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Toronto Notes 2019 Antimicrobial Quick Reference Family Medicine FM49 Antimicrobial Quick Reference
Condition
RESPIRATORY/ENT Acute Rhinitis
(common cold) Pharyngitis (sore throat)
Strep Pharyngitis
Sinusitis
RESPIRATORY/ENT Acute Otitis Media
Microorganisms
Rhinovirus, coronavirus, influenza, RSV, parainflunenza, adenovirus
Rhinovirus, adenovirus, influenza, parainfluenza, coxsackievirus, coronavirus
Antimicrobial
None
None
Children:
1st line: penicillin V 40 mg/kg/d PO div bid-tid (max 750 mg/d) x 10 d (use adult dose if >27 kg) amoxicillin 40 mg/kg/d PO div bid-tid x 10 d
2nd line: erythromycin estolate 40 mg/kg/d PO div bid-tid x 10 d
3rd line: cephalexin 25-50 mg/kg/d PO div qid x 10 d
cefprozil 15 mg/kg/d PO div bid x 10 d
Adults:
1st line: penicillin V 300 mg PO tid or 600 mg bid x 10 d 2nd line: erythromycin 250 mg PO qid x 10 d
3rd line: cephalexin 250 mg PO qid x 10 d
cefadroxil 500 mg PO bid x 10 d
Children:
1st line: amoxicillin 80 mg/kg/d PO div bid-tid x 5-10 d (max 3 g/d) x 10-14 d 2nd line: amoxicillin/clavulanate 40-80 mg/kg/d div bid (max 3 g/d) x 10-14 d cefprozil 30 mg/kg/d PO div bid x 10-14 d
3rd line: cefuroxime-AX 30-40 mg/kg/d PO div bid x 10-14 d
clarithromycin 15 mg/kg/d PO div bid x 10-14 d
Adults:
1st line: amoxicillin 500 mg PO tid x 5-10 d
2nd line: amoxicillin/clavulanate 500 or 875 mg PO bid x 5-10 d cefuroxime-AX 250-500 mg PO bid x 5-10 d
3rd line: levofloxacin 500 mg PO OD x 5-10 d
moxifloxacin 400 mg PO OD x 5-10 d
Children:
Treat if under age 6 mo
If age 6-24 mo, watchful waiting appropriate if parents can observe child for 48-72 h with appropriate medical follow-up
If age >24 mo, treat if worsens after 48-72 h
10 d course if age <24 mo, 5 d course if age >24 mo
1st line: amoxicillin 80 mg/kg/d PO div bid-tid (max 3 g/d)
2nd line: amoxicillin/clavulanate 40-80 mg/kg/d PO div bid (max 3 g/d)
cefprozil 30 mg/kg/d PO div bid
3rd line: cefuroxime-AX 30-40 mg/kg/d PO div bid
clarithromycin 15 mg/kg/d PO div bid
Chronic TM perforation or ventilation tubes: Ciprodex® otic suspension 4 drops bid x 5 d
Adults:
1st line: amoxicillin 500 mg PO tid x 7-10 d
2nd line: amoxicillin/clavulanate 500 mg PO tid or 875 mg PO bid x 7-10 d
cefprozil 250-500 mg PO bid x 7-10 d
Chronic TM perforation or ventilation tubes: Ciprodex® otic suspension 4 drops bid x 5 d
Cortisporin® otic solution 4 drops tid or qid (3 drops tid or qid for children) TM defect: Ciprodex® otic suspension 4 drops bid x 5 d
Necrotizing (i.e. bone involvement): ciprofloxacin 750 mg PO bid x 4-8 wk
None
1st line: amoxicillin 1,000 mg PO tid x 7-14 d
(for patients over age 50 where mycoplasma infection is less likely)
erythromycin 500 mg PO qid x 7-14 d
clarithromycin 500 mg PO bid or 1,000 mg (ER) PO OD x 7-14 d
azithromycin 500 mg PO on 1st d then 250 mg PO OD x 4 d or 500 mg PO OD x 3 d 2nd line: doxycycline 100 mg PO on 1st d then 100 mg PO OD x 7-14 d
ANYONE of the β-lactam agents below:
amoxicillin 1,000 mg PO tid x 7-14 d
amoxicillin/clavulanate 500 mg PO tid or 875 mg PO bid x 7-14 d cefuroxime-AX 500 mg PO bid x 7-14 d
cefprozil 500 mg PO bid x 7-14 d
PLUS ONE of the following:
clarithromycin 500 mg PO bid or 1,000 mg (ER) PO OD x 7-14 d azithromycin 500 mg PO OD on 1st d then 250 mg PO OD x 4 d doxycycline 100 mg PO bid on 1st d then 100 mg PO OD x 7-14 d OR ANY ONE of the following:
levofloxacin 750 mg PO OD x 7-14 d
moxifloxacin 400 mg PO OD x 7-14 d
penicillin V potassium 500 mg PO qid x 7-10 d clindamycin 300 mg PO qid or 600 mg bid x 7-10 d
Otitis Externa
Bronchitis
Community Acquired Pneumonia: Outpatient without Comorbidity
Community Acquired Pneumonia: Outpatient with Comorbidity
Dental Infections/Periapical and Periodontal Abscesses
Group A β-Hemolytic Streptococcus
S. pneumoniae H. influenzae M. catarrhalis S. aureus
S. pneumoniae H. influenzae M. catarrhalis Group A Strep S. aureus
P. aeruginosa
Coliforms
S. aureus
H. influenzae, parainfluenza, coronavirus,
rhinovirus, RSV
S. pneumoniae M. pneumoniae C. pneumoniae
S. pneumoniae M. pneumoniae C. pneumoniae H. influenzae
Oral Flora