Narrow spectrum (β-lactamase susceptible) | - Penicillin G (IV)
- Benzathine penicillin G (IM)
- Procaine penicillin G (IM)
- Penicillin V (PO)
| - Streptococcus Group A, B, viridans
- Most Streptococcus pneumoniae
- Treponema pallidum
- Neisseria meningitidis
- Actinomyces spp.
- Pasteurella multocida
- Some anaerobes
| - Anaphylaxis
- Rash
- Drug fever
- Bone marrow suppression
- Hemolytic anemia
- Interstitial nephritis
- Renal impairment
| - Penicillin V is acid stable in the stomach
- Resistance caused by degradation of antibiotic by bacterial penicillinases
|
Aminopenicillins | - Ampicillin (IV, IM, PO)
- Amoxicillin (PO)
| - Streptococcus Group A, B, viridans
- S. pneumoniae
- Enterococcus spp.
- Listeria monocytogenes
- Haemophilus influenzae if β-lactamase negative
- Kingella kingae
- Some gram- negative organisms: Escherichia coli, Salmonella spp., Shigella spp., Proteus spp.
| - GI disturbance
- Elevated LFTs
- Bone marrow suppression
- Hemolytic anemia
- Allergic reaction
- Renal impairment
| - Better PO with amoxicillin than ampicillin
|
β-Lactamase resistant (antistaphylococcal penicillins) | - Nafcillin (IV)
- Oxacillin (IV)
- Dicloxacillin (PO)
| - S. aureus (MSSA)
- Streptococcus Group A, B, viridans
- S. pneumoniae
| - Interstitial nephritis
- Renal impairment
- Hepatic toxicity
- Bone marrow suppression
- Allergic reaction
| - No activity against gram-negative organisms
- Nafcillin causes more phlebitis than oxacillin (decreased with slow infusion, large-gauge IV)
|
Antipseudomonal penicillins | - Piperacillin (IV)
- Ticarcillin (IV)
- Carbenicillin (PO)
| - Pseudomonas aeruginosa
- Streptococcus Group A, B, viridans
- S. pneumoniae
- Enterococcus spp.
- Some gram-negative → Escherichia coli, Enterobacter spp., Salmonella spp., Shigella spp., Proteus spp., Citrobacter spp., Haemophilus spp.
- Neisseria spp.
| - Platelet dysfunction
- High Na load
- Hypokalemia
- Serum sickness
- Bone marrow suppression
- Renal impairment
| - S. viridans and Enterococci are only 30%-60% susceptible
|
Penicillin + β-lactamase inhibitor | - Amoxicillin + clavulanate (PO)
- Ticarcillin + clavulanate (IV)
- Ampicillin + sulbactam (IV)
- Piperacillin + tazobactam (IV)
| - Streptococcus Group A, B, viridans
- S. pneumoniae
- Enterococcus spp.
- S. aureus (MSSA)
- Gram-negative organisms: E. coli, Klebsiella spp., Salmonella spp., Shigella spp., Proteus spp., Aeromonas spp., Pasteurella multocida
- P. aeruginosa (piperacillin/tazobactam and ticarcillin/ clavulanate)
- Anaerobes
| - GI disturbance
- Diarrhea (especially amoxicillin/clavulanate)
- Rash
- Renal impairment
| - S. viridans and Enterococci are only 30%–60% susceptible to ticarcillin/clavulanate and piperacillin/tazobactam
|