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What age ranges get abx in strep pharyngitis?
How soon do you give CAP tx in the ED?
< 4 hours
3 viral causes of pneumonia
Influenza, parainfluenza, varicella
Pt with pneumonia with extrapulmonary manifestations, diarrhea, and sweaty abdominal pain has what type?
What is the preferred abx combo for outpt CAP?
Doxy, levo or moxy, and a macrolide (azithromycin)
What are alternate outpt CAP therapies for pts <50 yo and no comorbidities?
macrolide or doxycycline
What are alternate outpt CAP therapies for pts >50 yo or with comorbidities?
Fluoro (levo or moxy)
What are options for empiric abx for hospitalized pneumonia pts?
- 2G or 3G ceph +/- macrolide
- beta lactam/betalactamase inhibitor +/- macrolide
- Quinolone alone
How do you treat a nursing home pneumonia?
- Pseudomonas: quinolones (cipro, though not as empiric, it doesn't cover strep pneumo)
- 4G ceph (cefapine IV)
- Zosin, gentamycin
what is a significant urine WBC count?
> 10^5 in non pregnant women, ?100 cfu in men and pregnant women
Which UTI pts would you suspect having anaerobes?
Lower UTI tx
short course (3 days) of Bactrim, Cipro or Levo, or macrodantin
What abx DON'T you use for low UTI?
oral PCN or ceph
What can cause a clinical UTI with low grade pyuria without bacteruria?
- chlamydia, trichomonas, herpes
- viral (esp. adenovirus)
Outpt tx for pyelo
- 14 days or longer
- bactrim, quinolone, certain cephalosporins
- NO amp, macrodantin, keflex
what can prevent rheumatic fever with strep?
- tx started <9 days from onset of sx
- The only abx that can do this is PCN G IM
what can prevent GN in strep?
no abx, bc GN is an immune reaction
What are Centor criteria?
- temp >38
- Absence of cough
- Tender and enlarged cervical nodes
- Tonsillar swelling or exudates
- age 3-14 years
- -1 point for age >45
What are indications for steroids in pharyngitis/tonsillitis?
- difficulty swallowing, pain and inflammation
- dexamethasone or prednisone
How do you tx severe strep in the ED?
- Abx (PCN, Azith, clinda, ceftriaxone)
- Steroid (prednisone, decadron, solumedrol)
- Wait two hours and most pts feel better
length of abx tx for sinusitis
3 days (may be as good as two weeks due to the fact that a lot of sinusitis is viral)
most common cause of epiglottitis
traditionally H flu, now it's mostly GM+ bacteria
- all children get artificial airway (intubate with anesthesia in the OR with ENT present)
- If intubation unsuccessful, do surgical or needle cricothyroidectomy (if that fails then tracheostomy)
- after airway has been secured, do rocephni +/- Vanco
Most common cause of stridor in children
Heliox (but not possible if pt requires >40% O2)
- thorough cleansing of ear canal most important
- TM intact: irrigate w/hypertonic saline, h. peroxide, vinegar/alcohol mixture (1:1)
TM perf: cortisporin otic suspension or opthalmic drops
most useful tool in OM dx
pneumatic otoscopy (light reflex no dx value)
OM tx failures
- Augmentin, ceph, or zithromax
- If those fail, ceftriaxone
OM tx length
10 days <6, 5 days if older
- avoid neomycin due to allergy
- Bleph-10 polymixin, quinolones x5d