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Antibiotics 1 (Upper Respiratory Tract Infections (URTI) (Acute…
Antibiotics 1
Upper Respiratory Tract Infections (URTI)
Acute Rhinosinusitis
80% resolves within 14 days, therefore mostly use analgesia
Consider 7 day abx if prudent nasal discharge
Amoxicillin 500mg TDS for 7 days or Doxycycline 100mg BD for 7 days or Phenoxymethylpenicillin 500mg QDS for 7 days
In persistent infections use amoxicillin 500mg QDS and metronmidazole 400mg TDS for 7 days
Acute otitis media
Optimise analgesia and target abx
<2 years AND bilateral AOM or bulging membrane and 4 or more marked symptoms
Amoxicillin 250-500mg BD for 5 days or clarithromycin 250-500mg BD for 5 days
All ages with ottorhoea
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Acute otitis externa
If cellulitis/disease extends outside ear canal, give abs and refer to exclude malignant OE
Otherwise start with topical acetic acid 2% or as a 2nd line use antibiotic +- steroid (neomycin surface and corticosteroid)
Acute sore throat
Avoid abx but use "Fever PAIN" score
2-3 score = 30-40% strep. Give delayed prescription
0-1 score = 13-18% strep. Therefore NO abx
4 score = 62-65% strep. Give immediate abx px
If giving abs - Phenoxymethylpenicillin 500mg QDS or 1g BD for 10 days. Penicillin allergy - give clarithroymycin 250-500mg BD for 5 days or Erythromycin 500mg QDS for 5 days (in pregnancy)
Lower Respiratory Tract Infections (LRTI)
Acute exacerbation of COPD
Treat if purulent sputum and increased SOB and/or increased sputum volume
Amoxicillin 500mg TD or Doxycycline 100mg BD or clarithromycin 500mg BD for 5 days. If resistant, Clarithromycin 500mg BD for 5 days.
Acute bronchitis
Consider 7 day delayed abx
Immediate abx if >80 years AND either hospitalisation in last year, oral steroids, diabetic or congestive heart failure. Or >65 years AND 2 of above.
Amoxicillin 500mg TDS for 5 days or Doxycycline 100mg BD for 5 days
Community-acquired pneumonia
Use CRB65 score
Confusion, RR >30/min, BP systolic <90mmHg or diastolic 60 or less mmHg, 65 or older.
1-2 = Intermediate risk, consider hospital
3-4 = High risk, urgent hospital admission
0 = Low risk
CRB=1/2 and at home, amoxicillin 500mg TDS AND clarithromycin 500mg BD for 7 days OR Doxycycline 100mg BD for 7 days
CRB65=0, amoxicillin 500mg TDS or Doxycycline 100mg BD or clarithromycin 500mg BD for 5 days