ENT Antibiotics

Question 1

Acute necrotizing ulcerative gingivitis

(polymicrobial including fusobacterium necrophorum, treponema spp, selenomonas, prevotella)

Answer 1

• Amoxicillin/Clavulanate 875 mg PO two times daily AND
• Metronidazole 500mg PO three times daily x 7 days [1] OR
• Clindamycin 300mg PO three times daily OR
• Doxycycline 100 mg PO BID x 10 days[2]
• If allergic to penicillin, the use Ciprofloxacin 500mg twice daily AND metronidazole 500mg PO three times daily

Question 2

Conjunctivitis

Answer 2

• Newborn
  
  • azithromycin 20mg/kg PO once OR
  • erythromycin 12.5mg/kg PO q6hours x14days
• Chlamydial
  
  • Doxycycline 100mg PO BID x 7days OR
  • Azithromycin 1g PO one time.
• Gonococcal
  
  • Ceftriaxone 1g IM + Azithromycin 1g PO

Question 3

Bacterial Conjunctivitis

Answer 3

• erythromycin
• levofloxacin
• moxifloxacin
• azithromycin

Question 4

Dental Abscess

Answer 4

• Amoxicillin-clavulanate (Augmentin) 875 mg
• Clindamycin 300mg PO
• Penicillin VK 500mg
• Ampicillin/sulbactam 3g

Question 5

Ludwig’s Angina

Answer 5

• Must cover typical polymicrobial oral flora and tailored to each patient.
• Most commonly 3rd gen cephalosporin + clindamycin/metronidazole.
• MRSA and G(-) rods should be covered if immunocompromised.

Question 6

Mastoiditis

Answer 6

Coverage against S. pneumoniae, S. pyogenes, S. aureus, H. influenzae.

• Clindamycin 600mg IV q8 hours OR (if MRSA concern use Vancomycin regimen)
• Vancomycin 15-20mg/kg IV q12 hours PLUS
  
  • Ceftriaxone 1g (50mg/kg) IV once daily OR
  • Ampicillin/Sulbactam 3g (50mg/kg) IV q6 hours

If chronic or severe, need pseudomonas coverage

• Vanco + Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose)

Question 7

Otitis Media

Answer 7

Initial Treatment

• Amoxicillin 80-90mg/kg/day divided into 2 daily doses 7-10 days

Treatment during prior Month

• If amoxicillin taken in past 30 days, Amoxicillin/Clavulanate
• 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
• Clavulanate increases vomiting/diarrhea
• Cefdinir 14mg/kg/day BID x7-10 days
• Cefpodoxime 10mg/kg PO daily x7-10 days
• Cefuroxime 15mg/kg PO BID x7-10 days
• Cefprozil 15mg/kg PO BID x7-10 days

Question 8

Otitis media Penicillin allergy

Answer 8

Penicillin Allergy

• Azithromycin 10mg/kg/day x 1 day and 5mg/kg/day x 4 remaining days
• Clarithromycin 7.5mg/kg PO BID x 10 days
• Clindamycin 10mg/kg PO three times daily

Clindamycin does not cover H. influenza and M. catarrhalis and treatment should favor Azithromycin use

Question 9

Otitis Externa

Answer 9

• Floxin otic: 5 drops in affected ear BID x 7 days[7]
  
  • Safe with perforations
• Cipro HC otic: 3 drops in affected ear BID x 7 days
  
  • Contains hydrocortisone to promote faster healing
  • Not safe with perforation
• CiproDex: 4 drops in affected ear BID x 7 days
  
  • Similar to Cipro HC but contains dexamethasone
• Cortisporin otic (neomycin/polymixin B/hydrocortisone)
  
  • 4 drops in ear TID-QID x 7days
  • Use suspension (NOT solution) if possiblity of perforation
  • Animal studies suggest possible toxicity from the neomycin although rigorous data is lacking[8]

Question 10

Strep Pharyngitis

Answer 10

• Penicillin V 250mg PO BID. or 500mg BID x 10 days

PCN Allergy

• Cefuroxime 10mg/kg PO QID x10days, 250mg PO BID x4d
• Clindamycin 7.5mg/kg PO QID x 10d (child) or 450mg PO TID x 10d OR

Azithromycin 12mg/kg QD (child) or 500mg on day 1; then 250mg on days 2-5

Question 11

Periorbital Cellulitis

Answer 11

Outpatient

• Amoxicillin/Clavulanate 875mg BID x7-10 days OR
• Cefpodoxime 200mg BID x7-10d OR
• Cephalexin 450mg PO three times daily OR
• Cefdinir 600mg PO once daily x7-10 days

Inpatient

• Vancomycin 15-20mg/kg IV BID + (one of the following)
• Ampicillin/Sulbactam 3 g IV q6hr OR
• Ticarcillin/Clavulanate 3.1 g IV q4h OR
• Piperacillin-Tazobactam 4.5 g IV q6h OR
• Ceftriaxone 2 g IV q12hr OR
• Cefotaxime 2 g IV q4h

Question 12

Peritonsillar Abscess

Answer 12

Outpatient Options

• Clindamycin 300mg PO Q6hrs x7-10d
• Amoxicillin/Clavulanate 875 mg PO BID x 7-10d
• Penicillin V 500mg PO + Metronidazole 500mg QID

Inpatient Options

• Ampicillin/Sulbactam 3 gm (75mg/kg) IV four times daily
• Pipericillin/Tazobactam 4.5 gm IV TID
• Ticarcillin/Clavulanate 3.1 g IV QID
• Clindamycin 600-900mg IV TID
• Penicillin G 4 million units (50,000 units/kg) IV four times daily + Metronidazole 500mg IV three times daily

Question 13

Pertussis < 1 month old

Answer 13

Azithromycin 10mg/kg QD x 5days

Question 14

Pertussis > 1 mo old

Answer 14

• Azithromycin 10mg/kg !D x 5days
• TMP/SMX 4mg/kg PO BID daily x14 days.

Question 15

Suppurative Parotitis

Answer 15

• Amoxicillin/Clavulanate 875mg (45mg/kg) PO BID OR
• Clindamycin 450mg PO three times daily or 10mg/kg PO four times daily
• Dicloxacillin 500mg (7.5mg/kg) PO four times daily
• Cephalexin 500mg (12.5mg/kg) PO four times daily
• Nafcillin 2g IV six times daily or 50mg/kg IV four times daily
• Vancomycin 15-20mg/kg IV BID daily

Question 16

Thrush

Answer 16

• Nystatin oral suspension 400,000-600,000 units (swish and swallow) Q6H until 48 hours after symptoms disappear OR
• Clotrimazole 10 mg troches 5 times/day for 14 consecutive days OR
• Fluconazole 200 mg (Peds: 6 mg/kg) PO on day one, followed by 100 mg (Peds: 3 mg/kg_ daily for two weeks.
• Fluconazole is reserved for moderate to severe disease