Management of URTI

Question 1

How are URTIs transmitted?

Answer 1

• Droplets or aerosols containing virus are expelled when people with the URTI cough, sneeze or talk
• Spreads indirectly when person touches surface w virus droplets, then touches their nose or mouth
• When an infected person shares food with others during mealtime without a serving spoon

Question 2

What are the host innate mechanisms against URTI?

Answer 2

• Nostril hairs and mucus traps organisms
• Angle between pharynx and nose prevents particles from falling into the airways
• Mucociliary system in the lower airways transport the pathogens back to the pharynx
• Adenoids and tonsils also contain immunological cells that attack the pathogens

Question 3

When should oseltamivir be used for influenza?

Answer 3

For individuals who are either: hospitalised, high risk for complications or their illness is severe/complicated/progressive

Question 4

How should oseltamivir be dosed for influenza treatment?

Answer 4

Start within 48h of symptoms, max 5 days
PO 75mg BD x 5/7

Question 5

What is the main bacteria that is likely to be found with pharyngitis?

Answer 5

Group A beta-haemolytic streptococcus (mainly S.pyogenes)

Question 6

What are the criteria to decide if to treat pharyngitis with antibiotics?

Answer 6

Fever >38C
Swollen, tender anterior cervical lymph nodes
Tonsillar exudate
Absence of cough
Age

Score of 2-3: test 1st, treat if +ve
Score of 4-5: start empiric Abx

Question 7

What are the first line options for pharyngitis?

Answer 7

PO Penicillin V 250mg Q6H
PO Amoxicillin 500mg Q12H

Both regimens for 10 days

Question 8

What are the alternative options for pharyngitis treatment if patient has a penicillin allergy?

Answer 8

PO Cephalexin 500mg Q12H x 10/7
PO Azithromycin 500mg OD x 5/7
PO Clarithromycin 250mg Q12H x 10/7
PO Clindamycin 300mg Q8H x 10/7

Question 9

When should antibiotics be used for sinusitis?

Answer 9

→ Sx persist >10 days w/o any clinical improvement
→ Sx are severe: fever>30C, purulent nasal discharge, facial pain for >3 consecutive days
→ Sx worsen after an initial period of improvement: new-onset fever, increased nasal discharge

Question 10

What are the first line choices for sinusitis treatment?

Answer 10

PO Amoxicillin 500mg Q8H
PO Augmentin 625mg Q8H

Both for 5-7 days

Question 11

What are the choices for sinusitis treatment if patient has penicillin allergy?

Answer 11

PO Cefuroxime 500mg Q12H
PO Levofloxacin 500mg OD
PO Moxifloxacin 400mg OD

All for 5-7 days