Bucher/Jones Table of ANTIBIOTICS: From Head to Toes 1

Location Infection Bugs Antibiotics Dosing Notes/Pitfalls COST

Tinea Capitis T. tonsurans Griseofulvin microsize [125 mg/5ml] 10mg/LB div QD-BID (Max 1 g/day) x 6wk Give until hair regrows (usually 6-8wks) $$$
Take w/ fatty meal (better to div dose BID)
HEAD

Lamisil (Terbinafine) >4 yo and <25 kg : 125 mg QD x 6 wk Sprinkle granules onto NON-acidic foods
[125,187.5 mg granule pkt] 25-35 kg: 187.5 mg QD x 6 wk No need to monitor LFTs if <12 WKS tx $$$$$
[250 mg tabs] – only form on $4 list >35 kg and Adults: 250 mg QD x 6 wk Can use tabs for kids (may crush) $
Conjunctivitis Staph, Strep, Hflu Polytrim (PolyMxB/TMP) 1 gtt Q3H x 7-10 days $
EYES

Sulamyd (Sulfacetamide Ophthalmic) 1 gtt Q3H x 7-10 days Warn pt that this often burns upon applic $
Gentamicin Ophthalmic 1 gtt Q4H x 7 days Use for 1 day after symptoms resolve $
Ocuflox (Ofloxacin Ophthalmic) 1 gtt Q4H 1st 2 days, then QID x 5 days $$
Otitis Media Strep pneum, Hflu, Mcat Amoxicillin [250,500 mg caps] >3mo: 90 mg/kg/d div Q8-12H x 5 days* *<2 yo or severe infxn Treat x 10 days $
[125,200,250,400 mg chews + susp/5ml] Adults: 1 gm TID x 5 days $
(Think of Bacterial Augmentin ES [600/42.9 mg/5ml] >3mo or <40 kg: 90mg/kd/d div Q12H x 10 days Use for Tx FAILURES with Amox $$$$$
Sinusitis as “Adult Augmentin XR [1000/62.5 mg ER tab] Adults: 2 tabs po BID x 10 days Give w/food or milk to decr GI side-effects $$$$$
Otitis Media”) • Note: No regular forms of Augmentin for OM/Sinsuitis given incr prev of drug-resist Strep pneum (unable to dose reg forms at 90mg/kg or 2 gm BID given GI side-effects from clav acid)
• HOWEVER: When Augmentin becomes cheaper (no price advantage to doing this yet) you can come up with the ES or XR versions by dosing 50mg/kg Amox and 50 mg/kg Augmentin
for kids div Q12H, or the 500/125 mg Augmentin tab +3 500 mg Amoxil tabs for adults (still dosed BID).
Omnicef (Cefdinir) 6 mo-12 yr: 14mg/kg/d div Q12H x 5 days* (Max 600 mg/d) *<2 yo or severe infxn Treat x 10 days $$
[300 mg caps; 125,250 mg/5ml] >13 yo and Adults: 300 mg Q12H x 5 days* Warn parents this can TURN POOP RED
EARS

Zithromax (Azithromycin) >6mos: 10mg/kg/d QD day 1, then 5mg/kg/d QD days 2-5 Use ONLY if PCN & CEPH allergy $$
[250,500 mg tabs; 100,200 mg/5ml] Adults: Z-pak (500 mg day 1, then 250 mg days 2-5) Up to 50% S pneum resist to Macrolides
Ciprodex Otic (For pts w/ ear tubes ONLY) 4 gtt BID x 7 days - PUMP TRAGUS to get into middle ear $$$$$
Rocephin (Ceftriaxone) 50 mg/kg IM QD x 1 dose Use QD x 3 days for treatment failures or if IN
suspect resist Strep pneum OFFICE
Otitis Externa Pseudomonas, Gentamicin Ophthalmic (YES Ophthalmic) 4 gtt QID x 7 days (Use 48 hrs after symptoms resolve) Do not use if TM perf’d $
(ACUTE) Enterobacteriaceae, Cortisporin Otic [Susp only]-Soln has EtOH(bad) 5 gtt QID x 7 days (Max 10 days) Do not use if TM perf’d, Suspension ONLY $
Proteus, Staph aureus Acetasol HC (Acetic acid/Hydrocortisone Otic) 4 gtt QID x 5-7 days Do not use if TM perf’d, Will tx yeast/fungi $$
(Yeast/Fungi-rare) Ciprodex Otic 4 gtt BID x 7 days If Tubes can tx BOTH OM & OE $$$$$
(CHRONIC) Likely Seborrhea Acetasol HC as above PLUS tx for Seborrhea of Scalp: Selsun 2.5% Shampoo/Lotion OR Nizoral (Ketoconazole) Shampoo/Lotion
Thrush Oral Candidiasis Nystatin [100,000 units/ml] – Disp 2oz. bottle Infants: 1ml each side of mouth QID Use 48hr after symptoms resolve $$
Herpes Labialis HSV-1, 2 Acyclovir [200 mg caps; 400 mg tabs] 400 mg po TID x 5 days Use 200mg cap 2 po TID-only form on $4 $
(Cold Sores) Valtrex [1000 mg tabs] 2 gm BID x 1 day (use within 48-72h onset) $$$
Recurrent outbrks Zovirax Cream Apply 5x/day x 4 days Prevents transmission/soothes-not good tx $$$
Abreva Cream OTC Apply 5x/day until healed (Max 10 days) alone (use in combo with oral tx) $
MOUTH

