Dis Pathogen Emperic Th Adv Disadv

Acetaminophine (pain relief) for 48-72 hrs, most kids resolve, if not (only 1 out of 12) will
need AB. <2y-->10 days AB, >2y-->5 days, azithropmycin-->5 days for all ages
Serous Otitis media--> AB for 2w-3m

1) eff agnst 90% of bact of

Better abs than

New Episode &
AOM 2)most eff ag occ mild diarrhea, maculopapular

ampicillin
Serous OM:
pneumococci e' low suscp skin rash
Amoxicillin (TID),
to Pencef 3)Excll safety
Acute otitis Media AOM

Pivampicillin (BID), profile high cost, e' no improvement

S. pneumonia (+ve) Co trimoxazole (BID) Suitable for travelling bec liq 1) not eff agnst Strept gpA
H.influenza (-ve) formln has long shelf-life at RT 2) inc resist of pneumococci & H influ
Morhaxilla
catarrhalis (-ve) Recurrent: Amox/Clav: diarrhea occurs in 50%
Amoxicillin high dose or Amoxicillin /Clavu a' TID of pts
NB eff agnst amoxicillin resist strains of H 1) not eff ag S aureus or pneumococci
(1) ; pnuemococcal Cefixime (OD) influenza & M catarrhalis 2) Diarrhea in 10% of pts
vaccination is ineff in
AOM
NB (2) ; Oral anti Cefaclor (BID or TID) Serum sickness in 1% of children
eff agnst most bact of AOM
hist & decongestant
won't improve it av as sachets for 1) Bitter after taste of susp.'. Taken e'
Cefuroxime (BID)
travellers juice or food

Cefprozil (BID)
NB: Pneumoc are sometimes resistant to
good tasting liq formuln Azithro
Azithromycin OD HS
better tolerated than Bitter after taste to be taken e' food
Clarithromycin BID NB: Pneumoc are sometimes resist
eythro to it
Erythromycin/ Eryth--> 40% NV abd pain
Sulphaisoxazole Sulpha--> Rash
TID or QID

Penicillin V TID (all AB for full 10 days) or G

St Sore throat

Strept gp A od
(pharyngitis,
laryngitis)

NB: any if allergy; Erythromycin estolate, Erythromycin ethylsuccinate bid-qid, Clarithromycin

culture (acute or chronic BID, Azithromycin OD HS If not eff; Cephalexin
case) that yield Strpt
gpA-->AB for fear of Acetaminophine for pain and fever, Lozenges and gargle for symptomatic ttt
Rheumatoid fever If chronic carriage .'.addn of Rifampin in the last 4
days of Pen Or Clindamycin alone

a- hemolytic Amoxicillin (oral) or Ampicillin IV (before)

strept. or S
Prevention of

Endocarditis

viridans; for dental, Dental extractn; 3 g before & 1.5 after

Bacterial

oral, resp, oesoph If allergy: clinda, clarithro, azithro, cephadroxil, cephalexin allergy & Not oral;
proced (but not endos) Clinda, cephazolin
enterococcus If allergy & moderate risk; Vancomycin
fecalis; GI & Gu (but If high risk; (cardiac) Amp+genta before then Amp or Amox after if allergy;
not all types of delivery or
hyst) vanco+genta
Enfants:
H.
DOC < 1 m; Vancomycin + (Amp + genta or Cefotaxime)
influenza type b,
Bacterial meningitis

< 3 m or Elderly; Amp + Ceftriaxone or Cefotaxime. If S

S. Ceftriaxone or Cefotaxime pneum.'. > 3 m: Vancomycin + IV Cefotaxime (esp
pneumonia, Pen G if pneumococcal) or Ceftriaxone If allergy to B-
N. Pen G lactam or hypersensitivity: vancomycin + Rifampin Anti-inf Th: IV
meningitidis
Dexamethasone in child > 6w : 1) ttt & dec deafness caused by H influenza. 2)
Elderly; Amp considered for S pneumonia & N meningitidis but it dec penetration of AB to CSF
S. pneum, Ceftriaxone or Cefotaxime
Prophylaxis:
E coli, Amp
Pneumococcal conjugate vaccine & AB Th as Rifampin, Ceftriaxone or
Listeria Ciprofloxacin Response Monitoring: imprved brain func
monocytogene
Susc; Pen G, Amox, Macrolide
Community Acquired

