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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
Q

Apart from amoxicillin what are the advantages of using ceftriaxone over other cephalosporins for AOM?

A

Ceftriaxone is the only ceph option that achieve a drug concnetration above MIC for >40% of the dosing interval

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26
Q

Types of IgE mediated rx?

A

anaphylaxis, angioedema, wheezing, laryngeal edema, hypotension, hives

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27
Q

Types of serious delayed rx?

A

SJS, TEN, cytopenia

28
Q

Tx for AOM with severe penicillin allergy? SOA?

A
  1. Azithromycin (has activity for all 3)
  2. Clindamycin (NO activity against H flu or M. cat)
29
Q

When would you consider adjunct therapy for AOM?

A
  1. ABX doesn’t reduce pain in initial 24H of tx
  2. Pain continues for 3-7 days while on ABX
30
Q

What are the recommended adjuct meds for AOM? Dosing?

A

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
Q

Duration of AOM therapy?

A

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
Q

When do you follow up with AOM tx?

A

Within 48-72H

If sx worsen:
* Initial observation occurred: initiate ABX
* Initiated ABX: change therapy due to Hflu and Mcat risk

33
Q

Common pathogens of ABRS?

A
  1. S. pneumoniae
  2. H. influenzae
  3. M. catarrhalis
34
Q

ABRS commonly affect what?

A

Maxillary and ethmoid sinuses

35
Q

What are the presentations of ABRS?

A
  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
Q

Improvement of viral rhinosinusitis should be seen in ___ days?

A

7-10

37
Q

What is first line for ABRS?

A

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
Q

RF for pneumococcal resistance?

A
  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
Q

Identify medications for symptomatic management of ABRs?

A
  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
Q

What is the initial empiric tx for ABRS in children first line?

A

Augmentin

41
Q

What do you give for ABRS if child presents with b-lactam allergy?

A

Non-type 1 allergy: Clindamycin + cefixime or cefpodoxime

Type 1 allergy: Levofloxacin

42
Q

Dose of Augmenin for ABRS?

A

45 mg/kg/day (OR) 90 mg/kg/day, PO divided in 2 doses

43
Q

If a child has failed ABRS tx or show resistnce, what do you use?

A

Augmentin: 90 mg/kg/day, PO divided in 2 doses
Clindamycin + 3rd generation cephalosporin (i.e., cefixime or cefpodoxime)
Levofloxacin

44
Q

If a child has severe ABRS requiring hospitalization, what do you use?

A

Augmntin
Ceftriaxone
Cefotaxime
Levofloxacin

45
Q

What do you give for ABRS if an adult presents with b-lactam allergy?

A

Non type 1 allergy: Doxycycline
* Clindamycin + 3rd generation cephalosporin (i.e., cefixime or cefpodoxime)

Type 1 allergy: Doxycycline, Levofloxacin, Moxifloxacin

46
Q

If an adult has failed ABRS tx or show resistnce, what do you use?

A

Augmentin
Clindamycin + 3rd generation cephalosporin (i.e., cefixime or cefpodoxime)
Levofloxacin
Moxifloxacin
Doxycycline

47
Q

If an adult has severe ABRS requiring hospitalization, what do you use?

A
  1. Ampicillin-sulbactam
  2. Ceftriaxone
  3. Cefotaxime
  4. Levofloxacin
  5. Moxifloxacin
48
Q

Duration of therapy for ABRS? Evaluation?

A

Adults: 5-7 days
Children: 10-14 days

Reassess in 48-72 hrs

49
Q

What is most common sx of acute pharyngitis?

A

Sore throat primarily derived from viral etiology

50
Q

What is the pathogen causing acute pharyngitis?

A

S. pyogenes (Group A b-hemolytic Strep. pyogenes)

51
Q

Who are more susceptible to acute pharyngitis?

A
  1. Children 5-15 YO
  2. Parents of school aged children
  3. Individuals who work with children
52
Q

How long is the incubation period of GAS?

A

2-5 days

53
Q

Untreated GAS patients are infectious for how long? Treated patients?

A

Untreated: During acute illness and 7 days after
Treated: 24H after starting ABX

54
Q

most common bacterial cause of acute pharyngitis

A

GAS

55
Q

Presentation of viral pharyngitis?

A
  1. Conjunctivitis
  2. Cough
  3. Coryza: inflammation of mucous membrane in the nose
56
Q

What are the presentations of bacterial pharyngitis?

A
  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
Q

Lab tests for GAS?

A
  1. Throat swab and culture (gold standard)
  2. Rapid antigen detection test (more practical)
58
Q

Describe the Centor criteria?

A

≥ 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
Q

If RADT produces positive (+) result for the patient:

A

Pateint has GAS pharyngitis

60
Q

If RADT produces negative (-) result in children or adolescents:

A

Recommend a throat swab to confirm

61
Q

If RADT produces negative (-) result in adult patient:

A

NOT necessary to confirm results with throat culture -> patient is not likely to have GAS

62
Q

What is the preferred ABX for GAS?

A
  1. penicillin VK
  2. Penicillin G benzathine
  3. Amoxicillin
63
Q

What is the preferred ABX for GAS with non-type 1 allergy?

A
  1. Cephalexin
  2. Cefadroxil
  3. Cefuroxime
  4. Cefpodoxime
  5. Cefdinir
  6. Cefixime
64
Q

What is the preferred ABX for GAS with type 1 allergy?

A
  1. Clindamycin
  2. Azithromycin
65
Q

What is the duration of therapy for GAS?

A

Penicillin V, cephalosporin, clindamycin, clarithromycin: 10 days
Azithromycin: 5 days
Penicillin G benzathine: 1 day

66
Q

Evaluation and follow up with GAS tx?

A

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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