<prompt> Treatment of whooping cough is :RifampicinTetracyclineErythromycinAmpicillin  <response>: 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 Harrisons 16theInfective 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 - ErysipelascellulitisSevere - Penicillin G mild to moderate - Procaine Penicillin GP.825 - Necrotizing FascitismyositisSurgical debridement Penicillin G ClindamycinP.825 - PneumoniaempyemaPenicillin G Drainage of empyemaP.825 - Streptococcal toxic shock syndromePenicillin G Clindamycin intravenous immunoglobulinP.825 Group BPenicillinP.829Penicillin is the tt 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 tt of enterococcal infections.Viridans streptococciPenicillinP.831In neutropenic pts the tt 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 unknownTt with ceftriaxone vancomycin812, 813 - Susceptibility results availableSusceptible - Ceftriaxone Resistant - Tt with both ceftriaxone Vancomycin - Life threating penicillin allergyTt with imipenem Gram - negative Cocci Meningococcus Neisseria MeningitisPenicillin for confirmed invasin meningococcal diseaseP.853Alternatives - Chloramphenicol, Meropenem Moraxella CatarrhalisPenicillinClavulanic 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 diarrhoeaMetronidazole and vancomycinP. 761use of vancomycin in first episodes is discouraged because of possible drug resistanceClostridium tetaniI.V. PenicillinP.841Some prefer metronidazoleDiphtheria RespiratoryErythromycin or Procaine penicillin834, 835Administration of diptheria antitoxin is the most important element in the tt 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 PlagueStreptomycinP.925Gentamycin is considered as effectiveAlternative-Tetracycline chloramphenicolOther Gram-Negative bacilliInitial tt consists of cephalosporins such as Ceftriaxone or cefotaximeP.865Alternative - Penicillin ChloramphenicolHaemophilus infectionsHaemophilus influenzae b Haemophilus ducreyiThe recommended tt 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. TT as neurosyphilis Neuro syphilisAqueous Penicillin G or Aqueous Penicillin G Procaine Syphilis in pregnancyAccording to stage LeptospirosisMild - Doxycycline, Ampicillin or AmoxicillinModerateSevere - 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 womenP. 1257 Hook wormAlbendazole, Mebendazole, Pyrantel PamoateP. 1258 StrongyloidiasisIvermectin,P. 1259Alternative - AlbendazoleTrichuriasis WhipwormMebendazole or albendazoleP. 1259 Enterobiasis PinwormMebendazole, 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 wormMetronidazole 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 ttTrimethoprim sulfamethoxazole Alternative is dapsone - pyrimethamineP. 1247 ANTIVIRAL Influenza A and B Prophylaxis TreatmentAmantadine or rimantadine Oseltamivir, Zanamivir, AmantadineP. 1028 t 162.1Amantadine is used for influenza A onlyRSV InfectionRibavirin99 CMV-retinitis in immunocompromised host AIDSGanciclovir Valganciclovir, Foscarnet, CidofovirVaricellaImmunocompetent host Immunocompromised hostAcyclovirAcyclovir Herpes simplex EncephalitisAcyclovir NeonatalAcyclovir GenitalPrimary treatment Recurrent treatmentAcyclovirAcyclovir: 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 2bribavirin Pegylated-IFN- a 2b Pegylated-EFN- a 2bribavirin Pegylated-IFN- a 2aribavirin IFN ala conP. 10301 162.1 Chronic hepatitis DIFN-a2a or -a2b AntifungalIntravenous 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 pulmonaryItraconazoleAlternatives - 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 FluconazoleAlternatives-ObservationRisk factors, severe illness, rapid progression or diffuse pulmonary infiltratesAmphotericin B Alternatives-Switch to Itraconazole or fluconazoleChronic dissemination no CNS diseaseItraconazole or Fluconazole Alternatives-Amphotericin BMeningitisFluconazoleAlternatives-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 BAlternatives-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 meningitisAlternatives-Switch to fluconazoleAlternatives-itraconazoleCandidiasisCutaneousTopical Azole1187 VulvovaginalAzole cream or suppository or oral fluconazoleAlternatives-NystatinOropharyngealClotrimazole or fluconazoleAlternatives-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 