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Year 3 - Clinical > 7 - URTI > Flashcards

7 - URTI Flashcards

1
Q

At what age does acute otitis media most often occur?

A
  • Peak incidence at 6-24 months
  • 50% by 1 year
  • 70% by 3 years
  • Reduces by 7 years
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2
Q

Signs and symptoms of acute otitis media?

A
  • Middle ear inflammation, fluid collection (effusion)
  • Rapid onset
  • Otalgia (pain), otorrhea (drainage), fever, irritability, GI (vomiting, diarrhea), imbalance, hearing loss
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3
Q

Most common pathogens of acute otitis media?

A
  • Viral (RSV, influenza, rhinovirus) - immunization reduces episodes by 30-40%
  • S. pneumoniae
  • H. influenzae
  • Moraxella catarrhalis
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4
Q

What is otitis media w/ effusion?

A
  • Chronic middle ear inflammation w/ fluid collection, but no acute signs of infection
  • 90% spontaneous resolution w/in 3 months
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5
Q

Risk factors for acute otitis media?

A
  • Bottle fed
  • Daycare
  • Allergies
  • Passive smokes
  • Craniofacial anomaly
  • Immunocompromised
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6
Q

How is acute otitis media diagnosed?

A
  • Clinical presentation
  • Otoscopy shows impaired mobility, bulging, reddened membrane
  • Tympanocentesis for severe infection, tx failure, recurrence, and immunocompromised
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7
Q

When should antimicrobials be used for acute otitis media?

A

Greatest benefit in under 2 y/o, bilateral infection, otorrhea, or immunocompromised

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8
Q

What is watchful waiting?

A
  • Analgesia
  • Antimicrobial rx w/ detailed instructions to initiate therapy if persistent or worsening at 48-72 h from onset of illness
  • Follow-up
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9
Q

When should watchful waiting be considered?

A

6-23 months w/ mild infections and 2 years and older w/ mild-moderate infection (w/o recurrence, bilateral infection, otorrhea, sx > 72 h, craniofacial anomalies, or co-morbidities)

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10
Q

What are the antimicrobial options for acute otitis media?

A
  • High dose amoxicillin 80-90 mg/kg/day given q12h (max 3g/day)
    • Standard dose 40 mg/kg/day given q8h may be considered if over 2 y/o w/o risk factors for penicillin-resistance strep pneumoniae
  • Alternatives = cefprozil/ cefuroxime 30 mg/kg/day given q12h; clarithro 15 mg/kg/day given q12h
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11
Q

What are the antimicrobial options for acute otitis media (severe infection or risk factors for resistance)? What are the risk factors for resistance?

A
  • Beta lactam w/in 1 month, tx failure, recurrence w/in 1 month, or conjunctivitis indicative of H. influenzae)
  • Amox-clav 200/28.5 or 400/57
  • [Ceftriaxone 50 mg/kg IV/IM q24h x 3 days]
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12
Q

What is the typical response to antimicrobial therapy for acute otitis media?

A

Clinical improvement w/in 24-48 h and resolution w/in 72 h

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13
Q

What is the duration of antimicrobial therapy for acute otitis media?

A
  • Amox or amox-clav = 5-7 days or 10 days for under 2 y/o or complicated infection
  • Azithromycin = 5 days
  • Others = 7-10 days
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14
Q

What are some possible reasons for tx failure in acute otitis media?

A
  • Poor adherence
  • Low antimicrobial dose
  • Antimicrobial resistance
  • Immunosuppressed
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15
Q

What is some essential pt counselling info for acute otitis media?

A
  • Analgesia; avoid topical analgesics
  • Avoid decongestants and antihistamines
  • Adhere to antimicrobial regimen
  • Potential adverse effects
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16
Q

What is considered recurrent acute otitis media?

A

> 3 episodes w/in 6 months or > 4 episodes w/in 12 months

17
Q

What are some preventative measures for recurrent acute otitis media?

A
  • Minimize risk factors, investigate associations w/ allergic rhinitis or food allergies
  • Vaccination for influenzae and strep pneumo
  • Continuous antimicrobial prophylaxis reduces by 1.5 episodes/year by increases risk of resistance
  • Tympanostomy tubes reduces episodes by 2-3/year
18
Q

What is the role of topical antimicrobials in treating acute otitis media?

A
  • Used for children w/ tympanostomy tubes
  • Would use antibiotic eye drops b/c the tube directly enters the inner ear through the ear drum
  • Would use quinolones (must use sterile drops, so commonly use eye drops)
19
Q

What are the signs and symptoms of acute bacterial rhinosinusitis (ABRS)?