Lidocaine Ointment for PAIN (5%) Apply w/ Q-tip QID prn Disp 1 tube (35 gm) $
Herpes Zoster VZV Acyclovir [400,800 mg tabs] 800 mg po 5x/d x 7 days Start within 72 hrs of symptom onset $$
(Shingles) Valtrex [500,1000 mg tabs] 1 gm Q8H x 7 days Start within 48 hrs of symptom onset $$$$$
Consider Zostavax Vaccine: Can give after Shingles outbreak – Good ages 60-80 (NNT 60), No benefit >80yo for prevention of shingles episode
Dental Abscess Polymicrobial/Anaerobes PCN VK [250,500 mg tabs; 250 mg/5ml susp] 1 gm BID x 7 days $
Augmentin [875/125 mg tabs] 1 tab BID x 7 days $$$$
Use po Abx + Peridex Clindamycin [300 mg caps; 75mg/5ml] 300 mg Q8H x 7 days $$$
GET TO DENTIST !!! Peridex (Chlorhexidine topical) 15 mL swish for 30 sec and spit out BID 1 bottle (473ml) $

Cost Legend: $<12, $$~25, $$$~50, $$$$~75, $$$$$~100 and above

 Bucher/Jones Table of ANTIBIOTICS: From Head to Toes 2

Location Infection Bugs Antibiotics Dosing Notes/Pitfalls COST

Pharyngitis Strep Throat PCN VK <12 yo: 50mg/kg/d div Q8-Q12H x 10 days (Max 3 g/day) Give 1h before or 2h after meals $
(MOST ARE VIRAL Group A Beta Hemolytic [250,500 mg tabs; 125,250 mg/5ml] >12 yo and ADULTS: 1 gm po BID x 10 days
Tx based on rapid Amoxicillin [250,500 mg caps; 875 mg tabs] <12 yo: 50mg/kg/d div Q8-Q12H x 10 days (Max 3 g/day) $
strep results/high (NOTE: Ok to go back to [125,200,250,400 mg chews + susp/5ml] > 12yo and ADULTS: 1 gm po BID x 10 days
THROAT

level clinical school after 24hrs po Abx) Keflex (Cephalexin) <12 yo: 50mg/kg/d div Q8-Q12H x 10 days (Max 4 g/day) Good for Resist Strep given co-exist $
suspicion) [125,250 mg/5ml; 250,500 mg caps] >12 yo and ADULTS: 1 gm po BID x 10 days w/Staph/Hflu/Mcat – ?becoming 1st line?
Zithromax (Azithromycin) > 2 yo: *12mg/kg/d x 5 days (Max 500 mg/d) *Note the dosing differences for STREP $$
[250,500 mg tabs; 100,200 mg/5ml] Adults: Z-pak Pharyngitis
Mononucleosis MONO No specific treatment available…but consider po steroids for 5 days if significant tonsillar edema
(EBV) Orapred [15 mg/5ml, or ODT 10,15,30 mg] Kids: 2mg/kg div BID x 2 days, then 1mg/kg QD x 3 days Adults: Prednisone 20 mg 2 tabs QD x 5 days $$
Consider for Pharyngitis: MAGIC MOUTHWASH (Compounded) 1:1:1 mixture of Viscous Lidocaine/Benadryl/Maalox (write this out on Rx) Sig: Swish, gargle, spit-out 10-20 cc QID prn pain Disp 12 oz $$
Acute Sinusitis MOST ARE VIRAL: Rec 7-10d tx w/Antihist/Decongestants, reasonable regimen: Bromfed caps Q12H for adults and Atrovent Nasal [0.06%] 2 sprays QID prn congestion…if need Abx SEE OM ABOVE
Sinus Chronic Sinusitis NO ABX NEEDED: Consider Nasal Steroids (Flonase/Nasonex/etc.) 2 sprays/nostril QD x 1 wk, then 1 spray QD - AND/OR - PO steroids x 5 days (Orapred/Orapred ODT/Prednisone, etc.)
Bronchitis Acute (non-smoker) VIRAL: NO ANTIBIOTICS NEEDED. Offer Sx Rx (they want a Rx) Bromfed DM Syrup, Tussionex, Hycodan, Albuterol HFA, maybe 5 days Prednisone if wheezing/tight
Acute(SMOKERS) Doxycycline [100 mg caps] 1 cap po BID x 10 days $
-Often colonized w/ Zithromax [250,500 mg tabs] Z-pak $$
Hflu/Atypicals Bactrim (TMP/SMX) [DS tabs] 1 tab po BID x 10 days $
Pneumonia Strep, Mycoplasma, Hflu Doxycycline [100 mg caps] 1 cap po BID x 10 days If pt has been in HOSP tx for 14d TOTAL $
(Community Levaquin [500,750 mg tabs] 750 mg QD x 5 days -OR - 500 mg QD x 10 days Remember Quinolones are conc dep killers, $$$$$
Acquired Pneum) Avelox [400 mg tab] 400 mg QD x 10 days so higher dose is better for fewer days $$$$$
Pertussis Bordetella pertussis Zithromax (Azithromycin) >6mos: 10mg/kg/d QD day 1, then 5mg/kg/d QD days 2-5 -Think of pertussis in pts w/ characteristic $$
[250,500 mg tabs; 100,200 mg/5ml] Adults: Z-pak “whooping cough” or persistent cough(>14d)
LUNG

