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Other Antibiotic Treatments
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Epiglottitis causes in adult
Group A strep, S. pneumo, H. influenza B
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Epiglottitis causes in children
Staph aureus, Group A Strep, H flu B, S. pneumo
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1st Line drugs for Epiglottitis
cephalosporins: Cefotaxime, Ceftriaxone IV, Cefuroxime IV
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Adult Doses for Epiglottitis Rx
- Cefotaxime 1-2g q8h
- Ceftriaxone 1-2g q24h
- Cefuroxime IV 750-1.5g q8h
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Children Doses for Epiglottitis
- Cefotaxime 100-150mg/kg/d divided q4-6h (max 8g/d)
- Ceftriaxone IV 75-100mg/kg/d divided q12
- Cefuroxime IV 75-100mg/kg/d
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2nd line Rx for Epiglottitis (cephalosporin allergy)
Chloramphenicol IV or Levofloxacin IV (for child, weigh risk of severe infection vs cartilage damage)
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Laryngitis Rx
- None - viral.
- Avoid smoking and throat clearing. Rest voice. Analgesia, fluids, lozenges, salt water gargles
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Croup Rx
- Corticosteroids shown to reduce #/dur of admissions/intubations/repeat visits. Dexamethasone 0.6mg/kg PO x 1 good for outpatient mild to moderate croup (no benefit for more than one dose)
- Severe - Racemic epinephrine 0.5mL of 2.25% solution in 3mL of NS nebulized
- Need to watch for return of Sx when wears off at 2 hrs
- No evidence for mist therapy
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Otitis Externa (Swimmer's Ear) 1st line Rx
Buro-sol (otic solution) 2-3 drops TID
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Necrotizing Otitis Externa 1st line Rx
- Ciprofloxacin 750mg PO BID x 4-8 weeks
- *involves bone
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Adult OM without tympanic perforation 1st line Rx
Amoxicillin 500mg PO TID x ? 7d
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Adult OM with chronic tympanic membrane perforation Rx
Ciprodex (3mg cipro + 1 mg dexa per mL) 4 drops BID
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Length of Rx for OM in children
- 5 days for >2 yrs and not complication
- 10 days for < 2 yrs or complicated (recurrent, perforated ™)
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Dx of Sinusitis in Adult
- < 2% of viral upper reps infections are complicated by bacterial sinusitis
- Dx more likely when:
- Nasal obstruction or nasal purulence/discoloured postnasal drainage + 1 other major Sx: facial pain/pressure/fullness/hyposmia/anosmia
- And hasn't improved after 7 days or has worsened after 5-7 days
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1st line adult Rx for Acute Sinusitis
- Amoxicillin 500mg PO TID x 5-10 days
- *successful therapy means good improvement in Sx at 10d - not complete disappearance
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Other non-Abx Rx for acute sinusitis
- saline rinses, topical decongestants (not >3-4 d)
- Intra-nasal steroids, antihistamines
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Acute Sinusitis in Children - what suggests bacterial?
- Persistant Sx and Severe Sx
- Persistant Sx - >10d (less than 30 d) and not improving (10d mark differentiates viral from bacterial) of
- nasal congestion, discharge, cough. Others halitosis, facial pain, headache, low grade fever
- Severe Sx:
- Fever >39 C and purulent nasal discharge
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Acute Sinusitis Rx for Children
- Amoxicillin 80mg/kg/d divided BID or TID (3g max) x 10-14 day course
- (NNT=8 for short-term benefit in 1 patient)
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When to exclude anatomical AbN's in acute sinusitis in kids?
Recurrent episodes (≥4 /yr with resolution b/w) or chronic (12 weeks+)
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What makes a low risk AECOPD patient?
mild to moderate impaired lung fxn (FEV1>50% predicted), 4 or less exacerbations/yr, no significant cardiac disease.
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What makes a high risk AECOPD patient?
poor underlying lung fxn (FEV1<50%), or significant cardiac dz, or 4+ exacerbations/yr. Or other risk factors
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First list Rx for AECOPD/AECB in low risk?
- Amoxicillin, Doxycycline, Tetracycline or TMP/SMX
- Amox 500mg PO TID x 7-10 days
- Doxy 100mg BID x 1d, then 100mg PO OD
- Tetra 250-500mg mg QID
- Septra 2tabs BID or 1DS tab BID
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First line Rx for AECOPD/AECB in high risk?
- Amox/Clav 500mg TID or 875mg BID
- Levofloxacin 500mg qD x 7 days or 750mg qD x 5 days
- Moxifloxacin 400mg qD
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First line Rx for AECOPD in pt at risk for pseudomonas?
Ciprofloxacin 500-750mg BID
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UTI's - what is recurrent?
- 2 uncomplicated UTI's in 6 months OR
- 3+ +ive UCx in last 12 months
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UTI's - what is reinfection?
UTI >2 weeks after finishing Abx. Different organism, most common
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UTI's - what is a relapse?
UTI < 2wks after finishing Abx. Same organism, 5-10% of women
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