Abx

Question 1

Otitis Media

Answer 1

Consider Ø Rx and f/u prn (if >6 mo)
Common Bugs: S. Pneumo, H. Flu
1st Line: Amox (80/mg/kg/day, three divided doses)

Question 2

Acute Sinusitis

Answer 2

Common Bugs: S. Pneumo, H. Flu

1st Line: Amox (consider double dose), Levofloxacin if resistant

Question 3

Pharyngitis

Answer 3

Common Bugs: Group A strep
1st Line: PCN 500 BID x 10D
Erythromycin x 10D if PCN allergy Amox in kids (liquid amox tastes better than liquid PCN)

Question 4

Pneumonia

Answer 4

Common Bugs: S. Pneumo, Atypicals, H. Flu
1st Line: macrolide, doxycycline
Consider Levofloxacin if refractory,
Pt. is elderly, pt. has co-morbidities

Question 5

Traveller’s Diarrhea

Answer 5

Common Bugs: E. Coli, Salmonella, Shigella, Campylobacter, Parasite
1st Line (Bacterial): Cipro 500 BID
x 3 days, initiate if Sx’s >24 hours, fever, bloody diarrhea;
Single-dose azithromycin for kids
1st Line (Giardia, Entamoeba): Metronidazole

Question 6

Pseudomemb. Colitis/C. diff

Answer 6

PO Vanco 125 QID x 10D or
Fidaxomicin 200 BID x 10D
Metronidazole now 2nd line

Question 7

UTI (Uncomplicated)

Answer 7

Common Bugs: E. Coli, other Gram negs, S. Saphrophyticus
1st Line: Macrobid 100 BID x 5D, Bactrim DS BID x 3D
Cipro 250 BIDx 3D (second line)

Question 8

Chlamydia

Answer 8

1 gm Azithro po x 1

Partner(s) must be treated

Question 9

Gonorrhea

Answer 9

Ceftriaxone 250 IM x 1
& Azithro 1 gram PO x 1
Partner(s) must be treated

Question 10

Vaginitis (Candida)

Answer 10

OTC antifungals or Fluconazole 150mg PO x T

Question 11

Vaginitis (Bacterial Vaginosis)

Answer 11

Flagyl (po/pv)

Question 12

Vaginitis (Trichomonas)

Answer 12

Flagyl (treat partner)

Question 13

Cellulitis/Impetigo/Abscess

Answer 13

Diclox/Keflex (QID), 2nd line: Clinda

Drain Abscess, Can use Bactroban for impetigo; MRSA: Bactrim, Doxy

Question 14

Penicillins SE:

Answer 14

GI upset, allergic reaction (rash, anaphylaxis), yeast infection, ↓ seizure threshold, C. diff colitis

Question 15

Penicillin

Answer 15

+++ Group A Strep, oral anaerobes, T. pallidum
++ Strep pneumoniae,
— S. aureus, Gonorrhea

Question 16

Amoxicillin

Answer 16

+++ Group A Strep, Listeria, oral anaerobes
++ Strep Pneumo, Enterococcus
+ H. Flu, Moraxella, E. coli
— S. aureus, Gonorrhea

Question 17

Dicloxacillin

Answer 17

+++ S. aureus, ++ Strep, + Oral anaerobes

— Gram Negs, MRSA

Question 18

Amoxicillin/Clavulanic Acid (Augmentin)

Answer 18

+++ Group A Strep, oral anaerobes, H. flu, E. coli, Pasteurella multocida, S. aureus
++ Strep pneumo, Enterococcus
— resistant Pneumococcus

Question 19

Cephalosporins SE:

Answer 19

GI upset, allergic reaction (5% cross-allergenicity with PCN), yeast infection C. diff colitis

Question 20

1st Generation Cephalosporins: Cephalexin (Keflex)

Answer 20

+++ Group A Strep, Strep pneumo

++ S. aureus, + H. flu, Moraxella, E. coli

Question 21

2nd Generation Cephalosporins: Cefuroxime, others

Answer 21

+++ H. flu, E. coli, Moraxella

++ Strep pneumo, other Gram (-), GC

Question 22

Macrolides SE:

Answer 22

GI upset, allergic rxn (rare), yeast infxn, C. diff colitis.↑QT interval when combined w/ azoles (anti-fungals). Drug interxns: can increase levels of other drugs by inhibiting p450.

Question 23

Erythromycin

Answer 23

+++ “Atypicals” (Mycoplasma, Chlamydia, Legionella), Group A Strep, Pertussis
++ Strep pneumo, C. trachomatis,
P. acnes
+ S. aureus, H. Flu, Moraxella

Question 24

Azithromycin, Clarithromycin (Biaxin)

Answer 24

+++ “Atypicals,” Group A Strep, C. trachomatis, Pertussis

++ Strep pneumo, H. flu, Moraxella, S. aureus

Question 25

Trimethoprim/Sulfamethoxizole SE:

Answer 25

Allergic reaction (rash, Steven’s Johnson Syndrome), GI upset, yeast infxn, C. diff colitis, E. multiforme, Anemia with G-6PD deficiency

Question 26

Trimethoprim/Sulfamethoxizole coverage

Answer 26

+++ E. coli, PCP
++ Strep pneumo, H. Flu, Moraxella, MRSA
— Group A Strep, anaerobes

Question 27

Tetracyclines SE:

Answer 27

GI upset, photosensitivity rash, allergic rxn, C. diff colitis, yeast infection, bone/teeth discoloration: avoid < 8 yo, pregnant

Question 28

Doxycycline coverage

Answer 28

+++ C. trachomatis, Lyme, P.Acnes, MRSA, RMSF, “Atypicals” (Mycoplasma, Chlamydia,
Legionella)
++ Strep pneumo, H. Flu, Moraxella

Question 29

Metronidazole (Flagyl) SE:

Answer 29

disulfiram-like rxn (severe GI upset w/ EtOH), GI upset, metallic taste, allergic rxn

Question 30

Metronidazole (Flagyl) coverage

Answer 30

+++ Abdominal/Vaginal Anaerobes, C. difficile, Bact. vaginosis, Trich, Giardia, Ameobiasis
— Gram Negs, Gram Positives

Question 31

Clindamycin SE:

Answer 31

GI upset, allergic rash, yeast infection,

C. diff colitis

Question 32

Clindamycin coverage

Answer 32

+++ Oral/Vaginal Anaerobes,
S. aureus, Grp A Strep
++ Bacterial vaginosis, Strep pneumo, Trich
— Gram Negs

Question 33

Fluoroquinolones SE:

Answer 33

GI upset, allergic rxn (1%), HA, yeast infection, C. diff colitis. Damages developing cartilage: avoid in pregnacy, kids

Question 34

Cipro/Oflox/Norflox coverage

Answer 34

+++Gram Negs, Pseudomonas
++ Gonorrhea, Enterococcus
+ Strep
— Anaerobes, “Atypicals” (Mycoplasma, Chlamydia pneumoniae, Legionella)

Question 35

Levofloxicin (Levaquin), Gatifloxacin (Tequin) coverage

Answer 35

+++ Gram Negs, Pseudomonas, “Atypicals” (Mycoplasma, Chlamydia pneumoniae, Legionella), Strep pneumo (including resistant strep)
++ Enterococcus
— Anaerobes, Staph