More Antibiotic stuff.txt

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dohertys
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128449
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More Antibiotic stuff.txt
Updated:
2012-01-17 16:04:57
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Antibiotics Infectious disease family medicine
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More antiobiotic stuff
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  1. Other Antibiotic Treatments
  2. Epiglottitis causes in adult
    Group A strep, S. pneumo, H. influenza B
  3. Epiglottitis causes in children
    Staph aureus, Group A Strep, H flu B, S. pneumo
  4. 1st Line drugs for Epiglottitis
    cephalosporins: Cefotaxime, Ceftriaxone IV, Cefuroxime IV
  5. Adult Doses for Epiglottitis Rx
    • Cefotaxime 1-2g q8h
    • Ceftriaxone 1-2g q24h
    • Cefuroxime IV 750-1.5g q8h
  6. Children Doses for Epiglottitis
    • Cefotaxime 100-150mg/kg/d divided q4-6h (max 8g/d)
    • Ceftriaxone IV 75-100mg/kg/d divided q12
    • Cefuroxime IV 75-100mg/kg/d
  7. 2nd line Rx for Epiglottitis (cephalosporin allergy)
    Chloramphenicol IV or Levofloxacin IV (for child, weigh risk of severe infection vs cartilage damage)
  8. Laryngitis Rx
    • None - viral.
    • Avoid smoking and throat clearing. Rest voice. Analgesia, fluids, lozenges, salt water gargles
  9. Croup Rx
    • Corticosteroids shown to reduce #/dur of admissions/intubations/repeat visits. Dexamethasone 0.6mg/kg PO x 1 good for outpatient mild to moderate croup (no benefit for more than one dose)
    • Severe - Racemic epinephrine 0.5mL of 2.25% solution in 3mL of NS nebulized
    • Need to watch for return of Sx when wears off at 2 hrs
    • No evidence for mist therapy
  10. Otitis Externa (Swimmer's Ear) 1st line Rx
    Buro-sol (otic solution) 2-3 drops TID
  11. Necrotizing Otitis Externa 1st line Rx
    • Ciprofloxacin 750mg PO BID x 4-8 weeks
    • *involves bone
  12. Adult OM without tympanic perforation 1st line Rx
    Amoxicillin 500mg PO TID x ? 7d
  13. Adult OM with chronic tympanic membrane perforation Rx
    Ciprodex (3mg cipro + 1 mg dexa per mL) 4 drops BID
  14. Length of Rx for OM in children
    • 5 days for >2 yrs and not complication
    • 10 days for < 2 yrs or complicated (recurrent, perforated ™)
  15. Dx of Sinusitis in Adult
    • < 2% of viral upper reps infections are complicated by bacterial sinusitis
    • Dx more likely when:
    • Nasal obstruction or nasal purulence/discoloured postnasal drainage + 1 other major Sx: facial pain/pressure/fullness/hyposmia/anosmia
    • And hasn't improved after 7 days or has worsened after 5-7 days
  16. 1st line adult Rx for Acute Sinusitis
    • Amoxicillin 500mg PO TID x 5-10 days
    • *successful therapy means good improvement in Sx at 10d - not complete disappearance
  17. Other non-Abx Rx for acute sinusitis
    • saline rinses, topical decongestants (not >3-4 d)
    • Intra-nasal steroids, antihistamines
  18. Acute Sinusitis in Children - what suggests bacterial?
    • Persistant Sx and Severe Sx
    • Persistant Sx - >10d (less than 30 d) and not improving (10d mark differentiates viral from bacterial) of
    • nasal congestion, discharge, cough. Others halitosis, facial pain, headache, low grade fever
    • Severe Sx:
    • Fever >39 C and purulent nasal discharge
  19. Acute Sinusitis Rx for Children
    • Amoxicillin 80mg/kg/d divided BID or TID (3g max) x 10-14 day course
    • (NNT=8 for short-term benefit in 1 patient)
  20. When to exclude anatomical AbN's in acute sinusitis in kids?
    Recurrent episodes (≥4 /yr with resolution b/w) or chronic (12 weeks+)
  21. What makes a low risk AECOPD patient?
    mild to moderate impaired lung fxn (FEV1>50% predicted), 4 or less exacerbations/yr, no significant cardiac disease.
  22. What makes a high risk AECOPD patient?
    poor underlying lung fxn (FEV1<50%), or significant cardiac dz, or 4+ exacerbations/yr. Or other risk factors
  23. First list Rx for AECOPD/AECB in low risk?
    • Amoxicillin, Doxycycline, Tetracycline or TMP/SMX
    • Amox 500mg PO TID x 7-10 days
    • Doxy 100mg BID x 1d, then 100mg PO OD
    • Tetra 250-500mg mg QID
    • Septra 2tabs BID or 1DS tab BID
  24. First line Rx for AECOPD/AECB in high risk?
    • Amox/Clav 500mg TID or 875mg BID
    • Levofloxacin 500mg qD x 7 days or 750mg qD x 5 days
    • Moxifloxacin 400mg qD
  25. First line Rx for AECOPD in pt at risk for pseudomonas?
    Ciprofloxacin 500-750mg BID
  26. UTI's - what is recurrent?
    • 2 uncomplicated UTI's in 6 months OR
    • 3+ +ive UCx in last 12 months
  27. UTI's - what is reinfection?
    UTI >2 weeks after finishing Abx. Different organism, most common
  28. UTI's - what is a relapse?
    UTI < 2wks after finishing Abx. Same organism, 5-10% of women
  29. 1st line Rx for

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