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Phar455 > Shevchuk- pharyngitis > Flashcards

Shevchuk- pharyngitis Flashcards

1
Q

what is pharyngitis

A

inflammation in the back of throat aka sore throat

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2
Q

what causes pharyngitis

A
  • allergies
  • medications (ie steroid nasal spray)
  • irritating substances (hot/cold/smoke)
  • trauma
  • tumors
  • infection
  • *POINT BEING NOT EVERY SORE THROAT MEANS INFECTION
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3
Q

what is the most common cause of pharyngitis

A

rhinovirus- also can be many things like coronavirus or influenza, etc

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4
Q

is viral or bacterial more common

A

viral- wayyyyyy- up to 80% of the time

-means it is self limiting, can treat sx if bothersome but antimicrobials will not work

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5
Q

what virus causes mono

A

epstein barr virus- very sore throat, but not as common

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6
Q

where will antibiotics work for a sore throat?

A

only in 5-15% of bacterial cases- they are caused by group a hemolytic streptococci (GAS)
-most bacteria will go away on own, all other bacterial infections are self limiting

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7
Q

how common are bacterial cases

A

at most, 20%, and not all bacterial cases need treatment

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8
Q

why is there an overuse of antibiotics leading to antibiotic resistance?

A
  • patients expect them, aren’t satisfied without rx
  • will see other MD if don’t get them
  • quicker for MD to write rx than explain why don’t need one
  • BUT, not valid reasons, studies show they don’t care as long as you explain to them- might be better to rx a throat spray, analgesic etc instead
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9
Q

how it spreads

A

most among close contacts, with kids being the major reservoir

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10
Q

how common is group a strep in kids?

A

very unusual in children under 3, don’t consider ABs for them ususally

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11
Q

what is antimicrobial stewardship about?

A

not only using the right AB, but determining if they actually need one

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12
Q

signs and sx of GAS

A

-painful swallowing, exudates, enlarged anterior cervical nodes (neck), fever sometimes, increased WBCs (but blood work is rarely done so hard to tell), N/V (esp in children, but no diarrhea. Gut reacts to a lot of things in children very non specifically), scarlatiform (fine, pinpoint sand papery red rash/lesions) rash sometimes

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13
Q

what system helps determine the likelyhood of strep

A

center score

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14
Q

what are the anterior cervical lymph nodes?

A
  • prelaryngeal
  • thyroid
  • pretracheal
  • parathacheal
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15
Q

how to diagnose GAS

A
  • culture=gold standard (over 90% sensitivity), may take 1-2 days
  • rapid antigen detection test- takes minutes but very expensive, only 70-90% sensitivity
  • *CANNOT DIAGNOSE FROM SX ALONE
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16
Q

if pharyngitis is untreated, how long does it usually last

A
  • self limiting, lasts 8-10 days

- decrease in pain and SEs by about 16 hours at best with ABs

17
Q

why do we treat strep

A
  • to get rid of sore throat
  • reduce transmission to others
  • sometimes to reduce complications
  • prevent rheumatic heart disease
18
Q

what are complications of strep, and how to ABs play a role

A
  • immune complex with the antigen deposited in kidneys “acute post streptococcal glomerular nephritis”- no impact from ABs on development of this. 95% of cases will improve without treating kidney
  • tonsilitis (most common)- ABs can reduce sx, but this is still not that common in the grand scheme
  • peritonsillar absess
  • lymph adenitis
  • otitis media
  • sinusitis
19
Q

why could strep cause RHD (rheumatic heart disease), and how ABs play a role

A
  • antibodies against strep can cross react with heart proteins causing damage (usually to valves). Antibiotics can prevent RHD, however, it is so rare and you would have to treat a huge population to help one, all while spreading AB resistance- certainly worth it in children, in adults not as much
  • to prevent RHD, must treat with ABs within 9 days of sx onset- definitely have time to wait for a culture to come back
20
Q

starting AB therapy in _____ days of sx can improve by about ______ days

A

2-3
1-2 (more like 16 hours)
*important to recommend sx relief if bothering them

21
Q

when can a child go back to school after strep?

A

within 24 hours of AB therapy if feeling better as well

-in everyone, you reduce the risk of transmission to other in just 24 hours with AB treatment

22
Q

drug of choice for GAS and why

A
  • Penicillin V
  • narrow spectrum of activity, safe/effective/cheap
  • no known resistance to it from GAS; it is extremely sensitive to it
23
Q

dose of Penicilin V for GAS, therapy length, how to take, AE

A
  • 300mg TID (or QID, but harder to comply with, or 600mg BID, TID therapy is better because of short half life ie don’t do BID, and OD doesn’t work) for 10 days
  • preferably taken on an empty stomach
  • almost no AE except upset stomach possible
  • feel better in a few days
  • peds: 40mg/kg/day
24
Q

second choice for treating GAS, dosage, kids,

A

Amoxicillin- beta lactams have shown efficacy, but have broader spectrum than pen V

  • suspension tastes a lot better- use for kids, but still recommend pen V for adults
  • 500mg TID adults for 10 days
  • peds 40-50mg/kg/day TID for 10 days
  • can be taken with meals
25
Q

in penicillin allergies, what is the drug of choice for GAS?

A

macrolides (eryth/clarith/azith)

-true beta lactam allergy is only reason for this- they have increased SE and increased cost

26
Q

dose of ERYC

A

-250-500mg BID -QID for 10 days

27
Q

dose of ethylsuccinate

A

-40mg/kg/day BID-QID for 10 days

28
Q

dose of estolate

A

40mg/kg/day bID to QID for 10 days

29
Q

dose of azithromycin

A
  • 12mg/kg/day for 5 days (max 500mg/day)

- PKs allow it to bind to WBCs and only need to be used for 5 days and be equivalent to 10 days of clarith/eryth)

30
Q

rate of eryth (therofre clarith and azith will be too) resistance to GAS

A

10-15%, but could be even more

31
Q

disadvantages to macrolides in GAS

A
  • resistance
  • increased SEs
  • broad spectrum therefore resistance problems for other organisms, and increased impact on resistance
  • increased cost
32
Q

antibiotics saved for second line or treatment failures

A
  • cephalosporins- will definitely work, but more broad spectrum and therefore increased impact on resistance, also more money)
  • clindamycin (same prob as above)
  • IM penicillin (rarely used)
33
Q

trimethoprim and sulfamethoxazole - does it work for GAS

A

no

34
Q

symptomatic treatment for GAS

A
  • oral analgesics
  • throat spray- super short acting, don’t usually spray on right area, increased cost
  • lozenges- very soothing (demulcent effect, not drug in lozenge usually. Don’t need antiseptic ones)
  • gargling with salt water (1/4 tsp per L)
  • fluids
  • rest
  • popsicles

Phar455 (6 decks)

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