Sandbox ID Head and Neck: Difference between revisions

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Latest revision as of 14:13, 16 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]

1. Empiric antimicrobial therapy

Preferred regimen: Cefuroxime 50 mg/kg IV q8h OR Cefuroxime 10–15 mg/kg PO q12h (maximum dose is 1 g/day) 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.

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. Empiric antimicrobial therapy^[4]^[5]

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 erysipelas

Facial erysipelas^[7]

1. Causative pathogens

Staphylococcus aureus
Streptococcus spp. (Group A, B, C, & G)
Enterobacteriaceae
Clostridium spp.

2. Empiric antimicrobial therapy

Preferred regimen: Vancomycin 1 g IV q12h
Alternative regimen: Daptomycin 4 mg/kg IV q24h OR Linezolid 600 mg IV q12h

Mastoiditis

1. Acute Mastoiditis ^[8]

1.1 Causative pathogens:

Streptococcus pneumoniae
Streptococcus pyogenes
Staphylococcus aureus
Hemophilus influenzae
Pseudomonas aeruginosa

1.2 Acute mastoiditis, outpatient

1.2.1 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 (maximum dose is 400 mg/day) OR Cefprozil 30 mg/kg/day PO q12h (maximum dose is 1 g/day) OR Cefuroxime 15 mg/kg/day PO q12h (Maximum dose is 1 g/day)
Note: Duration of treatment in children <2 years-old is 10 days. In children ≥2 years, recommended duration is 5–7 days.

1.2.2 Pathogen-directed antimicrobial therapy

1.2.2.1 Staphylococcus aureus (MSSA)

Preferred regimen: Oxacillin 37 mg/kg IV q6h (maximum dose is 8-12 g/day)

1.2.2.2 Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 40 mg/kg/day IV q6-8h
Note: Maintain Vancomycin serum trough concentrations of 15-20 mcg/mL

1.3 Acute mastoiditis, inpatient

1.3.1 Empiric antimicrobial therapy

Preferred regimen: Cefotaxime 1-2 g IV q4-8h OR Ceftriaxone 1 g IV q24h

1.3.2 Pathogen-directed antimicrobial therapy

1.3.2.1 Staphylococcus aureus (MSSA)

Preferred regimen: Oxacillin 37 mg/kg IV q6h (maximum dose is 8-12 g/day)

1.3.2.2 Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 40 mg/kg/day IV q6-8h
Note: Maintain Vancomycin serum trough concentrations of 15-20 mcg/mL

2. Chronic Mastoiditis^[9]

2.1 Causative pathogens:

Polymicrobial
Enterobacteriaceae
Staphylococcus aureus
Pseudomonas aeruginosa

2.2 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 infections

Odontogenic infections^[10]

1. Empiric antimicrobial therapy

Preferred regimen: Clindamycin 300–450 mg PO q6h OR Clindamycin 600 mg IV q6–8h
Alternative regimen: Amoxicillin-Clavulanic acid 875/125 mg PO q12h OR Amoxicillin-Clavulanic acid 500/125 mg PO q8h OR Amoxicillin-Clavulanic acid 2000/125 mg PO q12h OR Cefotetan 2 g IV q12h

Orbital cellulitis

Orbital cellulitis ^[11]

1. Causative pathogens

Streptococcus pneumoniae
Hemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus

2. Empiric antimicrobial therapy

Preferred regimen: Vancomycin 1 g IV q12h AND Ceftriaxone 2 g IV q24h AND Metronidazole 1 g IV q12h
Alternative regimen (1): Vancomycin 1 g IV q12h AND Levofloxacin 750 mg IV q24h AND Metronidazole 1 g IV q12h
Alternative regimen (2): Daptomycin 6 mg/kg IV q24h AND Ceftriaxone 2 g IV q24h AND Metronidazole 1 g IV q12h
Alternative regimen (3): Daptomycin 6 mg/kg IV q24h AND Levofloxacin 750 mg IV q24h AND Metronidazole 1 g IV q12h

Oropharyngeal candidiasis

Oropharyngeal candidiasis^[12]

