peds Flashcards
risk factors for otitis media
smoke exposure
formula feeding
immunization status
atopy
daycare attendance
males
family history
onset before 12 months
non white
congenital anomalies
immune deficiency
difference in anatomy with kids in ears
shorter eustachian tube
bacteria is isolated from what percent of acute otitis media
65-75%
commom pathogens for acute otitis media
strep pneumo
h. flu
moraxella cat
- strep pyogenes (rare)
- viral 30%
when is pneumococcal vax given
2,4,6,12-15 months
how does tympanic membrane look in AOM
bulging
cloudy or purulent
immobile
diagnosis of acute otitis media requires what
- acute onset
- middle ear effusion
- symptoms
severe otitis media classification
> 39
patient populations that have the option to observe and not treat
nonsevere unilateral 6 month-2 years
nonsevere unilateral and bilateral 2 years +
if we choose to observe how long do we observe
48-72 hours
follow-up if failure
SNAP - safety net prescription
how is strep pneumo overcome in treatment of AOM
high dose amoxicillin
how is h flu and moraxella over come in treatment of AOM
amox/clav
adding a beta lactamase inhib
first line treatment AOM
amoxicillin 80-90mg/kg/day q12 h
when do we not use amoxicillin first line in AOM
allergy
known resistance
treatment failure (after 72h)
amoxicillin in last 30 days
conjuncitvitis
2nd line therapy used if amoxicillin failure or if high dose amoxicillin in last 30 days or conjuctivitis
amoxicillin/clav 90 mg/kg q12h
clav consideration
keep at <10 mg/kg/day
amox/clav strength
600/42.9
2nd line if pt has amox allergy
cefpodoxime
cefuroxime
cefdinir
when would we use ceftriaxone
oral not available
treatment failure
ceftraixone dosage form and dosing
IM
1 injection if initial dose
3 injections if treatment failure
disadvantages of ceftriaxone
calcium coadmin
c. diff risk
avoid in <1 month
how long should we have AOM treatment in < 2 years old pts
10 days
for pts over 2 years how long to treat
5-7 days
10 days if:
- severe or recurrent
- TM perforation
adjunctive therapy for AOM
APAP 10-15 mg/kg/day
ibuprofen 5-10 mg/kg/day
- ibuprofen not for <6 months
lidocaine OTC drop usage
do not use in ruptured membrane or tubes
may consider in 2+
follow-up timeline AOM
young infants -days
young children w freq - 2 weeks
children w sporadic episode - 1 month
older children - not needed
who may benefit from antibiotic prophylaxis AOM
> 6 episodes per year
treatment of AOM in tubes pts
ofloxacin or levofloxacin drops
4-5 drops BID 5-7 days
chronic supperative ottiis media risk pathogen
MRSA
(lasting >6 weeks)
chronic supperative otitis media treatmetn
ofloxacin or cipro drops x 2 weeks
otitis externa (swimmers ear) orgnaisms
pseudomonas
staph aureus
fungal
otitis externa
swimmers ear treatmet
ear drops
UTI ped risk factors girls
white
<12 months
temp >39
fever > 2 days
UTI ped risk factors boys
non black
temp >39
fever >24 h
uncircumcised
pathogens causing UTI in kids
e. coli 80-85%
also Klebsiella
signs and symptoms of UTI in peds
check all fever children < 2 years
newborns - jaundice, looking sick
infants/young kids - flank pain, foul urine
school kids - dysuria, frequnecy, urgency
preferred method of urine collection peds
catheterization fo < 2 years old
positive urinalysis results indicating UTI in ped
leukocyte esterase
nitrite
urine culture that would not be contaminanted CFU cound
> 100,000
10,000 in catheter
treatment of UTI in children
cephalexin q 6 hours
could do Bactrim
last line is FQs
what can we not give in a feeding tube
fluroquinolones
duration of treatment of UTI in uncomplicated < 2 years
7 days
duration of treatment of UTI in pyelonephritis peds
10-14 days
duration of treatment in UTI of older female peds
3-7 days
IV vs oral for UTI
IV if cant keep oral down (ceftriaxone)
or if looking toxic
what is bronchiolitis
lower resp infection
viral
edema, inflammation
what causes bronchiolitis
RSV
rhinovirus
RSV season is when
November-April
risk factors for RSV
age < 6 months
pre-term
chronic lung disease
weakened immune system
treatment of bronchiolitis
supportive therapy!
- oxygen
- hydration
- mechanical vent
- ECMO
how can we prevent RSV
nirsevimab
pregnant people vaccine
vaccine for pregnant people RSV
Abrysvo
how much time before pregnancy must RSV vaccine be given to pregnant women
14 days before delivery
when can babies get Nirsevimab
right at birth if RSV season
right before RSV season in office if its not in season
who should get second nirsevimab dose
chronic lung disease
chronic corticosteroid therapy
immunocompromised
heart disease
Indian
