Updated Infectious Disease First Line Treatments

What is the first line treatment for Measles (Rubeola)?

Supportive care (Hydration, Antipyretics); Vitamin A is recommended for all children

What is the first line treatment for Rubella (German Measles)?

Supportive care (Antipyretics, hydration)

What is the first line treatment for Roseola?

Supportive care (Self-limiting)

What is the first line treatment for Mononucleosis?

Supportive care (Rest, analgesics/antipyretics); Avoid contact sports for 4 weeks (risk of splenic rupture)

When are corticosteroids indicated in Mononucleosis?

Only for airway obstruction due to lymphadenopathy, hemolytic anemia, or severe thrombocytopenia

What is the first line treatment for Mumps?

Supportive care (Analgesics, antipyretics, fluids)

What is the first line treatment for Varicella Zoster (Chicken Pox) in healthy children (<12 years)?

Supportive care (Isolation, antihistamines for itch, Acetaminophen for fever); Avoid Aspirin (Reye syndrome)

What is the first line treatment for Varicella Zoster (Chicken Pox) in adults or immunocompromised patients?

Acyclovir

What is the first line treatment for Herpes Zoster (Shingles)?

Acyclovir, Valacyclovir, or Famciclovir (ideally started within 72 hours of rash onset)

What is the first line treatment for Chikungunya Virus (CHIKV)?

Supportive care (NSAIDs, rest, fluids)

What is the first line treatment for Dengue Virus (DENV)?

Supportive care (Fluid replacement is critical); Acetaminophen for fever/pain

Which medications should be AVOIDED in Dengue Virus infection?

Aspirin and NSAIDs (due to bleeding risk)

What is the first line treatment for Zika Virus (ZIKV)?

Supportive care (Rest, fluids, Acetaminophen); Avoid NSAIDs until Dengue is ruled out

What is the first line treatment for Cytomegalovirus (CMV)?

Ganciclovir or Valganciclovir

What is the first line treatment for Acute Poliomyelitis?

Supportive care (Pain control, Physical Therapy to prevent contractures); Respiratory support if needed

What is the first line treatment for Erythema Infectiosum (Fifth Disease)?

Supportive care (Self-limiting)

What is the first line treatment for Pediculosis Capitis (Head Lice)?

Permethrin 1% shampoo; Combing to remove nits

What is the first line treatment for Pediculosis Pubis (Crabs)?

Permethrin 1% cream or Malathion 0.5% lotion

What is the first line treatment for Pediculosis Corporis (Body Lice)?

Hygiene improvement; Washing clothing/bedding in hot water (Medication usually not needed for patient)

What is the first line treatment for Scabies?

Permethrin 5% cream (applied from neck down for 8-14 hours); Wash all bedding/clothing in hot water

What is the first line treatment for Bed Bugs?

Topical corticosteroids and/or antihistamines for itching; Eradication of the infestation in the environment

What is the first line treatment for Folliculitis?

Topical Mupirocin or Clindamycin; Antibacterial soap (Benzoyl peroxide)

What is the first line treatment for Pseudomonas "Hot Tub" Folliculitis?

Usually self-limiting (no treatment); Ciprofloxacin if severe/refractory

What is the first line treatment for Furuncles and Carbuncles?

Warm compresses; Incision and Drainage (I&D) is the mainstay

When are antibiotics indicated for Furuncles/Carbuncles?

If associated with cellulitis, systemic symptoms, or comorbidities (Use TMP-SMX or Doxycycline to cover MRSA)

What is the first line treatment for Impetigo (Limited/Localized)?

Topical Mupirocin (Bactroban)

What is the first line treatment for Impetigo (Widespread/Bullous)?

Oral antibiotics: Cephalexin or Dicloxacillin (cover Staph and Strep)

What is the first line treatment for Purulent Cellulitis (MRSA concern)?

TMP-SMX (Bactrim), Doxycycline, or Clindamycin

What is the first line treatment for Non-Purulent Cellulitis (Strep/MSSA concern)?

Cephalexin, Dicloxacillin, or Penicillin

What is the first line treatment for Erysipelas?

Penicillin V, Amoxicillin, or Cephalexin

What is the first line treatment for Staphylococcal Scalded Skin Syndrome (SSSS)?

IV Nafcillin or Oxacillin (Anti-staphylococcal penicillin); Vancomycin if MRSA suspected

What is the first line treatment for MRSA Skin Infections (Abscess)?

