Respiratory and EENT Infections Flashcards
pneumonia patho
organism invades lung parenchyma and host defenses depressed. bacterial pneumonia happens when lungs primary defenses altered by viral infection or immunological probs. chronically ill patients all ages more prone.
pneumonia treatment goals
return to baseline resp status. fever resolves 2-4d. leukocytosis resolves day 4 of treatment. CXR may take 4+ weeks to normal.
pneumonia common pathogens (adults)
s. pneumonae. if underlying lung disease, nontypeable hemophilus influenza and moraxella catahhralis. staph aureus is a co pathogen with influezna. mycoplasm pneumonae. viral pneumonia.
CAP treatment categories
1 (previously healthy with no risk factors for DRSP) 2 patients with risks 3&4 (hosptial/ICU). CURB 65 criteria evaluates confusion, uremia, RR, low BP, age 65+
treatment of pnumonia for cat 1 (healthy adult, no risk factors)
macrolide (azythromycin, clarithromycin, erythromycin). if allergy, doxycycline. treat for min 5 days
treatment of pnumonia for cat 2 (comorbiditiy or risk for DRSP)
respiratory flouroquinolone (moxi, gemi, or levofloxacin) or beta lactam + macrolide (amoxicilin, amoxicillin/clavulinate, cefpoxidome, cefuroxime, or parenteral ceftriaxone followed by oral cefpoxidime). doxycycline may be used as alt to macrolide
adult age >60 with comorbidities pneumonia treatment option outpatient
ceftriaxone (Rocephin) 1g daily via IV or IM or levofloxacin 500mg IV daily . switch to PO once can tolerate
treatment of CAP in prego
main pathogens s. pneumonia, h. influenziae, m. pneumoniae, and viruses. treat with macrolides (erythromycin, azithromycin cat B, clarithro cat C) . if high risk (comorbid, high risk DSRP): bet lactam + macrolide
patient ed for pneumonia
can be viral or bacterial or mycoplasmal. ed regarding abx rx. hydration, no smoke, rest. symptoms of worsening status. expect clinical improvement in 48-72h
common pneumonia pathogens children
s. pneumonia (most common in all ages of ppl). increase in viral pneumonia with PCV7vaccine. consider chlamydia in infants 4-16 weeks. consider mycoplasm if >5 through teens. MRSA can also cause.
treatment of pneumonia in kids <5 with s. pneumoniae
amoxicillin 80-90mg/kg/d
ceftriaxone 50mg/kg/d until able to take PO
if allergic to penicillin: clindamycin or macrolide
treatment of pneumonia in infatn with suspected chlamydial pneumonia
aithromycin 20mg/kg/d x3 d
or
eyrythromycin EryPed 50mg/kg x14 days
treatment of pneumonia kids >5
mycoplasm or other atypical most likely.
azythromycin 10mg/kg on day 1 and 5mg/kg day 2-5
clarithromycin 15mg/kg/d in 2 divided dose (max 1g/d)
erythromycin 40-50mg/kg/d
decongestants for URI
systemic sympathomimetics (pseudoephedrine, phenylephrine), topical decongestants (phenylephrine/Neosinephrine, oxymetazoline/Afrin). constrict capillary vessels, decreasing congestion. ADRs: tachycardia, HTN, anxiety/restless/irritable. dont give in young children
URI patient education
proper dosing of decongestants. avoid in child <4, elderly, CV disease. URIs resolve 7-10 days. no abx needed. fever not in adult, but low grade in kids sometimes.
sinusitis strict criteria and pathogens
persistent, not improving at least 10 days. common pathogens s. pneumoniae 30%, h. flu 20%, moraxella catahrallis 20%, rarely staph. bacteria isolated in 70% of patients
first line abx for sinusitis
amoxicillin (adults 500mg TID) (kids 80-90mg/kg/d in high risk, 45 in low risk).
also high dose Augmentin option
first line abx for sinusitis, penicillin allergy
adults: doxycycline or resp flouro (levo)
kids: cefdinir, cefuroxime, cefpodoxime
if sinusitis worsens after 72h
consider resistance . switch to Augmentin if amoxicllin was first choice. If AUgmentan was first choice, consider levo for adults or cefdinir, cefuroxime, or cefpodoxime for kids
sinusitis education
saline nasal spray or drops liquefy secretions and decreases crusting near sinus ostia. topical decongestants decrease tissue edema and nasal resistance, likely enhance drainage of secretions from sinus ostia. corticosteroids helpful if chronic, no evidence for acute.
