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pediatric antbx 2
antibiotics 2
| Question | Answer |
|---|---|
| AOM causative organisms | Strep. pneumo, non-typable H. influenzae, M. catarrhalis |
| High risk for AOM antiibiotic resistance | daycare, antibiotic use in previous 30 days |
| Low risk first-line therapy for AOM | Amoxicillin (40–45 mg/kg per d) or high-dose amoxicillin/clavulanate |
| potassium (80–90/6.4 mg/kg per d) | |
| High risk first-line therapy for AOM | High-dose amoxicillin/clavulanate potassium (80–90/6.4 mg/kg per d), |
| high-dose amoxicillin (80–90 mg/kg per d), cefuroxime axetil, | |
| cefpodoxime proxetil, or cefdinir | |
| cefuroxime axetil | Ceftin, |
| cefpodoxime proxetil | Vantin |
| cefdinir | Omnicef |
| How do cephalosporins work? | Inhibit peptidoglycan cell wall synthesis |
| First generation cephalosporins | cephalexin, cefradine, cefadroxil po, cefazolin IV |
| cephalexin | Keflex |
| cefazolin | Ancef |
| First-generation cephalosporin spectrum | Gram positive |
| Gram positive organisms | enterococcus, streptococcus, staphylococcus, mycoplasma, clostridium, M. catarrhalis, gardnerella, listeria |
| Gram negative organisms | H. Influenzae, Bortadella, campylobacter, chlamydia, enterobacter, E. coli, klebsiella, neisseria, proteus, psuedomonas, salmonella, shigella |
| First-generation cephalosporins used for | Skin, soft tissue, UTI |
| Second generation cephalosporins | cefaclor, cefprozil, cefpodoxime, loracarbef (po) |
| cefuroxime, cefoxitin (IV) | Ceftin |
| Cefaclor | Ceclor |
| Cefprozil | Cefzil |
| cefpodoxime | Vantin |
| loracarbef | Lorabid |
| cefuroxime | Ceftin |
| Second generation cephalosporin spectrum | gram neg > gram positive |
| Third generation cephalosporin spectrum | Gram neg >> gram pos, pseudomonas |
| Third generation cephalosporins | Cefixime PO, Cefotaxime, Ceftriaxone,Ceftizoxime, ceftazidime, cefoperazone |
| Cefixime | Suprax |
| Cefotaxime | Claforan |
| Ceftriaxone | Rocephin |
| Ceftizoxime | Cefizox |
| Ceftazidime | Fortaz |
| cefoperazone | cefobid |
| Fourth generation cephalosporin spectrum | Pseudomonas |
| cefradine | velosef |
| cefadroxil | duricef, ultracef |
| Failure at day 3 high risk AOM treatment | Ceftriaxone (IM) or clindamycin; tympanocentesis for culture |
| Failure at day 3 low risk AOM treatment | High-dose amoxicillin/clavulanate potassium (80–90/6.4 mg/kg per d), cefuroxime axetil, cefpodoxime proxetil, cefdinir, or ceftriaxone (IM) |
| Failure at 10-28 day high risk for AOM tx | High-dose amoxicillin/clavulanate potassium (80–90/6.4 mg/kg per d), cefuroxime axetil, cefpodoxime proxetil, cefdinir, or ceftriaxone (IM); tympanocentesis for culture |
| Failure at 10-28 day low risk for AOM tx | High-dose amoxicillin/clavulanate potassium (80–90/6.4 mg/kg per d), cefuroxime axetil, or ceftriaxone (IM) |
| AOM length of tx for < 6 or severe symptoms | 10 days |
| AOM length of tx for > 6 or mild-mod symptoms | 5-7 days |
| Bacterial sinusitis causative organisms | Strep. pneumo, non-typable H. influenzae, M. catarrhalis |
| AOM first line tx with PCN allergy | azithromycin 10 mg/kg x 1 day, followed by 5 mg/kg x 4 days |
| Bacterial sinusitis low risk mild-mod symptoms first-line tx | amoxicillin 45-90 mg/kg/day divided bid |
