Sandbox ID Head and Neck: Difference between revisions
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*'''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> | :*'''1. 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''' | ::* '''1.1 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''' | ::* '''1.2 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''' | ::* '''1.3 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''' | ::* '''1.4 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> | :* '''2. 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''' | ::* '''2.1 Submandibular space infections including Ludwig angina''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Viridans and other streptococci | ::::* Viridans and other streptococci | ||
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:::* 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 | :::* 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 | ||
::* '''Lateral pharyngeal or retropharyngeal space infections (odontogenic)''' | ::* '''2.2 Lateral pharyngeal or retropharyngeal space infections (odontogenic)''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Viridans and other streptococci | ::::* Viridans and other streptococci | ||
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:::* 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 | :::* 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 | ||
::* '''Lateral pharyngeal or retropharyngeal space infections (rhinogenic)''' | ::* '''2.3 Lateral pharyngeal or retropharyngeal space infections (rhinogenic)''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Streptococcus pyogenes | ::::* Streptococcus pyogenes | ||
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:::* 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 | :::* 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 | ||
::* '''Lateral pharyngeal or retropharyngeal space infections (otogenic)''' | ::* '''2.4 Lateral pharyngeal or retropharyngeal space infections (otogenic)''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Streptococcus pneumoniae | ::::* Streptococcus pneumoniae | ||
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:::* 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 | :::* 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 | ||
::* '''Peritonsillar abscess (quinsy)''' | ::* '''2.5 Peritonsillar abscess (quinsy)''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Viridans and other streptococci | ::::* Viridans and other streptococci | ||
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:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h | :::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h | ||
::* '''Suppurative parotitis''' | ::* '''2.6 Suppurative parotitis''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Staphylococcus | ::::* Staphylococcus | ||
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:::* Preferred regimen (immunocomppromised host): ([[Vancomycin]] 0.5 g IV q6h {{and}} [[Cefotaxime]] 2 g IV q6h) {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h | :::* Preferred regimen (immunocomppromised host): ([[Vancomycin]] 0.5 g IV q6h {{and}} [[Cefotaxime]] 2 g IV q6h) {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h | ||
::* '''Extension of osteomyelitis from prevertebral space infection''' | ::* '''2.7 Extension of osteomyelitis from prevertebral space infection''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Staphylococcus | ::::* Staphylococcus | ||
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:::* Preferred regimen (immunocomppromised host): ([[Vancomycin]] 0.5 g IV q6h {{and}} [[Cefotaxime]] 2 g IV q6h) {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h | :::* Preferred regimen (immunocomppromised host): ([[Vancomycin]] 0.5 g IV q6h {{and}} [[Cefotaxime]] 2 g IV q6h) {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h | ||
::* '''Pott's puffy tumor (frontal osteitis)''' | ::* '''2.8 Pott's puffy tumor (frontal osteitis)''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Streptococcus pyogenes | ::::* Streptococcus pyogenes | ||
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:::* 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 | :::* 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 | ||
::* '''Malignant otitis media''' | ::* '''2.9 Malignant otitis media''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Pseudomonas aeruginosa | ::::* Pseudomonas aeruginosa | ||
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:::* Preferred regimen (immunocomppromised host): ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h | :::* Preferred regimen (immunocomppromised host): ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h | ||
::* '''Petrous osteitis''' | ::* '''2.10 Petrous osteitis''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Pseudomonas aeruginosa | ::::* Pseudomonas aeruginosa | ||
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:::* Preferred regimen (immunocomppromised host): ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h | :::* Preferred regimen (immunocomppromised host): ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h | ||
::* '''Septic jugular thrombophlebitis (Lemierre syndrome)''' | ::* '''2.11 Septic jugular thrombophlebitis (Lemierre syndrome)''' | ||
:::* Causative pathogens | :::* Causative pathogens | ||
::::* Fusobacterium | ::::* Fusobacterium | ||
Revision as of 18:00, 14 July 2015
Anthrax, oropharyngeal
- Oropharyngeal anthrax[1]
- Preferred regimen: Ciprofloxacin 400 mg IV q8h AND (Clindamycin 900 mg IV q8h OR Linezolid 600 mg IV q12h)
- Alternative regimen: (Levofloxacin 750 mg IV q24h OR Moxifloxacin 400 mg IV q24h OR Meropenem 2 g IV q8h OR Imipenem 1 g IV q6h OR Doripenem 500 mg IV q8h OR Vancomycin 60 mg/kg/24h IV q8h OR Ampicillin 3 g IV q6h OR Penicillin G 4 MU IV q4h) AND (Doxycycline 200 mg IV initially, then 100 mg IV q12h OR Rifampin 600 mg IV q8h)
- Note: Treatment is for 14 days or until patient is clinically stable. Patients with exposure to aerosolized spores require 60 days of therapy (PO after first 2 weeks). Ampicillin and Penicillin G are only recommended for penicillin-susceptible strains. If Vancomycin is used, maintain serum trough concentrations of 15-20 mcg/mL. For pregnant or lactating women and children below the age of 8, avoid Doxycycline.
