Otitis Media/sinusitis/bronchitis/UTI Flashcards
acute otitis media is diagnosed based on
acute onset of pain and fever
a red, bulging tympanic membrane
middle ear effusion
AOM is managed by
analgesia (paracetamol or non-steroidal anti-inflammatory drugs)
when should antibiotics be used
minimally effective for most patients
most effective for children <2 years with bilateral otitis media and for children with discharging ears
national guidelines recommend antibiotic therapy for indigenous children
otitis media with effusion (OME)
presence of middle ear effusion (type B tympanogram or immobile tympanic membrane on pneumatic otoscopy) without AOM criteria
usually asymptomatic but can cause balance issues
management of OME
well children with OME with no speech and language delays can be observed for the first three months, perform audiological evaluation and refer to an ear, nose and throat specialist if they have bilateral hearing impairment >30dB or persistent effusion
children with effusions persisting longer than 3 months
may benefit from a 2-4 week course of amoxycillan
chronic suppurative otitis media
chronic discharge (at least 6 weeks) through a tympanic membrane perforation
managed with regular ear cleaning (dry mopping or betadine washouts) until discharge resolves, topical ear drops, audiological evaluation and ENT review
rhinosinusitis define
nasal blockage
nasal discharge
facial pain or pressure
reduction or loss of sense of smell
clinical features of acute rhinosinusitis that indicate spreading bacterial infection
clinical features of bacterial infection extending beyond the paranasal sinuses and nasal cavity into adjacent spaces (eg. meninges, ocular space, pariorbital space)
- acute onset confusion or impaired consciousness
- diplopia or impaired vision
- meningism (stiff neck, severe headache, photophobia)
- periorbital oedema or cellulitis
- proptosis
- signs of sepsis or septic shock
management of complicated bacterial rhinosinusitis (spreading)
hospitalisation for IV antibiotics and urgent surgical referral
how to tell the difference between bacterial and viral rhinsinusitis
treatment flow for acute rhinosinusitis
symptomatic therapy for acute rhinosinusitis
regular oral analgesia and salne nasal preperations (sprays, rinses or drops)
intranasal corticosteroids
intranasal and systemic decongestants are beneficial for short term (up to 5 days) if congestion is the prominent symptom
intranasal ipratropium bromide of rhinorrhea is the predominant symptom
ceasing smoking
return in 5 days if symptoms persist
how long does sinusitis usually last
2-3 weeks
when to offer an antibiotic in sinusitis
if the person is systemically unwell
has symptoms of a more serious illness or condition
has a high risk of complications
intraorbital or periorbital complications
intracranial complications
evidence for sinusitis self care
paracetamol or ibuprofen for pain
little evidence for nasal saline or nasal decongestants
no evidence for oral decongestants, antihistamines, mucolytics, steam inhalation or warm face packs
evidence for antibitoics for sinusitis
antibiotics make little difference to how long the symptoms last or the number of people who’s symptoms improve
possible adverse effects include diarrhoea and nausea
potential harms of antibiotics
adverse affects include diarrhoea, rash, hypersensitivity reactions
disrupt the balance of bacteria in the body, which can cause thrush or clostridium deficile
can breed superbugs
of every 100 patients treated with antibiotics for acute rhinosinusitis, 12 will have an adverse reaction
bacterial cause of sinusitis may be more likely if
symptoms last for more than 10 days
discoloured or purulent discharge
severe localised unilateral pain (particulalry pain over teeth and jaw)
fever
marked deterioration after an initial milder phase
choice of antibiotic for sinusitis
amoxicillin
if allergic: cefuroxime or doxycycline
antibiotic in pregnancy for sinusitis
erythromycin
what is bronchitis
self-limiting lower respiratory tract infection
most common cause of cough in general practice setting
symptoms of acute bronchitis
purulent or coloured sputum
dyspnoea
wheeze
chest discomfort or pain (due to frequent coughing)
nasal congestion
headache
fever
differential diagnosis of acute bronchitis
pneumonia
influenza
pertussis
asthma
heart failure
when to consider pneumonia instead of bronhcitis
consider in patients with tachypnoea at rest, tachycardia, persistent fever, rigors, hypoxaemia, or crepitations on auscultations that do not clear with coughing
what is the evidence for antibiotics for acute bronchitis
limited evidence for clinical benefit to support the use of antibiotics in acute bronchitis
may have a modest beneficial effect in frail, elderly people with multimorbidity
management of UTI
if not pregnant and mild symptoms, watch and wait and back up antibiotic
if pregnant immediate antibiotic
signs of pylonephritis
kidney pain/tenderness if back under rribs
new/different myalgia, flu like illness
shaking chills (rigours) or temperature
nausea/vomiting
send urine for culture if suspected and immediately start antibiotic
does vaginal discharge indicate UTI
75-80% with vaginal discharge do not have UTI
otitis externa treatment
topical dexamethasone + framycetin + gramicidin ear drops (sofradex)
instill 3 drops into the affected ear 3 times per day
a cotton ball must be placed into the ear canal for 20 minutes after the instillation of ear drops
cleaning and drying of the ear canal is important and must be done six hourly and/or prior to the instillation of ear drops
