Head & Neck Infections

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.)
* “high-dose” Amoxicillin = 90 mg/kg/d.
  • Up to 3 gm per day in heavy children, up to 2 gm q8h in adults.
Also Cover Moraxella
  • 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
If Cellulitis around External Ear
  • 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
Ophthalmic antibiotic Preparations
  • 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)
Antibiotics
  • 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
Pathogens
  • Anaerobic Bacteria (if submandibular/submental)
  • Skin Flora: Staph, maybe Strep
Antibiotics
  • 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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