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Empiric treatment of [[AOM]].<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>
{{familytree/start}}
{|
{{familytree | | | | | | | | | | | | | | A01 | | | | | | | A01=In the tumor central o peripheral?}}
| valign=top |
{{familytree | | | | | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | | | |}}
{| style="background: #FFFFFF;"
{{familytree | | | | | | | | | B01 | | | | | | | | B02 | | | | | | B01=Peripheral|B02=Central}}
| valign=top |
{{familytree | | | | | | | | | |!| | | | | | | | | |!| | | | | |}}
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
{{familytree | | | | | | | | | C01 | | | | | | | | |!| | | | | | | C01=Is the tumor T1 or T2a?}}
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Initial treatment''}}
{{familytree | | | | | | |,|-|-|^|-|-|.| | | | | | |!| | | | | | | |}}
|-
{{familytree | | | | | | D01 | | | | D02 | | | | | D03 | | | | | | | D01=T1ab, N0|D02=T2a, N0|D03=T1ab-2a, N0}}
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | '''Preferred Regimen (susceptible to penicillin)'''
{{familytree | | | | | | |!| | | | | |`|-|-|-|-|v|-|'| | | | | | | |}}
|-
{{familytree | | | | | | E01 | | | | | | | | | E02 | | | | | | | | E01='''Perform a pretreatment evaluation'''<br><br>*If not done, perform pulmonary function tests<br>*Perform bronchoscopy (if possible intraoperative)<br>*Perform a pathological lymph node evaluation<br>*If not done, order PET scan or CT scan|E02='''Perform a pretreatment evaluation'''<br><br>*If not done, perform pulmonary function tests<br>*Perform bronchoscopy (if possible intraoperative)<br>*Perform a pathological lymph node evaluation<br>*If not done, order PET scan or CT scan}}
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin]] 40-45 mg/kg PO q12h'''''<BR> OR <BR> ▸ '''''[[Amoxicillin-clavulanate]] 90/6.5 mg/kg/day PO divided in 2 doses'''''
{{familytree | | | | | | |!| | | | | | | | | | |!| | | | | | | |}}
|-
{{familytree | | | | | | F01 | | | | | | | | | F02 | | | | | | | | | F01=Does the pathological evaluation showed positive disease in the mediastinal lymph nodes?|F02=Does the pathological evaluation showed positive disease in the mediastinal lymph nodes?}}
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | '''Alternative Regimen (penicillin allergy or resistant strains)'''
{{familytree | | | |,|-|-|^|-|-|.| | | | | |,|-|^|-|.| | | | | |}}
|-
{{familytree | | | G01 | | | | G02 | | | | G03 | | G04 | | | | | G01=Yes|G02=No|G03=Yes|G04=No}}
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefdinir]] 14 mg/kg PO q24h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 50 mg/kg IM or IV q24h'''''<BR> OR <BR> ▸ '''''[[Cefuroxime]] 15 mg/kg PO q12h'''''<BR> OR <BR> ▸ '''''[[Cefpodoxime]] 5 mg/kg PO q12h'''''
{{familytree | | | |!| | | | | |!| | | | | |!| | | |!| | | | | | |}}
|-
{{familytree | | | H01 | | | | H02 | | | | H03 | | H04 | | | | | | | | H01=[[Non small cell carcinoma of the lung#Stage III|Click here for the Stage III treatment]]|H02=Is the tumor operable?|H03=[[Non small cell carcinoma of the lung#Stage III|Click here for the Stage III treatment]]|H04=Is the tumor operable?}}
|}
{{familytree | | | | | | | |,|-|^|-|.| | | | | |,|-|^|-|.| | | | | |}}
|}
{{familytree | | | | | | | I01 | | I02 | | | | I03 | | I04 | | | | | | I01=Yes|I02=No|I03=Yes|I04=No}}
|}
{{familytree | | | | | | | |!| | | |!| | | | | |!| | | |!| | | | | | |}}
 
