Medicine an Surgery notes

Apr 24th, 2015
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Case #1An 8-year-old boy is seen in Februarybecause of fever, headache, sorethroat, and malaise. Hes had norhinorrhea, cough, or hoarseness.Physical examination reveals atemperature of 103.5, exudativepharyngitis, and tender cervicaladenopathy.How will you treat him?Is penicillin still the drug of choice fortreatment of streptococcal pharygitis? AAP recommends oral penicillin V 23 times daily for 10 days, a singledose of benzathine penicillin, oramoxicillin 250 mg/kg tid for 10days Larger doses of penicillin once dailyresult in more relapses**Breese, 1965, Gerber, 1989Once daily dosing? Recommended by the FDA:azithromycin (Zithromax)cefixime (Suprax)cefdinir (Omnicef)cefadroxil (Ultracef, Duracef)ceftibutin (Cedax) Amoxicillin (750 mg once daily)**Feder, Pediatrics, 1999Shorter courses? Approved by the FDA for 5-dayregimen: cefpodoxime (Vantin) cefdinir (Omnicef) azithromycin (Zithromax)What about the penicillinallergic child? Erythromycin estolate (20-40mg/kg/d divided bid) orethylsuccinate (40 mg/kg/d dividedbid) Azithromycin (12 mg/kg/d x 5 d),clarithromycin (15 mg/kg/d div q 12hrs), clindamycin (20 mg/kg/d div q6-8 hrs)Why penicillin might fail Non-adherance to prescribedtherapy failure to recognize carriers ? beta-lactamase production byother pharyngeal flora new streptococcal infectionCase #2A 13-year-old boy has had fever and sorethro

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