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Respiratory diseases
C h ild ren ≥ 4 0 kg and ad ults: 1 5 0 0 to 2 0 0 0 m g / d ay d epend ing on th e 2
form ulation
av ailable:
R atio 8 :1 : 2 0 0 0 m g / d ay = 2 tablets of 5 0 0 / 6 2 .5 m g 2 tim es per d ay
R atio 7 :1 : 1 7 5 0 m g / d ay = 1 tablet of 8 7 5 / 1 2 5 m g 2 tim es per d ay
R atio 4 :1 : 1 5 0 0 m g / d ay = 1 tablet of 5 0 0 / 1 2 5 m g 3 tim es per d ay
N ote: th e d ose of clav ulanic acid sh ould not exceed 3 7 5 m g / d ay.
P ersistence of a ear d rainag e alone, w ith out fev er and pain, in a ch ild w h o h as
oth erw ise im prov ed (red uction in system ic sym ptom s and local inflam m ation) d oes
not w arrant a ch ang e in antibiotic th erapy. C lean ear canal by g entle d ry m opping
until no m ore d rainag e is obtained .
• A zith rom ycin or eryth rom ycin sh ould be reserv ed for v ery rare penicillin-allerg ic
apzaitthiernomtsy, cains PtreOatm ent failure (resistance to m acrolid es) is frequent.
eCrythhrioldmryecninoPv eOr 6 m onth s: 1 0 m g / kg once d aily for 3 d ays
3 0 to 5 0 m g / kg / d ay in 2 to 3 d iv id ed d oses for 1 0 d ays
Chronic suppurative otitis media (CSOM)
C h ronic bacterial infection of th e m id d le ear w ith persistent purulent d isch arg e th roug h
a perforated tym panic m em brane.
T h e principal causativ e org anism s are Pseudomonas aeruginosa, Proteus spp,
staph ylococcus, oth er G ram neg ativ es and anaerobes.
Clinical features
– P urulent d isch arg e for m ore th an 2 w eeks, often associated w ith h earing loss or ev en
d eafness; absence of pain and fev er
– O toscopy: perforation of th e tym panic m em brane and purulent exud ate
– C om plications:
• C onsid er a superinfection (A O M ) in th e case of new onset of fev er w ith ear pain,
and treat accord ing ly.
• C onsid er m astoid itis in th e case of new onset of h ig h fev er, sev ere ear pain and / or
tend er sw elling beh ind th e ear, in a patient w h o appears sig nificantly unw ell.
• C onsid er brain abscess or m ening itis in th e case of im paired consciousness, neck
stiffness and focal neurolog ical sig ns (e.g . facial nerv e paralysis).
Treatment
– R em ov e secretions from th e aud itory canal by g entle d ry m opping (use a d ry cotton
bud or a sm all piece of d ry cotton w ool) th en apply ciprofloxacin (ear d rops): 2 d rops
tw ice d aily, until no m ore d rainag e is obtained (m ax. 4 w eeks).
– C om plications:
• C h ronic m astoid itis is a m ed ical em erg ency th at requires prom pt h ospitalisation,
prolong ed antibiotic treatm ent th at cov ers th e causativ e org anism s of C SO M
(ceftriaxone IM 1 0 d ays + ciprofloxacin P O for 1 4 d ays), atraum atic cleaning of th e ear
canal; surg ical treatm ent m ay be required . B efore transfer to h ospital, if th e patient
need s to be transferred , ad m inister th e first d ose of antibiotics.
• M ening itis: see pag e 1 6 5 .
59
C h ild ren ≥ 4 0 kg and ad ults: 1 5 0 0 to 2 0 0 0 m g / d ay d epend ing on th e 2
form ulation
av ailable:
R atio 8 :1 : 2 0 0 0 m g / d ay = 2 tablets of 5 0 0 / 6 2 .5 m g 2 tim es per d ay
R atio 7 :1 : 1 7 5 0 m g / d ay = 1 tablet of 8 7 5 / 1 2 5 m g 2 tim es per d ay
R atio 4 :1 : 1 5 0 0 m g / d ay = 1 tablet of 5 0 0 / 1 2 5 m g 3 tim es per d ay
N ote: th e d ose of clav ulanic acid sh ould not exceed 3 7 5 m g / d ay.
P ersistence of a ear d rainag e alone, w ith out fev er and pain, in a ch ild w h o h as
oth erw ise im prov ed (red uction in system ic sym ptom s and local inflam m ation) d oes
not w arrant a ch ang e in antibiotic th erapy. C lean ear canal by g entle d ry m opping
until no m ore d rainag e is obtained .
• A zith rom ycin or eryth rom ycin sh ould be reserv ed for v ery rare penicillin-allerg ic
apzaitthiernomtsy, cains PtreOatm ent failure (resistance to m acrolid es) is frequent.
eCrythhrioldmryecninoPv eOr 6 m onth s: 1 0 m g / kg once d aily for 3 d ays
3 0 to 5 0 m g / kg / d ay in 2 to 3 d iv id ed d oses for 1 0 d ays
Chronic suppurative otitis media (CSOM)
C h ronic bacterial infection of th e m id d le ear w ith persistent purulent d isch arg e th roug h
a perforated tym panic m em brane.
T h e principal causativ e org anism s are Pseudomonas aeruginosa, Proteus spp,
staph ylococcus, oth er G ram neg ativ es and anaerobes.
Clinical features
– P urulent d isch arg e for m ore th an 2 w eeks, often associated w ith h earing loss or ev en
d eafness; absence of pain and fev er
– O toscopy: perforation of th e tym panic m em brane and purulent exud ate
– C om plications:
• C onsid er a superinfection (A O M ) in th e case of new onset of fev er w ith ear pain,
and treat accord ing ly.
• C onsid er m astoid itis in th e case of new onset of h ig h fev er, sev ere ear pain and / or
tend er sw elling beh ind th e ear, in a patient w h o appears sig nificantly unw ell.
• C onsid er brain abscess or m ening itis in th e case of im paired consciousness, neck
stiffness and focal neurolog ical sig ns (e.g . facial nerv e paralysis).
Treatment
– R em ov e secretions from th e aud itory canal by g entle d ry m opping (use a d ry cotton
bud or a sm all piece of d ry cotton w ool) th en apply ciprofloxacin (ear d rops): 2 d rops
tw ice d aily, until no m ore d rainag e is obtained (m ax. 4 w eeks).
– C om plications:
• C h ronic m astoid itis is a m ed ical em erg ency th at requires prom pt h ospitalisation,
prolong ed antibiotic treatm ent th at cov ers th e causativ e org anism s of C SO M
(ceftriaxone IM 1 0 d ays + ciprofloxacin P O for 1 4 d ays), atraum atic cleaning of th e ear
canal; surg ical treatm ent m ay be required . B efore transfer to h ospital, if th e patient
need s to be transferred , ad m inister th e first d ose of antibiotics.
• M ening itis: see pag e 1 6 5 .
59
