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This material is from the The American Society of Health-System Pharmacists (ASHP) Local Backup Copy Alternative Injectable Antimicrobial Agents - Gentamicin

Table 1. Alternative injectable antimicrobial agents by organism 3,4,6,9-15

Susceptible Organisms Possible Alternatives*
Organisms susceptible to both piperacillin injection and piperacillin/tazobactam injection
Acinetobacter species** Amikacin, ampicillin/sulbactam, cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, gatifloxacin, imipenem/cilastatin, levofloxacin, meropenem, moxifloxacin, ofloxacin, ticarcillin/clavulanate, trimethoprim/sulfamethoxazole
Anaerobic cocci Cefazolin, cephapirin, clindamycin, doxycycline, erythromycin, minocycline
Bacteroides species (including Bacteroides fragilis) Ampicillin/sulbactam, cefoxitin, clindamycin, doxycycline, ertapenem, imipenem/cilastatin, meropenem, metronidazole, minocycline, ticarcillin/clavulanate
Clostridium species Clindamycin, doxycycline, ertapenem, erythromycin, imipenem/cilastatin, meropenem
Enterobacter species** Amikacin, aztreonam, cefepime, cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, gatifloxacin, gentamicin, imipenem/cilastatin, levofloxacin, meropenem, moxifloxacin, ofloxacin, ticarcillin/clavulanate, tobramycin
Enterococci (e.g., Streptococcus faecalis) Amikacin, ampicillin/sulbactam, ciprofloxacin, gatifloxacin, gentamicin, linezolid, moxifloxacin, tobramycin, vancomycin

Note: Aminoglycosides should not be used as a single agent against enterococci but have synergistic activity with á-lactam antibiotics or vancomycin. Ciprofloxacin should not be used for systemic infections caused by this organism, although it has been effective in treating urinary tract infections.
Escherichia coli** Amikacin, ampicillin/sulbactam, aztreonam, cefazolin, cefepime, cefotaxime, ceftazidime, ceftriaxone, cephapirin, ciprofloxacin, doxycycline, ertapenem, gatifloxacin, entamicin, imipenem/cilastatin, levofloxacin, meropenem, moxifloxacin, ofloxacin, ticarcillin/clavulanate, ticarcillin, tobramycin,
Haemophilus influenzae Ampicillin/sulbactam, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, ciprofloxacin, ertapenem, gatifloxacin, levofloxacin, moxifloxacin, nafcillin, ofloxacin, trimethoprim/sulfamethoxazole
Klebsiella species** Amikacin, aztreonam, cefazolin, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, cephapirin, ciprofloxacin, ertapenem, gatifloxacin, gentamicin, imipenem/cilastatin, levofloxacin, meropenem, moxifloxacin, ofloxacin, tobramycin, trimethoprim/sulfamethoxazole
Neisseria gonorrhoeae Ampicillin/sulbactam, cefepime, cefotaxime, cefoxitin, ceftriaxone, cefuroxime, ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin, ofloxacin, trimethoprim/sulfamethoxazole
Proteus mirabilis** Aztreonam, cefazolin, ceftriaxone, cephapirin, gentamicin, imipenem/cilastatin, meropenem, ticarcillin, tobramycin, trimethoprim/sulfamethoxazole
Proteus species (other than Proteus mirabilis)** Ampicillin/sulbactam, aztreonam, cefepime, cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, gatifloxacin, gentamicin, imipenem/cilastatin, levofloxacin, meropenem, moxifloxacin, ofloxacin, ticarcillin/clavulanate, ticarcillin, tobramycin, trimethoprim/sulfamethoxazole
Pseudomonas aeruginosa** Amikacin, aztreonam, cefepime, ceftazidime, ciprofloxacin, gentamicin, imipenem/cilastatin, meropenem, ticarcillin, tobramycin

Note: Ticarcillin should not be used as monotherapy but has synergistic activity with an aminoglycoside.
Serratia species** Amikacin, ampicillin/sulbactam, aztreonam,cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, gatifloxacin, gentamicin, imipenem/cilastatin, levofloxacin, meropenem, moxifloxacin, ofloxacin, ticarcillin/clavulanate, ticarcillin, tobramycin
Streptococcus pneumoniae Azithromycin, cefazolin, ceftriaxone, cephapirin, erythromycin, gatifloxacin, levofloxacin, linezolid, moxifloxacin, quinupristin/dalfopristin, ticarcillin, ticarcillin/clavulanate, vancomycin
Organisms susceptible to piperacillin/tazobactam injection
Bacteroides species (piperacillin-resistant, b-lactamase producing strains) Ampicillin/sulbactam, cefoxitin, clindamycin, ertapenem, imipenem/cilastatin, meropenem, metronidazole, ticarcillin/clavulanate
E. coli (piperacillin-resistant, b-lactamase producing strains)** Amikacin, ampicillin/sulbactam, aztreonam, cefepime, cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, doxycycline, ertapenem, gatifloxacin, gentamicin, imipenem/cilastatin, levofloxacin, meropenem, moxifloxacin, ofloxacin, ticarcillin/clavulanate, tobramycin
Haemophilus influenzae (piperacillin-resistant, b-lactamase producing strains) Ampicillin/sulbactam, cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, ertapenem, gatifloxacin, levofloxacin, moxifloxacin, nafcillin, ofloxacin, trimethoprim/sulfamethoxazole
Staphylococcus aureus (piperacillin-resistant, b-lactamase producing strains) Ampicillin/sulbactam, azithromycin, cefepime, cefotaxime, ceftizoxime, ceftriaxone, ciprofloxacin, ertapenem, erythromycin, gatifloxacin, imipenem, levofloxacin, linezolid, meropenem, moxifloxacin, nafcillin, ofloxacin, rifampin, ticarcillin/clavulanate, vancomycin

Note: Because resistance may develop rapidly, rifampin should not be used as a single agent but should be combined with another antimicrobial agent.
*The choice of a specific agent should be based on the specific organism isolated, available culture and susceptibility results, site of infection, severity of infection, and local antimicrobial susceptibility patterns. **These organisms can possess high-level resistance due to AmpC b-lactamase production. Some clinicians recommend using cephalosporins or extended-spectrum penicillins in combination with an agent from another antimicrobial class, or avoiding these classes of agents when treating organisms capable of producing AmpC.16,17

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