Sandbox ID Upper Respiratory Tract

# Epiglottitis
- Epiglottitis 
- Pediatrics
- Preferred regimen (1): Cefotaxime 50 mg/kg IV q8h
- Preferred regimen (2): Ceftriaxone 5075 mg/kg/day IV q1224h AND Vancomycin 10 mg/kg IV q6h
- Alternate regimen (1): Levofloxacin 500 mg IV q24h (or 8 mg/kg IV q12h) AND Clindamycin 2040 mg/kg/day IV q68h
- Adults
- Preferred regimen (1): Cefotaxime 2 g IV q48h
- Preferred regimen (2): Ceftriaxone 12 g/day IV q1224h AND Vancomycin 2 g/day IV q612h
- Alternate regimen (1): Levofloxacin 750 mg IV q24h AND Clindamycin 6001200 mg IV q612h

# Jugular vein phlebitis
- Septic jugular thrombophlebitis (Lemierre's syndrome)
- Causative pathogens
- Fusobacterium
- Viridans and other streptococci
- Staphylococcus
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host) (1): Penicillin G 24 MU IV q46h
- Preferred regimen (immunocompetent host) (2): Metronidazole 0.5 g IV q6h)
- Preferred regimen (immunocompetent host) (3): Ampicillin-Sulbactam 2 g IV q4h
- Preferred regimen (immunocompetent host) (4): Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
- Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
- Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
- Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host) (5): Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host) (6): Gatifloxacin 400 mg IV q24h

# Laryngitis
- Antibiotic use is not associated with significant improvement of objective symptoms and is not indicated in the treatment of acute laryngitis.

# Lemierre's syndrome
- Septic jugular thrombophlebitis (Lemierre's syndrome)
- Causative pathogens
- Fusobacterium
- Viridans and other streptococci
- Staphylococcus
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host) (1): (Penicillin G 24 MU IV q46h AND Metronidazole 0.5 g IV q6h)
- Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
- Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
- Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
- Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
- Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host) (5): Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host) (6): Gatifloxacin 400 mg IV q24h

# Ludwig's angina
- Ludwig's angina
- Causative pathogens
- Viridans and other streptococci
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host) (1): (Penicillin G 24 MU IV q46h AND Tobramycin 2 mg/kg IV q8h)
- Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
- Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
- Preferred regimen (immunocompetent host) (4): Doxycycline 200 mg IV q12h
- Preferred regimen (immunocompetent host) (5): Cefoxitin 2 g IV q6h
- Preferred regimen (immunocompetent host) (6): Cefotetan 2 g IV q12h
- Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
- Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
- Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
- Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host) (5): Meropenem 1 g IV q8h
- Preferred regimen (immunocomppromised host) (6): Gatifloxacin 200 mg IV q24h

# Parapharyngeal space infection
- Parapharyngeal space infection
- Causative pathogens
- Viridans and other streptococci
- Staphylococcus
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host) (1): (Penicillin G 24 MU IV q46h AND Metronidazole 0.5 g IV q6h)
- Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
- Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
- Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
- Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
- Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host) (5): Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host) (6): Gatifloxacin 400 mg IV q24h

# Pharyngitis, diphtheria
- Diphtheria
- The CDC recommends either:
- Preferred regimen (1): Erythromycin (PO or by IV) for 14 days (40 mg/kg per day with a maximum of 2 g/d)
- Preferred regimen (2): Procaine penicillin G given IM for 14 days (300,000 U/d for patients weighing 10 kg).
- Patients with allergies
- Preferred regimen (1): Penicillin G
- Preferred regimen (2): Erythromycin
- Preferred regimen (3): Eifampin
- Preferred regimen (4): Clindamycin

