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22 Cards in this Set

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Review diagnostic criteria for acute otitis media.
1. History of acute onset and signs and sx.
2. Presences of Middle Ear Effusion (MEE)
a. bulging of the TM
B. limited or absent mobility of TM
c. air-fluid level behind the TM
D. otorrhea
3. Signs and Symptoms of middle ear inflammation:
a. distinct erythema of the TM or otalgia.
Name the common organisms which cause AOM?
S. pneumoniae
H. influenzae non-typable
M. catarrhalis
Review mechanisms of bacterial resistance to antibiotics.
S. pneumoniae: can be overcome with higher doses of amoxicillin.
H. influenza and M. catarrhalis: B-lactamase producing (need to use amoxicillin/clavulanate, cefdinir, cefuroxime, ceftriaxone)
What are some characteristics of COMPT of otitis media?
Color: red, pale yellow
Other: fluid, pus, perforation with otorrhea, bullae
Mobility: 0 - 3 +
Position: Full, bulging
Translucence: Opacified
Who gets antibiotics and who does not?
Certain uncertain
<6 mo antibio antibio
6-2 yrs antibio sever:anti
nons: obs.
> 2 yrs sev: an observ
nonsev:obser
Treatment of Otitis Media:
type I: azithromycin, clari.
non - type I: cefdinir, rocephin, Cefpodoxime.

Recommended: with fever: augmentin

Nontype 1: I.m. Ceftriaxone (1 or 3 days.)
Treat of Otitis media after failure of antibacterial tx:
No fever: augmentin 90 mg/kg
type I: clindamycin
nontype I: I.M. ceftriaxone x 3 days.

Yes fever: I.m. ceftriaxone for 3 days. allergy...tympanocentesis then clindamycin
Treatment for OTITIS MEDIA:
Amoxicillin
Augmentin
Cefdinir
Cefuroxime (Ceftin):
Ceftriaxone
Azithromycin
Clarithromycin
Clindamycin
Ceftriaxone (Rocephin)
- IM injection
- reconstitute vial with 1% lidocaine in final conc. of 350 mg/mL to reduce pain of injection.
- increase in serum bilirubin
Azithromyin
- CYP 450 (3A4 SUBSTRATE)
- CYP 450 (3A3 AND 4 inhibitor)
14 days at room temperature:
- Clarithromycin
CYP450 3A3/4 SUBTRATE
CYP450 1A2 3A4 Inhibitor
- Clindamycin: c. difficile
CYP 450 3A3/4 SUBSTRATE
- Amoxicillin
What are some of the NON -preventable risk factors?
Genetics
Gender (boy)
Ethinicity (native, alaskan, inuit)
Low socioeconomic class.
Large families
Special Medical conditions
What are some preventable risk factors?
1. Day care attendance
2. Exposure to tobacco smoke
3. Lack of Breast-feeding
4. Extended pacifier use for greater than 10 month.
Common organism of pharyngitis
- M. catarrhis
- Group A strept
- Strept Pneumonie
- H. influenza
Diagnoses of pharyngitis:
- Age (5-15)
- Season
- Evidence of acute pharyngitis (erythema, edema, exudates)
- Tender, enlarged anterior cerivical lymph nodes.
- Middle grade fever (101-104 F)
- Absence of sx associated with viral URI
Pencillin V
- take with water on an empty stomach 1 hour before or 2 hours after meals.
- 14 days need to ref.
Medications for pharyngitis:
- Pencillin
- Amoxicillin
- Cephalosporins
- Clindamycin
- Azithromycin
What cephalosporins are 10 days therpay:
cephalexin
cefaclor
cefixime
cefprozil
Which are 4-5 days:
cefdinir
cefadroxil
cefuroxime
cepodoxime
What are some ways to ensure eradication of the organism/
- cephaloporin
- add rifampin to pencillin for the last 4 days.
- clindamycin
What are some supportive complications that can occur from pharynigitis?
- Acute otitis media
- Acute bacterial sinusitis
- Cervical adenitis
- Peritonsillar and retropharyngeal abscess
- Meningitis
- Sepsis
- necrotizing fascitis
What are some non-supportive complications that can occur from pharynigitis?
- Acute Rheumatic Fever
- Scarlet fever
- Acute Glomerulonephritis