first line drugs Flashcards
what conditions are treated with penicillins as first line?
syphillis, sinusitis, pneumonia cat 2 (with macrolide or doxycycline), AOM,
what conditions are treated with cephalosporins as first line?
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
what conditions are treated with macrolides (erythromycin, azithromcyin, clarithromycin) as first line?
chlamydia, pneumonia category 1, infants with chlamydial pneumonia, pneumonia category 2 with beta lactam, pneumonia in kids >5
what conditions are treated with tetracyclines as first line?
many conditions IF allergy to penicillin (sinusitis, syphilis) or macrolide (cat 1 pneumonia)
category 2 pneumonia if with beta lactam (as alt to macrolide),
what conditions are treated with flouroquinolones as first line?
pneumonia category 2, sinusitis in adults allergic to PCN
cat 1 pneumonia healthy adult including prego
5+ days macrolide - azythromycin (best for prego), clarithromycin, erythromycin (doxycycline if allergy if NOT prego)
pneumonia cat 2 risks - treatment including prego
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)
adult age >60 with comorbidities pneumonia treatment option outpatient
ceftriaxone (Rocephin) 1g daily via IV or IM or levofloxacin 500mg IV daily . switch to PO once can tolerate
pneumonia treatment children <5 (usually s. pneumoniae)
amoxicillin 80-90mg/kg/d
ceftriaxone 50mg/kg/d until able to take PO
(clindamycin or macrolide if allergy)
treatment of infant chlamydial pneumonia
azithromycin 20mg/kg/d x3 d
or
eyrythromycin EryPed 50mg/kg x14 days
first line treatment for sinusitis - kids and adults
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)
treatment of sinusitis after treated, worsening after 72h
switch to amoxicillin/clavulanate if amoxicillin 1st choice. if already tried, use levo (adults), cephalosporin (kids)
AOM treatment for kids
amoxicillin 80-90mg/kg/d (can add clavulanate); if PCN allergy, cephalosporin
AOM treatment after treaed, failure at 48-72hr
if initially used amoxicilin or other first line, give augmentin or ceftriaxone IM/IV x3 days. if penicillin allergy, clindamycin plus 3rd gen cephalosporin
AOM treatment, low risk, >2y/o
watchful wait 48-72h (dont do if <2, severe, or ottorhea)
AOM treatment, pain
tylenol 15mg/kg/dose ibuprofen 5-10mg/kg/dose topical analgesic (drops, TM must be intact, combo of antipyrine, benzocaine, glycerin)
gonococcal meningitis
erthromycin ointment 1h of birth
treat IM cefriaxone
conjunctivitis -otitis syndrome children <6
high dose amoxicillin
chlamydial conjunctivitis in newborn treatment
systemic erythromycin
treatment of gonococcal conjunctivities (newborns, sexy teens)
parenteral ceftriaxone and sterile saline irrigations
malignant otitis externa can be lethal
parenteral abx: aminoglycocide and carbenicilln for 4-6 weeks plus surgical debreidment
treatment of lower UTIs adults, no complicating factors and <20% local resistance
TPM/SMX one double strength tab BID for 3 days (longer if DM, prego, immunospr, fever/chills). alternative: cipro. 2nd line: cephalosporins, nitrofurantoin
treating UTI in kids
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
treating UTI in prego and asymptomatic bacteruremia
first line for pregnancy: beta lactams, cephalosporins (cephalexin 500mg q12h x3-7d)
other option:
nitrofurantoin 100 mg BID xv5-7d
gonorrhea treatment
Ceftriaxone 250mg IM once (may use cefipime 400mg PO once). repeat screen of women 3-6mos after treatment. treat chlamydia also and vice versa
chlamydia treatmetn
azithromycin 1g PO once or doxycycline 100mg BID for 7 days . test of cure in prego (also test again 3 mos)
metronidazole is first line drug for which conditions
BV, trichomoniaiss
group A beta-hemolytic streptococcus (bacterial laryngitis) treatment
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
alternative strep throat treatment if adherence may be an issue
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