# Pharyngitis, streptococcal
- Pharyngitis 
- Acute
- Children:
- Preferred regimen: Pencillin V PO 250 mg twice daily or 3 times daily
- Adolescents and adults:
- Preferred regimen (1): Pencillin V PO 250 mg 4 times daily or 500 mg twice daily for 10 days
- Preferred regimen (2): Amoxicillin 50 mg/kg once daily (max = 1000 mg) alternate:25 mg/kg (max = 500 mg) twice daily for 10 days
- Preferred regimen (3): Benzathine Penicillin G I.M 27 kg: 600 000 U; 27 kg: 1 200 000 U 1 dose only
- Preferred regimen (4): Cephalexin PO 20 mg/kg/dose twice daily (max = 500 mg/dose)for 10 days
- Alternate regimen (1): Cefadroxil PO 30 mg/kg OD (max = 1 g) for 10 days
- Alternate regimen (2): Clindamycin PO 7 mg/kg/dose 3 times daily (max = 300 mg/dose) for 10 days
- Alternate regimen (3): AzithromycinPO 12 mg/kg once daily (max = 500 mg) for 5 days
- Alternate regimen (4): Clarithromycin PO 7.5 mg/kg/dose twice daily (max = 250 mg/dose) for 10 days
- Chronic
- Preferred regimen (1): Clindamycin 2030 mg/kg/d in 3 doses (max = 300 mg/dose) for 10 days
- Preferred regimen (2): Penicillin AND Rifampin; Penicillin V: 50 mg/kg/d in 4 doses  10 d (max = 2000 mg/d) ;rifampin: 20 mg/kg/d in 1 dose  last 4 d of treatment (max = 600 mg/d) for 10 days AND Amoxicillinclavulanate 40 mg amoxicillin/kg/d in 3 doses (max = 2000 mg amoxicillin/d) for 10 days
- Preferred regimen (3): Benzathine penicillin G IM 600 000 U for <27 kg and 1 200 000 U for 27 kg single dose AND Rifampin PO 20 mg/kg/d in 2 doses (max = 600 mg/d) for 4 days

# Sinusitis, Acute
- Sinusitis 
- Sinusitis (Pediatrics)
- Preferred Regimen (1): Amoxicillin 90 mg / kg / day PO divided q12h
- Preferred Regimen (2): Amoxicillin-clavulanate (extra strength) suspension, 90 mg / kg / day (based on Amox component), PO divided q12h for 10-14 days
- If  non-type I hypersensitivity to penicillin :
- Preferred regimen (1): Cefuroxime axetil 30 mg / kg / day PO divided q12h for 10-14 days
- Alternate Regimen (1): Cefdinir 14 mg / kg / day PO divided q12-24h, max of 600 mg / day for 10-14 days
- Alternate Regimen (2):  Cefpodoxime 10 mg / kg / day PO divided q12h for 10-14 days
- Sinusitis (Adults)
- Preferred Regimen (1): Amoxicillin 250-500 mg  q8h or 500-875 mg q12h or extended-release tablet 775 mg once daily
- Preferred Regimen (2): Amoxicillin-clavulanate (extended release tabs) 1000 / 62.5 mg 2 tabs or 2000/125 mg 1 tab, PO q12h for 5-7 days
- Alternate Regimen
- If type 1 hypersensitivity to penicillin :
- Preferred regimen (1): Levofloxacin 750 mg PO once daily for 5-7 days
- Preferred regimen (2): Doxycycline 100 mg PO q12h for 5-7 days
- If type 2 hypersensitivity to penicillin :
- Preferred regimen (1): Cefdinir 600 mg / day divided q12h or q24h for 5-7 days
- Preferred regimen (2): Cefpodoxime 200 mg PO q12h for 5-7 days
- Preferred regimen (3): Cefuroxime axetil 500 mg PO q12h for 5-7 days

# Sinusitis, Chronic
- Sinusitis 
- Sinusitis (Pediatrics)
- Preferred Regimen:Amoxicillin-clavulanate 45 mg/kg per day q12h
- If penicillin allergy and patient is MRSA positive
- Clindamycin 20 to 40 mg/kg per day orally divided every 6 to 8 hours
- If anaerobes are involved
- Metronidazole PLUS one of the following: cefuroxime axetil, cefdinir, cefpodoxime proxetil,azithromycin, clarithromycin, or trimethoprim-sulfamethoxazole (TMP-SMX)
- Sinusitis (Adults)
- Preferred regimen (1): Amoxicillin-clavulanate 500 mg three times daily
- Preferred regimen (2): Amoxicillin-clavulanate 875 mg twice daily
- Preferred regimen (3): Amoxicillin-clavulanate two 1000 mg extended-release tablets twice daily)
- If penicillin allergy and patient is MRSA positive
- Preferred regimen (1): Clindamycin 300 mg four times daily or 450 mg three times daily)
- If anaerobes are involved
- Preferred regimen (1):Metronidazole AND one of the following: cefuroxime axetil, cefdinir, cefpodoxime proxetil, levofloxacin , azithromycin, clarithromycin
- Preferred regimen (2): trimethoprim-sulfamethoxazole (TMP-SMX)
- Alternate regimen: Moxifloxacin (400 mg once daily)

