Exam 3- Upper Respiratory Tract Infections Flashcards
What is the most common pathogen involved in Acute Bronchitis?
Respiratory viruses
What is the clinical presentation of Acute Bronchitis?
Cough
Sore Throat
Coryza (stuffy/runny nose, sneezing, post-nasal drip)
Malaise
Headache
Fever
Normal Chest Imaging (not pneumonia)
note: can have sputum purulence, does not mean it is bacterial
What is the treatment for acute bronchitis?
NEVER USE ANTIBIOTICS
-Self-limiting disease
-Symptom management
-Note that corticosteroids are also not needed
Inappropriate prescribing of antibiotics for acute bronchitis has a number-needed-to-harm of what?
5 patients
(this is very low which indicates that it does a lot of harm)
What is the definition used to diagnose Chronic Bronchitis?
Chronic cough with productive sputum on most days for:
>/= 3 CONSECUTIVE months
for
2 consecutive years
What are the 3 signs of an acute exacerbation of chronic bronchitis?
Increased sputum purulence
Increased sputum volume
Increased cough or SOB
What are the most common organisms responsible for acute exacerbation of chronic bronchitis?
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Pts with frequent antibiotic use:
-Enterobacterales
-Pseudomonas aeruginosa
What are the preferred treatment options for exacerbation of chronic bronchitis?
Amoxicillin/Clavulanate
Cefuroxime
Cefpodoxime
What are the alternative treatment options for exacerbation of chronic bronchitis?
(note that these have less coverage for strep pneumoniae)
Doxycycline
TMP/SMX
Azithromycin
What do we use for Pseudomonas risk in patients with acute exacerbation of chronic bronchitis?
Levofloxacin
What is the treatment duration for acute exacerbation of chronic bronchitis?
5-7 days
What are the most common pathogens for acute pharyngitis?
Respiratory viruses: Rhinovirus, Coronavirus, Adenovirus
Bacteria: **Streptococcus pyrogenes (Group A) **
What is the clinical presentation of acute pharyngitis?
Sudden onset sore throat with dysphagia and fever
Pharyngeal hyperemia and tonsillar swelling
Enlarged, tender lymph nodes
Red, swollen uvula
Petechiae on soft palate
note that leaving this untreated can lead to rheumatic fever and heart failure
What is the standard of care for testing for acute pharyngitis? What are its limitations?
Rapid Antigen Detection Tests (RADT)
Limitation: 70-90% sensitivity means there is a chance for false negatives
*Requires back up testing with a culture or PCR-based test if the RADT comes back negative
*Note that cultures are no longer the standard
What are the drugs of choice for acute pharyngitis, assuming no other factors are at play?
Penicillin VK
Amoxicillin
If a patient with acute pharyngitis has a non-anaphylactic allergy to penicillins, what treatment options do we have?
Cephalexin
Cefadroxil
Cefuroxime
Cefpodoxime
If a patient with acute pharyngitis has an anaphylactic allergy to penicillins, what treatment options do we have?
Azithromycin
Clindamycin (be careful you get the right C drug)
What is the clinical presentation of Acute Bacterial Rhinosinusitis (ABRS)?
Persistent symptoms >/= 10 days with no improvement
Severe symptoms: fever, purulent nasal discharge, facial pain for 3-4 consecutive
*Note that patient may feel better and then have relapsing new onset symptoms
What is the main distinction between Acute Bacterial Rhinosinusitis and Viral Rhinosinusitis?
Viral: Symptoms present < 10 days, not worsening
Bacterial: Symptoms present >/= 10 days with no improvement
What are the most common pathogens associated with Acute Bacterial Rhinosinusitis?
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Pathogens with frequent antibiotic use:
-Staphylococcus aureus (MSSA, MRSA)
-Pseudomonas aeruginosa
What are the 2 approaches to Acute Bacterial Rhinosinusitis Treatment?
- Initiate antibiotic therapy as soon as a bacterial infection is established
- Watchful waiting up to 7 days to observe if improvement occurs without antibiotic therapy
What is the first line treatment option for Acute Bacterial Rhinosinusitis?
Amoxicillin/Clavulanate
What are the second line treatment options for Acute Bacterial Rhinosinusitis?
Doxycycline
Levofloxacin
Moxifloxaci
What is are the treatment options for Acute Bacterial Rhinosinusitis if there is concern for MRSA?
Doxycycline
TMP/SMX
Linezolid
Clindamycin
How should treatment of Acute Bacterial Rhinosinusitis be adjusted if there is a concern for P. aeruginosa?
Consider higher doses of Levofloxacin
What drugs are not recommended in Acute Bacterial Rhinosinusitis treatment due to a concern for S. pneumoniae resistance?
Oral 2nd and 3rd gen cephalosporins
Macrolides
TMP/SMX
What supportive care options for patients with Acute Bacterial Rhinosinusitis to treat symptoms?
Intranasal saline irrigation
Warm facial packs
NSAIDs and/or acetaminophen
Maintain hydration (thin secretions)
Avoid antihistamines (thickens mucus)
Caution with decongestants (concern for rebound congestion)
