Top 25 Urgent Care Diagnoses: Comprehensive Treatment Guide
1. Upper Respiratory Tract Infection (URI/Common Cold)
Hallmark Signs: Rhinorrhea, nasal congestion, sore throat, cough without fever or with low-grade fever 1
Testing: None required; clinical diagnosis 1
Treatment:
- First-line: No antibiotics indicated 1
- Second-line: N/A
- Supportive Care: Adequate rest, hydration, analgesics (acetaminophen/ibuprofen), warm facial packs, steamy showers 1
Treatment Failure: Not applicable - viral illness
2. Acute Bronchitis
Hallmark Signs: Cough lasting up to 6 weeks (productive or non-productive), mild constitutional symptoms, absence of pneumonia signs 1
Testing: None if no pneumonia suspected; chest X-ray only if tachycardia (>100 bpm), tachypnea (>24 breaths/min), fever (>38°C), or abnormal chest exam 1
Treatment:
- First-line: No antibiotics - supportive care only 1
- Adults: Ibuprofen for symptom relief 1
- Pediatrics: Antipyretics (avoid aspirin in <16 years), fluids 1
- Second-line: N/A - antibiotics not indicated 1
Supportive Care: Rest, hydration, analgesics 1
Treatment Failure: If symptoms persist >6 weeks or pneumonia develops, reassess with chest X-ray 1
3. Acute Bacterial Sinusitis
Hallmark Signs: Symptoms >7 days with purulent nasal discharge, facial pain/pressure, nasal obstruction 1
Testing: Clinical diagnosis; plain radiographs show >6mm mucosal thickening in adults (>4mm in children) 1
Treatment:
Adults:
- First-line: Amoxicillin 500-1000mg PO every 8 hours for 10-14 days 1
- Second-line (no improvement in 3-5 days): High-dose amoxicillin-clavulanate (2g every 12 hours) OR cefuroxime axetil 1
- Penicillin allergy: Trimethoprim-sulfamethoxazole OR azithromycin 500mg QD x 3 days 1, 2
Pediatrics:
- First-line: Amoxicillin 45-90mg/kg/day divided every 8-12 hours 1
- Second-line: High-dose amoxicillin-clavulanate (90mg/kg amoxicillin + 6.4mg/kg clavulanate every 12 hours, max 2g) 1
- Penicillin allergy (non-immediate): Cefdinir, cefuroxime, cefpodoxime, or cefprozil 1, 3
- Penicillin allergy (immediate/anaphylactic): Clindamycin 7mg/kg/dose TID (max 300mg/dose) x 10 days 3
Supportive Care: Nasal corticosteroids, adequate hydration, warm facial packs, sleeping with head elevated 1
Treatment Failure: Switch to high-dose amoxicillin-clavulanate, cefuroxime, cefpodoxime, cefprozil, cefdinir, or consider quinolones/macrolides 1
4. Acute Pharyngitis/Strep Throat
Hallmark Signs: Sore throat, fever, tonsillar exudates, anterior cervical lymphadenopathy 3
Testing: Rapid strep test or throat culture 3
Treatment:
Adults:
- First-line: Amoxicillin 500-1000mg PO every 8 hours x 10 days 4
- Second-line: Azithromycin 500mg single dose Day 1, then 250mg daily Days 2-5 2
- Penicillin allergy (non-immediate): Cephalexin 500mg BID x 10 days OR cefadroxil 1g daily x 10 days 3
- Penicillin allergy (immediate): Clindamycin 300mg TID x 10 days OR azithromycin 500mg daily x 5 days 3
Pediatrics:
- First-line: Amoxicillin 50mg/kg/day (max 1000mg) divided BID x 10 days 3
- Penicillin allergy (non-immediate): Cephalexin 20mg/kg/dose BID (max 500mg/dose) x 10 days OR cefadroxil 30mg/kg once daily (max 1g) x 10 days 3
- Penicillin allergy (immediate): Clindamycin 7mg/kg/dose TID (max 300mg/dose) x 10 days OR azithromycin 12mg/kg once daily (max 500mg) x 5 days 3
Supportive Care: Analgesics, throat lozenges, adequate hydration 3
