Otitis & Sinusitis Flashcards
Contraindicated Meds in AOM & Sinusitis
Decongestants & Antihistamines d/t thickened mucous
Tx of AOM in Infants <6mo
Always tx if suspected
Tx of AOM in Infants 6mo - 2 yr
Tx if diagnosis is certain or systemic symptoms present (fever, lymphadenopathy)
Tx of AOM in Kids > 2 yr
Tx if systemic symptoms present (fever, lymphadenopathy
MC AOM Pathogens
S. pneumoniae; H. flu; M. cat
1st line tx for AOM
Amoxicillin x 7 d
2nd line tx for AOM (Amoxil failed)
Augmentin (preferred); Macrolides (Azithro or Clarithro); Bactrim DS
3rd line tx for AOM
Cefdinir (Omnicef)
AOM tx for PCN allergic
Macrolides (Azithro or Clarithro) or Bactrim DS
Clarithromycin (Biaxin XL) Unique AE
Metal taste in mouth
Cefdinir (Omnicef) Unique AE
Red stools
ABX requiring refrigeration
Augmentin
ABX requiring room temp
Azithromycin & Clindamycin & Cefdinir
Clindamycin drawback
Tastes terrible
Azithromycin drawback
Resistance; dosing packs (requires 2)
When to switch tx in AOM
No response within 72 hours of initiating tx
Aurodex
Pain relief ear drops (contain benzocaine)
OM with Effusion - Signs of Severity
Lasts > 3 mo; Sustained hearing or speech impairment; recurrent AOM
Tx of OM with Effusion
Tympanostomy tubes
OE - Signs of Severity
Periauricular Erythema; Lymphadenopathy; Fever
OE tx
Remove cerumen, desquaminated skin & purulent material; topical abx
1st line tx for OE
Ofloxacin 0.3% sol’n (Floxin Otic); Ciprofloxacin & Hydrocortisone (Cipro HC otic); Tobramycin & Dexamethasone (Tobradex) x 7 - 14 days
Contraindications for Ear Drops & Aural Irrigation
Ruptured TM
2nd line tx for OE or Severe OE
Oral FQs (Cipro/Levo)
OE Pathogens
Pseudomonas; S. aureus; Polymicrobial (1/3 of all cases)
How many days should a patient have s/sx of sinusitis before ABX are administered?
10 days
Tx for Sinusitis with 1-10 days of symptoms
Intranasal glucocorticoids (Flonase); Mucolytics (Mucinex)
1st Line ABX for Bacterial Sinusitis
Amoxicillin x 10 - 14 d
PCN Allergic Tx for Bacterial Sinusitis
Macrolides (Azithro or Clarithro); Bactrim DS; or 3rd Gen Cephalosporins (Cefdinir or Cefixime)
2nd Line ABX for Bacterial Sinusitis (Amoxil failed)
Augmentin; 2nd/3rd gen Ceph (Cefuroxime or Cefdinir); Levo or Moxifloxacin (avoid FQs in peds d/t bone/joint problems)
Adjuntive Tx to Avoid in Peds with Sinusitis
Decongestants & Antihistamines & Nasal corticosteroids
Rhinitis medicamentosa
Rebound congestion d/t prolonged use of Afrin or nasal corticosteroids
Safe Length of Use for Afrin
72 h
Pseudoephedrine MoA
Alpha-adrenergic stimulation»_space; Vasoconstriction of resp mucosa; Beta stimuation»_space; ^ Rate & contractility of heart; bronchorelaxation
Pseudoephedrine Side Effects
Cardio (tachy, palpitations, arrhythmia, ^BP); CNS (Dizzy, HA, Insomnia, Nervous, CNS stimulation)
Nasal Corticosteroids
Fluticasone Propionate (Flonase); Mometasone (Nasonex); Fluticaone furae (Veramyst); Budesonide (Rhinocort); Triamcinolone (Nasacort)
Nasal Corticosteroids Tx Length
1-2 sprays/nostril qd x 10-14 d; May take 3 days for noticable effect
Viral causes of Pharyngitis
Rhinovirus; Coronavirus; Adenovirus
MCC of Bacterial Pharyngitis
S. pyogenes
1st Line Tx for Bacterial Pharyngitis
Amoxicillin x 10 d
2nd Line Tx for Bacterial Pharyngitis (Amoxil fail)
Augmentin
PCN Allergic Tx for Bacterial Pharyngitis
Cefdinir (Omnicef); Cefuroxime (Ceftin); Azithro; Clarithro