# Sinusitis, post-intubation
- Sinusitis 
- Preferred regimen (1): Imipenem 0.5 gm IV q6h
- Preferred regimen (2): Meropenem 1 gm IV q8h,  MRSA suggestive on Gram - stain then add Vancomycin 1 gm IV q12h
- Alternative Regimen (1): Ceftazidime 2 gm IV q8h AND Vancomycin 1 gm IV q12h)
- Alternative Regimen (2): Cefepime 2 gm IV q12h AND Vancomycin 1 gm IV q12h)

# Sinusitis, treatment failure
- Sinusitis (Pediatrics)  
- If treatment failure then do a culture and treat accordingly or treatment in the absence of cultures and children failing Amoxicillin
- Amoxicillin-clavulanate (extra strength) suspension 90 mg/kg/day (Amoxicllin component) PO divided q12h for 10-14 days.
- Treatment in the absence of cultures and children failing Amoxicillin-clavulanate
- Clindamycin 30-40 mg/kg/day divided q8h AND third generation cephalosporin like Cefuroxime axetil 30 mg/kg/day PO divided q12h
Preferred regimen (1):  Cefdinir 14 mg/kg/day PO divided q12h or q24h 
Preferred regimen (2):Cefpodoxime 10 mg/kg/day PO divided q12h
- Sinusitis (Adults)
- If failure of treatment  even after 7 days of diagnosis
Preferred regimen (1): Amoxicillin-clavulanate 4g per day of amoxicillin equivalent
Preferred regimen (2): Levofloxacin 500 mg PO once daily
Preferred regimen (3): Moxifloxacin400 mg PO once daily

# Stomatitis, aphthous
- Stomatitis 
- Topical steroids may decrease pain and swelling

# Stomatitis, herpetic
- Stomatitis  
- Acyclovir 15 mg/kg PO q5h For 7 days

# Submandibular space infection
- Submandibular space infections including Ludwig angina
- Causative pathogens
- Viridans and other streptococci
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host) (1): Penicillin G 24 MU IV q46h AND Tobramycin 2 mg/kg IV q8h)
- Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
- Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
- Preferred regimen (immunocompetent host) (4): Doxycycline 200 mg IV q12h
- Preferred regimen (immunocompetent host) (5): Cefoxitin 2 g IV q6h
- Preferred regimen (immunocompetent host) (6): Cefotetan 2 g IV q12h
- Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
- Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
- Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
- Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host) (5): Meropenem 1 g IV q8h
- Preferred regimen (immunocomppromised host) (6): Gatifloxacin 200 mg IV q24h

# Tonsillitis
- Tonsillitis 
- Preferred regimen:Penicillin V PO 10 days or if compliance unlikely, Benzathine penicillin IM single dose
- Alternate regimen (1): 2nd generation Cephalosporins PO for 46 days
- Alternate regimen (2): Clindamycin or azithromycin for 5 days
- Alternate regimen (3): Clarithromycin for 10 days
- Alternate regimen (4): Erythromycin for 10 days. Extended-release amoxicillin is another (expensive) option

# Ulcerative gingivitis
- Provide patient with specific oral hygiene instructions to use a prescription antibacterial mouthwash: Chlorhexidine 0.12% twice daily.
- For any signs of systemic involvement, the recommended antibiotics are:
- Preferred regimen: Amoxicillin, 250 mg 3 x daily for 7 days  Metronidazole, 250 mg 3 x daily for 7 days

# Vincent's angina
- Vincent's angina  
- Preferred treatment:Penicillin G 4 million units IV q4h
- Alternate treatment: Clindamycin 600 mg IV q8h