Antimicrobial management of cardiorespiratory infections Flashcards
what are the 7 common viruses that cause upper respiratory tract infections?
rhinovirus, influenza/parainfluenza, coronavirus, adenovirus, respiratory syncytial virus, coxsackie, enterovirus
how do you treat uncomplicated influenza?
- If previously healthy: no treatment or oseltamivir PO (75mg BD PO/NG for 5 days) if physician feels patient is at serious risk of developing complications
- If at risk and not severely immunosuppressed: oseltamivir PO within 48 hours of onset or later at clinical discretion
- If at risk and severely immunosuppressed: :
o If dominant circulating strain has a lower risk of oseltamivir resistance (e.g. A(H3N2), influenza B); give Oseltamivir PO and clinical follow-up. Commence therapy within 48 hours of onset.
o If dominant circulating strain has a higher risk of oseltamivir resistance (e.g. A(H1N1)pdm09); give zanamivir INH within 48 hours of onset or later at clinical discretion. If unable to use inhaled preparations, use oseltamivir PO and clinical follow-up.
what is complicated influenza?
influenza requiring admission and/or with symptoms/signs of LRTI, CNS involvement and/or significant exacerbation of an underling medical condition.
how do you treat complicated influenza?
If not severely immunosuppressed:
o 1st line: Oseltamivir PO/NG
o 2nd line: Zanamivir INH or IV
If severely immunocompromised:
o If dominant circulating strain has a lower risk of oseltamivir resistance (e.g. A(H3N2), influenza B); Oseltamivir PO/NG is 1st line. Consider switching to Zanamivir INH++ ifpoor clinical response, evidence of GI dysfunction or subtype testing confirms a strain with potential oseltamivir resistance.
o If dominant circulating strain has a higher risk of oseltamivir resistance (e.g. A(H1N1)pdm09); give Zanamivir INH within 48 hours of onset or later at clinical discretion. Consider Zanamivir IV (600 mg twice daily for 5-10 days commenced within 6 days of the onset of symptoms) if patients cannot use inhaled preparations, have severe complicated illness (e.g. multiorgan failure).
what are the viral causes of pharyngitis?
o common: rhinovirus, influenza/parainfluenza, coronavirus, adenovirus, respiratory syncytial virus, coxsackie, enterovirus
o EBV, CMV, HSV, Measles, HIV etc.
what are the bacterial causes of pharyngitis?
o Group A, B, C Streptococci, Mycoplasma pneumoniae, Neisseria gonorrhoea, Corynebacterium diptheriae, etc.
what is the Centor criteria for streptococcal pharyngitis?
One point each for:
• Tonsillar exudate
• Tender cervical nodes
• Absence of cough
• History of fever
20% chance of GAS if 1-2 points - No treatment
50% chance of GAS if 3-4 points - Treatment advised
what is the treatment for group a streptococcal pharyngitis?
- Penicillin V 500mg QDS or 1g BD for 5- 10 days
* OR Clarithromycin 500mg BD for 5 days
What are the complications of Group A Streptococcus infection?
- Rheumatic fever
* Glomerulonephritis
when should you give antibiotics to children with otitis media?
In children, do not give antibiotics unless: • <2 years old • Symptoms persist for >48 hours • High fevers • Bilateral • Otorrhoea
what is otitis media treated with?
in children, treat with Amoxicillin for 5-7 days or Clarithromycin for 5-7 days
In adults, give Amoxicillin or co-amoxiclav or clarithromycin.
what are the complications of otitis media?
Complications include decreased hearing, mastoiditis and brain abscess.
what are the risk factors for pneumococcal pneumonia?
o Influenza
o Alcohol
o Smoking/COPD
o HIV