Common Diagnoses Bacteria Tx Diagnostics etc.

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hlarson
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260269
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Common Diagnoses Bacteria Tx Diagnostics etc.
Updated:
2014-02-05 02:04:55
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common diagnoses
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Common Diagnoses, Bacteria, Tx, Labs, etc.
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  1. Otitis Media (Common Pathogens)
    • S. pneumonia (gram positive), H. flu (gram
    • negative), M. catarrhalis (gram negative), viral
  2. Otitis media (First Line Drugs)
    Amoxicillin (80-90 mg/kg/day); Amox/clavulanate if recent abx tx or daycare;
  3. Otitis Media (Second Line Drugs)
    • Azithromycin (5 day),
    • clindamycin
    • erythromycin & sulfasoxazole
    • cefpodoxime (10 mg/kg/day)
    • cefdinir (14 mg/kg/day)
    • cefuroxime (30 mg/kg/day)
  4. Otitis Media (Duration)
    < 2 years
    2-5 years s/ recurrence
    >5 years
    • a. 10 days
    • b. 7 days
    • c. 5-7 days
  5. Otitis Media (Diagnostics)
    • Ear Exam - Moderate to severe bulging of TM OR new onset of otorrhea;
    • Ear Exam - mild bulging of TM And recent pain <48 hrs or intense erythema
    • Refer to ENT - aspirate
  6. Sinusitis (Common Pathogens)
    • H. flu
    • S. Pneumoniae
    • M. catarrhalis
    • viral
  7. Sinusitis (First Line Meds)
    • Tx is w/ abx is controversial, many will resolve spontaneous. Some will give most narrow spectrum. 
    • High dose amox (45-90 mg/kg/day) - High dose amox/clavulanate (45-90 or 90 mg/kg/day)
    • clavulanate 6.4 mg/kg – BID dosing Cefinir/Cefuroxime/Cefpodoxim
  8. Sinusitis (Second Line Meds)
    • Clarithromycin
    • Azithromycin
    • Clindimycin
  9. Sinusitis (Duration)
    10-28 days – hard to get the abx into the sinuses, so the tx duration is longer
  10. Sinusitis (Diagnostics)
    • Not in primary care
    • could do a Head CT, aspirate
    • refer to ENT for more tx
  11. Sinusitis (Treat Empirically?)
    Yes
  12. Sinusitis (Treat?)
    • Tx is w/ abx is controversial, many will resolve spontaneous. Some will give most narrow spectrum
    • Dx only if: prolonged nonspecific upper respiratory signs (no improvement 10-14 days); severe; T>39C, facial swelling, facial pain
  13. Pharyngitis (Common Pathogens)
    • Viral
    • Group A Strep
  14. Pharyngitis (First Line Meds)
    • Penicillin
    • Amoxicillin
  15. Pharyngitis (Second Line Meds)
    • Cephalexin 
    • Clindamycin
    • Azithro
    • Cefadroxol
    • Clarithromycin
  16. Pharyngitis (Duration)
    • PCN - IM x1
    • Otherwise, 10 day course
  17. Pharyngitis (Diagnostics)
    • Rapid Strep Cx
    • visual oral exam
    • PCR test (Kaiser, 24 hrs turnaround)
  18. Pharyngitis (Treat Empirically?)
    No, most infectious disease groups don’t tx. And the older the kid, the more likely it is viral – even if it looks like strep
