Podcast
Questions and Answers
A 7-year-old child presents with a history of recent hospitalization, attends daycare, and has received antibiotics within the last month. The child is diagnosed with acute bacterial sinusitis. Which antibiotic regimen would be BEST suited for this patient, considering the likely resistance patterns?
A 7-year-old child presents with a history of recent hospitalization, attends daycare, and has received antibiotics within the last month. The child is diagnosed with acute bacterial sinusitis. Which antibiotic regimen would be BEST suited for this patient, considering the likely resistance patterns?
- Levofloxacin 500 mg/day
- High-dose amoxicillin-clavulanate 90 mg/kg/day BID (correct)
- Intranasal corticosteroids alone, with close monitoring
- Amoxicillin-clavulanate 45 mg/kg/day BID
An adult patient is diagnosed with acute bacterial sinusitis following a viral upper respiratory infection. They report a history of allergic rhinitis and symptoms persisting for 12 days without improvement. Which ONE of the following represents the MOST appropriate initial management strategy?
An adult patient is diagnosed with acute bacterial sinusitis following a viral upper respiratory infection. They report a history of allergic rhinitis and symptoms persisting for 12 days without improvement. Which ONE of the following represents the MOST appropriate initial management strategy?
- Oral corticosteroids for 3 days to reduce inflammation
- Intranasal corticosteroids in addition to saline nasal irrigation (correct)
- Immediate referral to an otolaryngologist
- Empiric doxycycline for 7 days
A patient presents with acute pharyngitis. A rapid strep test is positive for Streptococcus pyogenes. The patient reports a severe allergy to penicillin (Type I hypersensitivity). Which of the following is the MOST appropriate antibiotic?
A patient presents with acute pharyngitis. A rapid strep test is positive for Streptococcus pyogenes. The patient reports a severe allergy to penicillin (Type I hypersensitivity). Which of the following is the MOST appropriate antibiotic?
- Cephalexin
- Azithromycin
- Doxycycline (correct)
- Amoxicillin
A 5-year-old patient presents with a three-day history of fever (up to 102.5°F), nasal congestion, and purulent nasal discharge. The parent reports that the child initially had mild cold symptoms that seemed to improve slightly before worsening again. According to the IDSA criteria, which factor is the LEAST reliable indicator for diagnosing acute bacterial sinusitis?
A 5-year-old patient presents with a three-day history of fever (up to 102.5°F), nasal congestion, and purulent nasal discharge. The parent reports that the child initially had mild cold symptoms that seemed to improve slightly before worsening again. According to the IDSA criteria, which factor is the LEAST reliable indicator for diagnosing acute bacterial sinusitis?
Why is it crucial to complete the full course of antibiotics prescribed for Streptococcus pyogenes pharyngitis, even after the patient feels better?
Why is it crucial to complete the full course of antibiotics prescribed for Streptococcus pyogenes pharyngitis, even after the patient feels better?
A 10-month-old infant presents with a tympanic membrane examination revealing mild bulging and a temperature of 100.8°F. The parent reports the infant has been tugging at their ear for the past 24 hours. Which of the following is the MOST appropriate initial management strategy?
A 10-month-old infant presents with a tympanic membrane examination revealing mild bulging and a temperature of 100.8°F. The parent reports the infant has been tugging at their ear for the past 24 hours. Which of the following is the MOST appropriate initial management strategy?
A 5-year-old child is diagnosed with acute otitis media (AOM). The parent reports the child has a severe allergy to penicillin (Type I). Which of the following is the MOST appropriate antibiotic choice?
A 5-year-old child is diagnosed with acute otitis media (AOM). The parent reports the child has a severe allergy to penicillin (Type I). Which of the following is the MOST appropriate antibiotic choice?
A 7-year-old child is diagnosed with mild acute otitis media. When deciding on duration of antibiotic therapy, which of the following represents the MOST appropriate treatment duration?
A 7-year-old child is diagnosed with mild acute otitis media. When deciding on duration of antibiotic therapy, which of the following represents the MOST appropriate treatment duration?
A child has experienced four episodes of acute otitis media in the past year, with three of those episodes occurring within the last six months. What is the MOST appropriate next step in managing this child's recurrent AOM?
A child has experienced four episodes of acute otitis media in the past year, with three of those episodes occurring within the last six months. What is the MOST appropriate next step in managing this child's recurrent AOM?
A 3-year-old child with a history of recurrent acute otitis media (AOM) presents with concurrent conjunctivitis and a suspected AOM infection. Which antibiotic is MOST appropriate as the FIRST-line treatment?
A 3-year-old child with a history of recurrent acute otitis media (AOM) presents with concurrent conjunctivitis and a suspected AOM infection. Which antibiotic is MOST appropriate as the FIRST-line treatment?
