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{{PBI|Histoplasmosis}}
===Epiglottitis===
:* 1. '''Adult treatment:'''  <ref name="pmid16206093">{{cite journal| author=Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Johnson RH, Stevens DA et al.| title=Coccidioidomycosis. | journal=Clin Infect Dis | year= 2005 | volume= 41 | issue= 9 | pages= 1217-23 | pmid=16206093 | doi=10.1086/496991 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16206093  }} </ref>
*Epiglottitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::* 1.1 '''Pulmonary'''
:*Pediatrics
:::* 1.1.1 '''Acute pulmonary histoplasmosis'''
::*Preferred regimen (1): [[Cefotaxime]] 50 mg/kg IV q8h
::::* 1.1.1.1 '''Moderate severe or severe'''
::*Preferred regimen (2): [[Ceftriaxone]] 50–75 mg/kg/day IV q12–24h {{and}} [[Vancomycin]] 10 mg/kg IV q6h
:::::* Preferred regimen (1): Lipid formulation of [[Amphotericin B]] (3.0–5.0 mg/kg IV q12h for 1–2 weeks) {{then}} [[Itraconazole]] (200 mg tid for 3 days {{then}} 200 mg bid for a total of 12 weeks).
::*Alternate regimen (1): [[Levofloxacin]] 500 mg IV q24h (or 8 mg/kg IV q12h) {{and}} [[Clindamycin]] 20–40 mg/kg/day IV q6–8h
:::::* Preferred regimen (2): [[Methylprednisolone]] (0.5–1.0 mg/kg IV q24h) during the first 1–2 weeks of antifungal therapy is recommended for patients who develop respiratory complications, including hypoxemia or significant respiratory distress
:::::* Alternative regimen: The deoxycholate formulation of [[Amphotericin B]] (0.7–1.0 mg/kg q24h IV) is an alternative to a lipid formulation in patients who are at a low risk for nephrotoxicity.
:::::* Note (1): In severe cases, cases accompanied by respiratory insufficiency, or hypoxemia, anecdotal reports suggest that corticosteroid therapy may hasten recovery
:::::* Note (2): The pulmonary infiltrates should be resolved on the chest radiograph before antifungal therapy is stopped.
::::* 1.1.1.2 '''Mild to moderate:'''
:::::* Treatment is usually unnecessary
:::::* Preferred regimen for patients who continue to have symptoms for >1 month: [[Itraconazole]] (200 mg tid for 3 days {{then} 200 mg qd {{or}} bid for 6–12 weeks)
:::::* Note (1): Antifungal treatment is unnecessary in patients with mild symptoms caused by acute pulmonary histoplasmosis


:::* 1.1.2 '''Chronic cavitary pulmonary histoplasmosis:'''
:*Adults
::::* Preferred regimen: [[Itraconazole]] (200 mg tid for 3 days and {{then}} qd or bid for at least 1 year) is recommended
::*Preferred regimen (1): [[Cefotaxime]] 2 g IV q4–8h
::::* Note (1): Blood levels of itraconazole should be obtained after the patient has been receiving this agent for at least 2 weeks to ensure adequate drug exposure
::*Preferred regimen (2): [[Ceftriaxone]] 1–2 g/day IV q12–24h {{and}} [[Vancomycin]] 2 g/day IV q6–12h
::::* Note (2): Patients with underlying emphysema often develop progressive pulmonary disease, which is characterized by cavities with surrounding inflammation after infection with hysotplasma capsulatum
::*Alternate regimen (1): [[Levofloxacin]] 750 mg IV q24h {{and}} [[Clindamycin]] 600–1200 mg IV q6–12h


:::* 1.1.3 '''Broncholithiasis'''
===Jugular vein phlebitis===
::::* Antifungal treatment is not recommended
* '''Septic jugular thrombophlebitis (Lemierre's syndrome)'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
::::* Note: Bronchoscopic or surgical removal of the broncholith is recommended
:* 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


