infectious disease- abx and ENT Flashcards
(27 cards)
unilateral ear pain
relief of pain by pulling the pinna
What is it?
How do you diagnos?
How do you treat?
Unilateral ear pain with relief of the pain by pulling on the pinna is indicitive of OTITIS MEDIA.
Diagnose OTITIS MEDIA with pneumatic insfflation- the TM will be tense and immobile
Treat the first occurance of otitis media with AMOXICILLIN.
How do you treat recurrent otitis media?
Treat recurrent otitis media with
AMOXICILLIN-CLAVULANATE
if it comes back 3x/6 mo or 4x/12 months consider ear tubes (tympanoplasty)
How do you treat Otitis Media if the patient is allergic to penicillins?
Treat Otitis Media in penicillin allergic patients with
CEFDINIR if there is no hx of anaphylaxis
AZITHROMYCIN if there IS a history of anaphylaxis
Swelling behind the ear or an anteriorly rotated ear
what is it?
how do you treat it?
Swelling behind the ear or an anteriorly rotated ear is indicitive of MASTOIDITIS
the risk of mastoiditis is increased with ear tubes (pseudomonas)
and immediate surgical evaluation and decompression is warrented.
Unilateral ear pain with pain on palpation of the pinna
What is it?
What is the most likely organism?
Unilateral ear pain that gets worse with palpation of the pinna is
OTITIS EXTERNA
Otitis Externa can be caused by frequent contact with water (PSEUDOMONAS) or because of repeated trauma (STAPH)
How do you treat Otitis Externa?
Otitis Externa usually resolves spontaneously.
If it doesn’t resolve, treat with topical abx (cipro ear drops)
and topical steroids
What are indications that sinusitus is caused by a bacteria?
Bacterial sinusitis is suspected in the presence of
Long duration (> 10 d)
high fever
worsening sxs
How do you treat bacterial sinusitis?
Treat bacterial sinusitis with amoxicillin-clavulonate
and evaluate for any foreign bodies that may be present.
What are indications that sinusitis is viral in nature?
Viral sinusitis is usually
short duration
low-grade fever
mild symptoms
the most common causative virus is rhinovirus. it is transmitted through large droplets.
Don’t order any studies on this… just wait it out.
pharyngitis + conjunctivitis
what is it?
pharyngitis + conjunctivitis
=
adenovirus
Pharyngitis + rash on the palms/soles
what is it?
pharyngitis + rash on the palms/soles
=
coxsackie
What is the CENTOR Criteria?
C- absent Cough
E- Exudates
N- Nodes = cervical lymphadenopathy
T- temperature > 38 C
OR- <14 (+1) > 44 (-1)
choice of treatment depends on score. 1= no treatment (its a virus) 2-3 do a rapid strep test, >4 empiric abx (amox-clav)
pharyngitis + enlarged spleen
what is it?
Pharyngitis + enlarged spleen
=
EBV.
get an EBV Panel
What is the empiric coverage for Staph?
the empiric abx to treat staph is
VANCOMYCIN
what drugs can be used for methicillin sensitive staph?
any of the -cillins but think
Nafcillin
(naf for staff)
How do you treat VRE?
Treat VRE with linezolid.
*Use sparingly as its the last resort. Resistance to linezolid means there is nothing left to use!
What is first line treatment for gram negatives?
coverage for gram negatives starts with amoxicillin (PO) or Ampicilin (IV).
the Aminoglycosides (gentamicin, amikacin) are synergistic with penicillins but are almost exclusively gram negative. They are RARELY the first choice for empiric treatment
What can be used to cover pseudomonas?
Pseudamonas can be treated with
ticarcillin/pipercillin
(zocyn = pipercillin + tazobactam)
Carbapenems
Cefepime
How should you treat bacterial meningitis?
Bacterial meningitis and inpatient pneumonia should be treated with a 3rd generation cephalosporin because it has sufficient gram negative coverage and it will also cross the BBB.
Bacterial meningitis
=
Vanc + ceftriaxone, + steroids (for boards) +/- ampicillin
When do you use a first generation cephalosporin?
Cefazolin- a first generation cephalosporin is used in the treatment of cellulitis and as a prophylatic before surgery.
What are the two options for treating anaerobes?
The two options for treating anaerobes are
- Metronidazole (gut and genitals)
- clindamycin (everywhere else)
What is the treatment of choice for a UTI in a pregnant woman?
use AMOXICILLIN to treat a UTI in a pregnant woman
What should you use to treat a person with septic pylonephritis?
septic pylonephritis should be treated with
IV Ceftriaxone
How should you treat ambulatory pylonephritis?
ambulatory pylonephritis should be treated with
CIPRO