  19. Skin Impetigo (Common Pathogens)
    • S. Aureus
    • Group A Strep
  20. Skin Impetigo (First Line Meds)
    • Ointment – mupirocin 2% 
    • dicloxacillin [12.5-25 mg/kg/day] PO Q6H
    • cephalexin [25=50 mg/kg/day] PO Q6H
  21. Skin Impetigo (Second Line Meds)
    • Azithro
    • Clindamycin
    • Doxycycline/Minocycline IF >8
  22. Skin Impetigo (Duration)
    7-10 days
  23. Skin Impetigo (Diagnostic)
    Skin cx – if not improving or recurring, may try second line tx
  24. Skin Impetigo (Treat Empirically?)
    Yes
  25. Skin Abscess/Infection (Common Pathogens)
    • MRSA
    • MSSA
    • S. Aureus
  26. Skin Abscess/Infection (First Line Meds)
    • Clindamycin – FDA approved for serious infections d/t S. Aureus
    • tetracyclines – FDA approved (not approved pregnancy or children < 8)
    • Inpatient – Vancomycin
  27. Skin Abscess/Infection (Second Line Meds)
    • Sulfamethoxazole/trimethoprim (not FDA approved for staph, will not cover strep, not in 3rd trimester or <2 mo);
    • Rifampin – only in combo w/ other agents, drug-drug interactions common, IDSA does not recommend Rifampin for MRSA in kids
    • Linezolid – FDA approved, only use in consult w/ ID specialist, many side effects, drug interactions
  28. Skin Abscess/Infection (Duration)
    10 days - depends on the response
  29. Skin Abscess/Infection (Diagnostics)
    • Skin Cx
    • Abscess Cx
  30. Skin Abscess/Infection (Treat Empirically?)
    Yes, concern for osteomyelitis
  31. MRSA Bacteremia
    • Heamtogenou or local spread from skin abscess
    • First Line Meds: Vanco IV
    • Second Line Meds: Clindamycin or Linazolid
  32. Community Acquired Pneumonia (Common Pathogens)
    1-6 months
    6 months - 5 yrs
    >5 yrs
    • a. C. trachomatis, B. pertussis
    • b. viral, S. Pneumoniae, atypical with M. pneumonia, C. pneumonia
    • c. S. pneumonia – typical, M. pneumonia, C. pneumonia – atypical
  33. Community Acquired Pneumonia (First LIne Meds)
    ??
  34. Community Acquired Pneumonia (Second Line Meds)
    ???
  35. Community Acquired Pneumonia (Duration)
    • Bacterial PNA - 10 days
    • Azithromycin - 5 days
  36. Community Acquired Pneumonia (Diagnostics)
    • CXR
    • Sputum
    • Flu/Respiratory Viral panel
  37. Community Acquired Pneumonia (Treat Empirically?)
    Yes
  38. UTI (Common Pathogens)
    • E. coli
    • Klebsiella
    • proteus
    • Enterobacter
    • Citrobacter
  39. UTI (First & Second Line Meds)
    • Cefixime
    • Cefdinir 
    • Ceftibutin or Amox/clavulanate Trimethoprim/sulfamethoxazole
    • nitrofurantoin
    • cephalexin
    • cefixime
    • ceftriaxone
    • cipro;
    • amoxicillin in infants < 2months
  40. UTI (Duration)
    7-10 days
  41. UTI (Diagnostics)
    • UA
    • UCX
    • Imaging
  42. UTI (Treat Empirically?)
    Yes
  43. UTI (Adolescent) (Common Pathogens)
    • E. coli
    • Klebsiella
    • Proteus
    • pseudomonas
    • Enterobacter
    • S. saprophyticus (sexually active)
  44. UTI (Adolescent) (First & Second Line Meds)
    • Sulfamethoxazole/trimethoprim
    • trimethoprim
    • ciprofloxacin (other fluororquinolones)
    • nitrofurantoin
    • fosfomycin (ACOG)
    • Cephalosporins – cephalexin for adolescents
  45. UTI (Adolescent) (Duration)
    • TMP/SMX - 3 days
    • Cephalexin - 5-7 days
    • Nitrofurantoin - 5 days
    • Fosfomycin - single dose
    • Males - 7 days
  46. UTI (Adolescent) (Diagnostics)
    • UA
    • UCX
    • Sexually active - Pelvic exam, Pregnancy test, swab
  47. UTI (Adolescent) (Treat Empirically?)
    Yes
  48. PID (Common Pathogens)
    • N. gonorrhea
    • C. trachomatis
    • M. genitalium
    • polymicrobial w/ anaerobes
    • Groups A & B strep
    • enteric pathogens
    • bacterial vaginosa
  49. PID (First Line Meds)
    Mild/Moderate
    • Ceftriaxone 250 mg IM & Doxycycline 100 mg PO BID x 14 days
    • Cefoxitin 2gm IM & Probenecid & Doxycycline w/ or s/ Metronidazole 500 mg po BID x 14 days
  50. PID (First Line Meds)
    Severe (pregnant, unable to tolerate PO, not improving)
    • hospitalize & treat w/ IV.
