Conjunctivitis, Otitis, Sinusitis, Thrush, Pharyngitis

Conjunctivitis Medications

Antivirals

• Ganciclovir

• Trifluridine

Antibacterials

• Aminoglycosides

• Fluoroquinolones

• Macrolides

• Sulfacetamide

• Combination Products

Conjunctivitis

Non-Antimicrobial Therapy

• Artificial Tears

• Topical Antihistamines

• Cold compress

Viral Conjunctivitis

Common pathogens: Adenovirus, herpes simplex virus, varicella zoster virus

Adenovirus

Which common pathogen that causes viral conjunctivitis are antivirals ineffective against?

Antivirals

MoA - nucleoside analogs which inhibit DNA Synthesis

Antivirals

Agents

• Ganciclovir - drops

• Trifluridine - drops

Antivirals

ADRs

• Blurry vision

Drug interactions

• None

Bacterial Conjunctivitis

Common pathogens

• S. aureus

• S. pneumoniae

• H. influenzae

Aminoglycosides

MoA

• Inhibition of RNA-dependent protein synthesis by binding to the 30S ribosomal subunit

Class Toxicities

• Nephrotoxicity, Ototoxicity, Neuromuscular blockade, myasthenia gravis exacerbation

Drug interactions

• Concomitant nephrotoxins and neuromuscular blocking agents

Aminoglycosides

Agents

• Gentamicin

• Tobramycin

Macrolides

MoA

• inhibition of RNA-dependent protein synthesis by binding to the 50S ribosomal subunit

Class Toxicities

• QT prolongation, GI upset, rash, transaminitis, myasthenia gravis exacerbation

Drug interactions

• CYP3A4 inhibitors and substrates (statins, calcium channel blockers, warfarin, tacrolimus, azoles, etc.)

  • Azithromycin (minor)

  • Erythromycin/Clarithromycin (major)

Macrolides

Agents

• Azithromycin

• Erythromycin

Fluoroquinolones (Quinolones)

MoA

• inhibition of DNA gyrase leading to supercoiled DNA and promoting DNA breakage

Class Toxicities

• QT prolongation, tendon rupture, tendonitis, neurotoxicity, aortic aneurysm/dissection, dysglycemia, GI upset, C. difficile diarrhea, phototoxicity, myasthenia gravis exacerbation

Drug Interactions

• Warfarin (increased INR)

• Binds to cations (Ca2+, Mg2+) in the gut

Fluoroquinolones (Quinolones)

Agents

• Besifloxacin

• Ciprofloxacin

• Gatifloxacin

• Levofloxacin

• Moxifloxacin

• Ofloxacin

Aminoglycosides, Quinolones (Fluoroquinolones)

Which 2 classes of antibiotics are preferred in contact wearers with bacterial conjunctivitis?

Sulfacetamide

MoA

• Interferes with bacterial growth by inhibiting bacterial folic acid synthesis through competitive antagonism of PABA

ADRs

• edema, hypersensitivity reaction, systemic lupus erythematosus, burning sensation of eyes, conjunctival hyperemia, conjunctivitis, corneal ulcer, eye irritation, stinging of eyes

Drug Interactions

• none
  

Otitis Medications

• Beta-Lactams

• Macrolides

• Fluoroquinolones

Acute otitis media (AOM)

acute inflammation of the middle ear with moderate-to-severe tympanic membrane bulging and new onset otalgia

• Mostly within first 3 years of life

• Common pathogens: S. pneumoniae, H. influenzae, M. catarrhalis, viruses

• Vaccines have reduced incidence

Otitis externa

Inflammation and maceration of the superficial tissues of the external auditory canal (ranges from acute localized to malignant)

• Due to water being trapped in the auditory canal

• Common pathogens: P. aeruginosa, Staphylococcus, fungi

<6 months

Which age range would this be the indicated antimicrobial therapy for acute otitis media?

