From the Guidelines
For the treatment of various urgent care illnesses, antibiotics such as amoxicillin, doxycycline, and macrolides are recommended, with the specific choice depending on the infection and patient comorbidities. When considering the treatment of community-acquired pneumonia, the American Thoracic Society and Infectious Diseases Society of America recommend amoxicillin 1g three times daily, doxycycline 100mg twice daily, or a macrolide for healthy outpatient adults without comorbidities or risk factors for antibiotic-resistant pathogens 1. For outpatient adults with comorbidities, combination therapy with amoxicillin/clavulanate and a macrolide, or monotherapy with a respiratory fluoroquinolone, is recommended 1. In the case of bronchiectasis, the British Thoracic Society guideline suggests using amoxicillin, doxycycline, or ciprofloxacin for the treatment of acute exacerbations, depending on the causative organism 1. Some key points to consider when prescribing antibiotics include:
- Completing the full course of treatment to prevent antibiotic resistance
- Using antibiotics only for bacterial infections, not viral illnesses
- Informing healthcare providers about allergies and other medications to prevent adverse interactions
- Considering the use of probiotics to maintain gut flora and reduce gastrointestinal side effects
- Being cautious when using aminoglycosides, particularly in pregnancy, renal failure, or the elderly 1. It's essential to choose the most appropriate antibiotic based on the specific infection, patient factors, and local resistance patterns to ensure effective treatment and minimize adverse effects.
From the FDA Drug Label
Azithromycin binds to the 23S rRNA of the bacterial 50S ribosomal subunit. It blocks protein synthesis by inhibiting the transpeptidation/translocation step of protein synthesis and by inhibiting the assembly of the 50S ribosomal subunit.
Levofloxacin is the L-isomer of the racemate, ofloxacin, a quinolone antimicrobial agent. The antibacterial activity of ofloxacin resides primarily in the L-isomer The mechanism of action of levofloxacin and other fluoroquinolone antimicrobials involves inhibition of bacterial topoisomerase IV and DNA gyrase (both of which are type II topoisomerases), enzymes required for DNA replication, transcription, repair and recombination
The antibiotics used to treat various urgent care illnesses are:
- Azithromycin: effective against Gram-positive and Gram-negative bacteria, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 2
- Levofloxacin: effective against Gram-positive and Gram-negative bacteria, including Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 3
From the Research
Antibiotics for Urgent Care Illnesses
- The following antibiotics are commonly used to treat urinary tract infections:
- For acute upper respiratory tract infections, skin and soft tissue infections, and urinary tract infections, guideline-concordant antibiotic prescribing can be improved through the implementation of outpatient antimicrobial stewardship guidelines 6
- Antibiotic stewardship interventions, such as provider education and the use of shared decision aids and 5 Ds tools, can improve proper prescribing and reduce antibiotic overuse in urgent care settings 7, 8
Specific Illnesses and Antibiotic Use
- Uncomplicated urinary tract infections:
- Acute upper respiratory tract infections:
- Antibiotic prescribing rates can be decreased through educational interventions and provider awareness of antibiotic overuse and resistance 8
- Pediatric acute otitis media:
- Watchful waiting and delaying antibiotic prescriptions can be effective in reducing unnecessary antibiotic use 7