Sandbox ID Upper Respiratory Tract

Epiglottitis

Epiglottitis ^[1]

Pediatrics

Preferred regimen (1): Cefotaxime 50 mg/kg IV q8h
Preferred regimen (2): Ceftriaxone 50–75 mg/kg/day IV q12–24h AND Vancomycin 10 mg/kg IV q6h
Alternate regimen (1): Levofloxacin 500 mg IV q24h (or 8 mg/kg IV q12h) AND Clindamycin 20–40 mg/kg/day IV q6–8h

Adults

Preferred regimen (1): Cefotaxime 2 g IV q4–8h
Preferred regimen (2): Ceftriaxone 1–2 g/day IV q12–24h AND Vancomycin 2 g/day IV q6–12h
Alternate regimen (1): Levofloxacin 750 mg IV q24h AND Clindamycin 600–1200 mg IV q6–12h

Jugular vein phlebitis

Septic jugular thrombophlebitis (Lemierre's syndrome)^[2]

Causative pathogens

Fusobacterium
Viridans and other streptococci
Staphylococcus
Peptostreptococcus
Bacteroides
Other oral anaerobes

Preferred regimen (immunocompetent host) (1): Penicillin G 2–4 MU IV q4–6h
Preferred regimen (immunocompetent host) (2): Metronidazole 0.5 g IV q6h)
Preferred regimen (immunocompetent host) (3): Ampicillin-Sulbactam 2 g IV q4h
Preferred regimen (immunocompetent host) (4): Clindamycin 600 mg IV q6h
Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
Preferred regimen (immunocomppromised host) (5): Imipenem 500 mg IV q6h
Preferred regimen (immunocomppromised host) (6): Gatifloxacin 400 mg IV q24h

Laryngitis

Antibiotic use is not associated with significant improvement of objective symptoms^[3]^[4]^[5] and is not indicated in the treatment of acute laryngitis.^[6]

Lemierre's syndrome

Septic jugular thrombophlebitis (Lemierre's syndrome)^[7]

Causative pathogens

Fusobacterium
Viridans and other streptococci
Staphylococcus
Peptostreptococcus
Bacteroides
Other oral anaerobes

Preferred regimen (immunocompetent host) (1): (Penicillin G 2–4 MU IV q4–6h AND Metronidazole 0.5 g IV q6h)
Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
Preferred regimen (immunocomppromised host) (5): Imipenem 500 mg IV q6h
Preferred regimen (immunocomppromised host) (6): Gatifloxacin 400 mg IV q24h

Ludwig's angina

Ludwig's angina^[8]

Causative pathogens

Viridans and other streptococci
Peptostreptococcus
Bacteroides
Other oral anaerobes

Preferred regimen (immunocompetent host) (1): (Penicillin G 2–4 MU IV q4–6h AND Tobramycin 2 mg/kg IV q8h)
Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
Preferred regimen (immunocompetent host) (4): Doxycycline 200 mg IV q12h
Preferred regimen (immunocompetent host) (5): Cefoxitin 2 g IV q6h
Preferred regimen (immunocompetent host) (6): Cefotetan 2 g IV q12h
Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
Preferred regimen (immunocomppromised host) (5): Meropenem 1 g IV q8h
Preferred regimen (immunocomppromised host) (6): Gatifloxacin 200 mg IV q24h

Parapharyngeal space infection

Parapharyngeal space infection^[9]

Causative pathogens

Viridans and other streptococci
Staphylococcus
Peptostreptococcus
Bacteroides
Other oral anaerobes

Preferred regimen (immunocompetent host) (1): (Penicillin G 2–4 MU IV q4–6h AND Metronidazole 0.5 g IV q6h)
Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
Preferred regimen (immunocomppromised host) (5): Imipenem 500 mg IV q6h
Preferred regimen (immunocomppromised host) (6): Gatifloxacin 400 mg IV q24h

Pharyngitis, diphtheria

Diphtheria^[10]

The CDC recommends either:

Preferred regimen (1): Erythromycin (PO or by IV) for 14 days (40 mg/kg per day with a maximum of 2 g/d)
Preferred regimen (2): Procaine penicillin G given IM for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg).

