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1、Drugs of Choice, First Choice, Alternative(s)GRAM-POSITIVE COCCIEnterococcus faecalis (generally not as resistant to antibiotics asEnterococcus faecium)Serious infection (endocarditis, meningitis, pyelonephritis with bacteremia)Ampicillin (or penicillin G) + (gentamicin or streptomycin)Vancomycin +
2、(gentamicin or streptomycin), linezolid, daptomycin,tigecyclineUrinary tract infection (UTI)Ampicillin, amoxicillinFosfomycin or nitrofurantoinE. faecium (generally more resistant to antibiotics than E. faecalis)Recommend consultation with infectious disease specialist.Linezolid, quinupristin/dalfop
3、ristin, daptomycin, tigecyclineStaphylococcus aureus/Staphylococcus epidermidisMethicillin (oxacillin)-sensitivePRPaFGC,b,c trimethoprim-sulfamethoxazole, clindamycin,d ampicillinsulbactam,or amoxicillin-clavulanateMethicillin (oxacillin)resistantVancomycin (gentamicin or rifampin)Trimethoprim-sulfa
4、methoxazole, doxycyclinee or clindamycind, Linezolid,quinupristin-dalfopristin, daptomycin, or tigecyclineStreptococcus (groups A, B, C, G, and Streptococcus bovis)Penicillin Gf or Vg or ampicillinFGC,b,c erythromycin, azithromycin, clarithromycin,hStreptococcus pneumoniaePenicillin-sensitive (MIC 0
5、.1 g/mL) organisms are encountered; streptomycin is used but can bemore toxic.lSecond-generation cephalosporinsIV: cefuroxime; PO: cefaclor, cefditoren,cefprozil, cefuroxime axetil, and loracarbef.mThird-generation cephalosporinsPO: cefdinir, cefixime, cefetamet, cefpodoximeproxetil, and ceftibuten.
6、nReserve for serious infection.oAminoglycosides: gentamicin, tobramycin, and amikacin; use per sensitivities.p-Lactamase inhibitor combinationIV: ampicillin-sulbactam, piperacillin-tazobactam, ticarcillin-clavulanate; PO: amoxicillin-clavulanate.qCefoxitinrIV/PO: ciprofloxacin, levofloxacin, and moxifloxacin.sReserve for serious infection when less toxic drugs are not effective.tGenerally reserved for patients with hypersensitivity reactions to penicillin.
