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Adult Rx for Group A Strep
Pen V 600mg PO BID x 10d
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If adult allergic to Pen?
- Erythromycin 500mg PO BID x 10d
- or 250mg PO QID x 10d
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1st line Child Rx Group A Strep pharyngitis?
- ≤ 27 kg: Pen V 40mg/kg/d PO divided BID x 10d
- >27 kg: Adult dose
- 2nd line: Amoxil 40mg/kg divided BID x 10d
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What is 2nd line after Pen and Amox for children with Strep throat?
Erythromycin estolate - 40mg/kg/d divided BID
- Rx if 22 yr old with sore throat?
- 90% chance of Mono/EBV
- 90%+ for heterophile Ab
- False -ive 25% in 1st week on Monospot
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Rx Otitis Externa
- Ciprodex (=cipro + dexa) 3 drops BID
- or Buro-solution 3 drops TID (in guidelines, but rarely used)
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Rx Ear effusions
Nothing! Not infection
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Otitis Media Rx (adult)
Amoxicillin 500mg PO TID x 5 days
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Otitis Media Rx (older children)
Amoxicillin 500mg PO TID x 5 days
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Otitis Media Rx - Amox resistant
Clavulin 500mg PO TID
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OM Rx in kids 2+ yrs (if severe)
Amoxicillin 90mg/kg/d divided BID x 5-7 days
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OM Rx in kids < 2 yrs
Amoxicillin 90mg/kg/d divide BID x 10days
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OM Rx if pen allergic
Use macrolide
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Sinusitis Rx
- Want to see 1st viral infection then sudden 2nd worsening suggesting bacterial infection:
- Amoxicillin 500mg PO TID x 10 days
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2nd line Sinusitis Rx
Clavulin, Cefprozil, Septra, Macrolide
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Bronchitis Rx
- Nothing! Viral
- No CXR as little utility in differing b/w mild pneumonia vs bronchitis
- If decide to Rx: macrolide (ie if >14 d Sx, ill)
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2 Rx of macrolides for bronchitis
- Clarithromycin(Biaxin) 500mg BID x 7d
- OR Azithromycin 500mg x 1d, then 250mg PO OD x 4d
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AECOPD (w simple COPD) 1st line drug choices
Amoxil, Cefuroxime (Ceftin), Clarithro, Doxycycline, Septra, Azithro
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AECOPD simple Rx
- Amoxicillin 500mg TID x 7d
- Ceftin (cefuroxime) 500mg BID x 7d
- Clarithro(Biaxin) 500mg BID x 7d
- Azithro 500mg x 1d, then 250mg PO OD x 4d
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Pneumonia Rx (kids < 5yrs)
Amoxil
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Pneumonia Rx (kids > 4/5 yrs)
Amoxil + Macrolide for atypical coverage
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Rx Pneumonia kids
- Clarithro(Biaxin) 15mg/kg divided BID x 7-10d
- Azithromycin 10mg/kg DIE x 1d, then 5mg/kg/d DIE x 4d
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CAP Rx for inpatient adults
- 2nd generation cephalosporin + macrolide
- or 2nd gen ceph + quinolone
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Cellulitis Rx 1st line
- Keflex or Duracef
- Keflex 500mg q6h x 7-10d
- Duracef (cefadroxil) 500-1000mg PO BID
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2nd line Cellulitis Rx
Cloxacillin
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UTI Rx - 1st line drugs
Fluroquinolones or Sulphas - 3 days
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Other UTI drugs that take 7 days
Nitrofurantoin, Clavulin, Cephadroxil
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Rx UTI uncomplicated
- Cipro 250mg PO BID x 3 days OR
- Septra DS 1 tab PO BID x 3 days (increasing R)
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Others
- Levofloxacin 250mg PO OD x 3 days
- Nitrofurantoin (Macrobid) 100mg PO q12h x 7d
- Clavulin 250mg PO q8h x 7days or 500mg q12h x 7d
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Oral Rx acute pyelonephritis or complicated UTI
- Cipro 500mg PO q12h x 14d (7d if young women without anatomic abN)
- or Levofloxacin 500mg q24h x 14d (or 7d "")
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IV Rx for acute peel (ie vomiting, pregnant)
- Ciprofloxacin 400mg IV BID x 14d
- or Levofloxacin 500mg IV DIE x 14d
- or Aminoglycoside + Ampicillin
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Rx C difficile
- Metronidazole 500mg PO TID x 10d (skip this at JGH)
- OR Vanco 125mg Po QID x 14d (can go up to 500mg QID)
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Sore Throat Score (McIsaac) - 5 criteria
- 1 point for each:
- Temp >38 C
- Absence of cough
- swollen, tender anterior cervical nodes
- Tonsillar swelling or exudate
- Age 3-14 (0 for 15-44, -1 for ≥45 yrs)
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At which sore throat scores do you not treat or do culture?
1 or less - 10% chance
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At which sore throat scores do you culture first and only Rx if positive?
Score of 2 or 3 = 11-35% chance - Culture or Rapid Ag test 1st
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At which sore throat score do you treat?
4+ = 51-53% chance. start Rx. If you do culture and is -ive then stop Rx.
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When should the sore throat score not be used?
- Test already positive in office - treat!
- Epidemic or in populations with rheumatic fever still a problem (first nations) or ppl with Hx of Rheumatic fever, valvular heart disease
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When should you still culture despite a negative Rapid Strep antigen test?
For children a Culture is still required. For adults, a negative antigen test is enough.
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What % of population is a carrier for Grp A Strep?
- 20%. Culture then during an ASx period to determine their carrier status.
- Only Rx then if outbreak in community/household
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What are some pharyngitis warning signs?
Significant trouble swallowing, drooling, altered 'hot-potato' voice or stridor - epiglottitis, peritonsillar abscess or retropharyngeal abscess until proven otherwise!
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