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Antibiotics  

ANTIBIOTICS  
REF:  Tarascon Pharmacopoeia 2006
PENICILLINS:

1st Generation Penicillins - Natural

  • Penicillins G  IV 8-12 million U/d divided q4-6h for Penicllin-sensitive pneumococcal pneumonia.  
    For Penicillin-sensitive pneumococal meningitis 24 million U/d IV divided q2-4h.
    For empiric therapy for native valve endocarditis 20 million U/d IV continuous infusion or divide q4h plus Nafcillin/Oxacillin and Gentamicin.
    For neurosyphilis:  18-24 million U/d IV conotinuous infusion or 3-4 million U IV q4h x 10-14 d.
  • Penicillins VK  500 mg PO bid-qid x 10d for Strep pharyngitis.  For secondary prevention of rheumatic fever 250 mg PO bid.
  • Procaine penicillin (Wycillin) IM 0.6 -1 million U daily for Vincent's infection (acute necrotizing ulcerative gingivitis), erysipeloid.
    For neurosyphilis:  2.4 million U IM daily plus probenecid 500 mg PO q6h, both x 10-14 days.
  • Bicillin C-R (Procaine penicillin + benzathine penicllin) IM 2.4 million U single dose for scarlet fever, erysipelas, URI, skin & soft-tissue infections due to Group A Strep.
    For pneumococcal infections other than meningitis  1.2 millioin U IM q2-3 days until afebrile x 48h.  Not for syphilis Rx.
  • Benzathine penicillin (Bi-cillin L-A)  IM 1.2 million U IM single dose for Strep pharyngitis.
    For primary, secondary, early latent syphilis 2.4 million U IM single dose.  For late latent or tertiary syphilis 2.4 million U IMI q week x 3 doses.

2nd Generation Penicillins - Penicilllinase-Resistant   (B-LACTAM resistant)

  • Cloxacillin PO 500 mg qid on empty stomach.  For severe infections:  1-2 g IV/IM q4h. For Staph osteomyelitis:  2 g IV/IM q6h.  (IV/IM not available in US)
  • Dicloxacillin (Dynapen)  PO 500 mg qid on empty stomach for Staph infection.
  • Nafcillin IV 1-2 g IV q4h for osteomyeliltis.  Empiric therapy for native valve endocarditis 2 g IV q4h plus penicillin/ampicillin and gentamicin.  For Staph infections, usual dose 500 mg IM q4-6h or 500 mg -2 g IV q4h.
  • Oxacillin IM/IV 250 mg - 2 g q4-6 h.  For osteomyelitis 1.5 -1 g IV q4h.  For empiric therapy  native valve endocarditis 2 g IV q4h with penicillin/ampicillin and gentamicin.

3rd Generation Penicillins - Aminopenicllins

  • Amoxicillin PO 250-500 mg tid or 500-875 mg bid for ENT, skin, GU infections.  For pneumonia 500 mg tid or 875 mg bid PO.
  • Amoxicillin-clavulanate (Augmentin, Clavulin) 500-875 mg PO bid or 500 mg tid for severe infections.  May be used for pneumonia, otitis media, sinusitis, skin infections, UTI.   (B-LACTAM resistant)
  • Ampicillin IV 1-2 g q4-6h  or 500 mg qid PO.  For sepsis, meningitis:  150-200 mg/d/day IV divided q3-4h.  For empiric therapy native valve endocarditis:  12 g/day IV continuous infusion or divided q4h plus nafcillin/oxacillin and gentamicin.
  • Ampicillin-sulbactam (Unasyn) IM/IV 1.5-3 g q6h for skin, intra-abdominal, gynecologic infections.   (B-LACTAM resistant)
  • Pivampicillin (Pondocillin) PO 500-1000 mg bid (Canada only)

