Exam 3 lecture 2 Flashcards
What is acute bronchitis? Most common pathogen that causes it?
Inflammation of the bronchi, caused by respiratory viruses
Clinical presentation of acute bronchitis, compare to pneumonia
Normal chest imaging (pneumonia has consolidation on chest x ray)
Fever
HEadache
Malaise
Coryza (runny nose, sneezing, post nasal drip) (They could have pirulence/sputum but not bacterial like pneumonia)
Sore throat
Cough
Treatment of acute bronchitis
ANTIBIOTIC THERAPY NOT NECESSARY PLEASE
symptomatic management
Corticosteroids not necessary
What is harm associated with the use of antibiotics and acute bronchitis (NNH)
5 patients.
Why would chronic bronchitis pts be more susceptible to bacteria infection
We slow everything down due to chronic inflammation and makes it hard for the body to eliminate bacteria
What is the established diagnosis for chronic bronchitis
Chronic cough with productive sputum on most days for > 3 consecutive months for 2 years
WHat are the hall mark signs of acute chronic bronchitis exacerbation
Increased sputum purulence
Increased sputum volume
Increased cough or SOB
WHat are the most common organisms seen with acute exacerbation of chronic bronchitis? Most common organisms seen with frequent antibiotic use?
Most common- strep. pneumoniae
H. Influenzae
<praxella catarrharis
Patients with frequent antibiotic use
- enterobacterales
-pseudomonas aeruginosa
What is 1st line for acute exacerbation of chronic bronchitis
Amox/clav (preferred)
Cefuroxime
Cefpodoxime
What are alternative tx for acute exacerbation of chronic bronchitis
Doxycycline
TMP/SMX
Azithro
What treatment is used for acute exacerbation of chronic bronchitis with risk for pseudomonas aeruginosa
Levo
tx duration for acute exacerbation of chronic bronchitis
5-7 days
What are common pathogens for acute pharyngitis?
Respiratory viruses
- rhino virus, corona virus, adenovirus
bacteria
- strep pyogenes (group A) Important
Clinical presentation of acute pharyngitis
Sudden onset of sore throat with dysphagia and fever
Pharyngeal hyperemia and tonsillar swelling
ENlarged tender lymph nodes
Red swollen uvula
Petechiae on soft plate
WHat is an important thing to note about testing for acute pharyngitis
Rapid antigen tests are used instead culture.
Back up testing with culture or PCR based needed if RADT negative
treatment of acute pharyngitis? duration? WHen should alternatives be used?
Targeted tx for strep pyogenes so B lactams are drugs of choice
Penicillin VK and amoxicillin
10 day duration
alterantive only used with anaphylactic rxn
What would we use for acute pharyngitis in case of non anaphylactic allergy to penicillin? Anaphylactic rxn to penicillin?
Non anaphylatic- cephalosporins (Cephalexin, cefadroxil, cefuroxime, cefpodoxime
Anaphylactic- Azithro, clinda
Describe symptoms and duration of acute rhinosinusitis? Viral
- Acute rhinosiusitis
Purulent nasal drainage
Nasal obstruction, facial pain/pressure
May last >4 wks
How long does viral sinusitis resolve in?
10 days
What are 3 things to know about acute bacterial rhinosinusitis (ABRS)
Persistent symptoms- >10 days with no improvement
severe symptoms- Fever, purulent nasal discharge, facial pain for 3-4 consecutive days
Worsening symptoms- new onset of symptoms after initial impROvement in sx
What is the difference between recurrent acute rhinosinusitis and chronic rhinosinusitis
Recurrent aucte rhinosinusitis- 4 or more episodes of ABRS per uear
Chronic rhinosinuusitis- >2 signs/symptoms for 12 wks or longer
common pathogens for acute bacteria rhinosinusitis? Additonal pathogens with frequent antibiotic use?
Strep pneumoniae
H. Influenza
M. Catarrhalis
with frequent antibiotic use
- staph aureus (MRSA, MSSA)
P. aeruginosa
What are the two approaches to ABRS treatment
- initiate antibacterial therapy AS SOON as bacterial infection esablished
- Watchful waiting up to 7 days to observe if improvement occurs without antibiotic therapy
1st line tx of ABRS and duration
- amox clav 5-7 days
2nd line tx of ABRS
Doxy
levo
moxi
What are not recommended for ABRS
oral 2nd and 3rd gen caphalosporins, macrolides and TMP-SMX not recommended due to concerns of S. pneumoniae resistance
For ABRS, what do we do if we have a concern for MRSA?
Add agent with MRSA coverage (Doxy, TMP/SMX, Linezolid, clindamycin)
Maintain coverage for common organisms unless culture suggests monomicrobial infections with MRSA
For ABRS, what do we do if we have concern for P. aeruginosa
Levofloxacin
,aintain coverage for common organsims unless it is shown monobacterial infection
Spportive care acute bacterial rhinosinusitis
Avoid antihitamines- thickens mucus, more difficult to clear
Maintain hydration- thin secretions
CAution with decongestants
NSAIDs and/or acetaminophen
Warm facial packs
Intranasal saline irrigation
What antibiotics put the patient at risk for P. aeruginosa
Antibiotics that do not cover P. aeruginosa
like amoxicillin, doxycycline, Azithro
What are the different levofloxacin doses?
