for CAP |
Ertapenem (Invanz) | CAP | RA: Injection F: IV D: 1 g daily | Inhibits bacterial cell wall synthesis | SE: Headache, Rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to ertapenem or carbapenem compounds; if allergic to penicillin: may have a cross reactions | E: R, feces (dose reduction required for renal dysfunction) GI: Pregnancy category B |
Imipenem (Primaxin) | HCAP | RA: Injection F: IVD: 500-1000 mg every 6 h | Inhibits bacterial cell wall synthesis | SE: Headache, seizure, rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to imipenem or carbapenem compounds; if allergic to penicillin: may have a cross reaction | E: R (dose reduction required for renal dysfunction) GI: Pregnancy category C; has been associated with seizures—use with caution in patients with history of seizures |
Meropenem (Merrem) | HCAP | RA: Injection F: IV D: 1-2 g every 8 h | Inhibits bacterial cell wall synthesis | SE: Headache, rash, GI, C. diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to meropenem or carbapenem compounds; if allergic to penicillin: may have a cross reaction | E: R (dose reduction required for renal dysfunction) GI: Pregnancy category B |
Doripenem (Doribax) | HCAP | RA: Injection F: IV D: 500 mg every 8 h | Inhibits bacterial cell wall synthesis | SE: Headache, rash, GI, C.diff, BMS (rare), allergic reaction (immediate—anaphylaxis or delayed—rash) CI: Hypersensitivity to doripenem or carbapenem compounds; if allergic to penicillin: may have a cross reaction | E: R (dose reduction required for renal dysfunction) GI: Pregnancy category B; administration is over 1 h (most antimicrobials are administered over 30 min, except for highly resistant bacteria, see Chapter 19); HCAP use is unlabeled/investigational at time of writing |
Levofloxacin (Levaquin) | CAP ; HCAP | RA: Oral, injection F: Solution, tablet, IV D: 500-750 mg daily | Inhibits DNA gyrase; inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands | SE: Headache, confusion, mental status changes, GI, C. diff, BMS (rare), allergic reaction (immediate or delayed), glucose (hypo or hyperglycemia), photosensitivity CI: Hypersensitivity to levofloxacin or other quinolones | E: R (dose reduction required for renal dysfunction) DI: QTc prolonging agents, cations, rare cases of torsade de pointes reported (use caution in patients with known prolongation of QT interval, bradycardia, hypokalemia, hypomagnesemia, or receiving Class 1a or Class III antiarrhythmics GI: Pregnancy category C; black box warning: reports of tendon inflammation and rupture (Achilles tendon); fluoroquinolones have been associated with the development of serious (sometimes fatal), hypoglycemia |
Ciprofloxacin (Cipro) | HCAP | RA: Oral, injection F: Suspension, tablet, IV D: Oral: 500-750 mg every 12 h, IV: 400 mg every 8-12 h | Inhibits DNA gyrase; inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands | SE: Headache, confusion, mental status changes, GI, C. diff, BMS (rare), allergic reaction (immediate or delayed), glucose (hypo- or hyperglycemia), photosensitivity CI: Hypersensitivity to ciprofloxacin or other quinolones | E: R, feces (dose reduction required for renal dysfunction) DI: Inhibits CYP-450 1A2 (strong) and 3A4 (weak), QTc prolonging agents, cations, theophylline, rare cases of torsade de pointes reported (use caution in patients with known prolongation of QT interval, bradycardia, hypokalemia, hypomagnesemia, or receiving Class 1a or Class III antiarrhythmics; GI: Pregnancy category C; black box warning: reports of tendon inflammation and rupture (Achilles tendon); fluoroquinolones have been associated with the development of serious (sometimes fatal), hypoglycemia |
Moxifloxacin (Avelox) | CAP | RA: Oral, injection F: Tablet, IV | Inhibits DNA gyrase; inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands | SE: Headache, confusion, mental status changes, GI, C. diff, BMS (rare), allergic reaction (immediate or delayed), glucose (hypo- or hyperglycemia), photosensitivity CI: Hypersensitivity to moxifloxacin or other quinolones | E: R (20%), H, feces DI: QTc prolonging agents, cations, rare cases of torsade de pointes reported (use caution in patients with known prolongation of QT interval, bradycardia, hypokalemia, hypomagnesemia, or receiving Class 1a or Class III antiarrhythmics GI: Pregnancy category C; black box warning; reports of tendon inflammation and rupture (Achilles tendon); fluoro-quinolones have been associated with the development of serious (sometimes fatal), hypoglycemia |
