Infectious Disease Medications

Question 1

What is the etiology of AOM?

Answer 1

Viral (Most common)

Bacterial
o Strep. pneumoniae
o H. influenzae

Question 2

What are the risk factors for AOM?

Answer 2

➢	Winter season/outbreaks of RSV or influenza virus
➢	Day-care center attendance
➢	Lack of breast-feeding
➢	Early age of first diagnosis
➢	Nasopharyngeal colonization with middle ear pathogens
➢	Genetic predisposition
➢	Siblings in the home
➢	Lower socioeconomic status
➢	Exposure to tobacco smoke
➢	Pacifier use
➢	Male gender
➢	Immunodeficiency
➢	Allergies

Question 3

How does a patient present with AOM?

Answer 3

• Acute onset
• Middle ear effusion
• Middle ear inflammation

Question 4

How do we treat AOM?

Answer 4

Acetaminophen and ibuprofen are fist line

Amoxicillin

Symptomatic treatment should be offered to all patients, regardless of diagnosis and use of antibiotics

Question 5

What is the etiology of pharyngitis?

Answer 5

Acute infection of the oropharynx or nasopharynx
➢ Viral (40-60% of cases)
➢ Bacterial (5-40% of cases)
• Group A β-hemolytic Streptococcus (GABHS)
• S. pyogenes (Strep Throat)

Question 6

How do we treat pharyngitis?

Answer 6

Analgesics: APAP first line (acetomenophen); ibuprofen; viscous lidocaine or throat sprays

Non-pharmacologic: Rest, fluids, lozenges, saltwater gargles

Antibiotics: Penicillin VK first line

Treatment failure: Clindamycin, amoxicilin-clavulanate

Question 7

How does a patient present with pharyngitis?

Answer 7

Sudden onset of sore throat
➢	Age 5 – 15 years
➢	Fever
➢	Headache
➢	N/V/Abdominal pain
➢	Tonsillopharyngeal inflammation
➢	Patchy tonsillopharyngeal exudates

If Viral: Conjunctivitis, Coryza, Cough

Question 8

What is the etiology or laryngitis?

Answer 8

Pathogens:
• Viral: Most common pathogen (any respiratory virus)
• Bacterial: M. catarrhalis or H. influenzae

Question 9

How does a patient present with laryngitis?

Answer 9

Recent onset of hoarseness or husky voice with a high pitch, often associated with a dry cough

Question 10

How do we treat laryngitis?

Answer 10

Voice rest and humidification

Question 11

What is the etiology of epiglottitis?

Answer 11

Most commonly due to Haemophilus influenzae type B (Hib)

Strep. pneumoniae, Groups A, B, and C Streptococcus, Candida albicans, Varicella zoster

Question 12

How does a patient present with epiglotittis?

Answer 12

Infection, inflammation, and swelling of the epiglottis

• Severe cases may cause complete airway obstruction

Question 13

How do we treat epiglotitis?

Answer 13

Maintain airway

IV antibiotics for 7-10 days total:
Peds: Cefotaxime, ceftriaxone
Adults: ceftriaxone, cefotaxime

Question 14

What is the etiology of pneumonia?

Answer 14

Bacteria 90% (S. pneumonia 20–60%)

Question 15

What are the risk factors for pneumonia?

Answer 15

• RR > 30 bpm
• PaO2 /FiO2 ratio < 250
• Multilobar inflitrates
• Confusion/disorientation
• BUN > 20 mg/dL
• WBC < 4000 cells/mm3
• Plts < 100,000 cells/mm3
• Temp < 36ºC
• Hypotension requiring fluid resuscitation

Question 16

How does a patient present with pneumonia?

Answer 16

Respiratory symptoms (cough, SOB), sputum production, pleuritic chest pain, fever, tachycardia, tachypnea

Physical exam: Rales, rhonchi, decreased bronchial breath sounds

Question 17

How do we treat pneumonia?

Answer 17

1st line: Macrolide
• Azithromycin, Clarithromycin&raquo_space; Erythromycin
• 2nd line: doxycycline (or minocycline)

β-lactam + macrolide (or doxycycline)- OPTION #1: Ceftriaxone, cefotaxime, high-dose ampicillin

Question 18

What is the etiology of bronchitis?

Answer 18

Most commonly viral etiology, but can be bacterial

Question 19

How does a patient present with bronchitis?

Answer 19

Inflammation of one or more bronchi, usually secondary to infection. Does not affect bronchioles or alveoli.
➢ Common during winter months
➢ Acute – affects all ages

Begins as URTI; hallmark is cough and occurs early

Question 20

How do we treat bronchitis?

Answer 20

Almost always self limited; symptomatic and supportive treatment only.

Chronic – primarily adults with COPD

Persistent symptoms > 2 weeks, consider bacterial involvement

➢ Macrolides – Azithro-, Clarithro- > Erythromycin
➢ Respiratory FQ – avoid unless recent h/o antibiotic use

Question 21

What is the etiology of sinusitis?

Answer 21

Usually preceded by a viral respiratory tract infection → mucosal inflammation. Sinus ostia (drainage system to nasal cavity) becomes blocked. Mucosal secretions become trapped, defenses are impaired → bacterial proliferation.

• S. pneumo
• H. influenzae

Really mostly viral 90 – 98%

Question 22

What are the risk factors for sinusitis?

Answer 22

• Age extremes (old, young)
• Smoke, other air pollutants
• Air travel & changes in atmospheric pressure
• Swimming
• Asthma/Allergies
• Dental disease
• Other medical conditions (DM, AIDS, pregnancy)
• Hospitalization

Question 23

How does a patient present with sinusitis?

Answer 23

Inflammation and/or infection of the paranasal sinus mucosa

Question 24

How do we treat sinusitis?

Answer 24

Augmentin, Doxy if PCN allergy

Question 25

What are the risk factors for skin and soft tissue infections?

Answer 25

* Obesity * Poor hygiene * Diabetes * Immune deficiency * Systemic or topical steroids * Problems with venous or lymphatic drainage of the area * Previous injury to the limb (e.g. trauma, radiotherapy, surgery) * Tinea pedis in the toes of the affected limb * Contact sports * IV drug use * Recurrent hospital admission

Question 26

How do we treat skin and soft tissue infections?

Answer 26

Dicloxacillin

Question 27

What is CURB-65?

Answer 27

Scoring system that uses presence/absence of disease modifying risk factors or clinical signs and symptoms to stratify patients based on mortality risk Helps identify appropriate tx setting for patient: Confusion, Uremia (BUN > 20), Resp Rate > 30, BP < 90/60, Age > 65 years