Sandbox ID Upper Respiratory Tract: Difference between revisions
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===Stomatitis, herpetic=== | ===Stomatitis, herpetic=== | ||
*Stomatitis | |||
:*[[Acyclovir]] 15 mg/kg PO q5h For 7 days | |||
===Submandibular space infection=== | ===Submandibular space infection=== |
Revision as of 14:56, 15 June 2015
Epiglottitis
- Epiglottitis
- Pediatrics
- Preferred regimen : Cefotaxime 50 mg/kg IV q8h OR Ceftriaxone 50–75 mg/kg/day IV q12–24h AND Vancomycin 10 mg/kg IV q6h
- Alternate regimen : Levofloxacin 500 mg IV q24h (or 8 mg/kg IV q12h) AND Clindamycin 20–40 mg/kg/day IV q6–8h
- Adults
- Preferred regimen : Cefotaxime 2 g IV q4–8h OR Ceftriaxone 1–2 g/day IV q12–24h AND Vancomycin 2 g/day IV q6–12h
- Alternate regimen : Levofloxacin 750 mg IV q24h AND Clindamycin 600–1200 mg IV q6–12h
Jugular vein phlebitis
- Septic jugular thrombophlebitis (Lemierre's syndrome)[1]
- Causative pathogens
- Fusobacterium
- Viridans and other streptococci
- Staphylococcus
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Penicillin G 2–4 MU IV q4–6h AND Metronidazole 0.5 g IV q6h) OR Ampicillin-Sulbactam 2 g IV q4h OR Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h OR Gatifloxacin 400 mg IV q24h
Laryngitis
- Antibiotic use is not associated with significant improvement of objective symptoms[2][3][4] and is not indicated in the treatment of acute laryngitis.[5]
Lemierre's syndrome
- Septic jugular thrombophlebitis (Lemierre's syndrome)[6]
- Causative pathogens
- Fusobacterium
- Viridans and other streptococci
- Staphylococcus
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Penicillin G 2–4 MU IV q4–6h AND Metronidazole 0.5 g IV q6h) OR Ampicillin-Sulbactam 2 g IV q4h OR Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h OR Gatifloxacin 400 mg IV q24h
Ludwig's angina
- Ludwig's angina[7]
- Causative pathogens
- Viridans and other streptococci
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Penicillin G 2–4 MU IV q4–6h AND Tobramycin 2 mg/kg IV q8h) OR Ampicillin-Sulbactam 2 g IV q4h OR Clindamycin 600 mg IV q6h OR Doxycycline 200 mg IV q12h OR Cefoxitin 2 g IV q6h OR Cefotetan 2 g IV q12h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h OR Gatifloxacin 200 mg IV q24h
Parapharyngeal space infection
- Parapharyngeal space infection[8]
- Causative pathogens
- Viridans and other streptococci
- Staphylococcus
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Penicillin G 2–4 MU IV q4–6h AND Metronidazole 0.5 g IV q6h) OR Ampicillin-Sulbactam 2 g IV q4h OR Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h OR Gatifloxacin 400 mg IV q24h
Pharyngitis, diphtheria
- Diphtheria[9]
- The CDC recommends either:
- Preferred regimen: Erythromycin (PO or by IV) for 14 days (40 mg/kg per day with a maximum of 2 g/d), OR Procaine penicillin G given IM for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg).
- Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.
