Penicillin beta-lactams
Penicillin (PCN)
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Class(es)
Penicillins/Beta-Lactams.
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Clinical use(s)
FDA approved: Syphilis, anthrax, listeria infections, meningococcal infections, pasteurella, serious gram-positive infections.
Off-label/clinical use: CAP (children), group B strep, osteomyelitis, SSTI. -
Mechanism(s) of action
Bactericidal.
Inhibits bacterial cell wall synthesis during active multiplication. -
Key adverse effects
Nausea, vomiting, diarrhea, seizure (rare).
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Key drug/food interactions
Tetracyclines (may ↓ effectiveness)
Food (may ↓ peak penicillin concentrations) -
Special considerations
Renally adjusted: CrCl < 10 ml/min.
Amoxicillin (Amoxil)
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Class(es)
Penicillins/Beta-lactam antibiotic
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Clinical use(s)
FDA approved: Ear, nose and throat bacterial infection, skin and soft tissue infection
Off-label/clinical use: Uncomplicated acute otitis media -
Mechanism(s) of action
Binds penicillin binding protein, which prevents cell wall synthesis
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Key adverse effects
Allergy (~10%), N/V/D (>1%)
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Key drug/food interactions
Concurrent use of PENICILLINS and TETRACYCLINES may decrease effectiveness.
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Special considerations
Available in oral form only. Contraindicated in serious hypersensitivity reactions to Beta Lactam antibiotics. Cross-sensitivity with cephalosporin antibiotics has been reported to be between .2% and 10%.
Ampicillin
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Class(es)
Penicillins/Beta-Lactams
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Clinical use(s)
FDA approved: Bacterial meningitis, gonorrhea, endocarditis, respiratory tract infection, sepsis, genitourinary/digestive tract infections.
Off-label/clinical use: Bacterial endocarditis (prophylaxis), bacteremia associated with IV line. -
Mechanism(s) of action
Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs). -
Key adverse effects
Diarrhea, anaphylaxis.
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Key drug/food interactions
Tetracyclines, bupropion/donepezil (lowers seizure threshold).
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Special considerations
Rapid infusion may cause seizures.
Renally adjusted: CrCl < 50 ml/min.
Dicloxacillin (Dynapen)
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Class(es)
Penicillins/Beta-Lactams
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Clinical use(s)
FDA approved: Infection due to staph aureus (MSSA).
Off-label/clinical use: Impetigo, SSTI. -
Mechanism(s) of action
Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs). -
Key adverse effects
Neurotoxicity (high doses), hypokalemia, bone marrow suppression, diarrhea
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Key drug/food interactions
Tetracylines, bupropion/donepezil (lowers seizure threshold), Food (may ↓ dicloxacillin concentrations)
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Special considerations
CYP3A4 inducer
Nafcillin (Nafcil, Nallpen)
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Class(es)
Pencillins/Beta-Lactams
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Clinical use(s)
FDA approved: Confirmed MSSA—meningitis, endocarditis.
Off-label/clinical use: Skin/soft tissue necrotizing infection, streptococcal skin infection, surgical site infection, catheter-related bacteremia. -
Mechanism(s) of action
Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs). -
Key adverse effects
Neurotoxicity (high doses), hypokalemia, bone marrow suppression, diarrhea.
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Key drug/food interactions
Fentanyl, cyclosporine, tetracylines, Food (may ↓ nafcillin concentrations).
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Special considerations
CYP3A4 inducer.
Dose adjust for severe renal and hepatic impairment.
Amoxicillin/Clavulanate (Augmentin)
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Class(es)
Aminopenicillins beta lactamase inhibitors
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Clinical use(s)
FDA approved: Acute otitis media, CAP, impetigo, SSTI, LRTI, sinusitis, UTI Â
Off-label/clinical use: Febrile neutropenia, streptococcal pharyngitis. -
Mechanism(s) of action
Amoxicillin: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs).
Clavulanic acid: Inactivates beta-lactamase enzymes. -
Key adverse effects
Diarrhea, nausea, vomiting
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Key drug/food interactions
Tetracyclines
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Special considerations
Renally adjusted: CrCl < 30 ml/min.
