-
What pathogens most commonly cause acute otitis media (AOM)?
- H. influenzae
- S. pneumoniae
- M. catarrhalis
-
What are the clinical symptoms of acute otitis media (AOM)?
- fever
- otalgia
- irritability
- tugging of the ear
- runny nose
- nasal congestion
- cough
- gray, bulging TM
- nonmotile TM
-
When should antibiotics be withheld for acute otitis media (AOM)?
- 6 mo – 2 yr: uncertain dx and non-severe
- ≥ 2 yr: uncertain dx (all) and non-severe, certain dx
-
What are the treatment goals for acute otitis media (AOM)?
- decrease symptoms
- eradication of infection
- prevention of complications
- avoidance of unnecessary antibiotics
-
What is the treatment for non-severe acute otitis media (AOM)?
Amoxicillin
-
What is the treatment for non-severe acute otitis media (AOM) with penicillin allergy?
- Non-type I:
- Cefdinir
- Cefuroxime
- Cefpodoxime
- Type I:
- Azithromycin
- Clarithromycin
- Cefuroxime axetil
- Cefdinir
- Clindamycin
-
What is the treatment for severe acute otitis media (AOM)?
Amoxicillin clavulanate
-
What is the treatment for severe acute otitis media (AOM) with penicillin allergy?
- Non-type I:
- Ceftriaxone IV/IM x 1-3d (Cefdinir, Cefuroxime, Cefpodoxime if not hospitalized)
- Type I:
- Cefuroxime axetil
- Cefdinir
- Azithromycin
- Clarithromycin
- Clindamycin
-
What is the duration of therapy for acute otitis media (AOM) in children < 2yo or those with severe illness?
10d
-
What is the duration of therapy for acute otitis media (AOM) in children at least 2yo or those with mild to moderate illness?
5-7d
-
What adjunctive therapies can be used to alleviate pain associated with acute otitis media (AOM)?
- antipyretics/analgesics
- Abiotic drops (benzocaine/antipyrene) - if membrane is intact
- local heat and cold
- decongestant/antihistamine or corticosteroids (generally ineffective)
-
What pathogens most commonly cause sinusitis?
- S. pneumoniae
- H. influenzae
- M. catarrhalis
-
What are the clinical symptoms of sinusitis?
- Common:
- mucopurulent nasal/postnasal discharge
- nasal congestion
- facial pain (often unilateral
- HA
- maxillary toothache
- diminished sense of smeill and/or taste
- Less Common:
- fatigue
- cough
- halitosis
- fever
- Children:
- persistent cough/throat clearing
- nasal/postnasal discharge
- congestion and mouth breathing
- halitosis
- morning periorbital swelling
- fever
-
When should antibiotics be withheld for sinusitis?
mild symptoms lasting < 10d
-
What are the treatment goals for sinusitis?
- decrease symptoms
- achieving and maintaining patency of the ostia
- decrease duration of symptoms
- preventing complications
- preventing progression to chronic status
- limiting antibiotic use to those who need it
-
What is the treatment for mild sinusitis lasting < 10d?
- analgesics/antipyretics
- nasal irrigation with saline; humidified air
- decongestants
- cough suppressants and expectorants (questionable)
-
What is the treatment for mild acute sinusitis with no recent antibiotic exposure?
- Amoxicillin
- Amoxicillin clavulanate
- Cefdinir
- Cefpodoxime proxetil
- Cefuroxime axetil
-
What is the treatment for mild acute sinusitis with no recent antibiotic exposure with B-lactam allergy?
- < 18:
- Bactrim
- Macrolide/azalide
- At least 18:
- Bactrim
- Doxycycline
- Macrolide/azalide
-
What is the treatment for mildmoderate acute sinusitis in patients < 18yo with recent antibiotic exposure?
- Amoxicillin clavulanate (high dose)
- Cefdinir
- Cefpodoxime or Cefuroxime
- Ceftriaxone
-
What is the treatment for mild/moderate acute sinusitis in patients < 18yo with recent antibiotic exposure with B-lactam allergy?
- Bactrim
- Macrolide/azalide
- Clindamycin +/- Rifampin
-
What is the treatment for mild/moderate acute sinusitis in patients at least 18yo with recent antibiotic exposure
- Resp. FQ
- Amoxicillin clavulanate (high dose)
- Ceftriaxone
- Combination tx
-
What is the treatment for mild/moderate acute sinusitis in patients at least 18yo with recent antibiotic exposure with B-lactam allergy?
- Resp. FQ
- Clindamycin + Rifampin
-
What is the duration of therapy for sinusitis?
10-14d or at least 7d after symptoms are under control
-
Acute sinusitis is usually diagnosed based on what?
symptoms and duration of illness
-
What pathogens most commonly cause pharyngitis?
- Virus
- S. pyogenes (Gp A B-hemolytic Strep - GAS)
-
What are the clinical symptoms of pharyngitis?
- fever > 38C
- Exudates (tonsillar)
- Tonsillar edema
- Cervical lymphadenopathy (tender)
- NO cough
-
What are the treatment goals for pharyngitis?
- decrease symptoms
- minimize ADRs
- prevent transmission
- prevent acute rheumatic fever and complications
-
What is the treatment for viral pharyngitis?
- warm saline gargles
- lozenges
- fluids
- analgesics
-
What is the treatment for GAS pharyngitis?
- DOC:
- Pen VK
- Penicillin benzathine IM
- Alternatives:
- Amoxicillin (DOC for kids - taste)
- Macrolide/Clindamycin (Type I Pen allergy)
- 1st gen Ceph (non-type I pen allergy)
- FQ, Cefdinir, Cefpodoxime (5d)
-
What are the reasons for treatment failure in GAS pharyngitis?
- ADHERENCE
- Re-infection
- B-lactamases produced by throat flora
-
What is the best way to diagnose GAS pharyngitis?
culture (not the rapid Strep test)
-
What is the most common mechanism of resistance to penicillin for the most common pathogens in AOM/sinusitis?
- S. pneumoniae - change in PBP
- H. influenzae - B-lactamases
- M. catarrhalis - B-lactamases
|
|
