AAO Antimicrobial REMAKE - American Academy of Otolaryngology-Head and ...

Antimicrobial Therapy

Pocket Guide to

Otolaryngology¡ª

Head and Neck Surgery

in

13th Edition

DAVID N.F. FAIRBANKS, M.D.

The American Academy of Otolaryngology¡ª

Head and Neck Surgery Foundation

EMPIRIC DRUG CHOICES FOR COMMON INFECTIONS OF THE EARS, NOSE, THROAT,

HEAD AND NECK (see page 26 ff for microbiology, rationale, and more options)

OTOLOGY (page 26 ff)

Primary Choice

Acute otitis media

high dose amoxicillin

(See pages 26-27, 46-48)

+/- clavulanate

Acute mastoiditis

vancomycin + ceftriaxone

Chr suppurative otitis media

ciprofloxacin otic

Acute otitis externa (ototopicals p. 55) alcohol/acid

Otomycosis (ototopicals p. 55)

alcohol/acid

Necrotizing otitis externa (p. 30)

ciprofloxacin otic/IV plus:

meropenem or ceftazidime

RHINOLOGY (page 30 ff)

Acute rhinosinusitis

Orbital/CNS extended (p. 32)

Chr rhinosinusitis

Pseudomonal

Fungal

Some Alternatives

ceftriaxone, resp quinolones

cefpodoxime or cefdinir

resp quinolones, etc. (p. 28)

ofloxacin otic, etc. (p. 28)

neo/polymyx, ciproflox, etc.

ketoconazole, etc. (p. 30)

piperacillin/tazobactam plus

gentamicin, etc.

high dose amoxicillin

levofloxacin, moxifloxacin

+/- clavulanate

cefpodoxime, etc.

ceftriaxone IV, or resp quinolone IV, or vancomycin + rifampin

amox/clav or clindamycin

ceph + metronidazole

ciprofloxacin or levofloxacin

topicals: ceftazidime,

gentamicin, etc. (p. 33)

voriconazole

itraconazole (pp. 22, 33)

PHARYNX, HEAD, NECK (p. 34 ff)

Tonsillo-adenoiditis

1st/2nd gen ceph +/- metronidazole, clindamycin, amox/clav

Acute pharyngitis (p. 36)

erythro-clarithromycin, penicillin, amox, 1st/2nd gen cephs

Diphtheria (p. 37)

erythromycin, or clindamycin, or penicillin (all plus antitoxin)

Necrotizing stomatitis (p. 37)

clindamycin, or amox/clav, or ampi/sulbac, or penicillin +

metronidazole

Aphthous stomatitis and herpangina (canker-sore mixture p. 38)

Thrush (fungal stomatitis) (p. 38)

topicals: nystatin or clotrimazole or fluconazole

Tracheobronchitis, subacute (p. 39) erythromycins, doxycycline, resp quinolones

Epiglottitis, acute (p. 39)

ceftriaxone IV, ampicillin/sulbactam IV, resp quinolone IV

Croup (p. 40)

ampicillin/sulbactam IV, ceftriaxone IV

Deep neck abscess (p. 40)

clindamycin or linezolid/vancomycin + metronidazole

Necrotizing fasciitis (p. 41)

clindamycin or meropenem + vancomycin +/- metronidazole

Sialadenitis (p. 41)

amox/clav or clindamycin or 1st gen ceph +/- metronidazole

For other infections, see pages 42-45.

For choices according to bacteria, see pages 81-85.

Abbreviations: amox/clav = amoxicillin/clavulanate (Augmentin, Augmentin ES, Augmentin XR)

Ampi/sulbac = ampicillin/sulbactam (Unasyn)

1st gen ceph = cephalexin (Keflex), cefazolin (Ancef, Kefzol), etc.

2nd gen/equiv ceph = cefuroxime (Ceftin), cefpodoxime (Vantin), cefdinir (Omnicef), etc.

Resp quinolones = levofloxacin (Levaquin), moxifloxacin (Avelox)

Pocket Guide to

ANTIMICROBIAL THERAPY

in

OTOLARYNGOLOGY--

HEAD AND NECK SURGERY

DAVID N.F. FAIRBANKS, M.D.

