EAR INFECTIONS
Acute Otitis Media (AOM)
- Causes: Viruses (up to 50%), bacterial co-infection (18–27%).
- Common Bacterial Pathogens: Streptococcus pneumoniae, non-typable Haemophilus influenzae, Moraxella catarrhalis.
- Occasional Pathogens: Streptococcus pyogenes, Staphylococcus aureus.
- Special Populations: Gram-negative enteric bacilli, MRSA.
Symptoms: Ear pain, discharge, hearing loss, fever, irritability, vertigo, tinnitus. Redness of the tympanic membrane may occur.
Management:
- Antibiotics deferred for 48 hours unless severe symptoms.
- Antibiotics required for:
- Children ≥6 months with severe symptoms.
- Bilateral AOM in children 6–23 months.
- Recurrent AOM, immunocompromised, neonates, structural ENT issues, day-care exposure.
Treatment
- First-line: Amoxicillin 90 mg/kg/day PO in 2–3 doses for 5–7 days (adults: 1 g PO 8 hourly).
- If recent amoxicillin use or purulent conjunctivitis: Amoxicillin-clavulanate.
- Penicillin allergy: Cefuroxime, cefpodoxime, ceftriaxone.
AOM with Tympanostomy Tubes
- Common pathogens: Pseudomonas aeruginosa, Staphylococcus aureus.
- Treatment: Topical ciprofloxacin.
Otitis Externa
- Causes: “Swimmer’s ear” – Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, Streptococcus pyogenes.
- Rare causes: TB, syphilis, yaws, leprosy, sarcoidosis.
Treatment:
- Clean ear canal.
- Topical therapy: dexamethasone, framycetin, gramicidin, ciprofloxacin/corticosteroid drops.
- Systemic antibiotics only if cellulitis or invasive infection.
Otomycosis
- Fungal infection: Aspergillus niger, Candida spp.
- Treatment: Cleaning + topical clotrimazole.
Malignant Otitis Externa
- Seen in elderly diabetics.
- Pathogen: Pseudomonas aeruginosa.
- Treatment: Parenteral antipseudomonal agents + surgery.
Mastoiditis
- Pathogens: Same as AOM.
- Treatment: Antibiotics, possible mastoidectomy.
- ENT referral recommended.
NOSE INFECTIONS
Acute Viral Rhinitis (Common Cold)
- Causes: Rhinoviruses (50%), coronaviruses, RSV, influenza, parainfluenza, adenovirus, metapneumovirus.
- Symptoms: Scratchy throat, nasal obstruction, rhinorrhoea, fever.
Treatment:
- Symptomatic: Paracetamol, decongestants (age >12), hydration, honey.
- Avoid: Antibiotics, antihistamines, antivirals, vitamins/herbals.
Acute Bacterial Rhinosinusitis (ABRS)
- Causes: Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Moraxella catarrhalis, anaerobes, atypicals.
- Diagnosis: Sinus aspirate or EDMM aspirates.
Treatment:
- First-line: Amoxicillin (Adults: 1 g PO 8 hourly; Children: 80–90 mg/kg/day).
- Alternatives: Amoxicillin-clavulanate, cefuroxime, cefpodoxime.
- If first-line fails: Moxifloxacin, levofloxacin, telithromycin.
- Penicillin allergy: Azithromycin, clarithromycin.
Red Flags for Referral: Systemic toxicity, altered mental status, severe headache, orbital swelling, vision changes.
Chronic Rhinosinusitis (CRS)
- Diagnosis: Endoscopic culture or maxillary tap.
- Pathogens: S. aureus, Enterobacteriaceae, Pseudomonas, S. pneumoniae, H. influenzae, β-haemolytic streptococci.
Treatment:
- Broad-spectrum antibiotics: Amoxicillin-clavulanate, respiratory fluoroquinolones.
- Longer duration than ABRS.
THROAT INFECTIONS
Pharyngitis and Tonsillitis
- Causes: Viruses (adenovirus, rhinovirus, influenza, EBV, CMV, HIV), bacteria (S. pyogenes, Fusobacterium, Arcanobacterium, Corynebacterium, Neisseria gonorrhoeae, Mycoplasma, Chlamydophila).
Symptoms: Sore throat, fever, odynophagia, headache, nausea, vomiting, abdominal pain, tonsillopharyngeal oedema, lymphadenopathy.
Diagnosis: Throat culture (90–95% sensitivity), ASOT not routinely recommended.
Treatment: Group A Streptococcal Pharyngitis
- Penicillin VK: Adults 500 mg PO 12 hourly; Children 250–500 mg PO 12 hourly for 10 days.
- Benzathine Penicillin: IM single dose.
- Amoxicillin: 500–1000 mg PO 12 hourly or 50 mg/kg/day once daily.
- Macrolides: Azithromycin, clarithromycin for penicillin allergy.
- Note: Amoxicillin may cause rash in EBV cases.
Oral Thrush (Oropharyngeal Candidiasis)
Treatment:
- Mild: Nystatin suspension or pastilles.
- Moderate to Severe: Oral fluconazole 100–200 mg daily.
- Oesophageal Candidiasis: Fluconazole 200–400 mg daily for 14–21 days.