4th Generation Penicillins - Extended Spectrum

  • Carbenicillin (Geocillin) 382-764 mg PO qid for UTI.  For prostatitis:  764 mg qid PO
  • Piperacillin IM/IV 6-8 g/d divided qq6-12h for simole UTI, community-acquired pneumonia.  For complicated UTI 8-16 g/d IV divided q6-8h.  For serious infections: 12-18 g/d IV divided q4-6h  (Max 24 g/d)
  • Piperacillin-tazobactam (Zosyn) IV 3.375 g q6h for appendicitis, peritonitis, skin infections, postpartum endometritis, PID, mod. community-acquired pneumonia.  For nosocomial pneumonia 4.5  g IV qq6h (with aminoglycoside initially and if Pseudomonasa is cultured)  (B-LACTAM resistant)
  • Ticarcillin (Ticar) IV 3 g q4h or 4 g q6h for sepsis, pneumonia, skin & soft tissue, intra-abdominal, femal GU infections.  
    For simple UTI: 1 g IM/IV q6h; complicated UTI 3 g IV q6h.
  • Ticarcillin-clabulanate (Timentin) For systemic infections or UTI;  3.1 g IV q4-6h; For gynecologic infections in adult <60 kg  200-300 mg/kg/day IV divided q4-6h.   
    Use q4h dosing interval for Pseudomonas infections.  (B-LACTAM resistant)


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CEPHALOSPORINS:

1st Generation Cephalosporins:

  • Cefazolin (Ancef)  For mild infections due to Gram positive cocci:  250-500 mg IM/IV q8h; Moderate/severe infections: 0.5 -1 g IIM/IV q6-8h.  Lilfe-threatening infections: 1 -1.5 g IV q6h. For pneumonia, sepsis, endocarditis, skin, bone & join, genital infections.   
    For simple UTI  1 g IM/IV q12h.  For pneumonococcal opneumonia 500 mg IM/IV q12h.  For sugical prophylaxis 1 g IM/IV 30-60 min preop, additional 0.5-1 g during surgery >2 h, and 0.5-1 g q6-8 h x 24 h postop.
  • Cephalexin (Keflex) PO 250-500 mg qid  (Max 4 g/day) for pneumonia, bone, GU infections.
  • Cefadroxil  (Duricef) PO 500 mg cap or 1 g tab bid for UTI, skiin infection, Strep pharyngitis.
  • Cephradine (Velosef) PO 250 mg qid or 500 mg bid for simple UTI, skin, or URI.  For lobar pneumonia, serious UTI, prostatitis 500 mg qid or 1 g bid.  (Max 4 g/d)

2nd Generation Cephalosporins:

  • Cefuroxime (Zinacef) IM/IV 750 mg q8h for uncomplicated pneumonia, URI, skin infections, disseminated gonorrhea.  
    For bone & join, or severe/complicated infections: 1.5 g IV q8h.
    For gonorrhea:  1.5 g IM single dose split into 2 injections, given with Probenecid 1 g PO.
    For Strep pharyngitis, sinusitis or bronchiti, skin infections PO 250-500 mg bid.  FOr simple UTI 125-250 mg PO bid.
    For simple gonorrhea: PO 1 g single dose.  For early lyme disease: 500 mg PO bid x 20 days.
  • Cefaclor (Ceclor) PO 250-500 mg tid
  • Cefotetan (Cefotan)  IM/IV 1-2 g q12h (may give up to 3 g q12h) for pneumonia, gynecologic, intra-abdominal, bone & join infections.
  • Cefoxitin (Mefoxin)  IV - Uncomplicated infection 1 g IV q6-8h; Moderate/severe infection 2 g q6-8h or 1 g q4h.
  • Cefprozil (Cefzil) PO 250-500 mg bid  for Strep pharyngitis, sinusitis, bronchitis, skin infections.
  • Loracarbef (Lorabid) PO 200-400 mg bid

3rd Generation Cephalosporins:

