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FM50 Family Medicine
Antimicrobial Quick Reference Toronto Notes 2019
Condition
GASTROENTEROLOGY Diarrhea – Enteritis
Microorganisms
Antimicrobial
Mild to moderate (i.e. <3 bowel movements per day, no blood, no fever): OTC loperamide 4 mg PO STAT then 2 mg PO after each loose stool (max 8 doses/d)
OTC bismuth subsalicylate (Pepto Bismol®) 2 tabs or 30 mL repeat q30min prn (max 8 doses/d) (prevention: 2 tabs or 30 mL qid with meals and in the evening)
Moderate to severe (i.e. >3 BM/d, blood, fever):
olfloxacin 400 mg PO single dose or 300 mg PO bid x 3 d (prevention: 300 mg PO OD) norfloxacin 800 mg PO single dose or 400 mg PO bid x 1-3 d (prevention: 400 mg PO OD) ciprofloxacin 750 mg PO single dose or 500 mg PO bid x 1-3 d (prevention: 500 mg PO OD) levofloxacin 500 mg PO OD x 1-3 d (prevention: 500 mg PO OD)
azithromycin 1,000 mg PO single dose or 500 mg PO OD x 1-3 d (children: 10 mg/kg/d x 3 d)
Azithromycin:
Recommended primarily for Thailand, India, Nepal, and Indonesia where Campylobacter resistance to quinolones is high
Considered drug of choice for children because of safety, tolerability, and ease of administration
Mild to moderate (WBC <5 x 109/L and Cr <1.5 x baseline): metronidazole 500 mg PO tid or 250 mg PO qid x 10 d (children: 15-30 mg/kg/d PO div tid-qid max 4 g/d)
Severe (WBC ≥15 x 109/L and Cr ≥1.5 x baseline):
vancomycin 125 mg PO qid x 10-14 d (children: 40 mg/kg/d PO div tid-qid x 10-14 d max 2 g/d)
1st line: (PPI PO bid + amoxicillin 1,000 mg PO bid + clarithromycin 500 mg PO bid x 7 d
[e.g. HP-PAC: lansoprazole 30 mg PO bid + amoxicillin 1,000 mg PO bid + clarithromycin 500 mg PO bid x 7 d])
(PPI PO bid + metronidazole 500 mg PO bid + clarithromycin 500 mg or 250 mg PO bid x 7 d)
2nd line: (PPI PO bid + metronidazole 500 mg PO bid + amoxicillin 1,000 mg PO bid x 7 d)
(PPI PO bid + bismuth subsalicylate 2 tabs or 30 mL qid + metronidazole 250 mg PO qid + tetracycline 500 mg PO qid x 7-14 d)
PPI: lansoprazole 30 mg or omeprazole 20 mg or pantoprazole 40 mg or rabeprazole 20 mg
permethrin cream 1%: apply as liquid onto washed hair for 10 min, then rinse; repeat in 1 wk
Treat only if patient is symptomatic
fluconazole 150 mg PO single dose
miconazole 2% cream (Monistat 7®): one applicator (5 g) intravaginally qhs x 7 d multiple other OTC azole treatments
If patient is asymptomatic, treatment is unnecessary unless high-risk pregnancy, prior IUD insertion, gynecologic surgery, induced abortion, or upper tract instrumentation
1st line: metronidazole 500 mg PO bid x 7 d
metronidazole 0.75% gel: one applicator (5 g) intravaginally qhs x 5 d
clindamycin 2% cream: one applicator (5 g) intravaginally qhs x 7 d 2nd line: metronidazole 2 g PO single dose
clindamycin 300 mg PO bid x 7 d
1° episode: acyclovir 400 mg PO tid x 5-7 d
famciclovir 250 mg PO tid x 5-7 d
valacyclovir 500-1,000 mg PO bid x 5-7 d
Recurrent Episode: acyclovir 400 mg PO tid x 5 d or 800 mg PO bid x 5 d or 800 mg PO tid x 2 d famciclovir 125 mg PO bid x 5 d
valacyclovir 500 mg PO bid x 3 d or 1,000 mg PO OD x 3 d Pregnancy:
1° episode: acyclovir 200 mg PO 5x/d x 5-10 d
Prior infection within previous yr: acyclovir 200 mg PO qid at 36 wk valacyclovir 500 mg PO bid at 36 wk
ceftriaxone 250 mg IM x 1 dose + azithromycin 1 g PO single dose or doxycycline 100 mg PO bid x 7 d
cloxacillin 500 mg PO qid x 7 d cephalexin 500 mg PO qid x 7 d
clotrimazole 1% cream bid ketoconazole 2% cream bid
Children:
1st line: cephalexin 50-100 mg/kg/d div qid x 10-14 d 2nd line: cloxacillin 50 mg/kg/d div qid x 10-14 d clindamycin 25 mg/kg/d x 10-14 d
Adults:
1st line: cephalexin 500 mg PO qid x 10-14 d 2nd line: cloxacillin 500 mg PO qid x 10-14 d clindamycin 300 mg PO x 10-14 d
Diarrhea – Post Antibiotics
(common with clindamycin)
Peptic Ulcer Disease
(non-NSAID related)
DERMATOLOGIC Head and Pubic Lice
(crabs)
Vulvovaginal Candidiasis
Bacterial Vaginosis
Herpes
Gonorrhea/Chlamydia
Mastitis
Tinea Cruris/Pedis
(jock itch/athlete’s foot)
Uncomplicated Cellulitis
Enterotoxigenic E. coli (ETEC) Campylobacter
Salmonella
Shigella
Viruses Protozoa
C. difficile
H. pylori
Pediculosis humanus capitis Phthirus pubis
Candida
Overgrowth of:
G. vaginalis M. hominis Anaerobes
Herpes simplex virus
N. gonorrhoeae C. trachomatis
S. aureus
S. pyogenes
Trichophyton
S. aureus
Group A Streptococcus