- If a patient’s symptoms are getting worse after 5-7 days, antibiotics are appropriate.
- FSH recommends using the Centor Criteria for evaluating whether sore throat is caused by bacterial or sinus infection.
- Be sure to check the patient’s consultation history for multiple antibiotics prescriptions.
- Be sure to check medication allergies.
- Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America
- The Lancet: A controlled human infection model of Streptococcus pyogenes pharyngitis (CHIVAS-M75: an observational, dose-finding study
Medication for diabetes, hypertension, thyroid, cholesterol, behavioral health, asthma, herpes, etc.
These medications should be only refilled. You should not make a diagnosis and choose dosage during consultation.
The limit is 3 prescription refills within the calendar year. Make sure to review past consults. Only 30 days can be prescribed at a time.
For each prescription, the First Stop Health doctor must advise the patient to see PCP/original prescribing specialist.
On the 4th prescription, doctors may decline or fill one more time on a case-by-case basis.
Contraception and emergency contraception
One 90-day prescription within a calendar year
No limit for emergency contraception
Make sure to take adequate medical history
Plan B One Step can be purchased OTC by anyone of any age and does not require a prescription. Typically covered by insurance with a prescription.
Smoking cessation drugs including Zyban and Chantix
The Affordable Care Act of 2010 expanded coverage of FDA-approved smoking cessation medications. It is now considered a preventive service and covers 90 days and 2 quit attempts per year.
Note: Clinical benefit is greatest if initiated within 48 hours. In patients with severe, complicated, or progressive illness, hospitalized patients, or those at increased risk for complications, initiate treatment as soon as possible even if >48 hours have elapsed since illness onset and do not delay for laboratory confirmation. For symptomatic outpatients with mild illness not at increased risk for complications, treatment can be considered if it can be initiated ≤48 hours following illness onset. Usual duration of therapy is 5 days; a longer duration can be considered in severely ill or immunocompromised patients (CDC 2021a).
Infants ≤8 months: Oral: 3 mg/kg/dose twice daily (AAP 2021; CDC 2021a; IDSA [Uyeki 2019]).
Infants ≥9 months: Oral: 3.5 mg/kg/dose twice daily (AAP 2021; IDSA [Uyeki 2019]); some experts still recommend manufacturer labeled dosing of 3 mg/kg/dose twice daily (CDC 2021a; IDSA [Uyeki 2019]).
Children and Adolescents:
≤15 kg: Oral: 30 mg twice daily.
>15 to 23 kg: Oral: 45 mg twice daily.
>23 to 40 kg: Oral: 60 mg twice daily.
>40 kg: Oral: 75 mg twice daily.