Pediatric ID Flashcards

Question

amoxicillin for AOM

Answer 1

``` First-line therapy - A few exceptions Advantages: -Achieves adequate concentrations -Safe & effective -Tastes good – “bubblegum medicine” -Low cost Reasons not to use: -Resistance -Treatment failure -PCN allergy -Type 1 cephalosporin allergy ```

Answer 2

1st choice if amoxicillin not an option and no allergies Advantages: Additional coverage for ß-lactamase production Disadvantages: -Not all formulations are interchangeable -Must choose appropriate formulation to avoid side effects associated with clavulanate - Main side effect is diarrhea, Dose clavulanate component at ≤ 10 mg/kg/day

Answer 3

``` All are considered 2nd line therapy and good options for treatment failure Cefdinir (Omnicef®) -14 mg/kg/day divided q12-24 hours -Tastes good; but has poor bioavailability -Not as affordable Cefuroxime (Ceftin®) -30 mg/kg/day divided q12 hours -Tastes bad -Not as affordable Cefpodoxime -10 mg/kg/day divided q12 hours -Tastes bad -Not as affordable ```

Answer 4

``` also 2nd line Azithromycin (Zithromax®) -Dosing regimen: 30 mg/kg/day x 1 day, 10 mg/kg/day x 3 days OR 10 mg/kg/day x 1 day, then 5 mg/kg/day daily x 4 days Advantages: Once daily dosing, Short duration of therapy Disadvantages: Cost, Increased macrolide resistance Clarithromycin -15 mg/kg/day divided q12 hours -Overall poor tolerability -Not most cost-effective option -Risk of increased macrolide resistance ```

Answer 5

``` Appropriate in severe cases when: -Oral treatment not option -Initial oral treatment fails -Highly resistant S. pneumoniae identified Dosing: -Intramuscular administration -50mg/kg daily -One dose** initial therapy -Three doses**- treatment failure Advantages: Broad spectrum of activity, Equally effective to 10 days of amoxicillin Disadvantages: Injection site pain, Cost, Avoid in under 2 mo of age, Cautions (Calcium co-administration, C. difficile associated-dz) ```

Answer 6

Exact effective duration is unknown Historical recommendation is 10 days 10 days of therapy is indicated for: Children under 6 years of age; Children with severe illness Shorter courses (5-7 days) may be used in children ≥ 6 years of age without severe disease

Answer 7

``` Analgesics -Acetaminophen/ibuprofen -Benzocaine drops - contraindicated in typanic membrane rupture -Narcotic analgesics Decongestants/antihistamines Dexamethasone ```

Answer 8

Within days for young infants with severe episode or children of any age with continuing pain Within 2 weeks for infants or young children with history of frequent recurrences 1 month after initial examination for children with only a sporadic episode of AOM No follow-up may be necessary for older children

Answer 9

``` Vaccination -Pneumococcal -Influenza Reduction of preventable risk factors -Exposure to tobacco smoke -Limit pacifier use to under 6 months -Breastfeed until at least 6 months of age -Avoid supine bottle feeding – “bottle propping” Prophylaxis Tympanostomy tubes ```

Answer 10

Antibiotic prophylaxis is controversial due to increased risk of developing resistance May be helpful to decrease recurrent episodes May also help to reduce risk of hearing loss Antibiotics utilized include: Amoxicillin, Sulfasoxazole, Sulfamethoxazole/trimethoprim (Bactrim™) Use for 6 months during spring and winter

Answer 11

Small ventilation tubes inserted through TM to provide drainage for eustachian tubes Indicated in recurrent AOM despite appropriate medical therapy -3 or more episodes in under 6 mo -4 or more episodes in under 12 mo Advantages Disadvantages

Answer 12

girls: white, under 12 mo, temp over 39, fever 2+ days, absence of another source of infection - 1 factor = 1% probability; 2 factors = 2% probability of UTI boys: nonblack, temp over 39, fever 24+ hours, absence of another source of infection, uncircumsized

Answer 13

Retrograde ascent - urethra to bladder Nosocomial infection - infants Hematogenous spread Fistula formation - not in US

Answer 14

E coli*** and others

Answer 15

evaluate all febrile children 2-24 months older children should be evaluated if clinical presentation s/sxs vary by age -newborns: jaundice, sepsis, failure to thrive, vomiting, fever -infants/young children: fever, strong-smelling urine, hematuria, abd/flank pain, new onset urinary incontinence -school-aged children: sxs similar to adults (dysuria, freq and urgency)