  • Ceftriaxone (Rocephin)  IV/IM 1-2 gm q24h (max 4g/d, divided q12h) for pneumonia, UTI, PID (hospitalized), sepsis, meningitis, skin, bone & join, intra-abdominal infections.  For gonorrhea: single dose 125 mg IM (250 mg if ambulatory Rx of PID)
  • Cefixime (Suprax) PO 200-400 mg qd for simple UTI, pharyngitis, bronchitis.  For gonorrhea 400 mg PO single dose.
  • Cefditoren (Spectracef) PO 200 mg tab 1-2 tab bid    
  • Cefdinir (Omnicef) PO 300 mg bid  for Strep pharyngitis, sinusitis, bronchitis, skin infections, community-acquired pneumonia.
  • Cefditoren (Spectracef) PO 200-400 mg bid
  • Cefoperazone (Cefobid) IV 1-2 g IV q12h usual dose for peritonitis, sepsis, pneumonia, intra-abdominal, skin & gynecologic infections, endometritis, PID.  For severe infections with less sensitive organisms may give up to 6-12g/d IV divided q6-12h.
  • Ceftazidime(Fortaz)  IM/IV 250 mg q12h for simple UTI.  For complicated UTI 500 mg q8-12h.  For uncomplicated pneumonia, mild skin ifection 500 mg -1 g IM/IV q8h.
    For more serious infection 2 g IV q8h.
  • Cefotaxime (Claforan) IM/IV 1 g q12 h for uncomplicated infections;  1-2 g q6-8h for moderate/severe infections.
  • Cefpodoxime (Vantin) 200-400 mg bid
  • Ceftizoxime(Cefizox)  IM/IV 500 mg q12h for simple UTI.  1-2 g IM/IV q8-12h for pneumonia, sepsis, intra-abdominal, skin, bone & joint infections.  For PID 2 g IV q8h.  
    For gonorrhea 1 g IM single dose or 2 g IM dose into 2 injections.

4th Generation Cephalosporins:

  • Cefepime (Maxipime) IM/IV 0.5 -1 g q12h for mild to mod. UTI; 2 g q12h for severe UTI, skin, complicated intra-abdominal infections or pneumonia.  Empiric therapy of febrile neutropenia 2 g IV q8h.


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MACROLIDES (ERYTHROMYCIN)
  • Erythromycin 250-500 qid, 333 mg tid, EES 400 mg qid PO, Erythromycin 500 mg q6h IV
  • Azithromycin (Zithromax) 500 mg day 1, then 250 mg days 2-5 PO; 500 mg once/d IV
  • Clarithromycin (Biaxin) 250-500 mg bid PO
  • Dirithromycin(Dynabac) 250 mg qd x 5 d

KETOLIDES

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Quinolone antibiotics

1st Generation Quinolones:

  • Nalidixic acid

2nd Generation Quinolones:

  • Cipro (Ciprofloxacin) 250 -500 -750mg tablets. Dose 250 - 500 mg bid PO or 200-400 mg IV q12h for UTI.
    For pneumonia, skin, bone/joint infections: 400 mg IV q8-12h or PO 500-750 mg bid.
    For acute sinusitis: 500 mg bid PO x 10d.  For chronic bacterial prostatitis:  500 mg bid PO x 4 wks.  
    For travel diarrhea:  500 mg bid POx 1-3 days.  For infectious diarrhea:  500 mg bid  POx 5-7d.  For Typhoid fever:  500 mg PO bid x 10d.  
    For Gonorrhea:  500 mg PO single dose (not for infections acquired in California, Hawaii, Asia or Pacific islands, or homosexual men).
    For nosocomial pneumonia:  400 mg IV q12h, then 500 mg PO bid.  For empiric therapy of febrile neutropenia:  400 mg IV q8h with piperacillin.
    For bioterrorism anthrax 400 mg IV a12h with >= 1 other drug intially, then monotherapy with 500 mg PO bid to complete 60 days.  Monotherapy for post-exposure prophylaxis or Rx of less severe cutaneous anthrx:  500 mg PO bid x 60 days.
    For malignant otitis externa:  400 mg IV q12h or 750 mg PO bid.
    For chancroid:  500 mg PO bid x 3 days. 
  • Floxin (Ofloxacin) PO or IV doses are the same.  200- 300 -400 mg tablets. Dose 400 mg bid PO or IV for pneumonia
    For gonorrhea:  400 mg PO single dose.  For Chlamydia:  300 mg bid x 1 wk.  For simple UTI 200 mg PO bid x 3d.   For complicated UTI 200 mg PO bid x 7-10d.
    For chronic bacterial prostatitis:  300 mg PO bid x 6 wks.
  • Maxaquin (Lomefloxacin) 400 mg tab. Dose 400 mg 1 tab/daily for 7-10d in uncomplicated UTI or bronchitis; 10-14d in complicated UTI; taken at least 2 h before or 4 h after antacids, can be taken with or without food.
  • Noroxin (Norfloxacin) 400 mg tab. Dose 400 mg bid before meal 7 10d for uncomplicated, 10-21d for complicated UTI.

