EENT- Ear Flashcards
What condition has the following clinical presentation:
Painful erythema and edema of the ear canal skin; often with purulent exudate
Otitis Externa
–Which condition has the following causes?
- Water exposure; i.e. swimmer’s ear
- Mechanical trauma; eg. Scratching, cotton applicators
- Infections with gram-negative rods:
- Pseudomonas
- Proteus
- fungi-Aspergillus (common in pts with hearing aids)
Otitis Externa
- Decrease excessive moisture: (Acetic Acid (VoSol) Otic +/- hydrocortisone or 50/50 mixture of isopropyl alcohol/white vinegar)
- Treat bacterial/fungal infection with antibacterial topical solutions (Aminoglycosides or fluouroquinolones)
- Oral- fluoroquinolones ciprofloxacin, effective against Pseudomonas
Treatment for Otitis externa
•Antibacterial topical solutions (generally 7-10 days)
- –Aminoglycoside
- Neomycin/Polymyxin/HC
- Gentamicin/tobramycin with/without corticosteroids (ophthalmic solutions)
- **Fluoroquinolones-ciprofloxacin
**Treatment for Otitis Externa caused by bacteria or fungus**
Which Otitis Externa medication?
–Contains: Acetic Acid, Propylene Glycol Diacetate, and Hydrocortisone
–Dosage: Instill 3-5 drops in ear(s) every 4-6 hours
–ADEs: Transient burning or stinging after instillation in the acutely inflamed ear
VoSol HC Otic
The following describes which antibiotic?
–Mixed antibiotic product with corticosteroid
–Interferes with bacterial protein synthesis by binding to 30S ribosomal subunits
•Neomycin sulfate, Polymyxin Sulfate and Hydrocortisone Otic Solution and Suspension
–>used to treat otitis externa
–ADEs: pain, fungal superinfection, pruritus
–Dosage: Instill 0.25 mL (contents of 1 single-dose container) into affected ear twice daily for 7 days
Fluoroquinolones- Ciprofloxacin Otic (for treatment of OE)
What is this a treatment for?
•Aminoglycosides Ophth Solution
- Gentamicin or Tobramyin
- +/- hydrocortisone
- Vestibular ototoxicity tympanic perforation
Otitis Externa
Which condition?
•Otalgia, erythema and hypomobility of tympanic membrane
- Usually precipitated by a viral URI that cause eustachian tube dysfunction
Acute Otitis Media
Which condition is commonly infected with the following organisms?
- Steptococcus pneumoniae
- non-typable H influenza
Acute Otitis Media
The following less common causative agents of which condition?
–Streptococcus pyogenes (Group A beta-hemolytic streptococcus)
–Staphylococcus aureus
–Moraxella catarrhalis
Acute Otitis Media
- Amoxicillin (1st line): Children >3 months and <40 kg: Oral: 80-90 mg/kg/day divided every 12 hours. Max: 3g/day
- Erythromycin plus sulfonamide (alt for PCN allergy)
- Cefaclor (alt for PCN allergy)
- Amoxicillin-clavulanate: (amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL)
Treatment options for AOM
AOM caused by Staph aureus can occur in which type of patients?
can occur in patients with chronic suppurative otitis media
- may be associated with persistent otorrhea that follows insertion of tympanostomy tubes
Which medication and for what condition?
Children ≥3 months and <40 kg:
- Oral: 90 mg/kg/day divided every 12 hours x10d in children with severe illness and when coverage for β-lactamase positive H. influenzae and M. catarrhalis is needed
Amoxicillin-Clavulanate
Possible tx for AOM
•When should you consider one of the following cephalosporins:
–Cefdinir 14 mg/kg per day orally in one or two doses (maximum 600 mg/day)
–Cefpodoxime 10 mg/kg orally in two doses (maximum 400 mg/day)
–Cefuroxime suspension 30 mg/kg per day orally divided in two doses (maximum 1 g/day)
–Cefuroxime tablets 250 mg orally every 12 hours
-Ceftriaxone 50 mg/kg IM once per day (maximum 1 g/day) for one to three doses
Treatment for AOM for a patient with penicllin allergy but did NOT experience an immediate type 1 hypersensitivity rxn (anaphylaxis, angioedema, bronchospasm, or urticaria)
ADEs for which drug group?
- Rash, diarrhea, increased transaminases
- Vaginitis
Cephalasporin group
Cephalosporins group requires dose adjustment with ______ impairment
renal
What is the first line tx for AOM due to increasing prevalence of S pneumoniae strains and other otopathogens that are not fully susceptible to amoxicillin?
**Amoxicillin-clavulanate**
dose: amoxicillin 875 mg with clavulanate 125 mg orally twice daily.
When would you use the following high-dose options:
Amoxicillin 1000 mg with clavulanate 62.5 mg, extended-release, orally twice daily
Amoxicillin 2000 mg with clavulanate 125 mg, extended-release, orally twice daily
•Adults with OM that are at high risk for severe infections or infections with resistant S. pneumoniae
(eg, those who live in regions with ≥10 percent penicillin-non-susceptible S. pneumoniae, >65 y/o, are immunocompromised, recently hospitalized, or have used antibiotics in the past month),
The following are treatment options for ____ without a PCN allergy
- Cefdinir, 300 mg orally twice daily or 600 mg once daily.
- Cefpodoxime, 200 mg orally twice daily.
- Cefuroxime, 500 mg orally twice daily.
- Ceftriaxone, 1 to 2 g IM or IV once daily for three days.
- 1 dose might be sufficient in peds but clinical trials have demonstrated 3d course to be more effective
1st line tx for a patient with OM that has a penicillin allergy without severe reactions, and who do not have a known allergy to a cephalosporin
treatment options for patients with a known severe allergy to beta-lactam antibiotics or who have a known allergy to cephalosporins (Which condition???)
- Doxycycline, 100mg PO Q12hrs
- Azithromycin, 500 mg orally on day 1, then 250 mg orally days 2 through 5
- Clarithromycin, 500 mg orally every 12 hours
OM in adults
S. pneumoniae isolates haven a high rate of resistance to _______
macrolides (azithromycin and clarithromycin)
