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Therapeutics 3 > Upper Respiratory Tract Infections > Flashcards

Upper Respiratory Tract Infections Flashcards

1
Q

AOM/AOE

What is the prevalence of acute otitis media (AOM)?

A

primarly a childhood infection (most cases children 6-24 months)

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2
Q

AOM/AOE

What bacteria is primarly responsible for acute otitis media (AOM)?

A
  • streptococcus pneumoniae
  • haemophilus influenzae
  • moraxella catarrhalis
  • staphylococcus aureus (adults)

viruses commonly implicated alone or in combination with bacteria

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3
Q

AOM/AOE

What is the clinical presentation of acute otitis media (AOM)?

A
  • often follows viral upper respiratory tract infection
  • acute onset otalgia (earache), if lasts >48 hours = moderate or severe)
  • buldging of tympanic membrane or reduced membrane mobility
  • fever (39C +)= “severe”
  • otorrhea (ear drainage)
  • diminished hearing
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4
Q

AOM/AOE

What is the criteria for acute otitis media diagnosis?

A
  • moderate to severe bulging of the tympanic membrane OR new onset otorrhea (ear drainage) not due to acute otitis externa
  • mild bulging of the tympanic membrane AND recent (<48hrs) ear pain or intense erythema of tympanic membrane
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5
Q

AOM/AOE

When may the “watch and wait” approach be appropiate for acute otitis media (AOM)?

A
  • children > 6 months with nonsevere unilateral acute otitis media without otorrhea (ear drainage)
  • children > 24 months with bilateral acute otitis media without otorrhea
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6
Q

AOM/AOE

When should acute otitis media (AOM) be treated with antibiotics?

A
  • presence of otorrhea (ear drainage)
  • severe symptoms (otalgia (ear pain) > 48 hours, toxic-appearing, temp >39C)
  • bilateral AOM in children < 2 years of age
  • if follow-up cannot be ensured
  • high-risk patients (immunocompromised, etc)
  • adults
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7
Q

AOM/AOE

What drug class is recommended for treatment of all cases of acute otitis media (AOM)?

A

analgesics

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8
Q

AOM/AOE

When should “watch and wait” be discontinued and drug therapy be implemented for acute otitis media (AOM)?

A

if child fails to improve within 48-72 hours of symptom onset

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9
Q

AOM/AOE

What is empiric therapy for acute otitis media (AOM)?

A
  1. high dose Amoxicillin 80-90mg/kg/day (divided in 2 doses)
  2. high dose Amoxicillin/Clavulanate 80-90/6.4mg/kg/day (divided in 2 doses)
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10
Q

AOM/AOE

Why is high dose Amoxicillin required for acute otitis media (AOM)?

A

to overcome streptococcus resistance

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11
Q

AOM/AOE

When would Amoxicillin/Clavulanate be used over Amoxicillin for acute otitis media (AOM)?

A

pt who have used amoxicillin in the previous 30 days, concurrent purulent conjunctivitis, history of recurrent infection unresponsive to amoxicillin

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12
Q

AOM/AOE

What is 2nd line therapy for patients with acute otitis media (AOM) with a penicillin allergy?

A
  • cefdinir
  • cefuroxime
  • cefpodoxime
  • clindamycin (not preferred because does not cover H. influenzae or M. catarrhalis)
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13
Q

AOM/AOE

What is the duration of antibiotic therapy for acute otitis media (AOM)?

A
  • severe @ any age= 10d
  • age <2 yrs w/ any severity= 10d
  • age 2-5 yrs, mild- mod severity= 7d
  • age 6+, mild- mod severity= 5-7d
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14
Q

AOM/AOE

When should tympanostomy tubes be considered?

A

if 3 episodes of acute otitis media (AOM) in 6 months OR 4 episodes of AOM in 12 months

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15
Q

AOM/AOE

Are prophylatic antibiotic recommended for acute otitis media (AOM)?

A

NO- not effective, costly, adverse effects, and may cause resistance

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16
Q

AOM/AOE

What is the more common name for acute otitis externa (AOE)?

A

swimmer’s ear

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17
Q

AOM/AOE

What are the common bacteria that cause acute otitis externa (OAE)?

A
  • pseudomonas aeruginosa
  • staphylococcus aureus
  • streptococcus pyogenes
18
Q

AOM/AOE

What are the treatment options for acute otitis externa (AOE)?

A
  • polymyxin B-neomycin-hydrocortisone (3-4 times/day)- only if tympanic membrane is intact because neomycin is ototoxic
  • ciprofloxacin + hydrocortisone or dexamethasone (BID)
  • ofloxacin (daily)
19
Q

AOM/AOE

What is the duration of therapy of antibiotic therapy for acute otitis externa (AOE)?

