Antibiotics

Definition
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Natural or synthetic substances that have a killing (bactericidal) or inhibiting (bacteriostatic) effect on pathogenic microorganisms, usually bacteria. Antibiotics attack the microbes e.g. at the cell wall(penicillins, cephalosporins), cell membrane permeability(polymyxins), nucleic and protein synthesis(tetracyclines, gyrase inhibitors, pleuromutilins, oxazolidinone, chloramphenicol, aminoglycosides, lincosamides, macrolides, glycylclines). Cyclic lipopeptides penetrate the bacterial cytoplasmic membrane via lipid side chains and, in the presence of calcium, form pores (ion channels) that lead to cytolysis of the pathogens (see also daptomycin).

Due to their inhibition of nucleic acid and protein synthesis, some antibiotics are also used as cytostatics, and in some cases also as immunosuppressants (e.g. Adria-, Dauno-, Mito-, Actinomycin).

Topical antibiotics are mostly used to treat wounds or for eradication in cases of MRSA/ORSA colonization (e.g., mupirocin). Topical antibiotics also play a role in acne therapy (e.g., erythromycin).

The following active ingredients play a role in dermatology (see also active ingredients, dermatological):

Preparations
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Overview of the most important antibiotics

Penicillin

Penicillin
Benzypencillin (Pencillin G)
Phenoxypenicillin (Penicillin V)
Aminopenicillins
Amoxipenicillin
Ampicillin
Aminopenicillins/Betalactamase inhibitors
Amoxicillin/Clavulanic acid
Ampcilllin/Sulbactam
Acylamiopenicillins
Mezlocillin
Piperacillin
Acylaminopenicillins/betactamase inhibitors
piperacillin/tacobactam
Isoxyzylpenicillins
Flucloxacillin

Cephalosporins

Group1
Cefazolin
Cefalexin
Cefadroxil
Cefaclor
Group 2
Cefuroxime
Cefotiam
Group 3a
Cefotaxime
Ceftibuten
Cefotriaxone
Cefexim
Cefpodoxime
Group 3b
Ceftazidem
Group 4
Cefepim
Group 5
Ceftarolin
Ceftobiprole

Carbapenems

imipenem/cilastatin

Glycopeptides

Vancomycin
Teicoplanin

Fluoroquinolones

Group 1
norfloxacin
Group 2
Ofloxacin
Ciprofloxacin
Group 3
Lefloxacin
Group 4
Moxifloxacin

Macrolides

Older macrolides
Erythromycin
Newer macrolides
Azithromycin
Clarithromycin
Roxithromycin
Telithromycin

Aminoglycosides

Amikacin
Gentamycin
Tobramycin

Tetracyclines

Tetracycline
Chlortetracycline
Oxytetracycline
Doxycycline
Minocycline

Trimethroprim

trimethroprime/co-trimooxazole

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Dermatology

Nummular dermatitis

Polyetiologic clinical picture. The disease is generally defined as a therapy-resistant, disseminated, usua...

Note(s)
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See below for information on the targeted therapeutic use of antibiotics:

Literature
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DGI: Definition Antibiotic Stewardship: https://www.dgi-net.de/fort-und-weiterbildung/antibiotic-stewardship-abs/
Dyar OJ et al.(2017) What is antimicrobial stewardship? Clin Microbiol Infect 23: 793-798
Gelmetti C et al (2008) Local antibiotics in dermatology. Dermatologic Therapy 21: 187-195
Lloyd D et al (2018) Antimicrobial Stewardship in Veterinary Medicine. Microbiology spectrum 6: 10.1128/microbiolspec ARBA-0023-2017.
Rittenhouse S et al (2006) Selection of retapamulin, a novel pleuromutilin for topical use. Antimicrob Agents Chemother 50: 3882-3885

Tables
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Pathogen	Therapy options (in vitro efficacy of the antibiotic used and the combination partner must be proven)
staph. aureus	Doxycycline (+ rifampicin), cotrimoxazole + rifampicin
Staph. aureus ("MRSA")	Vancomycin or teicoplanin (+ rifampicin or fosfomycin)
Staph. aureus ("MRSA")	linezolid (+ rifampicin for endocarditis), tigecycline
Enterococci, ß-lactam resistant	Teicoplanin, linezolid, in case of urinary tract infections possibly also nitrofurantoin or fosfomycin
Pneumococcus, penicillin tolerant	cefotaxime, ceftriaxone, ampicillin, moxifloxacin
Pneumococcus, penicillin-resistant	vancomycin + rifampicin, linezolid, moxifloxacin
Enterobacteriaceae, multi-resistant	meropenem, imipenem, ertapenem, ciprofloxacin, levofloxacin, cotrimoxazole, piperacillin/tazobactam, tigecyclin, for urinary tract infections also nitrofurantoin or fosfomycin
Pseudomonas aeruginosa, multi-resistant	Amikacin, Colistin

Pathogen	Therapy option	Alternatives
Staph. aureus; haemolytic streptococci	Clindamycin	cefadroxil, cefazolin, moxifloxacin, ampicillin/sulbactam, amoxicillin/clavulanic acid

Pathogen	Therapy option	Alternatives
Staph. aureus, haemolytic streptococci, enterobacteria, anaerobes, Pseudomonas aeruginosa	slight wound infections: Clindamycin	cefadroxil, ampicillin/sulbactam, amoxicillin/clavulanic acid, moxifloxacin
	severe wound infection: cefotiam (+ metronidazole)	Clindamycin (+ gentamicin), moxifloxacin
	Infections after bite wounds: Ampicillin/Sulbactam, Amoxicillin/Clavulanic acid	Moxifloxacin

Pathogen	Therapy options	Alternatives
Staph. aureus, streptococci, anaerobes, enterobacteria, Pseudomonas aeruginosa	Clindamycin (+ ciprofloxacin)	Piperacillin/Tazobactam, Ampicillin/Sulbactam, Amoxicillin/Clavulanic acid, Moxifloxacin, Doxycycline

	Largely harmless	After risk-benefit analysis	Contraindicated
Pregnancy	Penicillins, cephalosporins, erythromycin (except estolate), fusidic acid	Clavulanic acid, sulbactam, tazobactam, meropenem, imipenem, ertapenem, azithromycin, roxithromycin, clindamycin, vancomycin, teicoplanin, linezolid, fosfomycin	Tetracyclines, chloramphenicol, clarithromycin, TMP/sulfonamides (1st trimester and from 28th week), metronidazole, aminoglycosides, fluoroquinolones, nitrofurantoin, rifampicin, telithromycin, tigecyclin
Breastfeeding period	penicillins, cephalosporins	Clavulanic acid, sulbactam, tazobactam, meropenem, imipenem, ertapenem, azithromycin, roxithromycin, clindamycin, vancomycin, teicoplanin, linezolid, aminoglycosides, fosfomycin	Tetracyclines, chloramphenicol, TMP/sulfonamides, erythromycin, metronidazole, fluoroquinolones, nitrofurantoin, rifampicin, telithromycin, ertapenem, tigecyclin