Preferred regimen: Clotrimazole troches 10 mg TOP q4-5h OR Nystatin suspension or pastilles TOP q6h OR Fluconazole 100–200 mg PO q24h
Alternative regimen: Itraconazole solution 200 mg PO q24h OR Posaconazole 400 mg PO q24h OR Voriconazole 200 mg PO q24h OR Amphotericin B oral suspension PO q24h OR (Anidulafungin 200 mg IV once THEN Anidulafungin 100 mg IV q24h) OR (Caspofungin 70 mg IV once THEN Caspofungin 50 mg IV q24h) OR Micafungin 100 mg IV q24h OR Amphotericin B 0.3 mg/kg IV q24h
Note: Treat uncomplicated disease for 7–14 days. Fluconazole is recommended in moderate-to-severe disease, and topical therapy with Clotrimazole or Nystatin is recommended for mild disease. For refractory disease, consider the alternative regimen.

Otitis externa

1. Otitis externa, acute ^[13]

1.1 Causative pathogens

Pseudomonas aeruginosa
Candida spp.
Enterobacteriaceae
Proteus spp.
Staphylococcus aureus

1.2 Empiric antimicrobial therapy

Preferred regimen (1): Acetic acid 2.0% TOP tid for 7-10 days
Preferred regimen (2): Acetic acid 2.0%, Hydrocortisone 1.0% TOP tid for 7-10 days
Preferred regimen (3): Ciprofloxacin 0.2%, Hydrocortisone 1.0% TOP tid for 7-10 days
Preferred regimen (4): Ciprofloxacin 0.3%, Dexamethasone 0.1% TOP tid for 7-10 days
Preferred regimen (5): Neomycin, Polymyxin B, Hydrocortisone TOP tid for 7-10 days
Preferred regimen (6): Ofloxacin 0.3% TOP tid for 7-10 days

1.3 Pathogen-directed therapy

1.3.1 Fungal otitis externa^[13]

Preferred regimen: Fluconazole 200 mg PO once THEN Fluconazole 100 mg PO q24h for 3–5 days

1.3.2 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

2. Otitis externa, chronic^[13]

2.1 Empiric antimicrobial therapy

Preferred regimen: Neomycin, Polymyxin B, Hydrocortisone TOP q6-8h AND Selenium Sulfide Shampoo
Note: Selenium sulfide shampoo is recommended as the disease is usually secondary to seborrhea.

Acute Otitis media

Acute otitis media ^[14]

1. Causative pathogens

Streptococcus pneumoniae
Hemophilus influenzae
Moraxella catarrhalis
Polymicrobial
Viral

2. Empiric antimicrobial therapy

Preferred regimen: Amoxicillin 40–90 mg/kg/day PO q12h OR Amoxicillin-Clavulanate 90/6.4 mg/kg/day PO q12h
Alternative regimen: Cefdinir 14 mg/kg/day PO q12 or q24h OR Cefuroxime 30 mg/kg/day PO q12h OR Cefpodoxime 10 mg/kg/day PO q12h OR Ceftriaxone 50 mg/kg/day IM or IV q24h
Note: Amoxicillin-Clavulanate may be considered in patients with recent Amoxicillin intake or concomitant conjunctivitis. Alternative regimens should be considered in patients with Penicillin allergies. Re-evaluate after 2-3 days for treatment response.

3. Special considerations

3.1 Acute otitis media post-treatment failure (48-72 hours)

Preferred regimen: Amoxicillin-Clavulanate 90/6.4 mg/kg/day PO q12h OR Ceftriaxone 50 mg/kg/day IM or IV q24h
Alternative regimen: Clindamycin 30–40 mg/kg/day PO q8h ± (Cefdinir 14 mg/kg/day PO q12 or q24h OR Cefuroxime 30 mg/kg/day PO q12h OR Cefpodoxime 10 mg/kg/day PO q12h OR Ceftriaxone 50 mg/kg/day IM or IV q24h)