Incision and Drainage (I&D); Antibiotics (TMP-SMX, Doxycycline, Clindamycin)

What is the first line treatment for Pharyngitis (Viral)?

Supportive care (Fluids, lozenges, NSAIDs)

What is the first line treatment for Scarlet Fever?

Penicillin G or V; Amoxicillin

What is the first line treatment for Toxic Shock Syndrome?

Aggressive IV fluids/pressors; IV Clindamycin + Vancomycin (suppress toxin production and cover MRSA)

What is the first line treatment for Streptococcal Pharyngitis?

Penicillin V or Amoxicillin

What is the first line treatment for Facial Erysipelas?

IV antibiotics often required initially (Cefazolin or Ceftriaxone) or oral Penicillin/Amoxicillin

What is the first line treatment for Rheumatic Fever (Infection)?

Penicillin G benzathine (to eradicate GAS carriage)

What is the first line treatment for Rheumatic Fever (Arthritis/Carditis)?

Aspirin/NSAIDs (for arthritis); Corticosteroids (for severe carditis)

What is the first line treatment for Lyme Disease (Adults)?

Doxycycline

What is the first line treatment for Lyme Disease (Children <8 or Pregnant)?

Amoxicillin

What is the first line treatment for Rocky Mountain Spotted Fever?

Doxycycline (First line for ALL ages, including children)

What is the first line treatment for Ehrlichiosis?

Doxycycline

What is the first line treatment for Anaplasmosis?

Doxycycline

What is the first line treatment for Tularemia?

Streptomycin or Gentamicin

What is the first line treatment for Tick-Borne Relapsing Fever?

Doxycycline

What is the first line treatment for STARI?

Doxycycline

What is the first line treatment for Babesiosis?

Atovaquone + Azithromycin

What is the first line treatment for Cat Scratch Disease?

Azithromycin (if lymphadenopathy is severe); Often self-limiting

What is the first line treatment for Animal Bite (Dog/Cat)?

Amoxicillin-Clavulanate (Augmentin)

What is the first line treatment for Toxoplasmosis?

Pyrimethamine + Sulfadiazine + Leucovorin

What is the first line treatment for Rabies (Post-Exposure Prophylaxis)?

Human Rabies Immune Globulin (HRIG) + Rabies Vaccine (Series of 4 doses)

What is the first line treatment for Influenza?

Oseltamivir (Tamiflu) - most effective if started within 48 hours

What is the first line treatment for Viral Pneumonia?

Supportive care; Specific antivirals only for specific causes (e.g., Influenza, HSV)

What is the empiric treatment for Community Acquired Pneumonia (Outpatient, Healthy)?

Amoxicillin OR Doxycycline OR Macrolide (Azithromycin)

What is the empiric treatment for Community Acquired Pneumonia (Outpatient, Comorbidities)?

Amoxicillin-Clavulanate or Cephalosporin PLUS Macrolide or Doxycycline; OR Respiratory Fluoroquinolone (Levofloxacin) monotherapy

What is the empiric treatment for Community Acquired Pneumonia (Inpatient, Non-ICU)?

Beta-lactam (Ceftriaxone) + Macrolide (Azithromycin); OR Respiratory Fluoroquinolone (Levofloxacin)

What is the first line treatment for Pneumococcal Pneumonia (Targeted)?

Penicillin G or Amoxicillin (if sensitive); Ceftriaxone or Respiratory Fluoroquinolone (if resistant)

What is the first line treatment for Klebsiella pneumoniae?

Ceftriaxone or Carbapenems (Imipenem/Meropenem) depending on susceptibility

What is the first line treatment for Mycoplasma pneumoniae?

Macrolide (Azithromycin) or Doxycycline

What is the first line treatment for Chlamydia pneumoniae?

Macrolide (Azithromycin) or Doxycycline

What is the first line treatment for Chlamydia psittaci (Psittacosis)?

Doxycycline

What is the first line treatment for Legionella pneumophila?

Respiratory Fluoroquinolone (Levofloxacin) or Macrolide (Azithromycin)

What is the first line treatment for Acute Bronchitis?

Supportive care (Hydration, cough suppressants, bronchodilators); Antibiotics are NOT recommended usually

What is the first line treatment for Pertussis?

Macrolides (Azithromycin, Clarithromycin) - mainly to decrease transmission

What is the first line treatment for Respiratory Syncytial Virus (RSV)?