Bactrim (TMP/SMX) Kids: 10mg/kg/d div BID x 14d (based on TMP dose) -We are missing a lot of this - up to 20% of $
[40/200 mg/5ml; DS tabs] Adults: 1 Bactrim DS tab BID x 14d adults w/ persist cough(>14d) have pertussis
- Tx ALL household/close contacts as well
Pertussis Info: Can Dx based on Nasopharyngeal(NP) secretion culture, PCR of secretions, or Pertussis toxin Ab. 3 stages: Catarrhal(1-2wks), Paroxysmal Coughing(2-6wks),
Convalescence(1-2wks). Note: Tx may abort symptoms in Catarrhal stage, but NOT in Paroxysmal stage…Increasing amts of Pertussis led to new recs for Tdap booster
Flu Influenza A & B Tamiflu (Oseltamivir) Treatment: -At best will shorten duration of symptoms by $$$$$
[75 mg caps, 60 mg/5ml] Kids (>1 yo), <15 kg: 30mg po BID x 5d 1-2 days (if started within 48hrs of sx onset)
15-23 kg: 45mg po BID x 5d -Prevention of post-flu complications/need for
23-40 kg: 60mg po BID x 5d Abx for complications is pretty good (NNT 18)
>40 kg and Adults: 75 mg po BID x 5d -Prevention of hosp in adults NNT 100
Prophylaxis of Household Contacts: same doses as above, but treat only QD x 10d $$$$$
Gastritis H. pylori Amoxicillin 1 gm po BID, Flagyl 500 mg po BID, Prilosec OTC BID x 14d, then cont Prilosec QD x 2 mos -Remember take PPI’s on EMPTY STOMACH $$
Amoxicillin 1 gm po BID, Clarithromycin 500 mg BID, Prilosec OTC BID x 14 d, then cont Prilosec QD x 2 mos -H. pylori Stool Antigen test (>90% $$$$
Bismuth 262 mg 2 tabs po QID, Tetracycline 500 mg QID, Flagyl 500 mg TID, Prilosec OTC BID x 14 days, then sens/spec) can repeat test 8 wks after tx to $$
ABDOMEN

cont Prilosec QD x 2 mos test for cure

1 day regimen: Bismuth 262 mg 2 tabs po QID, Amox susp 2 gms QID, Flagyl 500 mg QID, Prevacid 60 mg x 1 Amox Susp (250mg/5ml – 8 tsp QID) $$
dose (Studies ongoing to confirm findings of superior efficacy to 14 day regimens—reserve for special situations)
Diverticulitis Enterobacteriaceae, Bactrim DS tabs (or Cipro) + Flagyl Bactrim DS 1 tab po BID (or Cipro 500 mg 2 tabs BID) + Remember no EtOH with Flagyl $
Bacteroides Flagyl 500 mg BID x 10 days
Augmentin XR [1000/62.5 mg ER tabs] 2 tabs po BID x 10 days SINGLE DRUG REGIMEN $$$$$
Colitis C. diff Flagyl (Metronidazole) [500 mg tabs] 1 tab po TID x 14 days $
Vancocin (Vancomycin) [125 mg caps] 1 cap po QID x 14 days Use for WBC>20k, Prior Tx failures w/Flagyl $$$$$

Cost Legend: $<12, $$~25, $$$~50, $$$$~75, $$$$$~100 and above

 Bucher/Jones Table of ANTIBIOTICS: From Head to Toes 3

Location Infection Bugs Antibiotics Dosing Notes/Pitfalls COST

UTI Uncomplicated:
E. coli, Proteus, Klebsiella
*Complicated: E. coli,
Enterobacter, Pseudo
KIDNEY
Bactrim (TMP/SMX) [DS tabs] 1 tab po BID x 3 days Consider Pyridium 200mg TID x 2 days for $
Cipro (Ciprofloxacin) [250 mg tabs] 1 tab po BID x 3 days dysuria $
Macrobid (Nitrofurantoin) [100 mg ER caps] 1 cap po BID x 7days $$
Amoxicillin [500mg cap]--Especially if pregnant 1 cap po BID x 7days $
Same as above, but tx 10-14 days *Consider to be “Complicated” if assoc w/
obstruction, reflux, foley cath