750 mg PO QD if trying to cover P. aeruginosa
500 mg PO QD for regular
What are the different types of genitourinary infections
Pyelonephritis
Cystitis
Urethritis
Prostatitis
Epididymitis
What are risk factors for genitourinary infections forthe different genders
Female- pregnancy
Sexual intercourse
Diaphragm/ spermicide use
Male- lack of circumcision
Prostatic enlargement
COndom catheter drainage
Both- urinary tract obstruction
Urinary instrument and catheterization
Neurogenic bladder
Renal transplantation
What are charcateristics of complicated UTIs
ANatomical abnormality of urinary tract
Recent urologic procedure or instrumentation
Immunocompromised pateints
Recurrent infections despite appropriate tx
Male sex
UTI in pregnancy
What are examples of anatomical abnormality of urinary tract
Obstruction (often due to calculi)
Hydronephrosis
Renal tract calculi
Colovesical fistula
What are patients with recent urologic procedure or instrumentation
Catheter
stenting
tubes
What is an uncomplicated UTI
Premenopausal women with normal anatomy
Patients not meeting criteria for complicated UTI
What is THE MOST common pathogen for genitourinary infections
E COLI
UTI signs and symptoms
- new onset dysuria (pain with urination), increased urinary urgency and increased frequency
- suprapubic heaviness sensationpain
-Urine may be turbid or foul smelling
-Hematuria
What are s/s of pyelonephritis
systemic igns of infection- fever, chills, rigors, nausea, vomiting, diarrhea
F;ank pain (costovertebral angle (CVA) tenderness)
What are some clinical presentations of complicated UTI
Classic UTI sx present but not always
- fever
-malaise
-altered mental status
incontinence
What are some clinical presentations of catheter associated UTI
Classic UTI sx often not present
Pain over kidney
Fever
Lethargy and malaise
What do we need for diagnosis of UTI and pyelonephritis
1 of cystitis symptoms or pyelonephritis symptoms
with
Microbiologic criteria
For diagnosis of UTI and pyelonephritis, what are cystitis symptoms? What are pyelonephritis symptoms?
cystitic symptoms- dysuria, increased urinary frequency, increased urinary urgency, suprapubic heaviness/pain
Pyelonephritis- Fever, chills, rigors, CVA, tenderness, malaise
What are some microbiologic criteria for UTI/pyelonephritis diagnosis
> 10^5 of > or = 1 bacterial species from a clean void
> 10^3 of > or = 1 bacterial species from a catheter (placed in last 48 hrs)
What tools do we use to help us with microbiologic criteria
Urinalysis
Urine culture
What are 4 key components of urinalysis
Bacteria present
WBC present
Leukocyte esterase present
Nitrite may or may not be present (enterobacterales convert nitrates to nitrites)
Why are urine cultures helpful?
Assist with identification of organism and confrim suscpetibility to antibiotic resistance.
Turn around time 2-3 days
In a urinalysis, what would the presence of squamous epithelial cells suggest?
It would suggest that the sample we got is not clean
What is the treatment of asymptomatic bacteriuria
Does not require treatment outside of a few specific cases. Most commonly in pregnancy only.
What is the most misdiagnosed infection? What does this entail
ASB diagnosed as UTI is one of the most common misdiagnosed infections
Over diagnosis leads to overtreatmet leads to antimicrobial resistance
Commonly used agents for UTI agents (EXAM)
Nitrofurantoin (uncomplicated only)
Sulfamethoxazole/trimethoprim
Sluoroquinolones - cipro, levo
Fosomycin (uncomplicated only)
Beta lactams
What are the 5 B lactams that are commonly used oral agents for UTI tx
Cephalexin
Cefadroxil
Cefpodoxime
Amoxicillin/clauvlanate
Amoxicillin (only after susceptibility confirmed)
What is the recommended duration of tx for complicated and uncomplicated UTI
Uncomplicated- 3-7 days
Complicated- 7-14 days
When should we not use an agent empirically
If 20% resistance is seen
What are considerations for prostatitis treatment
Must consider antibiotic penetration into the prostate
- no active transport of antibiotics into the prostate tissue
- Need an option with high level of free drug, low protein binding
What are recommended tx options for prostatitis
Fluoroquinolones
SMX-TMP
Some beta lactams (Cephalexin, amox/clav)
Treatment duration for prostatitis
2-4 wk
What is the definition of recurrent UTI
3 or more infections in 1 year
2 or more infections in 6 months
What are potential causes for recurrent UTI? When may we consider prophylactic antibiotic?
Sexual intercourse and diaphragm/spermicide use
Post menopausal women
Urologic abnormality
May consider prophylactic antibiotic if no correctable cause identified
Would increased water intake hep with UTI
YES
What would we look at to determine amoxicillin susceptibility?
Ampicillin
What antibiotic would we look at to determine cefpodozime susceptibility
Cefazolin (clinical pearl)