Treatment Failure: Reevaluate if worsening after 48-72 hours or symptoms persist >5 days; consider alternative diagnosis or resistant organism 3
5. Acute Otitis Media
Hallmark Signs: Ear pain, fever, bulging/erythematous tympanic membrane, middle ear effusion 3
Testing: Otoscopic examination 3
Treatment:
Pediatrics:
- First-line: Amoxicillin 80-90mg/kg/day divided BID x 10 days 3
- Second-line: High-dose amoxicillin-clavulanate (90mg/kg amoxicillin + 6.4mg/kg clavulanate) BID 3
- Penicillin allergy (non-immediate): Cefdinir 14mg/kg/day in 1-2 doses OR cefuroxime 30mg/kg/day in 2 divided doses OR cefpodoxime 10mg/kg/day in 2 divided doses 3
- Penicillin allergy (immediate): Azithromycin 30mg/kg single dose OR 10mg/kg daily x 3 days OR 10mg/kg Day 1, then 5mg/kg Days 2-5 2
Adults:
Supportive Care: Analgesics (acetaminophen/ibuprofen), warm compresses 3
Treatment Failure: Switch to high-dose amoxicillin-clavulanate or second-generation cephalosporin; consider tympanocentesis if recurrent 3
6. Community-Acquired Pneumonia (Outpatient)
Hallmark Signs: Cough, fever, dyspnea, pleuritic chest pain, abnormal lung exam (rales, egophony) 1
Testing: Chest X-ray if tachycardia (>100 bpm), tachypnea (>24 breaths/min), fever (>38°C), abnormal chest exam 1
Treatment:
Adults (outpatient, non-severe):
- First-line: Amoxicillin 500-1000mg every 8 hours x 7-10 days 4
- Second-line: Amoxicillin 500-1000mg every 8 hours PLUS macrolide (azithromycin 500mg Day 1, then 250mg Days 2-5) 4, 2
Geriatric Patients:
- First-line: Amoxicillin 500-1000mg every 8 hours PLUS macrolide (azithromycin or clarithromycin) 4
- Duration: Minimum 5-7 days for uncomplicated CAP 4
Pediatrics:
- First-line: Amoxicillin 45-90mg/kg/day divided every 8-12 hours 4
- Second-line: Azithromycin 10mg/kg Day 1, then 5mg/kg Days 2-5 2
Supportive Care: Rest, hydration, antipyretics, oxygen if hypoxic 4
Treatment Failure: Evaluate at Day 5-7; if no improvement, add macrolide or switch to respiratory fluoroquinolone 4
7. Community-Acquired Pneumonia (Hospitalized, Non-Severe)
Hallmark Signs: Same as outpatient CAP but with risk factors (age >65, comorbidities, vital sign abnormalities) 1
Testing: Chest X-ray, blood tests (WBC, renal function), blood cultures 1
Treatment:
Adults:
- First-line: Amoxicillin PO PLUS macrolide (erythromycin or clarithromycin) 4
- Second-line: IV ceftriaxone 1-2g daily PLUS azithromycin 500mg daily 4
Geriatric Patients:
- First-line: Amoxicillin PLUS macrolide (azithromycin or clarithromycin) 4
Supportive Care: IV fluids, oxygen therapy, low molecular weight heparin for respiratory failure 1
Treatment Failure: Evaluate at Day 2-3; if fever persists or infiltrates progress, broaden coverage or consider resistant organisms 4
8. Community-Acquired Pneumonia (Severe)
Hallmark Signs: Respiratory distress, hypoxia (SaO2 <92%), hypotension, altered mental status 1, 4
Testing: Chest X-ray, blood cultures, CBC, renal function, arterial blood gas 1
Treatment:
Adults:
- First-line: IV broad-spectrum β-lactam (co-amoxiclav, cefuroxime, cefotaxime, or ceftriaxone) PLUS IV macrolide (clarithromycin or erythromycin) 4
- Duration: 10 days minimum 4
Geriatric Patients:
- First-line: IV ceftriaxone 1-2g daily PLUS IV azithromycin 500mg daily 4
Supportive Care: IV fluids, oxygen therapy, noninvasive ventilation if COPD, low molecular weight heparin 1
