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Pharmacology > Common infections > Flashcards

Common infections Flashcards

1
Q

Definition of pharyngitis

A

Infection or irritation of the pharynx and/or tonsils

Most cases are of viral origin, benign + self-limiting

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2
Q

Which specialty encounters the majority of pharyngitis patients?

A

Paediatrics

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3
Q

Causative organisms in pharyngitis?

A

Viral

  • rhinovirus
  • corona virus
  • adenovirus
  • parainfluenza
  • influenza
  • Epstein-Barr
  • cytomegalovirus

Bacterial

  • GABHS (15-30% paediatric cases; 5-10% adult cases)
  • mycoplasma pneumoniae
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4
Q

Clinical presentation in pharyngitis

A 
Sore throat
Odynophagia
Fever
Anterior cervical lymphadenopathy
Pharyngotonsillar exudate
NO cough
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5
Q

Treatment of pharyngitis

A
  1. Oral penicillin is 1st line (94% clinical response and 84% strep eradication rate)
  2. Cephalosporins 1st line in pt w/ history of recent AB use, recurrent pharyngitis infection, high community penicillin failure rate
  3. Macrolides if penicillin or cephalosporins C/I
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6
Q

Definition of tonsillitis

A

Inflammation of the tonsils

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7
Q

Causative organisms in tonsillitis

A

Viral

  • Epstein-Barr virus
  • cytomegalovirus
  • herpes simplex virus
  • adenovirus

Bacterial
- GABHS

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8
Q

Clinical presentation of tonsillities

A 
Sore throat
Fever
Halitosis
Dysphagia
Odynophagia
Tender cervical lymph nodes
Tonsillar exudate
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9
Q

What is dysphagia?

A

Difficulty swallowing

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10
Q

What is odynophagia?

A

Painful swallowing

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11
Q

Complications of tonsillitis

A

Peritonsillar abscess (Quinsy)
Peritonsillar cellulitis
GABHS complications

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12
Q

Complications of GABHS

A

Scarlet fever
Acute poststreptococcal glomerulonephritis
Rheumatic fever

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13
Q

Treatment of tonsillitis

A
  1. Oral penicillin
  2. Penicillin allergy
    - cephalosporin
    - macrolide
    - clindamycin
  3. Recurrent tonsillitis
    - amoxicillin/clavulanate
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14
Q

Definition of rhinosinusitis

A

Inflammation of the lining of the nasal cavity and paranasal sinuses

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15
Q

Causative organisms of rhinosinusitis

A

Viral
- common cold

Bacterial

  • strep pneumonia
  • strep pyogenes
  • morazella catarrhalis
  • staph aureus
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16
Q

Clinical presentation of sinusitis

A 
Pain + pressure over cheek radiating to frontal region/teeth (often maxillary sinuses affected)
Postnasal discharge
Blocked nose
Cough
Discoloured nasal discharge
Poor response to decongestants
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17
Q

Complications of sinusitis

A

Orbital cellulitis
Osteomyelitis
Intracranial extension
Cavernous sinus thrombosis

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18
Q

What ocular sign is present in caverneous sinus thrombosis?

A

Ophthalmoplegia

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19
Q

Acute viral rhinosinusitis treatment

A

Symptomatic
Analgesic
Antipyretic
Saline irrigation
Intranasal glucocorticosteroids in underling allergic rhinitis
Oral decongestants in Eustachian tube dysfunction
Intranasal decongestants e.g oxymetazoline (no evidence)
Antihistamine
Mucolytics

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20
Q

Bacterial sinusitis treatment

A 
1st line
- Amoxicillin w/wo clavulanate
-  Doxycycline
2nd line
- fluoroquinolones (levofloxacin, moxifloxacin)
- clindamycin
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21
Q

When prescribing intranasal glucocorticosteroids, which patients must you take caution with?

A

Hypertensive
Cardiovascular disease
Angle closure glaucoma
Bladder neck obstruction

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22
Q

Causative organisms of community acquire pneumonia (CAP)

A 
Bacterial
- strep pneumo
- haemophilus influenza
- moraxella catarrhalis
Above account for 85% of cases
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23
Q

Which organism is a likely cause of CAP in a chronic alcoholic?

A

Klebsiella pneumoniae

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24
Q

Which organism is a likely cause of CAP in post-influenza patient?