Do not use ER and 875 mg tablet in HD patients and CrCl < 30 ml/min.
Take with food.
Piperacillin/Tazobactam (Zosyn)
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Class(es)
Extended Spectrum Pencillins/Beta-Lactams.
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Clinical use(s)
FDA approved: Appendicitis, CAP/HAP, SSTI, pelvic inflammatory disease, peritonitis, puerperal endometritis.
Off-label/clinical use: Bacteremia associated with IV line, febrile neutropenia, infectious disease of abdomen. -
Mechanism(s) of action
Piperacillin: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs). Tazobactam: Inhibits many beta-lactamases.
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Key adverse effects
Diarrhea, nausea, headache, neutropenia.
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Key drug/food interactions
Tetracycline, vancomycin (↑ risk AKI).
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Special considerations
Renally adjusted: CrCl < 40 ml/min.
Meropenem (Merrem)
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Class(es)
Carbapenem.
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Clinical use(s)
FDA approved: Bacterial meningitis, SSTI, infection of the abdomen.
Off-label/clinical use: Bacteremia associated w/ IV line, cystic fibrosis, febrile neutropenia, HAP. -
Mechanism(s) of action
Exerts bactericidal activity by inhibiting cell wall synthesis by penetrating the cell wall of most gram-positive and gram-negative bacteria to reach penicillin-binding–protein (PBP) targets.
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Key adverse effects
Diarrhea, N/V, rash, anemia, headache.
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Key drug/food interactions
Valproic acid, cholera vaccine, live typhoid vaccine, probenecid.
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Special considerations
Injection only.
Renal impairment: CrCl <50 ml/min—dose adjust.
Aztreonam (Azactam)
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Class(es)
Monobactam.
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Clinical use(s)
FDA approved: Cystic fibrosis, disease w/ Gram negative bacteria, endometritis, female genital infection, SSTI, LRTI, peritonitis, sepsis, UTI.
Off-label/clinical use: Meningitis, musculoskeletal infection, febrile neutropenia, gonorrhea, post-op prophylaxis, traveler’s diarrhea. -
Mechanism(s) of action
Bactericidal against gram-negative aerobic bacteria by binding to penicillin-binding protein-3(PBP-3), which results in inhibition of bacterial cell wall synthesis.
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Key adverse effects
Chest discomfort, ALT/AST elevation, SCr elevation, cough, congestion.
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Key drug/food interactions
Cholera vaccine.
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Special considerations
Injection and inhalation routes.
Renal impairment: CrCl <30 ml/min—dose adjust.
Cephalosporins
Cephalexin (Keflex)
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Class(es)
1st-generation cephalosporin
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Clinical use(s)
FDA approved: Skin and soft tissue infection, osteomyelitis.
Off-label/clinical use: Prophylaxis for bacterial endocarditis. -
Mechanism(s) of action
Binds to penicillin binding proteins in cell wall membrane.
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Key adverse effects
C. diff–associated diarrhea (CDAD), seizures (high doses especially in renal impairment)
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Key drug/food interactions
Concurrent use of loop diuretics or aminoglycosides may increase risk of renal toxicity.
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Special considerations
Can be taken with or without food. Taking cephalexin with food may decrease GI irritation. Available only in oral form (capsules, tablets, oral suspension).
Cefazolin (Ancef)
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Class(es)
1st-generation cephalosporin
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Clinical use(s)
FDA approved: Respiratory tract infections, endocarditis, intra-abdominal infections.
Off-label/clinical use: Bacteremia associated with IV line, bacterial endocarditis (prophylaxis). -
Mechanism(s) of action
Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs). -
Key adverse effects
Diarrhea, pruritis, anaphylaxis, Stevens-Johnson syndrome.
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Key drug/food interactions
Warfarin (may ↑ risk bleeding).
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Special considerations
Renally adjusted: CrCl < 54 ml/min. Available as injectable only.
Cefotaxime (Claforan)
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Class(es)
3rd-generation cephalosporin
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Clinical use(s)
FDA approved: Bacterial meningitis, bone/joint infections, intra-abdominal infections, LRTI, SSTI.
