Beta Lactam Antibiotic Spectrum of Activity

Table 1. Penicillins ( + usually effective clinically; +/- clinical trials lacking or only 30-60% sensitivity rate; 0 not effective clinically or <30% susceptibility)
Staph. H. Moraxe streptoco enterococ aureus MRS influenz lla 1 cci cus (methicil A ae species lin S) Nonpseudomo Pseudomo nas nas Anaerobes aerobic g- aeruginosa rods G.I. tract (B. E. Penicilli n G (IV); Penicilli nV (PO) faecalis + N. meningitidis fragilis) 0 Clostridia species (not difficile)+ Oral anaerobes

Class

Name

Neisseria species

+ 0 0 0 0
N. gonorrhoea e0

True penicillins

E. faecium +/

+/Penicillinase resistant semisynthetic Nafcillin (IV); dicloxaci lin (PO)

0
G.I. tract (B. fragilis) 0

N. meningitidis Ampicilli Aminopenicil n (IV); lins amoxicill in (PO)

+ + + 0 0 +/0
N. gonorrhoea e0

E. coli +/Most others 0

Clostridia species (not

difficile) + Oral anaerobes

+/-

G.I. tract (B. fragilis) 0 Clostridia species (not difficile) + Oral anaerobes

Ureidopenicil Piperacil lins lin

+/-

+/-

+/1

MRSA= methicillin resistant Staphylococcus aureus

Table 2. Penicillin/beta lactamase inhibitor combinations

Staph. streptococ enterococc aureus ci us (methicill in S) MRS A1 NonH. Moraxell Neisseri Pseudomon pseudomon Anaerob influenz a a as as aerobic es ae species species aeruginosa g- rods

Name

Ampicillin/sulbacta m (IV); Amoxicillin/clavulan ate (PO) Ticarcillin/clavulanat e (IV) Piperacillin/tazobact am (IV)2

+ + +

+ + +

+ + +

0 0 0

+ + +

+ + +

+ + +

+ + +

0 + +

+ + +

Due to the greater intrinsic activity of piperacillin against aerobic gram negative rods, piperacillin/tazobactam is more effective against gram negative rods than ampicillin/sulbactam or Ticarcillin/clavulanate. However, the beta lactamase inhibitors are not effective at inhibiting the chromosomal beta lactamases of Pseudomonas species, so the combination drugs have no therapeutic advantage over the beta lactam drug alone versus Pseudomonas.

Table 3. Cephalosporins (note: although the chart shows most of the cephalosporins to be significantly active vs Staph. aureus there are relative degrees of activity, i.e., the general trend is for 1st generation agents to be more active against gram positives and later generations to be more active vs gram negatives; cefepime is the exception having excellent gram positive and gram negative activitiy; likewise, although the chart shows most cephalosporins to have anaerobic activity for oral anaerobes and clostridia species, only cephamycins have useful Bacteroides fragilis activity and from a practical standpoint cephalosporins other than cephamycins are rarely chosen for treating anaerobes since better agents are available)
Staph. H. Moraxel streptoc enterococ aureus MRS influen la occi cus (methici A1 zae species llin S) Neisseria species NonPseudomo pseudomonas nas Anaerobes aerobic gaeruginos rods a

Class

Name

Cefazoli 1st n (IV); generation Cephale xin (PO)

+; not cephale xin

+/-

0
N. gonorrhoeae

0; some E. coli andKlebsiel la OK

0
G.I. tract (B. fragilis)0

Cefuroxi 2nd me generation (IV/PO); (true cefaclor cephalo) (PO)

+; cefa + 0 + 0 +
clor is +/-

+/-; N.
meningitidis

+/-

0
Clostridia species (not

difficile) + Oral anaerobes

+
2nd generation Cefoxitin (cephamyc (IV) in)

+/-

+
G.I. tract (B. fragilis)0

Ceftriax one 3rd (IV/IM); generation cefixime (PO)

+/-

Clostridia species (not difficile) + Oral anaerobes

+/G.I. tract (B.

+
3rd much generation less Ceftazidi (antiactive me (IV) pseudomo than nas) ceftriaxon e vs pneumoc occi

fragilis)0 Clostridia species (not difficile) + Oral anaerobes

+/-

+/-

+
4th Cefepim generation e (IV)

Table 4. Monobactams
Staph. NonH. Moraxell Neisseri streptococc enterococcu aureus MRSA pseudomona Pseudomona Anaerobe influenza a a 1 i s (methicilli s aerobic g- s aeruginosa s e species species n S) rods 0 0 0 0 + + + + + 0

Name

Aztreona m

Table 5. Carbapenems
Name streptococ enterococc ci us Staph. H. Moraxell Neisseri NonMRSA aureus influenza a a pseudomon 1 (methicilli e species species as aerobic Pseudomon Anaerobe as s aeruginosa

n S) Imipenem/cilasta tin (IV) Meropenem (IV) Ertapenem (IV)

g- rods

+ + +

+; E. faecalis only +/-; E. faecalis only

+ + +

0 0 0

+ + +

+ + +

+ + +

+ + +

+ + 0

+ + +