Otitis Media Overview

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Questions and Answers

What is the first line of treatment for Necrotizing Fasciitis?

Antibiotic therapy alone

Wound dressing

Intravenous fluids

Surgical intervention (correct)

Which of the following types of bacteria is classified under Type 1 Necrotizing Fasciitis?

Group A Streptococci

Clostridiodies perfringens

Vibrio vulnificus

Polymicrobial flora (correct)

Which antibiotic combination is used as empirical therapy for treating Necrotizing Fasciitis?

Ceftriaxone and Doxycycline

Ciprofloxacin and Metronidazole

Vancomycin/Linezolid with Piperacillin/Tazobactam (correct)

Amoxicillin and Clindamycin

What is a characteristic symptom of Gas Gangrene?

Presence of gas pockets Signup and view all the answers

Which of the following is NOT a common pathogen associated with Gas Gangrene?

Staphylococcus epidermidis Signup and view all the answers

Which imaging technique is used to detect abscesses in cases of purulent infection?

CT scan Signup and view all the answers

What is the duration of treatment for moderate Purulent Infections after incision and drainage?

5-14 days Signup and view all the answers

Which antibiotic regimen is recommended for the targeted therapy of Vibrio vulnificus?

Doxycycline + Ceftazidime Signup and view all the answers

Which oral medications are used for moderate SSTIs if MSSA is confirmed?

Dicloxacillin Signup and view all the answers

What is the recommended duration of treatment for animal bite wounds?

3-5 days Signup and view all the answers

In cases of human bites, which bacteria is NOT typically involved?

E. coli Signup and view all the answers

Which intravenous medication is NOT effective against empiric or confirmed MRSA for severe SSTIs?

Nitrofurantoin Signup and view all the answers

What is a common pathogen associated with surgical site infections?

S. aureus Signup and view all the answers

Which of the following is NOT considered a common treatment for human bites?

Vancomycin Signup and view all the answers

What is a key consideration for managing SSTIs effectively?

Source control, if achievable Signup and view all the answers

Which vaccination is recommended for post-exposure prophylaxis after an animal bite?

Rabies Signup and view all the answers

Which of the following are characteristics of a furuncle?

A firm tender red nodule with spontaneous drainage Signup and view all the answers

What is the primary coverage for mild non-purulent infections such as erysipelas?

Group A Streptococcus Signup and view all the answers

In non-purulent infections, which of the following symptoms indicates a moderate severity?

Systemic signs and symptoms of infection Signup and view all the answers

Which treatment is recommended for a carbuncle?

Incision and drainage (I & D) Signup and view all the answers

What is a common risk factor for Pseudomonas aeruginosa infection?

High local prevalence Signup and view all the answers

Which treatment is appropriate for a severe non-purulent infection?

Broad spectrum including MRSA and gram-negative coverage Signup and view all the answers

What feature distinguishes necrotizing fasciitis from other non-purulent infections?

Rapid spreading causing tissue death Signup and view all the answers

Which antibiotic is preferred for oral therapy of mild infections confirmed to be caused by streptococci?

Penicillin VK Signup and view all the answers

What is an essential characteristic of cellulitis?

It starts superficial and can spread deeper. Signup and view all the answers

What is a typical presentation of impetigo?

Honey-colored crusts with dried discharge Signup and view all the answers

What is the first-line treatment for acute otitis media in children?

Amoxicillin high dose Signup and view all the answers

Which condition does NOT require antibiotic therapy?

Chronic otitis media Signup and view all the answers

What indicates a need for antibiotics if the child has an acute ear infection?

Ear pain lasting more than 48 hours Signup and view all the answers

In which situation would you prescribe Amoxicillin Clavulanate instead of Amoxicillin?

Ongoing symptoms without improvement after Amoxicillin Signup and view all the answers

What must be monitored before initiating antibiotics in non-severe unilateral acute otitis media in children aged 6 months and older?

Joint decision made with parents Signup and view all the answers

What is the recommended dosage of Cefdinir for children?

14 mg/kg/day Signup and view all the answers

Which symptom does NOT warrant immediate initiation of antibiotics for acute otitis media?

Bilateral acute otitis media without otorrhea Signup and view all the answers

What would you expect in the physical findings of a skin and soft tissue infection?

Presence of fever Signup and view all the answers

What type of skin infection is monomicrobial and involves previously healthy skin?

Primary infection Signup and view all the answers

What is a common lab finding for skin and soft tissue infections?