Recurrent (>3 episodes/yr) Bactrim DS (TMP/SMX) 2 tabs po x 1 at symptom onset -OR- 1 tab after sex (if frequent UTIs post-coitus) $
Pyelonephritis Same as above and Cipro (Ciprofloxacin) [500 mg tabs] 1 tab po BID x 7 days $
Pseudomonas Levaquin [500,750 mg tabs] 750 mg po QD x 5 days -OR- 500 mg po QD x 7 days $$$$$
Bactrim (TMP/SMX) [DS tabs] 1 tab po BID x 14 days $
UTI’s in KIDS E. coli, Proteus, Klebsiella Omnicef (Cefdinir) 6 mo-12 yo: 14mg/kg/d div Q12H x 10 days - 3rd gen Ceph 1st line tx – due to emerging $$
[125,250 mg/5ml; 300 mg cap] >12 yo: 300 mg BID x 10 days E. coli resistance to Amox
Bactrim (TMP/SMX) 10mg/kg/d div BID x 10 days (based on TMP component) Workup(Renal U/S+VCUG) for 1st UTI if… $
[40/200 mg/5ml] <5 yo with febrile UTI or boys of any age or
girls <3 yo w/ 1st UTI
Acute Prostatitis Enterobacteriaceae Cipro (Ciprofloxacin) [500 mg tabs] 1 tab po BID x 14 days $
Levaquin [500 mg tab] 1 tab po QD x 14 days $$$$$
PROSTATE *Bactrim (TMP/SMX) [DS tabs] 1 tab po BID x 14 days * not as good as quinolones in prostatitis $
Chronic Same as above Same as above Cipro/Levo x 4 wks; Bactrim DS x 6wk-3mos Most chronic forms are not bacterial
Prostatitis
Urethritis/Cervicitis Gonorrhea (GC) Rocephin (Ceftriaxone) + TX FOR CHLAMYDIA 125 mg IM x 1 dose Tx w/Quinolones or other po Abx is NOT recommended
Chlamydia Zithromax [250 mg, 1 gm powder pkt] 1 gm po x 1 dose Use 4-250 mg tabs – MUCH CHEAPER $
Doxycycline [100 mg caps] 1 cap po BID x 7 days $
Levaquin [500 mg tabs] 1 tab po QD x 7 days (Remember-no longer reliable for GC tx) $$$$$
Vaginitis Trichomonas Flagyl (Metronidazole) [500 mg tab] 2 gms po x 1 dose No EtOH while taking Flagyl/Tindamax $
MUST TX PARTNER(S) Tindamax [500 mg tabs] 2 gms po x 1 dose For Flagyl tx failures $$
Candida Vagistat (Tioconazole) OTC 1 Applicatorful PV QHS x 1 dose $
Gynazole 1 Applicatorful PV QHS x 1 dose OB’s love this one $$$
Diflucan (Fluconazole) [150 mg tab] 1 tab po x 1 DOSE $
Recurrent Candida Infxn: Diflucan Suppressive Therapy [150 mg tab] 1 tab po qWK x 6 MONTHS $
GENITALS

(>4 episodes/yr)
Bacterial Vaginosis
Recurrent BV
PID/Epididymitis Enterobacter, Chlamydia,
Bacteroides, Gonorrhea
Genital Herpes INITIAL EPISODE
(HSV-1,2)
EPISODIC
RECURRENCES
SUPRESSIVE THERAPY
(>6 episodes/yr)
*Boric Acid Suppositories [600 mg] 1 PV 3x/wk *get at compounding pharmacy $$
Flagyl (Metronidazole) [500 mg tab] 1 tab po BID x 7 days No EtOH while taking Flagyl/Tindamax $
Vandazol (Metronidazole vaginal) 1 applicatorful PV QHS x 5 nights $$
Clindamycin [300 mg caps] 1 cap po BID x 7 days Give Diflucan for likely yeast infxn w/Clinda $$$
Cleocin Vaginal [100 mg supp, 2% cream] 1 applicatorful QHS PV x 3-7d, 100 mg supp PV QHS x 3d NO CLINDA PV in pregnancy-INCREASED $$$$
Clindesse 1 applicatorful PV QHS x 1 dose RISK OF PREMATURE DELIVERY $$$$
Tindamax [500 mg tabs] 1 gm po QD x 5 days -OR- 2 gms po QD x 2 days Consider for Treatment FAILURES $$
Consider Boric Acid Suppositories [600 mg] 1 supp PV 3x/wk Get at compounding pharmacy $$
Rocephin 250 mg IM x 1 + Doxy + Flagyl Doxy 100 mg BID x 14d + Flagyl 500 mg BID x 14d Note: Increased dose of Rocephin compared $
Rocephin 250 mg IM x 1 + Levaquin + Flagyl Levaquin 500 mg QD x 14d + Flagyl 500 mg BID x 14d w/ tx of Gonorrhea alone $$$$$
Acyclovir [200 mg caps; 400,800 mg tabs] 400 mg po TID x 7-10 days $$
Valtrex [500,1000 mg tabs] 1000 mg BID x 10 days $$$$$
Acyclovir [200 mg cap; 400,800 mg tabs] 400 mg po TID x 5 days -OR- 800 mg po TID x 2 days $$
Valtrex [500 mg tab] 500 mg BID x 3 days $$$$$
Acyclovir [400,800 mg tab] 400 mg BID ($400/yr) -Reduces freq of outbrks by 70-80% $$
Valtrex [500,1000 mg tab] 500 or 1000 mg po QD ($1600 or $3200/yr) -If still w/outbrks at 500mg → incr to 1000mg $$$$$

