Sandbox ID Head and Neck

Anthrax, oropharyngeal

Oropharyngeal anthrax^[1]

Preferred regimen: (Ciprofloxacin 400 mg IV q8h OR Doxycycline 100 mg IV q12h) AND (Clindamycin 600 mg IV q8h OR Penicillin G 4 MU IV q4-6h OR Meropenem 1 g IV q6-8h OR Rifampin 300 mg IV q12h)

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, children < 5 yrs ^[2]

Preferred regimen: Cefuroxime50 q8h IV (80 q8h for meningitis) OR PO 10–15mg bid (max 1 gm per day)OR Ceftriaxone 50 q24h (meningitis 100)
Alternative regimen: Amoxicillin-Clavulanate45 OR 90 (AM/CL-HD) divided 12h ,if over 12weeks OR TMP-SMX8–12 TMP component divided 12h; (Pneumocystis: 20 TMP component divided q6h)

Cervico-facial actinomycosis

Cervico-facial actinomycosis^[3]

Preferred treatment

Mild: penicillin V PO 2months OR Doxycycline 100mg PO q12h for 2 months
Complicated: penicillin G 10-20 MU/d divided q6h for 4-6weeks followed by oral penicillin V 2-4 g/d divided q6h for 6-12 months.

Allergic to Penicillin : Tetracycline, Clindamycin, and Erythromycin and cephalosporins.

Deep neck infection

Deep neck infection

Empiric antimicrobial therapy^[4]^[5]

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 daily (if Eikenella is suspected)

Nosocomial deep neck infection or immunocompromised host

Preferred regimen: Ticarcillin-Clavulanate 3.0 g IV q6h OR Piperacillin-Tazobactam 3.0 g IV q6h OR Imipenem-Cilastatin 500 mg IV q6h OR Ciprofloxacin 400 mg IV q12h OR Levofloxacin 750 mg IV q24h

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 1.0 g IV q12h

Necrotizing fasciitis

Preferred regimen: Ceftriaxone 2.0 g IV q8h AND Clindamycin 600–900 mg IV q8h AND Metronidazole 500 mg IV q6h

Specific anatomic considerations^[6]

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

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

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

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

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

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

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

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

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

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

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 cellulitis

Mastoiditis

Mastoiditis, Acute

Mastoiditis ^[7]

Preferred Regimen : Ceftriaxone 2 gm IV qd OR Levofloxacin 750 mg IV qd

Mastoiditis, Chronic

Mastoiditis^[8]

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

Odontogenic infection^[9]

Preferred regimen : Clindamycin 300–450 mg po q6h OR 600 mg IV q6–8h
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

Orbital cellulitis

Orbital cellulitis ^[10]

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
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.

Oropharyngeal candidiasis

Oropharyngeal candidiasis^[11]

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 ^[12]

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 ^[12]

Preferred Regimen : Neomycin, polymyxin B, hydrocortisone 4 drops tid or qid AND Selenium sulfide shampoo

Otitis externa, Fungal

Otitis externa ^[12]

Preferred Regimen : Fluconazole 200 mg po x 1 dose, then 100 mg po x 3–5 days

Otitis externa, Malignant

Otitis externa ^[12]

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 ^[13]

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 ^[14]

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 ^[15]

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).

Otitis media, Prophylaxis

Otitis media^[16]

Preferred regimen : Sulfisoxazole 50 mg/kg PO at bedtime or amoxicillin 20 mg/kg PO q24h

Otitis media, Treatment failure

Otitis media ^[14]

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 third generation Cephalosporin

Note: Consider Tympanocentesis if clinically indicated.

Parotitis

Parotitis^[17]

Preferred regimen

MSSA : Nafcillin or oxacillin 2 gm IV q4h
MRSA : vancomycin

Juvenile recurrent parotitis ^[18]

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.

viral ^[18]

Preferred regimen: Currently, the accepted treatment for mumps includes supportive care consisting of hydration, oral hygiene and bed rest

References

↑ 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.
↑ 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.
↑ 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.
↑ ^12.0 ^12.1 ^12.2 ^12.3 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.
↑ ^14.0 ^14.1 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.
↑ 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.
↑ ^18.0 ^18.1 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.

[pmid21852539-1] 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.

[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.

[pmid19191635-11] 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.

[pmid24492208-12] 12.0 ^12.1 ^12.2 ^12.3 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.

[pmid12690268-13] 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.

[pmid23439909-14] 14.0 ^14.1 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.

[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] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[pmid19608051-18] 18.0 ^18.1 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.

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