:::* 1.1.4 '''Pulmonary nodules (Histoplasmomas)'''
===Laryngitis===
::::* Antifungal treatment is not recommended**
* Antibiotic use is not associated with significant improvement of objective symptoms<ref name="Reveiz-2005">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume =  | issue = 1 | pages = CD004783 | month =  | year = 2005 | doi = 10.1002/14651858.CD004783.pub2 | PMID = 15674965 }}</ref><ref name="Reveiz-2007">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume =  | issue = 2 | pages = CD004783 | month =  | year = 2007 | doi = 10.1002/14651858.CD004783.pub3 | PMID = 17443555 }}</ref><ref name="Reveiz-2013">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume = 3 | issue =  | pages = CD004783 | month =  | year = 2013 | doi = 10.1002/14651858.CD004783.pub4 | PMID = 23543536 }}</ref> and is not indicated in the treatment of acute laryngitis.<ref name="Schwartz-2009">{{Cite journal  | last1 = Schwartz | first1 = SR. | last2 = Cohen | first2 = SM. | last3 = Dailey | first3 = SH. | last4 = Rosenfeld | first4 = RM. | last5 = Deutsch | first5 = ES. | last6 = Gillespie | first6 = MB. | last7 = Granieri | first7 = E. | last8 = Hapner | first8 = ER. | last9 = Kimball | first9 = CE. | title = Clinical practice guideline: hoarseness (dysphonia). | journal = Otolaryngol Head Neck Surg | volume = 141 | issue = 3 Suppl 2 | pages = S1-S31 | month = Sep | year = 2009 | doi = 10.1016/j.otohns.2009.06.744 | PMID = 19729111 }}</ref>
::::* Note: There is no evidence that antifungal agents have any effect on histoplasmomas or that histoplasmomas contain viable organisms.


::* 1.2 '''Mediastinitis'''  
===Lemierre's syndrome===
* '''Septic jugular thrombophlebitis (Lemierre's syndrome)'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
:* 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


:::* 1.2.1 '''Mediastinal lymphadenitis'''
===Ludwig's angina===
::::* 1.2.1.1 '''Asymptomatic cases'''
* '''Ludwig's angina'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
:::::* Treatment is usually unnecessary
:* Causative pathogens
::::* 1.2.1.2 '''Patients who have symptoms that warrant treatment with corticosteroids and in those who continue to have symptoms for > 1 month'''
::* Viridans and other streptococci
:::::* [[Itraconazole]] (200 mg 3 tid for 3 days and {{then}} 200 mg qd or bid for 6–12 weeks)
::* Peptostreptococcus
::::* 1.2.1.2 '''Severe cases with obstruction or compression of contiguous structures'''
::* Bacteroides
:::::* Preferred regimen: [[Prednisone]] (0.5–1.0 mg/kg qd [maximum 80 mg qd] in tapering doses over 1–2 weeks)
::* Other oral anaerobes
:::::* Note (1): Antifungal treatment is unnecessary in most patients with symptoms due to mediastinal lymphadenitis
:* Preferred regimen (immunocompetent host) (1): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Tobramycin]] 2 mg/kg IV q8h)
:::::* Note (2): Itraconazole is recommended for 6–12 weeks to reduce the risk of progressive disseminated disease caused by corticosteroid-induced immunosuppression in patients who are given corticosteroids and in patients whose symptoms last longer than 1 month.
:* 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


:::* 1.2.2 '''Mediastinal granuloma'''
===Parapharyngeal space infection===
::::* 1.2.2.1 '''Asymptomatic cases'''
* '''Parapharyngeal space infection'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
:::::* Treatment is usually unnecessary
:* Causative pathogens
::::* 1.2.2.2 '''Symptomatic cases'''
::* Viridans and other streptococci
:::::* Preferred regimen: [[Itraconazole]] (200 mg 3 times qd for 3 days and {{then}} qd or bid for 6–12 weeks)
::* Staphylococcus
:::::* Note (1): [[Itraconazole]] is appropriate for symptomatic cases but there are no controlled trials to prove its efficacy.
::* Peptostreptococcus
:::::* Note (2): There is no evidence that mediastinal granuloma evolves into mediastinal fibrosis. Thus treatment with either surgery or itraconazole should not be used to prevent the development of mediastinal fibrosis
::* 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


