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A summary of empiric antimicrobial therapy for common conditions encountered in otolaryngology can be found in Table 2–1. In general, when culture and susceptibility data are finalized, it is important to use the narrowest agent possible. This may not only be cost effective in many cases but will also decrease selection pressure for the development of antimicrobial resistance. Note that a history of an allergy to penicillin in the past is not reliable. Only a small proportion of patients (< 5%) with a stated history of penicillin allergy actually experience an adverse reaction when challenged with the drug. If there are concerns, penicillin skin testing may be a helpful procedure to truly identify patients at risk of a true IgE-mediated reaction. All others can be safely prescribed β-lactams leading to a wider choice of agents and enhance our ability to use targeted therapy when possible.

Table 2–1Examples of initial antimicrobial therapy for selected conditions in head and neck infection.

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