Strept Resis; Pen G, Cefo, cef, levo

Sympt; cough, shortness of breath, plueritic chest pain, sputum,
fever, chilis, myalgia, arthalgia, headache severe; resp rate > 30
Mycoplasma Pneum
Doxycilline, macrolide
Clamydia If severity is < 90; ttt at home & Macrolide or Doxycycline
Pneumonia

H influenza Cephalosporin, or If hospitalized; Levofloxacin OR (2nd or 3rd Ceph + macrolide)

M. catarrhalis Amox/Clav
If ICU; IV Levofloxacin + B-lactam (imipenem or
Staph aureus Meth susc-->Cloxacilin meropenem) OR Macrolide + Aminoglycoside + IV B-
Legionella MRSA-->Vancomycin lactam
Fquinolone Or macrolide NB Vaccination ag Pneumo & influenza shd b considered
+ Rifampin (never used alone in CAP)
 latent TB: INH for 9 m If resist: Rifampin 6m OR Rifampin+Pyrazinamide 8 w
Active TB: INH+Rifampin+Pyrazinamide+Ethambutol or Streptomycin (initial emp th)
Regimen; 6m; INH + Rifampin + Pyrazinamide (2 m) then INH + Rifampin (4m)
mycobacterium
9 m; INH + Rifampin
TB

Tuberclosis
Preg; INH + Rifampin + Ethambutol
(Mantoux Test)
Breast Feeding; Anti TB D' are safe as only
small conc in milk 2nd line Th; Cycloserine,
Ethionamide, Aminoglycoside
NB: BCG is not generally used In Canada
Lep
ros

Mycobact
Staph Leprae
aureus, g-ve Dapson + Rifampin
y

enterics,
Neonates; gp B strept,
Child; gpA strept,
Cloxacillin + Cefotaxime
Osteomyelitis

Adults; No
NB; Adults, Cloxacillin only
Acute

Diabetic Foot; Imipenem + Cilastatin or Cipro + Clindamycan

Staph aureus, Strept,
g-ve bacilli, anaerobes If DM + HT ; Clinda + Genta for 6w

Imidazole; (top) clotri,

hypersensitivity,
1 in preg used e' caution
eco, mico, tio

local
candida--> cheesy Triazoles;
not used in 1st trimeter
discharge+ pruritis+ terconazole (top)
VVC

inflam pH < 4.5

(all D' have no SE: NVD, abd pain, H, dizz, pruritis, DI: inc INR e' warfarin, inc phenytoin &
established Data in Fluconazole rash, thrombocytopenia, inc theophylline, dec BG e' sulfonylureas,
Lactation) transaminases, hypo K+ dec by Rifampin Preg: CI
PolyeneMacrolide
used in Preg until 6 wks preterm
Nystatin
2
Bacterial
Trichomoni Vaginosi

NVD, abd pain, constipation,

grey/milky dischrge e' heartburn, H diz Vertigo
Clindamycin Used in Preg & Lact
s

odour pH > 4.5 Oral: pseudomembranous colitis

topical; VVC
3 NVD, abd pain, H ataxia Vertigo
pseudomembranous colitis, DI: e' warfarin inc INR, e' alc Disulfuram like
Bact Vag +

Trichomonas-->
asis

purulent discharge e' reaction, e' Disulfuram confusion &

odour, pruritis & inflam Metronidazole VVC, transient leucopenia, mettalic
psychosis, dec e' barb & phenytoin
pH >4.5 partner shd b ttt taste , gynecomastia, dark urine, Preg: used e' caution in 2nd & 3rd tri
photosensitivity