AOM cause
Eustachian tube dysfunction (neg pressure causes reflux of bacteria into middle ear). pathogens: s. pneumonaia, nontypeable h. influenziae, m. catahhralis, microbiology changing d/t pneumonia vaccine (s. pneumonia decreeing, h. influenzia increasing). respiratory viruss account for 40-75% of AOM in kids
dx of AOM and goals
moderate to severe bulging of TM or new onset ottohrea, mild bulging of TM and <48h ear pain or intense redness of TM . goals: clear infection from middle ear fluid; since treatment empiric, change of abx may be needed
AAP/AAFP guidelines for AOM treatment kids
observation without abx for 48-72h in child >2 with non severe illness. if giving abx, first choice amoxicillin 80-90mg/kg/d. other choice amoxicillin/clavulinate same amoxicillin dose
when in IOM should abx be given without first observation period?
all AOM in 6mos-2y/o unless just unilateral without otorrhea. in those >2, should not observe first if otorrhea with AOM or with severe symptoms
treatment of AOM if PCN allergy
cefinidir 14mg/kg/d in 1-2 doses
cefpoxidime 10mg/kg/d once daily
cefuroxime 30mg/kg/d in 2 doses
ceftriaxone 50mg IM 1 day or x 3 days
how is AOM treated if treatmetn failure at 48-72hr
if initially used amoxicilin or other first line, give augmentin or ceftriaxone IM/IV x3 days. if penicillin allergy, clindamycin plus 3rd gen cephalosporin
AOM education
proper use abx, predicted course of infection once start abx, fu in 2-3 days if no improvement, pain control, prevention (reconsider daycare attendance, breastfeed first 6mos, avoid bottle propping or supine bottle feeding, no tobacco smoke exposure, vaccine)
who can get initial observation before abx for AOM
low risk patients (>2y, mild otalgia, temp <39), adequate pain management essential, safety net rx WASP wait and see rx
pain management with AOM
tylenol 15mg/kg/dose ibuprofen 5-10mg/kg/dose topical analgesic (drops, TM must be intact, combo of antipyrine, benzocaine, glycerin)
gonococcal meningitis treat/prevent
eyrthryomycin ointment w/in 1 hour birth. treatment: IM ceftriaxone
chlamydial conjunctivitis in newborn treatment
systemic erythromycin
treatment of gonococcal conjunctivities
newborns, sexually promiscous teens/adults. parenteral ceftriaxone and sterile saline irrigations
conjunctivitis -otitis syndrome
children <6. h. influenzae majority. treat with high dose amoxicillin
viral conjunctiviitis
adenovirus, HSV, herpes zoster. treat with opthamalic abx. if suspect herpes keratitis, refer
patient education for contagous eye
admin instructions to prevent contamination, how to instill drops/ointment. ADRs. lifestyle: handwashing, dont share towels, throw away eye makeup, clear purulent discharge with wet cotton or washcloth
malignant otitis externa
rare but poss leathal infection by p. auruginosa. OE extends, invades surrounding tissues, causing osteomylitis of base of skull and purulent meninges. parenteral abx: aminoglycocide and carbenicilln for 4-6 weeks plus surgical debreidment
group A beta-hemolitic streptococci treatment
Penicillin V FOR 10 DAYS to prevent rheumatic fever even if no symptoms
250mg 2-3 times per day <27kg
500mg 2-3 times per day teens/adults >27kg
