RTIs Flashcards
normal respiratory flora
strep pneumoniae strep pyogenes strep viridans staph aureus moraxella catarrhalis haemophilus neisseria lactobacilla
signs/symptoms of pertussis
- Stage 1 = 1-2 wks, runny nose, low grade fever, mild cough
- Stage 2 = 2-10 wks, fits of rapid coughing with whoop on inspiration, vomiting, exhaustion
- Stage 3 = 2-3 wks, coughing lessens, susceptible to other rtis
pertussis diagnosis
- physical exam
- nasopharyngeal sample tested with PCR and cultures
main antibiotic for pertussis
macrolides
alternative treatment for pertussis
tmp/smz
group A strep pharyngitis presentation
- sudden sore throat
- age 5-15
- fever, headache
- N/V
- tonsillar inflammation
viral pharyngitis
- conjunctivitis
- coryza (inflammation, runny nose)
- cough
- diarrhea
- hoarsenes
strep throat workup process
- swab throat
- test using rapid antigen detection test (RADT)
- if negative do culture in kids
treatment for strep pharyngitis
- penicillin vk x 10d
- amoxicillin x 10d
- cephalexin x 10d
- z-pak if penicillin allergy
rhinosinusitis presentation
inflammation of nasal mucosal lining for at least 4 weeks
one of the following:
-severe symptoms lasting more than 3-4 days
-persistent symptoms lasting over 10 days
-worsening symptoms after viral URI
major criteria for bacterial sinusitis diagnosis
- purulent nasal discharge
- nasal congestion
- facial congestion
- fever
minor criteria for bacterial sinusitis diagnosis
- ear pain
- dental pain
- cough
- fever
bacterial sinusitis treatment
amoxicillin/clavulanate
10-14 days in children
5-7 in adults
alternatives for sinusitis treatment
doxycycline
quinolones
ceftriaxone
if first treatment fails in sinusitis
children: double dose of augmentin
adults: augmentin XR
adjunctive therapies to do in bacterial sinusitis
hydrate
analgesics
antipyretics
irrigation
therapies to NOT do in bacterial sinusitis
decongestants
antihistamines
sinusitis cultures obtained from
middle meatus endoscopically
community acquired pneumonia bugs
s. pneumoniae (75%)
legionella pneumoniae
chalmydia pneumonia
mycoplasma pneumoniae
factors in pneumonia development
- decreased clearance of airway debris
- depressed macrophage activity
- enhancement of aspiration
presenting signs of pneumonia
- fever over 100.4
- over 20 breaths/min
- tachycardia
- bradycardia if legionella
- crackles w/ inspiration
- infiltrates in chest x-ray`
symptoms of pneumonia
fever chills chest pain cough sputum
WBC components
- neutrophils
- lymphocytes (infection fighters)
- monocytes (lil macrophages)
- eosinophils (hypersensitivity)
signs of atypical pneumonia
nausea, vomiting, confusion
atypical bacteria in pneumonia
mycoplasma
legionella
chlamydia
pneumonia workup
- gram stain from sputum
- gram stain and culture from blood
- urine test for legionella
- chest xray for inflatrates
empiric pneumonia treatment
if MIC < 2
- amoxicillin/amp
- IV pcn
- imipenem
- macrolides
- quinolones
- cefuroxime
empiric treatment for outpatient CAP
macrolide w or w/o amoxicillin
3-7 days if no bacteremia
10-14 if bacteremia
treatment of CAP if macrolide resistance
- levo or moxi
- amoxicillin TID
- augmentin
- cefpodoxime
- doxy
treatment for inpatient CAP
ceftriaxone + azithromycin
patients at risk for pseudomonas
- hospital stay >5 days
- prolonged nursing home stay
- structural lung disease
- on steroids
- neutropenia
who to calculate ANC for
immunocompromised pts
info needed for ANC calculation
WBC
%neutrophils
%bands
duration of therapy for CAP
5 days - no immunocompromise or structural disease
7 days - moderate immunocompromise
10-14 days - poor clinical response, significant immunocompromise
patients at risk for h.influenzae pneumonia
adults elderly alcoholics COPD immune deficiencies
treatment for non beta-lactamase h.influenzae
amoxicillin
zpak
cefdinir
treatment for beta-lactamase producing h.influenzae
augmentin
cefpodoxime, cefdinir
zpak
patients at risk for moraxella catarrhalis pneumonia
smokers
copd
steroid users
treatment for moraxella catarrhalis
augmentin cefuroxime zpak moxi/levo doxy
patients at risk for legionella pneumonia
smokers elderly liver disease COPD high dose steroids
treatment for legionella
azithromycin (all macrolides)
levo/moxi
14-21 days for severe
7-14 days for mild-mod
treatment for mycoplasma pneumonia
doxy
zpak
clarithromycin
levo/moxi
treatment for chlamydia pneumoniae
doxy
zpak
clarithromycin
levo/moxi
patients at risk for staph aureus pneumonia
head trauma
prolonged hospitalizations
post flu
treatment for staph aureus
nafciullin cefazolin dicloxacillin clindamycin vanco if PCN allergy
specific monitoring parameters for patient undergoing treatment for pneumonia
- pain
- sleeping
- cough productive or not
- SoB
- mental status
monitoring parameters for infection in pneumonia
- lung exam
- chest xray
- cultures
- electrolyte changes
- sputum changes
monitoring parameters for antibiotic use in pneumonia
- renal function
- side effects of antibiotics
- labs of vanco serum levels
bacteria implicated in pneumonia of smoking/COPD patients
S.pneumo
H.flu
M.cat
legionella
bacteria implicated in postviral bronchitis pneumonia patients
S.Pneumo
S.aureus
bacteria implicated in pneumonia of healthy patients
mycoplasma
chlamydia pneumoniae
S.pneumoniae
bacteria implicated in pneumonia patients that use alcohol
S.pneumonia
anaerobes