4 Gonococcal by Cephalosporin: Ceftriaxone (inj), Cefixime (oral) Ceftriaxone: Preg e' caution
Cervicitis & Urethritis

Neisseria Quinolones: Cipro, ofloxacin Quinolones: not used in Preg

gonorrhea Spectinomycin (not eff in pharyngeal gonococcal inf) Spect:Preg e' caution (alt for Ceftriaxon)
Doxycycline (bid x 7d) Tetracycline (qid x 7d) CI in Preg
Chlamydial:
Chlamydia Macrolides: Azithro (1gx 1 dose), Preg e' caution, alt for tetracycline
Trachomatis --> erythro (test of cure after 3 wks) used in Preg, L e' caution,
mucopurulent disch Quinolones: Ofloxacin CI in Preg
(opaque/yellow) e'
frequent urination --> Amoxicillin (test of cure after 3 wks)
sterility recent partner ttt used in Preg & L (alt for erythro in 3rd tri)

5 Cephalosporin or Quinolones + Doxycycline or metronidazole

PI
"Shunker dis" D

6 Treponema safe in Preg & Lact

Benzathine Penicillin G: 1ry, 2ry & early latent: once/
Syphilis

Pallidium SE: may cause Jarisch Herxheimer dis in

Late latent x3
2ry Syphilis

recent partner ttt

Tetracycline or Doxycycline or Ceftriaxone
alt in allergy CI in Preg
Erythromycin
Uncomplicated: Co-trimoxazole (if 1st inf--> 3d, Recurrent-->7d,
E coli CI in Renal Failure (not as eff as
complicated 10-14d), Nirofurantoin , Cephalosporins
3d Cotrimoxazole)
Complicated; Ecoli,
10-14d
UTI

Paerogenosa, P flouroquinolones 2nd line due to cost

mirabilis, E. fecalis NB: ttt can be by single dose if cystitis
Pyelonephritis Aminoglycosides Parentral 14d
Acute cystitis;
Amoxicillin / Clav, or Pivmecillinam (Ampicillin)
(urethritis) / Preg
 Enterobacteriaceae,
Prostati
Bact Staph aureus,
Cotrimoxazole, floroquinolone, Doxycycline 6 weeks
tis
P
aerogenosa
Enterotoxigenic Ecoli SE: black stool and tongue
Prevention:
CI: e' anticoag, salicylates, allergy
Bi subsalicylate
Traveller's Diarrhea

Campylobacter, to salicylates
salmonella, Shigella
Proph AB as cotrimoxazole & Doxycycline r
Floroquinolone (cipro-nor) used proph in Diplomatic missi not recomm->clstridium difficile assoc diarr
mild: BSS+Antimotility ttt; SE: Toxic megacolon CI: e'
Moderate Loperamide dysentry--> risk of bloody stool & fever
or severe:
Fluids+AB+Antimotility AB: 1. Fquinolones (cipro-nor) eff & safe
2. Doxycycline or Cotrimoxazole
Rehydran (esp infants &
useful if Diar>14hrs & wt loss, steatorrhea, or
preg) or 3. Metronidazole Giardia Lamblia inf
less pref 1tsp salt+ 8tsp
sugar + 1 L h2o
4. Azithromycin not for prophy
Safe in Preg & children
SE; Retinopathy, pigmentation, hearing
Chloroquin & Hydroxychloroquin (alt) loss, seizures, severe
neuropsychological SE
Safe in 2nd half of Preg & children
Mephloquin less severe
neuropsychological SE
Malaria

Anopheline CI in Preg & children (discolor teeth)

No need for dose adj in renal failure
Mosquito Doxycycline 100mg to be taken e' food & avoid sun
bet dusk & dawn exposure (photosensitivity)

CI in Preg
Primaquin (for terminal prophy & radicle cure, for GI upset (to be taken e' food), potent
dormant liver forms; hypnozoids) v eff prophy oxidising agent, induce hemolytic anemia in
No vaccine for malaria those e G-6PD def (shd take enz before ttt)

Malarone (ttt & prophy of chloroquin resist) CI in Preg & children

Fansidar Self ttt regimen when medical care is not av
j