Influenza
Influenza viruses A and B
are most common causes of flu in children and adults
Inpatient medications
Remdesivir
Dexamathasone (If O2 saturations <94%)
definition
Middle ear inflammation
Symptoms
ear pain, hearing impairment, poor sleeping and eating
What pathogen is S. pneumonia treating
S. pneumonia
Medication options
oseltamivir (Tamiflu) and zanamivir (Relenza), other options have been phased out due to growing resistance
New medication: Baloxavir marboxil (Xofluza)
Endonuclease inhibitor
Outpatient
Paxlovid (nirmatrelvir and ritonavir): many significant drug interactions
Molnupravir
Remdesivir: patient needs to get IV therapy doses for 3 days (urgent care/ER)
Goal to prevent hospitalizations
Acute otitis media (AOM)
symptomatic and rapid with effusion/fluid in middle ear
AOM most common at 6-18 months old
Signs
fever, bulging tympanic membrane, middle ear effusion
Antibiotic choices - 1st incidence
Amoxicillin
High middle ear penetration, inexpensive
Aspiration
Concern for anaerobes
Otitis media with effusion (OME)
otitis media with effusion: not acute or infectious; antibiotic not effective
Complications
perforated eardrum, hearing or speech impairment
Received amoxicillin within past 30 days or history of recurrent AOM
amoxicillin clavulanate
Aspiration Treatment options
metronidazole + penicillin G or amoxicillin, or ampicillin/sulbactam
Risk factors
male, daycare attendance, siblings, tobacco smoke exposure, immunocompromised, and young age at first
diagnosis
Diagnosis
bulging of tympanic membrane + ear pain if mild bulging
Allergy to penicillin - Non anaphylaxis
cephalosporin (cefdinir, cefuroxime, cefpodoxime, ceftriaxone)
Prevention of Respiratory Infections
Recommended in children under 2 years old, adults over 65 years old and people 2-64 years old with certain medical conditions
Pneumococcal conjugate vaccine (PCV)
Pathogens
H. influenzae in ~60% of bacterial cases
Viruses found with or without bacteria in ~70% of
cases
Treat with antibiotics if
severe disease of 6-23 months old and both ears infected
Severe ear pain or ear pain for at least 2 days
Temperature > 39 C (102.2 F)
Allergy to penicillin - Anaphylaxis
consider cephalosporin, alternative: macrolide or clindamycin
Prevention of Respiratory Infections
All adults over 65 years old, 2-64 years old with certain medical conditions and 19 to 64 years old that smoke cigarettes
Pneumococcal polysaccharide vaccine (PSV)
pathogen risk for children less than 2
penicillin resistant Strep pneumoniae (PRSP)
PRSP is prevalent in up to 44% of S. pneumoniae strains
Treatment with antibiotic depends on severity and age
<2 years old: 10 days
2-5 years old: 7 days
>6 years old: 5-7 days
Severe (perforated ear drums), recurrent may warrant longer duration of 10 days
central feature
Pain
Pain
Acetaminophen and ibuprofen commonly used
Avoid ibuprofen if <6 months old