3.2 Acute otitis media post-intubation^[15]

Preferred regimen: Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q12h OR Imipenem 0.5 g IV q6h OR Meropenem 500 mg IV q8h OR Piperacillin-Tazobactam 4–6 g IV q4–6h OR Ticarcillin-Clavulanate 3 g IV q4h OR Ciprofloxacin 400 mg IV q12h OR Ciprofloxacin 750 mg PO q12h

Parotitis

Parotitis^[16]

1. Causative pathogens

Staphylococcus aureus
Streptococcus pyogenes
Mumps
Aerobic gram-negative bacilli
Enterovirus
Influenza virus

2. Empiric antimicrobial therapy

Preferred regimen (MSSA suspected): Nafcillin 2 g IV q4h OR Oxacillin 2 g IV q4h
Preferred regimen (MRSA suspected): Vancomycin 1 g IV q12h

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.
↑ 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.

[pmid24447897-1] 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.

[pmid21990282-3] 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.

[pmid19191635-12] 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.

[pmid24492208-13] 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.

[pmid23439909-14] 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.

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@@ Line 7: / Line 7: @@
 ===Buccal cellulitis===
 *'''Buccal cellulitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:*Preferred regimen: [[Cefuroxime]] 50 mg/kg IV q8h {{or}} [[Cefuroxime]] 10–15 mg/kg PO q12h {{or}} [[Ceftriaxone]] 50 mg/kg IV q24h
+:*'''1. Empiric antimicrobial therapy'''
-:*Alternative regimen: [[Amoxicillin-Clavulanate]] 90 mg/kg/day PO q12h
+::*Preferred regimen: [[Cefuroxime]] 50 mg/kg IV q8h {{or}} [[Cefuroxime]] 10–15 mg/kg PO q12h (maximum dose is 1 g/day) {{or}} [[Ceftriaxone]] 50 mg/kg IV q24h
-:*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.
+::*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.
 ===Cervico-facial actinomycosis===
@@ Line 132: / Line 133: @@
 :::* 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 erysipelas===
+*'''Facial erysipelas'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-* Facial cellulitis, odontogenic <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:*'''1. Causative pathogens'''
-:* Causative pathogens
+::*Staphylococcus aureus
-::* Aerobic and facultative organisms
+::*Streptococcus spp. (Group A, B, C, & G)
-:::* Streptococcus, group A beta-hemolytic
+::*Enterobacteriaceae
-:::* Neisseria
+::*Clostridium spp.
-:::* Eikenella
+:*'''2. Empiric antimicrobial therapy'''
-::* Anaerobic organisms
+::*Preferred regimen: [[Vancomycin]] 1 g IV q12h
-:::* Prevotella
+::*Alternative regimen: [[Daptomycin]] 4 mg/kg IV q24h {{or}} [[Linezolid]] 600 mg IV q12h
-:::* Peptostreptococcus
-:* '''Empiric antimicrobial therapy'''
-::* Preferred regimen (outpatient): [[Amoxicillin-Clavulanate]] {{or}} [[Clindamycin]]
-::* Preferred regimen (inpatient): [[Ampicillin-Sulbactam]] {{or}} [[Clindamycin]]
 ===Mastoiditis===
@@ Line 158: / Line 155: @@
 ::*'''1.2.1 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
+:::*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 (maximum dose is 400 mg/day) {{or}}  [[Cefprozil]] 30 mg/kg/day PO q12h (maximum dose is 1 g/day) {{or}} [[Cefuroxime]] 15 mg/kg/day PO q12h (Maximum dose is 1 g/day)
-:::*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.
+:::*Note: Duration of treatment in children <2 years-old is 10 days. In children ≥2 years, recommended duration is 5–7 days.
 ::*'''1.2.2 Pathogen-directed antimicrobial therapy'''
 :::*'''1.2.2.1 Staphylococcus aureus (MSSA)'''
-::::*Preferred regimen: [[Oxacillin]] 37 mg/kg IV q6h
+::::*Preferred regimen: [[Oxacillin]] 37 mg/kg IV q6h (maximum dose is 8-12 g/day)