{{familytree | | | | | | | J01 | | J02 | | | | J03 | | J04 | | | | | | J01=Surgical resection + lymph node dissection|J02=Radiotherapy with stereotactic ablative radiotherapy|J03=Surgical resection + lymph node dissection|J04=Does the patient presents metastasis to ipsilateral peribronchial and/or hiliar nodesand intrapulmonar nodes (N1)?}}
{|
{{familytree | | | | | | | | | | | | | | | | | | | |,|-|^|-|.| | | | |}}
| valign=top |
{{familytree | | | | | | | | | | | | | | | | | | | K01 | | K02 | | | | |K01=Yes|K02=No}}
{| style="background: #FFFFFF;"
{{familytree | | | | | | | | | | | | | | | | | | | |!| | | |!| | | | | |}}
| valign=top |
{{familytree | | | | | | | | | | | | | | | | | | | L01 | | L02 | | | | | L01=Chemotherapy + radiation therapy|L02=Radiotherapy with stereotactic ablative radiotherapy<br>Adjuvant chemotherapy should be added for high-risk stages}}
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
{{familytree/end}}
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Initial treatment''}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | '''Preferred Regimen (susceptible to penicillin)'''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 90/6.5 mg/kg/day PO divided in 2 doses'''''
<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 50 mg/kg IM or IV q24h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | '''Alternative Regimen (penicillin allergy or resistant strains)'''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 10 mg/kg PO q8h'''''<BR> PLUS <BR> ▸ '''''[[Ceftriaxone]] 50 mg/kg IM or IV q24h'''''
|-
|}
|}
|}
 
*Failure of initial antibiotic treatment is defined as lack of clinical improvement during the first 48 to 72 hours.  [[Fever]] should decrease and [[irritability]] should disappear of considerably decline.
*If severe symptoms remain or worsen [[antibiotic treatment]] should be changed.  Recommended changes appear below:
:*Children receiving [[amoxicillin]] should receive high dose [[amoxicillin-clavulanate]]
:*Children receiving [[amoxicillin-clavulanate]] or oral third-generation cephalosporines should receive IM or IV [[ceftriaxone]]
:*Three day treatment with [[ceftriaxone]] is recommended
*[[Tympanocentesis]] should be considered if more than one regimen has failed
*[[Clindamycin]] should be administered to patients who didn't respond to several [[Antibiotic treatment|antibiotic treatments]] and [[tympanocentesis]] can't be performed.

Revision as of 19:35, 16 June 2014

 
 
 
 
 
 
 
 
 
 
 
 
 
In the tumor central o peripheral?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Peripheral
 
 
 
 
 
 
 
Central
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the tumor T1 or T2a?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
T1ab, N0
 
 
 
T2a, N0
 
 
 
 
T1ab-2a, N0
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform a pretreatment evaluation

*If not done, perform pulmonary function tests
*Perform bronchoscopy (if possible intraoperative)
*Perform a pathological lymph node evaluation
*If not done, order PET scan or CT scan
 
 
 
 
 
 
 
 
Perform a pretreatment evaluation

*If not done, perform pulmonary function tests
*Perform bronchoscopy (if possible intraoperative)
*Perform a pathological lymph node evaluation
*If not done, order PET scan or CT scan
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the pathological evaluation showed positive disease in the mediastinal lymph nodes?
 
 
 
 
 
 
 
 
Does the pathological evaluation showed positive disease in the mediastinal lymph nodes?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Click here for the Stage III treatment
 
 
 
Is the tumor operable?
 
 
 
Click here for the Stage III treatment
 
Is the tumor operable?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surgical resection + lymph node dissection
 
Radiotherapy with stereotactic ablative radiotherapy
 
 
 
Surgical resection + lymph node dissection
 
Does the patient presents metastasis to ipsilateral peribronchial and/or hiliar nodesand intrapulmonar nodes (N1)?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chemotherapy + radiation therapy
 
Radiotherapy with stereotactic ablative radiotherapy
Adjuvant chemotherapy should be added for high-risk stages
 
 
 
 
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