Antibiotics

Question 1

Staph/Strep skin infection with low likelihood of MRSA

Answer 1

Cephalexin (Keflex, a first gen ceph) or amox-clav (Augmentin)

Question 2

Staph/Strep skin infection with HIGH likelihood of MRSA

Answer 2

Clindamycin, TMP-SMX, or

Doxycycline (if child is older than 8y)

Question 3

Mild inflammatory acne

Answer 3

Topical abx: Clindamycin, erythromycin (though perhaps not available), and benzoyl peroxide

Question 4

Severe inflammatory acne

Answer 4

Oral abx: Tetracycline, doxycycline, minocycline

Question 5

Tinea capitis

Answer 5

Oral griseofulvin x 6-12 weeks (no prior labs needed). Fluconazole or terbinafine are acceptable alternatives.

Question 6

Tinea versicolor

Answer 6

Option 1. No sun + Astringent + topical antifungal cream.
Option 2: Oral ketoconazole, fluconazole, or itraconazole.
Option 3: Topical selenium sulfide or zinc (shampoo)

Question 7

Septic arthritis in neonates

Answer 7

Cloxacillin/gentamicin
Bugs: Group B Strep, E coli, Staph aureus
Often concomitant osteomyelitis

Question 8

Septic arthritis in infants

Answer 8

Cefuroxime (2nd gen ceph) or cefotaxime (3rd gen ceph)

Bugs: Strep pneumo, group A beta hemolytic Strep, H flu, Staph aureus

Question 9

Septic arthritis in a child

Answer 9

Cefazolin (Ancef, IV, first gen ceph)

Bugs: Strep pneumo, group A beta hemolytic Strep, H flu, Staph aureus

Question 10

Septic arthritis in an adolescent

Answer 10

Ceftriaxone/Cefixime + Azithromycin (to cover GC) N. gonorrhea, too.

Question 11

Septic arthritis or osteomyelitis in patient with sickle cell

Answer 11

3rd gen cephalosporin such as Cefotaxime (to cover Salmonella)

Question 12

Septic arthritis with HIGH likelihood of MRSA

Answer 12

Add vancomycin

Question 13

H flu osteomyelitis

Answer 13

2nd or 3rd gen cephalosporin

In general, tx osteomyelitis with IV->PO abx x 4-6 weeks

Question 14

Staph aureus or Group A Strep (pyogenes) osteomyelitis

Answer 14

oxacillin/nafcillin
1st/2nd gen cephalosporin
Clindamycin (if PCN allergic)

Question 15

First generation cephalosporins

Answer 15

Cephalexin (Keflex, PO) and Cefazolin (Ancef, IV)
GramPos ++ (not MRSA)
GramNeg + (PEcK)

Question 16

Second generation cephalosporins

Answer 16

Cefaclor, Cefuroxime, Cefotetan, Cefoxitin (no “T” except cefotetan, which has 2 T’s and is a 2nd gen ceph)
GramPos NO
GramNeg ++ (HEN PEcK)

Question 17

Third generation cephalosporins

Answer 17

Ceftriaxone, Cefotaxime, Ceftazidime, Cefpodoxime (all have a T except CefPodoXime which is the X-cePtion)
GramPos Not really except good for Strep
GramNeg +++ (including Pseudomonas, esp Ceftaz - like TazMonian devil)

Question 18

HEN PEcK

Answer 18

H flu, Enterobacter, Neisseria

Proteus, E coli, Klebsiella

Question 19

Enterococcus

Answer 19

Vancomycin, linezolid, ampicillin (ampicillin is actually better than vanc!)
Rifampin, quinolones
DO NOT CHOOSE Clindamycin or Cephalosporin!!!

Question 20

Quinolones (aka Fluoroquinolones)

Answer 20

Ciprofloxacin (2nd gen), levofloxacin, moxifloxacin
Avoid in under 18yo due to tendon rupture
Good broad spectrum drugs, ex. Hospital acquired PNA

Question 21

Macrolides

Answer 21

Erythromycin, Azithromycin, Clarithromycin
Avoid erythro in under 1 mos due to pyloric stenosis
Bacteriostatic
SE: Increased GI motility

Question 22

Fourth generation cephalosporins

Answer 22

Cefepime
GramPos ++ (as good as first gen ceph)
GramNeg ++ More resistant to beta-lactamases

Question 23

Carbapenems

Answer 23

Imipenem

Extended-spectrum beta lactamase (ESBL) producing organisms, such as Enterobacter (a GramNeg org)

Question 24

Metronidazole

Answer 24

Anaerobes and parasites
Especially intra-abdominal infections
Ex. Giardia, Entamoeba, Trichomonas, Bacterioides, C dif, and Gardnerella

Question 25

Albendazole

Pyrantel pamoate

Answer 25

Worms

Ex. Enterobius (pin worms) = one time dose, can repeat in 2 weeks if recurs. But other bugs require multiple doses

Question 26

Tetracyclines

Answer 26

Tetracycline, doxycycline, minocycline
Avoid in under 8yo due to teeth staining
Exception: Doxy is first line for Rocky Mountain Spotted Fever, regardless of patient’s age.

Question 27

Meningitis prophylaxis

Answer 27

Who: Household contacts, people who ate/slept near index case within 7 days of symptom onset.
Tx: Oral Rifampin 4 doses over 3 days; IM Ceftriaxone x 1; or Ciprofloxacin x 1 dose if >18yo