-::::*Note: Maximum dose is 8-12 g/day
 :::*'''1.2.2.2 Staphylococcus aureus (MRSA)'''
 ::::*Preferred regimen: [[Vancomycin]] 40 mg/kg/day IV q6-8h
@@ Line 172: / Line 168: @@
 ::*'''1.3.2 Pathogen-directed antimicrobial therapy'''
 :::*'''1.3.2.1 Staphylococcus aureus (MSSA)'''
-::::*Preferred regimen: [[Oxacillin]] 37 mg/kg IV q6h
+::::*Preferred regimen: [[Oxacillin]] 37 mg/kg IV q6h (maximum dose is 8-12 g/day)
-::::*Note: Maximum dose is 8-12 g/day
 :::*'''1.3.2.2 Staphylococcus aureus (MRSA)'''
 ::::*Preferred regimen: [[Vancomycin]] 40 mg/kg/day IV q6-8h
@@ Line 188: / Line 183: @@
 ::*Note: Treatment is reserved for acute exacerbations or perioperatively. It is recommended not to treat without surgical cultures.
-===Odontogenic infection===
+===Odontogenic infections===
-*Odontogenic infection<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+*'''Odontogenic infections'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:*Preferred regimen : [[Clindamycin]] 300–450 mg po q6h {{or}} 600 mg IV q6–8h
+:*'''1. Empiric antimicrobial therapy'''
-:*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
+::*Preferred regimen: [[Clindamycin]] 300–450 mg PO q6h {{or}} [[Clindamycin]] 600 mg IV q6–8h
+::*Alternative regimen: [[Amoxicillin-Clavulanic acid]] 875/125 mg PO q12h {{or}} [[Amoxicillin-Clavulanic acid]] 500/125 mg PO q8h {{or}} [[Amoxicillin-Clavulanic acid]] 2000/125 mg PO q12h {{or}} [[Cefotetan]] 2 g IV q12h
 ===Orbital cellulitis===
-*Orbital cellulitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+*'''Orbital cellulitis''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:*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
+:*'''1. Causative pathogens'''
-:*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.
+::*Streptococcus pneumoniae
+::*Hemophilus influenzae
+::*Moraxella catarrhalis
+::*Staphylococcus aureus
+:*'''2. Empiric antimicrobial therapy'''
+::*Preferred regimen: [[Vancomycin]] 1 g IV q12h {{and}} [[Ceftriaxone]] 2 g IV q24h {{and}} [[Metronidazole]] 1 g IV q12h
+::*Alternative regimen (1): [[Vancomycin]] 1 g IV q12h {{and}} [[Levofloxacin]] 750 mg IV q24h {{and}} [[Metronidazole]] 1 g IV q12h
+::*Alternative regimen (2): [[Daptomycin]] 6 mg/kg IV q24h {{and}} [[Ceftriaxone]] 2 g IV q24h {{and}} [[Metronidazole]] 1 g IV q12h
+::*Alternative regimen (3): [[Daptomycin]] 6 mg/kg IV q24h {{and}} [[Levofloxacin]] 750 mg IV q24h {{and}} [[Metronidazole]] 1 g IV q12h
 ===Oropharyngeal candidiasis===
-*Oropharyngeal candidiasis<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+*'''Oropharyngeal candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
-:*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)
+:*Preferred regimen: [[Clotrimazole]] troches 10 mg TOP q4-5h {{or}} [[Nystatin]] suspension or pastilles TOP q6h {{or}} [[Fluconazole]] 100–200 mg PO q24h
-:*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)
+:*Alternative regimen: [[Itraconazole]] solution 200 mg PO q24h {{or}} [[Posaconazole]] 400 mg PO q24h {{or}} [[Voriconazole]] 200 mg PO q24h {{or}} [[Amphotericin B]] oral suspension PO q24h {{or}} ([[Anidulafungin]] 200 mg IV once <u>'''THEN'''</u> [[Anidulafungin]] 100 mg IV q24h) {{or}} ([[Caspofungin]] 70 mg IV once <u>'''THEN'''</u> [[Caspofungin]] 50 mg IV q24h) {{or}} [[Micafungin]] 100 mg IV q24h {{or}} [[Amphotericin B]] 0.3 mg/kg IV q24h
+:*Note: Treat uncomplicated disease for 7–14 days. [[Fluconazole]] is recommended in moderate-to-severe disease, and topical therapy with [[Clotrimazole]] or [[Nystatin]] is recommended for mild disease.  For refractory disease, consider the alternative regimen.
