A parent brings her two year old son to your office because of a chief complaint of fussiness and tugging at his right ear for the past two days. He has had coughing and runny nose for about 5 days that has been treated with an over-the-counter cold medicine. He also has a low-grade fever of about 101 degrees axillary (38.3C).for the past two days. Both parents smoke cigarettes. He attends daycare. His past medical history is significant for ear infections in the past, with his last otitis media being 5 months ago treated with amoxicillin. His immunizations are up to date, including heptavalent pneumococcal vaccine. Exam: VS T 38.4, P 100, RR 28, BP 100/65. He is active, alert to his surroundings and otherwise in no distress. HEENT: Right tympanic membrane is erythematous and bulging with poor mobility,Left TM is clear with good mobility. Throat is non-erythematous. There are shotty cervical lymph nodes. Lungs are clear to auscultation. The rest of the examination is normal. He is diagnosed with acute right otitis media. He is prescribed amoxicillin and acetaminophen. A follow-up visit is scheduled in 10 days

Antibiotics are one of the most important classes of medications prescribed by physicians. The most important item of information is to be able to use an antibiotic which satis factorily cures the patient of an infection.. Antibiotic therapy is initiated in three basic ways: 1) empiric therapy. 2) specific therapy. 3) prophylaxis.

Empiric therapy is the selection of treatment based on clinical and laboratory information with the exception of culture and sensitivity information. Specific therapy is the selection of an antibiotic based on the culture and sensitivity testing of the organism causing the infection. Prophylaxis is the use of antibiotics to prevent an infection which is anticipated.

1.Final Diagnosis (system affected & Causative organism). 2.Special situations. 3.Follow up.

It is very important to localize the affected system in order to choose the most efficient antibiotic with least adverse effects on this system and the body.

I- Respiratory system

Antibiotics used for respiratory tract infection: * Quinolones are contraindicated for children below 16 years old ?!

II- Gastrointestinal tract (GIT) Gastroentritis Causative organisms: E.coli Campylobacter. shigella. salmonella * Chloramphenicole is not advised nowadays as 1 st line for children ?!

III- Central Nervous system(CNS) Encephalitis & menenigitis Causative organisms: In Neonates.GBS.,E.coli,and Listeria monocytogenes. In Infants and children: S.Pneumoniae,H.influenza,and Meningeococci.

IV- Urinary tract (UTI) Causative organisms: E.coli. pseudomonas. Klebsiela.

Prescribing antibiotic therapy should be in terms of:

Take Care!!! Oral administration is the rule EXCEPT: Indications for parentral administrations are: severe cases ?! contraindication to oral route e.g. persistent vomiting & diarrhea. certain drugs available only parentral e.g. 3 rd generation cepahlosporine.

What if no response??!

Empirical antibiotic use is: Not random. Not random. According to Guidelines. According to Guidelines. Combination therapy is indicated to cover both gram +ve and –ve bacteria. Combination therapy is indicated to cover both gram +ve and –ve bacteria.

“Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing” Voltaire…