Off-label/clinical use: Bacterial endocarditis, Lyme disease, salmonella. -
Mechanism(s) of action
Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs). -
Key adverse effects
Diarrhea, vomiting, hypersensitivity.
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Key drug/food interactions
Warfarin (may ↑ risk bleeding).
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Special considerations
Renally adjusted: CrCl < 20 ml/min.
Cefdinir (Omnicef)
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Class(es)
3rd-generation cephalosporin
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Clinical use(s)
FDA approved: Acute bacterial otitis media, acute exacerbation chronic bronchitis, acute maxillary sinusitis, CAP, pharyngitis/tonsillitis, SSTI.
Off-label/clinical use: Cystitis. -
Mechanism(s) of action
Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs). -
Key adverse effects
Diarrhea, nausea.
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Key drug/food interactions
Warfarin (may ↑ risk bleeding).
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Special considerations
Renally adjusted: CrCl < 30 ml/min.
Administer at least 2 hours before or after antacids/iron supplements.
Ceftriaxone (Rocephin)
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Class(es)
3rd-generation cephalosporin
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Clinical use(s)
FDA approved: Acute otitis media, bacterial meningitis, upper/lower respiratory tract infection, UTI.
Off-label/clinical use: Syphillus, endocarditis. -
Mechanism(s) of action
Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs) -
Key adverse effects
Diarrhea, hypersensitivity reaction, eosinophilia.
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Key drug/food interactions
Calcium-containing products.
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Special considerations
Calcium products precipitate ceftriaxone.
Avoid in neonates.
Combined renal/hepatic impairment: NTE 2 grams/day.
Ceftazidime (Fortaz)
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Class(es)
3rd-generation cephalosporin
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Clinical use(s)
FDA approved: Bacterial meningitis, bacterial sepsis, pneumonia, SSTI, osteomyelitis, LRTI, UTI.
Off-label/clinical use: Bacterial endocarditis, chronic purulent otitis media. -
Mechanism(s) of action
Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs). -
Key adverse effects
Diarrhea, anaphylaxis.
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Key drug/food interactions
Warfarin (may ↑ risk bleeding).
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Special considerations
Renally adjusted: CrCl < 50 ml/min.
Cefepime (Maxipime)
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Class(es)
4th-generation cephalosporin
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Clinical use(s)
FDA approved: Pneumonia, SSTI (uncomplicated), infectious disease of abdomen.
Off-label/clinical use: Bacterial meningitis, infective endocarditis, peritoneal dialysis-associated peritonitis. -
Mechanism(s) of action
Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs). -
Key adverse effects
Direct positive Coombs test, diarrhea.
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Key drug/food interactions
Warfarin (may ↑ risk bleeding).
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Special considerations
Renally adjusted: CrCl < 60 ml/min.
Other antibiotics
Clindamycin (Cleocin)
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Class(es)
Lincosamide
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Clinical use(s)
FDA approved: Bacterial disease (severe) Including susceptible infections due to anaerobic and aerobic gram positive organisms.
Off-label/clinical use: Acne vulgaris (topical). -
Mechanism(s) of action
Inhibits protein synthesis at the level of the 50S ribosomal subunit.
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Key adverse effects
The most common reported AE is mild to moderate morbilliform-like skin rashes. High risk antibiotic for C. difficile associated diarrhea.
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Key drug/food interactions
Concurrent use of clindamycin and erythromycin may result in antagonistic antimicrobial effects.
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Special considerations
Patient should take capsules with a full glass of water to avoid esophageal irritation.
Metronidazole (Flagyl)
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Class(es)
Antiprotozoal, antibacterial and antihelminthic nitroimidazole agent
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Clinical use(s)
FDA approved: Infection due to anaerobic bacteria, trichomoniasis, bacterial vaginosis.
Off-label/clinical use: Crohn's disease. -
Mechanism(s) of action
Bacteriocidal against anaerobes by hindering the DNA processes.
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Key adverse effects
Headache (5–18%), vaginitis (10–15%).
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Key drug/food interactions
Contraindications: Alcohol use during and for at least 3 days after metronidazole use. Disulfiram use within 2 weeks of therapy. Significantly increased risk of bleed with warfarin therapy.
