URI Flashcards
Acute Otitis Media is defined as
rapid developing, symptomatic middle ear infection with effusion or presence of fluid
Common bacterial causative agent for AOM
S. Pneumonae, H. influenzae, M catarrhalis
First line therapy for AOM
Amoxicillin x 10d
2m-5y 80-90mg/kg/d divided q12hr
Otitis Media with effision is defined as
presence of middle ear fluid without symptoms of acute illness
Common viral causative agents
RSV, influenza, parainfluenza, enterovirus, rhinovirus, adenovirus
Risk factors for OM
Native American or Inuit GERD socioeconomic status male recent viral infection age of <1yo
AOM clinical presentation young children
ear tugging, irritable, poor sleeping, poor eating habits
AOM clinical presentation for older children
ear pain, ear fullness, hearing impairment
Signs of AOM
some pt have fever, middle ear effusion, otorrhea, bulging TM, limited or absent mobility of TM, redness of TM, cloudy TM
AOM dx
-moderate to severe bulging of TM or -new onset of otorrhea not due to OE or -mild bulging of the TM AND recent onset of ear pain or redness of TM (<48hr)
AOM antibiotic therapy- who gets treated?
ALL children <6m with suspected AOM
Pt with severe SS no matter the age
102.2 >fever, persistent ear pain or inability to follow up
children <2y with bilateral AOM
For all others, close observation and follow up in 2-3 days- abx if SS have not improved at that time
First line therapy if previous AOM <30d
Augmentin 80-90mg/kg/d divided q12hr x10d
First line therapy if allergic to PNC
Cephalosporin - cefuroxime, cefdinir, cefpodoxime PO
Type 1 PCN allergy is…
hives, anaphylaxis
non-type 1 pnc allergy is…
rash
Preferred oral cephalosporin?
Cefdinir
Observational treatment with AOM is indicated when…
pt is 6m-2y with mild SS or uncertain dx
pt >2yo with uncertain dx
If SS get worse or don’t go away in 48-72, concider abx therapy
What supplements can not be taken with cephalosporins
Iron, antacids. Separate by 2 hours
Adjunctive therapy with AOM…
Do not use ibuprofen in children under 6mos
Do not alternate Tylenol and ibuprofen
Decongestants, steroids, and antihistamines have no role in AOM treatment, can prolong effusion or duration
What vaccines can help prevent OM?
Flu vaccine for 2yo >
Explain the anatomy of the ear in an adult vs child
.
Sinusitis, define…
an inflammation or infection of the paranasal sinus mucosa.
Chronic sinusitis
Chronic rhinosinusitis typically persists as a cough, rhinorrhea, or nasal obstruction for greater than 90 days.
Acute Bacterial Sinusitis (ABRS)
Acute bacterial rhinosinusitis is an infection of the sinuses that can occur independently or be superimposed on chronic sinusitis.
Acute sinusitis
Acute rhinosinusitis is characterized by symptoms that resolve completely in under four weeks.
Bacterial vs Viral Sinusitis…
Viral resolves in 7-10d
Bacterial SS more sever than viral. SS without resolution that last 8-10d> after a cold. Fever, malaise. Facial pain, pressure. Symptoms can get better then more severe
Risk for ABRS
smoke inhalation septal defects dental surgery winter season recent viral infection cystic fibrosis swimming allergies nasal drug use mechanical ventilation in a hospital setting
Pathogens of ABRS
Streptococcus pneumoniae and H influenza are the tow main pathogens - about 70%
M. Catarrhalis contribute to approximate 20% of the cases seen in children.
ABRS presentation, adults
.
ABRS non Rx therapy
Saline nasal spray, nasal irrigation (isotonic or hypertonic), humidifiers
Oral decongestants, who should avoid use?
avoid in children <4yo, pt with uncontrolled HTN, IHD
Intra nasal decongestants
used in ages 6 and older limit to 3 days to avoid rebound congestion
Treatment algorithm for ABRS
amoxicillin
if recent amor use in past 30 days then Augmentin
if PCN allergy > cephalosporins
cefuroxime, cefdnir, cefpodoxime
non type 1 PCN allergy in ABRS, treatment is…
uncomplicated :1st cephalosporin 2nd cephalosporins
3rd clines or FQ
type 1 PCN allergy and treatment failure
uncomplicated macrolide, bactrum, doxy, FQ
clindamycin or FQ
cephalosporin has a cross reactivity with PCN allergies
For patients with a type I penicillin allergy and uncomplicated ABRS, treatment is
clarithromycin, azithromycin, Bactrim, doxycycline, or a respiratory fluoroquinolone can be used
For patients with treatment failure or recent antibiotic use
a respiratory fluoroquinolone is recommended and for resistance, clindamycin.
what cephalosporins are indicated for PCN allergy
cefpodoxime cefuroxime cefdnir
When to use antihistamines in sinusitis
avoid- they thicken mucus and impartial clearance
however consider their use in pt with chronic sinusitis and predisposed allergies
Intranasal steroids
alleries or chronic sinusitis - may be beneficial mono or with abx for ABRS
what is pharyngitis
acute throat infection, viral or bacterial usually self limiting- untreated bacterial can cause streptococcal illness
usually in winter time and early spring
what causes pharyngitis
normal viral pathogens for respiratory infx and Epstein bar
bacterial is caused by group A BH strep, Strep PY - direct contact with infected secretions
how do you dx pharyngitis
will present with swollen lymph nodes, painful to swallow, petechiae on soft palate HA, and pain, nc in Childs especially
red throat with possible exudate, scarlet rash
rapid antigen test-80-90 percent accurate, results in minutes
Gold standard is throat culture- 24-48hr results
ALL neg rapids in children, adolescents, and adults with heavy contact with peds
complications of pharyngitis
abx therapy only prevents accesses, lymphadenitis, and rheumatic fever
It does not impact
acute gloulernephritis
reactive arthritis
PANDAS- OCD, tics post strep infx
how to treat pharyngitis x 10 days
infectious period goes from 10d-24h Pen V 100mg 500 mg/d max, split TID or QID peds 250 bid-tid, 500 bid for > 12yo AMOX same as Pen V but TID peds 4-50 mg/kg/d - BID-TID PCN allergy- macrolide or cephalexin (1st gen )
CENTOR criteria for STREP
each gets 1 pt fever >101 no cough swollen nodes swelling, exudate age 3-14 subtract a point for age >45
SCORE: perent chance of 0: 1-2.5 1: 5-10 2: 11-17 3:28-35 >4: 51-53
Recurrent Pharyngitis
clinda
augmenting
pen B
Pen B with rifampin
