Pharynx, larynx, trachea wickUPpharynxlarynxtrachea wickup.pptxVIP

Pharynx, larynx, trachea Dr K Outhoff A. Local and systemic drugs and their side effects for: Aphthous ulcers Acute tonsillitis and pharyngitis Peritonsillitis and tonsil abscess Fungal throat infection Oesophageal reflux Acute epiglottitis Acute laryngeal oedema Iatrogenic conditions 1. Aphthous ulcers Rx: underlying cause Mouthwashes Mechanical protection: carmellose gelatine paste Analgesics Topical corticosteroids (unlikely but possible adrenocortical suppression and thrush) reverse capillary permeability and suppress migration of lymphocytes Acute tonsillitis Acute tonsillitis / pharyngitis Viral 80% EBV, Cytomegalovirus Adenoviruses Measles Bacterial 20% Streptococcus pyogenes (GABHS) Tonsillitis Acute glomerulonephritis Rheumatic Fever Rx aimed at preventing above complications Pen VK given 30 minutes before food, twice daily X 10/7 Amoxicillin (rash if EBV present), no food restrictions, once or twice daily X 10/7 Clindamycin if allergy (Macrolide if allergy) Short course (3-5 days) possible with co-amoxiclav, azithro, clarithro, cefpodoxime, cefuroxime 3. Peritonsillitis and abscess Peritonsillar abscess (quinsy) Rx: throat cellulitis with high dose penicillin, macrolides ? Diphtheria: adherent tonsillar exudate (pseudomembrane) Toxin from Corynebacterium diphtheriae Rx: Diphtheria antitoxin Antibiotics : amoxicillin / erythromycin Antimicrobial spectrum and indications for erythromycin: gram positives and others Corynebacterium diphtheriae Mycoplasma pneumoniae c) Bordetella pertussis d) Legionella pneumophila e) Moraxella catarrhalis f) Chlamydia infections g) Penicillin allergy Erythromycin types: Erythromycin base Acid labile Enteric coated: unpredictable absorption Erythromycin stearate Acid stable Erythromycin ethylsuccinate Acid stable Erythromycin estolate Best absorption Higher plasma concentrations Higher propensity for allergic intrahepatic cholestatic jaundice Additional Antimicrobial Spectrum for newer macrolides Cl