Lecture 18 Flashcards
what is pertussis, how does it sprad
whooping cough
bacteria remain on surface of airways
spread by cough and nasal droplets
how does bacteria work in pertrusis
bacteria produces toxins, which paralyze respiratory cell cillia. doesnt allow body to clear out mucous
pertussis common pathogen
bordetella perussis
aerobic gram - coccobacillus
humans are the only host
which age group is most susceptible
infants
first stage of pertussis
catarrhal stage, lasts 1-2 weeks.
runny nose, sneezing, low grade fever, mild cough
second stage of pertussis
paroxysmal stage (lasts 1-6 weeks)
bursts of cough, thick music, high pitched whoop
can vomit and get exhausted
appear normal between attacks
last stage
Convalescent stage, gradual recovery
what happens if you have ab in the cat stage
may prevent or minimize severity
what happens if you have ab in the paroxysmal stage
decreases transmission to others but does not affect duration of pertussis or severity of disease
Which class of ab do we give
macrolides, if allergy, then tmp smx
dose of macrolides - clarithromycin
7.5mg/kg PO BID x 7 days
dose of macrolides - azithromycin
10mg/kg PO daily x 5 days
dose of macrolides - erythromycin
10mg/kg PO QID x 7 days
if macrolide allergy, dose of TMP/SMX
4mg/kg PO BID x 10 days
does diphenhydramine work
no
does salbutamol work
no change in coughing
how effective it pertussis immunization
85%, but need boosters
who do we give antibiotics to as prevention
- infants under 2 months of age
- infants under 12 mo age if unvaccinated
- pregnant woman in 3rd trimester
- direct contacts prior to them developing signs/symptoms
what is defined as direct contact
- face to face exposure for less than 5 minutes
- shared confined space in close proximity for greater than an hour
- respiratory, oral, or nasal secretion –> kissing, coughing, sneezed upon
pertussis prevention dose azithromycin
Infant < 6 mo: 10mg/kg PO daily for 5 days
Child: 10mg/kg PO x 1 then 5mg/kg PO daily x 4 days
Adults: 500mg PO x 1 then 250mg PO daily x 4 days
pertussis prevention dose clarithromycin
child: 7.5mg/kg PO BID x 7 days
adults: 500mg PO BID x 7 days
which med to use in pregnant woman
azithro or erythro
allergy to macrolides, tmp/smx dosing prevention
child: 4mg/kg PO BID x 10 days
adult: 1DS tab PO BID x 10 days
Croup risk factors
- late fall- early winter disease
- age: 3 mo - 3 years of age
- boys > girls
Croup common pathogens
VIRUSES
parainfluenzae
influenza A/B
RSV
HMPV
coronavirus
croup signs/symptoms
cough, sounds like seal
rhinorrhea
symptoms are worse at night
inspiratory stridor
chest wall retractions
xray: steeple sign
non pharm for kids, croup
keep child calm
cold air
Croup Pharmacotherapy
Corticosteroids
croup dexamethasone dosing
0.6mg/kg PO 1 dose, max 16mg/dose
relieves symptoms within 2-3 hours
croup budesonide inhaled dosing
2mg inh via neb x 1 dose
croup inhaled epinephrine dosing
5mg epinephrine inh via neb, 10 minute onset, lasts 1-2 hours
what is bronchiolitis
LRTI
obstruction of small airways
- acute inflammation
- edema
- necrosis of epithelial cells
- increased mucous
bronchiolitis risk factors
age <1
ex prem
Congenital cardiac disease
chronic pulm disease
immunodeficiency
winter/spring
viral URTI
Bronchiolitis
VIRUSES
- RSV
-Inf A/b
-HMPV
etc
bronchiolitis
fever, cough, rhinorrhea
decreased feeding
increased resp rate, wheeze/crackles
grunting sound, nasal flaring, in-drawing, belly breathing
bronchiolitis pharmacotherpy
oxygen if O2 less than 92%
hydration
concern with children with pharmacotherapy
hyponatremia - low sodium, can develop seizures
how to prevent hyponatremia
add sodium to feeds
if IV fluid, add 0.9% NaCl in there
which therapies are not recommended for bronchiolitis
salbutamol
corticosteroids
antibiotics
antivirals
Palivizumab prevention treatment dosing and effectiveness
IM injection monthly, 3-4 doses, decreased hospitalizations
Nirsevimab prevention treatment dosing and effectiveness
IM injection, one dose per season, lasts 5 month, decreases severe RSV
acute bronchitis symptom
cough, occurs in winter, prolonged can last more than 3 weeks, no fever, normal vitals
common pathogens of acute bronchitis
Mycoplasma pneumonia
chlamydia pneumonia
bordetella pertussis
Treatment
- acetaminophen and ibuprofen
does dextromethorphan, codeine, OTC cough and cold prep work with acute bronchitis
no benefit, no evidence of efficacy
beta 2 agonists for acute bronchitis
may be evidence for those who have airflow obstruction
what is post natal age
time from birth till now
corrected gestational age
gestational age at birth + post natal age
