Upper respiratory tract infection

Question 1

When are antibiotics used for sinusitis?

Answer 1

-Persistent sx >10 day without clinical improvement
-Severe sx > 3-4 days at the beginning of illness
oFever >102
oPurulent nasal discharge
oFacial pain
-Worsening sx after typical viral upper respiratory infection -> double sickening
oNew onset fever, headache or increased nasal drainage

Question 2

what antibiotics are used for sinusitis?

Answer 2

• Amoxicillin/clavulanate (workhorse)
• Fluoroquinolone
• Clindamycin

Question 3

When can you recommend a high dose of amoxicillin/clavulanate to a patient with sinusitis

Answer 3

• Region with 10% penicillin non-susceptible S. pneumonia
• Severe infection
• Attendance at daycare
• Age <2 or >65 of age
• Recent hospitalization
• Abx in the prior month
• Immunocompromised

Question 4

Duration of therapy for sinusitis

Answer 4

adults: 5-7 days
children: 10-14 days

Question 5

Common pathogen for pharyngitis

Answer 5

Viral: rhinovirus
Bacterial: Group A strep

Question 6

Treatment of pharyngitis

Answer 6

-Penicillin VK or Amoxicillin x10 days

Question 7

what would your prescribe a patient who has pharyngitis with a penicillin allergy

Answer 7

-mild: cephalexin x10 days
-severe: clindamycin x10 days
or
Azithromycin x5 days

Question 8

what could you prescribe a patient who is unlikely adherent with pharyngitis

Answer 8

Benzathine penicillin IM x1 dose

Question 9

Antibiotics criteria of OM

Answer 9

• 6months to 12 years PLUS moderate to severe pain OR temperature 102.2
• 6months to 23 months PLUS non- severe bilateral acute OM

Consider those…

• 6mo to 23mo with non-severe unilateral
• 2-12yo with non-severe acute OM

Question 10

First line treatment for OM

Answer 10

-Amoxicillin (80-90 mg/kg/day) divided into 2 doses
-Amoxicillin-clavulanate (90mg/kg/day of amoxicillin and 6.4 mg/kg/day of clavulanate)
——Given when amoxicillin was given in last 30 days -> failure to treatment (purulent conjunctivitis, recurrent unresponsive to amox)
OR
-Ceftriaxone (50mg IM or IV x3 days)

Question 11

COPD exacerbation corticosteroid

Answer 11

IV prednisolone or PO prednisone

x 5-14 days

Question 12

When would you give an antibiotic for COPD exacerbation?

Answer 12

• Only if patient has increased dyspnea, increase sputum volume and increase sputum purulence
• requires mechanical ventilation with COPD exacerbation

Question 13

What antibiotics would you give pt with COPD exacerbations?

Answer 13

azithromycin, doxycycline, amox/clav

x5-7 days