Sandbox ID Head and Neck: Difference between revisions

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===Deep neck infection===
===Deep neck infection===


* Deep neck infection
*'''Deep neck infection'''
:* Empiric antimicrobial therapy<ref>{{cite book | last = Flint | first = Paul | title = Cummings otolaryngology head & neck surgery | publisher = Mosby/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 978-0323052832 }}</ref><ref>{{Cite journal| doi = 10.1016/j.otc.2008.01.002| issn = 0030-6665| volume = 41| issue = 3| pages = 459–483, vii| last1 = Vieira| first1 = Francisco| last2 = Allen| first2 = Shawn M.| last3 = Stocks| first3 = Rose Mary S.| last4 = Thompson| first4 = Jerome W.| title = Deep neck infection| journal = Otolaryngologic Clinics of North America| date = 2008-06| pmid = 18435993}}</ref>
:*'''Empiric antimicrobial therapy'''<ref>{{cite book | last = Flint | first = Paul | title = Cummings otolaryngology head & neck surgery | publisher = Mosby/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 978-0323052832 }}</ref><ref>{{Cite journal| doi = 10.1016/j.otc.2008.01.002| issn = 0030-6665| volume = 41| issue = 3| pages = 459–483, vii| last1 = Vieira| first1 = Francisco| last2 = Allen| first2 = Shawn M.| last3 = Stocks| first3 = Rose Mary S.| last4 = Thompson| first4 = Jerome W.| title = Deep neck infection| journal = Otolaryngologic Clinics of North America| date = 2008-06| pmid = 18435993}}</ref>
::* Community-acquired deep neck infection
::* '''Community-acquired deep neck infection'''
:::* Preferred regimen: [[Ampicillin-Sulbactam]] 1.5–3.0 g IV q6h {{or}} [[Clindamycin]] 600–900 mg IV q8h {{or}} [[Moxifloxacin]] 400 mg IV q24h (if ''[[Eikenella]]'' is suspected)
:::* Preferred regimen: [[Ampicillin-Sulbactam]] 1.5–3.0 g IV q6h {{or}} [[Clindamycin]] 600–900 mg IV q8h {{or}} [[Moxifloxacin]] 400 mg IV q24h (if ''[[Eikenella]]'' is suspected)


::* Nosocomial deep neck infection or immunocompromised host
::* '''Nosocomial deep neck infection or immunocompromised host'''
:::* Preferred regimen: [[Ticarcillin-Clavulanate]] 3 g IV q6h {{or}} [[Piperacillin-Tazobactam]] 3 g IV q6h {{or}} [[Imipenem-Cilastatin]] 500 mg IV q6h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 750 mg IV q24h
:::* Preferred regimen: [[Ticarcillin-Clavulanate]] 3 g IV q6h {{or}} [[Piperacillin-Tazobactam]] 3 g IV q6h {{or}} [[Imipenem-Cilastatin]] 500 mg IV q6h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 750 mg IV q24h


::* Deep neck infection with high-risk of MRSA
::* '''Deep neck infection with high-risk of MRSA'''
:::* Preferred regimen: ([[Clindamycin]] 600–900 mg IV q8h {{or}} [[Trimethoprim-Sulfamethoxazole]] 10 mg/kg/day IV q8h {{and}} [[Vancomycin]] 1 g IV q12h
:::* Preferred regimen: ([[Clindamycin]] 600–900 mg IV q8h {{or}} [[Trimethoprim-Sulfamethoxazole]] 10 mg/kg/day IV q8h {{and}} [[Vancomycin]] 1 g IV q12h


::* Necrotizing fasciitis
::* '''Necrotizing fasciitis'''
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q8h {{and}} [[Clindamycin]] 600–900 mg IV q8h {{and}} [[Metronidazole]] 500 mg IV q6h
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q8h {{and}} [[Clindamycin]] 600–900 mg IV q8h {{and}} [[Metronidazole]] 500 mg IV q6h


