Treatment of whooping cough is :
Ans. is 'c' Erythromycin DOC for pertussis infection - ErythromycinDOC is one of the favorites of all paper setters. Below given list will be helpful to tackle these type of questions.Drug of choice for suspected or proved microbial pathogens (according to Harrison's 16th/e)Infective organismDrugs of choiceReferenceCommentsGram-Positive CocciPenicillinP.822AlternativeStaphylococcal inf.- Sensitive to penicillinNafcillin, cefazolin, Vancomycin- Sensitive to methicillinNafcillin or oxacillinP.822Cefazolin, Vancomycin- Resistant to methicillinVancomycinP.822TMP-SMX, Minocycline-Resistant to methicillin with intermediate or complete resistance to vancomycinUncertainP.822 * Streptococcal inf. Group A - PharyngitisBenzathine Penicillin GP.825 - ImpetigoBenzathine Penicillin GP.825 - Erysipelas/cellulitisSevere - Penicillin G mild to moderate - Procaine Penicillin GP.825 - Necrotizing Fascitis/myositisSurgical debridement + Penicillin G + ClindamycinP.825 - Pneumonia/empyemaPenicillin G + Drainage of empyemaP.825 - Streptococcal toxic shock syndromePenicillin G + Clindamycin + intravenous immunoglobulinP.825 Group BPenicillinP.829Penicillin is the t/t of choice for all group B streptococcal infectionGroup DEnterococci and non enterococcalCombination therapyIf penicillin allergicPenicillin or Ampicillin + Gentamycin Vancomycin in combination with GentamycinP.830Enterococci are resistant to all cephalosporins therefore this class of antibiotic should not be used for t/t of enterococcal infections.Viridans streptococciPenicillinP.831In neutropenic pts the t/t is first started with vancomycin (as they are often resistant to penicillin)* Streptococcus pneumoniaeFor otitis mediaAmoxicillin812,813Second line - Amoxicillin Third line - ceftriaxoneFor PneumococcalPneumoniaOral therapy - amoxicillin, quinolone eg. GatifloxacinParenteral - Penicillin, Ampicillin, therapy Ceftriaxone, cefotaxime, Quinolone * Streptococcus meningitis - Antibiotic susceptibility unknownT/t with ceftriaxone + vancomycin812, 813 - Susceptibility results availableSusceptible - Ceftriaxone Resistant - T/t with both ceftriaxone & Vancomycin - Life threating penicillin allergyT/t with imipenem Gram - negative Cocci * Meningococcus (Neisseria Meningitis)Penicillin for confirmed invasin meningococcal diseaseP.853Alternatives - Chloramphenicol, Meropenem* Moraxella CatarrhalisPenicillin/Clavulanic acid is highly appropriateP.863Alternatives - Cephalosporins (2nd or 3rd generation) Tetracyclines, Macrolides, Ketolide, Trimethoprim - Sulfamethoxazole* Gonococcal infectionCervix, urethra, pharynx RectumFirst line-Ceftriaxone, Ciprofloxacin ofloxacin861Alternative- Spectinomycin, Ceftizoxime, CefotetanGonococcal conjunctivitisCeftriaxone861 Ophthalmia neonatorumCeftriaxone861 Disseminated gonococcal infectionPatient tolerant of b lactam drugsCeftriaxone, Cefotaxime, Ceftizoxime Patient allergic to b lactam drugsCiprofloxacin, Ofloxacin, Spectinomycin Continuation therapyCiprofloxacin, Ofloxacin, Levofloxacin Gonorrhoeae EpididymitisCeftriaxone followed by doxycycline765 Gonococcal urethritisCefpodoxime or ceftriaxone or fluoroquinolones765 P1DORALRegimen A - Ofloxacin or levofloxacin Plus metronidazoleRegimen B - Ceftriaxone plus doxycycline plus metronidazolePARENTERALRegimen A - Cefotetan or cefoxitin plus GentamycinRegimen B - Clindamycin Plus gentamycin771 Gram-Positive bacilli:Ciprofloxacin or doxycycline +Rifampicin, penicillin or ChloramphenicolP. 710 Bacillus Anthrax ClostridiumGas gangrenePenicillin (i.v.) + clindamycinP.761 Clostridial sepsisPenicillin (i.v.) + ClindamycinP. 761 Suppurative deep tissue infectionsPenicillin (i.v.) + Gentamycin or third generation cephalosporinP. 761 Clostridium difficile (diarrhoea)Metronidazole and vancomycinP. 