Primary care treatment plans

Question 1

Treatment plan for strep throat

Answer 1

Children: less than or equal to 27 kg (59.4lbs)
Penicillin V oral: 250 mg BID or TID x 10days
Amoxicillin: 50mg/kg 1 time per day x 10 days
Pen allergies:
Azithromycin: 12mg/kg/dose (max 500mg/dose) followed by 6 mg/kg/dose (250 max dose) on days 2 through 5

Adults:
Penicillin V oral: 500 BID or TID x 10 days
Amoxicillin: 500 mg BID x 10 days
Pen allergy: azithromycin mg orally on day 1 followed by 250 mg orally on days 2 through 5.

Question 2

Treatment plan for Acute otitis media

Answer 2

Pain: ibuprofen or acetaminophen

If no recent beta-lactam therapy, concomitant purulent conjunctivitis or history of recurrent AOM:
amoxicillin 90mg/kg per day divided into two doses for 10 days
If yes to above than use augmentan
If pen allergy: cefdinir or azithromycin

Most common pathogens:
50%: S pneumoniae
45%: H. influenzae
10%: M. catarrhalis (gram neg diplococcus with beta lactamase)

Treatment failure: lack of improvement in 48-72 hours when treated with abx.