Upper Respiratory Tract Infections

Question 1

Acute Otitis Media pathogens

Answer 1

Streptococcus pneumoniae
Non-typeable H influenzae
Moraxella catarrhalis
Streptococcus pyogenes

Question 2

Acute Otitis Media Signs and Symptoms

Answer 2

Bulging of the tympanic membrane or reduced membrane mobility
Otorrhea
Otalgia
Fever
Diminished hearing

Question 3

First-line therapy for Acute Otitis Media

Answer 3

Amoxicillin
Amox/Clav
Ceftriaxone
Cefpodoxime (PCN allergy non-ana)
Cefuroxime (PCN allergy non-ana)
Cefdinir (PCN allergy non-ana)
Clindamycin (PCN allergy ana)
Levofloxacin (PCN allergy ana)

Question 4

When to go to second line therapy

Answer 4

No improvement 48-72 hours post first antibiotic dose

Question 5

Second-Line therapy for Acute Otitis Media

Answer 5

High dose Amox/Clav
Ceftriaxone
Oral clindamycin +/- oral 3rd generation cephalosporin

Question 6

Recurrent infections

Answer 6

Tympanostomy tubes

Question 7

Acute Otitis Externa

Answer 7

Infection of the skin of the hairy and glabrous external ear canal

Question 8

Acute otitis Externa pathogens

Answer 8

Pseudomonas aeruginosa (especially in cases of water immersion)
Staphylococcus aureus
Streptococcus pyogenes

Question 9

Treatment for acute otitis externa - mild cases

Answer 9

Topical antibiotics

Question 10

Treatment for acute otitis externa - moderate to severe cases

Answer 10

Pain management
Otic antibiotics for 7 days

Question 11

Otic antibiotics

Answer 11

Polymyxin B + neomycin + hydrocortisone 3-4 times a day
Ciprofloxacin + hydrocortisone (or dexamethasone) BID
Ofloxacin daily

Question 12

When not to use neomycin

Answer 12

Tympanic membrane is not intact

Question 13

Neomycin is __________

Answer 13

ototoxic
So DO NOT use if the tympanic membrane is detached