    • Cefoteta 2g IV Q6 or Cefoxitin 2g IV Q6 + Doxycycline 100 mg PO or IV Q12
    • clindamycin or Gentamycin IV
  51. PID (Second Line Drugs)
    Mild/Moderate
    • Clinda 900 mg IV Q8H + Gentamycin,
    • After 24 hrs, clinda 450 mg PO Q6 + Doxycycline 100 mg PO BID
  52. PID (Duration)
    14 days
  53. PID (Diagnostics)
    • CBC, CRP or ESR
    • Ultrasound
    • UA
    • Chlamydia/GC swab
    • Pregnancy test
    • Pelvic exa
  54. PID (Treat Empirically?)
    Treat if CMT or uterine tenderness or adnexal tenderness – LOW threshold of suspicion. Signs of lower genital tract inflammation (cervical friability, leukocytes in cervical or vaginal secretions) increases specificity
  55. Sepsis (0-30 days) (Common Pathogens)
    • Group Beta Strep
    • Listeria
    • E. Coli
  56. Sepsis (0-30 days) (First Line Meds)
    • Group B Strep, Listeria - Ampicillin
    • E. Coli - Gentamycin
  57. Sepsis (0-30 days) (Duration)
    5 days, tx based on cx
  58. Sepsis (0-30 days) (Diagnostics)
    • BCX, CBC w/ diff, CRP
    • UCX
    • CXR – if resp distress
  59. Sepsis (0-30 days) (Treat Empirically?)
    Yes
  60. Sepsis (30-90 days) (Common Pathogens)
    • H. influenza B (HIB)
    • N. meningitis
    • S. pneumonia
    • Group B strep
    • E. coli
    • L. monocytogenes
  61. Sepsis (30-90 days) (First Line Meds)
    • Vancomycin 60 mg/kg/day Q6 AND cefotaxime 300 mg/kg/day Q8
    • Ceftriaxone 100 mg/kg/day in 1-2 doses
  62. Sepsis (30-90 days) (Duration)
    2-3 weeks, depends on cx
  63. Sepsis (30-90 days) (Diagnostics)
    • LP
    • BCX, CBC,coags, electrolytes, Bun/Cr/glucose
    • UCX
  64. Sepsis (30-90 days) (Treat Empirically?)
    Yes
  65. Meningitis >3 months (Common Pathogens)
    • S. pneumonia
    • N. meningitides
    • GBS
    • Nontypable H. flu
    • most common organisms PCN resistant pneumococcus
  66. Meningitis >3 months (First Line Meds)
    • Combination of 3rd generation cephalosporins: Ceftriaxone 50 mg/kg IV Q12 or cefotaxime 50 mg/kg IV q6 & Vancomycin 20 mg/kg IV Q6 trough prior to 3rd dose
    • dexamethasone 0.15 mg/kg Q6 x 4 days unless side effects or bacteria NOT H. flu or S. pneumo
  67. Meningitis >3 months (Second Line Meds)
    • Meropenem 
    • Vancomycin
    • & Rifampin (rifampin is not a solo tx)
  68. Meningitis >3 months (Duration)
    Tx until cx negative, tx based on what grows in cx
  69. Meningitis >3 months (Diagnostics)
    • BCX, CBC w/ diff, coags, Chem 10, crp (low early for bacterial infection, high w/ viral)
    • UCX
    • LP – protein, glucose,
  70. Meningitis >3 months (Treat Empirically?)
    Yes

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