1 / 32

Common Outpatient Infections

Common Outpatient Infections. Rodolfo E Bégué, MD Chief, Pediatric Infectious Diseases LSUHSC, New Orleans. Otitis Media Sinusitis Pharyngitis Lymphadenitis Pneumonia Urinary tract infection Diarrhea. Impetigo/cellulitis Wounds/bites Infestations Fungal Parasites Herpes Exanthems.

knut
Download Presentation

Common Outpatient Infections

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Common Outpatient Infections Rodolfo E Bégué, MD Chief, Pediatric Infectious Diseases LSUHSC, New Orleans

  2. Otitis Media Sinusitis Pharyngitis Lymphadenitis Pneumonia Urinary tract infection Diarrhea Impetigo/cellulitis Wounds/bites Infestations Fungal Parasites Herpes Exanthems Common Outpatient Infections

  3. Otitis Media Diagnosis • Acute onset • Inflammation • Middle ear fluid Normal AOM

  4. Otitis Media Etiology • Streptococcus pneumoniae Penicillin-susceptible Penicillin-non susceptible • Haemophilus influenzae (non-typeable) • Moraxella catarrhalis

  5. Otitis Media Treatment • ~ 80% resolve spontaneouslyantibiotics increase resolution to ~ 95% • Priority to treat is children < 2 years and severe cases • Drug of Choice: AMOXICILLIN 80-90 mg/kg/d

  6. Otitis Media Failure: • Amoxicillin / clavulanate • Ceftriaxone (1-3 doses) • Tympanocentesis

  7. Otitis Media Alternatives: • Cefdinir (Omnicef) • Cefuroxime (Ceftin) • Cefpodoxime (Vantin) • Ceftriaxone • Azitromycin • Clarithromycin

  8. Recurrent Otitis Media • 3 episodes in 6 months4 episodes in 12 months • Check for environmental factors • Chemoprophylaxis: amoxicillin (20 mg/kg/d) sulfisoxazole (35-70 mg/kg/d) • Ventilating tubes

  9. Otitis Media with Effusion • Middle ear fluidNo inflammation • Must de differentiated from AOM AOM OME Normal

  10. Otitis Media with Effusion Management • Intervention only necessary if there is hearing deficit (bilateral and >20db in “best” ear) • First 3 months: watchful waiting (>95% will resolve) • After 3 months: hearing testing (> 20 db?) • > 4 months: discuss with ENTconsider ventilating tubes

  11. AOMT • Augmentin • Ciprodex Ciprofloxacin 0.3% Dexamethasone 0.1%Cipro HC Ciprofloxacin HCl 0.2% Hydrocortisone 1%Floxin Ofloxacin 0.3%

  12. Otitis Externa • Swimmer’s ear • Staphylococcus aureus, Pseudomonas spp • Cleansing, drying • Neomycin otic solution with polymyxin B and hydrocortisone (Cortisporin)Ciprofloxacin with hydrocortisone (Cipro HC Otic) Ofloxacin otic solution (Floxin Otic) • 2% acetic acidGentamicin ophthalmic (Garamycin)Tobramycin opthalmic (Tobrex)

  13. Diagnosis is clinical URI symptoms that persist > 10 days URI symptoms that get worse after 5 days Sinus pain uncommon Do not do plain films Do not abuse CT Sinusitis

  14. Etiology: Similar to AOM Treatment: Similar to AOM, except that duration is ~ 2 weeks (7 d after patient is free of symptoms) Sinusitis

  15. UNCOMMON Suspect Other etiologies (CF, anatomical) Other explanations (asthma, allergies environmental factors Chronic Sinusitis

  16. Pharyngitis • Viral most common (EBV, rhinovirus, etc) • Allergies • Bacterial: Group A Streptococcus Other Streptococcus

  17. Strept Pharyngitis Diagnosis: • Clinical > 2 years old, acute onset, fever, unilateral lymphadenitis, no URI • Rapid test • Culture (GAS only vs others) • Beware of carriers (need ASLO)

  18. Pharyngitis Treatment: • Penicillin V 250 mg PO bid x 10 daysamoxicillin 40 mg/kg/d div bid x 10 days • Alternatives:benzathine penicillin G, erythromycin, clindamycin, cephalexin, • Others:clarithromycin, cefuroxime, cefixime, ceftibuten, cefdinir, cefpodoxime, azithromycin

