ENT and Eyes

First-line treatment for otitis media

Amoxicillin

Treatment for otitis media in penicillin allergy

Clarithromycin (erythromycin in pregnancy)

What to do if symptoms worsen after 2–3 days?

Switch to co-amoxiclav

What ear drops can be used for pain if no antibiotics are given?

Phenazone + lidocaine

First-line treatment for acute otitis externa

Topical acetic acid 2%

acts as an astringent in the external ear canal by reducing the pH reducing bacterial and fungal cell growth
Use for minimum one week → max 2

Second-line treatment for acute otitis externa

Topical neomycin sulphate + corticosteroid

Treatments for fungal chronic otitis externa

• Clotrimazole 1% solution

• Clioquinol + corticosteroid

• Acetic acid 2%

Treatments for bacterial chronic otitis externa

• Gentamicin ear drops

• Ciprofloxacin ear drops

• ± systemic flucloxacillin

Treatment for otitis externa without bacterial/fungal cause

Prednisolone ear drops

What organism causes strep throat and scarlet fever?

Streptococcus bacteria

First-line treatment for both strep throat and scarlet fever

Phenoxymethylpenicillin

Second-line treatment for strep throat

Clarithromycin

Second-line treatment for scarlet fever

• Amoxicillin

• Azithromycin

Key symptoms of scarlet fever

• Flu-like symptoms

• High temperature

• Sore throat

• Swollen neck glands

Characteristic rash in scarlet fever

Red rash with small raised bumps (sandpaper-like)

Classic tongue appearance in scarlet fever

Strawberry tongue (white coating initially)

First-line treatment for dental abscess

• Amoxicillin

• Phenoxymethylpenicillin

Second-line treatment for dental abscess

• Metronidazole

• Clarithromycin

What analgesia should be offered for dental abscess?

Paracetamol or NSAIDs

First-line eye drops for conjunctivitis

Chloramphenicol 0.5% drops

Dosing for chloramphenicol eye drops

• 1 drop every 2 hours for 48 hours

• Then 3–4 times daily

Chloramphenicol ointment dosing

3–4 times daily

Alternative treatment for conjunctivitis

Fusidic acid 1% eye drops (1 drop twice daily)

How long should conjunctivitis treatment continue?

Until 48 hours after symptoms resolve

When should chloramphenicol NOT be given OTC?

• Pregnancy

• Children under 2 years

Who is topical ear treatment with aminoglycosides contraindicated in?

perforated tympanic membrane

How long does it take for otitis media to clear up?

3 to 7 days without antibacterial drugs → usually self limiting

What is otitis media with effusion?

• glue ear

• is characterised by the collection of fluid within the middle ear without any signs of inflammation or infection

• If no hearing loss with resolve by it’s self

Topical antihistamines in nasal allergy

azelastine are faster than oral antihistamines
Good for break through symptoms
less effective than nasal corticosteroids

Topical nasal decongestants in nasal allergy

Can be used for a short period to provide quick relief → to allow penetration of nasal corticosteroid

Systemic nasal decongestants use in nasal allergy

weakly effective in reducing nasal obstruction → but have considerable side effect → not recommended

Treatment for moderate to severe allergic rhinitis?

topical nasal corticosteroid during periods of allergen exposure

When should topical corticosteroid preparations be avoided?

in the presence of untreated nasal infections, after nasal surgery, pulmonary tuberculos

Which nasal corticosteroids have negligible systemic absorption

mometasone furoate and fluticasone

Which nasal corticosteroids have high systemic absorption

betamethasone → only used short term

What is nasal mucosal also sensitive to?

to changes in atmospheric temperature, humidity and these alone may cause nasal congestion

Which preparation is used for nasal staphylococci?

Use antimicrobial preparations such as chlorhexidine with neomycin cream (Naseptin®)

Define sinunsitis?

• Inflammation of the mucosal lining of the paranasal sinuses

  • Usually self limiting condition

• Generally triggered by viral infection

• Sometimes complicated with bacterial

What treatment in sinusitis less than 10 days

Selfcare

What treatment in sinusitis more than 10 days

high dose nasal corticosteroid → such as mometasone or fluticasone for 14 days

Or back up antibiotic prescription → only offered in severely unwell or bacterial infection suspected

First line acute sinusitis?

• First line:

  • Non-life threatening symptoms: phenoxymethylpenicillin.

• 2nd

  • Co amoxiclav

• Penicillin allergic

  • doxycycline or clarithromycin

Dental infections and antibiotics?

PHE advises antibacterial use only in the presence of systemic features of infection or severe infection

What antibiotics are usually used in dental infections

Metronidazole or amoxicillin → usually 3 days
Abscess → phenoxymethylpenicillin → 5 days

What is first line in acute sore throat?

Phenoxymethylpenicillin → 5-10 days

clarithromycin or erythromycin (in pregnancy) → 5 days

Problem with blind prescribing in oral bacterial infections?

for unexplained pyrexia, cervical lymphadenopathy, or facial swelling can lead to difficulty in establishing the diagnosis

First-line antibiotic for dentoalveolar abscess

Phenoxymethylpenicillin

How does amoxicillin compare to phenoxymethylpenicillin in oral dental infections?

• Equally effective

• Better absorbed

• May promote resistance

Why might amoxicillin increase resistance risk?

Broad-spectrum activity encourages resistant organisms

Is amoxicillin effective against beta-lactamase-producing bacteria?

No

When is amoxicillin particularly useful in oral dental infections?

Short-course oral regimens

Why is co-amoxiclav useful in dental infections?

Active against beta-lactamase-producing bacteria

When should co-amoxiclav be used?

• Severe dental infection with spreading cellulitis

• Infection not responding to first-line treatment

Do cephalosporins offer advantages over penicillins in dental infections?

No (often less active against anaerobes)

How do oral streptococci resistant to penicillin respond to cephalosporins?

Usually also resistant

Why is this resistance clinically important?

Especially in patients with rheumatic fever on long-term penicillin

Examples of cephalosporins used in oral infections

Cefalexin, cefradine

Role of tetracyclines in oral infections

• Effective against anaerobes (in adults)

• Reduced use due to resistance

When might tetracyclines still be used?

Refractory periodontal disease (specialist advice)

Advantage of doxycycline over other tetracyclines

• Longer duration of action

• Once-daily dosing

• More active against anaerobes

When are macrolides used in oral infections?

• Penicillin allergy

• Beta-lactamase-producing organisms

Key limitation of macrolides

High resistance or rapid development of resistance

How should macrolides be used?

Short courses only

Should clindamycin be routinely used in dental infections?

No

Why is clindamycin not preferred?

• Not more effective than penicillins

• Possible cross-resistance with erythromycin

When is metronidazole used in dental infections?

• Penicillin allergy

• Infections caused by beta-lactamase-producing anaerobes

What are fungal mouth infections usually caused by?

Candida spp. (candidiasis or candidosis)

Oral thrush people at risk?

• receiving inhaled corticosteroids,

• chemotherapy,

• or broad-spectrum antibacterials,

• and in patients with serious systemic disease associated with reduced immunity such as leukaemia, other malignancies, and HIV infection.

First line treatment oral thrush

• treat with miconazole oral gel

  • if this is unsuitable, oral nystatin may be given

What is Denture stomatitis

a common, non-contagious inflammatory condition under dentures, primarily caused by Candida yeast overgrowth. 

Treatment Denture stomatitis

Cleanse dentures

Max 6 hours wear

proper fitting

brush with soft brush

Miconazole gel may be needed