Upper Respiratory Tract Infection Flashcards
What are the risk factors for URTI?
- contact with young children
- lack of personal / hand hygiene
- chronic respiratory diseases e.g. asthma, allergic rhinitis
- smoking
- immunocompromised
- anatomical anomalies
What is the clinical presentation of a Common Cold?
Low grade temperature, rhinorrhea, nasal blockage, sneezing, productive cough, headache, body ache
What are the common pathogens causing common cold?
Rhinovirus, Coronavirus
What are the monitoring points for Common Cold?
- most will recover in 7 to 10 days
- see doctor if symptoms get better then worsen
- cough may last 2-3 weeks
What is the clinical presentation for Influenza?
Fever, chills, headache, myalgia, malaise, anorexia, confusion (elderly), sore throat, dry cough, nasal discharge
What is the recommended regimen for the treatment of influenza?
PO Oseltamivir 75mg BD x 5d
When should oseltamivir be initiated for hospitalised / high-risk / severe patients?
Best within 48H, up to 5 days
When should oseltamivir be initiated for outpatient?
within 48H
What is the MoA of oseltamivir?
Neuraminidase inhibitor, prevents protein cleavage and release of new virus
What are the side effects of oseltamivir?
Headache, mild N/V
What are the monitoring points for influenza?
- will have symptoms for a week
- see doctor if no improvement in 10 days / symptoms get better then worsen
What is the clinical presentation of pharyngitis?
Fever, swollen and tender lymph nodes, sore throat, erythema and inflammation of pharynx and tonsils (with or without patchy exudates)
What is the modified centor criteria for s. pyogenes pharyngitis?
Fever > 38c
Swollen lymph nodes
Tonsillar exudates
Absence of cough
3-14yo +1 / 15-45yo +0 / >45 -1
0-1: unlikely bacterial
2-3: culture
4-5: likely bacterial, treat
What are the complications of s. pyogenes pharyngitis?
- acute rheumatic fever (prevented by abx)
- acute glomerulonephritis (not prevented by abx)
What are the first-line treatment regimens for s. pyogenes pharyngitis?
PO penicillin V 250mg Q6H
PO amoxicillin 500mg Q12H
What are the treatment regimens for s. pyogenes pharyngitis for patients with penicillin allergy?
Mild
- PO Cephalexin 500mg Q12 (x in amoxicillin allergy)
- PO Cefuroxime 250mg Q12
Others
- azithromycin 500mg OD
- clarithromycin 500mg Q12
- clindamycin 300mg Q8H
What is the treatment duration for s. pyogenes pharyngitis?
x 10d (5d for azithromycin)
What is the pathogenesis of acute bacterial rhinosinusitis?
Viral URTI -> sinus obstruction, trapping of bacteria -> infection
What are the symptoms of acute rhinosinusitis?
facial pain, purulent nasal discharge, nasal congestion, decreased sense of taste and smell, headache, cough, ear fullness, bad breath, dental pain
When should a patient presenting with rhinosinusitis symptoms be referred to the emergency department?
Signs of spread to orbits / CNS
- limited ocular movements
- acute vision changes
- unilateral weakness
- confusion
What are the pathogens responsible for bacterial rhinosinusitis?
Main
- h. influenzae
- s. pneumoniae
others
- s. pyogenes
- moraxella catarrhalis
- anaerobes
When should antibiotics be initiated for patients presenting with rhinosinusitis symptoms?
> = 1 of the following
- symptoms for > 10 days without improvement
- severe symptoms: fever > 39c, purulent nasal discharge, facial pain for >=3 consecutive days
- initial improvement -> worsening
What are the first-line treatment regimens for bacterial rhinosinusitis?
PO amoxicillin 500mg Q8H
PO amox-clav 625mg Q8H
What are the treatment regimens for bacterial rhinosinusitis in patients with penicillin allergy?
non-severe: PO cefuroxime 500mg Q12H
PO levofloxacin 500mg OD or moxifloxacin 400mg OD
What is the duration of treatment for bacterial rhinosinusitis?
x 5-7d