Pharyngitis, streptococcal
- Acute
- Preferred regimen
- Children: Pencillin V PO 250 mg twice daily or 3 times daily
- Adolescents and adults: Pencillin V PO 250 mg 4 times daily or 500 mg twice daily for 10 days OR Amoxicillin 50 mg/kg once daily (max = 1000 mg) alternate:25 mg/kg (max = 500 mg) twice daily for 10 days OR Benzathine Penicillin G I.M 27 kg: 600 000 U; ≥27 kg: 1 200 000 U 1 dose only OR Cephalexin PO 20 mg/kg/dose twice daily (max = 500 mg/dose)for 10 days
- Alternate regimen :
- Cefadroxil PO 30 mg/kg OD (max = 1 g) for 10 days OR Clindamycin PO 7 mg/kg/dose 3 times daily (max = 300 mg/dose) for 10 days OR AzithromycinPO 12 mg/kg once daily (max = 500 mg) for 5 days OR Clarithromycin PO 7.5 mg/kg/dose twice daily (max = 250 mg/dose) for 10 days
- Chronic
- Preferred regimen
- Clindamycin 20–30 mg/kg/d in 3 doses (max = 300 mg/dose) for 10 days OR Penicillin AND Rifampin; Penicillin V: 50 mg/kg/d in 4 doses × 10 d (max = 2000 mg/d) ;rifampin: 20 mg/kg/d in 1 dose × last 4 d of treatment (max = 600 mg/d) for 10 days AND Amoxicillin–clavulanate 40 mg amoxicillin/kg/d in 3 doses (max = 2000 mg amoxicillin/d) for 10 days OR Benzathine penicillin G IM 600 000 U for <27 kg and 1 200 000 U for ≥27 kg single dose AND rifampin PO 20 mg/kg/d in 2 doses (max = 600 mg/d) for 4 days
Sinusitis, Acute
- Sinusitis (Pediatrics)
- Preferred Regimen : Amoxicillin 90 mg / kg / day PO divided q12h OR Amoxicillin-clavulanate (extra strength) suspension, 90 mg / kg / day (based on Amox component), PO divided q12h for 10-14 days
- Alternate Regimen
- If non-type I hypersensitivity to penicillin : Cefuroxime axetil 30 mg / kg / day PO divided q12h for 10-14 days OR Cefdinir 14 mg / kg / day PO divided q12-24h, max of 600 mg / day for 10-14 days OR Cefpodoxime 10 mg / kg / day PO divided q12h for 10-14 days
- Sinusitis (Adults)
- Preferred Regimen : Amoxicillin 250-500 mg q8h or 500-875 mg q12h or extended-release tablet 775 mg once daily OR Amoxicillin-clavulanate (extended release tabs) 1000 / 62.5 mg 2 tabs or 2000/125 mg 1 tab, PO q12h for 5-7 days
- Alternate Regimen
- If type 1 hypersensitivity to penicillin : Levofloxacin 750 mg PO once daily for 5-7 days OR Doxycycline 100 mg PO q12h for 5-7 days
- If type 2 hypersensitivity to penicillin : Cefdinir 600 mg / day divided q12h or q24h for 5-7 days OR Cefpodoxime 200 mg PO q12h for 5-7 days OR Cefuroxime axetil 500 mg PO q12h for 5-7 days
Sinusitis, Chronic
- Sinusitis (Pediatrics)
- Preferred Regimen:Amoxicillin-clavulanate 45 mg/kg per day q12h
- If penicillin allergy and patient is MRSA positive
- Clindamycin 20 to 40 mg/kg per day orally divided every 6 to 8 hours
- If anaerobes are involved
- Metronidazole PLUS one of the following: cefuroxime axetil, cefdinir, cefpodoxime proxetil,azithromycin, clarithromycin, or trimethoprim-sulfamethoxazole (TMP-SMX)
- Sinusitis (Adults)
- Preferred Regimen
- Amoxicillin-clavulanate 500 mg three times daily OR 875 mg twice daily OR two 1000 mg extended-release tablets twice daily)
- If penicillin allergy and patient is MRSA positive
- Clindamycin 300 mg four times daily or 450 mg three times daily)
- If anaerobes are involved
- Metronidazole PLUS one of the following: cefuroxime axetil, cefdinir, cefpodoxime proxetil, levofloxacin , azithromycin, clarithromycin, or trimethoprim-sulfamethoxazole (TMP-SMX)
- Alternate regimen
- Moxifloxacin (400 mg once daily)
Sinusitis, Post-intubation
- Sinusitis
- Preferred regimen : Imipenem 0.5 gm IV q6h OR Meropenem 1 gm IV q8h, MRSA suggestive on Gram - stain then add Vancomycin 1 gm IV q12h
- Alternate Regimen : (Ceftazidime 2 gm IV q8h AND Vancomycin 1 gm IV q12h) OR (Cefepime 2 gm IV q12h AND Vancomycin 1 gm IV q12h)
Sinusitis, Treatment failure
- Sinusitis (Pediatrics)
- If treatment failure then do a culture and treat accordingly or treatment in the absence of cultures and children failing Amoxicillin
- Amoxicillin-clavulanate (extra strength) suspension 90 mg/kg/day (Amoxicllin component) PO divided q12h for 10-14 days.
