Trimethoprim-sulfamethoxazole (TMP-SMX), also known as co-trimoxazole, is a combination of two antimicrobial agents that act synergistically against a wide variety of bacteria. Antibiotic treatment of VRE in stool cultures is discouraged, and may lead to increased transmission by causing diarrhea and emergence of antimicrobial resistance among VRE. Trimethoprim- Sulfamethoxazole (TMP-SMX, Bactrim) (PO, IV) – has broad spectrum of coverage to GN’s, Staph. There is variable Strep coverage and no Enterococcal or anaerobic coverage. Cephalosporins as well as beta-lactamase inhibitor combinations have in-vitro activity for HECK-YeS organisms but may induce production of beta-lactamases Tigecycline is active against HECK-YeS organisms, but for Proteus spp it depends on local susceptibility data SAP = Special Access Program (i.e., not marketed but available from Health Canada) Anaerobic coverage (e.g., metronidazole plus cefepime produces broad-spectrum coverage). It can be used in a broad range of infections (e.g., abdominal, CNS, gynecologic, respiratory, bacteremia, or soft tissue). Below are resources that may be helpful in gauging the spectrum of activity (how broad or narrow an antibiotic is) and figuring out what categories of bacteria might be treated by different antibiotic choices. The following regimens include coverage for MSSA, community-acquired MRSA (CA-MRSA), and streptococci. Coverage for gram negative organisms is not needed except in very specific patient populations (outlined below). Tobramycin aminoglycoside aerobic gram –ve’s + Pseudomonas coverage 3-5mg/kg/day in 3 divided doses - monitor nephrotoxic, ototoxic, peripheral neuritis, neuromuscular blockage prolongation Vancomycin glycopeptide derivative MRSA, MRSE, gram +ves, pencillin resistant streptococcus pneumoniae and C. difficile 10mg/kg LD - dose of plasma. Bactrim and Bactrim DS contain a combination of two antibiotics, sulfamethoxazole and trimethoprim, that treat different types of infection caused by bacteria. Bactrim DS (double strength) tablets are twice as strong as Bactrim tablets. Tetracyclines (e.g., doxycycline) and trimethoprim/sulfamethoxazole (SMX/TMP, Bactrim ®, Septra ®) can both provide more reliable MRSA coverage than clindamycin, but both have been described as possessing unreliable activity against β-hemolytic Streptococci.