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Family Diagnosis and Treatment

Published on January 2017 | Categories: Documents | Downloads: 5 | Comments: 0
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http://www.cram.com/flashcards/family-medicine-common-diagnosis-and-treatment-2671045
UTI
E. coli (75-95%) occasionally proteus mirabillis, klebsiella pneumoniea or staphylococcus saprophyticus
TMP-SMX- bactrim (resistance >20%)
Ampicillin (resistance >20%)
Fluoroquinolones (resistance <10%)
Amoxicillin + Clavulinic acid (resistance < 10%)
Pharyngitis causes
Major cause viral- influenza, parainfluenza, coronavirus, rhinovirus, HSV, EBV, HIV
Group A Strep, Mycoplasma pnuemaniae, Chlamydophila pneumoniae, N. gonorrhoeae, groups C and G, etc.
Allergy
Bacterial Sinusitis vs Viral Sinusitis diagnosis
Bacterial lasts greater than 10 days or onset with severe symptoms (fever >102 and purulent nasal discharge ro facial pain) lasting 3 consecutive days at the beginning of
illness or onset with worsening symptoms following a viral URI that lasted 5-6 days and was improving
Non purulent Cellulitis causes
Beta hymolytic streptococci and S. aureus are most common
treat with
adults; kids
Dicloxacillin 500 mg every 6 hours; 25-50 mg/kd in four doses
Cephalexin- 500 mg every 6 hours; 25-50 mg/kg in 3-4 doses
Clindamycin-300-450 mg every 6-8 hours; 20-30 mg/kg in 4 doses
Rhus dermatitis topical treatment
Topical
Topical astringents such as aluminum acetate or aluminum sulfate calcium acetate may be used to dry weekping lesions.
High potency topical corticosteroids (avoid on thin skin of face, genitals, or intertriginous areas), clobetasol propionate 0.05% cream
Systemic treatment
Sedating antihistamines do not reduce the pruritis but do help with sleep. Nonsedating antihistamines should not be used
Systemic corticosteroids- oral prednisone taper 2-3 weeks (60-40-20 mg). IM dose of 1 mg/kg triamcinolone acetonide + betamethasone (0.1 mg/kg)
Antibiotics if infection is suspected
Streptococcal tonsillopharyngitis treatment
Penicillin V- 10 days
Amoxicillin is often used for children b/c it tasted better
Penicillin G (IM)- single dose
Otitis media adult
Mild to moderate Amoxicillen 500 mg every 12 hours or 250 mg every 8 hours. 5-7 days
Severe disease (fever, significant hearing loss, severe pain or marked erythema)- Amoxicillen 875 mg every 12 hours or 500 mg every 8 hours. 10 days
Otitis externa
Topical treatment
Topical
Antibiotics- ofloxacin, ciprofloxacin, polymyxin B, neomycin, tobramycin, gentamicin
Glucorticoids to reduce inflammation- hydrocortisone
Oral treatment
In mild to moderate cases no difference in clinical response between a topical and TMP-SMX
Deeper tissue infections- ciprofloxacin (500mg BID 7-10 days) or ofloxacin
Pain- NSAIDs
Streptococcal pharyngitis in a beta lactam sensitive pt
Cephalosporins- cefuroxime, cefpodoxime, cefdinir and ceftriaxone
Macrolides (clarithromxin, azithromycin, erythromycin) for pencillin allergic pts
Acute viral rhinosinusitis
NSAIDs and acetaminophen
Saline (or STERILE water) irrigation
Intranasal glucocorticoids- decrease inflammation (systemic glucocoritcoids are recommended against)
Topical decongestants- oxymetazoline--use sparingly to avoid rebound congestion
Oral decongestants
Mucolytics- guaifenesin
Acute bacterial rhinosinusitis

Amoxicillen-clavulanate 5-7 days (according to UptoDate) 500mg/125mg TID or 875mg/125mg BID
What about penicillin sensitive pts?
Doxycycline or levofloxacin or moxifloxacin
Purulent cellulitis
Suspect MRSA
Treat empirically with clindamycin, TMP-SMX, Tetracycline (doxycycline or minocycline) linezolid or tedizolid
Otitis media adult penicillin allergy
Pts who report an allergy but did not experience urticaria or anaphylaxis
Cefdinir- 300 mg BID or 600 mg 1x/day
Cefpodoxime- 200 mg BID
Cefuroxime- 500 mg BID
Ceftriaxone- 2 g IM or IV 1x
Pts with a severe allergy to beta lactam antibiotic
Macrolide- erythromycin + sulfisoxazole
or
Azithromycin
or
Clarithromycin
TMP-SMX may be used in regions where pneumococcal resistance is not a concern

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