Patients with allergies

Preferred regimen (1): Penicillin G
Preferred regimen (2): Erythromycin
Preferred regimen (3): Eifampin
Preferred regimen (4): Clindamycin

Pharyngitis, streptococcal

Pharyngitis ^[11]^[12]

Acute

Children:

Preferred regimen: Pencillin V PO 250 mg twice daily or 3 times daily

Adolescents and adults:

Preferred regimen (1): Pencillin V PO 250 mg 4 times daily or 500 mg twice daily for 10 days
Preferred regimen (2): Amoxicillin 50 mg/kg once daily (max = 1000 mg) alternate:25 mg/kg (max = 500 mg) twice daily for 10 days
Preferred regimen (3): Benzathine Penicillin G I.M 27 kg: 600 000 U; ≥27 kg: 1 200 000 U 1 dose only
Preferred regimen (4): Cephalexin PO 20 mg/kg/dose twice daily (max = 500 mg/dose)for 10 days
Alternate regimen (1): Cefadroxil PO 30 mg/kg OD (max = 1 g) for 10 days
Alternate regimen (2): Clindamycin PO 7 mg/kg/dose 3 times daily (max = 300 mg/dose) for 10 days
Alternate regimen (3): AzithromycinPO 12 mg/kg once daily (max = 500 mg) for 5 days
Alternate regimen (4): Clarithromycin PO 7.5 mg/kg/dose twice daily (max = 250 mg/dose) for 10 days

Chronic

Preferred regimen (1): Clindamycin 20–30 mg/kg/d in 3 doses (max = 300 mg/dose) for 10 days
Preferred regimen (2): Penicillin AND Rifampin; Penicillin V: 50 mg/kg/d in 4 doses × 10 d (max = 2000 mg/d) ;rifampin: 20 mg/kg/d in 1 dose × last 4 d of treatment (max = 600 mg/d) for 10 days AND Amoxicillin–clavulanate 40 mg amoxicillin/kg/d in 3 doses (max = 2000 mg amoxicillin/d) for 10 days
Preferred regimen (3): Benzathine penicillin G IM 600 000 U for <27 kg and 1 200 000 U for ≥27 kg single dose AND Rifampin PO 20 mg/kg/d in 2 doses (max = 600 mg/d) for 4 days

Sinusitis, Acute

Sinusitis ^[13]

Sinusitis (Pediatrics)

Preferred Regimen (1): Amoxicillin 90 mg / kg / day PO divided q12h
Preferred Regimen (2): Amoxicillin-clavulanate (extra strength) suspension, 90 mg / kg / day (based on Amox component), PO divided q12h for 10-14 days

If non-type I hypersensitivity to penicillin :

Preferred regimen (1): Cefuroxime axetil 30 mg / kg / day PO divided q12h for 10-14 days
Alternate Regimen (1): Cefdinir 14 mg / kg / day PO divided q12-24h, max of 600 mg / day for 10-14 days
Alternate Regimen (2): Cefpodoxime 10 mg / kg / day PO divided q12h for 10-14 days

Sinusitis (Adults)

Preferred Regimen (1): Amoxicillin 250-500 mg q8h or 500-875 mg q12h or extended-release tablet 775 mg once daily
Preferred Regimen (2): Amoxicillin-clavulanate (extended release tabs) 1000 / 62.5 mg 2 tabs or 2000/125 mg 1 tab, PO q12h for 5-7 days

Alternate Regimen

If type 1 hypersensitivity to penicillin :

Preferred regimen (1): Levofloxacin 750 mg PO once daily for 5-7 days
Preferred regimen (2): Doxycycline 100 mg PO q12h for 5-7 days

If type 2 hypersensitivity to penicillin :

Preferred regimen (1): Cefdinir 600 mg / day divided q12h or q24h for 5-7 days
Preferred regimen (2): Cefpodoxime 200 mg PO q12h for 5-7 days
Preferred regimen (3): Cefuroxime axetil 500 mg PO q12h for 5-7 days

Sinusitis, Chronic

Sinusitis ^[14]

Sinusitis (Pediatrics)

Preferred Regimen:Amoxicillin-clavulanate 45 mg/kg per day q12h
If penicillin allergy and patient is MRSA positive

Clindamycin 20 to 40 mg/kg per day orally divided every 6 to 8 hours

If anaerobes are involved

Metronidazole PLUS one of the following: cefuroxime axetil, cefdinir, cefpodoxime proxetil,azithromycin, clarithromycin, or trimethoprim-sulfamethoxazole (TMP-SMX)