761use of vancomycin in first episodes is discouraged because of possible drug resistanceClostridium tetaniI.V. PenicillinP.841Some prefer metronidazoleDiphtheria (Respiratory)Erythromycin or Procaine penicillin834, 835Administration of diptheria antitoxin is the most important element in the t/t of respiratory diphtheriaListeria monocytogenesI.V. ampicillin or PenicillinP.839 Enteric Gram-negative bacilliCefotaxime, Ceftizoxime, Ceftriaxone ceftazidime, CefepimeFluoroquinolones, nitrofurantoinC.M.D.T. 2004 1487- 881. (37.1) Escherichia Coli SepsisUrinary infection Klebsiella infectionsCarbapenemsP.883Imipenem remain the most active antibiotic class against KlebsiellaSalmonellaCiprofloxacin, ceftriaxoneP.900Alternative-Azithromycin, ciprofloxacinShigellaIn developing countries In U.S.A.Nalidixic acid Ampicillin,Cotrimoxazole Ciprofloxacin, Azithromycin CefiximeP.906 CampylobacterErythromycinP.909 Yersinia pestis (Plague)StreptomycinP.925Gentamycin is considered as effectiveAlternative-Tetracycline & chloramphenicolOther Gram-Negative bacilliInitial t/t consists of cephalosporins such as Ceftriaxone or cefotaximeP.865Alternative - Penicillin + ChloramphenicolHaemophilus infectionsHaemophilus influenzae 'b' Haemophilus ducreyiThe recommended t/t is a single 1 gm oral dose of azithromycinP.867Alternative - Ceftriaxone ciprofloxacin, ErythromycinPertussisMacrolides Antibiotics - Erythromycin, clarithromycin, AzithromycinP.877Trimethoprim and sulfamethoxazole can be given to macrolide allergic patientsLegionellaNewer Macrolides - Azithromycin, clarithromycin, Respiratory Quinolones - levofloxacin, moxifloxacin GemifloxacinP.873 DonovanosisAzithromycin, Erythromycin, Tetracycline, DoxycyclineP. 933Azithromycin begin increasingly used as first choiceBrucellaMonotherapy - Streptomycin Dual therapy - Streptomycin & Tetracycline917, 916The gold standard is Ultra muscular streptomycin together with doxycyclineTularemiaStreptomycin (i.m.) for both adult & childrenP.921 Gardnerella VaginosisMetronidazoleP. 767 ChlamydiaChlamydia trachomatisAzithromycin1015-18Erythromycin is D.O.C. is pregnant womenChlamydia psittaci Chlamydia pneumoniaeTetracyclineErythromycin, Tetracycline, AzithromycinP. 1018Alternatives - FluoroquinolonesChlamydia urethritisAzithromycin or DoxycyclineP. 765 Rickettsial infections Rocky mountain spotted feverDoxycycline1001-02 Rickettsial PoxDoxycycline or Ciprofloxacin1001-02 Endemic typhusDoxycycline or Chloramphenicol1001-02 Epidemic typhusDoxycycline1001-02 Scrub typhusDoxycycline or Chloramphenicol1001-02 * Spirochetes P.983 Syphilis Primary, Secondary>> or early latentPenicillin G benzathine Late Latent cardiovascular or benign tertiaryNormal C.S.F. - Penicillin benzathine Abnormal C.S.F. T/T as neurosyphilis Neuro syphilisAqueous Penicillin G or Aqueous Penicillin G Procaine Syphilis in pregnancyAccording to stage LeptospirosisMild - Doxycycline, Ampicillin or AmoxicillinModerate/Severe - Penicillin G, Ampicillin,Amoxicillin, ErythromycinP.911 BorreliaRelapsing fever Lyme diseaseDoxycycline (or other tetracyclines) Erythromycin, ChloramphenicolP.995 Oral therapy - Adult - Doxycycline < 9 year AmoxicillinIntravenous therapy - Ceftriaxone Second choice - Amoxicillin Third choice - cefuroxime Second choice - Cefotaxime Third choice - Na PenicillinMycoplasmaErythromycin or doxycyclineCMDT 2004 P. 1489Alternatives - Clarithromycin Azithromycin, Fluoroquinolone Third generation cephalosporins or cefotaxime in the initial therapy as it also covers meningitis causing bacteriaActinomycetesActinomycosisNocardiaPenicillinP.939 Sulfonamides minocycline is an acceptable alternativeP.937Some believe that cotrimoxazole may be more effective but it poses a greater risk of hematological toxicityHelminthic infections * Cestodes H. NanaPraziquantelP. 1276 Taenia saginataPraziquantelP. 1273 Taenia SoliumPraziquantelP. 1274 * TrematodeSchistosomiasisPraziquantelP. 1271 Liver flukes Lung flukesPraziquantelPraziquantelP. 1271 * Nematodes (tissues) TrichinellaEnteric stage - Mebendazole & AlbendazoleP. 1254Trichinella larva in muscle (Drugs ineffective)* Intestinal Nematodes AscariasisAlbendazole, Mebendazole, Pyrantel Pamoate (used in Pregnant women)P. 1257 Hook wormAlbendazole, Mebendazole, Pyrantel PamoateP. 1258 StrongyloidiasisIvermectin,P. 1259Alternative - AlbendazoleTrichuriasis (Whipworm)Mebendazole or albendazoleP. 1259 Enterobiasis (Pinworm)Mebendazole, Albendazole, Pyrantel pamoateP. 1259 Extraintestinal Nematodes FilariaFilariasisTropical Pulmonary EosinophilaDiethyl carbimazole Diethyl carbimazoleP. 1262 P. 1263 OnchocerciasisIvermectin is the D.O.C.P. 1264 Dracunculiasis (Guinea worm)Metronidazole may relieve symptoms but has no proven activity against the wormP. 