first line drugs

Question 1

what conditions are treated with penicillins as first line?

Answer 1

syphillis, sinusitis, pneumonia cat 2 (with macrolide or doxycycline), AOM,

Question 2

what conditions are treated with cephalosporins as first line?

Answer 2

gonorrhea (includes gonococcal meningitis at birth), cat 2 pneumonia (w/macrolide or doxy), s. pneumoniae kids <5

if allergy to PCN: AOM, sinusitis in kids

Question 3

what conditions are treated with macrolides (erythromycin, azithromcyin, clarithromycin) as first line?

Answer 3

chlamydia, pneumonia category 1, infants with chlamydial pneumonia, pneumonia category 2 with beta lactam, pneumonia in kids >5

Question 4

what conditions are treated with tetracyclines as first line?

Answer 4

many conditions IF allergy to penicillin (sinusitis, syphilis) or macrolide (cat 1 pneumonia)

category 2 pneumonia if with beta lactam (as alt to macrolide),

Question 5

what conditions are treated with flouroquinolones as first line?

Answer 5

pneumonia category 2, sinusitis in adults allergic to PCN

Question 6

cat 1 pneumonia healthy adult including prego

Answer 6

5+ days macrolide - azythromycin (best for prego), clarithromycin, erythromycin (doxycycline if allergy if NOT prego)

Question 7

pneumonia cat 2 risks - treatment including prego

Answer 7

respiratory flouroquinolone - gemi, moxi, levo (NOT if prego)
OR
beta lactam (amoxicilin, amoxicillin/clavulinate, cefpoxidome, cefuroxime, or parenteral ceftriaxone followed by oral cefpoxidime) + macrolide (or doxycycline if NOT prego)

Question 8

adult age >60 with comorbidities pneumonia treatment option outpatient

Answer 8

ceftriaxone (Rocephin) 1g daily via IV or IM or levofloxacin 500mg IV daily . switch to PO once can tolerate

Question 9

pneumonia treatment children <5 (usually s. pneumoniae)

Answer 9

amoxicillin 80-90mg/kg/d
ceftriaxone 50mg/kg/d until able to take PO
(clindamycin or macrolide if allergy)

Question 10

treatment of infant chlamydial pneumonia

Answer 10

azithromycin 20mg/kg/d x3 d
or
eyrythromycin EryPed 50mg/kg x14 days

Question 11

first line treatment for sinusitis - kids and adults

Answer 11

amoxicillin
adults 500mg TID (if allergy, levo or doxycycline)
kids 45mg/kg/d low risk, 80-90mg/kg/d high risk (if allergy, cephalosporin)

high dose Augmentin option (amoxicillin/clavulinate)

Question 12

treatment of sinusitis after treated, worsening after 72h

Answer 12

switch to amoxicillin/clavulanate if amoxicillin 1st choice. if already tried, use levo (adults), cephalosporin (kids)

Question 13

AOM treatment for kids

Answer 13

amoxicillin 80-90mg/kg/d (can add clavulanate); if PCN allergy, cephalosporin

Question 14

AOM treatment after treaed, failure at 48-72hr

Answer 14

if initially used amoxicilin or other first line, give augmentin or ceftriaxone IM/IV x3 days. if penicillin allergy, clindamycin plus 3rd gen cephalosporin

Question 15

AOM treatment, low risk, >2y/o

Answer 15

watchful wait 48-72h (dont do if <2, severe, or ottorhea)

Question 16

AOM treatment, pain

Answer 16

tylenol 15mg/kg/dose ibuprofen 5-10mg/kg/dose
topical analgesic (drops, TM must be intact, combo of antipyrine, benzocaine, glycerin)

Question 17

gonococcal meningitis

Answer 17

erthromycin ointment 1h of birth

treat IM cefriaxone

Question 18

conjunctivitis -otitis syndrome children <6

Answer 18

high dose amoxicillin

Question 19

chlamydial conjunctivitis in newborn treatment

Answer 19

systemic erythromycin

Question 20

treatment of gonococcal conjunctivities (newborns, sexy teens)

Answer 20

parenteral ceftriaxone and sterile saline irrigations

Question 21

malignant otitis externa can be lethal

Answer 21

parenteral abx: aminoglycocide and carbenicilln for 4-6 weeks plus surgical debreidment

Question 22

treatment of lower UTIs adults, no complicating factors and <20% local resistance

Answer 22

TPM/SMX one double strength tab BID for 3 days (longer if DM, prego, immunospr, fever/chills). alternative: cipro. 2nd line: cephalosporins, nitrofurantoin

Question 23

treating UTI in kids

Answer 23

dx w/cath specimin. 10 day treatment. fu culture to test for cure.

10 days 6-12mg trimethoprim, 30-60mg sulfamexole/kd/d in 2 dividied doses (1mL suspension/kg/d) kids 2+mos old

febrile: agressively with parenteral ceftriaxone until afebrile

Question 24

treating UTI in prego and asymptomatic bacteruremia

Answer 24

first line for pregnancy: beta lactams, cephalosporins (cephalexin 500mg q12h x3-7d)

other option:
nitrofurantoin 100 mg BID xv5-7d

Question 25

gonorrhea treatment

Answer 25

Ceftriaxone 250mg IM once (may use cefipime 400mg PO once). repeat screen of women 3-6mos after treatment. treat chlamydia also and vice versa

Question 26

chlamydia treatmetn

Answer 26

azithromycin 1g PO once or doxycycline 100mg BID for 7 days . test of cure in prego (also test again 3 mos)

Question 27

metronidazole is first line drug for which conditions

Answer 27

BV, trichomoniaiss

Question 28

group A beta-hemolytic streptococcus (bacterial laryngitis) treatment

Answer 28

Penicillin V FOR 10 DAYS to prevent rheumatic fever even if no symptoms
250mg 2-3 times per day <27kg
500mg 2-3 times per day teens/adults >27kg

Question 29

alternative strep throat treatment if adherence may be an issue

Answer 29

penicillin G benzathine as single IM dose 1.2 million U >27kg or 600k U <27kg. if poor taste issue: amoxicilin 50mg/kg/d daily x10d