Pediatric Treatment Recommendations Card Kentucky ANTIBIOTIC Expanded content and references available at: https://www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/pediatric-treatment-rec.html Awareness

Diagnosis Management

Non-specific viral/bacterial findings: Halitosis, fatigue, headache, decreased appetite Bacterial diagnosis: (one of the following) If bacterial infection is established: • Persistent symptoms: nasal discharge or daytime cough > 10 days • Watchful waiting for up to 3 days may be offered for children with persistent symptoms. Antibiotics should be prescribed for severe or worsening disease. • Worsening symptoms: worsening or new onset fever, daytime cough, or nasal discharge • First line: amoxicillin or amoxicillin/clavulanate after initial improvement of a viral URI.

• Severe symptoms: fever ≥39o C, purulent nasal discharge for at least 3 consecutive days. • Children who cannot tolerate oral: single dose of ceftriaxone can be used then switch to oral if Acute Sinusitis Acute improving Imaging tests are no longer recommended for uncomplicated cases • Further recommendations: AAP or IDSA guidelines1,2

Diagnosis Management (AOM) Definitive diagnosis requireseither: • Watchful waiting for mild cases with unilateral symptoms in children 6-23 months or unilateral or bilateral symptoms in children >2y • Moderate or severe bulging of the tympanic membrane (TM) or • First line: amoxicillin for children who have not received it within the past 30 days new onset otorrhea not due to otitis externa • Mild bulging of the TM AND recent (<48h) onset of otalgia • Amoxicillin/clavulanate if amoxicillin has been taken within 30d, concurrent purulent (holding, tugging, rubbing of the ear) or intense erythema of the TM conjunctivitis, or history of recurrent AOM unresponsive to amoxicillin • Allergy: cefdinir, cefuroxime, cefpodoxime or ceftriaxone AOM should not be diagnosed in children without middle ear effusion • Prophylactic antibiotics are not recommended (based on pneumatic otoscopy and/or tympanometry) • Further recommendations: AAP guidelines3 Acute Otitis Media Acute

Diagnosis Management

Clinical features alone do not distinguish between GAS and viral • First line: amoxicillin and penicillin V • Allergy: cephalexin, cefadroxil, clindamycin, clarithromycin or azithromycin Children with a plus 2 or more should undergo a Rapid Antigen Detection Test • Duration: 10 days (RADT): • Absence of cough • Presence of tonsillar exudates or swelling • History of fever • Presence of swollen and tender anterior cervical lymph nodes

Pharyngitis • Age < 15 years Do not test in children < 3 years (GAS rarely causes pharyngitis and is uncom- mon) o Negative RADT should be backed up by a throat culture o Positive RADTs do not require back-up culture represent theofficialviews oftheCabinet for Healthand Family Services, Department for Medicaid Services. HealthandInformationof Public Sciences. This content issolelytheresponsibility oftheauthors anddoesnotnecessarily Medicaid”, Norton Children’s Hospital,andthe University ofLouisville: SchoolofMedicine, DepartmentofPediatrics; School Services undertheState University Partnership contract titled“Improving Care Qualityfor Children Receiving Kentucky This project was supported by the following: Kentucky Cabinet for HealthandFamily Services: Departmentfor Medicaid Pediatric Treatment Recommendations Card 4. 3. 2. 1. Urinary Tract Infections Common Cold http://pediatrics.aappublications.org/content/early/2011/08/24/peds.2011-1330 Urinary tract infection: Clinicalpractice guidelinefor thediagnosisandmanagementofinitialUTIinfebrile infants andchildren 2to 24 months The diagnosisandmanagementofacute otitismedia. IDSA clinicalpractice guidelinefor acute bacterial rhinosinusitisinchildren andadults Clinical practice guidelinefor thediagnosisandmanagement ofacute bacterial sinusitisinchildren aged1to 18years. Pediatrics. (UTI) Bronchiolitis or non-specific upper respiratory infection (URI) Diagnosis Diagnosis *Nitrites are notasensitive measure inchildren andcannotbeusedto ruleoutUTIs Diagnosis • • • • • • • • • (absence ofviral symptoms, severe distress, frequent recurrences, lackofimprovement) warranted inatypical disease Routine labtests andradiologic studies are notrecommended, butachest x-ray may be respiratory effort Characterized by: rhinorrhea,cough, wheezing, tachypnea and/or increased Occurs inchildren <24 months Fever, ifpresent, occurs earlyintheillness nasal discharge beginsasclearandchangesthroughout thecourse oftheillness. Viral URIsare often characterized by nasaldischarge andcongestion orcough. Usually likelihood ofUTI. unexplained fever isnolongerrecommended butshouldbebasedonthechild’s The decisionto assess for UTIinurinetesting for allchildren 2-24 monthswith o Obtainedthrough catheterization orsuprapubic aspiration (NOT bag) o o Urinalysis suggestive ofinfection Definitive diagnosis:(all required) School agedchildren: dysuria, frequency, orurgency Infants: fever and/or strong-smelling urine ≥ for children 2-24 months • 50,000 CFUs/mL ofasingleuropathogen . Pyuria (leukocyte. Pyuria esterase or5WBCs), , ornitrites*

Pediatrics. 2013;131(3):e964-99. http://pediatrics.aappublications.org/content/early/2013/02/20/peds.2012-3488 . ClinInfect Dis.2012;54(8):e72-e112.

Management Management Management • • • • • • • • • • • • • • https://academic.oup.com/cid/article/54/8/1041/364141/Executive-Summary-IDSA-Clinical-Practice-Guideline without asthma Inhaled corticosteroids andoral prednisolone donotimprove outcomes inchildren in children <6years. Potential for harmandnoproven benefit from OTC cough and cold medications Symptomatic relief. Further recommendations: AAP guidelines Abnormal imagingresults require furthertesting Febrile infants withUTIsshouldundergo renal andbladderUSduringorfollowing theirfirst UTI. Antibiotics notrecommended for asymptomatic bacteriuria o o Ages 2-24 months: Initial treatment shouldbebasedonlocalsusceptibility No role for corticosteroids, ribavirin, orchest physiotherapy No evidence to supportroutine suctioningofthelower pharynxorlarynx(deep suctioning) hospitalized setting Albuterol andnebulized racemic epinephrineshouldnotbeadministered outsideofthe Nasal suctioning Antibiotics shouldnotbeused Usually patients worsen between 3-5days, thenimprove Duration: cefprozil orcephalexin Suggested agents: 2013;132(1):e262-80. 7-14 days ismainstay of therapy Antibioticsshouldnotbeprescribed for theseconditions . Pediatrics. 2011;128(3):595–610. TMP/SMX, amoxicillin/clavulanate, cefixime, cefpodoxime, http://pediatrics.aappublications.org/content/early/2013/06/19/peds.2013-1071 4

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