CHA Family Medicine Residency

Tufts family medicine residents have "the best of both worlds"


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No more codeine

FDA: The safety of codeine in children 18 years of age and younger  12/10/2015

Reference ID: 3200177

This is kind of old news, but FDA is coming down harder on codeine-containing meds, especially in kids and adolescents. Includes similar conclusions by European Medicines Agency. A lot of information in this document, including some good graphics on pharmacology and why codeine can be so dangerous.

I would broaden that to “all humans”. Probably other species as well. Really just no good indication for codeine for anything. Any combination drug with a “C” or “AC” after it could contain codeine. Also, of course, “Tylenol #3”. I still  see a lot of Cheratussin AC out there, sadly sometimes prescribed by Malden providers.

Let’s just not use this stuff at all.

Especially if you see a child who has been prescribed it by some ED or urgent care. Tell them to throw it out.

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Quinolones and FDA

FDA: Quinolones are mo’ bad.

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm500665.htm

Avoid antibiotics in general. Right?

Nitrofurantoin seems generally ok for UTI, but some elders weird-out on that as well.

Macrolides can kill you. Suddenly. Rarely. Especially azithro. QTc and whatnot.

Amoxicillin, cephalosporins of course are options.

Doxycycline is sometimes forgotten as an option for respiratory/cutaneous/GI/GU infections. Don’t go in the sun.

SXT-TMP (Bactrim) – effective for a lot of infections, but E coli often resistant.

Consider IM ceftriaxone for elderly in nursing home with UTI