Family Medicine - Antimicrobials

Front 1

Acute Rhinitis (common cold)

Microorganisms? Antimicrobial?

Back 1

Microorganisms: Viral - rhinovirus, adenovirus, RSV, influenza, etc.

Antimicrobial: None

Front 2

Pharyngitis (sore throat)

Microorganisms? Antimicrobial?

Back 2

Microorganisms: Viral - adenovirus, rhinovirus

Antimicrobial: None

Front 3

Strep Pharyngitis

Microorganisms? Antimicrobial?

Back 3

Microorganisms: Group A β-Hemolytic Strep

Antimicrobial:
1st line - pen V 3oo mg PO tid or 600 mg bid x 10d
2nd line - erythromycin 250 mg PO qid x 10d

Front 4

Sinusitis

Microorganisms? Antimicrobial?

Back 4

Microorganisms: S. pneumoniae, H. influenzae, M. catarrhalis, Group A Strep, Anaerobes, S. aureus

Antimicrobial:
1st line - amoxicillin 500 mg PO tid x 10d
2nd line - amox/clavulin 875 mg PO bid x 10d

Front 5

Acute Otitis Media

Microorganisms? Antimicrobial?

Back 5

Microorganisms: S. pneumoniae, H. influenzae, M. catarrhalis, Group A Strep, S. aureus, Viral

Antimicrobial:
< 6 months, treat immediately for 7 days.
6-24 months, watchful waiting appropriate if parents can observe child for 48-72 h with appropriate follow up.
> 24 months old, treat if worsens after 48-72 h.
Adults treat immediately to prevent complications.

Children: amoxicillin 80 mg/kg/d div bid or tid (maximum 3g/d) x 5 d if > 24 m old or 10 d if < 24 m old
Adults: amoxicillin 500 mg PO tid x 7-10d
Use macrolide if penicillin allergy.

Front 6

Otitis Externa

Microorganisms? Antimicrobial?

Back 6

Microorganisms: Pseudomonas, S. aureus, Fungal

Antimicrobial: 1st line - Buro-sol 2-3 drops tid
2nd line - cortisporin otic solution 4 drops tid
tympanic membrane defect - cirpodex 4 drops qid

Front 7

Acute Bronchitis

How to distinguish from URTI and pneumonia?

Back 7

Acute bronchitis - inflammation of the bronchi. Presents as cough +/- sputum production. Cough will last > 5 days (usually 10-20 days vs. URTI < 5d) and there should not be fever (vs. pneumonia or influenza)

Front 8

Acute Bronchitis

Microorganisms? Antimicrobial?

Back 8

Microorganisms: Usually viral - Rhinovirus, Coronavirus, Adenovirus, RSV, Influenza, Parainfluenza.
Bacterial - S. pneumoniae, H. influenzae, M. pnuemoniae, C. pneumoniae.

Antimicrobial: Abx not recommended.

Front 9

Community Acquired Pneumonia

Microorganisms? Antimicrobial?

Back 9

Microorganisms: S. pneumoniae, M. pneumoniae, C. pneummoniae, H. influenza

Antimicrobial:
amoxicillin 1 g PO qid x 7-10d (for patients over 50)
or
erythromycin 500 mg PO qid x 7-10d
or
clarithromycin 500 mg PO bid or 1000 mg (ER) x 7-10d

Front 10

Diarrhea

Microorganisms? Antimicrobial?

Back 10

Microorganisms: Bloody - Salmonella, Shigella, Campylobacter, Yersinia, E. coli O1575:H7
Nonbloody - Norwalk, Rotavirus, Giardia,

Antimicrobial:
mild to moderate (no blood, no fever, < 3 bm/d): use OTC antimotility agents and fluids
moderate to severe (blood, fever, > 3 bm/d): ciprofloxacin 750 mg single dose or 500 mg PO bid x 1-3d
Levofloxacin 500 mg PO OD x 1-3d
Note: if post antibiotics add metronidazole or vancomycin

Front 11

UTI

Microorganisms? Antimicrobial?

Back 11

Microorganisms: KEEPS - Klebsiella, E. coli, Enterobacter, Enterococci, Proteus, S. saprophyticus

Antimicrobial: ciprofloxacin 250 mg PO bid or cirpo ER 500 mg OD x 3d

Front 12

Vaginal Candidiasis (yeast infection)

Microorganisms? Antimicrobial?

Back 12

Microorganisms: Candida albicans

Antimicrobial: Treat only if patient is symptomatic
fluconazole 150 mg PO single dose

Front 13

Gonorrhea/Chlamydia

Microorganisms? Antimicrobial?

Back 13

Microorganisms: N. gonorrheae, C. trachomatis

Antimicrobial: cefixime 400 mg PO single dose + azithromycin 1 g PO single dose

Front 14

Herpes

Microorganisms? Antimicrobial?

Back 14

Microorganisms: Herpes simplex virus

Antimicrobial: acyclovir 400 mg PO tid 7-10d

Front 15

Bacterial Vaginosis

Microorganisms? Antimicrobial?

Back 15

Microorganisms: Gadnerella vaginalis

Antimicrobial: metronidizole 500 mg PO bid x 7d

Front 16

Tinea Cruis or Tinea Pedis

Microorganisms? Antimicrobial?

Back 16

Microorganisms: Trichophyton

Antimicrobial: clotrimazole 1% cream - apply bid
ketoconazole 1% cream - apply bid

Front 17

Cellulitis (uncomplicated)

Microorganisms? Antimicrobial?

Back 17

Microorganisms: beta-hemolytic Strep sp., Staphylococcus

Antimicrobial: 1st line - cephalexin 500 mg PO q6h x 10-14d
2nd line - cloxacillin 500 mg PO q6h x 10-14d

Front 18

Bacterial Conjunctivitis

Microorganisms? Antimicrobial?

Back 18

Microorganisms: S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis

Antimicrobial: sulfacetamide 1-2 gtts q2-3h then taper to bid x 5-7d