A

Staph aureus

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25
Q

Which organism is a likely cause of CAP in bronchiectasis patient?

A

Pseudomonas aeruginosa

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26
Q

Which organism is a likely cause of CAP in cystic fibrosis patient?

A

Pseudomonas aeruginosa

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27
Q

Atypical causes of CAP?

A

Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella spp

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28
Q

Clinical presentation of CAP?

A

Fever
Productive cough
Pleuritic chest pain

29
Q

How does one diagnose CAP?

A

Clinically

CXR

30
Q

Outpatient treatment of CAP?

A

Patient <65yo w/o comorbidities or AB exposure in past 90 days

  • oral high dose amoxicillin
  • oral macrolide/azalide in presence of severe betalactam allergy

Patient >65 yo, w/ comorbidities or AB within past 90 days

  • oral amoxicillin-clavulanate
  • oral 2nd generation cephalosporin
31
Q

Hospital treatment of CAP?

A

Patient <65yo w/o comorbidities or AB exposure in past 90 days

  • IV amipicillin
  • IV penicillin if above unavailable

Patient >65 yo, w/ comorbidities or AB within past 90 days

  • IV amoxicillin-clavulanate
  • cefuroxime
  • 3rd gen cephalosporin (ceftriaxone; cefotaxime)

Severe CAP
- same options as above + macrolide

Definitive therapy based on drug susceptibility testing

32
Q

Role of respiratory fluoroquinolones in treatment of CAP

A

Moxifloxacin, levofloxacin
Reserved for patients with
- severe beta lactam allergy
- no alternative to beta-lactam/macrolide treatment

33
Q

Pathophysiology of urinary tract infections

A

Ascending colonization of the urinary tract

a) vaginal flora
b) perineal flora
c) fecal flora

34
Q

Causative organisms of acute cystitis

A 
Escherichia coli
Staphylococcus sacrophyticus
Klebsiella
Proteus
Enterobacter
Pseudomonas
35
Q

Clinical presentation of acute cystitis

A 
Dysuria
Frequency
Urgency
Haematuria
Suprapubic discomfort
36
Q

Diagnosis of acute cystitis

A

Urine dipstix
Midstream clean catch urine specimen
- urine microscopy
- urinalysis

37
Q

Treatment of acute cystitis

A

1st line
- nitrofurantoin 100mg BD x5days
- trimpethoprim/sulfamethoxazole 960mg BD
- fosfomycin tromeatamol
2nd line
- fluoroquinolones (ofloxacin, ciprofloxacin, levofloxacin)
- beta lactams (amoxyclav, cefaclor, cefpodoxime)

38
Q

Why are beta lactams not recommended for 1st line acute cystitis treatment?

A

Widespread e.coli resistance rates >20%

39
Q

Why are fluoroquinolones not recommended for 1st line acute cystitis treatment?

A

Preserve effectiveness against resistance

40
Q

What are options for acute cystitis treatment in pregnancy?

A

Penicillin

Cephalosporins

41
Q

Definition of pyelonephritis

A

Infection of the renal pelvis + kidney

42
Q

Which population group is pyelonephritis most often seen in?

A

Most often seen in young adult women

43
Q

Clinical presentation of pyelonephritis?

A

Fever
Flank pain
Malaise
WBCs + bacteria in urine

44
Q

Causative organisms of pyelonephritis?

A

E.coli
Klebsiella pneumoniae
Staphylococcus saprophyticus

Rare:
Candida
Enterococcus
Enterobacteriaeceae
Pseudomonas aeruginosa
Ureaplasma spp
45
Q

Outpatient treatment of acute pyelonephritis

A

Empiric therapy:

  • ceftriaxone IV 1 g daily for 48 hours, or until fever subsides OR
  • entamicin IV 6 mg/kg daily (ensure normal renal function)
  • piptaz

Switch to oral therapy as soon as the patient is able to take oral fluids:
- amoxicillin/clavulanic acid, oral, 875/125 mg 12-hourly for 7 days.

