EXAM 3 URTI Flashcards
Acute bronchitis common pathogens
respiratory viruses
acute bronchitis clinical presentation
Cough, sore throat, stuffy nose, malaise, H/A, fever, normal CXR
Acute bronchitis treatment
Self-limiting
Corticosteroids not necessary
ABX NOTnecessary –> bc virus
Acute exacerbations of chronic bronchitis
Chronic cough w/ productive sputum on most days for >3 consecutive months for 2 years
Hallmark signs:
Increased sputum purulence and volume
Increased cough or SOB
Acute exacerbations of chronic bronchitis pathogens
Common pathogens:
Strep pneumo
H. flu
Moraxella catarrhalis
Patients w/ frequent ABX use: enterobacterales, pseudomonas aeruginosa
Acute exacerbations of chronic bronchitis treatment
preferred:
amoxicillin/clavulanate
cefuroxime
cefpodoxime
Alternative:
Doxycycline
TMP/SMX
azithromycin
Risk for pseudomonas
Levofloxacin
acute pharyngitis pathogens
Respiratory viruses: rhinovirus, corona, adenovirus
Bacteria: streptococcus pyogenes (group A)
acute pharyngitis presentation
Sudden onset sore throat with dysphagia and fever
Tonsil swelling
Red
Tender lympnodes
acute pharyngitis testing
Throat culture:
Limitation –> delays
Rapid antigen detection test (RADT): standard of care
Limitation –> sensitivity 70-90% compared to culture, so chance of false negative
acute pharyngitis treatment
Target: strep pyogenes (group A)
Penicillin VK
Amoxicillin
acute pharyngitis treatment alternatives if penicillin allergy
Non-anaphylaxtic RXN:
Cephalexin
Cefadroxil
Cefuroxime
Cefpodoxime
Anaphylactic RXN:
azithromycin
clindamycin
Acute rhinosinusitis
Purulent nasal drainage
Nasal obstruction, pain/pressure
May last >4 weeks
Viral rhinosinusitis
Acute rhinosinusitis thought to be due to viral pathogen
Symptoms present <10 days, not worsening
Acute bacterial rhinosinusitis
Bacterial
Persistent symptoms > 10 days w/ no improvement
Severe symptoms –> fever, purulent nasal discharge, facial pain, 3-4 consecutive days at beginning of illness
Worsening symptoms – new onset of symptoms after initial improvement
Acute bacterial rhinosinusitis pathogenesis
Viral URTI causes mucosal inflammation
Decreased sinus drainage causes mucosal secretions trapped
Local bacteria proliferate –> bacterial infection
Acute bacterial rhinosinusitis common pathogens
Strep pneumo
H. flu
Moraxella catarrhalis
Acute bacterial rhinosinusitis presentation
major: purulent nasal discharge, nasal/facial congestion, facial pain, hyposmia, fever
Minor: H/A, ear pain, halitosis, dental pain, cough fatigue
Acute bacterial rhinosinusitis treatment
Initiate ABX as soon as bacterial infection established
Watchful waiting up to 7 days to observe improvement
1st line:
Augmentin TID or BID (in PCN allergy)
2nd line:
Doxycycline
levofloxacin
moxifloxacin
why are oral 2nd and 3rd gen cephalosporins, macrolides, and TMP/SMX not recommended?
concerns for S. pnuemoniae resistance
Acute bacterial rhinosinusitis treatment
MRSA and pseudomonas
MRSA:
add agent with MRSA coverage
pseudomonas:
increase levofloxacin to higher dose
Acute bacterial rhinosinusitis supportive care
Intranasal saline
Warm facial pack
NSAIDs / APAP
hydration
avoid antihistamines
caution with decongestants –> rebound
