TOPICS
• Otitis Media & Sinusitis • Otitis Externa • Conjunctivitis • Pharyngitis • Oral Infections • Lymphadenitis (click link for Common Doses of Antibiotics)OTITIS MEDIA & SINUSITIS (bacterial)
Main Pathogens- Streptococcus pneumoniae (“Pneumococcus”)
- Hemophilus influenzae (“H. flu”)
- Moraxella catarrhalis
Antibiotics
Initial Choices (for Pneumococcus & H. Flu)- Amoxicillin (maybe high-dose)*
- Amoxicillin-clavulanate
- Doxycycline (if >8 y.o.)
- Up to 3 gm per day in heavy children, up to 2 gm q8h in adults.
- Amoxacillin-clavulanate
- Cefuroxime
- Levofloxacin (avoid in children)
NOTE: Macrolides (e.g. azithromycin) & TMP-SMX no longer recommended due to ≥30% Pneumococcal resistance. See IDSA 2012 Guidelines.
OTITIS EXTERNA
Main Pathogens- Pseudomonas aeruginosa
- Staphyloococcus aureus (incl. MRSA)
Antibiotics
Topical Drops (usually otic)- Ciprofloxacin or Ofloxacin
- Neomycin + Polymyxin + hydrocortisone (Cortisporin®)
- Gentamicin or Tobramycin ophthalmic drops
- Tobramycin + dexamethasone ophthalmic suspension
- MRSA coverage PLUS drops as above
- Ciprofloxacin p.o. [won’t cover MRSA]
- If febrile or diabetic, admit for IV Tx
CONJUNCTIVITIS (bacterial)
Main Pathogens- Streptococcus pneumoniae (“Pneumococcus”)
- Hemophilus influenzae (“H. flu”)
- Moraxella catarrhalis
- Staphylococcus aureus
- Erythromycin ointment
- Polymyxin-Trimethoprim drops (Polytrim®)
- Azithromycin drops [expensive]
- Ciprofloxacin / Oflaoxacin drops [expensive]
- AVOID sulfonamide drops [sensitizing]
- AVOID neomycin preparations [very sensitizing]
PHARYNGITIS (bacterial)
Only Bacterial Pathogen- Streptococcus pyogenes (Group A beta-hemolytic Strep)
- Pen VK 250 mg Q.I.D. x10 days
- Pen-allergic: cephalosporin, macrolide, or clindamycin
- Hx Rheumatic Carditis: Benzathine Penicillin 1,200,000 Units IM
ORAL INFECTIONS (bacterial)
Pathogens — Anaerobic Bacteria
Antibiotics- Pen VK 500 mg Q.I.D.
- Amoxicillin-clavulanate (Augmentin®) or Clindamycin *
- Pen-Allergic: Clindamycin or Metronidazole
- More severe infection: Clindamycin or Metronidazole
* some sources prefer these in case oral beta-lactamases present
LYMPHADENITIS (cervical)
Definition- Acute, painful, focal, tender, single node
- Not acute, tender, regional nodes
- Not solitary non-painful, non-tender node
- Anaerobic Bacteria (if submandibular/submental)
- Skin Flora: Staph, maybe Strep
- For Oral Anaerobes, see above
- For MRSA: TMP-SMX, Doxycycline, Clindamycin
- See Infectious Disease – 1 (Skin & Soft Tissue) re: Tx skin sources
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