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A 12 year-old girl has 6 day h/0 of progressive cough and greenish nasal discharge. She recollects body aches , LGF approximately a weeks before the current symptoms. She also reports fever and chills, moderate headache (worse with leaning forward). She has no significant past medical history.Her temperature is 102.3 F, blood pressure is 128/74 mm Hg, pulse is 113/min, and respirations are 12/min. Physical examination shows significant tenderness over the right maxillary sinus. The remainder of her physical examination is normal. Which of the following is the most appropriate MX strategy?
A. Amox- clavulanate
B. levofloxacin
C.Amoxicillin
E. cefpodoxime
D. sinus CT
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High or Low dose ?
When do we use High dose ?
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not mentioned in mtb though
but i thought starting with low dose first, and re-evaluate after 3 days, if not response, change to another antibiotic
Indications for using high dose from beginning:
-Exposure to antibiotics within 30 d;
-Recent treatment failure;
->30% prevalence of penicillin-resistant S. pneumoniae
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Pls correct me if I'm wrong
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IDSA 2012 guidelines
High-dose’’ (2 g orally twice daily or 90 mg/kg/day orally twice daily) amoxicillin-clavulanate
is recommended for children and adults with ABRS
Geographic regions with high endemic rates (10%) of invasive penicillin-nonsusceptible S. pneumoniae,
those with severe infection (eg, evidence of systemic toxicity with fever of 39C[102F] or higher, and threat of suppurative complications)
attendance at daycare,
age less than 2 or > 65 years,
recent hospitalization,
antibiotic use within the past month
who are immunocompromised