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Special considerations
U.S. boxed warning: Metronidazole has been shown to be carcinogenic in mice and rats. Its use, therefore, should be reserved only for conditions for which it is approved.Â
Doxycycline (Oracea)
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Class(es)
Tetracycline
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Clinical use(s)
FDA approved: Gram-negative infections (E. coli, Enterobacter aerogenes, Shigella spp., Acinetobacter spp., Klebsiella spp., bacteroides spp., Neisseria menginitidis); gram-positive infections (Streptococcus spp.).
Off-label/clinical use: Cellulitis, bite-wound infection. -
Mechanism(s) of action
Inhibits protein synthesis by binding with the 30S and possibly 50S ribosomal subunit(s) of susceptible bacteria.
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Key adverse effects
Photosensitivity, diarrhea, nasopharyngitis.
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Key drug/food interactions
Penicillin, acitretin, methotrexate; food may decrease absorption.
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Special considerations
Take on empty stomach unless GI irritation occurs.
Vancomycin (Vancocin)
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Class(es)
Glycopeptide
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Clinical use(s)
FDA approved: C. difficile diarrhea, skin and soft tissue infection, infective endocarditis.
Off-label/clinical use: Bacteremia. -
Mechanism(s) of action
Inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization of the cell wall.
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Key adverse effects
Red man syndrome, nephrotoxicity, hyperkalemia, hypotension (accompanied by flushing).
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Key drug/food interactions
Aminoglycosides may enhance the nephrotoxic effect of vancomycin.
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Special considerations
Available in IV form for systemic infections. Systemic dosing is based on patient weight and renal function. Available in oral form for use in C. difficile diarrhea treatment.
Linezolid (Zyvox)
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Class(es)
Oxazolidinone
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Clinical use(s)
FDA approved: CAP, HAP, SSTI, VRE infection.
Off-label/clinical use: Bacteremia associated with IV line, febrile neutropenia, infection of bone, infections disorder of joint, endocarditis. -
Mechanism(s) of action
Inhibits bacterial reproduction of aerobic gram-positive bacteria and certain gram-negative and anaerobic bacteria, by selectively binding to a site on the 23S ribosomal RNA of the 50S subunit, thereby preventing initiation complex formation with the 70S ribosomal subunit.
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Key adverse effects
Diarrhea, N/V.
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Key drug/food interactions
MAOIs, SSRIs, mirtazapine, carbidopa/levodopa.
Avocado, bitter orange, tyramine containing foods. -
Special considerations
Injection only.
Bacteriostatic against enterococci and staphylococci, and bactericidal for a majority of streptococci isolates.
Daptomycin (Cubicin)
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Class(es)
Cyclic lipopeptide
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Clinical use(s)
FDA approved: Bacteremia due to S. aureus, SSTI.
Off-label/clinical use: Bacteremia associated with IV line, disease due to Gram positive bacteria, osteomyelitis, septic arthritis. -
Mechanism(s) of action
Binds to bacterial cell membranes and causes cell death by inducing rapid depolarization of the membrane potential, leading to disruption of DNA, RNA, and protein synthesis.
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Key adverse effects
Pruritis, rash, diarrhea, vomiting, insomnia.
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Key drug/food interactions
HMG CoA reductase inhibitors.
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Special considerations
Injection only.
Renal impairment: CrCl <30 ml/min.—dose adjust.
Sulfamethoxazole-Trimethoprim (Bactrim)
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Class(es)
Sulfonamide antibiotic
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Clinical use(s)
FDA approved: Urinary tract infection, acute exacerbation of COPD.
Off-label/clinical use: UTI prophylaxis. -
Mechanism(s) of action
Interferes with the production of folic acid.
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Key adverse effects
Urticaria, anorexia, N/V, hepatotoxcity (rare).
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Key drug/food interactions
Concurrent use with potassium-sparing drugs may result in increased risk of hyperkalemia. Concurrent use with warfarin significantly increases risk of bleed.
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Special considerations
For IV formulation, do not administer by IM injection, bolus, or rapid infusion.
Nitrofurantoin (Macrodantin, Macrobid)
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Class(es)
Nitrofurans
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Clinical use(s)
FDA approved: UTI treatment and prophylaxis.
