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Therapeutics IV > Upper Respiratory Infection - Block 2 > Flashcards

Upper Respiratory Infection - Block 2 Flashcards

1
Q

Most URTIs derive from?

A

Viral etiologies

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2
Q

What is the most common infection for pediatric patients receiving antibiotics in the US?

A

Acute otitis media: 6-24 months olds

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3
Q

What are the subtypes of otitis media?

A
  1. Aucte otitis media
  2. Otitis media with effusion
  3. Chronic otitis media
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4
Q
A
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5
Q

What are the common pathogens of AOM? MOA?

A
  1. Strep pneumoniae: alteration of PBP
  2. H. flu: production of b-lactamases
  3. Moraxella catarrhalis: production of b-lactamases
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6
Q

Describe the appearances of a non-infected vs otitis media?

A

Non-infected: thin, clear tympanic membrane
Otitis media: bulging, erythematous tympanic membrane from fluid build up

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7
Q

Why are children more susceptible to ear infections?

A

Shorter, more horizontal ETs -> increased bacteria entry

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8
Q

What are the s/s of AOM?

A

Otalgia: moderate to severs if pain is ≥48H
Fever: Severe if ≥39C or 102.2F

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9
Q

What is the diagnostic criteria for AOM?

A

Middle ear effusion and 1 of the following:
1. Moderate-severe bulging of tympanic membrane or new onset otorrhea
2. Mild bulging of tympanic membrane AND onset of ear pain within last 48H OR intense erythema of tympanic membrane

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10
Q

What is the screening tool for middle ear effusion?

A

pneumatoscopy and/or tympanometry

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11
Q

What is the difference between AOM and otitis media with effusion?

A

Otitis media with effusion: has the fluid without s/s of acute ear infection

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12
Q

Pharm tx for OM with effusion?

A

ABX is not necessary

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13
Q

First line treatment for AOM?

A

Amoxicillin

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14
Q

Consider change to current treatment plan, if complications develop or symptoms worsen within ___ days?

A

3

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15
Q

What is initial observation?

A

Only initiate ABX if sx worsen/decline within 48-72H of sx onset

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16
Q

Who qualifies for initial ABX?

A
  1. Children ≥ 6 months with AOM who present with severe symptoms (i.e., toxic-appearing, persistent ear pain ≥ 48 hours , or temperature ≥ 39°C or 102.2°F)
  2. Children ≥ 6 months with AOM and otorrhea
  3. Children aged 6 – 23 months with bilateral AOM
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17
Q

Who qualifies for initial observation?

A
  1. Children ≥ 6 months with non-severe unilateral AOM without otorrhea
  2. Children ≥ 2 years with bilateral AOM without otorrhea
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18
Q

Pharm tx of initial diagnosis of AOM?

A
  1. Amoxicillion
  2. Augmentin
  3. Azithromycin or Clindamycin
  4. Cefdinir, Cefuroxime, Cefpodoxime
  5. Ceftriaxone
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19
Q

Pharm tx for AOM tx failure at 48-72H?

A

Augmentin or Ceftriaxone

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20
Q

How long do you need to reconsider tx plan?

A

symptoms worsen or decline with 48 - 72 hours of onset

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21
Q

How is excluded from amoxicillin tx?

A
  1. Recieved amoxicillin in the past 30 days
  2. Have concurrent purulent conjunctivitis
  3. Have a hx of recurrent infections unresponsive to amoxicillin

These patients get Augmentin

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22
Q

Why is amoxicillin considered the first line?

A

Efficacious for S. pneumoniae
* More spontaneous resolution with H flu and Morexella

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23
Q

What are the advantages of using Augmentin in AOM?

A

Patients with concurrent purulent conjuntivitis and AOM are likely infected by non-typeable H. flu -> requiring b-lactamase inhibitor

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24
Q

AOM tx for non severe penicillin allergies?

A

Second gen: Ceftin (cefuroxime)
Third gen:
* Omnicef (cefdinir)
* Vantin (Cefpodoxime)
* Rocephin (Ceftriaxone)

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25
Apart from amoxicillin what are the advantages of using ceftriaxone over other cephalosporins for AOM?
Ceftriaxone is the only ceph option that achieve a drug concnetration above MIC for >40% of the dosing interval
26
Types of IgE mediated rx?
anaphylaxis, angioedema, wheezing, laryngeal edema, hypotension, hives
27
Types of serious delayed rx?
SJS, TEN, cytopenia
28
Tx for AOM with severe penicillin allergy? SOA?
1. Azithromycin (has activity for all 3) 2. Clindamycin (**NO** activity against H flu or M. cat)
29
When would you consider adjunct therapy for AOM?
1. ABX doesn't reduce pain in initial 24H of tx 2. Pain continues for 3-7 days while on ABX
30
What are the recommended adjuct meds for AOM? Dosing?
**Tylenol:** * WBD: 10-15 mg/kg Q4-6H, don't exceed 5 dose/24H * Max DD: 75 mg/kg/d **Don't exceed 4g/d** **Motrin:** * WBD: 4-10 mg/kg Q6-8H * Max: 600 mg/dose * Max DD: 2.4 g/d
31
Duration of AOM therapy?
**Penicillin and cephalosporin (except Rocephin):** * <2YO, with perforation or recurrent AOM: 10 days * ≥ 2YO, no perforation or hx of recurrent AOM: 5-7 days **Azithromycin:** 5 days **Ceftriaxone:** 1-3 days
32
When do you follow up with AOM tx?
Within 48-72H **If sx worsen:** * Initial observation occurred: initiate ABX * Initiated ABX: change therapy due to Hflu and Mcat risk
33
Common pathogens of ABRS?
1. **S. pneumoniae** 1. **H. influenzae** 1. M. catarrhalis
34
ABRS commonly affect what?
Maxillary and ethmoid sinuses
35
What are the presentations of ABRS?
1. Onset with persistent signs or sx, lasting for ≥10 days 2. Onset with severe sx for 3-4 consecutive days 3. Onset with worsening sx lasting 5-6 dyas (double sickening)
36
Improvement of viral rhinosinusitis should be seen in ___ days?
7-10
37
What is first line for ABRS?
Child: Augmenten 45 mg/kg/day (OR) 90 mg/kg/day, PO divided in 2 doses Adults: Augmenten 500/125mg PO TID (OR) 875/125mg PO BID (OR) 2,000/125mg PO BID
38
RF for pneumococcal resistance?
1. Living in geographic regions with rates of penicillin-non-susceptible S. pneumoniae 2. Age ≤2YO or ≥65YO 3. Attendance at daycare 4. Recent hospitalization within the past 5 days 5. ABX within the past month 6. Immunocompromised px 7. Multiple comorbidities 8. Severe infection
39
Identify medications for symptomatic management of ABRs?
1. OTC analgesics for pain and fever 2. OTC products for nasal drainage and inflammation 3. Don't use products that excessively dry nasal mucosa or clear secretions (sudafed, afrine, antihistamines)
40
What is the initial empiric tx for ABRS in children first line?
Augmentin
41
What do you give for ABRS if child presents with b-lactam allergy?
**Non-type 1 allergy:** Clindamycin + cefixime or cefpodoxime **Type 1 allergy:** Levofloxacin
42
Dose of Augmenin for ABRS?
45 mg/kg/day (OR) 90 mg/kg/day, PO divided in 2 doses
43
If a child has failed ABRS tx or show resistnce, what do you use?
Augmentin: 90 mg/kg/day, PO divided in 2 doses Clindamycin + 3rd generation cephalosporin (i.e., cefixime or cefpodoxime) Levofloxacin
44
If a child has severe ABRS requiring hospitalization, what do you use?
Augmntin Ceftriaxone Cefotaxime Levofloxacin
45
What do you give for ABRS if an adult presents with b-lactam allergy?
**Non type 1 allergy:** Doxycycline * Clindamycin + 3rd generation cephalosporin (i.e., cefixime or cefpodoxime) **Type 1 allergy:** Doxycycline, Levofloxacin, Moxifloxacin
46
If an adult has failed ABRS tx or show resistnce, what do you use?
Augmentin Clindamycin + 3rd generation cephalosporin (i.e., cefixime or cefpodoxime) Levofloxacin Moxifloxacin Doxycycline
47
If an adult has severe ABRS requiring hospitalization, what do you use?
1. Ampicillin-sulbactam 2. Ceftriaxone 3. Cefotaxime 4. Levofloxacin 5. Moxifloxacin
48
Duration of therapy for ABRS? Evaluation?
**Adults:** 5-7 days **Children:** 10-14 days Reassess in 48-72 hrs
49
What is most common sx of acute pharyngitis?
Sore throat primarily derived from viral etiology
50
What is the pathogen causing acute pharyngitis?
S. pyogenes (Group A b-hemolytic Strep. pyogenes)
51
Who are more susceptible to acute pharyngitis?
1. Children 5-15 YO 2. Parents of school aged children 3. Individuals who work with children
52
How long is the incubation period of GAS?
2-5 days
53
Untreated GAS patients are infectious for how long? Treated patients?
**Untreated:** During acute illness and 7 days after **Treated:** 24H after starting ABX
54
most common bacterial cause of acute pharyngitis
GAS
55
Presentation of viral pharyngitis?
1. Conjunctivitis 2. Cough 3. Coryza: inflammation of mucous membrane in the nose
56
What are the presentations of bacterial pharyngitis?
1. SOre throat 2. Painful swallowing 3. Fever 4. HA 5. N/V 6. Erythema/inflammation 7. Red swollen uvula, petchiae on soft palate
57
Lab tests for GAS?
1. Throat swab and culture (gold standard) 2. Rapid antigen detection test (more practical)
58
Describe the Centor criteria?
**≥ 3 Centor criteria** -> test for GAS **< 3 Centor criteria** -> GAS unlikely; no testing necessary * **DOESN'T** replace GAS testing Can't cough, exudate, nodes, temp >38C, Young or old * <15YO: +1 point * >44YO: -1 point
59
If RADT produces positive (+) result for the patient:
Pateint has GAS pharyngitis
60
If RADT produces negative (-) result in children or adolescents:
Recommend a throat swab to confirm
61
If RADT produces negative (-) result in adult patient:
NOT necessary to confirm results with throat culture -> patient is not likely to have GAS
62
What is the preferred ABX for GAS?
1. penicillin VK 2. Penicillin G benzathine 3. Amoxicillin
63
What is the preferred ABX for GAS with non-type 1 allergy?
1. Cephalexin 2. Cefadroxil 3. Cefuroxime 4. Cefpodoxime 5. Cefdinir 6. Cefixime
64
What is the preferred ABX for GAS with type 1 allergy?
1. Clindamycin 2. Azithromycin
65
What is the duration of therapy for GAS?
Penicillin V, cephalosporin, clindamycin, clarithromycin: 10 days Azithromycin: 5 days Penicillin G benzathine: 1 day
66
Evaluation and follow up with GAS tx?
Without ABX: resolution 3-4 days With ABX: resolution is earlier Follow-up testing generally is **NOT** necessary, unless patients remains symptomatic 2-7 days after finishing initial antibiotic therapy.

Therapeutics IV (39 decks)

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