Cost Legend: $<12, $$~25, $$$~50, $$$$~75, $$$$$~100 and above

 Bucher/Jones Table of ANTIBIOTICS: From Head to Toes 4

Location Infection Bugs Antibiotics Dosing Notes/Pitfalls COST

Genital Warts HPV-6,11,16,18, & others Condylox (Podofilox topical) [0.5% soln] Apply BID x 3 days, rest 4 days...then may REPEAT for Max Avoid surrounding skin $$$$$
Genitals… 4 cycles
cont’d Aldara (Imiquimod topical) [5% cream] Apply QHS, leave on 6-10 hrs, then wash off - 3x/wk Max duration 16 wks $$$$$
Consider Gardasil Vaccine: Prevention of Cervical CA/Genital Warts (HPV types 6,11,16,18) - - NOT FOR TREATMENT. Age Recs: 9-26yo. 3 dose series (0, 2, 6 mos apart)
Acne vulgaris P. acnes Basic Regimen: Benzoyl Peroxide (10% cream) in AM AND Retin-A in PM (Start w/ 0.025% cream and work up) Wash face and let DRY before applying $$
- If out of control add: PO Antibiotic: Minocycline 100 mg BID x 7 days, then QD x 3 MONTHS $$
- Consider topical Abx Cleocin T (1% Gel, Lotion, Soln) Apply BID -OR- Erythromycin (2% Gel) Apply BID No need for topical Abx if on po treatment $$$/$$
Acne rosacea Mainly Topical Tx Metronidazole topical [gel, cream (0.75%)] – Apply BID after washing face $$$
Noritate [1% Metronidazole cream] – Apply QHS after washing face $$$$$
- If out of control PO Antibiotic: Minocycline 100 mg BID x 7 days, then QD x 3 MONTHS -Unlike Acne above, use topical AND po Abx $$
BITES CAT Augmentin (Amoxicillin/clav) <3mo: 30mg/kg/d div Q12H x 7 days (use 125/37.5 dose) -Treat ALL CAT bites (>80% get infected) $$$$$
Pasteurella,Staph [250/125,500/125,875/125 mg caps] >3mo, <40 kg: 30mg/kg/d div Q12H x 7 days -Give w/food or milk to decrease the GI side-
Consider [125/37.5,200/28.5,250/62.5,400/57 mg CHEWS >40 kg and Adults: 500-875/125 BID x 7 days effects (diarrhea)
Tetanus Booster or susp/5ml]
for ALL bites Doxycycline [100 mg caps] 1 cap po BID x 7 days $
Cat-Scratch Disease Zithromax (Azithromycin) Kids >45 kg and Adults: Z-pak -Lymphadenitis seen near cat scratch $$
Bartonella henselae [250,500 mg tabs; 100,200 mg/5ml susp] Kids: <45 kg: 10mg/kg QD day 1, then 5mg/kd QD days 2-5
DOGS (man’s best friend) Augmentin (Amoxicillin/clav) <3mo: 30 mg/kg/d div Q12H x 7 days (use 125/37.5 dose) -Treat only severe bites (~ 5% get infected) $$$$$
[250/125,500/125,875/125 caps] >3mo, < 40kg: 30 mg/kg/d div Q12H x 7 days -Give w/food milk to decrease the GI side-
[125/37.5,200/28.5,250/62.5,400/57 mg CHEWS >40 kg and Adults: 500-875/125 mg BID x 7 days effects (diarrhea)
or susp/5ml]
Clindamycin + Levaquin Clinda 300 mg Q8H x 7d + Levaquin 500 mg QD x 7d Give Diflucan for likely yeast infxn w/Clinda $$$$$
For Kids: Clindamycin [75 mg/5ml] + Clinda 40mg/kg/d (Max 1 gm) div Q8H + Bactrim 10mg/kg/d $$$
Bactrim (TMP/SMX) [40/200 mg/5ml] (based on TMP component) div BID x 7 days
SKIN

TETANUS WOUND CLASSIFICATION TETANUS IMMUNIZATION SCHEDULE

Clinical Features Tetanus Prone Non-Tetanus Prone History of Tetanus Immunization Dirty, Tetanus-Prone Wound Clean, Non-Tetanus Prone Wound
Age of wound > 6 hours < 6 hours Tdap 1 TIG Tdap TIG
Configuration Stellate, avulsion Linear Unknown or < 3 doses Yes Yes Yes No
Depth > 1 cm < 1 cm > 3 doses No 2 No No 3 No
Mechanism of Injury Missile, crush, burn, frostbite Sharp surface (glass/knife) 1 Tdap: Tetanus booster shot (Note return of Pertussis in Tetanus booster recs); TIG: Tetanus Immune Globulin.
2 YES if > 5 yrs since last booster
Contaminants (dirt, saliva, etc) Present Absent
3 YES if > 10 yrs since last Td booster
Devitalized Tissue Present Absent

Cellulitis: Staph/Strep
-Boils/Abscesses
Consider MRSA if tx
failure/recurrent episodes
-severe/recurrent consider
-Impetigo Staph/Strep
-Erysipelas Group A Strep/Staph
Consider MRSA if tx
failure/recurrent episodes
-Diabetic cellulitis Staph, Strep,
and foot ulcers Enterobacteriaceae,
ANAEROBES
Consider MRSA if tx
failure/recurrent episodes
Keflex (Cephalexin)
[125,250 mg/5ml; 250,500 mg caps]
Bactroban (Mupirocin) Ointment
Bactroban (Mupirocin) Nasal
See Above: Keflex -OR- Bactroban ointment------Newer agent: Altabax [1% oint]: Apply BID x 5 days (no indication for MRSA – YET?)
Keflex (Cephalexin)
[125,250 mg/5ml; 250,500 mg caps]
Augmentin [875/125 mg tab]
Zithromax (Azithromycin)
[250,500 mg tabs; 100,200 mg/5ml susp]
Bactrim + Flagyl
Cipro(Ciprofloxacin) + Clindamycin
Augmentin [875/125 mg tabs]
Levaquin + Flagyl
Kids <12: 50mg/kg/d div Q12H x 10 days (Max 4gm/d) If abscess present NEED I&D, consider $
>12 and Adults: 1 gm BID x 10 days culture
Apply TID x 10-14 days Great MRSA coverage $$
Apply BID to nares x 5d for eradication of Staph colonization Apply ½ of single-use tube BID (Box of 10) $
$$$$
Kids <12: 50mg/kg/d div Q12H x 10 days (Max 3gm/d) SHARP BORDERS should clue you in to dx $
>12 and Adults: 1 gm BID x 10 days
1 po BID x 7-10 days; see CAT BITES for kids dosing Give w/ food or milk to decr GI side-effects $$$$$
Kids >45kg and Adults: Z-pak $$
Kids <45kg: 10mg/kg QD day 1, then 5 mg/kd QD days 2-5
BactrimDS 2 tabs po BID + Flagyl 500 mg BID x 10-14 days No EtOH w/Flagyl $$
Cipro 500mg 2 tabs po BID+ Clinda 300mg po Q8H x 10-14d $$$
1 tab po BID x 10-14 days $$$$$
Levaquin 750 mg po QD + Flagyl 500 mg po BID x 10-14 d $$$$$