A
  • Nasal obstruction or purulence discharge plus pain, pressure (fullness) or lack of smell for > 7-10 days w/o improvement
  • Severe sx for > 3 days w/ purulence and fever > 39 C
  • Biphasic febrile-illness after 5-7 days w/ initial improvement then worsening
20
Q

Most common pathogens in ABRS?

A
  • S. pneumoniae
  • H. influenzae
  • M. catarrhalis
21
Q

Risk factors for ABRS?

A
  • Anatomical anomalies (septal deviation)

- Smoking, allergic rhinitis, asthma, cystic fibrosis, immunocompromised

22
Q

What is the role of intranasal corticosteroids for ABRS?

A
  • Fluticasone furoate 10 mg 2 puffs q12h or mometasone furoate 50 ug 2 puffs q12h x 14 days used for mild-moderate infection > 5-7 days
  • Moderate benefit to alleviate sx and hasten recovery
  • 70-90% spontaneous resolution
23
Q

When are antimicrobials used for ABRS? What are the options?

A
  • Moderate-severe infection
  • Amox 500-1000 mg q8h
  • Alternatives = cefprozil/ cefuroxime 500 mg q12h
  • [Clarithro/ azithro] - increasing resistance
  • [TMP-SMX] - increasing resistance and more adverse effects
24
Q

What is the typical response to antimicrobial therapy for ABRS?

A
  • Clinical improvement w/in 2-3 days
  • Significant by 7-10 days
  • Full resolution by 3-4 weeks
25
Q

What is the duration of therapy for ABRS?

A
  • 5-10 days for adults

- 10-14 days for children

26
Q

What are some self-tx measures that can reduce sx of ABRS?

A
  • Analgesia
  • Normal saline nasal drops or irrigation, steam inhalation
  • Decongestants and antihistamines not recommended
27
Q

What are the most common pathogens and what is the epidemiology of acute pharyngitis?

A
  • Viral (influenza, rhinovirus, coronavirus, EBV) in 90% of adults and 70% of children – resolves spontaneously w/in 5-7 days
  • S. pyogenes most significant
  • Peak incidence at 5-15 years
  • Highly communicable for 7 days following acute illness
28
Q

What is the clinical criteria used in assessing for group A strep pharyngitis?

A
  • Exudates (red, edematous)
  • Adenopathy (swollen lymph nodes)
  • Fever > 38 C
  • Cough absent
29
Q

How is group A strep diagnosed?

A
  • Rapid antigen diagnostic test (70-90% sensitivity, 95% specificity) throat swab, results w/in 1 h
  • Confirmatory culture (90% sensitivity, 95% specificity) if negative RADT, results w/in 48 h
  • Current recommendations to w/hold antimicrobial therapy until diagnostic confirmation
30
Q

What are some potential complications w/ group A strep pharyngitis?

A
  • Acute otitis media, ABRS, peri-tonsillar abscess, and necrotizing fasciitis
  • Scarlet fever (< 10% of cases) w/ diffuse, popular, sandpaper-like rash that typically starts on groin or axillae and progresses rapidly to trunk and extremities
  • Acute rheumatic fever (0.3-3%) w/ delayed presentation at 2-3 weeks of rash, SC nodules, arthritis
  • Post-strep glomerulonephritis and strep TSS (both rare)
31
Q

What are goals of antimicrobial therapy for group A strep pharyngitis?

A
  • Limit transmission
  • Hasten sx w/ 1-2 day decrease in duration
  • Avoid complications
  • Eradicate group A strep to prevent acute rheumatic fever
32
Q

How effective are antimicrobials in treating group A strep pharyngitis?

A
  • Clinical response rate = 70-90% and bacterial eradication in over 80%
  • Higher clinical response and bactericidal eradication rates w/ cephalosporins than penicillins
33
Q

What are the antimicrobial options for group A strep pharyngitis?

A
  • Pen V 600 mg q12h (adults), 300 mg q12h (children)
  • Amox (more palatable for children but more adverse effects) 500 mg q12h (adults), 40-50 mg/kg/day q8-12h (children)
  • Alternatives = cefdroxil/ cephalexin; clinda; erythro
  • Recurrent or chronic carrier eradication = cefdroxil/ cephalexin; clinda; pen V + rifampin
34
Q

What is some essential pt counselling info for treating group A strep pharyngitis?

A
  • Analgesics for pain control; salt-water gargle, lozenges
  • Adhere to antimicrobial regimen
  • Potential adverse effects
35
Q

What is the typical response for antimicrobial therapy for group A strep pharyngitis?

A

Significant clinical improvement and bacterial eradication w/in 3-4 days

36
Q

What is the duration of antimicrobial therapy for group A strep pharyngitis?

A
  • Penicillin = 10 days
  • Cephalosporins = 5 days
  • Azithromycin = 3-5 days

Year 3 - Clinical (30 decks)

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