Treatment Of Respiratory Tract Infections

Question 1

What is the general approach to antibiotic therapy in pharyngitis?

Answer 1

1. Start Abx if symptoms are severe, in epidemic & history of rheumatic fever.
2. Antimicrobial therapy should be reserved for those who have features of disease or positive tests
3. Abx treatment decreases inf period from 10 to 1-2 days.
4. Delayed Ab treatment up to 9 days prevents complications
5. Children should be kept at home till afebrile and after 24 hours from initiation of Abx treatment
6. Symptomatic contacts recieve Abx without culture

Question 2

Mention Abx therapy of pharyngitis

Answer 2

Penicillin V/K OR Amoxicillin OR Benzathine penicillin (single dose IM)
Non-type I allergy: 1st Gen cephalosporins
Type I allergy: azithromycin for 5 days OR clindamycin

Question 3

Diphtheria Abx

Answer 3

Penicillin OR erythromycin

Question 4

Compare acute OM & OM with effusion

Answer 4

A: rapid onset, inflammation with erythema, otalgia & effusion, need ABx therapy.
W/effusion: no symptoms of acute illness, presented up to 6 months after acute episode, no need for antibiotic, occurs in atopic children.

Question 5

Describe Abx therapy of OM

Answer 5

Amoxicillin (+clavulanate if severe)
Non-type 1 allergy: 2rd gen cephalosporins
Type 1 allergy: azithromycin 5 days OR clindamycin
Failure of therapy: clindamycin

Question 6

Compare CI of oral/intranasal decongestants

Answer 6

O: children less than 2 yrs, pts with HTN or ischemic heart disease
IN: less than 6 yrs, for 3 days only (rebound nasal congestion)

Question 7

2nd gen antihistamines may play a role in …….

Answer 7

Chronic sinustitis & allergic types

Question 8

Mention an indication of intranasal corticosteroids

Answer 8

Acute bacterial rhinosinusitis

Question 9

Abx therapy of ABRS in children

Answer 9

Fisrt line: amoxicilliun + calvulanate, second line: same with inc dose
Non type I allergy: Clindamycin + cephalopsporin
Type I: Levofloxacin
Severe hospilalized: ampicillin sulbactam OR ceftriaxone OR levofloxacin

Question 10

Difference between Abx treatment in adult than in child

Answer 10

In adult:
Doxycycline may be given first line or in beta lactam allergy.
Moxifloxacin may be given in beta lactam allergy

Question 11

What is the precautioun of using antitussives in bronchitis?

Answer 11

Should be used cautiously when cough is productive

Question 12

When is antibiotic used in bronchitis?

Answer 12

Persistent fever, respiratory symptoms for more than 4-6 days for predisposed pts (elderly/immuncom)l the possibility of concurrent bac inf is suspected.

Question 13

When is chronic bronchitis diagnosed

Answer 13

Chronic productive cough with sputum more than 3 cons months for 2 consecutive years without an underlying etiology of bronchiectasis or TB

Question 14

What is the first priority in pneumonia treatment?

Answer 14

Evaluate adequacy of respiratory function

Question 15

Write a short note on CURB 65

Answer 15

1. Confusion
2. BUN greater than 7 mmol/L (19 mg/dL)
3. RR more than 30
4. BP less than 90 mmHg systolic or less than 60 mmHg diastolic.
5. More than 65 yrs of age
   A score of 0-1 is treated at homep
   2 , consider hospilatlization or monitor closely as outpatient
   3-5 , required hospitalization with ICU addmission.

Question 16

Mention therapy regimen for ICU pseudomonas patient.

Answer 16

Combination:
1. IV beta lactam
Plus cipro, levofloxacin 
OR 
2. Aminoglycoside plus azithromycin or fluoroquinilones

Question 17

If ORSA is suspected, …… are added

Answer 17

Vancomycin or Linezolid

Question 18

When to convert a patient to oral therapy?

Answer 18

A. Vital signs are stable for 24 hrs. Temp, RR, HR, SBP
B. The oxygenation is improved and stable
C. Tolerating oral therapy
Switch within 48-72 hrs of stability

Question 19

…… is inactivated by lung surfactant

Answer 19

Daptomycin

Question 20

Duration of therapy with -ve blood culture is …..

Duration of therapy with +ve blood culture is ….

Answer 20

7-14 days

14 days after -ve blood culture

Question 21

TTT of aspiration pneumonia

Answer 21

1, Oral aspiration: ampicillin/sulbactam + clindamycin/metronidazole
2, Gastric aspiration: piperacillin/tazobactam or ticacillin/clavulanate + clindamycin/metronidazole