Eye, Ears, Nose, Throat

Conjunctivitis

Common Pathogen(s)
Usually viruses; Chlamydia

Antibiotic - 1st line Chloramphenicol 0.5% eye drops 2-hourly until infection controlled, then 6 hourly until 48 hours after healing. Chlamydia: Doxycycline 100mg q12h PO for 7- 10 days.

Comment
Viral, Chlamydia, and bacterial swabs are required

 

Periorbital Cellulitis - preseptal

Antibiotic - 1st line Co-amoxiclav (consider C difficile risk) 1.2g q8h IV or Piperacillin-tazobactam 4.5g q8h IV if risk factors for C. difficile MRSA colonised, add in Vancomycin IV (dosed as per trust vancomycin guideline)

Comment
Orbital cellulitis is a medical emergency  requiring Ophtho/ Micro input immediately.

 

Acute otitis media

Common Pathogen(s)
Strep pneumoniae;
H influenzae.

Antibiotic - 1st line Amoxicillin 500mg q8h PO for 5 days.

2nd Line Clarithromycin 500mg q12h PO for 5 days

Comment
If mastoiditis, discuss with Microbiologist/ ENT during work hours.

 

Otitis externa

Common Pathogen(s)
Polymicrobial colonisation.

Antibiotic - 1st line Antibiotics not usually required.

Comment
If malignant otitis externa suspected, discuss with ENT consultant.

 

Severe Throat infections / Quinsy

Common Pathogen(s)
Strep. Pyogenes.

Antibiotic - 1st line Phenoxymethyl penicillin 500mg q6h PO and metronidazole 400mg PO q8h or Benzylpenicillin 1.2g IV 6 hourly if NBM and metronidazole 500mg IV q8h if severe, replace metronidazole with add Clindamycin 600mg q6h IV.

Penicillin allergy Clindamycin IV 600mg q6h

Comment
If Fusobacterium necroforum (Lemierre's disease) or oesophageal perforation suspected, discuss with microbiologist

 

Sinusitis– acute

Duration 7 days

Common Pathogen(s)
Commonly - Rhinovirus and other viruses
S. pneumoniae  ; Haemophilus influenzae 
Less common pathogens include: M. catarrhalis, S. aureus and anaerobes; fungi are rare pathogens for acute infection.

Antibiotic - 1st line Amoxicillin  500mg q8h PO

Antibiotic – 2nd line Doxycycline 100mg q 12h PO Or Clarithromycin 500mg q 12h PO

Comment
Antibacterial should usually be used only for persistent symptoms and purulent discharge lasting at least 7 days or if severe symptoms. Also, consider antibacterial for those at high risk of serious complications (e.g. in immunosuppression, cystic fibrosis).

 

Dental Abscess

Duration 5 days

Antibiotic - 1st line Amoxicillin  500mg q8h PO

Antibiotic – 2nd line Metronidazole 400mg q8h PO

Antibacterial required only in severe disease with cellulitis or if systemic features of infection