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Antibiotics
Dosing for AOM
I. Penicillin
1. amoxicillin (amoxil)
A: 875mg q 12 hr x 7 days or 1000mg q 12 hr x 7 days.
P (2mo-12): 80-90mg/kg/day in bid dosing. max dose not to exceed adult dose.
<2mo: 30mg/kg/day in bid dosing.
Amoxicillin is not stable in the presence of beta lactamase producing organisms.
Considered first line agent in otitis media unless patient has had antibiotic exposure in the last 90 days.
2. amox/clavulanate (augmentin)
A: 875mg po bid x 10
P(2mo-5yr): 90mg/kg/day bid dosing x 10 days
P(6-12yr):90mg/kg/day bid dosing x 5-10days
First line in AOM with severe illness or recent abx use. Two 500mg augmentin tablets are not equal to a 1000mg tablet.
Give with food.
II. Second generation cephalosporin
1. Cefuroxime (ceftin)
A: 250-500mg po bid
P: 30mg/kg/day bid x 10 days
Do not use in pts with hives with pcn
III. Third generation cephalosporin
1. Cefpodoxime
A: 200-400mg bid x 7-10 days
P: 2mo-5yr. 10mg/kg/day bid dosing x 10 d.
6-12yr: 10mg/kg/day bid dosing x 5-10d. max 400mg/dose.
Again, avoid use in hive pcn allergy.
2. Cefdinir (omnicef)
A: 300mg po bid x 10d.
P: 6mo-5yr. 14mg/kg q12-24hr x 10d.
6-12yr: 14mg/kg q 12 hr x 5-10d OR q24 hr x 10d.
Max 300mg/dose or 600mg/day
Avoid antacids within 2 hrs due to absorption interference.
Stools may appear red.
3. ceftriaxone (rocephin)
P: 50mg/kg/day IM or IV x 3 days
Max not to exceed 1000mg/dose
Again, No if true PCN allergy. hives or anaphylaxis.
IV. Extended Spectrum Macrolides
1. azithromycin (zithromax)
A: 500mg daily x 3 days
P: 6 mo: 30mg/kg as single dose. Max 1.5 gms. OR 10mg/kg daily x 3 days. Max 500mg daily. OR 10mg/kg on day one, followed by 5mg/kg day 2-5. Max day 1 = 500mg. Max day 2-5 = 250mg.
Considered first line for PCN allergy, but lots of resistance.
2. clarithromycin (biaxin)
A: 500mg po bid x 7 days
P: 2mo-5yr: 15mg/kg/day bid dosing x 10days.
6-12: 15mg/kg/day in bid dosing x 5-10 days. Max: 500mg/dose.
Some medication interactions.
Take with food.
V. Lincosamide
1. Clindamycin (cleocin)
A: 150mg-300mg q 6 hr x 5-10d.
More serious infection: 300-450mg q 6 hr x 5-10days.
P: 2mo-5yr: 30-40mg/kg/day 3 divided doses x 10 days + 3rd generation cephalosporin
6-12: 30-40mg/kg/day in 3 divided doses x 5-10 days + 3rd generation cephalosporin. Not to exceed adult dose.
Save for worse infections.
S/E pseudomembranous colitis, C. Diff.
Take with full glass of water.
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Antihistamines
General:
avoid use with CNS depressants
Most are OTC
Cause sedation
Caution with glaucoma or BPH
avoid alcohol within 6 hours of taking
First Generation:
1. diphenhydramine (benadryl)
Adult- 25-50mg q 4-6hr. Max 300mg/day.
Peds age 6-12- 12.5-25 mg q4-6 hr. Max 150mg/day.
2. Hydroxyzine (atarax)
A: 25mg 3-4 times per day.
Second Generation: Not as sedating
1. Cetrizine (Zyrtec)
A: 5-10mg daily
Dose adjust for elderly, renal, liver impaired.
2. Levocetrizine (Xyzal)
A: 5mg po QHS
Avoid in children with renal impairment
3. Fexofenadine (Allegra)
A: 180 mg daily or 60mg bid.
Avoid aluminum and magnesium antacids
take with water, not fruit juices
not as sedating
4. Loratadine (Claritin)
A: 10mg daily.
not as sedating
renal and hepatic impairment needs adjusting
5. Desloratadine (Clarinex)
A: 5mg daily
not as sedating
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Combination Cough Medicines
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Decongestants
General:
act on adrenergic receptors affecting sympathetic tone of blood vessels and vasoconstriction
shrinks mm and improves ventilation
pseudoephedrine is now a DEA scheduled med.
1. pseudoephedrine (sudafed) (lots of generic)
A: two 30mg tabs q 4-6 hr
max 8 tabs in 24 hrs
Do not use in pts with htn.
do not crush, divide, or dissolve tablets
caution in thyroid disease, arrhythmias, prostate, and glaucoma.
2. Phenylephrine (sudafed PE)
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Nasal Steroids
General:
Indicated for allergic rhinitis
may take 2 weeks to improve symptoms
stop if no improvement by 3 weeks
use lowest dose
epistaxis may occur if mm dry
1. Budesonide (Rhinocort AQ)
2. Fluticasone (Flonase) (Veramyst)
3. Mometasone (Nasonex)
4. Triamcinolone (Nasacort) OTC
5. Ciclesonide (Omnaris)
6. Beclomethasone (Beconase AQ) (Qnasl)
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Ear Drops
I. Antibiotic drops with our without steroid
General:
instillation of cold fluids into ear causes dizziness, warm by holding bottle in hands for 1-2 minutes.
pt. to lie with affected ear upward. maintain position for 5 minutes to facilitate penetration into canal.
a wick may be useful to facilitate entry of medication in edematous canal. change q 24 hours.
1. Ciprofloxacin + hydrocortisone (Cipro HC otic)
-A&P (>1yr): 3 drops twice daily x 7 days
-Do not use with tubes or perforated ear drums, not sterile product.
-C/I in viral infection of external canal
2. Cipro 0.3% + dexamethasone 0.1% (ciprodex Otic)
-A&P (>6mo): 4 drops bid x 7 days
-Can be used with tubes, is sterile.
-C/I with viral infection
3. Neomycin sulfate 3.5mg, polymyxin b sulfate 10000 units and hydrocortisone 10mg/mL (cortisporin)
A: 4 drops 3-4 times daily x 10 days
P(2-6): 3 drops 3-4 times daily x 10 days.
-can produce permanent hearing loss due to cochlear damage.
-DO NOT USE IN PT. WITH PERFORATED TM.
-neomycin can cause cutaneous sensitization.
4. Quinolone antibiotic
Ofloxacin (floxin otic)
A: 10 drops once daily x 7 days
P (6mo-13) 5 drops daily x 7 days.
Ok if TM perf. in age 12 and older
ok in 12mo and older with tubes.
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