Pereira Kevin D - Pediatric Otolaryngology for the Clinician
Here you can read online Pereira Kevin D - Pediatric Otolaryngology for the Clinician full text of the book (entire story) in english for free. Download pdf and epub, get meaning, cover and reviews about this ebook. City: Totowa;NJ, year: 2009, publisher: Humana Press, genre: Children. Description of the work, (preface) as well as reviews are available. Best literature library LitArk.com created for fans of good reading and offers a wide selection of genres:
Romance novel
Science fiction
Adventure
Detective
Science
History
Home and family
Prose
Art
Politics
Computer
Non-fiction
Religion
Business
Children
Humor
Choose a favorite category and find really read worthwhile books. Enjoy immersion in the world of imagination, feel the emotions of the characters or learn something new for yourself, make an fascinating discovery.
- Book:Pediatric Otolaryngology for the Clinician
- Author:
- Publisher:Humana Press
- Genre:
- Year:2009
- City:Totowa;NJ
- Rating:5 / 5
- Favourites:Add to favourites
- Your mark:
Pediatric Otolaryngology for the Clinician: summary, description and annotation
We offer to read an annotation, description, summary or preface (depends on what the author of the book "Pediatric Otolaryngology for the Clinician" wrote himself). If you haven't found the necessary information about the book — write in the comments, we will try to find it.
Over the years, pediatric otolaryngology has become a recognized subspecialty within otolaryngology, head and neck surgery. Organizing the growth of clinical practice and knowledge in this area, this user-friendly book is divided into five sections: general ENT topics, otology, rhinology, head and neck disorders, and emergencies.;Preliminary; Antibiotic Therapy for Acute Otitis, Rhinosinusitis, and Pharyngotonsillitis; Pediatric Hearing Assessment; Speech, Voice, and Swallowing Assessment; Methicillin-Resistant Staphylococcus aureus (Mrsa) Infections of the Head and Neck in Children; Polysomnography in Children; External Otitis; Diagnosis and Management of Otitis Media; Tympanostomy Tubes and Otorrhea; Chronic Disorders of the Middle Ear and Mastoid (Tympanic Membrane Perforations and Cholesteatoma); Congenital Hearing Loss (Sensorineural and Conductive); Implantable Hearing Devices; Pediatric Facial Fractures.
Pereira Kevin D: author's other books
Who wrote Pediatric Otolaryngology for the Clinician? Find out the surname, the name of the author of the book and a list of all author's works by series.
Pereira Kevin D
Prashant Mahajan
Tegmark
Michelle L. Butterworth
Prem Puri (editor)
Richard M. Rosenfeld
Pediatric Otolaryngology for the Clinician — read online for free the complete book (whole text) full work
Below is the text of the book, divided by pages. System saving the place of the last page read, allows you to conveniently read the book "Pediatric Otolaryngology for the Clinician" online for free, without having to search again every time where you left off. Put a bookmark, and you can go to the page where you finished reading at any time.
Light
Font size:
↓
↑
Reset
Interval:
↓
↑
Bookmark:
Make
Part 1
General
General
Kevin D. Pereira and Ron B. Mitchell (eds.) Pediatric Otolaryngology for the Clinician 10.1007/978-1-60327-127-1_1 Humana Press, a part of Springer Science + Business Media, LLC 2009
1. Antibiotic Therapy for Acute Otitis, Rhinosinusitis, and Pharyngotonsillitis
Michael E. Pichichero 1
(1)
Rochester General Hospital, Research Institute, 1425 Portland Avenue, Rochester, NY, 14621
(2)
Department of Microbiology and Immunology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 672, Rochester, NY 14642, USA
Michael E. Pichichero
Email:
Key Points
- Classification of otitis media and bacterial rhinosinusitis into acute, recurrent and chronic impacts treatment decisions. Other variables of importance include the childs age, symptom severity, prior treatment history and daycare attendance.
- The etiology of both acute otitis media (AOM) and acute bacterial rhinosinusitis (ABRS) are similar, with the predominant pathogens being Haemophilus influenzae , Streptococcus pneumoniae , and Moraxella catarrhalis .
- Symptomatic and adjunctive therapies other than pain relievers are of limited value.
- Guidelines have been promulgated for antibiotic selection for both AOM and ABRS. Amoxicillin is recommended as first line. Amoxicillin/clavulanate, cefuroxime, cefpodoxime, and cefdinir are preferred as oral second-line agents. Duration of antibiotic therapy may be shortened to 5 days for many cases.
- Group A beta hemolytic streptococci (GABHS) are the major pathogens of the tonsillopharynx requiring antibiotic treatment.
- GABHS are sensitive in vitro to penicillins, macrolides, and cephalosporins. To eradicate GABHS, antibiotic concentrations in the throat must exceed minimum defined concentrations for time spans that vary with the drug.
- Penicillin is the treatment of choice endorsed by all guidelines. Cephalosporins produce better bacteriologic and clinical cure rates than penicillin; this superiority in outcomes has been increasing for over two decades.
