Gram-positive Gram-negative Anaerobes Atypicals

Strep Staph Enterococcus

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penicillin G, penicillin VK      ±         
ampicillin, amoxicillin         ±      

Disclaimer: This table is a teaching and learning tool and is not meant to be comprehensive. Please use clinical judgment and
other references for clinical decision-making. Thanks to the following individuals for their input: Roxane Carr, Tila Pelletier,
Penicillins amoxicillin/clavulanate          ±     
cloxacillin ±              
piperacillin/tazobactam              1 
1st cephalexin, cefazolin        ± ±      
2nd cefuroxime, cefprozil         ±      
Cephalosporins 3rd ceftriaxone, cefotaxime          ±2    1 
3rd ceftazidime ± ±        2  2
  1 
4th cefepime          2 2   1 
ertapenem          3    1 
Carbapenems
imipenem, meropenem      4        1 
Other "Gram- vancomycin              5 
positive" agents linezolid, daptomycin               
ciprofloxacin   ±6   ±        1 
Quinolones levofloxacin      ±        1 
moxifloxacin      ±       ± 1 
Aminoglycosides gentamicin, tobramycin   SYN SYN SYN SYN SYN        

Cesilia Nishi, Tim Lau. Last updated August 2013 by Charles Au.
Polymyxins colistin          7     
Sulfonamides co-trimoxazole (TMP-SMX) ± ±  CA() ±     ±     
erythromycin ± ± ±            
Macrolides
clarithromycin, azithromycin  ±             
Lincosamides clindamycin    CA(±)         ± 1 
Tetracyclines tetracycline, doxycycline  ±  CA()    ± ±   8 8  
and derivatives tigecycline               
Nitroimidazoles metronidazole               

Legend and Ackronyms: Notes:

CA: May be effective for community-acquired MRSA 1. These broad-spectrum antibiotics are associated with increased risk of C. difficile infection.
SYN: Synergy (combine with another agent) 2. Avoid using as monotherapy due to inducible resistance in these bacteria.
CoNS: Coagulase-negative Staphylococcus 3. Ertapenem does not cover Acinetobacter .
MSSA: Methicillin-sensitive Staph aureus 4. The activity of meropenem against Enterococcus is unclear. Formal susceptibility breakpoints are not available.
MRSA: Methicillin-resistant Staph aureus 5. Only enteral (PO or PR) vancomycin (not IV) is effective against C. difficile infection.
"SPACE" bugs: Serratia, P. vulgaris, Providencia, Morganella, 6. Requires double coverage with another agent, as resistance can develop rapidly.
Acinetobacter, Citrobacter, Enterobacter 7. Colistin does not cover Proteus or Serratia .
8. Doxycycline has some anaerobic activity.