Antibiotics ABRS, AOM, and Strep Flashcards
Three cardinal sxs of ABRS
Purulent nasal discharge
Nasal obstruction
Facial pain/ pressure/ fullness
Nonsevere ABRS treatment
watchful waiting
pain assessment and relief
symptomatic relief
reassess in 10 days-> abx if required
Sever illness of ABRS sxs
temp = or above 39C, 102F + purulent nasal discharge and/ or facial pain lasting 3-4 consecutive days
Double sickening meaning
onset of sinusitis with worsening symptoms, characterized by typical viral URI that appears to improve followed by sudden onset of worsening symptoms after 4-6 days
Treatment for severe ABRS / double sickening
Abx therapy
pain assessment and relief
symptomatic relief
reasses at day 3-5 switch therapy if worsening sxs or no improvement
Adult pt treatment for ABRS w/out risk factors and w/out penicillin allergy
Amoxicillin-clavulanate 875 mg PO BID
(Alternative: Doxycycline 100 mg PO BID)
Duration:
5-7 days
Adult pt treatment for ABRS w/out risk factors and with penicillin allergy
Doxycycline 100 mg PO BID Moxifloxacin 400 mg PO QD Levofloxacin 500-750 mg PO QD Duration: 5-7days
Adult pt treatment for ABRS with risk factors and w/out penicillin allergy
High-dose amoxicillin-clavulanate (2 grams PO BID)
(Alternative: Doxycycline)
Duration:
7-10days
Adult pt treatment for ABRS with risk factors and with penicillin allergy
Doxycycline Moxifloxacin Levofloxacin Duration 7-10 days
Risk factors for resistence for pts with ABRS
Age <2, >65 Daycare Prior antibiotics within past month Prior hospitalization within past 5 days Comorbidities Immunocompromised
Children:
tx for ABRS without risk factors and without penicillin allergy
Amoxicillin-clavulanate 45 mg/kg/day PO divided BID
Duration:
5-7 days
Children:
tx for ABRS without risk factors and with penicillin allergy
Clindamycin 30-40 mg/kg/day PO divided TID + cefixime or cefpodoxime 8-10 mg/kg/day PO divided BID
Levofloxacin 10-20 mg/kg/day PO divided QD or BID
Duration 5-7days
Children:
tx for ABRS with risk factors and without penicillin allergy
High-dose amoxicillin-clavulanate (90 mg/kg/day PO divided BID) Clindamycin + cefixime or cefpodoxime Levofloxacin Duration: 7-10 days
Children:
tx for ABRS with risk factors and with penicillin allergy
Clindamycin + cefixime or cefpodoxime
Levofloxacin
Duration:
7-10 days
Adjunct therapies for ABRS
Intranasal saline irrigation with either physiologic or hypertonic saline: YES
Intranasal corticosteroids: YES, particularly in patients with history of allergic rhinitis
PO corticosteroids: ???, not addressed in IDSA guidelines but several studies do show faster improvement/resolution
Topical/oral decongestants: NO
Topical/oral antihistamines: NO
Adults other OTC and supportive care options for ABRS
May be useful for both viral and bacterial sinusitis:
Analgesics (acetaminophen, NSAIDS)
Mucolytics (guaifenesin 2400 mg/day)
Other: humidifiers, warm aerosols, steam, aromatic vapors, hot soups, tea, sleeping upright
Pediatrics: Other OTC & Supportive Care Options
May be useful for both viral and bacterial sinusitis:
Analgesics:
acetaminophen (10-15 mg/kg every 4-6 hrs)
ibuprofen (5-10 mg/kg every 6-8 hrs)
FDA: OTC cough/cold medicines not recommended in children <2 years of age; data unclear in <12 years
May be of some benefit:
Intranasal corticosteroids for children >12 years
Saline irrigation
GAS Pharyngitis
Centor criteria
Fever >100.4 F +1 Tonsilar exudate +1 Anterior cervical lymphadenopathy +1 No cough +1 Age 3-14 +1 Age >44 -1
0 or 1 = no testing, no strep
=2 or above do rapid testing if positive -> abx
Abx DOC for GAS pharyngitis
penicillin VK or amoxicillin x 10 days
Alternatives in PCN-allergic patients (GAS Pharyngitis)
First-generation cephalosporin (e.g. cephalexin), clarithromycin, or clindamycin x 10 days
Azithromycin x 5 days
Treatment directed at relieving pharyngeal discomfort and associated systemic or respiratory symptoms
for acute pharyngitis (all types)
Warm saline gargles
Rest
Analgesics (acetaminophen, ibuprofen)
Liquids
Pain management for AOM
Acetaminophen
10-15 mg/kg/dose every 4-6 hours
Ibuprofen
5-10 mg/kg/dose every 6 hours
Others Topical analgesics & naturopathic drops Brief benefit for patients >5 years of age Avoid if perforated TM Homeopathic remedies Not supported with evidence
Uncomplicated AOM
Age: 6 mo to 2 yo
Sxs: otorrhea with AOM
Tx ?
Abx therapy
Uncomplicated AOM
Age: 6 mo to 2 yo
Sxs: unilateral or bilateral AOM with severe sxs
Tx ?
Abx therapy
