management Flashcards
diphtheria
pharmacologic treatment (2) plus duration
- diphtheria antitoxin x 1 dose to neutralize free toxins
< 2 days: 40-60k units; > 2 days: 80-120k units - antibiotic - to erradicate organism, prevent spread
erythromycin 50 mkday q6 x 14 days
aqueous penicillin G 100-150k u/kg/da q6 x 14 days
diphtheria
nonpharmacologic tx
- droplet and contact prec
- bed rest x 2 weeks
- immunization upon recovery
diphtheria
asymptomatic case contacts, first & second line
- monitor x 7 days
- culture nose, throat, cutaneous lesions
- Erythromycin 40-50 mkda q6 x 10 days OR
- Benzanthine Pen G 600k to 1.2 M IU x 1 dose
Acute pharyngitis
- Penicillin V 25-50 mkday q6 x 10 days
- Amoxicillin 50 mkday q8-12 x 10 days
allergic:
azithromycin 12 mkday x 5 days
Peritonsillar abscess
first line IV + stepdown; second line
- IV ampicillin-sulbactam 100 mkday q6
then coamox 40 mkday q8 - ceftriaxone 50 mkday + metro 30 mkday
Peritonsillar abscess
indications for tonsillectomy
- no improvement after 24 hrs of abx and drainage
- recurrent
- complications from peritonsillar abscess
Retropharyngeal abscess
first line, stepdown
- IV ampicillin-sulbactam 100 mkday q 6 then
- coamoxiclav 40 mkday q6
EBV
nonpharma, pharma
- rest, supportive, avoid contact sports x 2-3 wks
- PREDNISONE 1 mkda x 7 days (airway obst, thrombocytopenia, hemorrhage, anemia, seizure, mening)
Croup
- racemic epinephrine 0.5ml in 3ml NSS q 20 mins
- dexamethasone 0.15 - 0.6 mkdose x 1 dose
Bacterial tracheitis
- ceftriaxone 50-75 mkday q 12-24 PLUS
- clinda 30-40 mkday q 6-8 or vanco 15 mkdo q 6
Acute epiglotitis
- Ceftriaxone 50-75 mkday q12 x 10 days
Acute epiglottitis
prophylaxis - tx, who
Rifampicin 20 mkda x 4 days
- all household members
- < 4 yo, incomplete Hib
- < 12 mos, incomplete primary series
- immunocompromised
PCAP, nonsevere
duration of tx - 7 days
- amoxicillin 40-50 mkday q 8
- coamox 80-90 mkday q 12
- cefuroxime 20-30 mkday q 12
PCAP, severe
complete Hib
Penicillin G 200k IU q6
PCAP, severe
incomplete/unknown hib
Ampicillin 200 mkday q6
PCAP, severe
high level of pcn resistance
Cefuroxime 100-150 mkday q8;
ceftriaxone 75-100 mkday q12-24;
ampisul 200 mkday q 6
PCAP, influenza severe
Oseltamivir within 48 hrs of sx; BID x 5 days
> 1yo, 15 kg: 30 mg
15-23 kg: 45 mg
23-40 kg: 60 mg
>40 kg: 75 mg
Pertussis
Azithromycin x 5 days
< 6 mos: 10 mkday
> 6 mos: 10 mkday D1, 5 mkday D2-5
Hydration for mild to moderate dehdydration
rehydration: 75 ml/kg ORS x 4 hrs
replacement:
< 10 kg: 50-100ml/kg per loose stool, max 500
> 10 kg: 100-200 ml/kg; max 1L
adolescents: ad libitum, max 2L
Hydration for severe dehydration
20-30 ml/kg over 30-60 mins then
70 ml/kg over 2.5-5 hrs
10ml/kg for malnourished
tetanus
- human tetanus immunoglobulin 500 U IM x 1 dose to neutralize toxin
- metronidazole 30 mkday q6 x 7-10 days to decrease organism
- ms. relaxant: diazepam 0.1-0.2 mkdo
- dark, quiet, secluded setting
botulism
- human botulism immune globulin 50-100 mkdo x 1 dose
- no antibiotics
GBS
- IVIG 0.4 g/kg/day x 5 days or 1 g/kg/day x 2 days for severe or rapidly progressive weakness
- steroids, narcotic analgesic for pain
osteomyelitis
clindamycin 30 mkday q8 +/- ceftri 100 mkday
mrsa: vancomycin 20 mkdose q8
* 4-6 wks
septic arthritis
empiric
- clindamycin 30-40 mkday q6 or vancomycin 20 mkdo q8
- shift to oxacillin 150-200 mkday q6 if mssa
* 3 wks
reactive arthritis
NSAIDS
- naproxen 10-15 mkda BID RTC x 2 wks
- ibuprofen for younger kids
- treat infection if still ongoing
myasthenia gravis
pyridostigmine bromide 0.5-1 mkdose q4-6
longterm prednisone treatment
MIS-C
- IVIG 2g/kg over 8-12 hrs
- Methylprednisolone 1-2 mg/kg/day q12 then shift to pred 1-2 mkda once afebrile
- aspirin 3-5 mkday
Kawasaki
- IVIG 2 g/kg over 8-10 hrs within 10 days
- high dose aspirin 80-100 mg/kg/day q6 until afebrile for 48 hr then reduce to 3-5 mkda x 6-8 wks
Kawasaki, IVIG resistant
- 2nd dose IVIG 2g/kg OR
- methylpred 20-30 mg/kg x 3 days then taper over 2-3 weeks OR
- infliximab 5 mg/kg x 1 dose
COVID, severe to critical
- Dexamethasone 0.15 mkda IV OD up to 10 days OR methylpred 0.8 mg/kg IV OD
- Remdesivir 5 mg/kg D1 then 2.5 mg/kg D2 onwards x 5-10 days (for O2 requ, not intubated)
TTN
- O2 support
- salbutamol - facilitates fluid clearance by activating NaKATPase and ENaC
RDS
prophylaxis, treatment, prevention
- ncpap - prophylactic, or if FiO2 40-70% needed to maintain sats > 90%
- INSURE
intubate, surfactant, extubate
SURFACTANT
4 ml/kg q6-12 up to 2-4 doses - antenatal corticostaroids at 24-36 weeks
breast feeding jaundice
- admit
- ensure adequate breastfeeding at least 10 times per day
- start intensive phototherapy
- ensure adequate UO and BM
- repeat bili after 6 hrs of intensive phototherapy
orbital cellulitis
IV ampisul 200 mkda q6 or clinda 40 mkda q6-8 PLUS ceftriaxone 100-200 mkda q8 /cefotaxime 75-100 mkda q 12-24
add vancomycin 15 mkdo q6 and metro 30 mkda q8 if with CNS extension
ophthalmia neonatorum prophylaxis
all bbs, mom w gonococcal infection
- 0.5% erythromycin ointment, 1 strip to both eyes
- 1% silver nitrate
- ceftriaxone 50 mkdo IM for infants born to mothers with untreated gonococcal infection
ophthalmia neonatorum N. gonorrhea
- eye irrigation with normal saline q10-30 mins until discharge is clear
- ceftriaxone 25-50 mkday q24 IM/IV x 1 DOSE
if w sepsis:
cefotaxime 50 mkdo q12 x 7 days
if w meningitis: cefotax 10-14 days
ophthalmia neonatorum Chlamydia
- eye irrigation with normal saline q10-30 mins until discharge is clear
- erythromycin 50 mkday q6 x 14 days
acute purulent conjunctivitis
tobramycin eye drops, 1-2 drops q4 x 7 days
