1. Antibiotic, Antifungal, and Anti-helminthic Drug Indications (DOCs) Julia Jones (with fungal contributions from Wendy Chen)

2. Primary Syphilis Penicillin G, IM x 1 What if patient is very allergic to Penicillins? Doxycycline p.o. x 2wks

3. Staphylococci with plasmid- encoded β-lactamases Dicloxacillin

4. Pseudomonas Aeruginosa Piperacillin-Tazobactam What if patient is a little bit allergic to Penicillins? 3 rd gen ceph (ceftazadime) 4 th gen ceph (cefepime) What if patient is a lot allergic to Penicillins, cephalosporins? Aztreonam (monobactam) What if I wanted to use a protein synthesis inhibitor? Aminoglycosides What if that drug was too nephrotoxic? Aztreonam (monobactam) The Big Gun? Imipenem

5. Meningitis in patients >3 months old Ceftriaxone (IV, 3 rd GC)  can add Vancomycin +/- Rifampin

6. Gonorrhea 3 rd GC  Ceftriaxone (IM) or Cefixime (p.o.) What if very allergic to cephalosporins? ( 2 alternatives) FQs Azithromycin

7. Serratia Imapenem Aztreonam

8. EHEC None. Supportive/symptomatic

9. Typhoid Fever Ceftriaxone (serious G- infxn) Or? FQ, 2 nd line TMP/SMX

10. ETEC Severe G- infection: cephalosporin Severe G- rod aerobic infection: AG 2 nd line: TMP/SMX G- GI tract Tx: FQ

11. Shigella 1 st line: FQ 2 nd line: TMP/SMX Other? Amino-penicillin

12. Community-acquired pneumonia Azithromycin (ML) Plus? Ceftriaxone + AG

13. Nosocomial pneumonia Ceftriaxone + Gentamicin (aminoglycoside)

14. Serious Gram (-) infections Ceftriaxone

15. MRSA Vancomycin (sometimes add Gentamicin +/- Rifampin)

16. Mycoplasma pneumonia Doxycycline (tetracycline) Azithromycin

17. Enterobacter DOC? Imapenem Other choices? 2 nd /3 rd /4 th gen Cephalosporins Pipercillins

18. Chlamydia Doxycycline (+macrolide – azithromycin or erythromycin) How do I pick? depends on desired dosing regimen What other protein synthesis inhibitor? TMP/SMX

19. Rickettsia (RMSF) Doxycycline

20. Vibrio cholera Doxycycline

21. Legionella Doxycycline (+erythromycin)

22. Skin infections caused by community-acquired MRSA TMP/SMX What if allergic to sulfonamides? Doxycycline Other drugs? Clindamycin, FQs

23. Staph aureus drugs? Dicloxacillin Other drugs in this group? “I met a nasty ox:” Methicillin, Nafcillin, Oxacillin Vancomycin Clindamycin

24. Proteus Aminopenicillins All cephalosporins

25. Acinetobacter This used to be a pseudomonas Imepenem

26. Anthrax!! FQ This is actually the prophylactic Tx. Not DOC.

27. Lyme disease Doxycycline 3 rd gen cephalosporin

28. MAC (Mycobacterium avium) Azithromycin Ethambutol (FQ)

29. Hemophilis Amino-penicillins 2 nd /3 rd /4 th gen Ceph Aztreonam Chloramphenicol For prophylaxis? Rifampin Who gets it? All close contacts

30. Klebsiella All cephalosporins Aztreonam

31. Strep pneumo Penicillin Aminopenicillin + B-lactamase inhibitor Strep pneumo is notorious for what resistance mechanism? Altering PBP. Solution? 3 rd /4 th gen cephalosporins

32. Dental prophylaxis for endocarditis Clindamycin Aminopenicillins Rx for strep viridans/mutans? Penicillin

33. Lupus INH Ooh. Lupus is also a contraindication in which drug? Primaquine

34. Moraxella Amino-penicillin Azithromycin

35. Corynebacterial Diphtheria Macrolides (Azithromycin or Erythromycin) What else? Pen G/V

36. Anaerobic Abscesses Clindamycin or Metronidazole

37. Brain Abscesses Metronidazole

38. B.Frag Rx Metronidazole Imipenem (probably b/c this is a good Rx for mixed infections) What other drug is good for mixed infections? Clindamycin

39. Meningitis in a patient with a β- lactam allergy Chloroamphenicol

40. Strep Pyogenes? Pharyngitis Pen V what if allergic? Erythromycin

41. H.Pylori Amino penicillin + ML Or Doxycycline

42. Listeria meningitis Amino-penicillin

43. Adult sinusitis TMP/SMX Aminopenicillins

44. Nocardia TMP/SMX

45. Lower UTI TMP/SMX Upper + lower UTI FQ UTI d/t #1 cause in women E.Coli – AG UTI d/t #2 cause in women Staph saprophyticus--Dicloxaxillin

