Analgesia: APAP, NSAIDS, rarely opioids. Avoid ASA in kids. Antihistamines and decongestants are not usually recommended. Antibiotics only if: Bulging tympanic membrane, perforation or otorrhea Delay unless fever or otalgia > 48-72 hours in kids > 2 years. Not usually for otitis media with effusion, only if greater than 3 months Not for the persistence of […]
Infectious Disease
General Antibiotic Tips
It’s easier to remember antibiotics that don’t need renal adjustment than antibiotics that do. Certain antibiotics ROMANCCED the kidneys. Rifampin Oxacillin Moxifloxacin Azithromycin Nafcillin Clindamycin Ceftriaxone Erythromycin Doxycycline Antipseudomonals: IV :aminoglycodisdes pip/tazo (Zosyn) ticarcillin/clavulanic acid (Timentin) ceftazidime (Fortaz) cefepine (Maxipime) imipenem/cilastin (Primaxin) meropenem (Merem) doripenem (Dorax) ciprofloxacin (Cipro) colistin (Nebuliner) PO:norfloxacin ofloxinc ciprofloxacin (best) levofloxin Carbapenems […]
Influenza
Influenza mortality is greatest in those over 65 years of age. Flu onset is sudden: high fever, dry cough, headache, muscle aches, exhaustion Type A – causes epidemics every 1-3 years Type B – less likely to mutate than Type A. Epidemics seen every 5 years. Treatment: Mostly supportive care. Adamantanes: amantadine, rimantadine – no […]
Acne
Topical retinoids: adapalene, tazarotene, tretinoin Topical antibiotics: clindamycin, erythromycin Oral antibiotics: doxycycline, erythromycin, minocycline, tetracycline, Bactrim Non-antibiotic treatments: azelaic acid, benzoyl peroxide, dapsone, salicylic acid Accutane REMS program: You can read the whole thing here. Highlights- The goals of the isotretinoin risk evaluation and mitigation strategy are: To prevent fetal exposure to isotretinoin To inform […]
Skin and Soft Tissue Infections
Source control and debridement are very important in SSTIs. Folliculitis Inflammation of a single hair follicle Staphylococcus aureus or Pseudomonas aeruginosa Warm compresses to promote drainage, can use Topical agent 2-4x daily for 7 days If Pseudomonas, oral ciprofloxacin or levofloxacin Furuncles and carbuncles Inflammation of a single or multiple hair follicles Risk factors: poor […]
Diabetic Foot Infection
Up to 25% of diabetics develop infections, sometimes limbs amputated. Usually S. aureus, can be group B strep, enterococcus, proteus, E. coli, klebsiella, enterobacter, P. aeruginosa, bacteroides, peptostreptococcus Prevention is best. Mild infections: No antibiotics in the past month, local only involving skin and subcutaneous tissue, no SIRs. No MRSA risk – dicloxacillin, clindamycin, cephalexin, […]
Abdominal Infections
Complicated – extend beyond the hollow of the viscous origin into the peritoneal space. Associated with abscesses or peritonitis. Must drain, remove abscess, surgery Fluid resuscitation if sepsis Mild to moderate: cefoxitin, cefazolin, cefuroxime, ceftriaxone and metronidazole, ertapenem, moxifloxacin, cipro or levo AND metronidazole, tigecycline High risk or severe: pip/tazo, ceftazidime or cefepime AND metronidazole, cipro or levo AND metronidazole […]
HIV Infection
They probably won’t ask you to manage an HIV patient’s antiretrovirals, but prophylaxis and medication side effects are fair game. Know that everyone with a diagnosis of HIV should get HAART, which is usually 2 NRTIs and an NNRT or a PI. It’s always at least 3 drugs. You should probably be able to identify […]
Basic Vaccines
Hep A: Travelers, primate workers, healthcare workers, people with clotting disorders, homosexuals, people with liver disease should all get. Killer virus. Given in 2 doses, 6 months apart. Heb B: 3 doses, first administered at birth. Meningococcal: People in close quarters like military barracks or college dorms should get. HPV: All females from age 9-26 hours, […]
Pharyngitis aka Strep Throat
Caused by strep pyogenes or group A B-hemolytic strep, or viruses (rhinovirus, coronavirus, adenovirus, HSV, parainfluenza) Mononucleosis differential: splenomegaly, cervical adenopathy. A diffuse rash 2-3 days after PCN dose is indicative of mono. If you have to guess a sub for PCN allergic patients in ANYTHING chose a macrolide. Treatment: PCN V or Amoxil for […]