:::* 1.2.3 '''Mediastinal fibrosis'''
===Pharyngitis, diphtheria===
:::* Antifungal treatment is not recommended**
*Diphtheria<ref>''The first version of this article was adapted from the [[Centers for Disease Control and Prevention|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''.</ref>
:::* 1.2.3.1 '''If clinical findings cannot differentiate mediastinal fibrosis from mediastinal granuloma'''
:*The CDC recommends either:
:::* Preferred regimen: [[Itraconazole]] (200 mg qd or bid for 12 weeks)
::*Preferred regimen (1): [[Erythromycin]] (PO or by IV) for 14 days (40 mg/kg per day with a maximum of 2 g/d)
::::* Note: The placement of intravascular stents is recommended for selected patients with pulmonary vessel obstruction
::*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).
::::* Note (2): Mediastinal fibrosis is characterized by invasive fibrosis that encases mediastinal or hilar nodes and that is defined by occlusion of central vessels and airways
:*Patients with allergies
::*Preferred regimen (1): [[Penicillin G]]
::*Preferred regimen (2): [[Erythromycin]]
::*Preferred regimen (3): [[Eifampin]]
::*Preferred regimen (4): [[Clindamycin]]


::* 1.3 '''Pericarditis:'''
===Pharyngitis, streptococcal===
:::* 1.3.1 '''Mild cases'''
*Pharyngitis <ref name="Thomas-2000">{{Cite journal  | last1 = Thomas | first1 = M. | last2 = Del Mar | first2 = C. | last3 = Glasziou | first3 = P. | title = How effective are treatments other than antibiotics for acute sore throat? | journal = Br J Gen Pract | volume = 50 | issue = 459 | pages = 817-20 | month = Oct | year = 2000 | doi =  | PMID = 11127175 }}</ref><ref name="Spinks-2013">{{Cite journal  | last1 = Spinks | first1 = A. | last2 = Glasziou | first2 = PP. | last3 = Del Mar | first3 = CB. | title = Antibiotics for sore throat. | journal = Cochrane Database Syst Rev | volume = 11 | issue =  | pages = CD000023 | month =  | year = 2013 | doi = 10.1002/14651858.CD000023.pub4 | PMID = 24190439 }}</ref>
::::* Preferred regimen: Nonsteroidal anti-inflammatory therapy
:*Acute
:::* 1.3.2 '''Patients with evidence of hemodynamic compromise or unremitting symptoms after several days of therapy with nonsteroidal anti-inflammatory therapy'''
::*Children:
::::* [[Prednisone]] (0.5–1.0 mg/kg qd [maximum, 80 mg qd] in tapering doses over 1–2 weeks)  
*Preferred regimen: [[Pencillin V]] PO 250 mg twice daily or 3 times daily 
:::* 1.3.3 '''If corticosteroids are administered'''
::*Adolescents and adults:
::::* Preferred regimen: [[Itraconazole]] (200 mg tid for 3 days and {{then}} qd or bid for 6–12 weeks)
*Preferred regimen (1): [[Pencillin V]] PO 250 mg 4 times daily or 500 mg twice daily for 10 days
::::* Note (1): Pericardial fluid removal is indicated for patients with hemodynamic compromise.
*Preferred regimen (2): [[Amoxicillin]] 50 mg/kg once daily (max = 1000 mg) alternate:25 mg/kg (max = 500 mg) twice daily for 10 days
::::* Note (2): Pericarditis occurs as a complication of inflammation in adjacent mediastinal lymph nodes in patients with acute pulmonary histoplasmosis.
*Preferred regimen (3): [[Penicillin G|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): [[Azithromycin]]PO 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


::* 1.4 '''Central nervous system histoplasmosis'''
===Sinusitis, Acute===
:::* Preferred regimen: Liposomal [[Amphotericin B]] (5.0 mg/kg qd for a total of 175 mg/kg given over 4–6 weeks) followed by [[Itraconazole]] (200 mg 2 or 3 times qd) for at least 1 year and until resolution of cerebro spinal fluid abnormalities including Histoplasma antigen levels.
*Sinusitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:::* Note: Blood levels of Itraconazole should be obtained to ensure adequate drug exposure


