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11 Cards in this Set
- Front
- Back
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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 |
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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 |
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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 |
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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 |
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Malignant Otitis Externa is a person w/ DM, HIV/AIDS, on Chemotherapy - COMMON PATHOGENS |
Pseudomonas spp. in > 90% |
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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
*Comment: -Surgical debridement usually needed. -MRI or CT to evaluate for osteomyelitis may be indicated -Parenteral antimicrobial therapy may be warranted for severe disease |
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Acute Otitis Media - COMMON PATHOGENS |
S. pneumoniae H. influenzae M. catarrhalis Viral or no pathogen (approx. 55% bacterial, S. pneumoniae most common) |
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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
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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
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Exudative Pharyngitis - COMMON PATHOGENS |
Group A, C, G streptococcus Viral HHV-6 M. pneumoniae
*Comment: -Vesicular, ulcerative pharyngitis usually viral -Only 10% of adult pharyngitis due to group A streptococcus
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Exudative Pharyngitis - Recommended Antimicrobial Therapy |
First-line: penicillin V PO x 10 days OR benzathine penicillin IM x 1 dose if adherence an issue
Alternative: erythromycin x 10 days second generation cephalosporin x 4-6 days azithromycin x 5 days clarithromycin x 10 days
Up to 35% S. pyogenes isolates resistant to macrolides
*Comment: -No treatment recommended for asymptomatic group A streptococcus carrier
-For recurrent, culture-proven group A streptococcus, consider co-infection w/ beta-lactamase-producing organism -- Treat w/ amoxicillin w/ clavulanate or clindamycin
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