Exam 3: Pediatric Infections Flashcards
What are the 2 classifications of otitis media?
Otitis Media with Effusion (OME)
Acute Otitis Media (AOM)
What are some considerations for Otitis Media with Effusion?
-Middle ear fluid is sterile, no signs of acute infection
Antibiotics are not indicated and not beneficial
What are some considerations for Acute Otitis Media (AOM)?
Bacterial Infection likely
Antibiotics indicated if symptomatic
What anatomical difference makes kids more likely to get ear infections?
Kids have an anatomically different eustachian tube (more flat, shorter, less angled than adult)
-this makes them more at risk for an infection
-adult eustachian tubes are able to drain easier
-shorter, more flat tube means that reflux through the tube is a lot more likely
Pathologic bacteria are isolated from what percent of AOM cases?
65-75%
What are the 3 most common pathogens in AOM?
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
What vaccines do we currently have against pneumococcal organisms?
PCV15
PCV20
At what ages are pneumococcal vaccines given?
2 months
4 months
6 months
12-15 months
How do we diagnose AOM?
Look at the tympanic membrane
-Bulging
-Cloudy or purulent infection
-Immobile
Diagnosis requires:
-Acute onset
-Middle ear effusion (fluid collection)
-Symptoms of middle ear inflammation
What are the criteria for a non-severe AOM?
Mild otalgia (ear pain)
Fever <39C in past 24 hours
What are the criteria for a severe AOM?
Moderate to severe otalgia (ear pain)
Fever >/= 39C
What are the 3 times when observation is an option in AOM treatment?
Non-Severe:
6mo-2yr: with unilateral symptoms
> /= 2 years: with bilateral or unilateral symptoms
If we choose to observe a patient with possible AOM, how long do we defer antibiotics?
48-72 hours
What is a Safety-Net Antibiotic Prescription (SNAP)?
Parents allow 1-2 days for infection to resolve
-if symptoms persist or worsen then fill the prescription
-prevents patients from having to come back to the office
How do we overcome high levels of penicillin resistance in Streptococcus pneumoniae?
We give higher concentrations of antibiotic
(high-dose amoxicillin)
How do we overcome high levels of penicillin resistance in Haemophilus influenzae and Moraxella catarrhalis?
We give a combination penicillin with a B-lactamase inhibitor
(amox/clav)
What is the first-line therapy for Acute Otitis Media?
Amoxicillin 80-90 mg/kg/day divided Q12h for 5-10 days
*In what situations would we not use amoxicillin to treat AOM?
If the organism is known and has known resistance
Treatment failure (3 days)
Amoxicillin in last 30 days
Allergy
Concurrent conjunctivitis
What are the second-line treatment options for AOM?
Amoxicillin-Clavulanate 90 mg/kg/day amox component q12H
Oral cephalosporins
What are the disadvantages of using Amoxicillin-Clavulanate (Augmentin)?
May be more expensive
Diarrhea associated with clavulanate
What strength of Amoxicillin-Clavulanate (Augmentin) do we choose for AOM infections?
600mg amox/ 42.9 mg clav/ 5 mL
(ES-600)
extra strength
What is our goal clavulanate dosing in AOM?
under 10 mg/kg/day
(see lec for calculation)
What oral cephalosporins can be used as second line therapy in AOM?
Cefpodoxime*
Cefdinir (trashdinir)
Cefuroxime (must be compounded)
What cephalosporin can be used third-line for AOM if oral treatment fails/is not an option?
Ceftriaxone
*note that this is IM
Who would require 3 doses of Ceftriaxone?
Patients who failed therapy
(note that it is only 1 dose if patient has not failed therapy)
Who should Ceftriaxone be avoided in?
< 1 mo of age
What side effects can ceftriaxone have?
Calcium co-administration reduces absorption
C. diff
What is the preferred treatment duration for AOM with amoxicillin or amox/clav?
10 days for <2 years
5-7 days in >/=2
Who should we avoid Ibuprofen adjunctive therapy in?
< 6 months old
Who should we avoid Lidocaine otic drops as adjunctive therapy in?
Ruptured tympanic membrane or tubes
Children < 2
Who should we use caution in when prescribing decongestants/ antihistamines?
< 4 years old (not recommended)
What does follow-up look like for AOM?
Young infants with severe episode or children of any age with continuing pain: Within days
Infants or young children with history of frequent recurrences: 2 weeks
Children with only a sporadic episode of AOM: 1 month
Older children: No follow-up may be necessary
Who should receive antibiotic prophylaxis for AOM?
Child with >/= 6 episodes in the previous year
Who should receive eardrops for uncomplicated otorrhea?
Only patients with tympanostomy tubes
*treat if it does not resolve in 1 week
What ear drops can be used for otorrhea in patients with tympanostomy tubes?
Topical quinolone drops
What is Chronic Suppurative Otitis Media?
The most severe form
Characterized by: perforated tympanic membrane with persistent drainage for > 6 weeks
What is Acute Otitis Externa?
Swimmers Ear
-trauma or trapped moisture
-limited to external ear canal
How do we treat Acute Otitis Externa?
Ear drops first
What temperature is a risk factor for/may indicate a UTI?
> /= 39C
What is the most common pathogen found in UTI’s?
E coli**
What is the preferred method of urine collection for suspected uti in young children?
Catheterization
-preferred for <24 mo age group
What tests are performed to determine presence of UTI?
*Urinalysis
-Dip Stick
Urine Microscopy
Urine culture
What is the urine culture growth cutoff that indicates real growth for SPA or Catheterization?
> 10,000 CFU
What is the urine culture growth cutoff that indicates real growth for a clean catch?
> 100,000 CFU
True or False: Oral and IV therapy are equally efficacious for UTI treatment
True
What patient should receive IV therapy?
“Toxic” -just look bad
Unable to retain oral intake
What is the first line treatment for UTI?
Cephalexin
(traditionally amoxicillin but now pushing toward cephalexin due to resistance)
What are the second line treatment options for uti?
Amoxicillin/Clavulanate
SMX/TMP
What drug should we not use in children for uti’s?
Nitrofurantoin
*only used if it can be confirmed that it is only cystitis (not pyelo or urosepsis)
What drug class can be used if pseudomonas is found in a uti?
Fluoroquinolones
Who should receive renal/bladder ultrasounds as follow-up for a uti?
All boys
All girls < 3 years old
Girls 3-7 years with fever >38.5
What is bronchiolitis?
Viral lower respiratory tract infection
What is the clinical presentation of bronchiolitis?
Fever
Rhinorrhea
Cough
Sneezing
Severe:
-Nasal flaring
-Accessory muscle breathing
-Respiratory failure
*Note that symptoms peak around day 5
What virus most commonly causes bronchiolitis?
Respiratory syncytial virus (RSV)
note that this is caused by a virus
What is the treatment for bronchiolitis?
SUPPORTIVE THERAPY
-Oxygen
-Hydration
-Mechanical ventilation
-ECMO
How do we prevent RSV infections?
Influenza Vaccine
-6 mo and older
RSV Vaccine
What is the RSV vaccine used in babies?
Nirsevimab
What is the RSV vaccine used in pregnant women?
Bivalent RSVpreF
Who qualifies to receive the Bivalent RSVpreF vaccine?
Pregnant women who:
-Are 32 through 36 weeks pregnant
-Going to deliver baby during RSV season (september-january)
Must be given at least 14 days before delivery