Change antibiotics according to culture and
sensitivity result

46
Q

Nitrofurantoin in acute pyelonephritis treatment
Mechanism of action
Bioavailability
Susceptible strains

A

It inactivates or alters bacterial ribosomal proteins and other macromolecules that may interfere with metabolism and cell wall synthesis.
Bioavalability increased with food
Susceptible strains e.coli , klebsiella, enterobacter, staphylococcus sacrophyticus and aureus

47
Q

Quinolones in acute pyelonephritis treatment

Mechanism of action

A

Inhibits bacterial DNA gyrase
Responsible for cutting and supercoiling DNA
Post AB effect against gram negative and
positive organisms

48
Q

Quinolones in acute pyelonephritis treatment

Pharmacokinetics

A

80% systemic available after oral dose
Bioavailability decreased by antacids
Large volume of distribution including eye, lungs, prostatic fluid, CSF, bone and cartilage
Entero-hepatic cycle: AB in urine 5 days after stopping Rx
t½=4 hours. Rx less often than t½ (post AB effect)
Removed by glomerular filtration and tubular secretion
Less active in acidic urine

49
Q

Side effects of quinolones?

A 
GIT
CNS
Hypersensitivity
QT prolongation/ torsades de pointes
Liver and renal damage
Reversible arthralgia
Tendonitis/ tendon rupture
Drug interactions
50
Q

Dosages of quinolones in acute pyelonephritis treatment

A 
Ciprofloxacin: 
- 250-500 mg bd p.o
- 200-400mg IVI 8-12 hourly
Norfloxacin:
- 400 mg bd for 7-10 days
- (3 days Rx if uncomplicated)
Ofloxacin: 
- 100 mg bd 3-7 days
- 200 mg bd (pyelonephritis)
51
Q

Co-trimoxazole in acute pyelonephritis treatment

Mechanism of action

A

Sulfamethoxazole + trimethoprim

Inhibits folic acid production

52
Q

Complications of co-trimoxazole use?

A

Hypersensitivity reaction (SJS)
Aplastic anemia
Hemolytic anemia

53
Q

Contraindications of co-trimoxazole use?

A

Newborn
Porphyria
G6PD deficiency

54
Q

What score can be used for assessing a sore throat?

A

McIsaac score for % of GAS infection

55
Q

Which antibiotics are not recommended for empiric therapy of bacterial rhinosinusitis?

A

2nd/3rd generation cephalosporins (cefuroxime, cefpodoxime)
Macrolides (clarithromycin)
Trimethoprim sulfamethoxazole

56
Q

Discuss treatment of acute otitis media

A

Ibuprofen
Paracetamol
Topical benzocaine if no perforation

  1. Amoxicillin
  2. Augmentin
  3. Macrolides/clindamycin
  4. Cephalosporins
57
Q

How long do we treat children 2 years, children with tympanic
membrane perforation, and children with recurrent AOM for?

A

10 days

58
Q

How long do we treat children 2 years without a history of recurrent AOM for?

A

5-7 days

59
Q

Which infectious conjunctivitis is more likely?

A

Viral > bacterial

60
Q

Which population group is bacterial conjunctivitis more likely in?

A

Children > adults

61
Q

Name the red flag signs of ophthalmology

A 
VA reduction
Ciliary flush
Photophobia
Severe FB sensation
Corneal opacity
Fixed pupil
Severe headache w/ nausea
62
Q

Discuss the treatment of conjunctivitis

A

If bacterial:

  1. Erythromycin ophthalmic ointment
  2. Polymixin-trimethoprim drops
  3. Fluoroquinolone ophthalmic drops
  4. Azithromycin drops
63
Q

What is the common cause of anterior blepharitis?

A

Staph

Seborrhea

64
Q

What is the common cause of posterior blepharitis?

A

Meibomian gland dysfunction
Rosacea
Seborrheic dermatitis

65
Q

Discuss treatment of blepharitis

A

Topical/systemic antibiotics

Topical glucocorticoids

66
Q

Which microorganisms most commonly cause keratitis?

A

Bacterial

  • staph aureus
  • pseudomonas aeruginosa

Viral

  • herpes simplex
  • adenovirus
67
Q

What is a hordeolum?

A

An acute purulent inflammation of the eyelid

AKA a stye

68
Q

Discuss treatment of hordeola

A

Warm compress 15min x 4/d

Incision and curettage

69
Q

In which patients do you not treat cystitis with a fluoroquinolone?

A

Pregnancy

Children

Pharmacology (32 decks)

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