Makindo Medical Notes

Otitis Externa (OE)

• Likely Causes: Pseudomonas aeruginosa, fungi; eczema may present similarly.
• Treatment: Local cleaning plus antibacterial and corticosteroid combination drops or spray. Treat for 7 days.

Malignant Otitis Externa

• An aggressive, painful infection usually in immunocompromised patients.
• Action: Discuss with Consultant Microbiologist and refer to ENT for management.

Otitis Media (OM)

• Likely Causes: Viral, Streptococcus pneumoniae, Haemophilus influenzae; commonly seen in children.
• Treatment: Only treat if temperature >38.5°C or vomiting.
  • First-line: Amoxicillin 500 mg TDS PO for 3-7 days.
  • Penicillin Allergy: Consult with Consultant Microbiologist for alternatives.

Auricular Chondritis

• Likely Causes: Pseudomonas aeruginosa.
• Action: Discuss with Consultant Microbiologist and refer to ENT for specialized management.

Sinusitis

• Likely Causes: Viral, Streptococcus pneumoniae, Haemophilus influenzae, anaerobes.
• Guidance: Mostly self-limiting; wait 7 days unless the patient is systemically unwell.
• If Antibiotics Indicated:
  • Amoxicillin 500 mg TDS PO or Doxycycline 100 mg BD PO.
  • Treat for 3-5 days; consider nasal decongestant.

Chronic Sinusitis or Failure of Initial Therapy

• Action: Refer to ENT.
• Treatment: Co-Amoxiclav 625 mg TDS PO for up to 3 weeks.
• Penicillin Allergy: Contact Consultant Microbiologist for guidance.

Pharyngitis/Tonsillitis - Calculate the CENTOR Score

• Likely Causes: Commonly viral, Group A Streptococcus.
• First-line: Phenoxymethylpenicillin (Pen V) 500 mg QDS PO for 10 days.
• Penicillin Allergy: Clarithromycin 500 mg BD PO.

CENTOR Score

A 4-point score, with one point each for:

• Tonsillar exudate +1
• Tender anterior cervical lymph nodes +1
• Absence of cough +1
• History of fever +1

Score of 3 or 4 suggests a possible benefit from antibiotics. A score of less than 3 suggests an 80% chance the infection is viral and antibiotics may not be necessary. This is a guide only and should be used alongside clinical judgment.

Acute Epiglottitis/Supraglottitis

• Likely Causes: Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, others.
• Treatment: Ceftriaxone 2 g OD IV.
• Additional Guidance:
  • Refer urgently to ENT. Do not attempt throat swabs due to risk of airway obstruction.
  • Consult ITU if septic shock is suspected.
  • Obtain blood cultures before initiating antibiotics once the airway is secure.