RTS Infections MPharm 3 2024 S Amin (copy)

types of otc ear infections/ problems = 4

◦ Ear wax

◦ Mild Otitis Externa

◦ Otitis Media

◦ Otitis Media with effusion

when to refer ear infections

• Ear ache with fever, vomiting, nausea, dizziness, discharge or severe deafness

• Children < 6 years with ear pain

• Blocked or Perforated Ear

• Foreign object/Trauma

• Slow growing tumours

• OTC treatment failure > 3 days

• Tinnitus

• Meniere’s disease

• Mastoiditis

• Otitis Media

• Otitis Media with Effusion (Glue ear)

• Otitis Externa : severe, discharge, ezcema

Ear Wax -Treatments

OTC Ear Drops :Cerumunolytics

◦ Chlorobutanol , arachis oil ( Cerumol ® : avoid –nut allergy)

◦ Peroxide-based ( Exterol ®/Otex®)

◦ Docusate sodium (Waxsol®)

◦ Sodium Bicarbonate 5%

◦ Olive / almond oil

◦ Irrigation / Syringe : BNF warm water

◦ Avoid < 12 years

otitis external signs and symotyms- oe

= inflammation of outer ear canal

•ear pain

•itching and irritation in and around the ear canal

•some hearing loss

•tenderness when the ear or jaw moves

•redness and swelling of the outer ear and ear canal

•eczematous / scaly skin around the ear canal and/or external ear

•noticeable discharge (this can be thin, or thick and pus-like or ‘ custard-like’)

•swollen and sore throat glands

causes of OE

• Bacterial - Pseudomonas aeruginosa and Staphylococcus aureus or fungal causes eg Candida albicans or aspergillus

• Trauma

• Ear syringing

• Excess moisture

• Dermatitis (seborrheic)

• ‘Custard like’ discharge in bacterial OE

• Erythema and swellin

Mild Otitis Externa- symptoyms

Bacterial or fungal ◦ Swimmer’s ear

Symptoms: Pain, itch, dulled hearing and discharge

Mild Otitis Externa- otc treatment

◦ Acetic acid eg Ear Calm Spray (>12 years).

◦ Analgesics (Paracetamol /Ibuprofen)

◦ Antifungal drops eg Clotrimazole solution

MOE- self care

Swim ear plugs/drops, shower/swim cap, dry ears, warm flannel

Caution : cotton buds

MOE= refer

POM Treatment

◦ Antibiotics eg Chloramphenicol ear drops

◦ Corticosteroid (+ eczema) eg dexamethasone

◦ Combination steroid/antibiotic aural drops

◦ Aluminium acetate + ribbon gauze dressing/sponge wick (to keep ear canal open)

◦ Delayed Rx? Eg flucloxacillin , clarithromycin or ciprofloxacin

Acute Otitis Media – symptoms

Does the patient have acute onset of symptoms including:

In older children— earache

In younger children — holding, tugging, or rubbing of the ear

In younger children: non-specific symptoms such as fever, crying, poor feeding, restlessness, behavioural changes, cough, or rhinorrhoea

Otoscope Examination

:☐ A distinctly red, yellow, or cloudy tympanic membrane

☐ Moderate to severe bulging of the tympanic membrane, with loss of normal landmarks and an airfluid level behind the tympanic membrane

☐ Perforation of the tympanic membrane and/or sticky discharge in the external auditory canal

acute Otis media treatment

No penicillin allergy

First line: amoxicillin for 5 days

• Second line (worsening symptoms despite 2 to 3 days of antibacterial treatment): co-amoxiclav

Penicillin allergy or intolerance

• First line: clarithromycin or erythromycin (preferred in pregnancy)

.• Second line (worsening symptoms despite 2 to 3 days of antibacterial treatment): consult local microbiologist

Otitis media with effusion

Glue ear - the middle ear fills with mucus without inflammation

Common childhood condition (winter)

Symptoms:Hearing loss, mild pain, irritability and problems with sleep or balance.