1265 Protozoal infections AmoebaAsymptomatic carrier Acute Colitis Amoebic liver abscessIodoquinol Paromomycin Metronidazole + Luminal agent MetronidazoleP. 1217 TrichomoniasisMetronidazoleP. 1252 GiardiasisMetronidazoleP. 1250 Toxoplasma infection Congenital infection Immunocompetent patients Immunocompromised patientsOral pyrimethamine and sulfadiazine usually do not require t/tTrimethoprim sulfamethoxazole (Alternative is dapsone - pyrimethamine)P. 1247 ANTIVIRAL Influenza A and B Prophylaxis TreatmentAmantadine or rimantadine Oseltamivir, Zanamivir, AmantadineP. 1028 t (162.1)Amantadine is used for influenza A onlyRSV InfectionRibavirin99 CMV-retinitis in immunocompromised host (AIDS)Ganciclovir Valganciclovir, Foscarnet, CidofovirVaricellaImmunocompetent host Immunocompromised hostAcyclovirAcyclovir" Herpes simplex EncephalitisAcyclovir" NeonatalAcyclovir GenitalPrimary (treatment) Recurrent (treatment)AcyclovirAcyclovir: KeratitisTrifluridineP. 10291 (162.1) Herpes zoster Immunocompromised host Immunocompetent hostAcyclovirValacyclovir>> Herpes zoster ophthalmicusAcyclovir" Condyloma acuminatumIFN-a2bIFN-a n3" Chronic hepatitis BIFN- a 2bLamivudineAdefovir Chronic hepatitis CIFN- a 2a or a 2b IFN- a 2b/ribavirin Pegylated-IFN- a 2b Pegylated-EFN- a 2b/ribavirin Pegylated-IFN- a 2a/ribavirin IFN ala conP. 10301 (162.1) Chronic hepatitis DIFN-a2a or -a2b" Antifungal"Intravenous amphotericin B is the drug of choice for the treatment of patient with disseminated histoplasmosis who are severely ill or immunosuppressed or whose infection involves the C.N.S."P. 1180 Histoplasmosis Acute pulmonaryNone" Chronic pulmonaryItraconazole"Alternatives - Amphotericin BDisseminated Immunocompetent patient less severeItraconazole Alternatives - Amphotericin BRapid progressive severe illness CNS involvement, HIV infectionAmphotericin B Alternatives - ItraconazoleCoccidioidomycosisPatients with ever or rapid progressive disseminated coccidioidomycosis are first given intravenous Amphotericin B patients whose condition improves or who have more indolent disseminated infection are given itraconazole1181-82 No risk factorsItraconazole or Fluconazole"Alternatives-ObservationRisk factors, severe illness, rapid progression or diffuse pulmonary infiltratesAmphotericin B Alternatives-Switch to Itraconazole or fluconazoleChronic dissemination (no CNS disease)Itraconazole or Fluconazole Alternatives-Amphotericin BMeningitisFluconazole"Alternatives-intrathecalAmphotericin BBlastomycosisI.V. Amphotericin B is the drug of choice for patients with rapidly progressive infections, severe illness or CNS lesions.1183-83 Rapid progressing or severe illnessAmphotericin B"Alternatives-Switch to nasale when condition stabilizeCNS diseaseAmphotericin B for 10-12 weeks Alternatives-Give fluconazole if patient improvesIndolent infectionItraconazole CryptococcosisDiseases in AIDS patientsAmphotericin BP. 1185Alternatives-itraconazoleDisease of Non AIDS patientsMeningitis - Amphotericin BPulmonary disease -Treatment immunosuppressed patients as for meningitis"Alternatives-Switch to fluconazoleAlternatives-itraconazoleCandidiasisCutaneousTopical Azole1187 VulvovaginalAzole cream or suppository or oral fluconazole"Alternatives-NystatinOropharyngealClotrimazole or fluconazole"Alternatives-NystatinEsophagealFluconazole tablet Alternatives-For azole Unresponsive diseaseDeeply invasiveNon neutropenic - Fluconazole or Amphotericin caspofungin Neutropenic - Amphotericin B AspergillosisFungus base of the lungSurgical resectionP. 1189Alternatives-Bead embolization for hemoptysisAllergic bronchopulmonary aspergillosisShort course of Glucocorticoids Alternatives-itraconazole prophylaxisInvasive aspergillosisVoriconazole liposomal or conventional Amphotericin B Alternatives-Amphotericin B colloidal dispersion or lipid complex itraconazole or caspofunginMucormycosisIntravenous amphotericin B is usefulP. 1190 Pityriasis versicolorAzole creams, Application of Selenium itraconazole is also effectiveP. 1192 SporotrichosisItraconazole is the drug of choiceP. 1193 MycetomaActinomycetomaEumycetomaStreptomycin Dapsone and Cotrimoxazole Rarely responds to chemotherapyP. 1192 PneumocystosisPneumocystis cariniiTrimethoprim, SulfamethoxazoleP. 1195These are D.O.C. for all forms of Pneumocystosis
Rifampicin
Tetracycline
Erythromycin
Ampicillin
D.O.C