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Mechanism(s) of action
Nitrofurantoin is reduced by bacterial flavoproteins to reactive intermediates, which inactivate or alter bacterial ribosomal proteins and other macromolecules.
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Key adverse effects
Common: Skin eruptions, consisting of macular lesions, maculopapular lesions, or urticarial lesions. The most common reaction in pediatric patients was peripheral polyneuropathy.
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Key drug/food interactions
Concurrent use of NITROFURANTOIN and FLUCONAZOLE may result in increased risk of hepatic and pulmonary toxicity.
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Special considerations
Contraindicated for CrCl < 60 ml/min. Limited data suggests it’s safe and effective down to CrCl = 30 ml/min.
Fosfomycin (Monurol)
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Class(es)
Phosphonic acid derivative
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Clinical use(s)
FDA approved: Uncomplicated UTI.
Off-label/clinical use: Complicated UTI. -
Mechanism(s) of action
As a phosphonic acid derivative, fosfomycin inhibits bacterial wall synthesis (bactericidal) by inactivating the enzyme, pyruvyl transferase, which is critical in the synthesis of cell walls by bacteria.
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Key adverse effects
Diarrhea, nausea, headache.
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Key drug/food interactions
Cholera vaccine, lixisenatide.
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Special considerations
Supplied as powder for oral solution.
Gentamicin
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Class(es)
Aminoglycoside
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Clinical use(s)
FDA approved: Ophthalmic infections (eye drops), dermatologic infections (topical), infective endocarditis (systemic), synergy for gram-positive infections (systemic).
Off-label/clinical use: Adjunctive therapy for febrile neutropenia, pelvic inflammatory disease. -
Mechanism(s) of action
Inhibits protein synthesis in bacteria at the level of the 30S ribosome.
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Key adverse effects
CNS: Ataxia, vertigo.
EENT: Ototoxicity.
GU: Nephrotoxicity. -
Key drug/food interactions
Loop diuretics increase incidence of ototoxicity.
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Special considerations
US Boxed Warning: May cause nephrotoxicity.
US Boxed Warning: May cause neurotoxicity.
Monitor patient’s renal function throughout therapy.
Ciprofloxacin (Cipro)
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Class(es)
Fluoroquinolone
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Clinical use(s)
FDA approved: Treatment of cystitis and pyelonephritis.
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Mechanism(s) of action
Inhibits nucleic acid synthesis via inhibition of DNA gyrase.
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Key adverse effects
Tendon rupture, C Difficile colitis.
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Key drug/food interactions
Contraindicated with strong CYP3A4 inhibitors and QT prolonging agents. Significantly increased risk of bleed with warfarin therapy.
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Special considerations
Available in systemic, ophthalmic, and otic forms. The FDA advises that the serious side effects associated with fluoroquinolones generally outweigh the benefits for patients with acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections who have other treatment options.
Levofloxacin (Levaquin)
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Class(es)
Fluoroquinolone
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Clinical use(s)
FDA approved: CAP/HAP, complicated UTI, pyelonephritis, SSTI.
Off-label/clinical use: Acute otitis media (recurrent), chlamydial infection, traveler’s diarrhea, tuberculosis. -
Mechanism(s) of action
Inhibits DNA-gyrase in susceptible organisms thereby inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands.
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Key adverse effects
Diarrhea, headache, nausea, tendon rupture (rare).
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Key drug/food interactions
Avoid concurrent use QT prolonging medications, Warfarin (may ↑ risk bleeding).
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Special considerations
Risk of QT prolongation.
Renally adjusted: CrCl < 49 ml/min.
BBW: tendonitis/tendon rupture/peripheral neuropathy/CNS effects.
Clarithromycin (Biaxin)
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Class(es)
Macrolide
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Clinical use(s)
FDA approved: Bronchitis, AOM, CAP, Mycobacterium avium, SSTI, sinusitis, streptococcal pharyngitis.
Off-label/clinical use: Anthrax, endocarditis prophylaxis, LRTI, legionnaires, Lyme disease, pertussis, spotted fevers. -
Mechanism(s) of action
Clarithromycin binds to the 50S ribosomal subunit of the 70S ribosome of susceptible organisms, thereby inhibiting bacterial RNA-dependent protein synthesis.
