Exam 3: Pediatric Infections

Question 1

What are the 2 classifications of otitis media?

Answer 1

Otitis Media with Effusion (OME)

Acute Otitis Media (AOM)

Question 2

What are some considerations for Otitis Media with Effusion?

Answer 2

-Middle ear fluid is sterile, no signs of acute infection

Antibiotics are not indicated and not beneficial

Question 3

What are some considerations for Acute Otitis Media (AOM)?

Answer 3

Bacterial Infection likely

Antibiotics indicated if symptomatic

Question 4

What anatomical difference makes kids more likely to get ear infections?

Answer 4

Kids have an anatomically different eustachian tube (more flat, shorter, less angled than adult)

-this makes them more at risk for an infection
-adult eustachian tubes are able to drain easier
-shorter, more flat tube means that reflux through the tube is a lot more likely

Question 5

Pathologic bacteria are isolated from what percent of AOM cases?

Answer 5

65-75%

Question 6

What are the 3 most common pathogens in AOM?

Answer 6

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

Question 7

What vaccines do we currently have against pneumococcal organisms?

Answer 7

PCV15
PCV20

Question 8

At what ages are pneumococcal vaccines given?

Answer 8

2 months
4 months
6 months
12-15 months

Question 9

How do we diagnose AOM?

Answer 9

Look at the tympanic membrane
-Bulging
-Cloudy or purulent infection
-Immobile

Diagnosis requires:
-Acute onset
-Middle ear effusion (fluid collection)
-Symptoms of middle ear inflammation

Question 10

What are the criteria for a non-severe AOM?

Answer 10

Mild otalgia (ear pain)

Fever <39C in past 24 hours

Question 11

What are the criteria for a severe AOM?

Answer 11

Moderate to severe otalgia (ear pain)

Fever >/= 39C

Question 12

What are the 3 times when observation is an option in AOM treatment?

Answer 12

Non-Severe:

6mo-2yr: with unilateral symptoms

> /= 2 years: with bilateral or unilateral symptoms

Question 13

If we choose to observe a patient with possible AOM, how long do we defer antibiotics?

Answer 13

48-72 hours

Question 14

What is a Safety-Net Antibiotic Prescription (SNAP)?

Answer 14

Parents allow 1-2 days for infection to resolve

-if symptoms persist or worsen then fill the prescription
-prevents patients from having to come back to the office

Question 15

How do we overcome high levels of penicillin resistance in Streptococcus pneumoniae?

Answer 15

We give higher concentrations of antibiotic
(high-dose amoxicillin)

Question 16

How do we overcome high levels of penicillin resistance in Haemophilus influenzae and Moraxella catarrhalis?

Answer 16

We give a combination penicillin with a B-lactamase inhibitor

(amox/clav)

Question 17

What is the first-line therapy for Acute Otitis Media?

Answer 17

Amoxicillin 80-90 mg/kg/day divided Q12h for 5-10 days

Question 18

*In what situations would we not use amoxicillin to treat AOM?

Answer 18

If the organism is known and has known resistance

Treatment failure (3 days)

Amoxicillin in last 30 days

Allergy

Concurrent conjunctivitis

Question 19

What are the second-line treatment options for AOM?

Answer 19

Amoxicillin-Clavulanate 90 mg/kg/day amox component q12H

Oral cephalosporins

Question 20

What are the disadvantages of using Amoxicillin-Clavulanate (Augmentin)?

Answer 20

May be more expensive

Diarrhea associated with clavulanate

Question 21

What strength of Amoxicillin-Clavulanate (Augmentin) do we choose for AOM infections?

Answer 21

600mg amox/ 42.9 mg clav/ 5 mL

(ES-600)

extra strength

Question 22

What is our goal clavulanate dosing in AOM?

Answer 22

under 10 mg/kg/day
(see lec for calculation)

Question 23

What oral cephalosporins can be used as second line therapy in AOM?

Answer 23

Cefpodoxime*
Cefdinir (trashdinir)
Cefuroxime (must be compounded)

Question 24

What cephalosporin can be used third-line for AOM if oral treatment fails/is not an option?

Answer 24

Ceftriaxone

*note that this is IM

Question 25

Who would require 3 doses of Ceftriaxone?

Answer 25

Patients who failed therapy (note that it is only 1 dose if patient has not failed therapy)

Question 26

Who should Ceftriaxone be avoided in?

Answer 26

< 1 mo of age

Question 27

What side effects can ceftriaxone have?

