Antimicrobial management of cardiorespiratory infections Flashcards

1
Q

what are the 7 common viruses that cause upper respiratory tract infections?

A

rhinovirus, influenza/parainfluenza, coronavirus, adenovirus, respiratory syncytial virus, coxsackie, enterovirus

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2
Q

how do you treat uncomplicated influenza?

A
  • 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.
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3
Q

what is complicated influenza?

A

influenza requiring admission and/or with symptoms/signs of LRTI, CNS involvement and/or significant exacerbation of an underling medical condition.

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4
Q

how do you treat complicated influenza?

A

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).

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5
Q

what are the viral causes of pharyngitis?

A

o common: rhinovirus, influenza/parainfluenza, coronavirus, adenovirus, respiratory syncytial virus, coxsackie, enterovirus
o EBV, CMV, HSV, Measles, HIV etc.

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6
Q

what are the bacterial causes of pharyngitis?

A

o Group A, B, C Streptococci, Mycoplasma pneumoniae, Neisseria gonorrhoea, Corynebacterium diptheriae, etc.

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7
Q

what is the Centor criteria for streptococcal pharyngitis?

A

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

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8
Q

what is the treatment for group a streptococcal pharyngitis?

A
  • Penicillin V 500mg QDS or 1g BD for 5- 10 days

* OR Clarithromycin 500mg BD for 5 days

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9
Q

What are the complications of Group A Streptococcus infection?

A
  • Rheumatic fever

* Glomerulonephritis

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10
Q

when should you give antibiotics to children with otitis media?

A
In children, do not give antibiotics unless:
•	<2 years old
•	Symptoms persist for >48 hours 
•	High fevers
•	Bilateral
•	Otorrhoea
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11
Q

what is otitis media treated with?

A

in children, treat with Amoxicillin for 5-7 days or Clarithromycin for 5-7 days
In adults, give Amoxicillin or co-amoxiclav or clarithromycin.

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12
Q

what are the complications of otitis media?

A

Complications include decreased hearing, mastoiditis and brain abscess.

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13
Q

what are the risk factors for pneumococcal pneumonia?

A

o Influenza
o Alcohol
o Smoking/COPD
o HIV

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