Cost Legend: $<12, $$~25, $$$~50, $$$$~75, $$$$$~100 and above

 Bucher/Jones Table of ANTIBIOTICS: From Head to Toes 5

Location Infection Bugs Antibiotics Dosing Notes/Pitfalls COST

-Mastitis Staph, Strep Keflex (Cephalexin) 1 gm po BID x 7 days -Ok to nurse as long as no abscess, if $
[500 mg caps] abscess present then I&D and return to
Consider MRSA if tx
failure/recurrent episodes Bactrim (TMP/SMX) 1 tab po BID x 7 days nursing when pain allows $
[DS tabs] -BOTH are safe to use with breastfeeding
MRSA REGIMENS Minocycline [100 mg caps] 1 cap po BID x 10-14 days Better MRSA skin coverage than Doxy $$
Bactrim (TMP/SMX) [DS tabs] 2 tabs po BID x 10-14 days $
Attempt to get culture and sensitivities for Bactrim (TMP/SMX) for KIDS [40/200 mg/5ml] 20mg/kg/d div BID x 10-14 days (dose based on TMP) $
abscesses – the results will likely surprise Clindamycin [300 mg caps; 75 mg/5ml] 300 mg (or 40mg/kg/d- Max 1 gm/d) po Q8H x 10-14 days Give Diflucan for girls due to likely yeast infxn $$$
you!! Levaquin [750 mg tabs] 1 tab po QD x 10-14 days $$$$$
Avelox [400 mg tabs] 1 tab po QD x 10-14 days $$$$$
Zyvox 0-11 yo: 30mg/kg/d div Q8H x 10-14 days Reserve for tx failures/allergies to other Rx Very
[600 mg tabs; 100 mg/5ml] >12 yo and Adults: 600 mg BID x 10-14 days ($1500 for 20 tabs) Expnsv
TICK BITES Know the prevalence of both LYME’S DISEASE and Rocky-Mountain Spotted Fever (RMSF) in your area – often no treatment needed based on distribution of disease-carrying ticks
Lyme’s Disease If TICK attached for LESS than 72 HOURS AND was NOT ENGORGED – Minimal risk, reassure, no prophylaxis or treatment recommended
SKIN continued…

