E3 peds ID Flashcards
Middle ear fluid is sterile; no signs of acute infection.
Antibiotics not indicated and not beneficial
A. Otitis media with effusion (OME)
B. Acute otitis media (AOM)
A
Bacterial infection likely
Antibiotics indicated if symptomatic
A. Otitis media with effusion (OME)
B. Acute otitis media (AOM)
B
big 3 pathogens for acute otitis media
- strep pneumo
- H. flu
- moraxella
two current pneumococcal vaccines available for peds
- PCV15
- PCV20
1 clinical manifestation of AOM along with some other common ones
- oralgia (ear pain) *
- fever
- otorrhea (ear discharge)
3 things under tympanic membrane for diagnosis of AOM
- bulging
- cloudy or purulent effusion
- immobile
diagnosis of AOM:
diagnosis requires what 3 things
- acute onset
- middle ear effusion
- sxs of middle ear inflammation
2 things for non-severe AOM classification
- mild otalgia
AND - fever < 39C in past 24 hours
2 things for severe AOM classification
- moderate to severe otalgia
OR - fever >39C
theres a table for observation vs treatment for AOM, what are the 3 boxes that say you can observe
- unilateral 6 months-2 years old NON-SEVERE
- > 2 years old bilateral or unilateral NON-SEVERE
how can you overcome strep pneumo resistance when treating AOM?
high dose amoxicillin*
how do you overcome resistance of H.flu when treating AOM?
adding b-lactamase inhibitor **
first line antibiotic for AOM and dose
amoxicillin
80-90 mg/kg/day divided by q12h x 5-10 days
when are some times we would not use amoxicillin in AOM? (will be on exam!!)
- known resistance
- tx failure
- amox in last 30 days
- allergy
- concomitant conjunctivitis
2nd line for AOM
augmentin (usually if failure on just amox)
when is augmentin 1st line for AOM?
if amox in last 30 days OR conjunctivitis ***
dose of augmentin for AOM
90 mg/kg/day amox component divided by q12h
1 big disadvantage of augmentin in AOM and how to negate it
diarrhea*
dose clav at <10 mg/kg/day *
which of these are you picking for AOM
A. 125 mg amox/31.25 mg clav/5 mL
B. 200 mg amox/28.5 mg clav/5 mL
C. 250 mg amox/62.5 mg clav/5 mL
D. 400 mg amox/57 mg clav/5 mL
E. 600 mg amox/42.9 mg clav/5 mL
E, the extra strength is 600
where do cephalosporins fall for treatment of AOM? which ones do you use?
- 2nd line but may be 1st if needed
- cefpodoxime**, cefuroxime, cefdinir (fallen out of use)
cross reactivity is highest between penicillins and __ gen cephs
1st
what is the drug for severe cases of AOM when oral treatment is not an option?
ceftriaxone (parenteral only so)
dosing of ceftriaxone for AOM
50/mg/kg/day
one dose initial therapy
3 doses if treatment failure
when do you avoid using ceftriaxone in AOM?
if <1 month old -> can cause the carnicturus thing or whatever
2 cautions for use of ceftriaxone in AOM
calcium co-admin
c.diff risk
if a pt with AOM is younger than 2 how long do you do therapy? what if they’re older than 2?
10 days.
5-7 days if older
2 adjunctive therapies and their doses for AOM
tylenol: 10-15/mg/kg/day
ibuprofen: 5-10mg/kg/day q6-8h (ONLY IF OLDER THAN 6 MONTHS)
when do you want to follow up for AOM?
- infants/young children w/ hx or frequent recurrences:
- children w/ only a sporadic episode:
- older children
- within 2 weeks
- 1 month after
- no follow up needed
some prevention for AOM
- pneumococcal/flu vacs
- tubes
when would you consider tubes for AOM?