::* 1.5 '''Rheumatologic syndromes'''
*Sinusitis (Pediatrics)
:::* 1.5.1 '''Mild cases'''
:*Preferred Regimen (1): [[Amoxicillin]] 90 mg / kg / day PO divided q12h
::::* Preferred regimen: Nonsteroidal anti-inflammatory therapy
:*Preferred Regimen (2): [[Amoxicillin-clavulanate]] (extra strength) suspension, 90 mg / kg / day (based on Amox component), PO divided q12h for 10-14 days
:::* 1.5.2 '''Severe cases'''
::*If  non-type I hypersensitivity to penicillin :
::::* Preferred regimen: [[Prednisone]] (0.5–1.0 mg/kg qd [maximum, 80 mg qd] in tapering doses over 1–2 weeks)
:::*Preferred regimen (1): [[Cefuroxime axetil]] 30 mg / kg / day PO divided q12h for 10-14 days
:::* 1.5.3 '''Corticosteroids administration'''
:::*Alternate Regimen (1): [[Cefdinir]] 14 mg / kg / day PO divided q12-24h, max of 600 mg / day for 10-14 days
::::* [[Itraconazole]] (200 mg 3 times tid for 3 days and {{then}} qd or bid for 6–12 weeks)
:::*Alternate Regimen (2): [[Cefpodoxime]] 10 mg / kg / day PO divided q12h for 10-14 days
::::* Note (1): If corticosteroids are used, concurrent itraconazole treatment is recommended to reduce the risk of progressive infection
*Sinusitis (Adults)
::::* Note (2): Bone or joint involvement is very rare in progressive disseminated histoplasmosis but it should not be overlooked.
:*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


::* 1.6 '''Progressive disseminated histoplasmosis'''
:*Alternate Regimen 
:::* 1.6.1 '''Moderately severe to severe disease'''
::::* Preferred regimen: Liposomal [[Amphotericin B]] (3.0 mg/kg qd) is recommended for 1–2 weeks followed by oral [[Itraconazole]] (200 mg 3 times qd for 3 days and {{then}} 200 mg bid for a total of at least 12 months)
::::* Note (1): Substitution of another lipid formulation at a dosage of 5.0 mg/kg qd may be preferred in some patients because of cost or tolerability
::::* Note (2): The deoxycholate formulation of Amphotericin B (0.7–1.0 mg/kg qd) is an alternative to a lipid formulation in patients who are at a low risk for nephrotoxicity
:::* 1.6.2 '''Immunosupressed patients'''
::::* Lifelong suppressive therapy with [[Itraconazole]] (200 mg qd)
:::* 1.6.3 '''Mild to moderate disease'''
::::* [[Itraconazole]] (200 mg tid for 3 days and then bid qid for at least 12 months)
::::* Note (1): Lifelong suppressive therapy with itraconazole (200 mg daily) may be required in immunosuppressed patients if immunosuppression cannot be reversed and in patients who relapse despite receipt of appropriate therapy
::::* Note (2): Blood levels of itraconazole should be obtained to ensure adequate drug exposure
::::* Note (3): Antigen levels should be measured during therapy and for 12 months after therapy is ended to monitor for relapse. Persistent low-level antigenuria may not be a reason to prolong treatment in patients who have completed appropriate therapy and have no evidence of active infection.
::::* Note (4): Progressive disseminated histoplasmosis is fatal without therapy and treatment with either Amphotericin B or Itraconazole is highly effective. Among patients with AIDS and moderately severe to severe disseminated histoplasmosis, the rate of response was higher (88% vs. 64%) and the mortality rate was lower (2% vs. 13%) among recipients of liposomal amphotericin B (3 mg/kg qd for 1–2 weeks) than among recipients of the deoxycholate formulation.


