Sandbox ID Head and Neck: Difference between revisions
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===Parotitis=== | ===Parotitis=== | ||
Juvenile Recurrent Parotitis | Juvenile Recurrent Parotitis | ||
S. aureus, S. pyogenes, oral flora, & aerobic Gm-neg. bacilli (rare), mumps, rarely enteroviruses/ influenza: Nafcillin or oxacillin 2 gm IV q4h if MSSA; vanco if MRSA Predisposing factors: stone(s) in Stensen’s duct, dehydration. Therapy depends on ID of specific etiologic organism. “Cold” non-tender parotid swelling Granulomatous disease (e.g., mycobacteria, fungi, sarcoidosis, Sjögren’s syndrome), drugs (iodides, et al.), diabetes, cirrhosis, tumors |
Revision as of 14:31, 9 June 2015
Anthrax, oropharyngeal
- Post exposure prophylaxis [1]
- Preferred regimen : ciprofloxacin, 500 mg every 12 h OR doxycycline, 100 mg every 12 h OR levofloxacin, 750 mg every 24 h OR moxifloxacin, 400 mg every 24 h OR clindamycin, 600 mg every 8 h
- Alternatives for penicillin-susceptible strains amoxicillin, 1 g every 8 h OR penicillin VK, 500 mg every 6 h
- Oropharyngeal anthrax [2]
- Preferred regimen: Ciprofloxacin 400 mg intravenously every 8 h OR Doxycycline 100 mg intravenously every 12 h combined with second agent: Clindamycin 600 mg intravenously every 8 h or Penicillin G 4 MU every 4-6 hours OR Meropenem 1 gm intravenously every 6-8 hours or Rifampin 300 mg every 12 h.
- Note:Treatment for 60 days is recommended to avoid relapse or breakthrough of incubating disease. If initial therapy is intravenous, then convert to oral administration (Ciprofloxacin or Doxycycline) when clinically indicated. Steroids may be considered as an adjunct therapy for patients with severe edema and for meningitis. For pregnant women, avoid Doxycycline. Use Ciprofloxacin and switch to oral penicillin once susceptibilities are known.
Buccal cellulitis
- Buccal cellulitis
- Preferred regimen (Children <5 yrs) : Cefuroxime or ceftriaxone
- Alternate regimen : Amoxicillin-clavulanate or TMP-SMX With Hib immunization, invasive H. influenzae infections have Ļ by 95%. Now occurring in infants prior to immunization.
Cervico-facial actinomycosis
- Cervico-facial actinomycosis[3]
- Preferred treatment : High doses (18-24 million units a day) of intravenous penicillin G over two to six weeks, followed by oral penicillin V at a dose of 2-4 g/day for six to 12 months.
- Alternate treatment : Doxycycline, minocycline, clindamycin, and erythromycin are suitable for patients who are allergic to penicillin. Erythromycin is a safe option for pregnant patients.
Deep neck infection
- Empiric treatment
- Either penicillin in combination with a β-lactamase inhibitor (such as amoxicillin or ticarcillin with clavulanic acid) or a β-lactamase–resistant antibiotic (such as cefoxitin, cefuroxime, imipenem, or meropenem) in combination with a drug that is highly effective against most anaerobes (such as clindamycin or metronidazole)
- Vancomycin should be considered for empiric therapy in intravenous drug
- Ceftriaxone and clindamycin can be used as empiric therapy against community-acquired MRSA
Facial cellulitis
Mastoiditis
Mastoiditis, Acute
- Mastoiditis
- Preferred Regimen : Ceftriaxone 2 gm IV qd OR Levofloxacin 750 mg IV qd
Mastoiditis, Chronic
- Preferred Regimen : Vancomycin (trough: 15–20 mcg/mL) AND Piperacillin-Tazobactam 3.375 g IV q6h
- Alternative Regimen : Vancomycin (trough: 15–20 mcg/mL) AND Ciprofloxacin 400 mg IV q8h
Odontogenic infection
Orbital cellulitis
Oropharyngeal candidiasis
- Oropharyngeal candidiasis[4]
- 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 [5]
- Preferred regimen (1): Acetic acid 2.0% solution (Acetic acid otic)
- Preferred regimen (2): Acetic acid 2.0%, hydrocortisone 1.0% (Acetasol HC)
- Preferred regimen (3): Ciprofloxacin 0.2%, hydrocortisone 1.0% (Cipro HC)
- Preferred regimen (4): Ciprofloxacin 0.3%, dexamethasone 0.1% (Ciprodex)
- Preferred regimen (5): Neomycin, polymyxin B, hydrocortisone (Cortisporin Otic)
- Preferred regimen (6): Ofloxacin 0.3% (Floxin Otic)
Otitis externa, Chronic
- Otitis externa [5]
- Preferred Regimen : Neomycin, polymyxin B, hydrocortisone 4 drops tid or qid AND Selenium sulfide shampoo
Otitis externa, Fungal
- Otitis externa [5]
- Preferred Regimen : Fluconazole 200 mg po x 1 dose, then 100 mg po x 3–5 days
Otitis externa, Malignant
- Otitis externa [5]
- Preferred Regimen : Ciprofloxacin 400 mg IV q8h
- Alternative Regimen : Piperacillin-Tazobactam 3.375g IV q4h AND Tobramycin 3–5 mg/kg/day IV q8h
- Other Regimens for Susceptible Pseudomonas : Imipenem 0.5 g IV q6h OR Meropenem 1 g IV q8h OR Cefepime 2 g IV q12h OR Ceftazidime 2 g IV q8h
Otitis externa, Swimmer's ear
- Otitis externa [6]
- Preferred regimen : Ofloxacin 0.3% solution eardrops bid or [(polymyxin B + neomycin + hydrocortisone) qid] or (Ciprofloxacin + hydrocortisone bid) .
- For acute disease : Dicloxacillin 500 mg po 4x/day. If MRSA a concern, use TMP-SMX, doxycycline or clindamycin
Otitis media
Otitis media, Acute
- Otitis media [7]
- 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, Prophylaxis
Otitis media, Treatment failure
- Otitis media [7]
- 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 ± 3° Cephalosporin ± Tympanocentesis
Parotitis
Juvenile Recurrent Parotitis
S. aureus, S. pyogenes, oral flora, & aerobic Gm-neg. bacilli (rare), mumps, rarely enteroviruses/ influenza: Nafcillin or oxacillin 2 gm IV q4h if MSSA; vanco if MRSA Predisposing factors: stone(s) in Stensen’s duct, dehydration. Therapy depends on ID of specific etiologic organism. “Cold” non-tender parotid swelling Granulomatous disease (e.g., mycobacteria, fungi, sarcoidosis, Sjögren’s syndrome), drugs (iodides, et al.), diabetes, cirrhosis, tumors
- ↑ 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.
- ↑ Sweeney DA, Hicks CW, Cui X, Li Y, Eichacker PQ (2011). "Anthrax infection". Am J Respir Crit Care Med. 184 (12): 1333–41. doi:10.1164/rccm.201102-0209CI. PMC 3361358. PMID 21852539.
- ↑ Wong VK, Turmezei TD, Weston VC (2011). "Actinomycosis". BMJ. 343: d6099. doi:10.1136/bmj.d6099. PMID 21990282.
- ↑ 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.
- ↑ 5.0 5.1 5.2 5.3 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.
- ↑ Dohar JE (2003). "Evolution of management approaches for otitis externa". Pediatr Infect Dis J. 22 (4): 299–305, quiz 306-8. doi:10.1097/01.inf.0000059444.02851.1e. PMID 12690268.
- ↑ 7.0 7.1 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.