Clinical Professor of Otolaryngology

George Washington University

School of Medicine and Health Sciences

Published and Distributed by

American Academy of Otolaryngology-Head & Neck Surgery Foundation, Inc.

One Prince Street

Alexandria, VA 22314-3357, U.S.A.



Thirteenth Edition

Copyright ? 2007

American Academy of Otolaryngology--Head and Neck Surgery Foundation, Inc.

PREFACE

Of the historical events that have shaped the character of the specialty dealing with ear, nose, throat, head,

and neck disorders, probably none has carried the impact as did the appearance of antimicrobial agents for

clinical use. It is a story that continues to unfold even today with the appearance of new antibiotics every

year and the continuing emergence of new strains of resistant bacteria. Such change gives our knowledge

a short half-life, and perhaps in no other clinical discipline is reeducation as important as in the use of

antimicrobials.

One-fourth of all Americans who seek medical care do so because of an infectious disease, and over 150

million courses of antibiotics are prescribed each year. The five symptoms most commonly treated are

cough, sore throat, fever, nasal congestion, and earache, which suggests that the physician who deals with

the upper respiratory tract must be especially current in his understanding of the uses and costs of

antimicrobials.

With the objectives of improvement in patient care, curtailment of unnecessary or inappropriate prescribing

(to lessen emergence of resistant bacteria), and containment of costs, this monograph is provided to the

profession by the American Academy of Otolaryngology--Head and Neck Surgery Foundation in

consultation with various of the Academy's Committees and members (especially Drs. Michael Benninger,

Berrylin J. Ferguson, James Hadley, Michael D. Poole). Geraldine Hahn Ely has edited, prepared, and

maintained the manuscripts of this monograph.

This publication is offered as a concise, practical guide to the practicing physician dealing with the usual

or average patient. No recommendations for antimicrobial therapy can be absolute, and the good clinician

will modify them according to special circumstances in his patient or community. The recommendations

contained herein are not to be considered as any official position of the Academy, but, rather, the opinions

of the author, the members of the committees, and other consultants at the time of publication; they are

subject to change as new developments occur. It is anticipated that this guide will be revised and updated

biennially. (It is now in its thirteenth edition with more than 1.25 million copies printed since 1981.)

David N.F. Fairbanks, M.D.

Clinical Professor of Otolaryngology, George Washington University School

of Medicine and Health Sciences

Washington, D.C.

April 2005

Appreciation is offered to my wife, Sylvia, whose patience and understanding are exercised at the writing

of each revision.

TABLE OF CONTENTS

Section

Page

1. OVERVIEW OF ANTIMICROBIALS BY CATEGORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Penicillins (Beta Lactams) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Penicillin G and V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Antistaphylococcal (Penicillinase Resistant) Penicillins . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Amino-Penicillins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Augmented Amino-Penicillins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Antipseudomonas Penicillins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Cephalosporins (Beta Lactams) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Other Beta Lactam Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Macrolides - Ketolides - Azalides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Erythromycin/clarithromycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Telithromycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Azithromycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Clindamycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Tetracyclines & Tigecycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Chloramphenicol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Aminoglycosides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Quinolones (Fluoroquinolones) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Vancomycin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Daptomycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Linezolid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Metronidazole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Rifampin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Mupirocin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Sulfonamides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Antifungals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Antivirals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

II.

MICROBIOLOGY AND DRUG SELECTIONS FOR TREATMENT OF

INFECTIONS IN THE EAR, NOSE, THROAT, HEAD, AND NECK. . . . . . . . . . . . . . . . . . 26

EARS and RELATED STRUCTURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Acute Otitis Media and Bullous Myringitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Otitis Media with Effusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Acute Mastoiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Chronic Suppurative Oto-mastoiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Otitis Externa, Acute, Chronic, "Malignant" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Otomycosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

NOSE, SINUSES, and RELATED STRUCTURES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Acute Rhinosinusitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Acute Orbital Cellulitis/Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Chronic Rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Nosocomial Rhinosinusitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Chronic Rhino-Naso-Pharyngitis (carrier state). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

PHARYNX, LARYNX, and AERODIGESTIVE TRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Tonsillo-Adenoiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Pharyngitis: strep., gonococcal, diphtherial, etc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Stomatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

iii

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