- Treatment in the absence of cultures and children failing Amoxicillin-clavulanate
- Clindamycin 30-40 mg/kg/day divided q8h AND third generation cephalosporin like Cefuroxime axetil 30 mg/kg/day PO divided q12h OR Cefdinir 14 mg/kg/day PO divided q12h or q24h OR Cefpodoxime 10 mg/kg/day PO divided q12h
- Sinusitis (Adults)
- If failure of treatment even after 7 days of diagnosis : Amoxicillin-clavulanate 4g per day of amoxicillin equivalent OR Levofloxacin 500 mg PO once daily ORMoxifloxacin400 mg PO once daily
Stomatitis, aphthous
- Stomatitis
- Topical steroids may decrease pain and swelling
Stomatitis, herpetic
- Stomatitis
- Acyclovir 15 mg/kg PO q5h For 7 days
Submandibular space infection
- Submandibular space infections including Ludwig angina[12]
- Causative pathogens
- Viridans and other streptococci
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Penicillin G 2–4 MU IV q4–6h AND Tobramycin 2 mg/kg IV q8h) OR Ampicillin-Sulbactam 2 g IV q4h OR Clindamycin 600 mg IV q6h OR Doxycycline 200 mg IV q12h OR Cefoxitin 2 g IV q6h OR Cefotetan 2 g IV q12h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h OR Gatifloxacin 200 mg IV q24h
Tonsillitis
- Tonsillitis
- Preferred regimen:Penicillin V PO 10 days or if compliance unlikely, Benzathine penicillin IM single dose
- Alternate regimen:2nd generation Cephalosporins PO for 4–6 days OR clindamycin or azithromycin for 5 days OR clarithromycin for 10 days OR erythromycin for 10 days. Extended-release amoxicillin is another (expensive) option
Ulcerative gingivitis
Vincent's angina
- Vincent's angina
- Preferred treatment:Penicillin G 4 million units IV q4h
- Alternate treatment: Clindamycin 600 mg IV q8h
- ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
- ↑ Reveiz, L.; Cardona, AF.; Ospina, EG. (2005). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (1): CD004783. doi:10.1002/14651858.CD004783.pub2. PMID 15674965.
- ↑ Reveiz, L.; Cardona, AF.; Ospina, EG. (2007). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (2): CD004783. doi:10.1002/14651858.CD004783.pub3. PMID 17443555.
- ↑ Reveiz, L.; Cardona, AF. (2013). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev. 3: CD004783. doi:10.1002/14651858.CD004783.pub4. PMID 23543536.
- ↑ Schwartz, SR.; Cohen, SM.; Dailey, SH.; Rosenfeld, RM.; Deutsch, ES.; Gillespie, MB.; Granieri, E.; Hapner, ER.; Kimball, CE. (2009). "Clinical practice guideline: hoarseness (dysphonia)". Otolaryngol Head Neck Surg. 141 (3 Suppl 2): S1–S31. doi:10.1016/j.otohns.2009.06.744. PMID 19729111. Unknown parameter
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ignored (help) - ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
- ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
- ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
- ↑ The first version of this article was adapted from the CDC document "Diphtheria - 1995 Case Definition" athttp://www.cdc.gov/epo/dphsi/casedef/diphtheria_current.htm. As a work of an agency of the U.S. Government without any other copyright notice it should be available as a public domain resource.
- ↑ Thomas, M.; Del Mar, C.; Glasziou, P. (2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract. 50 (459): 817–20. PMID 11127175. Unknown parameter
|month=
ignored (help) - ↑ Spinks, A.; Glasziou, PP.; Del Mar, CB. (2013). "Antibiotics for sore throat". Cochrane Database Syst Rev. 11: CD000023. doi:10.1002/14651858.CD000023.pub4. PMID 24190439.
- ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.