Sinusitis (Adults)

Preferred regimen (1): Amoxicillin-clavulanate 500 mg three times daily
Preferred regimen (2): Amoxicillin-clavulanate 875 mg twice daily
Preferred regimen (3): Amoxicillin-clavulanate two 1000 mg extended-release tablets twice daily)
If penicillin allergy and patient is MRSA positive
Preferred regimen (1): Clindamycin 300 mg four times daily or 450 mg three times daily)
If anaerobes are involved
Preferred regimen (1):Metronidazole AND one of the following: cefuroxime axetil, cefdinir, cefpodoxime proxetil, levofloxacin , azithromycin, clarithromycin
Preferred regimen (2): trimethoprim-sulfamethoxazole (TMP-SMX)
Alternate regimen: Moxifloxacin (400 mg once daily)

Sinusitis, post-intubation

Sinusitis ^[15]

Preferred regimen (1): Imipenem 0.5 gm IV q6h
Preferred regimen (2): Meropenem 1 gm IV q8h, MRSA suggestive on Gram - stain then add Vancomycin 1 gm IV q12h
Alternative Regimen (1): Ceftazidime 2 gm IV q8h AND Vancomycin 1 gm IV q12h)
Alternative Regimen (2): Cefepime 2 gm IV q12h AND Vancomycin 1 gm IV q12h)

Sinusitis, treatment failure

Sinusitis (Pediatrics) ^[16]

If treatment failure then do a culture and treat accordingly or treatment in the absence of cultures and children failing Amoxicillin

Amoxicillin-clavulanate (extra strength) suspension 90 mg/kg/day (Amoxicllin component) PO divided q12h for 10-14 days.

Treatment in the absence of cultures and children failing Amoxicillin-clavulanate

Clindamycin 30-40 mg/kg/day divided q8h AND third generation cephalosporin like Cefuroxime axetil 30 mg/kg/day PO divided q12h

Preferred regimen (1): Cefdinir 14 mg/kg/day PO divided q12h or q24h Preferred regimen (2):Cefpodoxime 10 mg/kg/day PO divided q12h

Sinusitis (Adults)

If failure of treatment even after 7 days of diagnosis

Preferred regimen (1): Amoxicillin-clavulanate 4g per day of amoxicillin equivalent Preferred regimen (2): Levofloxacin 500 mg PO once daily Preferred regimen (3): Moxifloxacin400 mg PO once daily

Stomatitis, aphthous

Stomatitis ^[17]

Topical steroids may decrease pain and swelling

Stomatitis, herpetic

Stomatitis ^[18]

Acyclovir 15 mg/kg PO q5h For 7 days

Submandibular space infection

Submandibular space infections including Ludwig angina^[19]

Causative pathogens

Viridans and other streptococci
Peptostreptococcus
Bacteroides
Other oral anaerobes

Preferred regimen (immunocompetent host) (1): Penicillin G 2–4 MU IV q4–6h AND Tobramycin 2 mg/kg IV q8h)
Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
Preferred regimen (immunocompetent host) (4): Doxycycline 200 mg IV q12h
Preferred regimen (immunocompetent host) (5): Cefoxitin 2 g IV q6h

Preferred regimen (immunocompetent host) (6): Cefotetan 2 g IV q12h
Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
Preferred regimen (immunocomppromised host) (5): Meropenem 1 g IV q8h
Preferred regimen (immunocomppromised host) (6): Gatifloxacin 200 mg IV q24h

Tonsillitis

Tonsillitis ^[20]

Preferred regimen:Penicillin V PO 10 days or if compliance unlikely, Benzathine penicillin IM single dose

Alternate regimen (1): 2nd generation Cephalosporins PO for 4–6 days
Alternate regimen (2): Clindamycin or azithromycin for 5 days
Alternate regimen (3): Clarithromycin for 10 days
Alternate regimen (4): Erythromycin for 10 days. Extended-release amoxicillin is another (expensive) option

Ulcerative gingivitis

Provide patient with specific oral hygiene instructions to use a prescription antibacterial mouthwash: Chlorhexidine 0.12% twice daily.^[21]

For any signs of systemic involvement, the recommended antibiotics are:

