Upper Respiratory Tract Infections Flashcards
Examples of Upper Respiratory Infections
Acute otitis media
Sinusitis
Pharyngitis
Most Specific Sign of Acute Otitis Media
Bulging tympanic membrane
Common bacteria that cause acute otitis media
Streptococcus pneumoniae
Haemophilus influenzae
Non-Severe Acute Otitis Media (AOM)
Presence of mild otalgia (earache) < 48 hrs and temperature < 39 degrees C
Severe Acute Otitis Media (AOM)
Presence of moderate to severe otalgia or temperature at least 39 degrees C or otorrhea
Treatment of Mild to Moderate Otalgia
Acetaminophen
Ibuprofen (only in > 6 months)
Treatment of Moderate to Severe Otalgia
Tylenol #3
Topical Options of Otalgia
Benzocaine, lidocaine, procaine (only for ages 2+ and do not use in children with tympanic membrane perforation)
Treatment of AOM in < 6 months
ALWAYS give antibiotic therapy in patients in < 6 months regardless of severity
Treatment of Severe AOM + Otorrhea
Give antibiotic therapy, regardless of age
Treatment of Bilateral AOM without Otorrhea in 6 months to 2 years
Give antibiotic therapy
Treatment of Bilateral AOM without Otorrhea > 2 years
Observe for 48-72 hours before giving antibiotics
Treatment of Unilateral AOM without Otorrhea in > 6 months
Observe for 48-72 hours before giving antibiotics
DOC for AOM
High-dose amoxicillin (90 mg/kg/day in divided doses q12h)
DOC because overcomes S. pneumo resistance
Tx of AOM if Recent Beta-Lactam Therapy, Conjunctivitis, or Hx of Prior AOM
Augmentin (90 mg/kg/day of amoxicillin + 6.4 mg/kg/day of clavulanate in divided doses q12h)
Tx of AOM if PCN Allergy
2nd gen PO CEPHS: Cefuroxime, Cefpodoxime, Cefdinir
Ceftriaxone IM
Treatment Failure of AOM After 48-72 Hours
If initially treated with high-dose amoxicillin: Augmentin
If initially treated with Augmentin or PO Cephalosporin: Ceftriaxone 50 mg IM or IV x 3 days
Duration of Therapy for AOM
10 days if < 2 yo or severe sxs
7 days if 2-5 years without severe sxs
5-7 days if at least 6 years without severe sxs
Recurrent Otitis Media
Definition: At least 3 episodes in 6 months or at least 4 episodes in 1 year
Vaccination (pneumococcal, H. influenzae)
NO antibiotic prophylaxis
Tympanostomy Tube
Common pathogens causing sinusitis
Strep pneumo
H. influenzae
DOC for Sinusitis
Augmentin (500/125 mg PO TID or 875/125 mg PO BID)
Tx of Sinusitis if PCN Allergy
Doxycycline (avoid in children)
PO 2nd gen cephs: Cefixime or Cefpodoxime +/- clindamycin
Levofloxacin or moxifloxacin
Duration of Tx for Sinusitis
Adults: 5-7 days
Children: 10-14 days
Tx Failure of Sinusitis After 48-72 Hours
Augmentin -> doxycycline or respiratory fluoroquinolone (levofloxacin or moxifloxacin)
Adjunctive Therapy for Sinusitis
Intranasal corticosteroids for pts with hx of allergic rhinitis
Nasal irrigation for congestion sxs
NO systemic or oral corticosteroids
DOC for Pharyngitis/Strep Throat
Penicillin VK x 10 days
Alternative Tx for Pharyngitis/Strep Throat
Amoxicillin x 10 days
Penicillin G IM x 1 dose
Tx for Pharyngitis/Strep Throat if PCN Allergy
Cephalexin x 10 days
Clindamycin x 10 days
Z Pak x 5 days
Clarithromycin x 10 days
Common Pathogens Causing Acute Exacerbation of COPD
H. influenzae
S. pneumoniae
P. aeruginosa
Indications for Antibiotic Therapy of Acute Exacerbation of COPD
At least 65 yo History of exacerbations Presence of comorbidities Prior antibiotic use Culture data from past exacerbations
Outpatient Tx of Acute Exacerbation of COPD if Low Risk of Pseudomonas
Beta-lactam (Augmentin, 2nd gen PO CEPH - cefuroxime, cefpodoxime, cefdinir)
Tetracycline
Macrolide
Outpatient Tx of Acute Exacerbation of COPD if High Risk of Pseudomonas
If recent antimicrobial therapy, recent hospitalization, or bronchiectasis
Levofloxacin or ciprofloxacin
Duration of Outpatient Tx of Acute Exacerbation of COPD
5-7 days
Prevention of Acute Exacerbation of COPD
Vacciniations (pneumococcal, influenza)
If > 2 exacerbations/year despite optimal management, antimicrobial prophylaxis: azithromycin or erythromycin x 1 year
