Exam 3 - Lecture 5 (Pediatric ID) Flashcards
AOM causative pathogens
strep pneumo
H. flu
M. catarrhalis
pneumococcal vaccination timeline
2, 4, 6, 12-15 months
severe vs non severe AOM
non severe
-mild otalgia (earache)
-fever less than 39 C in past 24h
severe
-moderate to severe otalgia
-fever 39 C or more
AOM: when to treat (otorrhea)
always
AOM: when to treat (severe)
always
AOM: when to treat (non-severe)
Age bilateral unilateral
<6m treat treat
6-24m treat observe
24m+ observe observe
why is high dose amoxicillin used in AOM?
50% of penicillin strains are resistant due to alterations in PBPs. This is overcome by higher concentrations of antibiotic at necessary site.
AOM abx of choice and 2nd line?
amox
-use amox/clav if amox does not work
-addition of B-lactamase inh. is due to B-lactamse production by H. flu and M. cat
dose of amox to use
80-90mg/kg/day divided q12h x5-10 days
When to NOT use amoxicillin?
- known resistance
- tx failure
- amoxicillin in last 30 days
- allergy
- concurrent conjunctivitis
amox clav dosing
-want 90mg/kg/day of amox divided q12h
-want less than 10mg/kg/day of clav due to SE (diarrhea)
strength to choose of amox/clav if necessary
600mg amox/42.9mg clav per 5mL (ES - extra strength)
2nd line for AOM (or 1st if allergic to amox)
oral cephalosporins
-cefpodoxime (trashdinir)
–10mg/kg/day divided q12h
-cefdinir
–14mg/kg/day divided q12-24h
when to use (or not use) ceftriaxone in AOM
-for severe cases
-IM dosing
-avoid in <1month old pts (kernicterus)
10 days vs 5 days of therapy
10 days:
-under 2 y.o.
-severe or recurrent
-TM perforation
5 days:
may be used in children older than 2
adjunctive therapy for AOM (pain)
PO APAP
-10-15mg/kg/dose q4-6h (max 75mg/kg/day)
PO ibuprofen
5-10mg/kg/dose q6-8h if older than 6 months
when to follow up for AOM tx
- a few days for young infants with severe episode or children of any age with continuing pain
- within 2 weeks for infants or young children with history of frequent recurrences
- 1 month after initial examination for children with only a sporadic episode of AOM
- no follow up may be necessary for older children
tx for AOE (externa)
1st line: ear drops
-polymyxin B, neomycin, and hydrocortisone
-ofoloxacin
-cipro w/ hydrocortisone
unexplained fever in infants is most likely ____
UTI
most common UTI pathogen (infants, children and adults)
E. coli
UTI tx considerations
oral and IV equally efficacious
most pts take oral, give IV if pt is ‘toxic’ or unable to retain oral
switch to oral within 24-48 usually
UTI tx options
empiric:
-determined by local resistance rates, obtain cultures
-cephalexin: good E. coli susceptibility, q6-8h
-amoxicillin (traditionally 1st line): E. coli resistance (B-lactamase) makes case for amox/clav
other options for peds UTI
bactrim
nitrofurantoin (only in cystistis)
FQs (not ideal due to resistance, can be used if no other oral agents able to be used)
follow up plan for peds UTI
all boys: consider for renal/bladder ultrasound and voiding cystography
all girls < 3y: consider for renal/bladder ultrasound and voiding cystography
girls 3-7 w/ fever: consider for renal/bladder ultrasound and voiding cystography
for ages 2-24 months: only ultrasound