:* Specific anatomic considerations<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
:* '''Specific anatomic considerations'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
::* '''Submandibular space infections including Ludwig angina'''
::* '''Submandibular space infections including Ludwig angina'''
:::* Causative pathogens
:::* Causative pathogens

Revision as of 17:58, 14 July 2015

Anthrax, oropharyngeal

  • Oropharyngeal anthrax[1]

Buccal cellulitis

  • Buccal cellulitis[2]

Cervico-facial actinomycosis

  • Cervico-facial actinomycosis[3]

Deep neck infection

  • Deep neck infection
  • Empiric antimicrobial therapy[4][5]
  • Community-acquired deep neck infection
  • Nosocomial deep neck infection or immunocompromised host
  • Deep neck infection with high-risk of MRSA
  • Necrotizing fasciitis
  • Specific anatomic considerations[6]
  • Submandibular space infections including Ludwig angina
  • Causative pathogens
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • Lateral pharyngeal or retropharyngeal space infections (odontogenic)
  • Causative pathogens
  • Viridans and other streptococci
  • Staphylococcus
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • Lateral pharyngeal or retropharyngeal space infections (rhinogenic)
  • Causative pathogens
  • Streptococcus pyogenes
  • Fusobacterium
  • Peptostreptococcus
  • Other oral anaerobes
  • Lateral pharyngeal or retropharyngeal space infections (otogenic)
  • Causative pathogens
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • Peritonsillar abscess (quinsy)
  • Causative pathogens
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • Suppurative parotitis
  • Causative pathogens
  • Staphylococcus
  • Viridans and other streptococci
  • Bacteroides
  • Peptostreptococcus
  • Other oral anaerobes
  • Extension of osteomyelitis from prevertebral space infection
  • Causative pathogens
  • Staphylococcus
  • Facultative gram-negative bacilli
  • Pott's puffy tumor (frontal osteitis)
  • Causative pathogens
  • Streptococcus pyogenes
  • Fusobacterium
  • Peptostreptococcus
  • Other oral anaerobes
  • Malignant otitis media
  • Causative pathogens
  • Pseudomonas aeruginosa
  • Petrous osteitis
  • Causative pathogens
  • Pseudomonas aeruginosa
  • Septic jugular thrombophlebitis (Lemierre syndrome)
  • Causative pathogens
  • Fusobacterium
  • Viridans and other streptococci
  • Staphylococcus
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes

Facial cellulitis

  • Facial cellulitis, odontogenic [7]
  • Causative pathogens
  • Aerobic and facultative organisms
  • Streptococcus, group A beta-hemolytic
  • Neisseria
  • Eikenella
  • Anaerobic organisms
  • Prevotella
  • Peptostreptococcus
  • Empiric antimicrobial therapy

Mastoiditis

  • Acute Mastoiditis [8]
  • Causative pathogens:
  • Streptococcus pneumoniae
  • Streptococcus pyogenes
  • Staphylococcus aureus
  • Hemophilus influenzae
  • Pseudomonas aeruginosa
  • Acute mastoiditis, outpatient
  • Empiric antimicrobial therapy
  • Preferred regimen (no abx in past month): Amoxicillin 50 mg/kg/day PO q6h
  • Preferred regimen (abx in past month): Amoxicillin-Clavulanate 90 mg/kg/day PO q12h OR Cefdinir 14 mg/kg PO q24h OR Cefpodoxime 10 mg/kg/day PO q12h OR Cefprozil 30 mg/kg/day PO q12h OR Cefuroxime 15 mg/kg/day PO q12h
  • Note: Duration of treatment in children <2 years-old is 10 days. In children ≥2 years, recommended duration is 5–7 days. Maximum dose for Cefpodoxime is 400 mg/day. Maximum dose for Cefprozil is 1 g/day. Maximum dose for Cefuroxime is 1 g/day.
  • Pathogen-directed antimicrobial therapy
  • Staphylococcus aureus (MSSA)
  • Preferred regimen: Oxacillin 37 mg/kg IV q6h
  • Note: Maximum dose is 8-12 g/day
  • Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 40 mg/kg/day IV q6-8h
  • Note: Maintain Vancomycin serum trough concentrations of 15-20 mcg/mL
  • Acute mastoiditis, inpatient
  • Empiric antimicrobial therapy
  • Pathogen-directed antimicrobial therapy
  • Staphylococcus aureus (MSSA)
  • Note: Maximum dose is 8-12 g/day
  • Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 40 mg/kg/day IV q6-8h
  • Note: Maintain Vancomycin serum trough concentrations of 15-20 mcg/mL