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Key adverse effects
Taste disturbance, N/V, diarrhea.
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Key drug/food interactions
Significant bleed risk with concurrent warfarin therapy. Concomitant use with HMG-CoA reductase inhibitors extensively metabolized by CYP3A4 (eg, lovastatin or simvastatin) contraindicated.
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Special considerations
Renal impairment: CrCl <30 ml/min.—dose adjust.
Azithromycin (Zithromax)
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Class(es)
Macrolide antibiotic
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Clinical use(s)
FDA approved: Acute otitis media (ophthalmic), community acquired pneumonia (oral or IV for inpatient).
Off-label/clinical use: Bacterial endocarditis prophylaxis. -
Mechanism(s) of action
Inhibits protein synthesis at the level of the 50S ribosomal subunit.
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Key adverse effects
Injection site reaction (~6%), increased liver enzymes (~6%), QT interval prolongation.
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Key drug/food interactions
Avoid concomitant use with other QT prolonging agents. Increased risk of bleed with warfarin.
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Special considerations
Use contraindicated in patients with hepatic dysfunction. Separate oral administration from aluminum- or magnesium-containing antacids or decrease absorption may occur.
Antituberculars
Isoniazid (INH, Nydrazid)
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Class(es)
Antitubercular agent.
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Clinical use(s)
FDA approved: Active tuberculosis (HIV and non-HIV); inactive tuberculosis (HIV and non-HIV).
Off-label/clinical use: Atypical mycobacterial infection; determination of acetylation rate. -
Mechanism(s) of action
Bactericidal.
Inhibits synthesis of mycoloic acids, an essential component of the bacterial cell wall. -
Key adverse effects
Increased liver enzymes, neuropathy, neurotoxicity.
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Key drug/food interactions
Acetaminophen: ↑ risk hepatotoxicity.
Food: ↓ bioavailabilty. -
Special considerations
Avoid administration with food.
Use caution in severe renal/hepatic impairment.
BBW: Hepatitis.
Pyrazinamide(PZD)
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Class(es)
Nicotinamide analogue, antitubercular agent.
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Clinical use(s)
FDA approved: Tuberculosis.
Off-label/clinical use: -
Mechanism(s) of action
Bacteriostatic/bactericidal.
Converted to pyrazinoic acid in susceptible strains of Mycobacterium which lowers pH of environment (exact mechanism unknown). -
Key adverse effects
Hyperuricemia, N/V, Arthralgia.
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Key drug/food interactions
Rifampin: Severe hepatic impairment.
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Special considerations
Renally adjusted: CrCl < 30 ml/min.
Ethambutol (Myambutol)
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Class(es)
Antitubercular agent.
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Clinical use(s)
FDA approved: Pulmonary tuberculosis (adjunct).
Off-label/clinical use: Tuberculosis meningitis, MAC, nontuberculosis mycobacterial disease (M. kansasii). -
Mechanism(s) of action
It inhibits the synthesis of metabolites, subsequently impairing cell metabolism and cell multiplication eventually leading to cell death.
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Key adverse effects
Hepatotoxicity, anaphylaxis, optic neuritis.
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Key drug/food interactions
Aluminum-containing antacids (↓ serum concentrations of Ethambutol).
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Special considerations
Renally adjusted: CrCl < 30 ml/min.
Rifampin (Rifadin)
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Class(es)
Rifamycins, antitubercular agent.
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Clinical use(s)
FDA approved: Active or latent TB, meningococcal carriers.
Off-label/clinical use: Endocarditis (prosthetic valve), osteomylitis. -
Mechanism(s) of action
Inhibits RNA synthesis by blocking RNA transcription.
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Key adverse effects
EENT: red discoloration of tears; GI: N/C, diarrhea, flatulence; GU: red urine.
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Key drug/food interactions
Rifampin stimulates liver enzymes, which may increase the metabolism and decrease the effectiveness of many other drugs.
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Special considerations
Part of a four drug regimen for the treatment of active TB (rifampin + isoniazid + pyrazinamide + ethambutol). Has activity against organisms which create biofilms.