Sandbox ID Head and Neck: Difference between revisions

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:::* 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
:::* 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===
===Mastoiditis===

Revision as of 14:40, 15 July 2015

Anthrax, oropharyngeal

  • Oropharyngeal anthrax[1]

Buccal cellulitis

  • Buccal cellulitis[2]
  • 1. Empiric antimicrobial therapy

Cervico-facial actinomycosis

  • Cervico-facial actinomycosis[3]

Deep neck infection

  • Deep neck infection
  • 1. Empiric antimicrobial therapy[4][5]
  • 1.1 Community-acquired deep neck infection
  • 1.2 Nosocomial deep neck infection or immunocompromised host
  • 1.3 Deep neck infection with high-risk of MRSA
  • 1.4 Necrotizing fasciitis
  • 2. Specific anatomic considerations[6]
  • 2.1 Submandibular space infections including Ludwig angina
  • Causative pathogens
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • 2.2 Lateral pharyngeal or retropharyngeal space infections (odontogenic)
  • Causative pathogens
  • Viridans and other streptococci
  • Staphylococcus
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • 2.3 Lateral pharyngeal or retropharyngeal space infections (rhinogenic)
  • Causative pathogens
  • Streptococcus pyogenes
  • Fusobacterium
  • Peptostreptococcus
  • Other oral anaerobes
  • 2.4 Lateral pharyngeal or retropharyngeal space infections (otogenic)
  • Causative pathogens
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • 2.5 Peritonsillar abscess (quinsy)
  • Causative pathogens
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • 2.6 Suppurative parotitis
  • Causative pathogens
  • Staphylococcus
  • Viridans and other streptococci
  • Bacteroides
  • Peptostreptococcus
  • Other oral anaerobes
  • 2.7 Extension of osteomyelitis from prevertebral space infection
  • Causative pathogens
  • Staphylococcus
  • Facultative gram-negative bacilli
  • 2.8 Pott's puffy tumor (frontal osteitis)
  • Causative pathogens
  • Streptococcus pyogenes
  • Fusobacterium
  • Peptostreptococcus
  • Other oral anaerobes
  • 2.9 Malignant otitis media
  • Causative pathogens
  • Pseudomonas aeruginosa
  • 2.10 Petrous osteitis
  • Causative pathogens
  • Pseudomonas aeruginosa
  • 2.11 Septic jugular thrombophlebitis (Lemierre syndrome)
  • Causative pathogens
  • Fusobacterium
  • Viridans and other streptococci
  • Staphylococcus
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes

Facial erysipelas

  • Facial erysipelas [7]
  • 1. Causative pathogens
  • Staphylococcus aureus
  • Streptococcus spp. (Group A, B, C, & G)
  • Enterobacteriaceae
  • Clostridium spp.
  • 2. Empiric antimicrobial therapy

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 OR Cefprozil 30 mg/kg/day PO q12h OR Cefuroxime 15 mg/kg/day PO q12h
  • 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.
  • 1.2.2 Pathogen-directed antimicrobial therapy
  • 1.2.2.1 Staphylococcus aureus (MSSA)
  • Preferred regimen: Oxacillin 37 mg/kg IV q6h
  • 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
  • Note: Maintain Vancomycin serum trough concentrations of 15-20 mcg/mL
  • 1.3 Acute mastoiditis, inpatient
  • 1.3.1 Empiric antimicrobial therapy
  • 1.3.2 Pathogen-directed antimicrobial therapy
  • 1.3.2.1 Staphylococcus aureus (MSSA)
  • Preferred regimen: Oxacillin 37 mg/kg IV q6h
  • 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
  • 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

Odontogenic infections

  • Odontogenic infections[10]
  • 1. Empiric antimicrobial therapy

Orbital cellulitis

  • Orbital cellulitis [11]
  • 1. Causative pathogens
  • Streptococcus pneumoniae
  • Hemophilus influenzae
  • Moraxella catarrhalis
  • Staphylococcus aureus
  • 2. Empiric antimicrobial therapy

Oropharyngeal candidiasis

  • Oropharyngeal candidiasis[12]

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
  • 1.3 Pathogen-directed therapy
  • 1.3.1 Fungal otitis externa[13]
  • 1.3.2 Malignant otitis media, Pseudomonas aeruginosa[13]
  • 2. Otitis externa, chronic[13]
  • 2.1 Empiric antimicrobial therapy

Acute Otitis media

  • Acute otitis media [14]
  • 1. Causative pathogens
  • Streptococcus pneumoniae
  • Hemophilus influenzae
  • Moraxella catarrhalis
  • Polymicrobial
  • Viral
  • 2. Empiric antimicrobial therapy
  • 3. Special considerations
  • 3.1 Acute otitis media post-treatment failure (48-72 hours)
  • 3.2 Acute otitis media post-intubation[15]

Parotitis

  • Preferred regimen
  • MSSA : Nafcillin or oxacillin 2 gm IV q4h
  • MRSA : vancomycin
  • Juvenile recurrent parotitis [17]
  • Preferred regimen: B-lactam antibiotics (Penicillin VK or Amoxicillin–clavulanate for staphylococcal coverage)
  • Preferred regimen: Short-term, low-dose corticosteroid therapy can reduce inflammation and promote faster restoration of glandular function.
  • Preferred regimen: Currently, the accepted treatment for mumps includes supportive care consisting of hydration, oral hygiene and bed rest

References

  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.
  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.
  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.
  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.
  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.
  17. 17.0 17.1 Patel A, Karlis V (2009). "Diagnosis and management of pediatric salivary gland infections". Oral Maxillofac Surg Clin North Am. 21 (3): 345–52. doi:10.1016/j.coms.2009.05.002. PMID 19608051.