26 Upper Respiratory Tract Infections Wong-Beringer Flashcards
What are URIs?
Nonspecific term to describe acute infections involving the nose, paranasal sinuses, pharynx, larynx, trachea, bronchi. “Common Cold”: virus. No infiltrate in the chest X-Ray
What are the majority of URIs caused by?
Mostly caused by viruses (i.e. Rhinovirus, Influenza virus, etc.)
What are some bacterial causes of URIs?
Group A Strep, H. influenza, Moraxella, Pertussis, Mycoplasma, Chlamydiae
What are the most common bacterial superinfections of viral acute sinusitis?
H. influenza. Moraxella
What are the 3 most common causes of URIs?
Strep. pneumoniae, H. influenza, Moraxella
What are the S/Sxs of Pharyngitis?
Throat pain, fever +/-, visible exudates (+/-)
What is the Center Criteria for Strep Pharyngitis?
Fever, Absence of cough, Pharyngeal exudate, Tender anterior cervical lymphadenopathy. If meet 0-1 criteria: no abx. If meet 2-3 criteria: if positive rapid Strep Antigen Test, give abx. If meet all 4: give abx, +/- rapid test
Why is Abx treatment used for Streptococcal Pharyngitis?
Abx decrease Sx duration by 1-2 days if started w/in 2-3 days of onset; decrease acute rheumatic fever, decrease peritonsillar abscess
What is the DOC for Streptococcal pharyngitis?
PCN
What are the first line choices for treatment of Streptococcal Pharyngitis (after PCN)?
Benzathine PCN 1.2 MU IM x1 (one dose, very long lasting). Pen VK 500mg BID-TID x10 days
What are the second line choices for treatment of Streptococcal Pharyngitis?
Cefuroxime, Cefprozil, Cefdinir. Clarithromycin, Azithromycin (resistance increasingly common)
What is some supportive treatment for Streptococcal Pharyngitis?
Analgesics, Saline gargle
What is Acute Rhinosinusitis?
Inflammation of the nasal mucosa and paranasal sinus mucosa, lasting < 4 weeks
What are the predisposing factors for Acute Rhinosinusitis?
Viral URI. Allergic rhinitis - more associated w/ chronic rhinosinusitis (Sxs > 12 weeks) or recurrent acute rhinosinusitis (2-4 episodes in a year) nasal obstruction. NG tubes (hospitalized patients)
What are the S/Sxs of Acute Rhinosinusitis?
Purulent nasal discharge, post-nasal discharge. Unilateral maxillary sinus tenderness, maxillary toothache or facial pain (esp. unilateral). Sore throat, nasal congestion, HA, partial loss of smell, bad breath
What is the etiology of Acute Rhinosinusitis?
Viral mostly. Bacteria: Sxs persist x10 days or more, initial improvement but worsening after 5-7 days (S. pneumoniae, H. influenza, Moraxella)
What is the etiology of Chronic Rhinosinusitis?
Same bacteriology as Acute + anaerobes and S. aureus
What is the etiology of Hospitalized Rhinosinusitis?
Nosocomial sinusitis: enteric GNR +/- staph (especially in pts with NG tubes or mechanical ventilation)
What are the treatment options for Sinusitis?
Supportive (decongestants, analgesics, topical nasal steroids). Duration of Sxs > 10 days or severe symptoms –> oral Abx 10 days plus supportive therapy. Surgery - complicated cases
What is the first line abx for sinusitis (w/ no recent abx use)?
Amoxicillin (1.5-4g/d): 500-1g TID-QID
What is the second line abx for sinusitis (allergies, failed first line, abx use in past month)?
Amox/Clav, Cefuroxime, Cefdinir, Cefpodoxime, TMP/SMX, Doxycycline; Clarithromycin, Azithromycin
What is Acute Bronchitis?
Inflammation of the bronchus (infectious or non-infectious)
What are Sxs of Acute Bronchitis?
Low grade fever (T102 x < 3d), respiratory wheezes. Non-productive cough (can last 10-21 days before resolving). Runny nose, difficulty sleeping, sore throat
What is the etiology of Acute Bronchitis (bacteria)?
Chlamydia, Mycoplasma, Bordatella
What do you treat Acute Bronchitis with?
Macrolides (Chlamydia, Mycoplasma, Bordatella)
What is Bordatella Pertussis (Acute Bronchitis)?
Prolonged > 2 weeks dry cough, paroxysms of cough or post-tussive emesis preceded by mild illness with rhinorhea, fever and coryza
What are the symptoms of Acute Exacerbation of Chronic Bronchitis (AECB)?
Sputum production for > 3 months in 2 consecutive years. Part of symptoms of COPD, associated w/ cigarette smoking. Acute exacerbations –> increase: dyspnea, sputum volume, sputum purulence, cough
What is the classification of Acute Exacerbation of Chronic Bronchitis (AECB) Group I?
NO comorbid conditions. < 3 exacerbations/year. FEV1 > 50%
What is the classification of Acute Exacerbation of Chronic Bronchitis (AECB) Group II?
Renal/heart/hepatic comorbid conditions. 4+ exacerbations/year. FEV1 35-50%
What is the classification of Acute Exacerbation of Chronic Bronchitis (AECB) Group III?
Comorbid, STEROIDS. 4+ exacerbations/year. FEV1 < 35%
What are the bacterial causes of Acute Exacerbation of Chronic Bronchitis (AECB) Group I?
H. influenzae, S. pneumoniae, M. catarrhalis
What are the bacterial causes of Acute Exacerbation of Chronic Bronchitis (AECB) Group II?
Group I + S. aureus, Kleb pneum, other GNR
What are the bacterial causes of Acute Exacerbation of Chronic Bronchitis (AECB) Group III?
Group I/II + Pseudomonas, multi-R-GNR
What is the drug selection for AECB Group I?
Amoxicillin, Macrolides, Doxycycline
What is the drug selection for AECB Group II?
Amox/Clav, new gen oral CEPHs (Cefpodoxime, Cefdinir); respiratory FQ
What is the drug selection for AECB Group III?
High-dose Amox/Clav, Antipseudomonal FQs (Cipro, Levo)
What is AECB adjunctive therapy?
Removal of irritants (environmental). Oxygen therapy. Hydration. Systemic corticosteroid. Chest physiotherapy
What is supportive therapy for AECB?
Use of humidifier to moisten the air. Adequate fluid intake. Avoid smoking or exposure or 2nd hand smoke. Symptomatic relief
What is done for symptomatic relief of AECB?
Cough (Dextromethorphan/Guaifenesin. Antitissives). Pharyngitis (saline gargle). APAP, NSAID. Nasal decongestant. Antihistamines
When is the Tdap vaccine recommended?
Age 19-64, single dose to replace Td booster immunization if last dose of Td > 10 years ago. Adults anticipated close contact with infant aged < 12 months. Health care personnel with direct patient care
