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□ High dose amoxicillin/clavulanate (90 mg/ kg/day) by mouth divided into twice daily administration □ Levofloxacin 10-20 mg/kg/day by mouth divided into once or twice daily administration □ Clindamycin 30-40 mg/kg/day by mouth divided into three administrations daily plus cefixime or cefpodoxime 8-10 mg/kg/day by mouth divided into twice daily administration □ Duration of therapy = 7-10 days □ Levofloxacin 10-20 mg/kg/day by mouth divided into once or twice daily administration □ Clindamycin 30-40 mg/kg/day by mouth divided into three administrations daily plus cefixime or cefpodoxime 8-10 mg/kg/day by mouth divided into twice daily administration □ Duration of therapy = 7-10 days
Empiric antimicrobial therapy should be initiated as soon as the clinical diagnosis of ABRS is established as defined in the diagnosis section above. The type of antimicrobial ther- apy is based on age, penicillin allergies, and risk factors for resistance. Risk factors for resistance include age < 2 years or > 65 years, daycare exposure, prior antibiotic usage within the past month, prior hospitalization within the past 5 days, comorbidities, or immunocompromised hosts. Below are the specific IDSA recommendations in treating patients with ABRS: • No penicillin allergy (one of the following) □ Amoxicillin/Clavulanate 875 mg by mouth twice daily □ Alternative = doxycycline 100 mg by mouth twice daily □ Duration of therapy = 5-7 days • Penicillin allergy (one of the following) □ Doxycycline 100 mg by mouth twice daily □ Moxifloxacin 400 mg by mouth daily □ Levofloxacin 500-750 mg by mouth daily □ Duration of therapy = 5-7 days • Risk factors for resistance • No penicillin allergy (one of the following) □ High dose amoxicillin/clavulanate (2 grams) by mouth twice daily □ Alternative = doxycycline 100 mg by mouth twice daily □ Duration of therapy = 7-10 days • Penicillin allergy (one of the following) □ Doxycycline 100 mg by mouth twice daily □ Moxifloxacin 400 mg by mouth daily □ Levofloxacin 500-750 mg by mouth daily □ Duration of therapy = 7-10 days Antibiotic Therapy of ABRS in Adults • No risk factors for resistance □ Amoxicillin/clavulanate 45 mg/kg/day by mouth divided into twice daily administration □ Duration of therapy = 5-7 days • Penicillin allergy (one of the following) □ Levofloxacin 10-20 mg/kg/day by mouth divided into once or twice daily administration □ Clindamycin 30-40 mg/kg/day by mouth divided into three administrations daily plus cefixime or cefpodoxime 8-10 mg/kg/day by mouth divided into twice daily administration □ Duration of therapy = 5-7 days Antibiotic Therapy for ABRS in Children • No risk factors for resistance • No penicillin allergy PHARMACOLOGICAL APPROACH TO ABRS
• Penicillin allergy (one of the following)
Adjunctive therapies may be beneficial for symptom manage- ment in certain patients. Intranasal saline with either physiologic or hypertonic saline can be used to loosen encrusted mucus in the nose. Intranasal corticosteroids may pose a benefit for patients suffering from severe nasal congestion and nasal symp- toms, particularly in patients with a history of allergic rhinitis. A cold, also known as the common cold, is a viral infection of the upper respiratory tract. Health experts estimate that Americans experience 500 million cases of the cold each year, which makes this illness one of the top five diagnoses in the United States. On average, children usually have 6-10 colds per year while adults younger than 60 typically have 2-3 colds per year. Adults older than 60 years of age usually have only one cold per year. People can develop a cold at any time throughout the year; however, in the United States, the cold season extends from late August through early April. During this time, people are more likely to develop a cold. Colds are the leading cause of work and school absen- teeism. Although colds are usually self-limiting, patients frequently self-medicate due to the fact that symptoms are bothersome. Health experts estimate that Americans annually spend $7 billion on nonprescription cold and cough products. COLDS INTRODUCTION Limited to the upper respiratory tract, colds primarily affect the following respiratory structures: pharynx, nasopharynx, nose, cavernous sinusoids, and paranasal sinuses. The host defense system in the respiratory tract typically protects the body from infection and foreign particles, as it is well inner- vated and perfused, especially the nose. The nose contains sensory, cholinergic, and sympathetic nerves. When stimu- lated by an infectious process like a cold virus, these nerves play a role in the resulting symptoms and are also targets for nonprescription treatments. The stimulation of sensory fibers PATHOPHYSIOLOGY OF COLDS
• Risk factors for resistance • No penicillin allergy (one of the following)
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