Upper Respiratory Tract Infections Flashcards
AOM/AOE
What is the prevalence of acute otitis media (AOM)?
primarly a childhood infection (most cases children 6-24 months)
AOM/AOE
What bacteria is primarly responsible for acute otitis media (AOM)?
- streptococcus pneumoniae
- haemophilus influenzae
- moraxella catarrhalis
- staphylococcus aureus (adults)
viruses commonly implicated alone or in combination with bacteria
AOM/AOE
What is the clinical presentation of acute otitis media (AOM)?
- 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
AOM/AOE
What is the criteria for acute otitis media diagnosis?
- 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
AOM/AOE
When may the “watch and wait” approach be appropiate for acute otitis media (AOM)?
- children > 6 months with nonsevere unilateral acute otitis media without otorrhea (ear drainage)
- children > 24 months with bilateral acute otitis media without otorrhea
AOM/AOE
When should acute otitis media (AOM) be treated with antibiotics?
- 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
AOM/AOE
What drug class is recommended for treatment of all cases of acute otitis media (AOM)?
analgesics
AOM/AOE
When should “watch and wait” be discontinued and drug therapy be implemented for acute otitis media (AOM)?
if child fails to improve within 48-72 hours of symptom onset
AOM/AOE
What is empiric therapy for acute otitis media (AOM)?
- high dose Amoxicillin 80-90mg/kg/day (divided in 2 doses)
- high dose Amoxicillin/Clavulanate 80-90/6.4mg/kg/day (divided in 2 doses)
AOM/AOE
Why is high dose Amoxicillin required for acute otitis media (AOM)?
to overcome streptococcus resistance
AOM/AOE
When would Amoxicillin/Clavulanate be used over Amoxicillin for acute otitis media (AOM)?
pt who have used amoxicillin in the previous 30 days, concurrent purulent conjunctivitis, history of recurrent infection unresponsive to amoxicillin
AOM/AOE
What is 2nd line therapy for patients with acute otitis media (AOM) with a penicillin allergy?
- cefdinir
- cefuroxime
- cefpodoxime
- clindamycin (not preferred because does not cover H. influenzae or M. catarrhalis)
AOM/AOE
What is the duration of antibiotic therapy for acute otitis media (AOM)?
- 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
AOM/AOE
When should tympanostomy tubes be considered?
if 3 episodes of acute otitis media (AOM) in 6 months OR 4 episodes of AOM in 12 months
AOM/AOE
Are prophylatic antibiotic recommended for acute otitis media (AOM)?
NO- not effective, costly, adverse effects, and may cause resistance
AOM/AOE
What is the more common name for acute otitis externa (AOE)?
swimmer’s ear
AOM/AOE
What are the common bacteria that cause acute otitis externa (OAE)?
- pseudomonas aeruginosa
- staphylococcus aureus
- streptococcus pyogenes
AOM/AOE
What are the treatment options for acute otitis externa (AOE)?
- 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)
AOM/AOE
What is the duration of therapy of antibiotic therapy for acute otitis externa (AOE)?
7 days (3-6 days to see improvement)
Pharyngitis
What is acute pharyngitis?
infection of the oropharynx or nasopharynx commonly associated with sore throat + fever + pharyngeal inflammation
Pharyngitis
What are the common bacteria associated with pharyngitis?
group A streptococcus (streptococcus pyogenes)
virus= adenovirus (12-23% of cases)
Pharyngitis
What population is most likely to have pharyngitis?
ages 5-24 yrs
Pharyngitis
Should patients be treated for pharyngitis if suspected that the infection is from a viral source?
NO
Pharyngitis
How can bacterial pharyngitis be diagnosed?
nucleic acid amplification test (NAAT) or rapid antigen detection test (RADT)
treat if RADT is positive
Pharyngitis
What are the signs and symptoms of group A strep pharyngitis?
- 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
Pharyngitis
What are the signs and symptoms of viral pharyngitis?
- conjunctivitis (inflammation of the eye)
- coryza (upper respiratory tract congestion)
- cough
Pharyngitis
How is viral pharyngitis treated?
symptomatically treated for pt current symptoms
Phayngitis
What are the goals of therapy of pharyngitis treatment?
- prevent complications of infection= acute rhematic fever, peritonsillar abscess
- decrease time to symptom resolution
- reduce transmission
- prevent collateral damage (understand when to treat)
Pharyngitis
What is the treatment for Group A strep pharyngitis in adults?
- penicillin 500mg PO BID
- amoxicillin 500mg PO BID
considering no allergies; 10 day duration
Pharyngitis
What is the duration of therapy for group A strep treatment in adults?
10 days
Pharyngitis
What cephalosporin can be used in patients with mild PCN allergies for pharyngitis?
cephalexin (1st gen)
Pharyngitis
What antibiotics can be used in patients with true/severe PCN allergies?
- azithromycin x 5 days
- clarithromycin
- clindamycin
Pharyngitis
What antibiotics are not recommended for group A strep pharyngitis?
- tetracyclines (resistance)
- fluoroquinolones (unnecessary broad spectrum)
- trimethoprim/sulfamethoxazole (resistance)
Rhinosinusitis
What are the pathogens that cause Acute Bacterial Rhinosinusitis?
- streptococcus pneumoniae
- haemophilus influenzae
- moraxella catarrhalis
- staphylococcus aureus
Rhinosinusitis
What is the criteria to diagnosis acute bacterial rhinosinusitis (ABRS)?
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
Rhinosinusitis
What is the treatment of acute viral rhinosinusitis?
symptomatic management
Rhinosinusitis
What is the treatment for acute bacterial rhinosinusitis(ABRS)?
- watchful waiting, only initiate antibiotics if no symptom improvement by day 7 or if symptoms worsen
- antibiotic use, first line per IDSA
Rhinosinusitis
What are the antibacterial treatment options for acute bacterial rhinosinusitis (ABRS)?
- 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
Rhinosinusitis
What antibacterials are not recommended for treatment of acute bacterial rhinosinusitis (ABRS)?
- macrolides, high resistance rate & adverse drug effects
- trimethoprim/sulfamethoxazole, high resistance rates
Rhinosinusitis
What is done when patient is not responding to therapy for acte bacterial rhinosinusitis (ABRS)?
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