Supportive care (Oxygen, hydration); Ribavirin for severe/high-risk cases

What is the first line treatment for Croup (Mild)?

Single dose of Dexamethasone; Cool mist

What is the first line treatment for Croup (Moderate/Severe)?

Dexamethasone + Nebulized Epinephrine

What is the first line treatment for Guillain-Barré Syndrome (GBS)?

IVIG (Intravenous Immunoglobulin) or Plasmapheresis

What is the first line treatment for Swine Flu (H1N1)?

Oseltamivir (Tamiflu)

What is the first line treatment for SARS-CoV-2 (Mild/Moderate)?

Supportive care

What is the first line treatment for SARS-CoV-2 (High Risk)?

Nirmatrelvir/ritonavir (Paxlovid); Remdesivir

What is the first line treatment for Herpes Simplex Virus Type 1 (Oral)?

Oral Valacyclovir or Acyclovir

What is the first line treatment for Herpes Simplex Virus Type 2 (Genital)?

Oral Acyclovir, Valacyclovir, or Famciclovir

What is the first line treatment for Genital Warts (HPV) - Patient Applied?

Imiquimod cream

What is the first line treatment for Genital Warts (HPV) - Provider Administered?

Cryotherapy (Liquid nitrogen) or Podophyllin

What is the first line treatment for Chlamydia trachomatis?

Doxycycline (100mg BID x 7 days)

What is the alternative treatment for Chlamydia trachomatis (Pregnancy)?

Azithromycin (1g single dose)

What is the first line treatment for Fitz-Hugh-Curtis Syndrome?

Treat the underlying PID (Ceftriaxone + Doxycycline + Metronidazole)

What is the first line treatment for Lymphogranuloma Venereum (LGV)?

Doxycycline (100mg BID for 21 days)

What is the first line treatment for Reactive Arthritis?

NSAIDs; Treat underlying infection (Doxycycline for Chlamydia)

What is the first line treatment for Trichomonas vaginalis?

Metronidazole (Flagyl) - Patient AND Partner must be treated

What is the first line treatment for Primary, Secondary, and Early Latent Syphilis?

Penicillin G Benzathine (2.4 million units IM single dose)

What is the first line treatment for Late Latent or Tertiary Syphilis (Non-neuro)?

Penicillin G Benzathine (2.4 million units IM weekly x 3 doses)

What is the first line treatment for Neurosyphilis?

Aqueous Crystalline Penicillin G (IV for 10-14 days)

What is the first line treatment for Congenital Syphilis?

Aqueous Crystalline Penicillin G (IV for 10 days)

What is the first line treatment for Bacterial Vaginosis?

Metronidazole (oral or gel) or Clindamycin cream

What is the first line treatment for Chancroid?

Azithromycin (1g single dose) or Ceftriaxone (250mg IM)

What is the first line treatment for Gonorrhea?

Ceftriaxone (500mg IM single dose); Add Doxycycline if Chlamydia is not excluded

What is the first line treatment for Disseminated Gonococcal Infection?

Ceftriaxone (IV for at least 24-48h, then switch to oral Cefixime)

What is the first line treatment for HIV Infection?

Antiretroviral Therapy (ART): Typically 2 NRTIs + 1 Integrase Inhibitor

What is the first line treatment for Pneumocystis jirovecii Pneumonia (PJP)?

TMP-SMX (Bactrim)

When are corticosteroids added to PJP treatment?

If PaO2 < 70 mmHg or A-a gradient > 35 mmHg

What is the first line treatment for Mycobacterium Avium Complex (MAC)?

Clarithromycin + Ethambutol

What is the first line treatment for Kaposi Sarcoma?

HAART (Highly Active Antiretroviral Therapy) to treat the HIV

What is the first line treatment for Adenovirus/Norovirus/Rotavirus Gastroenteritis?

Supportive care; Oral Rehydration Therapy

What is the first line treatment for Cytomegalovirus (CMV) Gastroenteritis?

Ganciclovir or Valganciclovir

What is the first line treatment for Campylobacter jejuni Infection?

Supportive care (fluids); Azithromycin for severe cases

What is the first line treatment for Typhoid Fever?

Ceftriaxone or Azithromycin; (Ciprofloxacin if fully susceptible)

What is the first line treatment for Cholera?

Aggressive Fluid and Electrolyte Replacement (Oral Rehydration Solution or IV); Doxycycline (adjunct)