AcuteHyperacute Conjunctivitis Acute Hyperacute 1 AcuteHyperacute Conjunctivitis Acute

Acute/Hyperacute Conjunctivitis Acute Hyperacute 1

Acute/Hyperacute Conjunctivitis Acute Bugs: specific bug 1) S. pneumo: #1 ditto 2) S. aureus: Less severe 3) H. ditto fluditto Hyperacute 2

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu Hyperacute 3

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu dz (twomedia words) --Kids with otitis -- Hyperacute 4

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media -- Hyperacute 5

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media two wordslung dz --Adults with chronic Hyperacute 6

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Hyperacute 7

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? so --No, yes/no/maybe unless: Hyperacute 8

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Hyperacute 9

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Hyperacute 10

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: drop --Polytrim (has good H. flu coverage) -- Hyperacute 11

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) -- Hyperacute 12

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids dz/dz (to prevent otitis/pharyngitis) Hyperacute 13

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute 14

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) 15

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) 16

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? yes/no/maybe so --Yes 17

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes 18

Acute/Hyperacute Conjunctivitis Acute Hyperacute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Treatment: --If no corneal involvement: or Outpt? Med + route? Outpatient. Inptw/ 1 g Rocephin IM x 1 -- Cultures/stains needed? --Yes 19

Acute/Hyperacute Conjunctivitis Acute Hyperacute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Treatment: --If no corneal involvement: Outpatient w/ 1 g Rocephin IM x 1 -- Cultures/stains needed? --Yes 20

Acute/Hyperacute Conjunctivitis Acute Hyperacute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Treatment: --If no corneal involvement: Outpatient w/ 1 g Rocephin IM x 1 --If with corneal involvement: Inpt. Rocephin or Outpt? Med + route? Inpatient, 1 g IV q 12 o x 3 d Cultures/stains needed? --Yes 21

Acute/Hyperacute Conjunctivitis Acute Hyperacute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --No, unless: 1) debilitated 2) immunocompromised 3) unresponsive to treatment Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Treatment: --If no corneal involvement: Outpatient w/ 1 g Rocephin IM x 1 --If with corneal involvement: Inpatient, 1 g Rocephin IV q 12 o x 3 d Cultures/stains needed? --Yes 22

Acute/Hyperacute Conjunctivitis Acute But gonococcus is a venereal disease. How Bugs: does get in the eye? 1) S. it pneumo: #1 Seriously? Use your imagination. 2) S. aureus: Less severe 3) then, H. fluif we’re talking VD here, should OK with otitis media we--Kids be concerned about other ‘love bugs’? --Adults with chronic dz Yes. About 1/3 of pts with lung GC conjunctivitis will have a concurrent Chlamydial infection. Cultures/stains needed? --No, unless: does this have for managing What implication 1) debilitated GC conjunctivitis? immunocompromised In addition to 2)Rocephin for the GC, they should 3) unresponsive to treatment receive a dose of PO zithromycin. Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: --If no corneal involvement: Outpatient w/ 1 g Rocephin IM x 1 --If with corneal involvement: Inpatient, 1 g Rocephin IV q 12 o x 3 d 23

Acute/Hyperacute Conjunctivitis Acute But gonococcus is a venereal disease. How Bugs: does get in the eye? 1) S. it pneumo: #1 Seriously? Use your imagination. 2) S. aureus: Less severe 3) then, H. fluif we’re talking VD here, should OK with otitis media we--Kids be concerned about other ‘love bugs’? --Adults with chronic dz Yes. About 1/3 of pts with lung GC conjunctivitis will have a concurrent Chlamydial infection. Cultures/stains needed? --No, unless: does this have for managing What implication 1) debilitated GC conjunctivitis? immunocompromised In addition to 2)Rocephin for the GC, they should 3) unresponsive to treatment receive a dose of PO zithromycin. Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: --If no corneal involvement: Outpatient w/ 1 g Rocephin IM x 1 --If with corneal involvement: Inpatient, 1 g Rocephin IV q 12 o x 3 d 24

Acute/Hyperacute Conjunctivitis Acute But gonococcus is a venereal disease. How Bugs: does get in the eye? 1) S. it pneumo: #1 Seriously? Use your imagination. 2) S. aureus: Less severe 3) then, H. fluif we’re talking STDs here, should OK with otitis media we--Kids be concerned about other ‘love bugs’? --Adults with chronic dz Yes. About 1/3 of pts with lung GC conjunctivitis will have a concurrent Chlamydial infection. Cultures/stains needed? --No, unless: does this have for managing What implication 1) debilitated GC conjunctivitis? immunocompromised In addition to 2)Rocephin for the GC, they should 3) unresponsive to treatment receive a dose of PO zithromycin. Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: --If no corneal involvement: Outpatient w/ 1 g Rocephin IM x 1 --If with corneal involvement: Inpatient, 1 g Rocephin IV q 12 o x 3 d 25

Acute/Hyperacute Conjunctivitis Acute But gonococcus is a venereal disease. How Bugs: does get in the eye? 1) S. it pneumo: #1 Seriously? Use your imagination. 2) S. aureus: Less severe 3) then, H. fluif we’re talking STDs here, should OK with otitis media we--Kids be concerned about other ‘love bugs’? --Adults with chronic dz Yes. About 1/3 of pts with lung GC conjunctivitis will have a concurrent Chlamydial infection. Cultures/stains needed? --No, unless: does this have for managing What implication 1) debilitated GC conjunctivitis? immunocompromised In addition to 2)Rocephin for the GC, they should 3) unresponsive to treatment receive a dose of PO zithromycin. Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: --If no corneal involvement: Outpatient w/ 1 g Rocephin IM x 1 --If with corneal involvement: Inpatient, 1 g Rocephin IV q 12 o x 3 d 26