Gemifloxacin (Factive) | CAP | RA: Oral F: Tablet | Inhibits DNA gyrase; inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands | SE: Headache, confusion, mental status changes, GI, C. diff, BMS (rare), allergic reaction (immediate or delayed), glucose (hypo or hyperglycemia), photosensitivity CI: hypersensitivity to gemifloxacin or other quinolones | E: R (dose reduction required for renal dysfunction) DI: QTc prolonging agents, cations, rare cases of torsade de pointes reported (use caution in patients with known prolongation of QT interval, bradycardia, hypokalemia, hypomagnesemia, or receiving Class 1a or Class III antiarrhythmics GI: Pregnancy category C; black box warning; reports of tendon inflammation and rupture (Achilles tendon); fluoroquinolones have been associated with the development of serious (sometimes fatal), hypoglycemia |
Gentamicin (Garamycin) and Tobramycin (Tobrex) | HCAP | RA: Injection F: IV D: 1-2.5 mg/kg every 8-12 h (conventional) to produce peak of 8-10 mg/L and trough ≤ 2 mg/L, 4-7 mg/kg every 24, 36, 48 h (extended interval) check random level between 6-14 h to determine dosing interval | Inhibits protein synthesis by binding to 30s and 50s ribosomal subunit | SE: Neurotoxicity (vertigo, ataxia), ototoxicity, nephrotoxicity, rash, BMS (rare), GI, C. diff CI: Hypersensitivity to gentamicin, tobramycin or other aminoglycosides | E: R (dose modifications required for renal dysfunction) GI: Pregnancy category D; risk factors for nephrotoxicity: preexisting renal impairment, concomitant nephrotoxic drug, advanced age, dehydration; may cause neuromuscular blockade and respiratory paralysis; dosage individualization is critical because of low therapeutic index, initial and periodic plasma drug levels should be determined, particularly in critically ill patients or in disease states known to significantly alter aminoglycoside pharmacokinetics (cystic fibrosis, burns, or major surgery) |
Amikacin (Amikin) | HCAP | RA: Injection F: IV D: 5-7.5 mg/kg every 8 h (conventional), 15-20 mg/kg daily | Inhibits protein synthesis by binding to 30s and 50s ribosomal subunit | SE: Neurotoxicity (vertigo, ataxia), ototoxicity, nephrotoxicity, rash, BMS (rare), GI, C. diff CI: Hypersensitivity to amikacin or other aminoglycosides | E: R (dose modifications required for renal dysfunction) GI: Pregnancy category D; risk factors for nephrotoxicity: preexisting renal impairment, concomitant nephrotoxic drug, advanced age, dehydration; may cause neuromuscular blockade and respiratory paralysis; dosage individualization is critical because of low therapeutic index, initial and periodic plasma drug levels should be determined, particularly in critically ill patients or in disease states known to significantly alter aminoglycoside pharmacokinetics (cystic fibrosis, burns, or major surgery) |
Vancomycin (Vancocin) | HCAP | RA: Oral, injectionF: Capsule (treatment of C. diff only), IVD: Oral:125-250 mg every 6 h, IV: 1-2 g every 12 h to produce trough of 15-20 mg/L or AUC/MIC ratio ≤ 400 | Inhibits bacterial cell wall synthesis | SE: Red-man syndrome (rash), BMS (rare, except with high dose), ototoxicity, nephrotoxicity, increase nephrotoxic potential when combined with aminoglycoside CI: Hypersensitivity to vancomycin | E: R (dose modifications required for renal dysfunction) GI: Pregnancy category C, pharmacokinetics may be altered during pregnancy; dosing in dialysis patients is variable, poorly dialyzable by conventional hemodialysis, increased removal with high flux membranes and continuous renal replacement; Red-man syndrome is not an allergic reaction but is associated with too rapid infusion of the drug |
Linezolid (Zyvox) | HCAP | RA: Oral, injection F: Suspension, tablet, IV D: 600 mg every 12 h | Inhibits bacterial protein synthesis by binding to 23s ribosomal RNA of the 50s subunit | SE: Headache, GI, C. diff, rash, BMS. BMS (including anemia, leucopenia, pancytopenia, and thrombocytopenia may be more common in patients receiving for > 2 wk CI: Hypersensitivity to linezolid, concurrent use if within 2 wk of monoamine oxidase inhibitors, patients with uncontrolled hypertension, taking sympathomimetics, vasopressive agents, or dopaminergic agents unless closely monitored for increase in blood pressure, patients taking antidepressants with serotonin mechanism, meperidine unless closely monitored for serotonin syndrome | E: R (30% parent drug, 50% inactive metabolites), feces DI: Sympathomimetics, antidepressants with serotonin activity, meperidine, tyramine containing foods (hypertensive crisis) GI: Pregnancy category C; monitoring: weekly complete blood count, particularly in patients at increased risk of bleeding, preexisting myelosuppression, on concomitant medications that cause BMS, those requiring more than 2 wk of therapy |
Clindamycin (Cleocin) | Aspiration | RA: Oral, injection F: Capsule, solution, IV D: Oral: 300-450 mg every 6-8 h, IV: 600-900 mg every 8 h | Reversibly binds to 50s ribosomal subunit preventing peptide bond formation thus inhibiting bacterial protein synthesis | SE: Rash, GI, C. diff, BMS (rare) CI: Hypersensitivity to clindamycin | E: R (10%), H, feces GI: Pregnancy category B; can cause severe and possibly fatal colitis (C. diff infection) |