Acute mastoiditis. Axial CT image shows an acute fluid collection within the mastoid air cells on the left. Purulent fluid should be cultured whenever possible to help guide antimicrobial therapy. Initial empirical therapy is usually directed against the typical organisms associated with acute otitis media, such as S. pneumoniae, H. influenzae, and M. catarrhalis. Some patients with more severe or prolonged courses of illness should be treated for infection with S. aureus and gram-negative bacilli (including Pseudomonas). Broad empirical therapy is usually narrowed once culture results become available. Most patients can be treated conservatively with IV antibiotics; surgery (cortical mastoidectomy). | Chapter 031. Pharyngitis Sinusitis Otitis and Other Upper Respiratory Tract Infections Part 9 Acute mastoiditis. Axial CT image shows an acute fluid collection within the mastoid air cells on the left. Purulent fluid should be cultured whenever possible to help guide antimicrobial therapy. Initial empirical therapy is usually directed against the typical organisms associated with acute otitis media such as S. pneumoniae H. influenzae and M. catarrhalis. Some patients with more severe or prolonged courses of illness should be treated for infection with S. aureus and gram-negative bacilli including Pseudomonas . Broad empirical therapy is usually narrowed once culture results become available. Most patients can be treated conservatively with IV antibiotics surgery cortical mastoidectomy can be reserved for complicated cases and those in which conservative treatment has failed. Infections of the Pharynx and Oral Cavity Oropharyngeal infections range from mild self-limited viral illnesses to serious life-threatening bacterial infections. The most common presenting symptom is sore throat one of the most frequent reasons for ambulatory care visits by both adults and children. Although sore throat is a symptom in many noninfectious illnesses as well the overwhelming majority of patients with a new sore throat have acute pharyngitis of viral or bacterial etiology. Acute Pharyngitis Millions of visits to primary care providers each year are for sore throat the majority of cases of acute pharyngitis are caused by typical respiratory viruses. The most important source of concern is infection with group A 0-hemolytic Streptococcus S. pyogenes which is associated with acute glomerulonephritis and acute rheumatic fever. The risk of rheumatic fever can be reduced by timely penicillin therapy. Etiology A wide variety of organisms cause acute pharyngitis. The relative importance of the different pathogens can only be estimated since a significant proportion of cases 30 have no .
