EXAM 3 PEDS Flashcards
acute otitis media
ear infection
acute otitis media modifiable risk factor
Immunization status
acute otitis media organisms
Strep pneumo
H. flu
Moraxella catarrhalis
Diagnosis AOM
Visualize tympanic membrane
Normal TM: translucent, slightly concave, grey, and moves with pressure
AOM TM: bulging, cloudy fluid, immobile
Requires:
Acute onset
Middle ear effusion
Symptoms of middle ear inflammation
AOM severity
Non-severe:
Mild otalgia and Fever <39 C in 24hours
Severe
Moderate to severe otalgia
Or Fever >39 C
AOM treatment criteria
Always treat otorrhea and severe AOM
bi/unilateral: Non-severe AOM
Treat < 6months
Bilateral: Treat 6 months - 2 year
Bi/unilateral: Observe option > 2 years
AOM management
Observation: deferment ABX for 48-72 hrs
Watch for resolution of symptom
Symptomatic relief
Decision to observe based on: child’s age, diagnostic, severity
AOM organism resistance
Strep pneumonia:
Overcome by high dose amoxicillin
H. flu & Moraxella catarrhalis:
Overcome w/ b-lactamase inhibitor –> Augmentin
amoxicillin use AOM
first-line antibiotic
80-90 mg/kg/day divided Q12H for 5-10 days
half-life in ear is 4-6 hours vs 1 hr in serum
when do we not use amoxicillin?
Known resistance
treatment failure
amoxicillin in last 30 days
allergy
concurrent conjunctivitis
amoxicillin/clavulanate use AOM
2nd line after amoxicillin
1st line if amoxicillin in 30 days or conjunctivitis
90mg/kg/day amox component q12h
Diarrhea associated w/ clavulanate –> dose it <10mg/kg/day
oral cephalosporin use AOM
2nd line unless allergy
cefpodoxime
Ceftriaxone use AOM
For severe cases if PO is not an option
AOM adjunctive therapy
Analgesia: APAP PO, Ibuprofen PO
Lidocaine otic drops
AOM treatment duration
Duration:
10 day therapy for: severe/recurrent AOM, TM preformation, <2 y.o.
2-5 day therapy: children >2 years of age
Tympanostomy tubes
Treatment of uncomplicated ortorrhea
Give topical quinolone drops
Chronic suppurative otitis media
CSOM = most severe form
TM w/ persistent drainage >6 weeks
MRSA is most common organism
Treatment: cipro or ofloxacin x 2 weeks
Acute otitis Externa (swimmer’s ear)
Limited to external ear canal (outside TM)
Organism: pseudomonas, s. aureus
Treatment w/ ear drops first:
Polymyxin b, neomycin
Ofloxacin, cipro w/ hydrocortisone
PEDS UTI common pathogen
E. coli
PEDS UTI methods of urine collection
clean catch: older patients
CATHERTERIZATION: preffered for <25 months age group
supra-pubic aspiration (SPA): gold standard, but invasive for pts who fail catheter
bag specimen not recommended: high false positive
Urine culture
Clean Catch > 100,000 CFU/mL
Catheter specimen > 10,000 CFU/mL
SPA > 10,000 CF/mL
PEDS UTI treatment considerations
Oral and IV equally efficacious
Most patients can have oral
IV for: hemodynamically unstable or NPO
Can change to oral when patient has clinical improvement
PEDS UTI treatment duration
7-14 days for 2-24 months
10-14 days for pyelonephritis
3-7 days for cystitis in older F patients
PEDS UTI treatment agents
First line: cephalexin
Alternative agents:
Amoxicillin
Amoxicillin/clavulanate
TMP/SMX
Not really used:
Nitrofurantoin only used in cystitis, so not really used
FQs not really used bc of resistance
PEDS UTI prevention
Prophylaxis is questionable
what is bronchiolitis?
Viral LRTI in infants and young children
Acute inflammation, edema, and increased mucus
Presentation: fever, rhinorrhea, cough, sneezing
Increased work of breathing:
Nasal flaring, and can lead to respiratory failure
What causes bronchiolitis?
Many different viruses
Most common: respiratory syncytial virus (RSV)
Rhinovirus (2nd most common)
bronchiolitis treatment
Mainstay of treatment: supportive therapy
O2, hydration, mechanical ventilation, ECMO
bronchiolitis prevention non-pharm
Hand washing, isolation, sick pods
bronchiolitis prevention pharm
Pharmacologic:
Influenza vaccine
Everyone 6months +
Children 6 months to 8 years who have not gotten 2 doses –> separate dose by 4 weeks
RSV protection
- Vaccination of pregnant
- Monoclonal antibody for infants
Vaccination of pregnant people
Bivalent RSVpreF vaccine (Abrysvo – Pfizer)
Who qualifies:
Administered before and during start of RSV season (sept- jan)
People who are 32-36 weeks pregnant
Some increased risk of preterm birth in trials
Provides protection if given atleast 14 days before delivery and most cases replaces RSV infant immunization
Monoclonal antibody for infants
Nirsevimab: birth parent did not get RSV 14 days before delivery
Typically infants <8 months of age
Only indicated for prevention RSV
Must be given before/during RSV season
