Antibiotic Classes
Class↕ | Examples↕ | Mechanism↕ | Spectrum↕ | Common Uses↕ | Known For↕ |
|---|---|---|---|---|---|
Penicillins (natural) | Penicillin G, penicillin V | Inhibit cell wall synthesis (PBPs) | Narrow, mainly gram-positive | Strep throat, syphilis, dental infections | First antibiotic, discovered by Fleming in 1928, still first-line for strep and syphilis |
Aminopenicillins | Amoxicillin, ampicillin | Beta-lactam cell wall inhibition | Broader, some gram-negative | Ear infections, sinusitis, UTIs, dental | Amoxicillin is one of the most prescribed antibiotics in the world, often combined with clavulanate |
Cephalosporins | Cephalexin, ceftriaxone, cefepime | Beta-lactam cell wall inhibition | Varies by generation (1st-5th) | Skin, bone, meningitis (ceftriaxone), surgical prophylaxis | Five generations with increasing gram-negative coverage, ceftriaxone is hospital workhorse |
Macrolides | Azithromycin, clarithromycin, erythromycin | Inhibit 50S ribosomal subunit | Gram-positive, atypicals | Respiratory infections, chlamydia, H. pylori | Azithromycin famous Z-Pak, used for atypical pneumonia, prolongs QT interval |
Tetracyclines | Doxycycline, minocycline, tetracycline | Inhibit 30S ribosomal subunit | Broad, including atypicals | Acne, Lyme disease, rickettsial, chlamydia | Cannot be used in children or pregnancy (tooth staining), doxycycline is malaria prophylaxis |
Fluoroquinolones | Ciprofloxacin, levofloxacin, moxifloxacin | Inhibit DNA gyrase and topoisomerase IV | Broad | UTIs, respiratory, GI, anthrax | Black box warnings for tendon rupture and aortic aneurysm, once wildly overused |
Aminoglycosides | Gentamicin, tobramycin, amikacin | Inhibit 30S ribosome (bactericidal) | Gram-negative, synergy with beta-lactams | Serious gram-negative infections, TB | Nephrotoxic and ototoxic, used for life-threatening gram-negative sepsis |
Sulfonamides | Trimethoprim-sulfamethoxazole (Bactrim) | Folate synthesis inhibition | Broad | UTIs, MRSA, PCP pneumonia | First modern antibacterials (1930s), Bactrim is go-to for uncomplicated UTIs and community MRSA |
Glycopeptides | Vancomycin, teicoplanin | Inhibit cell wall (different site than beta-lactams) | Gram-positive, including MRSA | MRSA, C. difficile (oral), serious gram-positive | IV vancomycin is hospital MRSA workhorse, oral vanco for C. diff, red man syndrome if infused fast |
Carbapenems | Meropenem, imipenem, ertapenem | Beta-lactam cell wall inhibition | Very broad | Severe hospital infections, ESBL bacteria | Last-resort beta-lactams, reserved to prevent resistance, CRE bacteria are the nightmare scenario |
Lincosamides | Clindamycin | Inhibit 50S ribosome | Gram-positive, anaerobes | Skin and soft tissue, dental, aspiration pneumonia | High risk of C. difficile colitis, good for anaerobes above the diaphragm |
Oxazolidinones | Linezolid | Inhibit 50S ribosome initiation | Gram-positive including MRSA and VRE | VRE infections, MRSA pneumonia | One of the few drugs for VRE, oral bioavailability near 100%, serotonin syndrome risk |
Nitroimidazoles | Metronidazole (Flagyl) | DNA damage in anaerobes/protozoa | Anaerobes, protozoa | C. difficile, BV, trichomoniasis, abscesses | Disulfiram-like reaction with alcohol, also treats giardia and amoebiasis |
Polymyxins | Colistin, polymyxin B | Disrupt gram-negative cell membrane | Gram-negative (MDR) | Last resort for multi-drug resistant gram negatives | Abandoned for decades due to toxicity, now resurrected for resistant hospital infections |
Rifamycins | Rifampin, rifabutin, rifaximin | Inhibit bacterial RNA polymerase | Mycobacteria, some gram-positive | Tuberculosis, leprosy, prosthetic device infections | Turns urine and tears orange-red, cornerstone of TB therapy, strong CYP450 inducer |
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