Borrelia borgdorferi If TICK attached for LESS than 72 HOURS, but WAS ENGORGED – Offer prophylactic dose of Doxycycline 100mg caps– 2 caps po x 1 DOSE $
If TICK attached >72 HRS or local RASH at bite site, or symptoms of Lyme’s (myalgia,arthralgia,fever,HA,fatigue) – Doxycycline 100mg PO BID x 3 WEEKS $
(If Pregnant/Kids Amox 500 mg TID or 50mg/kg/d div TID x 3 WEEKS)
Rocky Mountain Spotted- Doxycycline [100 mg caps]: 1 cap po BID x 7d Features: Fever, Rash, Petechiae – Rash spreads from distal extremities to trunk $
Fever - Only 3-18% of pts present with fever/rash/hx tick exposure – many early deaths – empiric Doxy reasonable
R. rickettsii in endemic areas (Mid-Atlantic, Oklahoma, Montana, S. Dakota)
TINEA, TINEA, Capitis See HEAD section above – remember CAPITIS NEEDS PO TREATMENT – Topical therapy dose not work in the scalp
TINEA Corporis/Pedis Topical Agents (OTC are just as good): Lotrimin Ultra or Lamisil AT BID x 2-4 WEEKS $
Trichophyton sp. RX Topical (they will Demand them): Ketoconazole Crm 2%(30,60gm tubes): Apply BID x 2-4wks Tinea Pedis BID x 6 WKS $$
Mentax Cream (15,30 gm tubes): Apply QD x 2-4 wks For Tinea Pedis use BID $$$
Cruris (Jock-itch) Same as Above – May add Hydrocortisone Cream 2.5% (15, 30 ,45, 60 gm tubes) BID for extremely pruritic cases
Trichophyton sp. - Cruris rarely involves the SCROTUM, and the PENIS is NEVER involved (If penis is involved think CANDIDA – use Diflucan po or Nystatin cream)
Resistant Pedis Consider Lamisil Pulse Dosing: [250 mg tabs] – 1 tab po BID (or 2 po QD) x 1wk/month (Treat 1-2 mos for pedis) Note: Pulse dosing is generally thought to be $
Onychomycosis Lamisil (Terbinafine) [250 mg tabs] Pulse Dosing:1 tab po BID (or 2 po QD) x 1 wk/month safe with no routine monitoring of LFTs rec $
Sporanox (Itraconazole) [100mg caps] Pulse Dosing: 2 po BID x 1 wk/month [Tx fingernails x 2 mos, toenails x 4 mos] $$$$$
Tinea Versicolor Topical Treatment: See OTC recs above for Corporis or Rx Topicals (Mentax, Ketoconazole) -Often recurs, especially in summer months $-$$$
M. furfur Ketoconazole 1 tab po QD x 1 wk -OR- Alt: 2 tabs po x 1 dose [take w/OJ, -Hypopigmentation will remain until skin is $$
[200 mg tabs] work up sweat, no shower x 8hrs] tanned (even after infxn clears)
(Spaghetti & Meatballs on Selsun (Selenium Sulfide) Apply as lather to affected areas, leave on for 10 min and $
KOH) [2.5% Lotion/Shampoo] then wash off - daily x 1 wk, then 3-5x/wk x 2-4 more wks
LICE Permethrin 1% (OTC) Apply to DRY HAIR, leave on overnight, then wash off in AM - MUST TREAT ON DAY 1 and DAY 7 1% vs 5% same efficacy for LICE $
(including pubic Malathion (Ovide) Apply to DRY HAIR, leave on for 12 hrs (no shower cap), then wash off – MUST TREAT ON DAY 1 and Day 7 Flammable, Smells BAD, but works very well $$$$$
lice) Remember w/ LICE: vacuuming best way to get rid of lice, throw away brushes/combs, seal stuffed animals in bag x 2 wks or vacuum
SCABIES Elimite Apply from neck to soles of feet, leave on for 8-12 hrs, wash off (30 gm tube adequate for adult), May repeat in 1 wk $$$
(Permethrin 5% cream) - Note higher dose of Permethrin for SCABIES
Ivermectin [3, 6 mg tabs] 200 ug/kg as SINGLE ORAL DOSE (some recommend repeating in 2 wks x 1 more dose) Great therapy for NH/Community outbreaks $$

Cost Legend: $<12, $$~25, $$$~50, $$$$~75, $$$$$~100 and above

 Bucher/Jones Table of ANTIBIOTICS: From Head to Toes 6

NOT INFECTIOUS, BUT A FEW SKIN PEARLES FROM THE KELLY JONES LIBRARY
Atopic Dermatitis Basic Regimen (watch for co-existing Staph infxn or tx Staph empirically if no better with initial therapy - ?allergic rxn to skin Staph)
GET CONTROL Orapred [15 mg/5ml, or ODT 10, 15, 30 mg] Kids 2 mg/kg div BID x 2 days, then 1mg/kg QD x 3 days Adults: consider Prednisone 40 mg QD x 5d $-$$
Break Itch/Scratch Cycle Hydroxyzine at Bedtime Kids: [10 mg/5mL Syrup] Start 1 tsp po QHS and titrate up Adults: Atarax 25-50 mg tabs po QHS $
SKIN continued…

SOAP Recommend WHITE DOVE ONLY

LOTION Glycerin based: I Like Cetaphil Lotion – they MUST apply this BID, especially AFTER bath/shower to lock in moisture $
Topical Steroids Hydrocortisone Cream 2.5% for FACE Apply BID until control, then QD, then 2x/wk for maint (15,30,45, and 60 gm tubes) $
Derma-Smoothe FS (best kept Derm Secret) Apply oil BID to entire affected area until controlled Disp 120ml (4 oz) WITH REFILLS $$
(sometimes 2-3 mos), then QD, then 2x/wk for maint
PO Antibiotics (If severe) Keflex (Cephalexin) Kids <12: 50mg/kg/d div Q12H x 10-14 days (Max 4gm/d) Add Topical Tx : Bactroban Oint TID to $$
-superficial infxn often [125,250 mg/5ml; 250,500 mg caps] >12 and Adults: 1 gm po BID x 10-14 days affected area x 10-14 days; Go ahead and tx
present w/scratching Bactrim (TMP/SMX) [40/200 mg/5ml, DS tab] Kids: 10mg/kg/d div Q12H x 10-14d (dose based on TMP) intra-nasally BID x 5 days AND under the $$
Adults: 1 DS tab po BID x 10-14d fingernails x 5 days (if severe scratching
Consider MRSA if tx
failure/recurrent episodes involved)
BAD Diaper “Jones’ Happy Hiney” Give Rx for 1. Hydrocortisone Cream 2.5% and apply with equal amt of 2. Nystatin Cream BID x 7-10 days (or until gone, then 48 hrs after resolution of rash) $
Dermatitis Other TIPS: After BMs wash the area with lukewarm water and white DOVE soap, let area open to the air for as long as possible, then apply layer of baby powder, followed by GENEROUS coating of Zinc
Oxide Cream (Balmex, Desitin, Boudreaux’s Butt Paste)
Hemorrhoids Besides keeping BM soft (Colace, Miralax, etc), Recommend wiping with FLUSHABLE Tucks (Witch Hazel) Wipes (usually only avail in CVS/Walgreens brand), Sitz baths +/- Epsom salts TID, Anusol HC
cream BID-QID for comfort…THEN THE BIG GUN:
Proctocort Suppositories Use BID x 6 days (best to insert after BM if possible) DISP #12 (comes in packs of 12) $$$