::* 1.7 '''Prophylaxis recommended for immunosuppressed patients'''
::*If type 1 hypersensitivity to penicillin :
:::* Preferred regimen: [[Itraconazole]] (200 mg qd) in patients with HIV infection with CD4 cell counts <150 cells/mm3 in specific areas of endemicity where the incidence of histoplasmosis is >10 cases per 100 patient-years
:*Preferred regimen (1): [[Levofloxacin]] 750 mg PO once daily for 5-7 days
:::* Note: Prophylaxis with Itraconazole (200 mg qd) may be appropriate in specific circumstances in other immunosuppressed patients
:*Preferred regimen (2): [[Doxycycline]] 100 mg PO q12h for 5-7 days


::* 1.8 '''Performance Measures'''
::*If type 2 hypersensitivity to penicillin :
::::* Preferred regimen: [[Itraconazole]] is the preferred azole for initial therapy for patients with mild-to-moderate histoplasmosis and as step-down therapy after receipt of [[Amphotericin B]]
:*Preferred regimen (1): [[Cefdinir]] 600 mg / day divided q12h or q24h for 5-7 days
::::* Note: When other azole agents are used, the medical record should document the specific reasons that Itraconazole was not used and why other azoles were used.
:*Preferred regimen (2): [[Cefpodoxime]] 200 mg PO q12h for 5-7 days
::::* 14.1 '''Severe or moderately severe histoplasmosis'''
:*Preferred regimen (3): [[Cefuroxime axetil]] 500 mg PO q12h for 5-7 days
::::* Preferred regimen: [[Amphotericin B]]
::::* Note: When Amphotericin B is used the patient's electrolyte level renal function and blood cell count should be monitored several times per week and documented in the medical record.
::::* Note (2): Itraconazole drug levels should be measured during the first month in patients with disseminated or chronic pulmonary histoplasmosis and these levels should be documented in the medical record as well as the physician's response to levels that are too low.
::::* Note (3): Itraconazole should not be given to patients receiving contraindicated medications (i.e., pimozide, quinidine, dofetilide, lovastatin, simvastatin, midazolam, and triazolam). Reasons for deviation from this practice should be documented in the medical record.


===Sinusitis, Chronic===
*Sinusitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>


::* 2. '''Pregnancy treatment'''
*Sinusitis (Pediatrics)
::::* Preferred regimen: Lipid formulation [[Amphotericin B]] (3.0–5.0 mg/kg qd for 4–6 weeks) is recommended
:*Preferred Regimen:[[Amoxicillin-clavulanate]] 45 mg/kg per day q12h
::::* Prefered regimen low risk for nephrotoxicity: The deoxycholate formulation of [[Amphotericin B]] (0.7–1.0 mg/kg qd) is an alternative to a lipid formulation
:*If penicillin allergy and patient is MRSA positive
::::* Note (1): If the newborn shows evidence for infection, treatment is recommended with [[Amphotericin B]] deoxycholate (1.0 mg/kg daily for 4 weeks)
::*[[Clindamycin]] 20 to 40 mg/kg per day orally divided every 6 to 8 hours
::::* Note (2): Unique issues in pregnancy include the risk of teratogenic complications of azole therapy and of transplacental transmission of Histoplasma capsulatum to the fetus
:*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)


::* 3. '''Children treatment'''
===Sinusitis, post-intubation===
::::* 3.1 '''Acute pulmonary histoplasmosis'''
*Sinusitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::::* Treatment indications and regimens are similar to those for adults, except that [[Amphotericin B]] deoxycholate (1.0 mg/kg daily) is usually well tolerated and the lipid preparations are not preferred
:*Preferred regimen (1): [[Imipenem]] 0.5 gm IV q6h
::::* Note: [[Itraconazole dosage: 5.0–10.0 mg/kg daily in 2 divided doses (not to exceed 400 mg daily), generally using the solution formulation
:*Preferred regimen (2): [[Meropenem]] 1 gm IV q8h,  MRSA suggestive on Gram - stain then add [[Vancomycin]] 1 gm IV q12h
:*Alternate Regimen (1): [[Ceftazidime]] 2 gm IV q8h {{and}} [[Vancomycin]] 1 gm IV q12h)
:*Alternate Regimen (2): [[Cefepime]] 2 gm IV q12h {{and}} [[Vancomycin]] 1 gm IV q12h)