Keywords
Otitis media Sinusitis Rhinosinusitis Group A streptococci Tonsillitis Pharyngitis Penicillin Cephalosporin1.1 Treatment Considerations
A first step in treatment decisions regarding otitis media must focus on accurate diagnosis to distinguish the normal examination from that of acute otitis media (AOM) from otitis media with effusion (OME) or a retracted tympanic membrane (TM) without middle ear effusion. Acute bacterial sinusitis is defined by an inflammation of the mucosa of the paranasal sinuses caused by bacterial overgrowth in a closed cavity; the disorder is also called acute bacterial rhinosinusitis (ABRS). Persistent AOM and ABRS are defined as the persistence of symptoms and signs during or shortly (<1 month) following antibiotic therapy. Recurrent AOM and ABRS are defined as three or more separate episodes in a 6-month time span or four or more episodes in a 12-month time span. Chronic OM and sinusitis occur when there is a persistence of symptoms and signs for 3 months or longer ().
Antibiotic treatment of AOM and ABRS hastens recovery and reduces complications, but uncomplicated AOM and ABRS usually have a favorable natural history regardless of antibiotic therapy. Patients with persistent or recurrent AOM or ABRS more frequently have infections caused by antibiotic-resistant bacterial pathogens; a combination of host, pathogen, and environmental factors results in a markedly reduced spontaneous cure rate (approximately 50% in most studies). In the absence of appropriate treatment, chronic otitis media and chronic ABRS infrequently resolve without significant sequelae.
GABHS (Group A beta-hemolytic streptococci) infection produces a self-limited, localized inflammation of the tonsillopharynx generally lasting 36 days. Antibiotic treatment, if prompt and appropriate, reduces the duration of symptoms, shortens the period of contagion, and reduces the occurrence of localized spread and suppurative complications. A major objective of administering antibiotics is to prevent rheumatic fever ().
1.2 Additional Considerations in Antibiotic Selection
A number of factors can be implicated when initial empiric antibiotic treatment fails: (1) inadequate dosing, (2) poor absorption of orally administered antibiotics, (3) poor patient compliance, (4) poor tissue penetration, or (5) the presence of copathogens. Before prescribing an antibiotic, the clinician must consider several factors: (1) bacterial resistance patterns within the patients community, (2) the severity and duration of the infection, (3) any recent antibiotic therapies, (4) patient age, (5) past drug response, (6) any risk factors that may preclude an agent from the decision-making process, (7) product cost, and (8) availability. Before prescribing an antibiotic, the clinician should also consider the likely susceptibility of the suspected pathogen, as well as the patients allergy history.
Analgesics, decongestants, antihistamines, nasal sprays, and anti-inflammatory agents have been used to relieve symptoms, to treat, and to attempt to prevent the development of infections. None is particularly helpful. Systemic or local treatments (for example, topical analgesic ear drops for AOM) may reduce the pain associated with the infection, but this is perhaps only at the early stages of pathogenesis.
As noted in the guidelines, consideration should be given to comparative compliance features and duration of therapy in antibiotic selection in children. The main determinants of compliance are frequency of dosing, palatability of the agent, and duration of therapy. Less frequent doses (once or twice a day) are preferable to more frequent doses that interfere with daily routines. In many instances, palatability of the drug ultimately determines compliance in children.
Patients (and parents) prefer a shorter course of antibiotic therapy (5 days or less) rather than the traditional 10-day courses often used in the United States. Many patients and parents continue antibiotic therapy only while symptoms are present, perhaps followed by an additional 1 or 2 days; the remainder of the prescription may be saved for future use when similar symptoms arise. A 10-day treatment course with antibiotic has been standard in the United States although 3-, 5-, 7-, and 8-day regimens are frequently used in other countries. There is microbiologic and clinical evidence that shorter treatment regimens are effective in the majority of AOM and ABRS episodes.
Antibiotic cost is an interesting component of the treatment paradigm. Drug costs alone rarely reflect the total cost of treating an illness. For example, three office visits and three injections of intramuscular ceftriaxone would greatly escalate the cost of treatment. However, the cost of loss of work or school attendance as a result of treatment failure and repeat office visits for additional evaluation are also important yet often overlooked factors.
1.3 Antibiotic Treatment for AOM and ABRS
Factors favoring development of persistent and recurrent AOM and probably ABRS include: (1) an episode of infection in the first six months of life, (2) patient age less than 3 years, (3) parental smoking, and (4) day care attendance ().
Today, antibiotic choices should reflect pharmacokinetic/pharmacodynamic data and clinical trial results demonstrating effectiveness in eradication of the most likely pathogens based on tympanocentesis (and sinus) sampling and antibiotic-sensitivity testing. Thereafter, compliance factors (e.g., formulation, dosing schedule) and accessibility factors (e.g., availability, cost) should be taken into account. Studies from the early 1990s have described significant decreases in the susceptibility of upper respiratory bacteria to various antibiotics. After the introduction of a 7-valent pneumococcal conjugate vaccine in 2001 in the US, the prevalence in middle ear aspirates of H. influenzae increased and S. pneumoniae decreased.
Light
Font size:
↓
↑
Reset
Interval:
↓
↑
Bookmark:
Make
Similar books «Pediatric Otolaryngology for the Clinician»
Look at similar books to Pediatric Otolaryngology for the Clinician. We have selected literature similar in name and meaning in the hope of providing readers with more options to find new, interesting, not yet read works.
Prashant Mahajan
Tegmark
Michelle L. Butterworth
Prem Puri (editor)
Richard M. Rosenfeld
Reviews about «Pediatric Otolaryngology for the Clinician»
Discussion, reviews of the book Pediatric Otolaryngology for the Clinician and just readers' own opinions. Leave your comments, write what you think about the work, its meaning or the main characters. Specify what exactly you liked and what you didn't like, and why you think so.