CARBAPENENEMS

• Broadest spectrum of activity of all classes
• Imipenem has slightly better gm + activity; lowers seizure threshold
• Meropenem has slightly better gm - activity
• Ertapenem does not cover Pseudomonas
• Doripenem has the most activity against Pseudomonas
• May use in PCN allergic patients (cross reactivity lower than previously thought)

TIGECYCLINE

• Has broad coverage, but does not cover Pseudomonas
• Bacteriostatic; derivative of tetracycline
• Does NOT require renal dosing
• Higher mortality in VAP than other agents; do not use for intra-abdominal infections (poss higher risk of perforation)

AMIKACIN

• Has antipseudomonal activity
• Used in combination with other agents for MDR (multi-drug resistant) bacteria
• Causes nephrotoxicity and ototoxicity

COLISTIN

• Bacteriocidal against many MDR gram - bacteria
• Not active against Proteus, Provincia, Burkholderia, Neisseria, or Serratia
• Nephrotoxicity and ototoxicity reported

References