• Unilateral, Nonsevere AOM without Otorrhea - Antibiotic

• Bilateral, Nonsevere AOM without Otorrhea - Antibiotic

• Unilateral/Bilateral, Severe AOM or with Otorrhea - Antibiotic

6 months - 2 years

Which age range would this be the indicated antimicrobial therapy for acute otitis media?

• Unilateral, Nonsevere AOM without Otorrhea - Initial observation OR Antibiotic

• Bilateral, Nonsevere AOM without Otorrhea - Antibiotic

• Unilateral/Bilateral, Severe AOM or with Otorrhea - Antibiotic

>2 years

Which age range would this be the indicated antimicrobial therapy for acute otitis media?

• Unilateral, Nonsevere AOM without Otorrhea - Initial observation OR Antibiotic

• Bilateral, Nonsevere AOM without Otorrhea - Initial observation OR Antibiotic

• Unilateral/Bilateral, Severe AOM or with Otorrhea - Antibiotic

High-dose amoxicillin

What is the primary therapy for acute otitis media in pediatrics?

Amoxicillin, Amoxicillin-clavulanate

What is the primary therapy for acute otitis media in adults?

High-dose amoxicillin-clavulanate

What is the therapy for acute otitis media in pediatrics with

• Amoxicillin within prior 30 days

• ± concomitant purulent conjunctivitis

• ± previously failed amoxicillin

Amoxicillin-clavulanate

What is the therapy for acute otitis media in adults with

• Amoxicillin within prior 30 days

• ± concomitant purulent conjunctivitis

• ± previously failed amoxicillin

Acute Localized Otitis Externa

What are these antibiotics used to treat?

• Neomycin + polymyxin + hydrocortisone drops

• Acetic acid drops

• Acetic acid + hydrocortisone drops

• Ciprofloxacin + hydrocortisone drops

• Ciprofloxacin + dexamethasone drops

• Ofloxacin drops

Malignant Otitis Externa

What are these antibiotics used to treat?

• One of the drops used to treat acute localized otitis externa

• PLUS on of the following

• Cefepime IV

• Ceftazidime IV

• Piperacillin/tazobactam IV

• Ciprofloxacin IV/PO (adults ONLY)

Sinusitis Medications

• Beta-lactams

• Doxycycline

• Fluoroquinolones

Sinusitis

Paranasal sinus inflammation

• 5th most common diagnosis during family provider visits

• Up to 67% of cases causes are viral

• Common pathogens: S. pneumoniae, H. influenzae, M. Catarrhalis

Intranasal decongestants, antihistamines

What is generally not recommended to treat sinusitis?

Amoxicillin-clavulanate (PO)

What is the the primary therapy for sinusitis in pediatrics and adults without risk of resistance?

High-dose amoxicillin-clavulanate (PO)

What is the primary therapy for sinusitis in pediatrics and adults with risk of resistance?

7-10, severe, viral

Initiate antibiotics only in patients with acute rhinosinusitis with the following

• >_-__ days of persistent symptoms

• _______ symptoms (temp. >39C, purulent nasal discharge or facial pain >3 days)

• Worsening symptoms after typical 5-day _____ illness that was improving

Pharyngitis Medications

• Beta-lactams

• Macrolides

• Clindamycin

Corticosteroids

What non-antimicrobial therapy is not recommended to treat pharyngitis?

No

Do we offer prophylactic treatment for close contacts to pharyngitis?

Pharyngitis

The following are the primary therapies for what illness in pediatrics and adults?

• Penicillin VK PO

• Penicillin G Benzathine IM x1

• Amoxicillin PO

Thrush Medications

• Topical Antifungals

• Systemic Antifungals

Thrush

Chlorhexidine denture antiseptic is used as a non-antimicrobial therapy for what illness?

Mild Thrush

The following are the primary therapy for what illness

• Clotrimazole troche

• Miconazole buccal tab

• Nystatin suspension

Moderate to Severe Thrush

The following is the primary therapy for what illness

• Fluconazole 100-200 mg PO daily