Answer 16

Clean catch - Older patient groups Bag specimen - Unacceptably high rates of false-positive cultures Catheterization - Preferred for 2-24 month age group Supra-pubic aspiration - Gold-standard, but INVASIVE

Answer 17

Leukocyte esterase = most sensitive single test*** Nitrite - more specific but less sensitive Blood & Protein - Poor sensitivity and specificity, May be misleading

Answer 18

Done with culture Performed on any specimen -under 1 hour after voiding if kept at room temperature -under 4 hours after voiding if kept in the refrigerator

Answer 19

Pyuria is present | Positive if at least 10 WBCs per µL

Answer 20

Suprapubic aspiration - >1,000 CFU/mL Catheter specimen - >10,000 CFU/mL Clean-catch specimen - ≥100,000 CFU/mL

Answer 21

Oral and IV options are equally efficacious Most patients can have oral therapy Choose IV for patients who are: “Toxic”; Unable to retain oral intake Can change to oral therapy when patient has clinical improvement – usually within 24-48 hours Duration of therapy*

Answer 22

Therapy determined using local resistance patterns Amoxicillin traditional 1st line therapy in past -E. coli resistance makes it less acceptable choice -Higher cure rates with trimethoprim/sulfamethoxazole Oral options: amox, amox/clav, cefixime, cefpodoxime, cefprozil, cephalexin, TMP/SMX IV options: ceftriaxone, cefotaxime, ceftazidime, gentamicin, tobramycin, piperacillin

Answer 23

Traditionally not used in children (resistance and risk) May be useful in some circumstances -Multidrug-resistant pathogens with no safe alternative -IV therapy is not feasible -No other effective oral agent AAP guidelines recommend FQ use for Pseudomonas or other multidrug-resistant gram-negative bacteria

Answer 24

Approved for complicated E. coli UTIs and pyelonephritis in patients 1-17 years will clog G or NG tube - use levo

Answer 25

Considerations for renal/bladder ultrasound and voiding cystography - All boys - All girls under 3 years of age - Girls 3-7 years with fever > 38.5 degC - AAP recommends only ultrasound for 2-24 months of age

Answer 26

Efficacy of prophylaxis is questionable Some clinicians perceive benefit in children with vesicoureteral reflux (VUR) or immunosuppressed -No benefit found in mild to moderate -Some benefit with severe VUR Continuous prophylaxis may not reduce risk of pyelonephritis or renal damage Cranberry juice? NO

Answer 27

``` One of most common diseases of childhood Most infants infected during 1st year of life Characterized by: -Upper and lower airway disease -Wheezing -Reactive airway disease Re-infection throughout life is common Most common cause of bronchiolitis -Inflammation of bronchioles -Airway edema -Bronchospasm -Epithelial lining necrosis Incubation period 2-8 days -Symptoms may persist for up to one month ```

Answer 28

``` Age under 6 months Pre-term birth Cyanotic or complicated CHD Chronic lung disease Weakened immune system ```

Answer 29

Cold-like symptoms - Low-grade fever - Rhinorrhea - Increased work of breathing - Can progress to respiratory failure in some cases

Answer 30

``` Supportive therapy** -Oxygen -Hydration -Mechanical ventilation -ECMO β-adrenergic agonist - could help, continue if it is, but no data Corticosteroids - no data ```

Answer 31

Only licensed product for prevention of RSV Humanized murine monoclonal antibody - NOT a vaccine*** - do NOT need consent Give 1st dose prior to hospital discharge Primary benefit is a decrease in the rate of RSV associated hospitalization Discontinue prophylaxis if patient experiences RSV infection requiring hospitalization Not indicated for treatment of RSV

Answer 32

GA under 29 weeks and under 12 mo old GA under 32 weks w CLD (chronic lung disease of prematurity - Requirement of >21% oxygen for at least the first 28 days of life) and under 12 mo old Meet above definition of CLD and require chronic steroids, diuretics, or O2 during second year of life and under 24 mo old hemodynamically significant CHD (Acyanotic heart disease receiving medication to control heart failure symptoms; moderate to severe pulmonary HTN; +/-cyanotic lesions) and under 12 mo old profound immunocompromise (SCT, SOT, SCID) and under 24 mo old ***MAX 5 doses/season***

Answer 33

15mg/kg IM every month x up to 5 doses/season 50 mg/0.5 ml vial - $1,034.92 100 mg/1 ml vial - $2,069.84 Insurance will restrict to max of 5 doses with new guidelines