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ANTIBIOTICS 
6th year - 2015 - D2 
Basel Abu Fares 
Bashar Mudallal
Empiric Antimicrobial Therapy 
• Choose antibiotic(s) to cover for most likely and 
lethal organisms for the type of infection 
• Prior to obtaining laboratory results (usually 
reserved for serious infections) 
• Adjust antibiotic(s) based on C&S 
 if causative organism identified, use antibiotic to which 
organism is sensitive 
 if causative organism not identified, re-evaluate need for 
ongoing antimicrobial therapy (and continue with 
empiric antibiotic(s) if indicated)
Classification 
• Cell Wall Inhibitors 
• Glycopeptides 
• Protein Synthesis Inhibitors 
• Topoisomarase Inhibitors 
• Anti-metabolites 
• Anti-mycobacterials 
• Sulfones
Cell Wall Inhibitors 
•Include : 
-penicillins 
-cephalosporins 
-carbapenems 
-glycopeptides
Penicillins
Cephalosporins (IV/PO) 
• 1st generation: cephalexin/cefazolin (mostly GP, 
some GN) 
• 2nd generation: cefuroxime/cefuroxime (some 
GP and some GN, *anaerobes) 
• 3rd generation: cefixime/cefotaxime, ceftriaxone 
(good Streptococcalcoverage, mostly GN) and 
ceftazidime (no GP, mostly GN, Pseudomonas) 
• 4th generation: --/cefepime (most GP, most GN, 
Pseudomonas)
Carbapenems 
(broad coverage: GP, GN and 
anaerobes) 
•imipenem (+ Pseudomonas) 
•meropenem (+ Pseudomonas) 
•ertapenem
Glycopeptides 
(all GP and C. difficile– the 
oral form) 
• vancomycin
Protein Synthesis Inhibitors 
• 50S ribosome inhibitors 
-Macrolides 
-Lincosamides 
• 30S ribosome inhibitors 
-Aminoglycosides 
-Tetracyclines
Macrolides 
[GP, Hemophilus, and atypical bacteria 
(Legionella, Chlamydophila, 
Mycoplasma)] 
• erythromycin 
• clarithromycin 
• azithromycin
Lincosamides 
•clindamycin (most GP, GN 
anaerobes) 
•chloramphenicol (broad-spectrum) 
•linezolid (for resistant GP infections)
Aminoglycosides 
(GN aerobic bacilli) 
•gentamicin 
•tobramycin 
•amikacin
Tetracyclines 
(GP, syphilis, 
Chlamydophila, Rickettsia, 
Mycoplasma) 
•doxycycline/tetracycline
Topoisomarase Inhibitors 
•Flouroquinolones 
•Rifampin 
•Metronidazole
Fluoroquinolones 
(GN – although resistance becoming a huge 
problem) 
• ciprofloxacin (+ Pseudomonas) 
• norfloxacin (for UTI only) 
• respiratory fluoroquinolones (some GP, GN, 
"atypicals", Legionella, Mycoplasma, 
Chlamydophila) 
• levofloxacin 
• moxifloxacin (+ anaerobes)
Rifampin 
(GP mostly, H. Inf., N. 
meningitidis and mycobacteria)
Metronidazole 
(anaerobes incl. C. difficile; 
Trichomonas, Entamoeba)
Anti-metabolites 
•Trimethoprim-sulfamethoxazole 
•Nitrofurantoin
TMP/SMX 
(GN bacilli, S. saprophyticus, 
Enterococcus)
Nitrofurantoin 
•(GN bacilli, S. saprophyticus, 
Enterococcus)
Anti-mycobacterials
Sulfones
Antibiotics for Selected 
Bacteria
Others 
• treatment for C. Difficile: 
metronidazole OR oral vancomycin; 
consider both in serious infection
Resources 
• Toronto Notes 2014
THANK YOU 
The End

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