Antibiotic Decisions in Primary Care

Work through each visit: decide whether an antibiotic is indicated, choose the regimen, adjust for the patient in front of you, and select the duration. Correctly withholding an antibiotic counts the same as choosing the right drug.

Decisions correct: 0 / 0
Antibiotics appropriately withheld: 0
References

American College of Obstetricians and Gynecologists. (2023). Urinary tract infections in pregnant individuals. Obstetrics & Gynecology, 142(2), 435–445. https://doi.org/10.1097/AOG.0000000000005269

Centers for Disease Control and Prevention. (2024, April 16). Outpatient clinical care for adults. https://www.cdc.gov/antibiotic-use/hcp/clinical-care/adult-outpatient.html

Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., Moran, G. J., Nicolle, L. E., Raz, R., Schaeffer, A. J., & Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases, 52(5), e103–e120. https://doi.org/10.1093/cid/ciq257

Harris, A. M., Hicks, L. A., & Qaseem, A. (2016). Appropriate antibiotic use for acute respiratory tract infection in adults: Advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Annals of Internal Medicine, 164(6), 425–434. https://doi.org/10.7326/M15-1840

Jones, B. E., Ramirez, J. A., Oren, E., Soni, N. J., Sullivan, L. R., Restrepo, M. I., Musher, D. M., Erstad, B. L., Pickens, C., Vaughn, V. M., Helgeson, S. A., Crothers, K., Metlay, J. P., Bissell Turpin, B. D., Cao, B., Chalmers, J. D., Dela Cruz, C. S., Gendlina, I., Hojat, L. S., . . . Wilson, K. (2026). Diagnosis and management of community-acquired pneumonia: An official American Thoracic Society clinical practice guideline. American Journal of Respiratory and Critical Care Medicine, 212(1), 24–44. https://doi.org/10.1164/rccm.202507-1692ST

Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., Joffe, M. D., Miller, D. T., Rosenfeld, R. M., Sevilla, X. D., Schwartz, R. H., Thomas, P. A., & Tunkel, D. E. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964–e999. https://doi.org/10.1542/peds.2012-3488

Linder, J. A., Watson, M. E., Wessels, M. R., Carter, D. M., Cohen, A. L., Dien Bard, J., Erdem, G., Gregory, C. J., Kourtis, A. P., Martin, J. M., Mochon, A. B., Shapiro, D. J., Stevens, R. W., Kaur, D., & Barshak, M. B. (2026). 2025 clinical practice guideline update by the Infectious Diseases Society of America on group A streptococcal pharyngitis: Risk assessment using clinical scoring systems in children and adults. Clinical Infectious Diseases, 82(Suppl. 3), i97–i104. https://doi.org/10.1093/cid/ciaf668

Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia: An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), e45–e67. https://doi.org/10.1164/rccm.201908-1581ST

Nicolle, L. E., Gupta, K., Bradley, S. F., Colgan, R., DeMuri, G. P., Drekonja, D., Eckert, L. O., Geerlings, S. E., Köves, B., Hooton, T. M., Juthani-Mehta, M., Knight, S. L., Saint, S., Schaeffer, A. J., Trautner, B., Wullt, B., & Siemieniuk, R. (2019). Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 68(10), e83–e110. https://doi.org/10.1093/cid/ciy1121

Payne, S. C., McKenna, M., Buckley, J., Colandrea, M., Chow, A., Detwiller, K., Donaldson, A., Dubin, M., Finestone, S., Filip, P., Khalid, A., Peters, A. T., Rosenfeld, R., Akrami, Z., & Dhepyasuwan, N. (2025). Clinical practice guideline: Adult sinusitis update. Otolaryngology–Head and Neck Surgery, 173(S1), S1–S56. https://doi.org/10.1002/ohn.1344

Shulman, S. T., Bisno, A. L., Clegg, H. W., Gerber, M. A., Kaplan, E. L., Lee, G., Martin, J. M., & Van Beneden, C. (2012). Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), e86–e102. https://doi.org/10.1093/cid/cis629

Stevens, D. L., Bisno, A. L., Chambers, H. F., Dellinger, E. P., Goldstein, E. J. C., Gorbach, S. L., Hirschmann, J. V., Kaplan, S. L., Montoya, J. G., & Wade, J. C. (2014). Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 59(2), e10–e52. https://doi.org/10.1093/cid/ciu296

Trautner, B. W., Cortés-Penfield, N. W., Gupta, K., Hirsch, E. B., Horstman, M., Moran, G. J., Colgan, R., O’Horo, J. C., Ashraf, M. S., Connolly, S., Drekonja, D., Grigoryan, L., Huttner, A., Lazenby, G. B., Nicolle, L., Schaeffer, A., Yawetz, S., & Lavergne, V. (2026a). Clinical practice guidelines by Infectious Diseases Society of America (IDSA): 2025 guidelines on management and treatment of complicated urinary tract infections—Duration of antibiotics for complicated UTI. Clinical Infectious Diseases, 82(Suppl. 3), i79–i88. https://doi.org/10.1093/cid/ciaf462

Trautner, B. W., Cortés-Penfield, N. W., Gupta, K., Hirsch, E. B., Horstman, M., Moran, G. J., Colgan, R., O’Horo, J. C., Ashraf, M. S., Connolly, S., Drekonja, D., Grigoryan, L., Huttner, A., Lazenby, G. B., Nicolle, L., Schaeffer, A., Yawetz, S., & Lavergne, V. (2026b). Clinical practice guidelines by Infectious Diseases Society of America: 2025 guideline on management and treatment of complicated urinary tract infections—Selection of antibiotic therapy for complicated urinary tract infections. Clinical Infectious Diseases, 82(Suppl. 3), i36–i67. https://doi.org/10.1093/cid/ciaf460

2023 American Geriatrics Society Beers Criteria® Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. https://doi.org/10.1111/jgs.18372

Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021). Sexually transmitted infections treatment guidelines, 2021. MMWR Recommendations and Reports, 70(4), 1–187. https://doi.org/10.15585/mmwr.rr7004a1

For education and exam preparation only. Unless stated, cases assume no additional complicating factors. Local resistance patterns, allergies, comorbidities, current labeling, and other patient-specific factors should guide real prescribing.