Treatment Failure: Full reinvestigation, consider ICU transfer if failing to maintain SaO2 >92% on FiO2 >60%, shock, or rising PaCO2 >6.5 kPa 1
9. COPD Exacerbation (Hospitalized)
Hallmark Signs: Increased dyspnea, increased sputum volume, increased sputum purulence 1
Testing: Chest X-ray, arterial blood gas, sputum culture if severe or risk factors for Pseudomonas 1
Treatment:
Adults (Type I Anthonisen - all 3 symptoms):
- First-line: Amoxicillin-clavulanate 875mg BID x 5-7 days OR azithromycin 500mg QD x 3 days 1, 2
- Second-line (Pseudomonas risk): Fluoroquinolone (levofloxacin 750mg daily) OR anti-pseudomonal β-lactam 1
Adults (Type II Anthonisen - 2 symptoms including purulence):
- First-line: Same as Type I 1
Supportive Care: Bronchodilators, systemic corticosteroids, oxygen therapy, noninvasive ventilation if respiratory failure 1
Treatment Failure: Broaden coverage for Pseudomonas if risk factors present (recent hospitalization, frequent antibiotics, FEV1 <30%, prior Pseudomonas isolation) 1
10. Urinary Tract Infection (Uncomplicated Cystitis)
Hallmark Signs: Dysuria, frequency, urgency, suprapubic pain without fever or flank pain 1
Testing: Urinalysis with culture if recurrent or treatment failure 1
Treatment:
Adults (Women):
- First-line: Nitrofurantoin 100mg BID x 5 days OR trimethoprim-sulfamethoxazole DS BID x 3 days 1
- Second-line: Fosfomycin 3g single dose OR fluoroquinolone (ciprofloxacin 250mg BID x 3 days) 1
Adults (Men):
- First-line: Trimethoprim-sulfamethoxazole DS BID x 7 days OR fluoroquinolone x 7 days 1
Supportive Care: Increased fluid intake, phenazopyridine for dysuria (max 2 days) 1
Treatment Failure: Obtain urine culture and switch based on sensitivities; consider pyelonephritis if fever develops 1
11. Pyelonephritis
Hallmark Signs: Fever, flank pain, costovertebral angle tenderness, nausea/vomiting 1
Testing: Urinalysis, urine culture, blood cultures if severe, CBC, renal function 1
Treatment:
Adults (Outpatient):
- First-line: Ciprofloxacin 500mg BID x 7 days OR levofloxacin 750mg daily x 5 days 1
- Second-line: Ceftriaxone 1g IV/IM once, then oral fluoroquinolone or trimethoprim-sulfamethoxazole based on culture 1
Adults (Hospitalized):
- First-line: IV fluoroquinolone OR IV ceftriaxone 1-2g daily 1
Supportive Care: IV fluids, antiemetics, analgesics 1
Treatment Failure: Obtain imaging (CT) to rule out abscess or obstruction; adjust antibiotics based on culture 1
12. Cellulitis
Hallmark Signs: Erythema, warmth, swelling, tenderness of skin without purulence 1
Testing: Clinical diagnosis; blood cultures if systemic signs present 1
Treatment:
Adults:
- First-line: Cephalexin 500mg QID x 5-7 days OR dicloxacillin 500mg QID x 5-7 days 1
- Second-line (MRSA suspected): Trimethoprim-sulfamethoxazole DS BID PLUS cephalexin OR doxycycline 100mg BID 1
Pediatrics:
- First-line: Cephalexin 25-50mg/kg/day divided QID 1
Supportive Care: Elevation of affected limb, warm compresses, analgesics 1
Treatment Failure: Consider MRSA coverage, obtain wound culture if purulence develops, or hospitalize for IV antibiotics 1
13. Skin Abscess
Hallmark Signs: Fluctuant, tender, erythematous nodule with purulent drainage 1
Testing: Culture of purulent drainage 1
Treatment:
Adults:
- First-line: Incision and drainage (I&D) - primary treatment 1
