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835 > URI > Flashcards

URI Flashcards

1
Q

URI

A
  • Upper respiratory infections
  • Usually caused by viruses
  • Have non specific symptoms
  • Resolve spontaneously
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2
Q

Acute Otitis Media

A
  • Impaired mucociliary apparatus leading to Eustachian tube dysfunction
  • Middle ear becomes blocked with fluid and tympanic membrane swells
  • Bacteria then isn’t cleared and proliferates and causes infection
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3
Q

Why is AOM more common in children?

A

Eustachian tubes are shorter, narrower, and more horizontal than adults

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4
Q

AOM Etiology

A
  • 40-75% are viral

- Common bacterial pathogens: S. pneumoniae, H. influenzae, Morazella catarrhalis

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5
Q

AOM Clinical Presentation

A
  • Usually follows viral URI: fever, difficulty sleeping, and tugging at ear
  • Bulging of tympanic membrane
  • Otorrhea (discharge), otalgia (earache)
  • Erythema of tympanic membrane
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6
Q

Non-Severe AOM

A
  • Mild otalgia < 48 hours
  • Temperature: <39 degrees C
  • NEED BOTH
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7
Q

Severe AOM

A
  • Moderate-severe otalgia for >= 48 hours
  • Temperature >= 39 degrees C
  • EITHER
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8
Q

AOM Treatment: < 6 mo

A

10 days of antibiotics

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9
Q

AOM Treatment: 6-23 months

A
  • Severe/Non-severe bilateral: 10 days antibiotics

- Nonsevere unilateral: Observe or 10 days of antibiotics

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10
Q

“Observe”

A
  • Watchful waiting x 48-72 hours with follow-up

- Access to doctor/antibiotics if symptoms don’t improve in 2-3 days or worse at any time

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11
Q

AOM Treatment: 2+ Years

A
  • Severe: 10 days of antibiotics

- Non-severe: observe or 7 days of antibiotics

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12
Q

AOM: First Line Treatment

A
  • Amoxicillin: 80-90 mg/kg/day PO q12h

- Augmentin: Amox - 90 mg/kg/day and Clav - 6.4 mg/kg/day PO q12h

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13
Q

AOM Alternative Treatment

A
  • Cefdinir: 14 mg/kg/day PO q 12-24h
  • Cefuroxime: 30 mg/kg/day PO q12h
  • Cefpodoxime: 10 mg/kg/day PO q12h
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14
Q

AOM Pain Management

A
  • Ibuprofen: 10 mg/kg q6h PRN

- Tylenol: 15 mg/kg q4-6h PRN

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15
Q

AOM Treatment Failure

A
  • Should see improvement in 48-72 hours
  • Symptoms could worsen right after diagnosis
  • Switch antibiotics if no improvement: Amox => Aug => Ceftrixone
  • Consider tympanocentesis if still no improvement - Gram stain, culture, susceptibilities
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16
Q

AOM Treatment Failure Succession

A
  • 1st Line: Augmentin and Ceftriaxone
  • Alternative/Failure of 2nd: Clindamycin: 30-40 mg/kg/day PO q8h +/- 3rd gen ceph.
  • Failure of 2nd: also consider tympanocentesis
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17
Q

Acute Bacterial Rhinosinusitis

A

Inflammation of contiguous nasal mucosa/paranasal sinuses

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18
Q

ABR Risk Factors

A
  • Anatomic abnormalities (septal defect)
  • Allergies/allergic rhinitis
  • Tobacco smoke
  • Intranasal medications
  • Viral respiratory tract infections/winter months
  • Swimming/diving
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19
Q

ABR Etiology

A
  • 90-98% are viral

- Bacterial causers: S. pneumoniae, H. influenzae, Moraxella catarrhalis

20
Q

ABR Diagnosis

A
  • Persist signs/symptoms for 10+ days with no improvement
  • Severe signs/symptoms: Temp >= 39 C AND purulent nasal discharge/facial pain for 3-4+ consecutive days at the start of illness
  • Worsening/”double-sickening” signs/symptoms like new fever onset, headache, or increased nasal drainage after a typical 5-6 typical viral URI with improving symptoms
21
Q

Empiric ABR Children Treatment

A
  • Augmentin: 45 mg/kg/day PO q12h

- Augmentin: 90 mg/kg/day PO q12h

22
Q

ABR Children Treatment + