Upper Respiratory Flashcards
What are the two probable etiologies for otitis media? What are they resistant to?
1) Streptococcus pneumoniae: Resistance via penicillin-binding proteins
2) Haemophilus influenzae (non-typeable) & Moraxella catarrhalis: Resistance via β-lactamases
Acute otitis media:
1) Who is more susceptible?
2) What are the diagnostic criteria?
1) Children
2)-Moderate-to-severe bulging of the tympanic membrane or new onset otorrhea not due to acute otitis externa
-Mild bulging and onset of ear pain within the last 48 hours or intense erythema of the tympanic membrane
List 2 S/Sx of acute otitis media
1) Otalgia (mod/ severe if >48hrs)
2) Fever (severe if >/102.2)
1) Acute otitis media in kids can always be treated with APAP or ibuprofen, but when do you need to use antibiotics?
2) When can you choose to either use antibiotics or observation?
1) 6 months–12 years old + moderate to severe pain + 102.2°F
-6–23 months old + nonsevere bilateral acute otitis media
2) 6–23 months old + nonsevere unilateral acute otitis media
-24 months to 12 years old + nonsevere acute otitis media
Acute otitis media:
1) What is the first line of defense?
2) If a patient has received amoxicillin in the last 30 days, has concurrent purulent conjunctivitis, or has a history of recurrent infection unresponsive to the first line of defense, what’s the next first line Tx?
3) How should you Tx a pt if there’s failure @72 hours?
4) How long should Tx last?
1) Amoxicillin 80-90mg/kg/day orally in 2 doses
2) Augmentin [90mg/kg/day +6.4mg clavulanate in 2 doses]
3) Clindamycin 30-40mg/kg/day PO in 3 doses
-can also add 2nd or 3rd gen cephalosporin
4) 10 days
Acute otitis media:
1) Addition of what may decrease the length of time necessary for middle ear drainage when compared with a topical antibiotic alone?
2) How can you prevent this condition?
1) Dexamethasone to a topical antibiotic (ciprofloxacin (CiproDex))
2) Influenza, Haemophilus influenzea & pneumococcal vaccines
Recurrent AOM:
1) How is recurrent AOM defined?
2) What should you consider? Why?
1) 3 episodes in six months; 4 episodes in one year
2) Consider tympanostomy tubes (T tubes) to prevent AOM
-Reduces risk of hearing loss and language / learning disabilities
What is a formulary?
List of drugs for use
AOM review:
1) What are the criteria for giving antibiotics to a pt 6mo-12yo?
2) What abt 6-23mo old specifically?
1) 6 months – 12 years old + bilat moderate to severe pain (pain for 48 hours) + 102.2°F
2) 6 – 23 months old + nonsevere bilateral acute otitis media
Amoxil 80-90 mg/kg/day BID is the first line Tx for what?
AOM
What is the etiology of ABRS? (acute bacterial rhinosinusitis)
1&2) Streptococcus pneumoniae & Haemophilus influenzae
3) Moraxella catarrhalis
ABRS: What are the 3 most common clinical presentations/ diagnostic criteria?
1) Persistent/ not improving >10 days
2) Severe S/Sx >3-4d
3) Double-worsening (>3-4d)
ABRS:
1) What is not a recommended Tx?
2) When are intranasal corticosteroids recommended?
3) How long is Tx for adults?
4) What abt for kids?
1) Nasal decongestants and antihistamines
2) Only for patients with a Hx of allergic rhinitis
3) 5 – 7 days
4) 10 – 14 days
ABRS in kids:
1) What should be your first Tx?
2) What should be your second line?
3) What if a pt has a type I beta lactam sensitivity?
4) What abt for non-type 1 sensitivity?
1) Augmentin PO 45mg/kg/day (1/2 of the dose for AOM)
2) Augmentin PO 90mg/kg/day
3) Levofloxacin
4) Clindamycin + cefixime
ABRS adults:
1) First line Txs?
2) Second line Tx?
3) What if beta lactam allergy?
1) Augmentin PO 45 mg/kg/day BID or 875mg BID
-Augmentin PO 90mg/kg/day BID or 2000mg BID
3) Doxycycline PO [100mg BID or 200mg Qday]
ABRS:
1) When do you Rx Doxycycline 100mg BID?
2) When do you Rx Levofloxacin 10-20mg/kg/day?
3) What abt Clindamycin 30-40 mg/kg/day tid + cefixime 8mg/kg/day BID?
1) Adult Type I or Type II PCN allergy
2) Pediatric Type I PCN allergy
3) Pediatric Type II PCN allergy
1) What is usually the etiology of acute pharyngitis?
2) What 2 lab tests can be done for this Dx?
3) Why is it important to start abx?
4) What do you need to prevent?
1) β-hemolytic Streptococcus pyogenes
2) Throat swab + culture & RADT
3) Contagious period reduced to 1 day when antibiotics are started
4) Acute rheumatic fever
What are some temporary pain relief options for acute pharyngitis?
Antipyretics, analgesics, and nonprescription lozenges and
What are all the abx options for acute pharyngitis for both adults and kids? When do you use each?
1) Amoxil - 1st line
2) Cephalexin (Type II PCN allergy)
3) Azithromycin (Type I PCN allergy)
4) Clindamycin (Type I PCN allergy)
How do you dose amoxil for acute pharyngitis in both peds and adults?
1) Pediatrics: 50 mg / kg / day; max 1,000 mg / day; can divide dose; preferred over PCN due to palatability
2) Adults: 1,000 mg Qday; can divide dose
1) How do you dose cephalexin for acute pharyngitis in both peds and adults?
2) What abt clindamycin?
[not mentioned in class]
1) Pediatrics – 20mg/kg/dose BID
Adults – 500mg BID
2) Pediatrics – 7mg/kg/dose TID
Adults – 300mg TID
How long do you use azithromycin to Tx acute pharyngitis?
5 days
How long do you use most Txs for acute pharyngitis?
10 days (all except azithro)
