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DERM-HEENT > Antibiotics ABRS, AOM, and Strep > Flashcards

Antibiotics ABRS, AOM, and Strep Flashcards

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Dermatology Board Prep flashcards
1
Q

Three cardinal sxs of ABRS

A

Purulent nasal discharge
Nasal obstruction
Facial pain/ pressure/ fullness

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2
Q

Nonsevere ABRS treatment

A

watchful waiting
pain assessment and relief
symptomatic relief
reassess in 10 days-> abx if required

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3
Q

Sever illness of ABRS sxs

A

temp = or above 39C, 102F + purulent nasal discharge and/ or facial pain lasting 3-4 consecutive days

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4
Q

Double sickening meaning

A

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

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5
Q

Treatment for severe ABRS / double sickening

A

Abx therapy
pain assessment and relief
symptomatic relief
reasses at day 3-5 switch therapy if worsening sxs or no improvement

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6
Q

Adult pt treatment for ABRS w/out risk factors and w/out penicillin allergy

A

Amoxicillin-clavulanate 875 mg PO BID
(Alternative: Doxycycline 100 mg PO BID)
Duration:
5-7 days

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7
Q

Adult pt treatment for ABRS w/out risk factors and with penicillin allergy

A 
Doxycycline 100 mg PO BID
Moxifloxacin 400 mg PO QD
Levofloxacin 500-750 mg PO QD
Duration:
5-7days
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8
Q

Adult pt treatment for ABRS with risk factors and w/out penicillin allergy

A

High-dose amoxicillin-clavulanate (2 grams PO BID)
(Alternative: Doxycycline)
Duration:
7-10days

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9
Q

Adult pt treatment for ABRS with risk factors and with penicillin allergy

A 
Doxycycline
Moxifloxacin
Levofloxacin
Duration
7-10 days
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10
Q

Risk factors for resistence for pts with ABRS

A 
Age <2, >65
  Daycare
  Prior antibiotics within past month
  Prior hospitalization within past 5 days
  Comorbidities
  Immunocompromised
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11
Q

Children:

tx for ABRS without risk factors and without penicillin allergy

A

Amoxicillin-clavulanate 45 mg/kg/day PO divided BID
Duration:
5-7 days

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12
Q

Children:

tx for ABRS without risk factors and with penicillin allergy

A

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

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13
Q

Children:

tx for ABRS with risk factors and without penicillin allergy

A 
High-dose amoxicillin-clavulanate (90 mg/kg/day PO divided BID)
Clindamycin + cefixime or cefpodoxime
Levofloxacin
Duration: 
7-10 days
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14
Q

Children:

tx for ABRS with risk factors and with penicillin allergy

A

Clindamycin + cefixime or cefpodoxime
Levofloxacin
Duration:
7-10 days

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15
Q

Adjunct therapies for ABRS

A

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

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16
Q

Adults other OTC and supportive care options for ABRS

A

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

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17
Q

Pediatrics: Other OTC & Supportive Care Options

A

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

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18
Q

GAS Pharyngitis

Centor criteria

A 
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

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19
Q

Abx DOC for GAS pharyngitis

A

penicillin VK or amoxicillin x 10 days

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20
Q

Alternatives in PCN-allergic patients (GAS Pharyngitis)

A

First-generation cephalosporin (e.g. cephalexin), clarithromycin, or clindamycin x 10 days
Azithromycin x 5 days

21
Q

Treatment directed at relieving pharyngeal discomfort and associated systemic or respiratory symptoms
for acute pharyngitis (all types)

A

Warm saline gargles
Rest
Analgesics (acetaminophen, ibuprofen)
Liquids

22
Q

Pain management for AOM

A

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
23
Q

Uncomplicated AOM
Age: 6 mo to 2 yo
Sxs: otorrhea with AOM
Tx ?

A

Abx therapy

24
Q

Uncomplicated AOM
Age: 6 mo to 2 yo
Sxs: unilateral or bilateral AOM with severe sxs
Tx ?

A

Abx therapy

25
Q

Uncomplicated AOM
Age: 6 mo to 2 yo
Sxs: bilateral AOM w/out otorrhea
Tx ?

A

Abx therapy

26
Q

Uncomplicated AOM
Age: 6 mo to 2 yo
Sxs: unilateral AOM w/out otorrhea
Tx ?

A

Abx therapy or additional observation

27
Q

Uncomplicated AOM
Age: =/> 2 yo
Sxs: otorrhea with AOM
Tx ?

A

Abx therapy

28
Q

Uncomplicated AOM
Age: =/>2 yo
Sxs: unilateral or bilateral AOM with severe sxs
Tx ?

