respiratory tract infections

Question 1

antibiotic used to treat pharyngotonsillitis

Answer 1

1. Penicillin V oral / oral amoxicillin for 10 days (Group A Strep)

Question 2

if penicillin not tolerated, what is 2nd line antibiotic used to treat pharyngotonsillitis?

Answer 2

cephalosporins (ceftriaxone)
clindamycin
Macrolides

Question 3

If there is a Beta lactam allergy, what antibiotic does one use to treat pharyngotonsillitis?

Answer 3

General rule of thumb:
In case of avoiding all β-lactam antibiotics, most guidelines recommend clindamycine or vancomycine for Gram-positive cover, an aminoglycoside or fluoroquinolone when Gram-negative cover is needed, and metronidazole in case surgery is performed in an area with anaerobic flora

Question 4

First line antibiotic to treat otitis media

Answer 4

Coamoxiclav: covers most otopathogens (Strep pneu, H influ, M catarrhalis)

alternatives:
1. Cephalosporin
2. Amoxicillin (although H influ and M catarr release beta lactamases)

or if allergy to beta-lactams: doxycycline/macrolide (azithromycin)

Question 5

Acute bacterial sinusitis meds

Answer 5

amoxicillin or coamoxiclav

penicillin allergy: doxycycline

Macrolides (clarithromycin or azithromycin) and trimethoprim-sulfamethoxazole are not recommended for empiric therapy because of high rates of resistance of S. pneumoniae

Question 6

why are high doses of antibiotics required for sinusitis and otitis media?

Answer 6

Enclosed space
Pneumococcal eradication

Question 7

is acute bronchitis treated with antimicrobials

Answer 7

No, usually viral cause

Question 8

CAP organisms

Answer 8

Streptococcus pneumoniae
Atypical pathogens
* Mycoplasma pneumoniae
* Chlamydia pneumoniae
* Legionella species

Respiratory viruses
Haemophilus influenzae
Aerobic Gram-negative bacilli (e.g. Klebsiella pneumoniae)
Staphylococcus aureus.

Question 9

aspiration pneumonia antibiotics

Answer 9

1. coamoxiclav or penicillin plus metronidazole
2. clindamycin

Question 10

lung abscess antibiotics

Answer 10

1. ampicillin-sulbactam
2. carbapenem
3. clindamycin
4. moxifloxacin
5. levofloxacin plus metronidazole

Question 11

Acute on chronic bronchitis

Answer 11

Amoxicillin, co-amoxiclav, doxycycline

Question 12

mild/moderate CAP, no comorbidity

Answer 12

cover pneumococci

Narrow spectrum Beta-lactam (penicillin/amoxicillin) – oral or IVI
If poor response at 2-3 days exclude TB & consider atypical bacteria
(add macrolide)

Severe Beta-lactam allergy: moxifloxacin (also covers atypical bacteria)

Question 13

comorbidity/>65 yrs

Answer 13

cover all conventional bacteria
Broad spectrum Beta-lactam (ceftriaxone/co-amoxiclav) – oral or IVI
If poor response at 2-3 days exclude TB & consider atypical bacteria
(add macrolide)
Severe Beta-lactam allergy: moxifloxacin (also covers atypical bacteria)

Question 14

severe CAP

Answer 14

cover all conventional bacteria & atypicals
Broad spectrum Beta-lactam (3rd generation cephalosporin/co-amoxiclav)
PLUS macrolide
Severe Beta-lactam allergy: moxifloxacin (also covers atypical bacteria)