Cause disease all over body away from infection site because toxins, compliment, and antibody cross react 173. Bacterial Pharyngitis Ddx •Non-group A strep-Groups C or G strep •Neisseria gonorrhoeae-may see in sexually active teens •Viral pharyngitis •Mycoplasma pneumonia •Mononucleosis •HIV infection •Influenza 174. Pharyngitis Ddx <3years >6years •Differential diagnosis-in children less than 3 years-probably viral •Strep more common in children > 6 years of age •Throat culture-rapid antigen detection test (10-35 % false negatives) +culture –Don’t test for strep in children < 3years-they don’t have the ability to acquire ARF 175. GAS Rx • PCN- narrow spectrum, inexpensive, 10 day course • Amoxicillin- better tasting, shorter regime-6 days, cheap-drug of choice if child also has an OM • Augmentin -good choice for recurrent GAS • Avoid macrolides-4-48% resistance (zpak) • Avoid single dose ceftriaxone-failure rates of 54% •PCN allergy/PCN tolerance-Cehphalosporins-Cephalexin, cefadroxil, cefaclor, etc •Don’t need to culture healthy household members •6 GAS infections in one year or 3-4 infections in each of 2 years, consider tonsillectomy 176. Allergic Rhinnitis-MGMT RX •Allergen avoidance –Close windows, stay indoors, use AC • Intranasal glucocorticoids-most effective tx with few side-effects –Beclomethasone (Beconase, Vancenase) –Budesonide (Rhinocort)* –Fluticasone (Flonase)* –Limited to no effect on growth –Choose once daily medications to reduce risk of growth problems* –May also prescribe anti-histamines but some cause drowsiness and/or agitation in children-What age? –If parents prefer not to use INGCs, may prescribe Cromolyn sodium although less effective 177. Sinusitis xrays? CT? •X-rays not helpful unless maxillary sinuses involved •CT used only if disease becomes serious 178. Treat Sinusitis •Amoxicillin (90 mg/kg/day) or E-mycin for 14 days •If no improvement after 3-4 days, consider Augmentin, cefuroxime axetil, or a macrolide
•No decongestants or antihistamines •Humidifier may be helpful •Increase fluid intake 179. Croup- Steeple sign •Inflammation of the mucosal lining of larynx and tracheaànarrowing of the airwayàstridor, barking cough, retractions and hoarseness -narrowing of trachea 180. Laryngitis Laryngotrachetis Laryngotracheobronchitis Bacterial tracheitis Spasmodit croup •Laryngitis=inflammation of larynx •Laryngotracheitis (croup)-both trachea and larynx are inflammed •Laryngotracheobronchitis-trachea, larynx and bronchi are inflamed •Bacterial tracheitis-infection of subglottic trachea •Spasmodic croup-onset of symptoms at night lasting a short time 181. croup- Viral Bacterial causes •Most are viral –Parainfluenza virus type 1 (most common) –RSV –Adenoviruses •Bacterial causes- –Mild infection-mycoplasma pneumoniae –Secondary pathogens-strep pneumoniae, S. pyogenes, staph aureus 182.
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- Summer '17