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Suppurative Conjunctivitis (non-gonococcal, non-chlamydial) - COMMON PATHOGENS
Staphylococcus aureus (gram-positive cocci)
Streptococcus pneumoniae (gram-positive cocci)
Haemophilus influenzae (gram-negative)
Outbreaks due to atypical S. pneumoniae
*Comment: Bacterial and viral conjunctivitis ("pink eye", usually caused by adenovirus) often self-limiting. Relieve irritative sxs w/ use of cold artificial tear solution
Suppurative Conjunctivitis (non-gonococcal, non-chlamydial) - Recommended Antimicrobial
Primary: Ophthalmic treatment w/ FQ ocular solution (gatifloxacin, levofloxacin, moxifloxacin)
Alternative: Ophthalmic treatment w/ bacitracin-polymixin B w/ neomycin and hydrocortisone
*Comment: Most S. pneumoniae is resistant to tobramycin and gentamicin
Otitis Externa (Swimmmer's Ear) - COMMON PATHOGENS
Pseudomonas spp. (gram-negative bacilli)
Proteus spp.,
Enterobacteriaceae (gram-negative bacilli)
Acute Infection often S. aureus (gram-positive)
Fungi rare etiology
Otitis Externa (Swimmmer's Ear) - Recommended Antimicrobials
Otic drops w/ ofloxacin or ciprofloxacin w/ hydrocortisone
OR
Polymyxin B w/ neomycin and hydrocortisone
*Comment:
-Ear canal cleansing important.
-Decrease risk of re-infection by use of eardrops of 1:2 mixture of white vinegar and rubbing alcohol after swimming
Do not use neomycin if TM punctured
Malignant Otitis Externa is a person w/ DM, HIV/AIDS, on Chemotherapy - COMMON PATHOGENS
Pseudomonas spp. in > 90%
Malignant Otitis Externa is a person w/ DM, HIV/AIDS, on Chemotherapy - Recommended Antimicrobials
Oral Ciprofloxacin for early disease suitable for outpatient therapy
Other options available if inpatient therapy warranted in severe disease
-Surgical debridement usually needed.
-MRI or CT to evaluate for osteomyelitis may be indicated
-Parenteral antimicrobial therapy may be warranted for severe disease
Acute Otitis Media - COMMON PATHOGENS
S. pneumoniae
H. influenzae
M. catarrhalis
Viral or no pathogen (approx. 55% bacterial, S. pneumoniae most common)
Acute Otitis Media - Recommended Antimicrobials
If no antimicrobial therapy in the past month:
Amoxicillin at high dose (HD) (3-4 g/day in adults) OR
Usual doses (1.75-3 g/day in adults)
If antimicrobial therapy in the past month:
HD amoxicillin with or without Clavulanate, cefdinir, cefpodoxime, cefprozil, cefuroxime
If treatment failure > 72 hours of therapy and no antimicrobial therapy in past month:
HD amoxicillin w/ Clavulanate, cefdinir, cefpodoxime, cefprozil, cefuroxime, or IM ceftriaxone (ceftriaxone daily x 3 days)
If treatment failure > 72 hours and antimicrobial therapy in past month:
IM ceftriaxone qd x 3 days, clindamycin, or tympanocenteresis
Acute Otitis Media - Comments
-Consider drug-resistant S. pneumoniae (DRSP) risk: antimicrobial therapy in past 3 months, age < 2 years, day-care attendance.
-HD amoxicillin usually effective in DRSP
-Length of therapy: < 2 years, 10 days; > 2 years, 5-7 days
-If allergy to beta-lactam drugs: TMP-SMX, clarithromycin, azithromycin; all less effective against DRSP compared with other options
-If PCN allergy history is unclear or rash (no hive-form lesions), cephalosporins likely okay
-Clindamycin effective against DRSP, ineffective against H. influenzae, M. catarrhalis
Exudative Pharyngitis - COMMON PATHOGENS
Group A, C, G streptococcus
Viral
HHV-6
M. pneumoniae
-Vesicular, ulcerative pharyngitis usually viral
-Only 10% of adult pharyngitis due to group A streptococcus
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