abx for pharyngitis will reduce incidence of what complications?
Correct Answer Antibiotics also reduce the incidence of acute
rheumatic fever, peritonsillar and retropharyngeal abscesses.
Acute otitis media, which patients absolutely need abx? Correct
Answer · Patients who need ABX -
o Child <6mo, w/ severe s/s
o Child w/ severe AOM
o Child <24mo w/ bilat AOM
o Any child w/ whom f/u cannot be ensured.
Allergic Rhinitis, treatment guidelines, mild symptoms Correct
Answer Guidelines -
· Mild, intermittent symptoms -
o >12yo, first line treatment is 2nd generation oral antihistamine
(OAH) or intranasal antihistamine (INAH).
§ Cetirizine- Only one that causes drowsiness more than
placebo. § Fexofenadine § Loratadine § Levocitirizine - most
expensive § Desoloratadine
Allergic Rhinitis, treatment guidelines, moderate-severe
symptoms Correct Answer · Moderate/severe symptoms -
o Initially w/ 2nd generation OAH/INAH as needed, adding
intranasal corticosteroid (INCS) to the INAH.
§ INCS - most effective drug class for allergic rhinitis
symptoms, daily dosing.
· Budesonide · Fluticasone · Triamcinolone · Ciclesonide
, · Use after showering and direct spray away from septum to
improve deposition on mucosal surface.
· Leukotriene receptor antagonists (Montelukast, zafirlukast) are
not recommended for initial treatment of allergic rhinitis.
Corticosteroid injections are no longer recommended given their
side effect profile.
· Sublingual or subcutaneous immunotherapy should be offered
to patients who do not respond to pharmacologic therapy.
AOM, AAP update guidelines? Correct Answer · AAP update
guidelines -
o Severe AOM guidelines as -
§ Prescribe ABX for AOM in children 6mo or older w/ severe
s/s
§ Moderate or severe otalgia for at least 48hr or temp 102.2F
(39C)
AOM, complications Correct Answer Complications from OM
-
· Perforation of TM.
· Tympanosclerosis - May lead to conductive hearing loss.
· Mastoiditis - Patients with acute mastoiditis present with fever,
ear pain, and a protruding auricle.
· Meningitis.
AOM, duration of treatment - Correct Answer Duration of
treatment -
· AOM and <2yo - 10 days
· >2yo - 5-7 days, if severe 7 days.
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