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Goals of Therapy
Acute Otitis Media
Pain Management and Prudent antibiotic use - think of potential bacterial resistance
Acute bacterial rhinosinusitis
reduce s/sx, limit antibiotic treatment, eradicate bacterial infection, minimize duration of illness, prevent complications and progression of disease
Bacterial pharyngitis
Improve clinical s/sx, minimize ADRs, prevent transmission, prevent acute rheumatic fever and suppurative complications
Diagnosis of Acute Otitis Media
fever, pain in ear, presence of past infection, congestion, purulent discharge, redness and bulging of tympanic membrane
Lab tests: nasal swab and throat culture, procalcitonin test possible when warranted
Causative Organisms: S. pneumoniae, H, influenzae, M. catarrhalis
Most Common Types/Causes:
Acute bacterial rhinosinusitis
Acute otitis media
Bacterial Pharyngitis
Diagnosis of Acute Pharyngitis
Signs/Symptoms of GABHS: sore throat, pain on swallowing, fever, headache, N/V,abdominal pain, enlarged tender lymph nose, inflammation of tonsils, red swollen uvula
Lab Tests: Throat swab and culture, Rapid antigen-detection test (RADT)
Signs/Symptoms of Viral Origin: conjunctivitis, coryza, cough
Treatment
Non-Pharm: Gargling with salted wtaer, drinking lots of water, rest, use a humidifier, use saline nasal drops, use otc cough drops
Pharm:
Acute Bacterial Rhinosinusitis
Amoxicillin-clavulanate is first line
If viral rhinosinusitis instead of bacterial, will typically resolve in 7-10 days
Doxycycline or Cephalosporin (if allergic to penicillin)
Acute Pharyngitis
Preferred Antibiotics:
Penicillin G benzathine <27kg: 0.6 million units; >27kg 1.2 million units IM for a single dose
Amoxicillin 50mg/kg QD (max of 1000mg daily) for 10 days
Penicillin V: children: 250mg 2-3x daily; Adults: 250mg QID or 500mg BID for 10 days
Antibiotics if patient has a penicillin allergy:
Cefadroxil 30mg/kg QD for 10 days
Cephalexin 20mg/kg BID for 10 days
Clindamycin 7mg/kg TID for 10 days
Azithromycin 12mg/kg QD for day 1 and then 6mg/kg QD for 4 days
Clarithromycin 15mg/kg divided into 2 doses for 10 days
Acute Otitis Media
Ceftriaxone 25 mg/kg Q12H IV
amoxicillin/calvulanic 45 mg/kg/6.4 mg/kg po BID
amoxicillin 45 mg/kg po BID
Clindamycin plus cefixime or cefpodoxime (PCN allergy)
Pain management with ibuprofen and/or tylenol. Eardrops for local anesthetic
Monitoring and f/u
Monitor for adverse effects, adherence to regimen, fever resolution, presence of infection across family members
throat culture if infection lingers
Prevention
seven-valent pneumococcal conjugate vaccine and annual influenza vaccination
Diagnosis of Acute Bacterial Rhinosisusitis
Signs/Symptoms: purulent anterior nasal discharge, discolored nasal discharge, nasal congestion, facial congestion, facial pain, fever, headache, ear pain, dental pain, cough, fatigue