Complete Blood Count (CBC) Signup and view all the answers

Study Notes

Otitis Media

Otitis media is an inflammation of the middle ear.
There are three types of otitis media: acute otitis media, otitis media with effusion, and chronic otitis media.
Acute otitis media is a common infection in children, often occurring after a viral respiratory illness (common cold).
It can be caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
Symptoms of acute otitis media include ear pain (otalgia) and ear drainage (otorrhea).
Diagnosis is made by observing the tympanic membrane for bulging or erythema.
High dose amoxicillin is the first-line treatment for acute otitis media in children.
Amoxicillin-clavulanate is used if certain criteria are met, such as previous amoxicillin use or a history of recurrent infections.
Observation without antibiotics may be considered for children 6 months or older with non-severe, unilateral otitis media without otorrhea.
Observation without antibiotics may also be considered for children 24 months or older with bilateral otitis media without otorrhea.

Skin and Soft Tissue Infections (SSTIs)

SSTIs are categorized based on site, depth, presentation, and clinical setting.
They can be primary (involving healthy skin) or secondary (involving damaged skin).
Physical findings include erythema, induration, swelling, discharge, warmth, and pain.
Laboratory findings include elevated white blood cell count (WBC) and C-reactive protein (CRP).
Imaging (CT/MRI) can reveal soft tissue edema, fascial thickening, fluid collection, and soft tissue air.
Cultures and sensitivities are used to identify the causative organisms.
Common skin organisms include coagulase-negative Staphylococcus, Cutibacterium, Micrococcus, Corynebacterium, Staphylococcus aureus, and Streptococcus pyogenes.

Types of SSTIs

Superficial SSTIs:
- Impetigo: Characterized by honey-colored crusts, fluid-filled lesions, and a preference for topical treatment.
- Folliculitis: Inflammation of hair follicles.
- Furuncle (boil): Painful, pus-filled nodule developing in a hair follicle.
- Carbuncle: Multiple furuncles that coalesce, forming a deep follicular mass.
Non-superficial SSTIs:
- Non-purulent:
  - Erysipelas: Bright red, well-demarcated area with lymphatic involvement.
  - Cellulitis: Superficial infection that can spread deeper, potentially accompanied by an abscess.
  - Necrotizing fasciitis: Rapidly spreading infection causing tissue death, characterized by skin discoloration.
- Purulent:
  - Abscess: Localized fluid collection with pain, fever, and malaise.

Treatment Considerations

Treatment of SSTIs depends on the severity of the infection and the presence of systemic signs.
Mild infections are typically treated with oral antibiotics.
Moderate infections require intravenous antibiotics.
Severe infections often necessitate broad-spectrum coverage and IV antibiotics.
Source control is crucial in treating SSTIs, often requiring incision and drainage (I&D) of abscesses.
Empiric antimicrobial therapy is selected based on the infection site, risk factors, local susceptibility patterns, and likely pathogens.

Other SSTIs

Animal Bite Wounds:
- Polymicrobial in nature.
- Common organisms include Pasteurella, Streptococcus, and Staphylococcus.
- Treatment includes amoxicillin-clavulanate, doxycycline, or moxifloxacin.
- Prophylactic vaccinations for rabies and tetanus are recommended.
- Human Bite Wounds:
- Often clenched fist injuries.
- Common organisms include Viridians Streptococci, S. aureus, and Fusobacterium.
- Treatment includes amoxicillin-clavulanate, doxycycline, clindamycin + ciprofloxacin, or IV options like ampicillin-sulbactam, cefoxitin, ertapenem, or moxifloxacin.
Surgical Site Infections:
- Exogenous source contamination.
- Common organisms include S. aureus, coagulase-negative Staphylococcus, and Enterococci.
- Prophylaxis with cefazolin is used for MSSA coverage.
- MRSA coverage is recommended for high-risk surgeries.

General Treatment Guidelines

Not all SSTIs require antimicrobial treatment.
Source control is crucial when achievable.
Consider IV to PO conversion, if applicable, once source control is obtained and clinical stability achieved.
Empiric antimicrobials should be selected based on infection site, risk factors, local susceptibility patterns, history, and likely pathogens.
Most causative pathogens for SSTIs include Group A Streptococcus (non-purulent) and S. aureus (purulent).

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Description

This quiz covers the essential aspects of otitis media, including its types, symptoms, causes, and treatment options. Understand the differences between acute, chronic, and effusion types, as well as the management strategies for children affected by this condition.