Cost Legend: $<12, $$~25, $$$~50, $$$$~75, $$$$$~100 and above

 Bucher/Jones Table of ANTIBIOTICS: From Head to Toes 7

Antibiotics: Don’t forget to think about the coverage and the gaps…
Antibiotic Coverage Gaps Things to Remember…
Penicillin Gram + [Group A Strep (GAS), GBS], Enterococcus, NO STAPH, Atypicals, or Bad Gram – RENAL DOSING
Syphilis, Anaerobes (Pseudomonas)
Amoxicillin Gram + (no Staph), Enterococcus, Anaerobes, Basic NO STAPH, Atypicals, or Bad Gram – RENAL DOSING
Gram – (E. coli, Proteus, Salmonella, H. flu) (Pseudomonas)
Augmentin (Amoxicillin/clav) STAPH (No MRSA), Better Gram – coverage than No MRSA, Atypicals or Pseudomonas RENAL DOSING
- GI side effects(diarrhea) with clavulanate
Amox, Anaerobes
Keflex (Cephalexin) Broad Gram +, includes STAPH (No MRSA) No Gram –, MRSA, Atypicals, or Anaerobes RENAL DOSING
Omnicef (Cefdinir) Broad Gram +, Broad Gram – No MRSA, Atypicals, Pseudomonas, or -MAY TURN BMs RED!
RENAL DOSING
Anaerobes
Rocephin (Ceftriaxone) Gonorrhea, Broad Gram +, Broad Gram – No MRSA, Atypicals, Pseudomonas, or NO RENAL DOSING
Anaerobes
Zithromax (Azithromycin) Broad Gram +, H. flu, min Gram – Not great for Strep pneum, -Up to 50% Strep pneum resist to macrolides
Atypicals (Chlamydia/Mycoplasma/Legionella) No Pseudomonas or Anaerobes NO RENAL DOSING
Biaxin (Clarithromycin) Broad Gram +, H. flu, H. pylori, minimal Gram –, Not great for Strep pneum, -Up to 50% Strep pneum resist to macrolides.
Atypicals No Pseudomonas or Anaerobes RENAL DOSING Dysgeusia(bad taste)
Doxycycline Broad Gram + (includes Strep pneum, Staph, Not great for GAS (Strep throat), Minimal -Don’t use in kids <8 because of staining of the teeth NO
RENAL DOSING
MRSA), Acne (P. acnes), Atypicals Gram – and Anaerobes
Minocycline Better skin coverage for MRSA than Doxy, Broad Not great for GAS (Strep throat), Minimal -Don’t use in kids <8 because of staining of the teeth
- Warn pts about possible Vertigo/Dizziness side-effect
Gram + (includes Strep pneum, Staph, MRSA), Gram – and Anaerobes
NO RENAL DOSING
Acne (P. acnes), Atypicals
Bactrim (TMP/SMX) Broad Gram + and Gram –, MRSA (2 DS tabs BID) No GAS (Strep throat), Enterococcus, RENAL DOSING
Caution: Hyperkalemia possible
Anaerobes, Atypicals or Pseudomonas
Macrobid (Nitrofurantoin) Gram – (URINE ONLY DRUG) Contraindicated if Cr Cl<60 !!
Risk of Pulm Fibrosis for chronic supp therapy
Cleocin (Clindamycin) Broad Gram +, MRSA (Community-acquired), No Gram –, No Atypicals -Causes yeast infxns (give Diflucan)
NO RENAL DOSING
Anaerobes
Flagyl (Metronidazole) Broad Anaerobe, BV, Trich No Gram + or – (Anaerobes ONLY) -Disulfiram rxn – NO ETOH
RENAL DOSING
Tindamax (Tinidazole) Broad Anaerobe, BV, Trich No Gram + or – (Anaerobes ONLY) -Disulfiram rxn – NO ETOH
RENAL DOSING
Cipro (Ciprofloxacin) Gram – ONLY (includes Pseudomonas), Atypicals No Gram + or Anaerobes RENAL DOSING
Levaquin (Levofloxacin) Broad Gram + (includes MRSA, great Strep), Broad No Anaerobes, Not used for Gonorrhea RENAL DOSING
Gram –, Atypicals anymore
Avelox (Moxifloxacin) Broad Gram + (includes MRSA, great Strep), Broad No Anaerobes, DOES NOT GET INTO NO RENAL DOSING
Gram –, Atypicals URINE (hepatic metabolism)
Zyvox (Linezolid) GRAM + POWERHOUSE (MRSA, VRE) No Anaerobes, Atypicals or Gram – $$$$$$$ NO RENAL DOSING watch for serotonin syn
Vancocin (Vancomycin) PO USE ONLY FOR C. diff
Remember - The only Pseudomonas Abx are Zosyn, Cefepime, Quinolones, Tobramycin, Imi/Meropenem, and Aztreonam…The concentration dependant killers are Q,A,M (Quinolones,
Aminoglycosides, and Metronidazole/Tindamax) – so if you have the option in renal failure dosing, choose the dosing with the highest dose less often over lower doses more frequently.
Cost Legend: $<12, $$~25, $$$~50, $$$$~75, $$$$$~100 and above