- Antibiotics (if surrounding cellulitis >2cm, systemic signs, or immunocompromised): Trimethoprim-sulfamethoxazole DS BID x 5-7 days OR doxycycline 100mg BID x 5-7 days 1
Pediatrics:
- First-line: I&D 1
- Antibiotics (if indicated): Trimethoprim-sulfamethoxazole 8-10mg/kg/day (based on TMP component) divided BID 1
Supportive Care: Warm compresses, analgesics 1
Treatment Failure: Repeat I&D, adjust antibiotics based on culture, consider hospitalization for IV antibiotics 1
14. Influenza
Hallmark Signs: Fever >38.5°C, cough, myalgias, headache, sudden onset 1
Testing: Rapid influenza test or PCR if available 1
Treatment:
Adults:
- First-line: Oseltamivir 75mg BID x 5 days (within 48 hours of symptom onset) 1
- Antibiotics: Only if secondary bacterial infection suspected 1
Pediatrics:
- First-line (>1 year): Oseltamivir (dose based on weight) BID x 5 days 1
- <1 year: Assess by GP; low threshold for antibiotics if worsening 1
Supportive Care: Antipyretics (avoid aspirin in <16 years), fluids, rest 1
Treatment Failure: Consider secondary bacterial pneumonia if fever persists >5 days or worsens after initial improvement; add antibiotics for pneumonia coverage 1
15. Gastroenteritis (Acute Diarrhea)
Hallmark Signs: Diarrhea (≥3 loose stools/day), nausea, vomiting, abdominal cramping 1
Testing: Stool culture if bloody diarrhea, fever, severe dehydration, or immunocompromised 1
Treatment:
Adults:
- First-line: Supportive care only - no antibiotics for uncomplicated cases 1
- Antibiotics (if bloody diarrhea or positive culture): Ciprofloxacin 500mg BID x 3-5 days OR azithromycin 500mg daily x 3 days 1, 2
Pediatrics:
- First-line: Oral rehydration solution 1
- Antibiotics: Generally not indicated unless specific pathogen identified 1
Supportive Care: Oral rehydration solution, bland diet, probiotics 1
Treatment Failure: Reassess hydration status, obtain stool studies, consider hospitalization for IV fluids if severe dehydration 1
16. Appendicitis (Uncomplicated)
Hallmark Signs: Right lower quadrant pain, anorexia, nausea, fever, rebound tenderness 1
Testing: CT scan (preferred in adults), ultrasound (pediatrics), CBC, urinalysis to exclude UTI 1
Treatment:
Adults and Pediatrics:
- First-line: Urgent surgical consultation for appendectomy 1
- Preoperative antibiotics: Cefoxitin 2g IV OR cefotetan 2g IV OR ertapenem 1g IV 1
- Postoperative (if non-perforated): No additional antibiotics needed 1
Supportive Care: NPO, IV fluids, analgesics 1
Treatment Failure: N/A - surgical emergency 1
17. Appendicitis (Perforated/Complicated)
Hallmark Signs: Prolonged symptoms (>48 hours), diffuse peritonitis, abscess formation 1
Testing: CT scan showing perforation or abscess, CBC, blood cultures 1
Treatment:
Adults:
- First-line: Urgent source control (surgery or percutaneous drainage) PLUS broad-spectrum antibiotics 1
- Antibiotics: Piperacillin-tazobactam 3.375g IV every 6 hours OR ceftriaxone 2g IV daily PLUS metronidazole 500mg IV every 8 hours 1
- Duration: Continue until clinical improvement (typically 4-7 days) 1
Pediatrics:
- First-line: Same approach as adults with weight-based dosing 1
Supportive Care: IV fluids, NPO initially, analgesics 1
Treatment Failure: Broaden antibiotic coverage, obtain repeat imaging to assess for undrained abscess or ongoing contamination 1
18. Diverticulitis (Uncomplicated)