A

7 days (3-6 days to see improvement)

20
Q

Pharyngitis

What is acute pharyngitis?

A

infection of the oropharynx or nasopharynx commonly associated with sore throat + fever + pharyngeal inflammation

21
Q

Pharyngitis

What are the common bacteria associated with pharyngitis?

A

group A streptococcus (streptococcus pyogenes)

virus= adenovirus (12-23% of cases)

22
Q

Pharyngitis

What population is most likely to have pharyngitis?

A

ages 5-24 yrs

23
Q

Pharyngitis

Should patients be treated for pharyngitis if suspected that the infection is from a viral source?

A

NO

24
Q

Pharyngitis

How can bacterial pharyngitis be diagnosed?

A

nucleic acid amplification test (NAAT) or rapid antigen detection test (RADT)

treat if RADT is positive

25
Q

Pharyngitis

What are the signs and symptoms of group A strep pharyngitis?

A
  • sore throat/painful swallowing
  • fever, headache, N/V, abdominal pain
  • erythema/inflammation of tonsils/pharynxx +/- patchy exudates
  • enlarged, tender lymph nodes
  • red, swollen uvula, petechia on soft palate, scarlatiniform rash
26
Q

Pharyngitis

What are the signs and symptoms of viral pharyngitis?

A
  • conjunctivitis (inflammation of the eye)
  • coryza (upper respiratory tract congestion)
  • cough
27
Q

Pharyngitis

How is viral pharyngitis treated?

A

symptomatically treated for pt current symptoms

28
Q

Phayngitis

What are the goals of therapy of pharyngitis treatment?

A
  • prevent complications of infection= acute rhematic fever, peritonsillar abscess
  • decrease time to symptom resolution
  • reduce transmission
  • prevent collateral damage (understand when to treat)
29
Q

Pharyngitis

What is the treatment for Group A strep pharyngitis in adults?

A
  • penicillin 500mg PO BID
  • amoxicillin 500mg PO BID

considering no allergies; 10 day duration

30
Q

Pharyngitis

What is the duration of therapy for group A strep treatment in adults?

A

10 days

31
Q

Pharyngitis

What cephalosporin can be used in patients with mild PCN allergies for pharyngitis?

A

cephalexin (1st gen)

32
Q

Pharyngitis

What antibiotics can be used in patients with true/severe PCN allergies?

A
  • azithromycin x 5 days
  • clarithromycin
  • clindamycin
33
Q

Pharyngitis

What antibiotics are not recommended for group A strep pharyngitis?

A
  • tetracyclines (resistance)
  • fluoroquinolones (unnecessary broad spectrum)
  • trimethoprim/sulfamethoxazole (resistance)
34
Q

Rhinosinusitis

What are the pathogens that cause Acute Bacterial Rhinosinusitis?

A
  • streptococcus pneumoniae
  • haemophilus influenzae
  • moraxella catarrhalis
  • staphylococcus aureus
35
Q

Rhinosinusitis

What is the criteria to diagnosis acute bacterial rhinosinusitis (ABRS)?

A

purulent nasal discharge with nasal obstruction, facial pain, pressure or fullness or both that…
- persists for at least 10 days without improvement OR
- worsens within 10 days after initial improvement OR
- presents with severe signs/symptoms (high fever > 102.2F) lasting at least 3-4 days

36
Q

Rhinosinusitis

What is the treatment of acute viral rhinosinusitis?

A

symptomatic management

37
Q

Rhinosinusitis

What is the treatment for acute bacterial rhinosinusitis(ABRS)?

A
  • watchful waiting, only initiate antibiotics if no symptom improvement by day 7 or if symptoms worsen
  • antibiotic use, first line per IDSA
38
Q

Rhinosinusitis

What are the antibacterial treatment options for acute bacterial rhinosinusitis (ABRS)?

A
  • amoxicillin 875mg BID or 500mg TID
  • amoxicillin/clavulanate 875/125mg BID or 500/125mg TID
  • if risk of S. pneumoniae resistance to PCN= amoxicillin/clavulanate (XR) 2000mg PO BID
  • penicillin allergies= doxycycline 100mg PO BID or 200mg PO daily, levofloxacin 500mg PO daily
39
Q

Rhinosinusitis

What antibacterials are not recommended for treatment of acute bacterial rhinosinusitis (ABRS)?

A
  • macrolides, high resistance rate & adverse drug effects
  • trimethoprim/sulfamethoxazole, high resistance rates
40
Q

Rhinosinusitis

What is done when patient is not responding to therapy for acte bacterial rhinosinusitis (ABRS)?

A

switch antibiotic class or broaden the coverage, refer to specialist for imaging & cultures

worsening in 72 h or 3-5 days with no improvement of start of treatment

Therapeutics 3 (14 decks)

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