A

Abx therapy

29
Q

Uncomplicated AOM
Age: =/>2 yo
Sxs: bilateral AOM w/out otorrhea
Tx ?

A

Abx or additional observation

30
Q

Uncomplicated AOM
Age: =/>2 yo
Sxs: unilateral AOM w/out otorrhea
Tx ?

A

Abx or additional observation

31
Q

Common pathogens for AOM

A

S. pneumoniae (25-50%)
H. influenza (15-30%)
M. catarrhalis (3-20%)
Viral illness (40-75%)

32
Q

When to prescribe Amoxicillin for AOM

A

Child has not received amoxicillin in previous 30 days
Child does NOT have concurrent purulent conjunctivitis*
Child is NOT allergic to penicillin

33
Q

When to prescribe Augmentin for AOM

A

Child has received amoxicillin in past 30 days
Child has concurrent purulent conjunctivitis
History of recurrent AOM unresponsive to amoxicillin

34
Q

When to reassess pt after prescribing abx for ABRS

A

Reassessment in 48—72 hours to determine whether change in therapy is needed

35
Q

What dose of Amoxicillin for AOM

A

Amoxicillin: 80—90 mg/kg/DAY in 2 divided doses

36
Q

What dose of Augmentin for AOM

A

Augmentin (amoxicillin-clavulanate): 80—90 mg/kg/day in 2 divided doses
Amoxicillin to clavulanate ratio: 14:1

37
Q

Alternative First line Agents for AOM ( if penicillin allergy) -> substitutes for Amoxicillin

A

Cefdinir: 14 mg/kg/DAY in 1-2 divided doses
(Max: 600 mg/day)
Cefuroxime: 30 mg/kg/DAY in 2 divided doses
(Max: 1 g/day)

38
Q

Alternative First line Agents for AOM ( if penicillin allergy) -> substitutes for Augmentin

A

Cefpodoxime: 10 mg/kg/DAY in 2 divided doses
(Max: 400 mg/day)
Ceftriaxone (IM or IV): 50 mg/kg/DAY for 1-3 days
(Max: 1-2 g/day)

39
Q

Abx therapy for AOM -> abx escalation (after 48-72h failure to respond)
if 1st Amoxicillin,
Then…

A

Amoxicillin-clavulanate 80-90 mg/kg/DAY in two divided doses
Cefdinir, cefuroxime, cefpodoxime, or ceftriaxone
(doses previously stated)
Clindamycin 30-40 mg/kg/DAY in three divided doses +/- 3rd generation cephalosporin

40
Q

Abx therapy for AOM -> abx escalation (after 48-72h failure to respond)
if 1st Augmentin,
Then…

A

Cefdinir, cefuroxime, cefpodoxime, or ceftriaxone (doses previously stated)
Clindamycin 30-40 mg/kg/DAY in three divided doses +3rd generation cephalosporin

41
Q

Abx therapy for AOM -> abx escalation (after 48-72h failure to respond)
if 1st 3rd gen cephalosporins,
Then…

A

Clindamycin 30-40 mg/kg/DAY in three divided doses + 3rd generation cephalosporin
Alternative therapy, tympanocentesis or referral

42
Q

AOM treatment:

what if allergic to cephalosporins,

A

Macrolides (erythromycin and azithromycin)
->Limited efficacy against H.influenza and S.pneumo
Clindamycin
->Limited efficacy against H.influenza
Levofloxacin
->Reserve for treatment failures
->Attempt to obtain culture with tympanocentesis
Linezolid
->Reserve for treatment failures
->Attempt to obtain culture with tympanocentesis
Trimethoprim-sulfamethoxazole
->**High levels of pneumococcal resistance
->Typically avoid
In adults – can consider doxycycline

43
Q

Duration of therapy for AOM based on age

<2 years, how many days?

A

10 days

44
Q

Duration of therapy for AOM based on age

2-5 years, how many days?

A

7 days

45
Q

Duration of therapy for AOM based on age

>5 years, how many days?

A

5-7 days

46
Q

Severe signs and symptoms for AOM include:

A

Moderate or severe otalgia, or
Otalgia for at least 48 hours, or
Temperature >39°C

47
Q

WHen to offer tympanostomy tubes for recurrent AOM

A

3 episodes in 6 months OR

4 episodes in 1 year with 1 episode in preceding 6 months

48
Q

Preventive strategies for AOM

A

Pneumococcal conjugate vaccine according to schedule

Influenza vaccine annually

Encourage exclusive breast feeding for at least 6 months

Limit tobacco smoke exposure

DERM-HEENT (4 decks)

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