Acute/Hyperacute Conjunctivitis Acute But gonococcus is a venereal disease. How Bugs: does get in the eye? 1) S. it pneumo: #1 Seriously? Use your imagination. 2) S. aureus: Less severe 3) then, H. fluif we’re talking STDs here, should OK with otitis media we--Kids be concerned about other ‘love bugs’? --Adults with chronic dz Yes. About 1/3 of pts with lung GC conjunctivitis will have a concurrent Chlamydial infection. Cultures/stains needed? --No, unless: does this have for managing What implication 1) debilitated GC conjunctivitis? immunocompromised In addition to 2)Rocephin for the GC, they should 3) unresponsive to treatment receive a dose of PO zithromycin. Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: --If no corneal involvement: Outpatient w/ 1 g Rocephin IM x 1 --If with corneal involvement: Inpatient, 1 g Rocephin IV q 12 o x 3 d 27

Acute/Hyperacute Conjunctivitis Acute But gonococcus is a venereal disease. How Bugs: does get in the eye? 1) S. it pneumo: #1 Seriously? Use your imagination. 2) S. aureus: Less severe 3) then, H. fluif we’re talking STDs here, should OK with otitis media we--Kids be concerned about other ‘love bugs’? --Adults with chronic dz Yes. About 1/3 of pts with lung GC conjunctivitis will have a concurrent Chlamydial infection. Cultures/stains needed? --No, unless: does this have for managing What implication 1) debilitated GC conjunctivitis? immunocompromised In addition to 2)Rocephin for the GC, they should 3) unresponsive to treatment receive a dose of PO zithromycin. Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: --If no corneal involvement: Outpatient w/ 1 g Rocephin IM x 1 --If with corneal involvement: Inpatient, 1 g Rocephin IV q 12 o x 3 d 28

Acute/Hyperacute Conjunctivitis 29 Conjunctivitis Acute But gonococcus is a venereal disease. How Bugs: does get in the eye? 1) S. it pneumo: #1 Seriously? Use your imagination. 2) S. aureus: Less severe 3) then, H. fluif we’re talking STDs here, should OK with otitis media we--Kids be concerned about other ‘love bugs’? --Adults with chronic dz Yes. About 1/3 of pts with lung GC conjunctivitis will have a concurrent Chlamydial infection. Cultures/stains needed? --No, unless: does this have for managing What implication 1) debilitated GC conjunctivitis? immunocompromised In addition to 2)Rocephin for the GC, they should 3) unresponsive treatment receive an empirical dose of POtozithromycin Treatment: --Polytrim (has good H. flu coverage) --Consider PO abx if H. flu in kids (to prevent otitis/pharyngitis) Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: --If no corneal involvement: Outpatient w/ 1 g Rocephin IM x 1 --If with corneal involvement: Inpatient, 1 g Rocephin IV q 12 o x 3 d ^ (plus azithromycin PO ‘just in case’)

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: Cultures/stains needed? --If no corneal involvement: --No, unless: Outpatient w/ 1 g Rocephin IM x 1 1) debilitated 2) immunocompromised --If with corneal involvement: 3) unresponsive to treatment Inpatient, 1 g Rocephin IV q 12 o x 3 d Treatment: --Polytrim (has good H. flu coverage) addition --Consider. In. PO abx if to H. antibiotics, flu in kids what therapeutic maneuver should be performed? Copious irrigation with normal saline to remove inflammatory debris, cells, (to prevent otitis/pharyngitis) and proteases from the ocular surface 30

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: Cultures/stains needed? --If no corneal involvement: --No, unless: Outpatient w/ 1 g Rocephin IM x 1 1) debilitated 2) immunocompromised --If with corneal involvement: 3) unresponsive to treatment Inpatient, 1 g Rocephin IV q 12 o x 3 d Treatment: --Polytrim (has good H. flu coverage) addition --Consider. In. PO abx if to H. antibiotics, flu in kids what therapeutic maneuver should be performed? Copious irrigation with normal saline to remove inflammatory debris, cells, (to prevent otitis/pharyngitis) and proteases from the ocular surface 31

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: Cultures/stains needed? --If no corneal involvement: --No, unless: Outpatient w/ 1 g Rocephin IM x 1 1) debilitated 2) immunocompromised --If with corneal involvement: 3) unresponsive to treatment Inpatient, 1 g Rocephin IV q 12 o x 3 d Treatment: --Polytrim (has good H. flu coverage) When ulcerative keratitis develops in gonoccocal --Consider PO abx if H. flu in kids conjunctivitis, where is the ulcer likely to be located? In the corneal periphery— 40% develop PUK (to prevent otitis/pharyngitis) 32

Acute/Hyperacute Conjunctivitis Acute Bugs: 1) S. pneumo: #1 2) S. aureus: Less severe 3) H. flu --Kids with otitis media --Adults with chronic lung dz Hyperacute Bugs: 1) N. gonorrhea 2) N. menigitidis (much less common) Cultures/stains needed? --Yes Treatment: Cultures/stains needed? --If no corneal involvement: --No, unless: Outpatient w/ 1 g Rocephin IM x 1 1) debilitated 2) immunocompromised --If with corneal involvement: 3) unresponsive to treatment Inpatient, 1 g Rocephin IV q 12 o x 3 d Treatment: --Polytrim (has good H. flu coverage) When ulcerative keratitis develops in gonoccocal --Consider PO abx if H. flu in kids conjunctivitis, where is the ulcer likely to be located? In the corneal periphery— 40% develop PUK (to prevent otitis/pharyngitis) 33