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نموذج تعليمات المضادات الحيوية (أطفال
نموذج تعليمات المضادات الحيوية (أطفال
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Infectious Diseases
Society of
America guidelines.
2
Acute otitis -AOM is the most Definitive diagnosis -Mild cases with unilateral
common childhood requires either symptoms in children 6-23
media infection for which months of age or unilateral
antibiotics are -Moderate or severe or bilateral symptoms in
(AOM) 3-5
prescribed. bulging of tympanic children >2 years may be
membrane (TM) or new appropriate for watchful
-4-10% of children onset otorrhea not due to waiting based on shared
with AOM treated otitis externa. decision-making.
with antibiotics
experience adverse -Mild bulging of the TM -Amoxicillin remains first line
effects.
4 AND recent (<48h) onset therapy for children who
of otalgia (holding,
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-For further
recommendations on
alternative antibiotic
regimens, consult the
American Academy of
Pediatrics guidelines. 3
Pharyngitis 4, 6
-Recent guidelines -Clinical features alone do -Amoxicillin and penicillin V
aim to minimize not distinguish between remain first-line therapy.
unnecessary GAS and viral pharyngitis.
antibiotic exposure -For children with a non-
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by emphasizing
appropriate use of -Children with sore throat type I hypersensitivity to
rapid antigen plus 2 or more of the penicillin: cephalexin,
detection test following features should cefadroxil, clindamycin,
(RADT) testing and undergo a RADT test: clarithromycin, or
subsequent azithromycin are
-absence of cough recommended.
treatment .
-presence of tonsillar -For children with an
-During the winter
exudates or swelling immediate type I
and spring, up to
20% of hypersensitivity to penicillin:
-history of fever
asymptomatic clindamycin, clarithyomycin,
children can be or azithroymycin are
-presence of swollen and
colonized with recommended.
tender anterior cervical
group A beta- lymph nodes
-Recommended treatment
hemolytic
course for all oral beta
streptococci (GAS), -age < 15 years
lactams is 10 days.
leading to more
false positives from -Testing should generally
RADT-testing and not be performed in
increases in children < 3 years in
unnecessary whom GAS rarely causes
antibiotic exposure. pharyngitis and
rheumatic fever is
-Streptococcal uncommon.
pharyngitis is
primarily a disease -In children and
of children 5-15 adolescents, negative
years old and is rare RADT tests should be
in children < 3 years. backed up by a throat
culture; positive RADTs
do not require a back-up
culture.
Common -The course of most -Viral URIs are often -Management of the
uncomplicated viral characterized by nasal common cold, nonspecific
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cold or non- URIs is 5-7days. discharge and congestion URI, and acute cough illness
Colds usually last or cough. Usually nasal should focus on
specific around 10 days. discharge begins as clear symptomatic relief.
and changes throughout Antibiotics should not be
upper -At least 200 viruses the course of the illness. prescribed for these
can cause the conditions.
respiratory common cold. -Fever, if present, occurs
early in the illness. -There is potential for harm
tract and no proven benefit from
over-the-counter cough and
infection cold medications in children
< 6 years. These substances
(URI) 4,7 are among the top 20
substances leading to death
in children <5 years.
-Low-dose inhaled
corticosteroids and oral
prednisolone do not
improve outcomes in
children without asthma.
Bronchiolitis 8
ronchiolitis is Bronchiolitis occurs Usually patients
the most in children<24 worsen between 3-5
common months and is days, followed by
lower characterized by improvement.
respiratory rhinorrhea, cough, Antibiotics are not
tract infection wheezing, helpful and should not
in infants. tachypnea, and/ or be used.
It is most increased Nasal suctioning is
often caused respiratory effort. mainstay of therapy.
by respiratory Routine laboratory Neither albuterol nor
syncytial virus tests and radiologic nebulized racemic
but can be studies are not epinephrine should be
caused by recommended, but administered to
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Urinary tract -UTIs are common in -fever and or strong- -intial antibiotic
children, affecting smelling urine are treatment should be
infections 8% of girls and 2% common. based on local
of boys by age 7. antimicrobial
(UTIs) 8, 9 -In school-aged children, susceptibility patterns.
-The most common dysuria, frequency, or
causative pathogen urgency are common. -Suggested agents
is E. coli, accounting include
for approximately -A definitive diagnosis TMP/SMX,amoxicillin/
85% of cases. requires both a urinalysis clavulanate,cefixime,
suggestive of infection or cephalexin in
and at least 50,000 children 2- 24 months.
CFUs/mL of a single
uropathogen from urine -Duration of therapy
obtained through should be 7 – 14 days.
catheterization or
suprapubic aspiration -Antibiotic treatment
(NOT urine collected in a of asymptomatic
bag) for children 2–24 bacteriuria in children
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References
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