URI Exam 4 Flashcards
Mild illness for otitis media
- Temp < 39C
- Mild ear pain
Severe illness for otitis media
- Temp >= 39C
- Moderate to severe ear pain or duration of pain >= 48h
For otitis media, when is treatment indicated?
- All with severe illness or otorrhea
- < 24 months with bilateral, mild illness
For otitis media, when is observation indicated?
- All with unilateral, mild illness
- > 24 months with bilateral, mild illness
What is the dose for high-dose amoxicillin for otitis media?
45 mg/kg po BID
What is the dose for high-dose amoxicillin / clavulanate otitis media?
45 mg/kg po BID
Why would you use high dose amoxicillin in otitis media?
high dose helps concentration in middle ear fluids exceed MIC of intermediately resistant strains of S. pneumoniae
Why would you use high dose amoxicillin / clavulanate in otitis media?
- If amoxicillin given in last 30 days
- Presence of concomitant conjunctivitis (indicates H. influenzae likely pathogen)
- Use ES formulation (600mg/5mL)
If patient has PCN allergy, what can be used in otitis media?
- CEFDINIR
- 2nd and 3rd generation cephalosporins
What are agents that can be used to treat otitis externa?
- Antibiotic drops
- Steroid drops: reduce inflammation and swelling; rapid relief of symptoms
Treatment of otitis externa: antibiotic drops
- Acetic acid / hydrocortisone (Acetasol HC®)
- Neomycin, polymyxin B, hydrocortisone (Cortisporin®)
- Ciprofloxacin (Cetraxal®)
- Ciprofloxacin and dexamethasone (Ciprodex®)
- Ciprofloxacin and hydrocortisone (Cipro HC®)
- Ofloxacin 0.3% (Floxin®)
Treatment of otitis externa: special considerations
For patients who have a perforated tympanic membrane
- Avoid neomycin and acetic acid – ototoxic risks outweigh potential benefit
- Avoid Cipro HC – preparation is not sterile
Duration for treatment of otitis externa
3 days after symptom resolution
When would you need to use oral antibiotics for otitis externa?
- Persistent cases
- Temperature >38.3C
- Immuno-compromised patients: diabetics, HIV+, those on chemotherapy
What is the treatment for sinusitis?
- For adults: Amoxicillin / clavulanate
- For children: either Amoxicillin by itself or Amoxicillin / clavulanate
Dose of Amoxicillin / clavulanate for adults in sinusitis
- Standard dose: 875/125mg PO BID
- High dose: 2000 mg PO BID
Dose of Amoxicillin or Amoxicillin / clavulanate for adults in sinusitis
45 mg/kg PO BID
When should you consider high doses of amoxicillin (by itself or with clav) in sinusitis?
- For adults: Recent abx or hospitalization, age > 65, immuno-compromised
- For children: always
When should you consider using amoxicillin with clav as opposed to using it by itself in sinusitis?
- Severe onset (temp > 39C or purulent nasal discharge > 3 days)
- Children < 2 years of age
- Daycare attendees
- Recent antibiotics
What is first line for bacterial infection in sinusitis?
- For adults: Amoxicillin / clavulanate
- For children: either Amoxicillin by itself or Amoxicillin / clavulanate
Symptoms of sinusitis: bacterial
- Nasal discharge: Purulent at onset, lasts 3-4 days
- Fever: >39C
- Time course: Over 10 days without improvement
Symptoms of sinusitis: viral
- Nasal discharge: Clear and watery at onset, progressing to purulent by day 5, then back to clear and watery
- Fever: Absent or only within first 48h
- Time course: Symptoms peak by day 6, then improve and resolve by day 10
For sinusitis, what should be used if pt has PCN allergy?
- Adult: Doxycycline, levofloxacin
- Children: cefdinir
Treatment for pharyngitis
Amoxicillin has a once daily dosing option
primary bacterial pathogen for pharyngitis
Group A streptococcus
Treatment of pharyngitis caused by Group A streptococcus
- 1st line: Penicillin or amoxicillin
- Pain management: acetaminophen, ibuprofen
- Supportive care: Hydration, salt water gargles, lozenges, viscous lidocaine
For pharyngitis, what should a patient receive if they have a PCN allergy?
- Type I penicillin allergy: clindamycin or azithromycin
- Non-type I penicillin allergy: 2nd or 3rd generation cephalosporin -> cefdinir*, cefuroxime, cefpodoxime
contraindications associated with Bactrim
- Bilirubin displacement can lead to hyperbilirubinemia and kernicterus
- Avoid in infants < 2 months of age
contraindications associated with tetracyclines
- Causes permanent tooth discoloration and retardation of skeletal development
- Avoid in children < 8 years of age
contraindications associated with fluoroquinolones
- Can cause tendon rupture and cartilage erosion in weight-bearing joints
- Avoid in children < 18 years of age
