URTI Flashcards
Symptomatic management of AOM
Ibuprofen / acetaminophen
Topical lidocaine ( >2 yrs )
Topical lidocaine precautions
- > 2 yrs
2. Not in children with tympanic membrane perforation
Strategies of antibiotic treatment in AOM
- Immediate treatment with antibiotic
2. Observation w/initiation of antiB if the syms didn’t improve within 48-72 hrs
Choice of strategy depending on age?
- 6mon-2yrs: Treat immediately with antibiotic
- > = 2 yrs who appear toxic , otalgia >48 hrs, temp >=39: treat immediately
- > =2yrs w/mild syms: observe
First line AOM
- Amox
2. Amox-clav
First line amox /amox-clav DF?
Oral
When is amox first line before trying amox-clav
If there are NO risk factors for amoxcillin resistence
Alternatives for AOM children with mild or remote allergy to penicillins (ie without anaphylaxis, bronchospasm, or angioedema)
Cephalosporins like:
- Cefdinir
- Cefpodoxime
- Cefuroxime
- Ceftriaxone
Cephalosporins used for AOM DF?
All oral only ceftriaxone IM/IV
What is duration of action in all AOM drugs except Azithromycin?
- Children <2 years and children (any age) with tympanic membrane perforation or history of recurrent AOM: 10 days
- Children ≥2 years with intact tympanic membrane and no history of recurrent AOM: 5 to 7 days
Azithromycin dose & duration & what happens if there is pneumococcal resistance
- 10 mg/kg once on day 1 then 5mg/kg once per day on days 2 through 5
- 5 days
- Increasing the dose of macrolides generally will not overcome the resistance
Clinical presentations most consistent with bac vs viral rhinosinusitis
- Onset with persistent signs or symptoms, lasting for ≥ 10 days without any evidence of clinical improvement
- Onset with severe signs or symptoms of high fever (≥39°C [102.2°F]) and purulent nasal discharge or facial pain lasting for at least 3 to 4 consecutive days at the beginning of illness
- Onset with worsening signs or symptoms characterized by new-onset fever, headache, or increase in nasal discharge following a typical viral URI that lasted 5 to 6 days and were initially improving (“double sickening”)
Symptomatic treatment of acute bacterial rhinosinustitis
- Analgesics
- Glucocorticoids ( not used in AOM )
- Antihistamines ( not used in AOM )
- Decongestant
- Saline spray
- Anticholinergic spray
First line rhinosinusitis antibiotic treatment
- No risk factors for pneumococcal resistance: Amoxicillin or amoxicillin-clavulanate
- Risk factors for pneumococcal resistance: high dose Amoxic-calv
- In severe infection (hospitalization): IV ampicillin-sulbactam
Risk factors for pneumococcal resistance
- Age>65
- hospitalization in the last 5 days
- severe infection
- comorbidities (DM, cardiac, hepatic, or renal diseases)
Alternatives for AOM children with severe reaction◊ to beta-lactams including cephalosporins
- Azithromycin
- Clarithromycin
- Clindamycin
All Oral
Which antibiotics are used in penicillin allergy in acute bacterial rhinosinusitis?
- Doxycycline
- Cefixime / cefpodoxime w/ or w/out clindamycin
- Levofloxacin /moxifloxacin
Preferred Antibiotic for pharyngitis & its duration
Peniciillins
- Pencillin V oral
- Amoxicillin oral
- Pen G benzathine IM
10 DAYS except IM only single dose
alternative for mild reaction to penicillin in pharyngitis
Cephalosporins
1. 1st generations are preferred due to narrow spectrum
- Choose agents with side chain dissimilar to penicillin: cephalexin / cefadroxil / cefuroxime / cefpodoxime / cefdinir / cefixime
- Duration: 10 days
alternative in severe (IgE-mediate allergy) in pharyngitis
Macrolides:
Azithromycin
Clarithromycin
Clindamycin
Alternative to all lincosamide
What can we use if initial treatment failed?
- Choose different drug class
- broader-spectrum Amoxi-clav
- high dose Levofloxacin or moxifloxacin (these are better for redp & S.pneu)
( in cystitis levo & cipro not moxi )
Which drug is better for reducing rates of acute rhematic fever
Penicillins preferably IM single dose
Antiviral treatment for influenza
- Neuroaminidase inhibitors:
A. Zanamivir
B. Oseltamivir
C. Peramivir - Baloxavir
- Amantadine / ramantadine
1,2 for both inf A & B
3 is for inf A only