Preferred regimen: Amoxicillin, 250 mg 3 x daily for 7 days ± Metronidazole, 250 mg 3 x daily for 7 days

Vincent's angina

Vincent's angina ^[22]

Preferred treatment:Penicillin G 4 million units IV q4h
Alternate treatment: Clindamycin 600 mg IV q8h

References

↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
↑ Reveiz, L.; Cardona, AF.; Ospina, EG. (2005). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (1): CD004783. doi:10.1002/14651858.CD004783.pub2. PMID 15674965.
↑ Reveiz, L.; Cardona, AF.; Ospina, EG. (2007). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (2): CD004783. doi:10.1002/14651858.CD004783.pub3. PMID 17443555.
↑ Reveiz, L.; Cardona, AF. (2013). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev. 3: CD004783. doi:10.1002/14651858.CD004783.pub4. PMID 23543536.
↑ Schwartz, SR.; Cohen, SM.; Dailey, SH.; Rosenfeld, RM.; Deutsch, ES.; Gillespie, MB.; Granieri, E.; Hapner, ER.; Kimball, CE. (2009). "Clinical practice guideline: hoarseness (dysphonia)". Otolaryngol Head Neck Surg. 141 (3 Suppl 2): S1–S31. doi:10.1016/j.otohns.2009.06.744. PMID 19729111. Unknown parameter |month= ignored (help)
↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
↑ The first version of this article was adapted from the CDC document "Diphtheria - 1995 Case Definition" athttp://www.cdc.gov/epo/dphsi/casedef/diphtheria_current.htm. As a work of an agency of the U.S. Government without any other copyright notice it should be available as a public domain resource.
↑ Thomas, M.; Del Mar, C.; Glasziou, P. (2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract. 50 (459): 817–20. PMID 11127175. Unknown parameter |month= ignored (help)
↑ Spinks, A.; Glasziou, PP.; Del Mar, CB. (2013). "Antibiotics for sore throat". Cochrane Database Syst Rev. 11: CD000023. doi:10.1002/14651858.CD000023.pub4. PMID 24190439.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ "Managing Patients with Necrotizing Ulcerative Gingivitis".
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[1] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[2] Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.

[Reveiz-2005-3] Reveiz, L.; Cardona, AF.; Ospina, EG. (2005). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (1): CD004783. doi:10.1002/14651858.CD004783.pub2. PMID 15674965.

[Reveiz-2007-4] Reveiz, L.; Cardona, AF.; Ospina, EG. (2007). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (2): CD004783. doi:10.1002/14651858.CD004783.pub3. PMID 17443555.

[Reveiz-2013-5] Reveiz, L.; Cardona, AF. (2013). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev. 3: CD004783. doi:10.1002/14651858.CD004783.pub4. PMID 23543536.

[Schwartz-2009-6] Schwartz, SR.; Cohen, SM.; Dailey, SH.; Rosenfeld, RM.; Deutsch, ES.; Gillespie, MB.; Granieri, E.; Hapner, ER.; Kimball, CE. (2009). "Clinical practice guideline: hoarseness (dysphonia)". Otolaryngol Head Neck Surg. 141 (3 Suppl 2): S1–S31. doi:10.1016/j.otohns.2009.06.744. PMID 19729111. Unknown parameter |month= ignored (help)

[7] Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.

[8] Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.

[9] Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.

[10] The first version of this article was adapted from the CDC document "Diphtheria - 1995 Case Definition" athttp://www.cdc.gov/epo/dphsi/casedef/diphtheria_current.htm. As a work of an agency of the U.S. Government without any other copyright notice it should be available as a public domain resource.

[Thomas-2000-11] Thomas, M.; Del Mar, C.; Glasziou, P. (2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract. 50 (459): 817–20. PMID 11127175. Unknown parameter |month= ignored (help)

[Spinks-2013-12] Spinks, A.; Glasziou, PP.; Del Mar, CB. (2013). "Antibiotics for sore throat". Cochrane Database Syst Rev. 11: CD000023. doi:10.1002/14651858.CD000023.pub4. PMID 24190439.

[13] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[14] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[15] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[16] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[17] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[18] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[19] Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.

[20] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[21] "Managing Patients with Necrotizing Ulcerative Gingivitis".

[22] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]