46. Chronic Bronchitis TMP/SMX

47. Prostatitis TMP/SMX

48. Pneumocystis Pneumonia TMP/SMX Prevention/prophylaxis? Caspofungin Prophylaxis in an AIDS patient? Dapsone

49. Pseudomembranous Colitis due to C. difficile Metronidazole (1 st choice) Vancomycin (2 nd choice) What caused it in the first place? Any antibiotic can cause. In real life, FQ is apparently the #1. In our class, #1 is Clindamycin, #2 is amino-penicillins

50. Prophylaxis for meningitis due to H. influenzae or N. meningitidis Rifampin Side effect: Orange Pee

51. DOC for TB (5 in order; adverse effects in parentheses) IRPES (rhymes with “herpes”) : INH (peripheral neuropathy – give Vitamin B6) Rifampin (orange bodily fluids; ramps up P450) PZA (gout) Ethambutol (visual disturbances; gout) Streptomycin (ototoxic; nephrotoxic)

52. Leprosy Dapsone + Clofazimine + Rifampin

53. Systemic fungal infections (especially life-threatening) Amphotericin B

54. Ringworm Terbinafine (could also include itraconazole or ketoconazole)

55. Tinea capitis in kids Griseofulvin

56. Prevention of cryptococcal meningitis in AIDS patients already on Amphotericin B Fluconazole

57. Cryptococcal meningitis Amphotericin B + Flucytosine (then maybe add fluconazole)

58. Coccidiodal meningitis Fluconazole (could also use intrathecal Amphotericin B)

59. Non-meningeal coccidiosis Ketoconazole

60. Non-meningeal histoplasmosis Itraconazole

61. Blastomycosis Itraconazole

62. AIDS patients on amphotericin B- stabilized histoplasmosis Itraconazole

63. Invasive aspergillosis (1 st & 2 nd line drugs) Itraconazole (1 st line) Caspofungin (2 nd line)

64. Chromoblastomycosis Flucytosine (alone)

65. Neutropenic patient with fever and unresponsive to antibiotics Amphotericin B

66. Induction of AIDS therapy Amphotericin B

67. Sporothrix schenkii Itraconazole

68. Systemic Candidiasis Amphotericin B (if this doesn’t work, then use Caspofungin) (if that doesn’t work, then use Fluconazole)

69. Localized candidiasis (oropharyngeal, esophageal, vaginal) Amphotericin B (oral/topical; “swish and swallow” for oropharyngeal; topical use for vaginal; nystatin) Itraconazole Ketoconazole (for mucocutaneous candidiasis) Fluconazole

70. Anti-fungal drugs eliminated by the kidney Fluconazole Flucytosine

71. Anti-fungal drugs eliminated by the liver Ketoconazole Itraconazole

72. Fungicidal Drugs Amphotericin B Caspofungin Terbinafine

73. Fungistatic Drugs Azoles Flucytosine Griseofulvin

74. IV only (or main method) Caspofungin (Amphotericin B is usually IV- administered; Candida is the only indication for oral/topical use)

75. Immunocompetent patient suspected of having histoplasmosis Do not prescribe anything (this was one of the questions in the syllabus… tricky)

76. Pinworm Mebedazole (1 st choice) Pyrantel (2 nd choice)

77. Hookworm Mebedazole (1 st choice) Pyrantel (2 nd choice)

78. Cestodes Praziquantel

79. Trematodes Praziquantel

80. Cysticercosis Albendazole

81. Cystic Hydatid Disease Albendazole

82. Cutaneous larva migrans Albendazole

83. Filiariasis Ivermectin (1 st choice) Diethylcabamazine (2 nd choice)

84. Loiasis (worms in connective tissue) Diethylcarbamazine

85. Tropical eosinophilia Diethylcarbamazine

86. Onchocerciasis Ivermectin

87. Strongyloidiasis Ivermectin

88. Schistosomiasis Praziquantel

89. Malaria (erythrocytic form) Chloroquine Mefloquine Doxycycline Atovaquone-Proguanil Arteminsinin

90. Malaria (P. vivax & P. ovale in liver) Primaquine

91. Amebiasis Metronidazole

92. Giardiasis Metronidazole

93. Trichomoniasis Metronidazole

94. Cyclospora Infections TMP/SMX

95. Email me about any corrections or DOC additions! - Julia (jonj5@mail.uc.edu)