After 72 hours of amoxicillin treatment for acute otitis media, a child's symptoms have not improved. Which of the following is the MOST appropriate next step in management?
After 72 hours of amoxicillin treatment for acute otitis media, a child's symptoms have not improved. Which of the following is the MOST appropriate next step in management?
A 4-year-old child with a history of acute otitis media presents with moderate ear pain and a temperature of 102.5°F. The tympanic membrane examination reveals moderate bulging. According to AAP guidelines, which of the following is the MOST appropriate initial treatment strategy?
A 4-year-old child with a history of acute otitis media presents with moderate ear pain and a temperature of 102.5°F. The tympanic membrane examination reveals moderate bulging. According to AAP guidelines, which of the following is the MOST appropriate initial treatment strategy?
When counseling a parent on preventing acute otitis media (AOM) in their child, which of the following vaccinations should you emphasize?
When counseling a parent on preventing acute otitis media (AOM) in their child, which of the following vaccinations should you emphasize?
Flashcards
Acute Otitis Media
Acute Otitis Media
Infection of the middle ear characterized by inflammation and fluid.
Etiology of AOM
Etiology of AOM
Key bacteria include Strep pneumoniae, H.flu, and Moraxella catarrhalis.
Diagnosis criteria AOM
Diagnosis criteria AOM
Moderate/severe TM bulging or new otorrhea; mild bulging with pain onset.
First-line antibiotic
First-line antibiotic
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Augmentin usage
Augmentin usage
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Recurrent AOM definition
Recurrent AOM definition
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Antibiotic for type II PCN allergy
Antibiotic for type II PCN allergy
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Prevention of AOM
Prevention of AOM
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Flu Diagnosis Criteria
Flu Diagnosis Criteria
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High Dose Augmentin
High Dose Augmentin
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Strep Pyogenes
Strep Pyogenes
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Contagious Period Reduction
Contagious Period Reduction
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Study Notes
Acute Otitis Media
- Etiology: Streptococcus pneumoniae (resistance to penicillin), Haemophilus influenzae, and Moraxella catarrhalis (resistance to beta-lactamase).
- Diagnosis (AAP): Middle ear effusion (MEE) with moderate/severe bulging of the tympanic membrane or new onset otorrhea not due to another condition, or MEE with mild bulging and ear pain within 48 hours or tympanic membrane erythema.
- Treatment:
- Acetaminophen or ibuprofen for pain relief.
- Antibiotics (ABX) for children 6 months to 12 years with moderate-to-severe pain and fever ≥102.2°F. Options include amoxicillin, high-dose amoxicillin (if recent amoxicillin use, concurrent conjunctivitis, recurrent infection unresponsive to amoxicillin, or failure after 48-72 hours), cefdinir, or clindamycin (if penicillin allergy).
- Duration: 10 days, may shorten to 5-7 days for mild-moderate cases (≥6 years old) or 7 days (2-6 years old), sometimes dexamethasone added to topical ciprofloxacin to shorten duration by 1 day.
- Recurrent: Defined as 3 episodes in 6 months or 4 episodes in one year. Consider tube placement.
- Prevention: Flu, Haemophilus Influenza, and pneumococcal vaccines.
Acute Bacterial Rhinosinusitis
- Etiology: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Often preceded by a viral infection.
- Diagnosis (IDSA): Symptoms ≥10 days without improvement, ≥102.2°F for 3-4 consecutive days, or "double sickening".
- Treatment: Saline nasal spray, intranasal steroids (if history of allergic rhinitis), and supportive care.
- Duration: Adults 7 days, children 10 days.
Acute Pharyngitis
- Etiology: Streptococcus pyogenes (Group A).
- Diagnosis: Throat swab or rapid test.
- Treatment: Antibiotics shorten the contagious period to 1 day, but complete the course to avoid complications. Supportive care includes antipyretics, analgesics, lozenges.
- Duration: 10 days (exception: azithromycin for 5 days).
- Unique note: Abx use in pharyngitis should consider duration and possible complications of incomplete treatment.
Antimicrobial Use in Children (Summary of antibiotic choices)
- Amoxicillin (various conditions): Preferred in many instances.
- Augmentin (various conditions): High dose augmentin for cases possibly related to S. pneumoniae, severe infections, daycare attendance, age ≤2 years, recent hospitalization, prior abx use within month, or immunocompromised status.
- Cephalexin: Options in penicillin-allergies.
- Azithromycin: An alternative.
- Clindamycin: For penicillin allergies and infections not responding to other abx
- Levofloxacin: For adults (specific conditions indicated).
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Description
This lesson covers the etiology, diagnosis, and treatment of acute otitis media (AOM). It details diagnostic criteria from the AAP and treatment options, including antibiotics and pain management. Key pathogens and antibiotic resistance are also discussed.
