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45 Cards in this Set
- Front
- Back
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This condition is most common between the ages of 6 months and 2 years
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Otitis Media
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define
Acute Otitis Media (AOM): |
Rapidly developing fluid in the middle ear (effusion) that is SYMPTOMATIC
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define
Otitis media with effusion(OME): |
Fluid in middle ear with NO SYMPTOMS (fluid after acute infection can remain for 3 months)
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OM risk factors
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abx use in last 3 mos and day car = incr risk for abx resist
day care attendance*, family history of OM, siblings in the home, bottle feeding, lower socioeconomic status, smokers in household, cleft palate/craniofacial abnormalities, pacifier use, young age at 1st diagnosis* |
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Common Pathogens for OM
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S. pneumoniae
Haemophilus influenzae (B-lactamase sometimes) Moraxella catarrhalis (B-lactamase 100%) --2nd, 3rd, 4th gen Cefs Viral |
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Abx use for OM depends on...
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patient age, illness severity (fever, pain), and certainty of diagnosis
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OM tx
< 6 mos 6 mos - 2 yrs > 2 yrs |
< 6 mos = abx MUST TREAT
6-2 = W&W if healthy, NON-SEVERE sxs (and not recurrent disease) ---AND--- UNCERTAIN DIAGNOSIS >2 yrs W&W if healthy w/non-severe sxs --OR-- uncertain diagnsis |
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Rx thpy for
OM uncomplicated and PCN alt Type1 / non-T1 OM complicated and PCN alt Type1 / non-T1 |
uncomplicated = Amoxicillin 80-90 mg/kg/day
Non-Type I: Cefdinir, Cefuroxime, Cefpodoxime, (ALL ORAL) Type I: Azithromycin, clarithromycin (Mac) complicated = Amoxicillin-clavulanate 90 mg/kg/day amoxicillin with 6.4 mg/kg/day clavulanate Non-type I: Ceftriaxone for 1 or 3 days* Type I: same as above |
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Sxs for complicated vs uncomplicated OM
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Temperature > 39 C and/or severe otalgia (pain)
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AOM
What if there was a patient in for intial treatment for AOM with a Type I allergy to PCN and it is considered complicated. What antibiotics could be recommended |
Ceftriaxone 1d or 3d
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It is stated that if more severe symptoms it is more likely S. pneumoniae. If this is correct, how may the guidelines be going against evidence.
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guidelines say to use Augmentin if more severe but we've found that most ear infx are S. pneumonae...which amoxicillin covers; don't need H. influenza to cover most infx
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What are possible complications of otitis media?
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hearing loss, speech, sinusitis, meningitis, brain absence
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AOM
name the 2 agents good for all types of bacteria that could cause AOM? |
augmentin
ceftriaxone cover all 3 orgs |
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AOM with non-severe symptoms
AOM with severe symptoms AOM that failed amoxicillin 80-90 mg/kg/day AOM that failed amoxicillin/clavulanate 80-90 mg/kg/day |
amox -> aug -> ceftriax
A. amox B. augmentin C. augmentin D. ceftriaxone |
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AOM
General Guidelines for duration... 10 day therapy for <2 year old, those with recurrent, and older with severe 5-7 days may be used in older children with mild to moderate infection (Some suggest >5 year old to receive shorter therapy) Note: azithromycin and ceftriaxone are exceptions ___ day therapy for <2 year old, those with recurrent, and older with severe sxs ____ days may be used in older children with mild to moderate infection (Some suggest >5 year old to receive shorter therapy) Note: azithromycin and ceftriaxone are exceptions |
<2yr = 10 day thpy
>2yr = 5-7 azith and ceftriax are exceptions |
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Name the 3 most common bacterial pathogens that cause acute otitis media.
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a. Streptococcus Pneumoniae
b. Haemophilus Influenzae (B-lactamase) c. Maraxella Influenzae (B-lactamase – 100%) |
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Which antibiotic is “first line” for JB’s acute otitis media?
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Amoxicillin
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Does amoxicillin cover all 3 AOM pathogens? If not, explain why it is “first-line”.
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No
Most common bug is S. pneumonae - BUT this is changing with immuniz vs. S. pneumonae |
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How dose amox for AOM?
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amox = 80-90 mg/kg/day
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Alternating APAP and IBU is it better than monotherapy for pain?
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nope, may lead to OD too
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How do you counsel parents on admin ear drops for themselves and then for children.
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In ear you pull out and up,
if kids pull out and down when inserting medication in the ear + lay down for 5 min |
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AOM
If JB had a history of a Type 1 reaction to penicillin what would you give him? Does complicated/uncomp matter here? Why? |
Azithromycin
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AOM
If JB fails therapy after amoxicillin, what antibiotic would be second-line? |
Augmentin
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How much time should pass before you determine that a non-response to the antibiotic is a treatment failure?