 ===Otitis externa===
-*Otitis externa, acute <ref name="pmid24492208">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA et al.| title=Clinical practice guideline: acute otitis externa executive summary. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 2 | pages= 161-8 | pmid=24492208 | doi=10.1177/0194599813517659 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24492208  }} </ref>
+*'''1. Otitis externa, acute''' <ref name="pmid24492208">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA et al.| title=Clinical practice guideline: acute otitis externa executive summary. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 2 | pages= 161-8 | pmid=24492208 | doi=10.1177/0194599813517659 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24492208  }} </ref>
-:*Causative pathogens
+:*'''1.1 Causative pathogens'''
 ::*Pseudomonas aeruginosa
 ::*Candida spp.
@@ Line 212: / Line 217: @@
 ::*Proteus spp.
 ::*Staphylococcus aureus
-:*'''Empiric antimicrobial therapy'''
+:*'''1.2 Empiric antimicrobial therapy'''
-::*Preferred regimen (1): [[Acetic acid]] 2.0% TOP q6-8h
+::*Preferred regimen (1): [[Acetic acid]] 2.0% TOP tid for 7-10 days
-::*Preferred regimen (2): [[Acetic acid]] 2.0%, [[Hydrocortisone]] 1.0% TOP q6-8h
+::*Preferred regimen (2): [[Acetic acid]] 2.0%, [[Hydrocortisone]] 1.0% TOP tid for 7-10 days
-::*Preferred regimen (3): [[Ciprofloxacin]] 0.2%, [[Hydrocortisone]] 1.0% TOP q6-8h
+::*Preferred regimen (3): [[Ciprofloxacin]] 0.2%, [[Hydrocortisone]] 1.0% TOP tid for 7-10 days
-::*Preferred regimen (4): [[Ciprofloxacin]] 0.3%, [[Dexamethasone]] 0.1% TOP q6-8h
+::*Preferred regimen (4): [[Ciprofloxacin]] 0.3%, [[Dexamethasone]] 0.1% TOP tid for 7-10 days
-::*Preferred regimen (5): [[Neomycin]], [[Polymyxin B]], [[Hydrocortisone]] TOP q6-8h
+::*Preferred regimen (5): [[Neomycin]], [[Polymyxin B]], [[Hydrocortisone]] TOP tid for 7-10 days
-::*Preferred regimen (6): [[Ofloxacin]] 0.3% TOP q6-8h
+::*Preferred regimen (6): [[Ofloxacin]] 0.3% TOP tid for 7-10 days
-::*Note: Recommended treatment duration is 7-10 days.
+:*'''1.3 Pathogen-directed therapy'''
-:*'''Pathogen-directed therapy'''
+::*'''1.3.1 Fungal otitis externa'''<ref name="pmid24492208">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA et al.| title=Clinical practice guideline: acute otitis externa executive summary. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 2 | pages= 161-8 | pmid=24492208 | doi=10.1177/0194599813517659 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24492208  }} </ref>
-::*Fungal otitis externa <ref name="pmid24492208">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA et al.| title=Clinical practice guideline: acute otitis externa executive summary. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 2 | pages= 161-8 | pmid=24492208 | doi=10.1177/0194599813517659 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24492208  }} </ref>
 :::*Preferred regimen: [[Fluconazole]] 200 mg PO once <u>'''THEN'''</u> [[Fluconazole]] 100 mg PO q24h for 3–5 days
-::*Malignant otitis media, Pseudomonas aeruginosa<ref name="pmid24492208">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA et al.| title=Clinical practice guideline: acute otitis externa executive summary. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 2 | pages= 161-8 | pmid=24492208 | doi=10.1177/0194599813517659 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24492208  }} </ref>