Hallmark Signs: Left lower quadrant pain, fever, change in bowel habits, tenderness without peritonitis 1
Testing: CT scan with IV contrast (preferred), CBC 1
Treatment:
Adults (Outpatient):
- First-line: Ciprofloxacin 500mg BID PLUS metronidazole 500mg TID x 7-10 days OR amoxicillin-clavulanate 875mg BID x 7-10 days 1
Adults (Hospitalized):
- First-line: IV ceftriaxone 1-2g daily PLUS metronidazole 500mg IV every 8 hours OR piperacillin-tazobactam 3.375g IV every 6 hours 1
Supportive Care: Clear liquid diet initially, advance as tolerated, analgesics 1
Treatment Failure: Obtain repeat CT to assess for abscess or perforation; consider percutaneous drainage or surgery 1
19. Cholecystitis
Hallmark Signs: Right upper quadrant pain, fever, nausea/vomiting, positive Murphy's sign 1
Testing: Ultrasound (gallbladder wall thickening, pericholecystic fluid, stones), CBC, liver function tests 1
Treatment:
Adults:
- First-line: Surgical consultation for cholecystectomy (within 72 hours) PLUS antibiotics 1
- Antibiotics: Ceftriaxone 1-2g IV daily PLUS metronidazole 500mg IV every 8 hours OR piperacillin-tazobactam 3.375g IV every 6 hours 1
- Duration: Continue until 24 hours after clinical improvement 1
Supportive Care: NPO, IV fluids, analgesics, antiemetics 1
Treatment Failure: Broaden antibiotics, consider percutaneous cholecystostomy if not surgical candidate 1
20. Gastritis/Peptic Ulcer Disease
Hallmark Signs: Epigastric pain, nausea, dyspepsia, hematemesis or melena if bleeding 1
Testing: H. pylori testing (stool antigen or breath test), CBC if bleeding suspected 1
Treatment:
Adults (Non-bleeding):
- First-line: Proton pump inhibitor (omeprazole 20mg BID or pantoprazole 40mg BID) 1
- If H. pylori positive: Triple therapy - PPI BID PLUS amoxicillin 1g BID PLUS clarithromycin 500mg BID x 14 days 1
Adults (Bleeding):
- First-line: IV PPI (pantoprazole 80mg bolus, then 8mg/hour infusion), urgent endoscopy 1
Supportive Care: Avoid NSAIDs, alcohol, smoking cessation 1
Treatment Failure: Repeat H. pylori testing, consider endoscopy, switch to quadruple therapy if persistent infection 1
21. Allergic Reaction (Mild-Moderate)
Hallmark Signs: Urticaria, pruritus, angioedema without respiratory or cardiovascular compromise 1
Testing: Clinical diagnosis 1
Treatment:
Adults:
- First-line: Diphenhydramine 25-50mg PO/IV OR cetirizine 10mg PO 1
- Second-line: Add H2 blocker (famotidine 20mg PO/IV) and/or corticosteroid (prednisone 40-60mg PO) 1
Pediatrics:
- First-line: Diphenhydramine 1mg/kg PO/IV (max 50mg) OR cetirizine 0.25mg/kg PO 1
Supportive Care: Remove offending agent, observation 1
Treatment Failure: Escalate to epinephrine if progression to anaphylaxis (respiratory distress, hypotension) 1
22. Anaphylaxis
Hallmark Signs: Urticaria/angioedema PLUS respiratory compromise (wheezing, stridor) OR hypotension OR GI symptoms 1
Testing: Clinical diagnosis - do not delay treatment 1
Treatment:
Adults:
- First-line: Epinephrine 0.3-0.5mg IM (1:1000) immediately; repeat every 5-15 minutes as needed 1
- Second-line: IV fluids (1-2L bolus), diphenhydramine 50mg IV, famotidine 20mg IV, methylprednisolone 125mg IV 1
Pediatrics:
- First-line: Epinephrine 0.01mg/kg IM (max 0.3mg for <30kg, 0.5mg for >30kg) 1
- Second-line: IV fluids 20mL/kg bolus, diphenhydramine 1mg/kg IV, famotidine 0.25mg/kg IV, methylprednisolone 1-2mg/kg IV 1
