Acute Infections (URI) PDF
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South College
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This document provides information on the diagnosis, treatment, and duration of three medical conditions: acute otitis media, acute bacterial rhinosinusitis, and acute pharyngitis. It includes details on symptoms, causes, and antibiotic choices. It's a valuable resource for medical professionals.
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Acute Otitis Media Etiology o Strep pneumomiae (resistance to penicillin binding pro) o H. flu and Moraxella catarrhalis (resistance to B-lactamase) Can overcome this resistance with Augmentin Diagnosis from AAP o MEE...
Acute Otitis Media Etiology o Strep pneumomiae (resistance to penicillin binding pro) o H. flu and Moraxella catarrhalis (resistance to B-lactamase) Can overcome this resistance with Augmentin Diagnosis from AAP o MEE w/ moderate/severe bulging of tympanic membrane or new onset otorrhea not due to AOE o MEE w/ mild bulging of TM and onset of ear pain within the last 48h or erythema of TM Treatment o APAP or ibuprofen o ABX (6mns is a hard stop) 6mns - 12y w/ moderate to severe pain + ≥102.2°F 6mns - 23mns w/ non-severe BIL AOM o Observation or abx 6mns - 23mns w/ non-severe UNL AOM 24mns - 12y w/ non-severe AOM o Duration 10 days; may treat 5-7 with mild/mod cases >6yo or 7 days is 2 - 6yo May add dexamethasone to topical cipro to decrease time by 1day Recurrent o Defined: 3 episodes in 6mns or 4 episodes in 1y o Consider t-tube placement Prevention o Flu, H. Flu, and pneumococcal vx Children Antibiotic When to Use Dose Amoxicillin 1st line 80-90 mg/kg/d BID Augmentin If pt has one of the following: 90mg/kg/day BID A. Received amox in the last 30 d B. Concurrent conjunctivitis C. Hx of recurrent infection unresponsive to amox D. Therapy failure after 48-72 hours Cefdinir Type II PCN allergy 14mg/kg/d Clindamycin Type I PCN allergy 30-40mg/kg/d TID Therapy failure after 48-72 hours ± Cefdinir Acute Bacterial Rhinosinusitis Etiology: o Strep pneumomiae o H. flu and Moraxella catarrhalis o Can be preceded by a viral infection Diagnosis from IDSA o ≥ 10 days without improvement o ≥102.2°F for 3-4 consecutive days o "Double sickening" Treatment o Saline spray for irrigation o IN corticosteroids for pt's w/ Hx of AR o Duration Adults 7d Children 10d Children Antibiotic When to Use Dose Augmentin First line 45mg/kg/d BID High Dose Augmentin Endemic areas of s. pneumoniae, severe infxn, daycare, 65y, recent hospitalization, abx 2000mg BID use in the last month, immunocomp. Doxycycline Type I or II PCN allergy 100mg BID Levofloxacin 1st line failure 500mg/d Acute Pharyngitis Etiology o Strep Pyogenes (Group A) Diagnosis o "Pretty obvious" -Dr Lewis in reference to all the s/s o Throat swab/rapid Treatment o Starting abx reduces contagious period to 1 day o Finish course of abx due to complication of rheumatic fever o Can use antipyretics, analgesics, lozenges, etc. o Duration 10 days Exception: Azithromycin for 5 days due to PAE Chronic Carriers o Clindamycin, PCN + Rifampin, or Augmentin Children Antibiotic When to Use Dose Amoxicillin Preferred over PCN due to palatability 50mg/kg/d (MAX 100mg/d) Cephalexin Type II PCN allergy 20mg/kg/dose BID Azithromycin Type I PCN allergy 12mg/kg/d Clindamycin Type I PCN allergy or macrolide resistance 7mg/kg/dose TID Adults Antibiotic When to Use Dose Amoxicillin 1,000mg/Day (can divide) Cephalexin Type II PCN allergy 500mg/d Azithromycin Type I PCN allergy 500mg/d Clindamycin Type I PCN allergy or macrolide resistance 300mg TID