Chronic mastoiditis

  • Chronic Mastoiditis [9]
  • Causative pathogens:
  • Polymicrobial
  • Enterobacteriaceae
  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Empiric antimicrobial therapy

Odontogenic infection

  • Odontogenic infection[10]

Orbital cellulitis

  • Orbital cellulitis [11]

Oropharyngeal candidiasis

  • Oropharyngeal candidiasis[12]

Otitis externa

  • Otitis externa, acute [13]
  • Causative pathogens
  • Pseudomonas aeruginosa
  • Candida spp.
  • Enterobacteriaceae
  • Proteus spp.
  • Staphylococcus aureus
  • Empiric antimicrobial therapy
  • Pathogen-directed therapy
  • Fungal otitis externa [13]
  • Malignant otitis media, Pseudomonas aeruginosa[13]
  • Otitis externa, acute [13]
  • Empiric antimicrobial therapy

Otitis media

Otitis media, Acute

Otitis media, Post-intubation

Otitis media, Prophylaxis

Otitis media, Treatment failure

Note: Consider Tympanocentesis if clinically indicated.

Parotitis

  • Preferred regimen
  • MSSA : Nafcillin or oxacillin 2 gm IV q4h
  • MRSA : vancomycin
  • Juvenile recurrent parotitis [18]
  • Preferred regimen: B-lactam antibiotics (Penicillin VK or Amoxicillin–clavulanate for staphylococcal coverage)
  • Preferred regimen: Short-term, low-dose corticosteroid therapy can reduce inflammation and promote faster restoration of glandular function.
  • Preferred regimen: Currently, the accepted treatment for mumps includes supportive care consisting of hydration, oral hygiene and bed rest

References

  1. Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT; et al. (2014). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130687. PMC 3901462. PMID 24447897.
  2. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  3. Wong VK, Turmezei TD, Weston VC (2011). "Actinomycosis". BMJ. 343: d6099. doi:10.1136/bmj.d6099. PMID 21990282.
  4. Flint, Paul (2010). Cummings otolaryngology head & neck surgery. Philadelphia, PA: Mosby/Elsevier. ISBN 978-0323052832.
  5. Vieira, Francisco; Allen, Shawn M.; Stocks, Rose Mary S.; Thompson, Jerome W. (2008-06). "Deep neck infection". Otolaryngologic Clinics of North America. 41 (3): 459–483, vii. doi:10.1016/j.otc.2008.01.002. ISSN 0030-6665. PMID 18435993. Check date values in: |date= (help)
  6. Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
  7. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  8. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  9. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  10. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  11. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  12. Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE; et al. (2009). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clin Infect Dis. 48 (5): 503–35. doi:10.1086/596757. PMID 19191635.
  13. 13.0 13.1 13.2 13.3 Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA; et al. (2014). "Clinical practice guideline: acute otitis externa executive summary". Otolaryngol Head Neck Surg. 150 (2): 161–8. doi:10.1177/0194599813517659. PMID 24492208.
  14. 14.0 14.1 Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA; et al. (2013). "The diagnosis and management of acute otitis media". Pediatrics. 131 (3): e964–99. doi:10.1542/peds.2012-3488. PMID 23439909.
  15. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  16. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  17. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  18. 18.0 18.1 Patel A, Karlis V (2009). "Diagnosis and management of pediatric salivary gland infections". Oral Maxillofac Surg Clin North Am. 21 (3): 345–52. doi:10.1016/j.coms.2009.05.002. PMID 19608051.