Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

220 Bacterial Pneumonia Balanitis

macrolides, fluoroquinolones active against sensitive strains

(MIC<0.1); penicillins, fluoroquinolones, cephalosporins active

against intermediate strains (MIC 0.1–1.0); vancomycin, fluoro-

quinolones active against resistant strains (MIC>1.0)

➣H influenzae: second- or third-generation cephalosporin, flu-

oroquinolones, amoxicillin-clavulanic acid, azithromycin, clar-

ithromycin, trimethoprim-sulfamethoxazole

➣C pneumoniae: macrolide, doxycycline, or fluoroquinolone

➣Legionella: azithromycin or a fluoroquinolone (+rifampin in

severe disease)

➣M pneumoniae: doxycycline or a macrolide

follow-up

■Clinical improvement in 3–5 d

If using telithromycin (ketolide), monitor for signs of liver toxicity;

three severe cases have recently been reported.

■Follow-up CXR if symptoms persist (exclude empyema, cavitation)

and in elderly in 8–12 wks (to exclude malignancy)

complications and prognosis

■Empyema and abscess occur infrequently.

■Mortality 10–15%: mainly in elderly with comorbid illnesses and

immunocompromised

■Prevention with pneumococcal vaccination in those >50 y or with

underlying diseases; yearly influenza vaccination

Balanitis...........................................

KEY H. STAGE, MD, FACS

history & physical

Signs & Symptoms

■Balanitis is inflammation of the glans penis; balanoposthitis refers

to inflammation of both the glans penis and prepuce.

■Physical signs of balanitis and balanoposthitis include erythema,

scaling, aculopapular exanthem, moist discharge, fissuring, and

ulceration with or without induration.

➣Benign lesions: Pearly penile papules (may look like genital

warts), Fordyce spots (yellow submucosal sebaceous glands),