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URI( upper respiratory infection) (Acute Bacterial Rhinosinusitis (goals,…

- - - - Bulging of the tympanic membrane
      - Otorrhea
      - Otalgia (considered to be moderate or severe if pain lasts at least 48 hours)
      - Fever (considered to be severe if temperature is 39°C [102.2°F] or higher)
- - - - nasal decongestant sprays that reduce inflammation by vasoconstriction
        
        limited to no more than 3 days to prevent the development of tolerance and/or rebound congestion
      - Irrigation of the nasal cavity with saline and steam inhalation
    - - children
        
        Augmentin 45 mg/kg/day orally twice daily or 90 mg/kg/day orally twice daily
        
        Clindamycin (30-40 mg/kg/day orally three times daily) plus cefixime (8 mg/kg/day orally twice daily) or cefpodoxime (10 mg/kg/day orally twice daily)
        
        Levofloxacin 10-20 mg/kg/day orally every 12-24 hours
        
        Risk for Antibiotic Resistance or Failed Initial Therapy
        
        Augmentin
        
        90 mg/kg/day orally twice daily
        
        Clindamycin (30-40 mg/kg/day orally three times daily) plus cefixime (8 mg/kg/day orally twice daily) or cefpodoxime (10 mg/kg/day orally twice daily)
        
        Levofloxacin 10-20 mg/kg/day orally every 12-24 hours
        
        Severe Infection Requiring Hospitalization
        
        Ampicillin-sulbactam 200-400 mg/kg/day IV every 6 hours
        
        Ceftriaxone 50 mg/kg/day IV every 12 hours
        
        Cefotaxime 100-200 mg/kg/day IV every 6 hours
        
        Levofloxacin 10-20 mg/kg/day IV every 12-24 hours
      - first line: AUGMENTIN
      - adults
        
        Initial Empirical Therapy
        
        Augmentin 500 mg/125 mg orally three times daily, or 875 mg/125 mg orally twice daily or 2,000 mg/125 mg orally twice daily
        
        Doxycycline 100 mg orally twice daily or 200 mg orally once daily
        
        Levofloxacin 500 mg orally once daily
        
        Moxifloxacin 400 mg orally once daily
        
        Risk for Antibiotic Resistance or Failed Initial Therapy
        
        Augmentin® 2,000 mg/125 mg orally twice daily
        
        Levofloxacin 500 mg orally once daily
        
        Moxifloxacin 400 mg orally once daily
        
        Severe Infection Requiring Hospitalization
        
        Unasyn® 1.5-3 g IV every 6 hours
        
        Levaquin® 500 mg orally once daily
        
        Moxifloxacin 400 mg orally once daily
        
        Ceftriaxone 1-2 g IV every 12-24 hours
        
        Cefotaxime 2 g IV every 4-6 hours
- - - - sore throat
      - pain on swallowing
      - fever
      - headache
      - nausea/vomit
      - abdominal pain
      - erythema/inflammation of the tonsils and pharynx
      - enlarged, tender lymph nodes
      - red swollen uvulva, petechiae on soft palate, scarlatiniform rash
    - - conjunctivitis
      - coryza
      - cough
    - - sore throat of sudden onset (self-limiting)
      - Fever and constitutional symptoms resolving in about 3 to 5 days
  - - - supportive care
    - - GABHS
        
        pen V
        
        Children: 250 mg twice daily or three times daily orally
        Adult: 250 mg four times daily or 500 mg twice daily orally
        one dose
        
        Pen G benzathine
        
        < 27 kg: 0.6 million units; 27 kg or greater: 1.2 million units intramuscularly x10 days
        
        amoxicillin
        
        50 mg/kg once daily (maximum 1,000 mg); 25 mg/kg (maximum 500 mg) twice daily x10 days
        
        alternatives
        
        cephalexin
        
        cefadroxil
        
        clindamycin
        
        azithromycin
        
        clarithromycin
      - GABHS Chronic Carriers
        
        clindamycin
        
        augmentin
        
        pen V & rifampin
        
        pen G benzathine & rifampin
      - supportive care
        
        antipyretics
        
        analgesics
        
        lozenges or sprays including menthol
        
        topical anesthetics