Prescription Examples for Common Diseases
Hypertension
For hypertension in patients with type 2 diabetes, initiate therapy with an ACE inhibitor or ARB, followed by addition of a diuretic, then beta-blocker or calcium channel blocker as needed to reach target BP <130/80 mmHg 1, 2.
Example regimen:
- First-line: Lisinopril 10-40 mg daily OR Losartan 50-100 mg daily
- Second-line (add): Hydrochlorothiazide 12.5-25 mg daily OR Chlorthalidone 12.5-25 mg daily
- Third-line (add): Metoprolol succinate 50-200 mg daily OR Amlodipine 5-10 mg daily
Most patients require 2-3 medications to reach target, with over 90% of diabetic hypertensive patients taking ACE inhibitors or ARBs as foundation therapy 2. Medications should be dosed at higher than two-thirds maximum effective dose for optimal control 2.
Type 2 Diabetes
Target A1C <7% for most patients, with individualized goals between 6.5-7.5% based on comorbidities; maintain fasting glucose 70-140 mg/dL 1.
Example regimen:
- First-line: Metformin 500-1000 mg twice daily (titrate gradually)
- Second-line (add if A1C not at goal): GLP-1 agonist (e.g., Semaglutide 0.25-1 mg weekly) OR SGLT2 inhibitor (e.g., Empagliflozin 10-25 mg daily)
- For cardiovascular/renal protection: Prioritize GLP-1 agonists or SGLT2 inhibitors regardless of A1C
Monitor eGFR and UACR regularly; target eGFR >60 and UACR <30 1.
Hyperlipidemia
Target LDL-C <100 mg/dL for most patients, <70 mg/dL for high-risk patients, and non-HDL-C <130 mg/dL 1.
Example regimen:
- First-line: Atorvastatin 20-80 mg daily OR Rosuvastatin 10-40 mg daily
- Second-line (if not at goal): Add Ezetimibe 10 mg daily
- For severe hypertriglyceridemia (>500 mg/dL): Add fenofibrate 145 mg daily
Statin therapy is proven beneficial for dyslipidemia, but lifestyle modification with weight loss and exercise remains essential 3.
Acute Bacterial Sinusitis
Only prescribe antibiotics when symptoms persist >10 days without improvement, are severe (fever >39°C, purulent discharge, facial pain >3 consecutive days), or worsen after initial improvement ("double sickening") 4.
Example regimen when bacterial infection confirmed:
- First-line: Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days
- Alternative (penicillin allergy): Doxycycline 100 mg twice daily for 5-7 days
Critical pitfall: Most acute rhinosinusitis is viral—fewer than 2% of viral URIs progress to bacterial infection 4. Imaging has no role in diagnosis and cannot differentiate viral from bacterial causes 4. Symptomatic treatment with analgesics and decongestants is appropriate for most cases.
Community-Acquired Pneumonia
For hospitalized patients without risk factors for resistant bacteria, use beta-lactam/macrolide combination therapy for minimum 3 days 5, 6.
Example regimen:
- Hospitalized, non-ICU: Ceftriaxone 1-2 g IV daily PLUS Azithromycin 500 mg IV/PO daily
- Outpatient, previously healthy: Amoxicillin 1 g three times daily OR Doxycycline 100 mg twice daily
- Outpatient with comorbidities: Amoxicillin-clavulanate 875/125 mg twice daily PLUS Azithromycin 500 mg day 1, then 250 mg daily
Always test for COVID-19 and influenza when these viruses are circulating in the community, as positive results affect treatment and infection control 5, 6. For severe CAP, administer systemic corticosteroids within 24 hours to reduce 28-day mortality 5. Minimum antibiotic duration is 3 days for hospitalized patients 5, 6.
Acute Uncomplicated Cystitis
Example regimen (women):
- First-line: Nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for 5 days
- Alternative: Trimethoprim-sulfamethoxazole DS twice daily for 3 days (if local resistance <20%)
- Alternative: Fosfomycin 3 g single dose
Duration should be short-course as indicated above for uncomplicated cases.
Acute Streptococcal Pharyngitis
Test with rapid antigen detection test and/or culture before prescribing antibiotics; only treat confirmed group A Streptococcus 4.
Example regimen when positive:
- First-line: Penicillin V 500 mg twice daily for 10 days OR Amoxicillin 500 mg twice daily for 10 days
- Penicillin allergy: Azithromycin 500 mg day 1, then 250 mg daily for 4 days OR Cephalexin 500 mg twice daily for 10 days (if no severe allergy)
Offer analgesic therapy with aspirin, acetaminophen, NSAIDs, or throat lozenges for symptom relief 4. Most sore throats resolve in less than 1 week without antibiotics 4.
Major Depressive Disorder
Example regimen:
- First-line: Sertraline 50-200 mg daily OR Escitalopram 10-20 mg daily
- Alternative: Bupropion XL 150-300 mg daily (especially if fatigue/low energy predominant)
- Alternative: Mirtazapine 15-45 mg at bedtime (if insomnia/poor appetite)
Allow 4-6 weeks at therapeutic dose before assessing response. If partial response, optimize dose before switching agents.
Persistent Asthma
Example regimen:
- Mild persistent: Low-dose inhaled corticosteroid (e.g., Fluticasone 88-264 mcg/day OR Budesonide 180-600 mcg/day)
- Moderate persistent: Medium-dose ICS (e.g., Fluticasone 264-440 mcg/day) PLUS long-acting beta-agonist (e.g., Salmeterol 50 mcg twice daily) OR combination inhaler (Fluticasone/Salmeterol 250/50 mcg twice daily)
- Rescue: Albuterol 90 mcg, 2 puffs as needed
Controller therapy should be taken daily regardless of symptoms.