Buccal cellulitis
- Buccal cellulitis[2]
- Preferred regimen: Cefuroxime 50 mg/kg IV q8h OR Cefuroxime 10–15 mg/kg PO q12h OR Ceftriaxone 50 mg/kg IV q24h
- Alternative regimen: Amoxicillin-Clavulanate 90 mg/kg/day PO q12h
- Note: In case of suspected meningitis, increase Cefuroxime dose to 80 mg/kg IV q8h, or Ceftriaxone dose to 50 mg/kg IV q24h. For oral Cefuroxime, maximum dose is 1 g per day.
Cervico-facial actinomycosis
- Cervico-facial actinomycosis[3]
- Preferred regimen: Ampicillin 50 mg/kg/day IV q8h (4-6 weeks) THEN Penicillin V 2-4 g/day PO q6h (3-6 months)
- Alternative regimen: Penicillin G 10-20 MU/day IV q6h (4-6 weeks) THEN Penicillin V 2-4 g/day PO q6h (3-6 months)
- Note: In patients allergic to Penicillin, consider Doxycycline, Clindamycin, or Erythromycin.
Deep neck infection
- Deep neck infection
-
- 1.1 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)
- 1.2 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
- 1.3 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
- 1.4 Necrotizing fasciitis
- Preferred regimen: Ceftriaxone 2 g IV q8h AND Clindamycin 600–900 mg IV q8h AND Metronidazole 500 mg IV q6h
- 2. Specific anatomic considerations[6]
- 2.1 Submandibular space infections including Ludwig angina
- 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
- 2.2 Lateral pharyngeal or retropharyngeal space infections (odontogenic)
- 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
- 2.3 Lateral pharyngeal or retropharyngeal space infections (rhinogenic)
- Causative pathogens
- Streptococcus pyogenes
- Fusobacterium
- Peptostreptococcus
- Other oral anaerobes
- Preferred regimen (immunocompetent host): Penicillin G 2–4 MU IV q4–6h OR (Ciprofloxacin 200 mg q12h AND Metronidazole 0.5 g IV q6h) OR Gatifloxacin 400 mg IV q24h 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
- 2.4 Lateral pharyngeal or retropharyngeal space infections (otogenic)
- Causative pathogens
- Streptococcus pneumoniae
- Haemophilus influenzae
- Viridans and other streptococci
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): Penicillin G 2–4 MU IV q4–6h OR (Ciprofloxacin 200 mg q12h AND Metronidazole 0.5 g IV q6h) OR Gatifloxacin 400 mg IV q24h 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
- 2.5 Peritonsillar abscess (quinsy)
- Causative pathogens
- Viridans and other streptococci
- 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 OR Cefoxitin 2 g IV q6h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h
- 2.6 Suppurative parotitis
- Causative pathogens
- Staphylococcus
- Viridans and other streptococci
- Bacteroides
- Peptostreptococcus
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Nafcillin 1.5 g IV q4–6h AND Metronidazole 0.5 g IV q6h) OR Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host): (Vancomycin 0.5 g IV q6h AND Cefotaxime 2 g IV q6h) OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h
- 2.7 Extension of osteomyelitis from prevertebral space infection
- Causative pathogens
- Staphylococcus
- Facultative gram-negative bacilli
- Preferred regimen (immunocompetent host): (Nafcillin 1.5 g IV q4–6h AND Metronidazole 0.5 g IV q6h) OR Ciprofloxacin 200 mg q12h
- Preferred regimen (immunocomppromised host): (Vancomycin 0.5 g IV q6h AND Cefotaxime 2 g IV q6h) OR Ceftizoxime 4 g IV q8h OR Imipenem 500 mg IV q6h
- 2.8 Pott's puffy tumor (frontal osteitis)
- Causative pathogens
- Streptococcus pyogenes
- Fusobacterium