- _ or more episodes in < 6mo
- _ or more episodes in <12 mo
3
4
what is the most severe form of otitis media?
chronic suppurative otitis media (CSOM)
most common isolate for CSOM
MRSA
initial treatment for CSOM
ofloxacin or cipro ear drops x 2 weeks
2 organisms for acute otitis externa (AOE)
pseudomonas (water bug)
S. aureus
what should you treat swimmers ear with first?
ear drops (polymyxin B, neomycin, ofloxacin, cipro w/ hydrocortisone)
4 things listed under pathogenesis for peds UTI
- retrograde ascent
- nosocomial infection
- hematogenous spread
- fistula formation
MOST common pathogen for ped UTIs
E. Coli !!!!!
(can also be Kleb, proteus, enterobacter, citrobacter, staph something, enterococcus)
3 methods of urine collection for ped UTIs
- clean catch -> pref in older age groups
- catheterization -> pref for <24 months
- supra-pubic aspiration (SPA) -> gold standard but we dont do it as much
urinalysis for ped UTI:
test urinalysis on any “fresh” urine specimen
- <_ hour(s) after voiding if room temp
- <_ hour(s) after voiding if refrigerated
1
4
what is something you look out for if you’re using a urine dipstick for ped UTI
leukocyte esterase
leukocyte esterase suggests ______ and presence of _____
inflammation, WBCs
t or f:
absence of leukocyte esterase in asymptomatic bacteriuria is a disadvantage
false, is an advantage
leukocyte esterase separates ___________ bacteriuria from true _____
asymptomatic
UTI
More sensitive, less specific
a. leukocyte esterase
b. nitrite
A
less sensitive, more specific
a. leukocyte esterase
b. nitrite
b
false positive common
a. leukocyte esterase
b. nitrite
a
false positive uncommon
a. leukocyte esterase
b. nitrite
b
when nitrite and leukocyte esterase are both negative -> ____% predicitive
100
what evaluates WBCs, RBCs, and bacteria in a sample?
urine microscopy
T or F:
IV and oral tx for ped UTI is equally efficacious
true
when do you want to choose IV treatment in ped UTI
- toxic (do they look septic?)
- unable to retain oral intake
ped UTI duration of therapy for 2-24 months
7-14 days
ped UTI duration of therapy for pyelonephritis
10-14 days
ped UTI duration of therapy for cystitis in older female patients
3-7 days
traditional 1st line for ped UTIs
amoxicillin, but e.coli resistance is on the come up so she said to pick cephalexin instead*
FQs arent usually used in kids but what 3 times can we consider them for ped UTI?
- multidrug-resistant pathogens with no safe alts
- IV therapy is not feasible
- no other effective oral agent
2 weird pearls for FQs in ped UTI
- dont give cipro suspension through a feeding tube
- quinolone liquids usually require PAs
3 things for considerations for renal/bladder ultrasound and voiding cystography in ped UTI
- All boys
- All girls < 3 years of age
- Girls 3-7 years with fever > 38.5 degC
what is bronchiolitis caused by (not pathogen yet)
lower respiratory tract infection
3 signs/sxs for bronchiolitis
acute inflammation, edema, increased mucus
4 clinical presentation things for bronchiolitis
- fever
- rhinorrhea
- cough
- sneezing
most common cause of bronchiolitis
RSV**
mainstay treatment of bronchiolitis/RSV (4) (IS AN EXAM QUESTION)
SUPPORTIVE THERAPY:
- oxygen
- hydration
- mech vent
- ECMO -> life support basically
main prevention for bronchiolitis/RSV
hand washing, flu shot, RSV shot
2 ways to protect babies from severe RSV: *******
- vaccination of pregnant people 32-36 weeks of gestation***
- monoclonal antibody for infants -> Palivizumab, Nirsevimab
what is a clinical pearl for pregnant people getting vaccinated for RSV that WILL be on the exam?
IF SHOT IS GIVEN AT LEAST 14 DAYS BEFORE DELIVERY IT IS PROTECTIVE
when do you consider Nirsevimab for infants?
if mom did not get RSV shot at least 14 days before delivery *
dosing for Nirsevimab:
<5kg
5kg or more
50
100