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48-72hrs
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List 3 risk factors (in general) for developing otitis media.
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Day care
Previous URI Pacifier Smoking (odd, I know) Children predisposed: Tube is shorter Tube is more flaccid Tube is more horizontal than adults Therefore, do not drain as well and doesn’t protect middle ear as well from infection |
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Sinusitis
Acute sinusitis symptoms resolves in ... Chronic sinusitis persists ____ days as cough, rhinorrhea, or nasal obstruction |
< 4 weeks
>90 days |
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Sinusitis
Etiology |
Viral infection or allergy related mucosal inflammation and damage to mucociliary clearance
May result in blockage of the opening of the sinuses which may result in bacterial growth |
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What are the most common organisms that cause acute bacterial sinusitis? How are these organisms the same or different than otitis media?
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Same as AOM: S. pneumonia, H. influenza, Maxella catarrhalis
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What are the complications of sinusitis?
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Meningitis, orbital cellulitis
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Informative only:
What are AB’s symptoms that are suggestive of acute bacterial sinusitis (ABS)? What are other symptoms patients may have with sinusitis? |
Infx >7 days – hasn’t resolved and a slight fever with pain in her molars. Likely a secondary bacterial infx following viral initiation of sinusitis.
• Nasal discharge/congestion • Headache • MAXILLARY TOOTH PAIN, facial or sinus pain that may radiate (unilateral in particular) as well as deterioration after initial improvement • SEVERE & PERSISTANT (beyond 7 days) signs and symptoms are most likely bacterial and should be treated with antimicrobials |
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In sinusitis, what is the recommended length of symptoms prior to initiation of therapy?
Is there any reason therapy may be started earlier? |
10 days
Persistent, worsening, severe sxs (e.g. fever, extreme pain etc.) |
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What OTC medications may be recommended for acute sinusitis this time?
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humidifiers, vapo-rub, irrigation, saline nasal sprays
NOT decongestants, antihistamines...etc. |
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At what time frame do you expect improvement with abx use?
If no improvment,what antibiotics should now be instituted |
3 days
Augmentin or otherwise: cefdinir, cefpodoxine, CEFUROXIME *not cefipime, though you could use it |
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Mild-mod, NO RECENT ABX
First line therapy <18 vs. >18 |
Same:
amoxicillin - cephs |
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ABS
How do we treat it? What should abx's be reserved for? |
<10 days and mild symptoms = usually self resolves symptom relief
Watchful waiting up to 7 days after diagnosis Antibiotic therapy should be reserved for: Persistent, worsening, or severe sinusitis Patients with moderately severe symptoms >10 days OR worsened within 10 days after initial improvement OR severe disease regardless of duration |
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Pharyngitis
most common bug if bacterial? usually self resolves ____ days |
If bacterial, most common is Group A streptococcus – Beta hemolytic: (S. pyogenes)
2-4 days after onset |
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Pharyngitis
Name of scoring system used to determine if the pt should be tested or not? |
Centor Score
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ABS
If treating child <18 don't give these abx classes ____ & ____ |
FQ/doxy
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ABS (acute bacterial sinusitus)
TX summary steps: pt shows up has sxs = wait ___ days still sick...give ____ and wait ___ days still not resoved; give ____ unless allergy, then give one of these .... |
10d
amoxicillin 3d augmentin 2nd/3rd cef, macrolides, doxy, bactrim |
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Pharyngitis
bugs.. resolves in... |
Grp A strp PYOGENES (B-hemo)
viral 2-4 days (self limit) |
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Pharyngitis
Centor score criteria includes... |
cough
swollen nodes (cervical ADENOPATHY) FEVER T>38C TONSILLAR EXUDATE |
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Pharyngitis
Labs, DX |
RADT - rapid antigen detection test
if fail = throat culture if: --<18 or adult around kids --AND-- have sxs |
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Pharyngitis
Sxs Tx just for sxs |
sudden onset throat pain swelling
fever HA/N/V cramps red/swollen pharynx gargle, rest, analgesic, fluids |
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Pharyngitis
When should we consider assessing pt via throat culture? |
If <18 year old or adult with significant pediatric involvement/contact and negative rapid antigen consider throat culture
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Pharyngitis
Who requires ABX Tx? Which ABX is DOC? Length of thpy? What if peni allgergy? |
pts w/Centor = 3 or 4 and pos RADT or throat culture
PCN VK, IM PeniG benzathine, oral amox x10 days allergy: oral ERYTHROMYCIN; 1ST GEN CEPH (cefazolin, cephalexin) |
