Pediatrics - Acute Otitis Media & Urinary Tract Infections Flashcards
What is the definition of uncomplicated otitis media?
without otorrhea
What is the definition of non-severe otitis media?
with presence of mild otalgia AND temperature <39 dC
What is the definition of severe otitis media?
with presence of moderate-to-severe otalgia OR fever >39 dC
When is peak incidence for AOM? When is it most common?
6-12 months; 6-24 months
What are risk factors for AOM?
genetics/family history, allergies, lack of breastfeeding, low SE status, smoke exposure, daycare attendance, pacifier use, winter
What are signs/symptoms of AOM?
otalgia (ear-tugging), irritability, HA, vomiting/diarrhea, fever, restless sleep, poor feeding
What is treatment for mild symptoms of AOM in children >2 yo?
“watchful waiting”
What is first-line treatment for AOM (initial immediate or delayed)? (2)
amoxicillin (80-90 mg/kg/day in 2 doses) OR amoxicillin-clavulanate (90 mg/kg/day in 2 doses; ratio 14:1)
What is alternative treatment for AOM (initial immediate or delayed)? (4)
cefdinir (14 mg/kg/day in 1-2 doses), cefuroxime (30 mg/kg/day in 2 doses), cefpodoxime (10 mg/kg/day in 2 doses), ceftriaxone (50 mg/day IM/IV for 1-3 days)
What is the antibiotic treatment duration for patients 2 or less? >2?
10 days; 5-7 days
What is the treatment for pain management resulting from AOM? (2)
ibuprofen 5-10 mg/kg/dose q6hr PRN, APAP 10-15 mg/kg/dose q4-6hr PRN
What is the MOA for a tympanostomy tube?
moves the fluid from behind the eardrum to the outside of the ear
What are disadvantages of tympanostomy tubes?
scarring of tympanic membrane, children must be put under general anesthesia for procedure
What is the most common pathogen for pediatric UTIs?
E. coli
What are risk factors for UTIs?
younger age groups (neonates/infants), female sex, uncircumcised, constipation, anatomic abnormalities (e.g., vesicoureteral reflux), functional abnormalities (e.g., neurogenic bladder), female sexual activity, immunocompromised, DM, genetics
What are infection pathways for UTIs? (4)
retrograde ascent (most common), nosocomial infection (catheter/resistant pathogens), hematogenous routes, fistula
What is the difference between a complicated and uncomplicated UTI?
complicated = GU tract w/structural/functional abnormalities, uncomplicated = normal UT
What are neonate signs/symptoms of UTIs?
jaundice, FTT, fever, difficulty feeding, irritability, vomiting/diarrhea
What are infant signs/symptoms of UTIs?
nonspecific signs similar to neonates with exception of jaundice
What are children signs/symptoms of UTIs?
fever, frequency, dysuria, enuresis, hematuria, abdominal pain
What is not to replace urine culture as a diagnostic tool?
rapid urine tests
What is definition of a UTI?
significant bacturia + pyuria
What is first-line treatment for UTIs? (3)
cephalosporin, trimethoprim/sulfamethoxazole, beta-lactams
What is the treatment duration for uncomplicated UTIs?
7 days
What is the treatment duration for complicated UTIs/pyelonephritis?
10-14 days
What is an AE of ciprofloxacin?
tendon rupture/tendonitis
What is an AE of ceftibuten?
serum sickness reaction
What is an AE of trimethoprim/sulfamethoxazole? (2)
hematologic AEs, interstitial nephritis
What are risk factors for vesicoureteral reflux (VUR)?
febrile UTIs, parent/sibling with VUR, prenatal hydronephrosis
What is the goal of UTI prophylaxis?
prevent irreversible damage (scarring)
What is the preferred antibiotic in 2 or less months old?
amoxicillin 10-15 mg/kg once daily
What is the preferred antibiotic in >2 months old? (2)
trimethoprim/sulfamethoxazole 2 or 5 mg/kg once daily, nitrofurantoin 1-2 mg/kg once daily