3rd Generation Quinolones:

  • Levaquin (Levofloxacin) PO or IV doses are the same.  500 mg qd PO, IV x 7d for community-acquired pneumonia, bronchitis; x 7-14d for nosocomial pneumonia or complicatred skin infections, acute sinusitis.    For simple UTI:  250 mg PO daily x 3d, x10d for complicated UTI or acute pyelonephritis.
    For post-exposure anthrax prophylaxis:  500 mg PO daily x 60d.
    For Legionnaires' disease:  1 g IV/PO on 1st day, then 500 mg IV/PO daily.
    For travel diarrhea or shigella:  500 mg PO daily x 1-3d, x 5-7d for salmonella.

4th Generation Quinolones:

  • Avelox (Moxifloxacin) PO/IV 400 mg daily x 5d for bronchitis exacerbation, x 5-14d IV initially for complicated intra-abdominal infection or pneumonia.
  • Gatifloxacin (Tequin) PO or IV doses are the same. 400 mg daily x 7-14d for community-acquired pneumonia, chronic bronchitis exacerbation, complicated UTI, acute pyelonephritis, sinusitis, skin infections.  For simple UTI  400 mg PO single dose or 200 mg daily x 3d.  
    (NEJM March 30, 2006 Volume 354:1352-1361 - the use of gatifloxacin among outpatients is associated with an increased risk of in-hospital treatment for both hypoglycemia and hyperglycemia.)
  • Gemifloxacin (Factive) PO 320 mg daily for bronchitis or community-acquired pneumonia.  



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AMINOGLYCOSIDES
  • Gentamicin (Garamycin) 3-5 mg/kg/d IIM/IV divided q8h.
    Peak 5-10 mcg/mL, trough <2 mcg/mL for Gram negative infections.
    -100 mg load, then 80-110 mg q8h IV or single daily dose (5-7 mg/kg/24h IV) per pharmacist
  • Tobramycin (Nebcin) 3-5 mg/kg/d IMI/IV divided q8h.
    Peak 5-10 mcg/mL, trough <2 mcg/mL for Gram negative infections.
    For cystic fibrosis:  10 mg/kg/d IV divided q6h with target peak of 8-12 mcg/mL.  Nebulized for cystic fibrosis (TOBI) 300 mg neb bid 28 days on, then 28 days off.
  • Amikacin (Amikin) 15 mg/kg/d up to 1500 mg/d IM/IV divided q8-12h for Gram negative infections .  
    Peak 20-35 mcg/mL, trough <5 mcg/mL
  • Streptomycin 15 mg/kg up to 1 g IM/IV daily as  comgined therapy for TB.  If >59 yo, give 10 mg/kg up to 750 mg IM/IV daily.
  • Spectinomycin (Trobicin) 2 g IM single dose for Gonorrhea;  2 gm IM q12h for disseminated gonorrhea.   

CARBAPENEMS (IMIPENEM - Cilastatin)

  • Imipenem-Cilastatin (Primaxin)
    for pneumonia, sepsis, endocarditis, polymicrobic, intra-abdominal, gynecologic, bone & join, skin infections.
    In normal renal function, >=70 kg patients: Mild infection: 250-500 mg IV q6h; Moderate infection: 500 mg  IV q6-8h; Severe infection: 500 IV q6h to 1 g q6-8h.
  • Ertapenem (Invanz) 1 g IM/IV over 30 min q24h x <=14 days for IV, x <=7 dyas for IM
    - for comminity-acquired pneumonia, diabtic foot, complicated intra-abdomina, skin, urinary tract, acute pelvic infections.
  • Meropenem (Merrem) For intra-abdominal infections:  1 g IV q8h.  For complicated skin infections: 500 mg IV q8h.

SULFONAMIDES
  • Septra/Bactrim (Trimethoprim-Sulfamethoxazole) DS 1 tab bid PO for UTI, shigellosis, bronchitis or traveler's diarrhea.
    For pneumocystis Rx: IV 15-20 mg TMZ/kg/day in q6-8 h divided doses x 21 days toal;  Pneumonocystis prophylaxis 1 DS tab PO bid.