- Peptostreptococcus
- Other oral anaerobes
- Preferred regimen (immunocompetent host): Penicillin G 2–4 MU IV q4–6h OR (Ciprofloxacin 200 mg q12h AND Metronidazole 0.5 g IV q6h) OR Gatifloxacin 400 mg IV q24h 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
- 2.9 Malignant otitis media
- Causative pathogens
- Pseudomonas aeruginosa
- Preferred regimen (immunocompetent host): Ciprofloxacin 200 mg q12h OR (Tobramycin 2 mg/kg IV q8h AND Ceftazidime 2 g IV q6h) OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host): (Tobramycin 2 mg/kg IV q8h AND Ceftazidime 2 g IV q6h) OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h
- 2.10 Petrous osteitis
- Causative pathogens
- Pseudomonas aeruginosa
- Preferred regimen (immunocompetent host): Ciprofloxacin 200 mg q12h OR (Tobramycin 2 mg/kg IV q8h AND Ceftazidime 2 g IV q6h) OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host): (Tobramycin 2 mg/kg IV q8h AND Ceftazidime 2 g IV q6h) OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h
- 2.11 Septic jugular thrombophlebitis (Lemierre syndrome)
- 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
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
- Preferred regimen (outpatient): Amoxicillin-Clavulanate OR Clindamycin
- Preferred regimen (inpatient): Ampicillin-Sulbactam OR Clindamycin
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
- Preferred regimen: Cefotaxime 1-2 g IV q4-8h OR Ceftriaxone 1 g IV q24h
- 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
Chronic mastoiditis
- Chronic Mastoiditis [9]
- Causative pathogens:
- Polymicrobial
- Enterobacteriaceae
- Staphylococcus aureus
- Pseudomonas aeruginosa
- Empiric antimicrobial therapy
- Preferred regimen: Imipenem 0.5 g IV q6h OR Piperacillin-Tazobactam 3.375 g IV q4-6h OR Meropenem 1 g IV q8h OR Ticarcillin-Clavulanate 3.1 g IV q6h
- Note: Treatment is reserved for acute exacerbations or perioperatively. It is recommended not to treat without surgical cultures.
Odontogenic infection
- Odontogenic infection[10]
- Preferred regimen : Clindamycin 300–450 mg po q6h OR 600 mg IV q6–8h
- Alternate regimen : (Amoxicillin-Clavulanic acid 875/125 mg po bid OR 500/125 mg tid or 2000/125 mg bid) or Cefotetan 2 gm IV q12h
Orbital cellulitis
- Orbital cellulitis [11]
- Preferred treatment : Nafcillin 2 gm IV q4h (or if MRSA-vancomycin 1 gm IV q12h) AND ceftriaxone 2 gm IV q24h AND metronidazole 1 gm IV q12h
- If penicillin/cephalosporin allergy: Vancomycin AND levofloxacin 750 mg IV once daily AND metronidazole IV. If vancomycin intolerant, another option for s. aureus is daptomycin 6 mg/kg IV q24h.
Oropharyngeal candidiasis
- Oropharyngeal candidiasis[12]
- Preferred treatment : Clotrimazole troches 10 mg 5 times daily OR nystatin suspension or pastilles qid (B-II) OR fluconazole 100–200 mg daily (A-I)
- Alternate treatment : Itraconazole solution 200 mg daily OR posaconazole 400 mg qd (A-II) OR voriconazole 200 mg bid OR AmB oral suspension (B-II) OR IV echinocandin OR AmB-d 0.3 mg/kg daily (B-II) (Fluconazole is recommended for moderate-to-severe disease, and topical therapy with clotrimazole or nystatin is recommended for mild disease. Treat uncomplicated disease for 7–14 days. For refractory disease, itraconazole, voriconazole, posaconazole, or AmB suspension is recommended)
Otitis externa
- Otitis externa, acute [13]
- Causative pathogens
- Pseudomonas aeruginosa
- Candida spp.
