Pediatric ID Flashcards
What are the common causative pathogens for AOM?
acute otitis media
- streptococcus pneumoniae
- haemophilus influenzae
- moraxella catarrhalis
Which patients get treated for AOM regardless of severity?
patients < 6 months old
Which patients are eligible for observation opposed to initiating treatment right away for AOM?
acute otitis media
- 6 mo/o - 2 y/o with non-severe unilateral AOM
- older than 2 y/o with non-severe AOM
- all patients with otorrhea require tx
- all patients with severe AOM require treatment
Which drug is first line for AOM?
amoxicillin
What is the dosing for amoxicillin for AOM?
80-90 mg/kg/day divided into Q12H for 5-10 days
This is a high dose of amoxicillin, but it is required for this indication to overcome potential resistance and reach adequate concentrations in the ear!
When can’t amoxicillin be used for AOM?
- known resistance
- treatment failure
- amoxicillin in the last 30 days
- allergy
- concurrent conjunctivitis
When is amox/clav used for AOM?
- 1st line if amoxicillin used in last 30 days
- 1st line if concurrent conjunctivitis
- 2nd line if amoxicillin failure
What is the dosing for amoxicillin-clavulanate for AOM?
90 mg/kg/day of the amoxicillin component divided Q12H
What is the goal limit for clavulanate to minimize diarrhea?
< 10 mg/kg/day
Which amox/clav ratio should be used for AOM?
600 mg amox/42.9 mg clav/5 mL
extra strength (ES)
Which drugs can be used for AOM in the case of pcn allergy?
- cefpodoxime
- cefdinir (trash)
When might ceftriaxone be used for AOM?
- for severe cases if oral tx is not an option
- initial oral tx fails
- Dose: 50 mg/kg daily IM - one dose for initial therapy
- as effective as 10 days of amoxicillin
What is the duration of therapy for AOM in children under 2 years old?
10 days
What is the duration of therapy for AOM in children over 2 years old?
- 5-7 days
- 10 days if severe/recurrent or TM perforation
What analgesics can be used as adjunctive therapy for AOM?
- APAP
- Ibuprofen
What is the pediatric dosing for APAP?
- 10-15 mg/kg/dose Q4-6H
- Max of 75 mg/kg/day
What is the pediatric dosing for ibuprofen?
- 5-10 mg/kg/dose Q6-8H
- only use if the patient is older than 6 months
When can ear drops be used for AOM?
topical quinolone drops - ofloxacin, ciprofloxacin
Only for the tx of uncomplicated otorrhea in patients with tympanostomy tubes
Topical quinolones can increase risk of perforation in patients w/out tubes
What is the most common causative pathogen for UTIs?
e. coli
Which method should be used for urine collection for urinalysis in pediatric patients?
Catheterization
- preferred for <2years of age group
- clean catch may be appropriate for older patient groups
- supra-pubic aspiration is gold-standard but invasive so it’s reserved for young children who fail catheterization
Which dosage forms can be used for UTI treatment?
- Oral and IV are equally efficacious
- Use IV for patients who can’t retail oral (vomiting)
- can change to oral from IV when patient has clinical improvement
What is the duration of therapy for UTIs in pediatric patients?
- 10-14 days for pyelonephritis
controversial… duration varies from 3-14 days
What are the first line options for UTIs in pediatric patients?
- cephalexin
- amoxicillin
E. coli resistance to amoxicillin makes it a less acceptable choice
What are alternative treatment options for UTIs in pediatric patients?
- amox/clav
- TMP/SMX
- nitrofurantoin - not commonly used; must confirm pt ONLY has cystitis bc it doesn’t reach high enough concentrations to treat pyelo or urosepsis
- FQs –> resistance is a major concern… traditionally not used in children
When might fluroquinolones be used in children for UTIs?
- MDR pathogens with no safe alternative
- if IV therapy is not feasible
- No other effective oral agent
Why can’t cipro suspension be given through a feeding tube?
It will clog it.
What are the common causes of bronchiolitis?
Presents as cold-like symptoms that increase the work required to breathe
- respiratory syncytial virus (RSV)
- rhinovirus
- other viruses
What is the mainstay of treatment for RSV?
- supportive therapy:
- oxygen
- hydration
- mechanical ventilation
- ECMO
Exam Q
At what age is the flu vaccine recommended?
Everyone 6 months and older
Children aged 6 months to 8 years who have not gotten 2 doses should get 2 doses separated by at least 4 weeks
What are the two methods of RSV protection for infants?
- vaccination of pregnant people between 32-36 weeks gestation
- Nirsevimab (Beyfortus) for infants)
When is vaccination of pregnant people a valid strategy to protect infants from RSV?
Abrysvo
- must be given at least 14 days before delivery
- 32 to 36 weeks pregnant
- administered before and during start of RSV season (Sept - Jan)
When should Nirsevimab (Beyfortus) be administered to infants?
- If the infant was born during RSV season, and their parent didn’t get RSV vaccination at least 14 days before delivery, the infant should receive one dose at birth.
- If the infant was born outside of RSV season, they should receive one dose prior to their first RSV season.