young children- speech and language development

Resolves within three months without treatment,

Persistent cases – grommet Refer patient for examination and diagnosis

Impetigo

A highly infectious, common, superficial bacterial skin infection

2 types

non-bullous (usually on face)

bullous

Impetigo : Non Bullous

Thin walled reddish vesicles/pustules

Rupture – golden /brown crusts

Itchy

Can be asymptomatic

Lymph nodes – may be swollen Mouth/nose – other parts of face and extremities

Localised (< 3 lesions/clusters) Widespread (> 4 lesions/clusters

Impetigo : Bullous

Common in infants

Fluid filled vesicles 2-3 days

Rupture – thin, flat yellow/brown crusts

Common in skin folds – armpit, groin, toes, under breast, buttocks

Systemic : fever /swollen lymph nodes – widespread areas

Impetigo - management

Self-care

Hygiene measures

Infectious – avoid school /work

Underlying skin conditions eg eczema

Treatments

Non-bullous (localised) : see Pharmacy First Scheme – check PGD inclusion/exclusioncriteria Localised:First line: topical Hydrogen Peroxide 1% cream . Apply BD/TDS for 5-7 days

2nd Line : Fusidic acid 2% topical widespread

non-bullous impetigo or bullous, systemically unwell or severeOral antibiotics check Pharmacy First / CKS guidelines : Flucloxacillin for 5 days or Clarithromycin, Erythromycin (pen allergy/pregnant)

Conjunctivitis- types

Infective

◦ Bacterial – muco purulent, yellow sticky discharge – eyelashes Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae

◦ Viral - watery, red eye.

◦ Sore, burn, gritty , swollen, irritated, eyelid may be swollen

◦ Contagious : one eye-> infects both

◦ Most cases self-limiting (5-7 days)

◦ Direct/indirect contact

Allergic : seasonal, perennial, contact dermatoconjunctivitis, giant papillary conjunctivitis

Irritant eg smoke, chlorine, eyelash etc

ConjunctivitisRefer to GP / A&E

Refer to GP / A&E

◦ Pain in eyes, photophobia, disturbed vision, acute glaucoma, eye surgery (last 6 months) , Children < age 2 , pregnant/breast-feeding, corneal abrasion, foreign body, recurrent conjunctivitis ,keratitis, STI

◦ OTC treatment failure or symptoms worsen

◦ Complications: Meningitis, Neo-natal conjunctivitis (urgent -permanent damage)

Risk Groups◦ Children/elderly/Newborn◦ URTI◦ Diabetes◦ Corticosteroids◦ Blepharitis◦ Close contact eg school, work

Conjunctivitis : Treatment

Infective: Acute Bacterial Conjunctivitis (Viral : not OTC )

2+

5 days duration

◦ 10ml Chloramphenicol 0.5% eye drops - Optrex® Infected Eye store in fridge 2°C - 8°C◦ 4g Chloramphenicol 1% eye ointment ◦ Propamidine isethionate eg Brolene® eye drops

allergic:

(antihistamines, sodium cromoglygate, intraocular drops /nasal spray – see Hay fever)

irritant

witch hazel (Optrex sore eyes®), naphazoline (Murine ®)

Blepharitis

◦ Inflammation - rim of eyelid

◦ Common :1 in 20 eye problems)/ Age 40+

◦ Burn, sting, crusty eyelashes, itchy + sore eyelids

◦ Long term, chronic

◦ Causes: bacterial or Seborrhoeic Dermatitis

◦ Can lead to bacterial conjunctivitis

◦ Not contagious

Treat:◦ Cotton wool , boiled water compress◦ Propamidine isethionate (Brolene eye drops)◦ Antibiotics (POM) eg chloramphenicol or tetracyclines◦ Avoid: eye make-up

Styes

◦ Small pimple or boil on in/outside of eyelid

◦ Painful lump, pus

◦ Common◦ Usually self-limiting : 1-3 weeks

Treat◦ Warm compress◦ Analgesics : paracetamol, ibuprofen

Refer◦ Chalazion (meibimian cysts), preseptal cellulitis

meningitis symptoms

• glass test

• fever vomiting

• severe headache

• stiff neck

• dislike of bright lights

• confused

• very sleepy

• rash

• seizures

Toxic shock syndrome (TSS)

Rare but life-threatening bacterial infection Caused by Staphylococcus aureus and Streptococcus pyogenes

1 in 3 (40 develop TSS, 2-3 die annually)

Risk Factors◦ Menstrual period – tampon risk ◦ Female barrier contraceptives ◦ Wound infection after surgery◦ Staphylococcal infection or streptococcal infection◦ Using nasal packing to treat a nosebleed◦ Labour◦ Skin wound – cut, burn or recent chickenpox