Notable Toxicities
First-Line Agents
Causative Pathogens
Gaps in Coverage
MISC :)
100

Rhabdomyolysis / Muscle toxicity (1)

Daptomycin 

Rare: FQs, macrolides, SMX-TMP 

100

Acute otitis media (drug + dose required!) (1)

Amox or amox/clav; 90 mg/kg/day PO divided q12h

100

#1 cause of bacterial pharyngitis (1)

GAS (aka Streptococcus pyogenes)

100

Ertapenem (1)

Acinetobacter

Pseudomonas aeruginosa

Enterococcus

100

Chelating antimicrobials (2) 

~separate from cations~

Fluoroquinolones

Tetracyclines

INSTIs

200

QT prolongation (2)

Fluoroquinolones

Macrolides

Lefamulin

Azoles

200

Infections caused by Treponema pallidum (Syphilis) (1)

Penicillin

200

Acute otitis media (3)

S. pneumoniae, H. influenzae, M. catarrhalis

200

Cephalosporins (class-wide coverage gap) (1)

Enterococcus
200

Antibiotic classes with significant post-antibiotic effect (2)

Fluoroquinolones

Aminoglycosides

300

Ototoxicity / Hearing disturbance (2)

Aminoglycosides

Vancomycin

Macrolides (less common)

300

Candidemia (Candida bloodstream infection) (1)

Echinocandins

*mortality benefit vs. other antifungals!*

300

Empiric coverage against this bug is ALWAYS required for febrile neutropenia (1)

Pseudomonas aeruginosa

300

Fluconazole (1)

Molds

Candida krusei

300

Pharmacodynamic parameter describing beta-lactam bacterial killing

Time > MIC

400
Ocular toxicity / Visual disturbance (2)

Voriconazole

Linezolid

Ethambutol

Less common: FQs, tetracyclines, amphotericin B

400

Complicated UTI / Pyelonephritis (ORALS only!) (2)

Ciprofloxacin or levofloxacin

TMP-SMX

NOT: nitrofurantoin, oral fosfomycin

400

Infective endocarditis (3)

Staphylococcus, Streptococcus, Enterococcus

400

Aztreonam (1)

Gram-positive bacteria

Anaerobes

400

Oral MRSA coverage (3)

SMX-TMP

Clindamycin

Doxy/mino/omadacycline

Linezolid/tedizolid

Delafloxacin

Rifampin (synergy)

500

Peripheral neuropathy (2)

Linezolid/tedizolid

Metronidazole

Fluoroquinolones

Isoniazid

Ethambutol

NRTIs

Nitrofurantoin

500

HIV - initial regimen (1)

*Describe a typical first-line regimen using ART drug classes OR specific agent(s)*

Biktarvy (BIC/FTC/TAF) 

Dovato (DTG/3TC) 

DTG + (TAF or TDF) + (3TC or FTC) 

 

1 INSTI + 2 NRTIs 

500

Neonatal meningitis (4)

GBS (AKA S. agalactiae), L. monocytogenes, GN rods (E. coli, K. pneumoniae)

500

Tigecycline (1)

Pseudomonas, Proteus, Providencia (Morganella)

Tiger don't Prr

500

Anti-Pseudomonas agents (5)

Pip/tazo, ceftaz, ceftaz/avi, cefepime, ceftol/tazo, cefiderocol, aztreonam

Mero/imipenem 

Cipro/levo/delafloxacin

Tobramycin, amikacin

Colistin, polymyxin B