Answer 27

Calcium co-administration reduces absorption **C. diff**

Question 28

What is the preferred treatment duration for AOM with amoxicillin or amox/clav?

Answer 28

10 days for <2 years 5-7 days in >/=2

Question 29

Who should we avoid Ibuprofen adjunctive therapy in?

Answer 29

< 6 months old

Question 30

Who should we avoid Lidocaine otic drops as adjunctive therapy in?

Answer 30

Ruptured tympanic membrane or tubes Children < 2

Question 31

Who should we use caution in when prescribing decongestants/ antihistamines?

Answer 31

< 4 years old (not recommended)

Question 32

What does follow-up look like for AOM?

Answer 32

Young infants with severe episode or children of any age with continuing pain: Within days Infants or young children with history of frequent recurrences: 2 weeks Children with only a sporadic episode of AOM: 1 month Older children: No follow-up may be necessary

Question 33

Who should receive antibiotic prophylaxis for AOM?

Answer 33

Child with >/= 6 episodes in the previous year

Question 34

Who should receive eardrops for uncomplicated otorrhea?

Answer 34

Only patients with tympanostomy tubes *treat if it does not resolve in 1 week

Question 35

What ear drops can be used for otorrhea in patients with tympanostomy tubes?

Answer 35

Topical quinolone drops

Question 36

What is Chronic Suppurative Otitis Media?

Answer 36

The most severe form Characterized by: perforated tympanic membrane with persistent drainage for > 6 weeks

Question 37

What is Acute Otitis Externa?

Answer 37

Swimmers Ear -trauma or trapped moisture -limited to external ear canal

Question 38

How do we treat Acute Otitis Externa?

Answer 38

Ear drops first

Question 39

What temperature is a risk factor for/may indicate a UTI?

Answer 39

>/= 39C

Question 40

What is the most common pathogen found in UTI's?

Answer 40

E coli**

Question 41

What is the preferred method of urine collection for suspected uti in young children?

Answer 41

*Catheterization* -preferred for <24 mo age group

Question 42

What tests are performed to determine presence of UTI?

Answer 42

*Urinalysis -Dip Stick Urine Microscopy Urine culture

Question 43

What is the urine culture growth cutoff that indicates real growth for SPA or Catheterization?

Answer 43

>10,000 CFU

Question 44

What is the urine culture growth cutoff that indicates real growth for a clean catch?

Answer 44

>100,000 CFU

Question 45

True or False: Oral and IV therapy are equally efficacious for UTI treatment

Answer 45

True

Question 46

What patient should receive IV therapy?

Answer 46

"Toxic" -just look bad Unable to retain oral intake

Question 47

What is the first line treatment for UTI?

Answer 47

Cephalexin (traditionally amoxicillin but now pushing toward cephalexin due to resistance)

Question 48

What are the second line treatment options for uti?

Answer 48

Amoxicillin/Clavulanate SMX/TMP

Question 49

What drug should we not use in children for uti's?

Answer 49

Nitrofurantoin *only used if it can be confirmed that it is only cystitis (not pyelo or urosepsis)

Question 50

What drug class can be used if pseudomonas is found in a uti?

Answer 50

Fluoroquinolones

Question 51

Who should receive renal/bladder ultrasounds as follow-up for a uti?

Answer 51

All boys All girls < 3 years old Girls 3-7 years with fever >38.5

Question 52

What is bronchiolitis?

Answer 52

Viral lower respiratory tract infection

Question 53

What is the clinical presentation of bronchiolitis?

Answer 53

Fever Rhinorrhea Cough Sneezing Severe: -Nasal flaring -Accessory muscle breathing -Respiratory failure *Note that symptoms peak around day 5

Question 54

What virus most commonly causes bronchiolitis?

Answer 54

Respiratory syncytial virus (RSV) *note that this is caused by a virus*

Question 55

What is the treatment for bronchiolitis?

Answer 55

**SUPPORTIVE THERAPY** -Oxygen -Hydration -Mechanical ventilation -ECMO

Question 56

How do we prevent RSV infections?

Answer 56

Influenza Vaccine -6 mo and older RSV Vaccine

Question 57

What is the RSV vaccine used in babies?

Answer 57

Nirsevimab

Question 58

What is the RSV vaccine used in pregnant women?

Answer 58

Bivalent RSVpreF

Question 59

Who qualifies to receive the Bivalent RSVpreF vaccine?

Answer 59

Pregnant women who: -Are 32 through 36 weeks pregnant -Going to deliver baby during RSV season (september-january) *Must be given at least 14 days before delivery*