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Activity of antimicrobial agents against anaerobes

Activity of antimicrobial agents against anaerobes
Agent Comments
Nearly always active
Metronidazole Limited activity (increased resistance) against microaerophilic streptococci (eg, S. milleri), Cutibacterium (formerly Propionibacterium), and Actinomyces species; bactericidal against most gram-negative anaerobic strains
Carbapenems Resist hydrolysis by most Bacteroides beta-lactamases, although it can occur occasionally[1,2]
Beta-lactam plus beta-lactamase inhibitors The addition of a beta-lactamase inhibitor to a beta-lactam dramatically increases activity against anaerobes that produce a beta-lactamase
Variable activity
Clindamycin B. fragilis group: 20 to 60% of strains resistant; some Clostridia including C. perfringens are resistant
Cephamycins (Cefoxitin/Cefotetan) B. fragilis group: 6 to 44% of strains resistant[2,3]
Penicillin Inactive against some or most penicillinase-producing anaerobes, including most of the B. fragilis group and many strains of Prevotella melaninogenica, P. intermedia, P. bivia, P. disiens, and some Clostridia, including C. perfringens
Other cephalosporins Overall, less activity in vitro than penicillin G against most anaerobes and not recommended for therapy of anaerobic infections
Tetracycline Inactive against many anaerobes and most strains of B. fragilis; doxycycline and minocycline are somewhat more active than tetracycline
Vancomycin Active against gram-positive anaerobes; inactive against gram-negative anaerobes except when given orally where vancomycin greatly diminishes the colon microbiota including B. fragilis[4]
Linezolid Active against gram-positive anaerobes only
Daptomycin Active against gram-positive anaerobes only
Macrolides Inactive against many Fusobacterium spp and some B. fragilis spp
Fluoroquinolones Not recommended for therapy of anaerobic infections due to increased resistance in Bacteroides spp, including B. fragilis sensu stricto
Tigecycline Active against some anaerobes, including strains of B. fragilis that are resistant to beta-lactams, clindamycin, and quinolones[2]
Poor activity
Aminoglycosides  
Trimethoprim-sulfamethoxazole  
Monobactams (aztreonam)  
References:
  1. Ulger Toprak N, Akgul O, Bilgin H, et al. Frequency and associated factors for carbapenem-non-susceptible Bacteroides fragilis group bacteria colonization in hospitalized patients: Case control study in a university hospital in Turkey. Indian J Med Microbiol 2021; 39:518.
  2. Wybo I, Van den Bossche D, Soetens O, et al. Fourth Belgian multicentre survey of antibiotic susceptibility of anaerobic bacteria. J Antimicrob Chemother 2014; 69:155.
  3. Snydman DR, Jacobus NV, McDermott LA, et al. Trends in antimicrobial resistance among Bacteroides species and Parabacteroides species in the United States from 2010-2012 with comparison to 2008-2009. Anaerobe 2017; 43:21.
  4. Edlund C, Barkholt L, Olsson-Liljequist B, Nord CE. Effect of vancomycin on intestinal flora of patients who previously received antimicrobial therapy. Clin Infect Dis 1997; 25:729.
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