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Diagnosis
Initial Testing:
- Acute Otitis Media: pneumatic otoscope to check for ear infection
- Acute Bacterial Rhinosinusitis: clinical criteria, sinus puncture and culture, sinus radiography
- Acute Pharyngitis: Throat swab and culture
Classification: Otitis media, rhinosinusitis, and pharyngitis are the three most common upper respiratory tract infections.
Signs and Symptoms:
- Acute Otitis Media: acute onset of ear pain, moderate-severe bulging of the tympanic membrane, fever, otorrhea.
- Acute Bacterial Rhinosinusitis: purulent anterior nasal discharge, nasal congestion, fever, headache, ear pain, cough, fatigue
- Acute Pharyngitis: sore throat, erythema/inflammation of the tonsils, enlarged lymph nodes, headache, N/V, fever
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Pharmacologic Treatment
Acute Otitis Media
Ceftriaxone
Dosing regimen: IM, IV: 1 to 2 g once daily for 3 days
MOA: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis.
Adverse reactions: skin tightness, skin rash, diarrhea, eosinophilia
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PK/PD: Protein binding - 85% to 90%; helf-life elimination - 5 to 9 hours; time to peak - 2 to 3 hours
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Warnings: Hypersensitivity, renal/hepatic function impairment
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Education/Counseling: Drink lots of noncaffeine liquids unless told to drink less liquid by your doctor
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cefpodoxime, cefuroxime, cefdinir, amoxicillin-clavulanate, amoxicillin
Acute Pharyngitis
Penicillin V, penicillin G benzathine, Clindamycin, amoxicillin-clavulanate
Amoxicillin
Monitoring: renal, hepatic, and hematologic function periodically. monitor for allergic rxn
Warnings: allergic rxn, GI upset, hepatic dysfunction
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Interactions: warfarin, Acemetacin
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MOA: Amoxicillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis.
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PK,PD
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Time to peak: Capsule, oral suspension: 1 to 2 hours; chewable tablet: 1 hour; extended release: 3.1 hours.
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Goals of Therapy:
- Acute Otitis Media: Treatment goals include pain management and prudent antibiotic use
- Acute Bacterial Rhinosinusitis: re to reduce signs and symptoms, achieve and maintain patency of the ostia, limit antibiotic treatment to those who may benefit, eradicate the bacterial infection with appropriate antibiotic therapy, minimize the duration of illness, prevent complications, and prevent progression from acute disease to chronic disease
- Acute Pharyngitis: improve clinical signs and symptoms, minimize adverse drug reactions, prevent transmission to close contacts, and prevent acute rheumatic fever and suppurative complications, such as peritonsillar abscess, cervical lymphadenitis, and mastoiditis.
Follow Up Monitoring: Follow up with PCP in one week. If prescribed antibiotics, be sure to take the full course of antibiotics.
Non-Pharmacologic Treatment
- Acute Otitis Media: Eardrops, acetaminophen/ibuprofen for pain relief
- Acute Bacterial Rhinosinusitis: Non- pharmacologic treatment not recommended
- Acute Pharyngitis: Supportive care: antipyretic medications, analgesics, nonprescription menthol lozenges and sprays