- Enterobacteriaceae
- Proteus spp.
- Staphylococcus aureus
- Empiric antimicrobial therapy
- Preferred regimen (1): Acetic acid 2.0% TOP q6-8h
- Preferred regimen (2): Acetic acid 2.0%, Hydrocortisone 1.0% TOP q6-8h
- Preferred regimen (3): Ciprofloxacin 0.2%, Hydrocortisone 1.0% TOP q6-8h
- Preferred regimen (4): Ciprofloxacin 0.3%, Dexamethasone 0.1% TOP q6-8h
- Preferred regimen (5): Neomycin, Polymyxin B, Hydrocortisone TOP q6-8h
- Preferred regimen (6): Ofloxacin 0.3% TOP q6-8h
- Note: Recommended treatment duration is 7-10 days.
- Pathogen-directed therapy
- Fungal otitis externa [13]
- Preferred regimen: Fluconazole 200 mg PO once THEN Fluconazole 100 mg PO q24h for 3–5 days
- Malignant otitis media, Pseudomonas aeruginosa[13]
- Preferred regimen: Imipenem 0.5 g IV q6h OR Meropenem 1 g IV q8h OR Ciprofloxacin 400 mg IV q8h OR Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q12h OR (Piperacillin-Tazobactam 4-6g IV q4h AND Tobramycin 3–5 mg/kg/day IV q8h)
- Note: Oral Ciprofloxacin may be used by only in patients with very early disease
- Otitis externa, acute [13]
- Empiric antimicrobial therapy
Otitis media
Otitis media, Acute
- Otitis media [14]
- Preferred Regimen : Amoxicillin 80–90 mg/kg/d bid OR Amoxicillin 90 mg/kg/d with Clavulanate 6.4 mg/kg/d
- Alternative Regimen (if allergic to penicillin) : Cefdinir 14 mg/kg/d qd or bid OR Cefuroxime 30 mg/kg/d bid OR Cefpodoxime 10 mg/kg/d bid OR Ceftriaxone 50 mg/kg IM/IV qd
Otitis media, Post-intubation
- Otitis media [15]
- Preferred regimen : Ceftazidime 2 gm IV q8h OR Cefepime 2 gm q12h or Imipenem 0.5 gm IV q6h OR Meropenem OR (Piperacillin-Tazobactam)4–6 gm IV q4–6h OR Ticarcillin-Clavulanate 3 gm IV q4h OR Ciprofloxacin 400 mg IV q12h (or 750 mg po q12h).
Otitis media, Prophylaxis
- Otitis media[16]
- Preferred regimen : Sulfisoxazole 50 mg/kg PO at bedtime or amoxicillin 20 mg/kg PO q24h
Otitis media, Treatment failure
- Otitis media [14]
- Preferred Regimen : Amoxicillin 90 mg/kg/d with Clavulanate 6.4 mg/kg/d OR Ceftriaxone 50 mg/kg IM/IV qd
- Alternative Regimen : Clindamycin 30–40 mg/kg/d tid OR third generation Cephalosporin
- Note: Consider Tympanocentesis if clinically indicated.
Parotitis
- Parotitis[17]
- 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.
- viral [18]
- Preferred regimen: Currently, the accepted treatment for mumps includes supportive care consisting of hydration, oral hygiene and bed rest
References
- ↑ 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.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Wong VK, Turmezei TD, Weston VC (2011). "Actinomycosis". BMJ. 343: d6099. doi:10.1136/bmj.d6099. PMID 21990282.
- ↑ Flint, Paul (2010). Cummings otolaryngology head & neck surgery. Philadelphia, PA: Mosby/Elsevier. ISBN 978-0323052832.
- ↑ 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) - ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ 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.
- ↑ 13.0 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.
- ↑ 14.0 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.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ 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.