+::*'''1.3.2 Malignant otitis media, Pseudomonas aeruginosa'''<ref name="pmid24492208">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA et al.| title=Clinical practice guideline: acute otitis externa executive summary. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 2 | pages= 161-8 | pmid=24492208 | doi=10.1177/0194599813517659 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24492208  }} </ref>
 :::*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 <ref name="pmid24492208">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA et al.| title=Clinical practice guideline: acute otitis externa executive summary. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 2 | pages= 161-8 | pmid=24492208 | doi=10.1177/0194599813517659 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24492208  }} </ref>
+*'''2. Otitis externa, chronic'''<ref name="pmid24492208">{{cite journal| author=Rosenfeld RM, Schwartz SR, Cannon CR, Roland PS, Simon GR, Kumar KA et al.| title=Clinical practice guideline: acute otitis externa executive summary. | journal=Otolaryngol Head Neck Surg | year= 2014 | volume= 150 | issue= 2 | pages= 161-8 | pmid=24492208 | doi=10.1177/0194599813517659 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24492208  }} </ref>
-:*'''Empiric antimicrobial therapy'''
+:*'''2.1 Empiric antimicrobial therapy'''
-::*
+::*Preferred regimen: [[Neomycin]], [[Polymyxin B]], [[Hydrocortisone]] TOP q6-8h {{and}} [[Selenium Sulfide]] Shampoo
+::*Note: Selenium sulfide shampoo is recommended as the disease is usually secondary to seborrhea.
-===Otitis media===
+===Acute Otitis media===
+*'''Acute otitis media''' <ref name="pmid23439909">{{cite journal| author=Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA et al.| title=The diagnosis and management of acute otitis media. | journal=Pediatrics | year= 2013 | volume= 131 | issue= 3 | pages= e964-99 | pmid=23439909 | doi=10.1542/peds.2012-3488 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439909  }} </ref>
-===Otitis media, Acute===
+:*'''1. Causative pathogens'''
-*Otitis media <ref name="pmid23439909">{{cite journal| author=Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA et al.| title=The diagnosis and management of acute otitis media. | journal=Pediatrics | year= 2013 | volume= 131 | issue= 3 | pages= e964-99 | pmid=23439909 | doi=10.1542/peds.2012-3488 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439909  }} </ref>
+::*Streptococcus pneumoniae
-:*Preferred Regimen : [[Amoxicillin]] 80–90 mg/kg/d bid {{or}} [[Amoxicillin]] 90 mg/kg/d with [[Clavulanate]] 6.4 mg/kg/d
+::*Hemophilus influenzae
-:*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
+::*Moraxella catarrhalis
+::*Polymicrobial
-===Otitis media, Post-intubation===
+::*Viral
-*Otitis media <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:*'''2. Empiric antimicrobial therapy'''
-:*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).
+::*Preferred regimen: [[Amoxicillin]] 40–90 mg/kg/day PO q12h {{or}} [[Amoxicillin-Clavulanate]] 90/6.4 mg/kg/day PO q12h
+::*Alternative regimen: [[Cefdinir]] 14 mg/kg/day PO q12 or q24h {{or}} [[Cefuroxime]] 30 mg/kg/day PO q12h {{or}} [[Cefpodoxime]] 10 mg/kg/day PO q12h {{or}} [[Ceftriaxone]] 50 mg/kg/day IM or IV q24h
-===Otitis media, Prophylaxis===
+::*Note: [[Amoxicillin-Clavulanate]] may be considered in patients with recent [[Amoxicillin]] intake or concomitant conjunctivitis. Alternative regimens should be considered in patients with [[Penicillin]] allergies. Re-evaluate after 2-3 days for treatment response.
-*Otitis media<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:*'''3. Special considerations'''
+::*'''3.1 Acute otitis media post-treatment failure (48-72 hours)'''
-:*Preferred regimen : [[Sulfisoxazole]] 50 mg/kg PO at bedtime or [[amoxicillin]] 20 mg/kg PO q24h