TETRACYCLINE
*For streptococcus pneumoniae, Legionella, Chlamydia pneumoniae, Mycoplasma pneumoniae, Gonorrhea, Syphillis, chancroid, granuloma inguinale, lymphogranuloma venereium, leptospirosis, psittacosis, Brucellosis, prostatitis, sinusitis, chronic bronchitis, travel diarrhea, Shigella, cholera, amebiasis, tropical sprue,  Lyme disease, Rocky mountain spotted fever, actinomycosis

  • Tetracycline PO 500 mg qid on empty stomach.
    For primary, secondary, early latent syphilis (in penicillin-allergic pts) 500 mg qid PO x 14d.  For late latent or tertiary syphilis 500 mg qid x 4 weeks.
  • Doxycycline (Vibramycin) PO 100 mg bid for chlamydia, nonGC urethritis, prostatitis, acne vulgaris, periodontitis.
    For Cholera 300 mg PO single dose.
    For primary, secondary, early latent syphilis (in penicillin-allergic pts) 100 mg bid PO x 14d.  For late latent or tertiary syphilis 100 mg PO bid x 4 weeks.
    For Malaria prophylaxis:  100 mg PO daily starting 1-2d before exposure until 4 wks after.
    May also give by IV 200 mg on the 1sr d in 1-2 infusions, then 100-200 mg /d in 1-2 infusions.

    * Active against the following (    except a small number of S.pneumo & H.influenza.)
    -Moraxella caratthalis, Mycoplasma pneumonaie, Ricketssiae sp., Streptococcus anerobic, Vibrio cholerae,  Campylobacter jejuni, Chlamydophilia pneumoniae, Chlamydia trachomatis, Clostridium perfringens, Clostridium tetani, Tetanus, Q-fever, Tularemia.
    For bioterrorism anthrax:      100 mg bid x 60 days.  Use IV with >= other drug for initial Rx of inhalation or severe cutaneous anthras.   Use PO monotherapy for less severe cutaneous anthrax or post-exposure prophylaxis.  
  • Minocycline (Minocin) IV/PO 200 mg  1st dose, then 100 mg q12h (Max 400 mg/d IV).  For acne vulgaris 50 mg PO bid.


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OTHER ANTIBIOTICS:

METRONIDAZOLE (Flagyl) 500 mg 3-4x/day PO or IV
For Trichomoniasis:  2 g PO single dose or 250 mg PO tid x 7d.
For bacterial vaginosis: 750 mg PO daily x 7d o nempty stomach.
For Anaerobic bacterial infections:  Load 1 g or 15 mg/kg IV, then 500 mg q6h or 7.5 mg/kg q6h PO/IV, each IV dose over 1 h (not to exceed 4 g/d).
For propohylaxis, colorectal surgery:  15 mg/kg IV completed 1 h preop, then 7.5 mg/kg IV q6h x 2 doses.
For acute amebic dysentery:  750 mg PO tid x 5-10d.
For Amebic liver abscess:  500-750 mg PO tid x 5-10 d.

CLINDAMYCIN (Cleocin) 600-900 mg q8h IV  for serious anaerobic, streptococcal, staph infections.  150-300-450 mg qid PO
- For bacterial vaginosi:  300 mg PO bid x 7d.  For oral/dental infection:  300 mg PO qid.
- For strep pharyngitis (repeated culture-positive episodes):  300 mg bid or 150 mg qid PO x 10d.

NITROFURANTOIN (Macrodantin, Macrobid) Macrobid 100 mg bid PO or Macrodantin 50-100 mg qid PO  with food/milk x 7dfor cystitis.  
For long-term suppressive UTI therapy:  50-100 mg PO qhs.

VANCOMYCIN (Vancocin)  For severe Staph infection, endocarditis:  1 g IV q12h, each dose over 1h or 30 mg/kg/d IV divided q12h.
For empiric therapy, native valve endocarditis:  15 mg/kg IMax 2g/d unless levels monitored) IV q12h with gentamicin.
For Clostridium difficile diarrhea:  125 mg PO qid x 7-10d (IV administration ineffective for this indication)

IMIPENEM-Cilastatin (Primaxin) IV 250-500 mg IV q6h for mild infection, 500 mg IV q6-8h or 1 g q8h for moderate infection, 1 g q6h for severe infection in pneumonia, sepsis, endocarditis, polymicrobic, intra-abdominal, gynecologic, bone & joint, skin infections.

