Makindo Medical Notes.com

Otitis externa (OE)

• Likely causes: Ps. aeruginosa, fungi. Eczema may present as OE.
• Local toilet plus drops/spray of antibacterial plus corticosteroid combination
• Treat for 7 days.

Malignant Otitis Externa

• (Aggressive painful infection in immunocompromised patients) discuss with Consultant Microbiologist and refer to ENT

Otitis media (OM)

• Likely causes: viral, Strep pneumoniae, H influenzae (commonly in children)
• Treat (only if temperature >38.5° C or vomiting) for 3 - 7 days.
• Amoxicillin 500mg TDS PO. Penicillin allergy - Contact Consultant Microbiologist

Auricular chondritis

• Likely causes: Ps aeruginosa
• Discuss with Consultant Microbiologist and refer to ENT.

Sinusitis

• Likely causes: viral, Strep pneumoniae, H influenzae, anaerobes
• Mostly self-limited, so wait 7 days unless the patient is systemically unwell.
• If antibiotics are indicated: Amoxicillin 500mg tds PO or doxycycline 100mg bd PO
• Treat for 3 - 5 days. A nasal decongestant may be required.

Chronic sinusitis or failure of initial therapy.

• Refer to ENT. Treat with: Co-Amoxiclav 625mg tds PO
• May require up to 3 weeks of treatment.
• Penicillin allergy - Contact Consultant Microbiologist

Pharyngitis/tonsillitis - Calculate the CENTOR score

• Likely causes: Commonly viral, Group A strep
• Phenoxymethylpenicillin (Pen V) 500mg qds PO
• Penicillin allergic: Clarithromycin 500mg bd PO
• Treat for 10 days

CENTOR score: A 4 point score, one point for each of:

• tonsillar exudate +1
• tender anterior cervical lymph nodes +1
• absence of cough +1
• history of fever +1

  Score of 3 or 4 suggests the patient may benefit from antibiotics. A score less than 3 suggests an 80% chance the patient does not have an infection and antibiotics are unnecessary. Use as a guide only. The CENTOR score is not ideal and will lead to some patients with bacterial pharyngitis not being treated and result in unnecessary antibiotic treatment for others

Acute epiglottitis/supraglottitis

• Likely causes: H influenzae, Strep pneumoniae, Staph aureus, others Ceftriaxone 2g od IV
• Refer to ENT, Do not attempt to take a throat swab: risk of airway obstruction. Discuss with ITU if septic shock is suspected.
• Take blood cultures before starting antibiotics once the airway secure