+:::*Preferred regimen: [[Amoxicillin-Clavulanate]] 90/6.4 mg/kg/day PO q12h {{or}} [[Ceftriaxone]] 50 mg/kg/day IM or IV q24h
+:::*Alternative regimen: [[Clindamycin]] 30–40 mg/kg/day PO q8h '''±''' ([[Cefdinir]] 14 mg/kg/day PO q12 or q24h {{or}} [[Cefuroxime]] 30 mg/kg/day PO q12h {{or}} [[Cefpodoxime]] 10 mg/kg/day PO q12h {{or}} [[Ceftriaxone]] 50 mg/kg/day IM or IV q24h)
-===Otitis media, Treatment failure===
+::*'''3.2 Acute otitis media post-intubation'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-*Otitis media <ref name="pmid23439909">{{cite journal| author=Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA et al.| title=The diagnosis and management of acute otitis media. | journal=Pediatrics | year= 2013 | volume= 131 | issue= 3 | pages= e964-99 | pmid=23439909 | doi=10.1542/peds.2012-3488 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439909  }} </ref>
+:::*Preferred regimen: [[Ceftazidime]] 2 g IV q8h {{or}} [[Cefepime]] 2 g IV q12h {{or}} [[Imipenem]] 0.5 g IV q6h {{or}} [[Meropenem]] 500 mg IV q8h {{or}} [[Piperacillin-Tazobactam]] 4–6 g IV q4–6h {{or}} [[Ticarcillin-Clavulanate]] 3 g IV q4h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Ciprofloxacin]] 750 mg PO q12h
-:*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}} [[Cephalosporin|third generation Cephalosporin]]
-:: Note: Consider [[Tympanocentesis]] if clinically indicated.
 ===Parotitis===
-*Parotitis<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+*'''Parotitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:*Preferred regimen
+:*'''1. Causative pathogens'''
-::*<u>MSSA</u> : Nafcillin or oxacillin 2 gm IV q4h
+::*Staphylococcus aureus
-::*<u>MRSA</u> : vancomycin
+::*Streptococcus pyogenes
+::*Mumps
-*Juvenile recurrent parotitis <ref name="pmid19608051">{{cite journal| author=Patel A, Karlis V| title=Diagnosis and management of pediatric salivary gland infections. | journal=Oral Maxillofac Surg Clin North Am | year= 2009 | volume= 21 | issue= 3 | pages= 345-52 | pmid=19608051 | doi=10.1016/j.coms.2009.05.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19608051  }} </ref>
+::*Aerobic gram-negative bacilli
-:*Preferred regimen: B-lactam antibiotics (Penicillin VK or Amoxicillin–clavulanate for staphylococcal coverage)
+::*Enterovirus
+::*Influenza virus
-:*Preferred regimen: Short-term, low-dose corticosteroid therapy can reduce inflammation and promote faster restoration of glandular function.
+:*'''2. Empiric antimicrobial therapy'''
+::*Preferred regimen (MSSA suspected): [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
-*viral <ref name="pmid19608051">{{cite journal| author=Patel A, Karlis V| title=Diagnosis and management of pediatric salivary gland infections. | journal=Oral Maxillofac Surg Clin North Am | year= 2009 | volume= 21 | issue= 3 | pages= 345-52 | pmid=19608051 | doi=10.1016/j.coms.2009.05.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19608051  }} </ref>
+::*Preferred regimen (MRSA suspected): [[Vancomycin]] 1 g IV q12h
-:*Preferred regimen: Currently, the accepted treatment for mumps includes supportive care consisting of hydration, oral hygiene and bed rest
 ==References==
 {{reflist}}

Sandbox ID Head and Neck: Difference between revisions

Latest revision as of 14:13, 16 July 2015

Contents

Anthrax, oropharyngeal

Buccal cellulitis

Cervico-facial actinomycosis

Deep neck infection

Facial erysipelas

Mastoiditis

Odontogenic infections

Orbital cellulitis

Oropharyngeal candidiasis

Otitis externa

Acute Otitis media

Parotitis

References

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