  19. Generalized Viral (EBV) Toxoplasmosis Syphilis Single Acute:Staph / Strep Chronic:Bartonella henselaeMycobacteria Lymphadenitis

  20. Acute Lymphadenitis • Clindamycin, cephalexin, macrolide • US  Aspiration Gorup A Streptococcus Staphylococcus aureus

  21. Chronic (sub-acute) lymphadenitis • To consider: CBC, EBV, PPD, B. henselae titers, Toxo, others depending on risk factors • Can treat as for “acute” first • Watch for 2-3 w and re-evaluate • If all negative and not any better, consider wait vs re-test vs aspiration/incision/excision B. henselae MAIC M. tuberculosis

  22. Etiologies ViralRSVInfluenza BacterialStrep pneumoniae AtypicalMycoplasmaChlamydiaTuberculosis Treatment Amoxicillin (2m- 5 yrs) MacrolideErythromycinAzithromycin Antivirals(Oseltamivir) CA Pneumonia

  23. Urinary Tract Infection • Not difficult to treat, only difficult to diagnose but the implications of a missed diagnosis may be terrible • Always suspect in febrile children < 2 yrs of age • Dx of UTI requires a UCx (bag-specimen not good) • UA (WBC), dipstick OK as a guide, especially in combination

  24. Etiology Escherichia coli Enterococcus Treatment Amoxicillin TMP / SMX Cefixime Quinolone Urinary Tract Infection • Follow-up • US, VCUG • DMSA scan • Consider prophylaxis

  25. Acute Gastroenteritis • “Always” infectious • Viruses: rotavirus, calicivirus, others • Bacteria: Campylobacter, Shigella, Salmonella, Yersinia, E. coli • Antibiotics usually not required, unless diarrhea is dysenteric TMP/SMX, Azithromycin, Quinolones • Clostridium difficile

  26. Impetigo / cellulitis • Etiology:Group A Streptococcus Staphylococcus aureus (MRSA) • Treatment:Bacitracin, Mupirocin, RetapaluminCephalexin, clindamycin, TMP/SMX, erytho, linezolid Drain any abscess

  27. Etiology Staph aureus (~ 3 d) Pseudom spp (~ 7 d) Mycobacteria (~ 2-4 w) Treatment Wound careTetanus vaccineAnti-Staph antibiotics If no responseSurgical exploration  cultureCeftazidime  ciprofloxacin (for 2 w) Puncture wounds (foot)

  28. Etiology Pasteurella multocida Eikenella corrodens Streptococcus spp / Staphylococcus spp Neisseria spp / Corynebacterium spp Anaerobes Polymicrobial Prophylaxis and Treatment Wound careTetanus shotRabies prophylaxis (?) Amoxicillin / clavulanate clindamycin + TMP/SMX Bites

  29. Fungal Infections • Oral candidiasisoral nystatin or clotrimazolefluconazole 3 mg/kg qd x 7d • Tinea corporistopical clotrimazole or terbinafine bid 2-3 w+ fluconazole 3 mg/kg/w x 2-3 w • Tinea capitisgriseofulvin 10 mg/kg qd x 4-8 wterbinafine 125 mg qd x 4 w (Lamisil)

  30. Worms Enterobius vermicularis(Ascaris) Scotch tape test Mebendazole 100 mg Pyrantel pamoate 11 mg/kgAlbendazole 400 mg All repeat in 1 w Protozoans Giardia (Cryptosporidium) Metronidazole 5 mg/kg q8h x 5-10dFurazolidone 2 mg/kg q6h x 7-10dAlbendazole 400 mg/d x 5d(Nitazoxanide) Parasites • Taeniasis • Praziquantel, different doses Uncertain significance Entamoeba coli, Endolimax nana, Iodamoeba butschlii Blastocystis hominis, Dientamoeba fragilis

  31. Standard: Permethrin: 1% Nix (Tx of choice) Pyrethrins: RID, A-200, R&C, Pronto, Clear Lice System Lindane 1%: Kwell Upgrade: Permethrin 5%: Elimite Malathion 0.5%: Ovide Crotamiton 10%: Eurax TMP/SMX PO Ivermectin PO200 g/kg Head Lice

  32. QUESTIONS ?

More Related