1. Natural Penicillins (quick reference table)
- Examples: Penicillin G (IV,IM), Penicillin V po
- Spectrum:
- Gram-positive: Effective against Streptococcus species, Enterococcus (limited)
- Gram-negative: Limited (mainly Neisseria species)
- Anaerobes: Limited anaerobic coverage
- Key Notes:
- First-line treatment for syphilis.
- No MSSA coverage.
- Good for streptococcal infections.
2. Aminopenicillins
- Examples: Ampicillin IV, Amoxicillin po
- Spectrum:
- Gram-positive: Streptococcus, Enterococcus faecalis, Listeria
- Gram-negative: Limited, covers some H. influenzae and E. coli
- Anaerobes: Limited anaerobic activity
- Key Notes:
- Listeria coverage makes it a drug of choice for Listeria infections.
- Commonly used in respiratory and urinary tract infections.
3. Anti-Staphylococcal Penicillins
- Examples: Nafcillin, Oxacillin
- Spectrum:
- Gram-positive: Effective against MSSA, Streptococcus
- Gram-negative: No coverage
- Anaerobes: No coverage
- Key Notes:
- First-line treatment for MSSA infections.
- No activity against MRSA, Gram-negative, or anaerobes.
4. Penicillins with β-lactamase Inhibitors
- Examples: Amoxicillin/Clavulanate (po Augmentin), Ampicillin/Sulbactam ( IV Unasyn)
- Spectrum:
- Gram-positive: MSSA, Streptococcus, Enterococcus
- Gram-negative: Extended coverage for H. influenzae, E. coli, Klebsiella, Acinetobacter (Sulbactam)
- Anaerobes: Good anaerobic coverage
- Key Notes:
- The β-lactamase inhibitors expand coverage to resistant Gram-negative and anaerobic organisms.
- Used for mixed infections (e.g., respiratory, intra-abdominal).
5. Anti-Pseudomonal Penicillins with β-lactamase Inhibitors
- Examples: Piperacillin/Tazobactam (Zosyn IV)
- Spectrum:
- Gram-positive: MSSA, Streptococcus, Enterococcus
- Gram-negative: Broad, including Pseudomonas, Enterobacteriaceae
- Anaerobes: Good anaerobic coverage
- Key Notes:
- Used in severe infections, especially where Pseudomonas and mixed infections are suspected.
Summary
- Natural Penicillins: Great for Streptococcus, syphilis, but no MSSA coverage.
- Aminopenicillins: Broader Gram-positive coverage with Listeria activity, used in respiratory and urinary tract infections.
- Anti-Staphylococcal Penicillins: Best for severe MSSA infections but limited in other coverage.
- Penicillins with β-lactamase Inhibitors: Expands to MSSA, Gram-negative and anaerobic coverage, used in mixed infections.
- Anti-Pseudomonal Penicillins: Broad-spectrum, including Pseudomonas and anaerobic coverage, used in severe infections.
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