Broad Spectrum: may need stronger narrow therapy

Penicillin: -allergies: give macrolides

GAS no resistance -interstitial nephritis

-Strep pharyngitis/tonsillitis,
-Erysipelas
-Syphilis
Co amoxiclav (AUGMETIN): -Pseudo Colitis (C. difficle)
G+ and G- Enterococci (HHELPSS) -Allergies

-Otitis media, sinusitis (S. pneum, H. influ, M. Catarr)

-Cellulitis, skin abscess, animal bites
-Pneumonia (LRTI)
Trimethoprim Sulfamethoxazole (TMP-SMX): Treats Marrow Poorly
Enterococci especially Salmonella and Shigella -Megaloblastic Anemia, leukopenia
-G6PD hemolysis
-UTI -Nephrotoxic
-Enteritis, Diarrhea
Chloramphenicol -Anemia and Aplastic anemia
But inexpensive
-meningitis (S. pneum, N. mening, H. influen)
-Chronic Suppurative OM (Pseudomonas, S aureus)

Narrow spectrum
Tetracyclines: tetracycline, Doxycycline -Teeth discoloration
Can enter intracellular -Inhibit Bone growth
-C/I pregnancy
-Chlamydia (intracellular MO)
-Syphilis
-Atypical pneumonia (mycoplasma pneumonia)
-Brucellosis
-Lyme disease
-Rickettsia
-Chronic Suppurative OM (Pseudomonas, S aureus)

-Acne
-MRSA (doxycycline)
Clindamycin
Anaerobic above diaphragm

-Lung abscess
-Aspiration pneumonia
-oral infection
Metronidazole -Metallic taste
Anaerobic below diaphragm: C. difficile, bacteroides

-Pseudomembranous colitis
-Gardnerella vaginalis
-H. pyloris in penicillin allergy
-Parasites
Gram +
Macrolides (Azithro, Clarithro, Erythromycin) -Arrhythmia (QT prolonged)
-Hepatotoxic (cholestatic hepatitis,
-Penicillin allergies kernicterus, inhibits Cyt P450)
-Otitis media, Sinusitis, pharyngitis/tonsillitis,
-Conjunctivis (mild), corneal abrasion (non contact lens) -Incr oral anticoag conc
-chlamydia in neonates (tetracycline is avoided)

-Atypical Pneumonia (mycoplasma pneumonia)

Vancomycin -Nephrotoxic
-Ototoxic
-MRSA -Thrombophlebitis
-Pseudomembranous Colitis

Gram -
3rd Gen Cephalosporin (ceftriaxone, cefotaxime, ceftazidine):
penetrates BBB

-Otitis Media, Cellulits

-Meningitis (S. pneum, N. mening, H. influen), Gonorrhea
-Malignant Otitis Externa (anti pseudomonal: ceftazidime, 4 th G (cefepime)
Fluoroquinolones (ciprofloxacin, norfloxacin, Levofloxacin): Hurt Bone (-olone) attachments
Pseudomonas and Enterococci -cartilage damage
-tendonitis
-Otitis Externa (pseudomonas), Perichondritis -C/I pregnancy
-Chronic Suppurative OM (Pseudomonas, S aureus)

-Conjunctivits (severe), Corneal abrasion (contact lens)

-Pneumonia (LRTI)

-UTI (pyelonephritis)
-Prostatitis
-Bone/Joint infection
Aminoglycosides (gentamicin, streptomycin, neomycin) -Nephrotoxic
General infections (pseudomonas-Enterococci) -Ototoxic
-Teratogen
-Surgical preparations (bowel)
-topical skin infection (usually with polymyxin B and bacitracin)

-Chronic Suppurative OM (Pseudomonas, S aureus)

-Brucellosis
Antifungal
Clotrimazole -Hepatotoxic
2 wk on 1 wk off 1wk on (Trophozoite AND spores) -Inhibits testosterone (gynecomastia)
-Inhibits Cyt P450
-Otomycosis (Aspergillus>Candida)
Fluconazole -Hepatotoxic
-Inhibits testosterone (gynecomastia)
-All candida types -Inhibits Cyt P450
Ketoconazole

-Sebhorric dermatitis
-Dandruff
-T versicolor and T infections
Nystatin

-ONLY topical (oral/vaginal) candidiasis

Amphotericin B -Nephrotoxic
-some ototoxicity
-Serious systemic mycosis -“Shake and bake” Fever and chills
-Hypotension
-Arrhythmia
-Anemia
-IV phlebitis

Ototoxic drugs:
- AB: aminoglycosides, vancomycin, erythromycin, ampicillin
- Loop diuretics: furosemide
- Antimalarial: quinine, chloroquine
- Analgesics: aspirin, ibuprofen
- Cytotoxic: cisplatin
- Chemicals: alcohol, marijuana, tobacco, CO
- propranolol

RSV: commonest cause of bronchiolitis; most infections <2yrs old

Parainfluenza: commonest cause of Croup: barking cough (less frequently by Hib)
Rhinovirus: commonest cause of the Common Cold

Hib (bacterial): epiglottitis/supraglottitis

B. pertussis: whooping cough (cough fit then gasp, 100 day cough)

URTI
Bacterial infection Viral infection
- exudates on tonsils or pharynx - runny nose (profuse, initially clear can become
- high fever >=38.3 white yellow or green)
- tender Jugulodigastric LN - low grade fever
- longer than 7-10 days (secondary infection can be - cough
seen as getting better then worse) - 7-10 days
- absence of conjunctivitis cough rhinorrhea - sore throat
- nasal erythema and edema
Associated illnesses: Common illness:
- Sinusitis – Runny nose lasting longer than 7-10 - Cold- no treatment
days - Influenza: abrupt, body aches, high fever; tamiflu
- Ear infection – Ear pain accompanied by new within 48 hrs; can become pneumonia,
onset fever and several days of a runny nose encephalitis, myocarditis
- Pneumonia – Persistent cough, stomach ache or
difficulty breathing: procalcitonin levels elevated
in bacterial not in viral
- Urinary tract infection – Fever without an easily
identifiable source of infection (more common in
girls and boys who are not circumcised)