| Bacterial sinusitis high risk severe symptoms first line tx | augmentin (90 mg/kg/day amox., 6.4 mg/kg/day clavulanic acid) divided bid |
| Bacterial sinusitis first-line tx with PCN allergy | azithromycin 10 mg/kg kg x 1 day, followed by 5 mg/kg x 4 day, or clarithromycin 15 mg/kg/day divided bid |
| Group A strep pharyngitis first-line tx | Penicillin V is the recommended treatment. For children < 27 kg, |
| 400,000 u (250 mg) tid. For children > 27 kg, 800,000 u (500 mg) bid or tid. | |
| Group A strep pharyngitis tx with PCN allergy | erythromycin 20-40 mg/kg divided in 2-4 doses is first line therapy |
| Length of tx for GABHS | 10 days |
| Cellulitis/abscess causative organisms | Group A strep, staph aureus, possible MRSA |
| First-line therapy non-MRSA | Keflex |
| First-line therapy MRSA | clindamycin (30 mg/kg/day divided tid) |
| Length of tx for cellulitis/abscess | 5-10 days |
| Community-acquired pneumonia causative organisms < 4 years | 0-3 weeks: GBS, Gram – rods, CMV |
| 3 weeks – 3 months: Chlamydia trachomatis, Strep pneumo, RSV, paraflu | |
| 4 months – 4 yrs: Viruses most common, then strep pneumo, than mycoplasma | |
| pneumoniae (in older patients in age range) | |
| Community-acquired pneumonia causative organisms > 4 years | 5 yrs – 15 yrs: Mycoplasma pneumoniae, Chlamydia pneumoniae, Strep pneumo |
| Community-acquired pneumonia tx 0-3 weeks | Hospital |
| Community-acquired pneumonia tx 3 weeks-3 months | If afebrile, azithromycin, 10 mg/kg x 1 day, then 5 mg/kg x 4 days, or erythromycin 30-40 mg/kg divided in 4 doses are recommended first line therapies. If the patient has a well defined, lobar infiltrate on CXR, however, amoxicillin should be used, eithe |
| recurrent AOM | 3 or more episodes in 6 months, or 4 or more in 12 months with 1 in last 6 months |
| Non-severe bilateral AOM in <2 yrs tx | antibiotics |
| Non-severe unilateral AOM in all ages tx | antibiotics or observation |
| AOM with purulent conjuncitivis tx | Augmentin |
| If no improvement in 48-72 hours | reassess tx |
| What vaccine helps prevent AOM? | PCV |
| What 3 antibiotics are approved for short-course tx of GAS | Cefdinir, cefpodoxime, azithromycin |
| Recommended antbx for perianal strep | Augmentin or cephalosporin |
| second-line tx for GAS | Augmentin, cephalexin, cefdinir, cefixime |
| S/S of bacterial sinusitis | S/S > 10 days, stuffy nose, HA, face pain, coughing day/night, nasal discharge; purulent nose, fever >102 x 3 days |
| When to get a contrast CT or MRI of paranasal sinuses | a swollen eye, proptosis, impaired EOM |
| First-line Antbx treatment for low risk ABS | Amoxicillin 45mg/kg/d in 2 divided doses for 10-14 days |
| First-line Antbx tx for high risk ABS | Amoxicillin or augmentin 80-90 mg/kd/d in 2 divided doses, no more than 2 gms, or ceftriaxone 50 mg/kg/dose |
| 2nd-line antbx tx for ABS | Cefpodoxime, cefdinir |
| Causative bacteria for ABS | Strep pneumoniae, H flu, M Catarrhalis |
| What antbx don't work for ABS | Azithromycin, Bactrim |
| Preferred antbx for MRSA | Clindamycin |
| Causative bacteria of impetigo | S. Aureus, S. Pyogenes |
| The only antbx for staph, MRSA and S pyogenes | Clindamycin |
| antbx for mrsa | clindamycin, bactrim |
| Preferred tx for bacterial conjunctivitis | polymyxin or floroquinolones |
Created by:
hschlessman