Aztreonam (Azactam)  IM/IV 500 mg - 1 g q8-12h for UTI.  For pneumonia, sepsis, skin, intra-abdominal, gynecologic infections: 1-2 g IM/IV q8-12 h for moderate infection, 2 g IV q6-8h for severe infections or Pseudomonas aeruginosa infections.

Chloramphenicol IV 50 mg/kg/d IV divided q6h for Typhoid fever, rickettsial infections.  Up to 75-100 mg/kg/d IV for serious infections untreable with other agents.

Linezolid (Zyvox)  IV & PO doses are the same.
For Vancomycin-resistat E. faecium infection: 600 mg IV/PO q12h x 14-28 d, infuse over 30-120 min.  
For pneumonia, complicated skin infections (including diabetic foot): 600 mg IV/PO q12h x 10-14d.  For uncomplicated skin infections:  400 mg bid x 10-14d.
-effective against G+ bacteria as vancomycin-resistant Enterococcus faecium & hospital-acquired pneumonia & complicated skin infections, as those caused by methicillin-resistant Staphyloccus aureus
* Myelosuppression (including anemia, leukopenia, pancytopenia, & thrombocytopenia) has been reported in patients receiving linezolid).  When discontinued, the affected hematologic parameters have risen toward pretreatment levels.  - March 15, 2001

Tigecycline (Tygacil), a new antibiotic designed as first-line treatment for hospital infections that are resistant to other antibiotics. It is an intravenous medication approved for use in skin and stomach infections.      IV 100 mg first dose, thenn 50 mg IV q12h infuse over 30-60 min.

RIFAMPIN - For Tuberculosis:  10 mg/kg up to 600 mg PO/IV daily.  For Neisseria meningitidis carriers:  600 mg PO bid x 2d, take on empty stomach. IV and pO doses are the same.   For Leprosy:  600 mg PO q month with dapsone.  For prophylaxis of H influenza type b infection:  20 mg/kg up to 600 mg PO daily x 4d.  

Colistimethate (Coly-Mycin)  IV/IM 2.5-5 mg/kg/d divided q6-12h slow injection over 3-5 min or IV continuous infusion for Gram-negative infections, esp. Pseudomonas aeruginosa.

Daptomycin (Cubicin) IV 4-6 mg/kg daily unfused over 30 minx 7-14 d for complicated skin infections (Staph aureus).

Drotrecogin (Xigris) IV 24 mcg/kg/h x 96 h to reduce mortality in sepsis.

Lincomycin (Lincocin)  For serious Gram-positive infecton:  600 mg IM q12-24h or IV 600-1000 mg Q8-12h.  Max IV 8g/d).    Reserve for patients who are allergic or do not resopnd to penicillins.

Rifaximin (Xifaxan):  for travelers diarrhea  200 mg PO tid x 3d

Synercid (quinupristin + dalfopristin)  for Vancomycin-resistant E faecium infections (not active against E. faecalis)  IV 7.5 mg/kg q8h.  For complicated Staphlococcal/streptococcal skin infections:  7.5 mg/kg q12h IV infuse over 1 h.

Trimethoprim (Primisol)  for uncomplicated UTI 100 mg PO bid or 200 mg PO daily.

Merrem (Meropenem) 1 gm q8h IV for complicated appendicitis or peritonitis.  IV 500 mg q8h for complicated skin infections.

Mepron (Atovaquone) PO 250 mg tab 3 tab bid x21d with meal for Pneumocystis carinii pneumonia (in pts intolerant to Septra)

Neutrexin (Trimetrexate) 45 mg/m2 IV over 60-90 min IV 1x/d  x 21d for Pneumocystis pneumonia with concurrent Leucovorin PO 20 mg/m2 IV/PO q6h x 24d. (Round PO leucovorin dose up to next higher 25 mg increment)

Mycobutin (Rifabutin) 150 mg cap bid PO as prophylaxis for disseminated Mycobacterium Avium Complex


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