::::* '''Progressive disseminated histoplasmosis'''
===Sinusitis, treatment failure===
::::* Prefered regimen: [[Amphotericin B]] deoxycholate (1.0 mg/kg qd for 4–6 weeks)
*Sinusitis (Pediatrics)  <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::::* Alternative regimen: [[Amphotericin B]] deoxycholate (1.0 mg/kg qd for 2–4 weeks) followed by itraconazole (5.0–10.0 mg/kg qd in 2 divided doses) to complete 3 months of therapy.
:*If treatment failure then do a culture and treat accordingly or treatment in the absence of cultures and children failing [[Amoxicillin]]
::::* '''Immunosuppressed patients if immunosuppression cannot be reversed and patients in relapse despite appropiate therapy'''
::*[[Amoxicillin-clavulanate]] (extra strength) suspension 90 mg/kg/day (Amoxicllin component) PO divided q12h for 10-14 days.
::::: Preferred regimen: Lifelong suppressive therapy with [[Itraconazole]] (5.0 mg/kg qd up to 200 mg qd)
:*Treatment in the absence of cultures and children failing [[Amoxicillin-clavulanate]]
::::* Note (1): Longer therapy may be needed for patients with severe disease, immunosuppression, or primary immunodeficiency syndromes
::*[[Clindamycin]] 30-40 mg/kg/day divided q8h {{and}} third generation [[cephalosporin]] like [[Cefuroxime axetil]] 30 mg/kg/day PO divided q12h
::::* Note (2): Blood levels of itraconazole should be obtained to ensure adequate drug exposure
Preferred regimen (1): [[Cefdinir]] 14 mg/kg/day PO divided q12h or q24h
::::* Note (3): Antigen levels should be monitored during therapy and for 12 months after therapy is ended to monitor for relapse. Persistent low-level antigenuria may not be a reason to prolong treatment in patients who have completed appropriate therapy and have no evidence of active infection.
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): [[Moxifloxacin]]400 mg PO once daily


===Stomatitis, aphthous===
*Stomatitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*[[Topical steroids]] may decrease pain and swelling


***Evidence summary
===Stomatitis, herpetic===
*Stomatitis  <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*[[Acyclovir]] 15 mg/kg PO q5h For 7 days


===Submandibular space infection===
* '''Submandibular space infections including Ludwig angina'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
:* 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 <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*Preferred regimen:[[Penicillin V]] PO 10 days or if compliance unlikely, [[Benzathine penicillin]] IM single dose


:*Alternate regimen (1): [[Cephalosporins|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.<ref>{{Cite web | title =Managing Patients with Necrotizing Ulcerative Gingivitis
| url = http://www.jcda.ca/article/d46}}</ref>
*For any signs of systemic involvement, the recommended antibiotics are:
:*Preferred regimen: [[Amoxicillin]], 250 mg 3 x daily for 7 days {{withorwithout}} [[Metronidazole]], 250 mg 3 x daily for 7 days
===Vincent's angina===
*Vincent's angina  <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*Preferred treatment:[[Penicillin G]] 4 million units IV q4h
:*Alternate treatment: [[Clindamycin]] 600 mg IV q8h


==References==
{{reflist}}
{{reflist}}

Latest revision as of 18:00, 30 July 2015

Epiglottitis

  • Epiglottitis [1]
  • Pediatrics
  • Adults

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

  • 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

Pharyngitis, streptococcal

  • 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 (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 (Pediatrics)
  • Clindamycin 20 to 40 mg/kg per day orally divided every 6 to 8 hours
  • If anaerobes are involved
  • Sinusitis (Adults)

Sinusitis, post-intubation

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.

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, herpetic

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

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:

Vincent's angina

  • Vincent's angina [22]
  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.
  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.
  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.
  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.
  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.
  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)
  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.
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