URI

Treatment

Goals of Therapy

Monitoring and f/u

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

Non-Pharm: Gargling with salted wtaer, drinking lots of water, rest, use a humidifier, use saline nasal drops, use otc cough drops

Pharm:

Causative Organisms: S. pneumoniae, H, influenzae, M. catarrhalis

Acute Otitis Media

Most Common Types/Causes:

Acute bacterial rhinosinusitis

Acute otitis media

Acute bacterial rhinosinusitis

Bacterial Pharyngitis

Monitor for adverse effects, adherence to regimen, fever resolution, presence of infection across family members

throat culture if infection lingers

Pain Management and Prudent antibiotic use - think of potential bacterial resistance

Prevention

seven-valent pneumococcal conjugate vaccine and annual influenza vaccination

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 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

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

Acute Bacterial Rhinosinusitis

Amoxicillin-clavulanate is first line

If viral rhinosinusitis instead of bacterial, will typically resolve in 7-10 days

Acute Pharyngitis

Preferred Antibiotics:

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

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

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

Doxycycline or Cephalosporin (if allergic to penicillin)

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