Supportive Care: Oxygen, cardiac monitoring, supine position with legs elevated 1
Treatment Failure: Repeat epinephrine, consider epinephrine infusion, intubation if airway compromise 1
23. Asthma Exacerbation (Mild-Moderate)
Hallmark Signs: Wheezing, dyspnea, chest tightness, cough, peak flow 40-69% predicted 1
Testing: Peak flow measurement, pulse oximetry 1
Treatment:
Adults:
- First-line: Albuterol 2.5-5mg nebulized every 20 minutes x 3 doses OR MDI 4-8 puffs every 20 minutes 1
- Second-line: Add ipratropium 0.5mg nebulized with albuterol, prednisone 40-60mg PO 1
Pediatrics:
- First-line: Albuterol 0.15mg/kg (min 2.5mg) nebulized every 20 minutes x 3 doses 1
- Second-line: Add ipratropium 0.25mg (<20kg) or 0.5mg (>20kg) nebulized, prednisolone 1-2mg/kg PO (max 60mg) 1
Supportive Care: Oxygen to maintain SaO2 >90%, reassess after each treatment 1
Treatment Failure: Continue albuterol every 1-2 hours, add IV magnesium sulfate 2g over 20 minutes, consider hospitalization if no improvement 1
24. Asthma Exacerbation (Severe)
Hallmark Signs: Severe dyspnea at rest, inability to speak full sentences, peak flow <40% predicted, SaO2 <90% 1
Testing: Peak flow, pulse oximetry, arterial blood gas if severe 1
Treatment:
Adults:
- First-line: Continuous albuterol nebulization PLUS ipratropium 0.5mg every 20 minutes x 3 doses PLUS methylprednisolone 125mg IV 1
- Second-line: IV magnesium sulfate 2g over 20 minutes, consider epinephrine 0.3mg IM if life-threatening 1
Pediatrics:
- First-line: Continuous albuterol nebulization PLUS ipratropium PLUS methylprednisolone 1-2mg/kg IV 1
- Second-line: IV magnesium sulfate 50mg/kg (max 2g) over 20 minutes 1
Supportive Care: Oxygen, cardiac monitoring, IV access 1
Treatment Failure: ICU admission, consider intubation if respiratory failure, BiPAP if available 1
25. Migraine Headache
Hallmark Signs: Unilateral throbbing headache, photophobia, phonophobia, nausea, aura 1
Testing: Clinical diagnosis; neuroimaging only if atypical features or focal neurologic deficits 1
Treatment:
Adults:
- First-line: Sumatriptan 6mg SC OR 50-100mg PO PLUS metoclopramide 10mg IV OR prochlorperazine 10mg IV 1
- Second-line: Ketorolac 30mg IV PLUS diphenhydramine 25mg IV PLUS dexamethasone 10mg IV (to prevent recurrence) 1
Pediatrics:
- First-line: Ibuprofen 10mg/kg PO (max 800mg) PLUS metoclopramide 0.1-0.2mg/kg IV (max 10mg) 1
- Second-line: Ketorolac 0.5mg/kg IV (max 30mg) PLUS diphenhydramine 1mg/kg IV 1
Supportive Care: Dark, quiet room; IV fluids if dehydrated 1
Treatment Failure: Consider IV valproate 500-1000mg over 15 minutes or admit for refractory migraine management 1
Common Pitfalls Across All Diagnoses
- Do not prescribe antibiotics for viral URIs or acute bronchitis - leads to resistance and adverse effects without benefit 1
- Do not assume all penicillin-allergic patients cannot receive cephalosporins - only immediate/anaphylactic reactions require complete avoidance 3
- Do not delay antibiotics in severe infections or septic shock - administer within 1 hour of recognition 1
- Do not underdose antibiotics - use high-dose amoxicillin (80-90mg/kg/day in pediatrics) for resistant organisms 1, 3
- Do not use trimethoprim-sulfamethoxazole for strep throat - 50% resistance rates 3
- Complete full antibiotic courses - 10 days for most bacterial infections (except azithromycin) to prevent resistance and complications 3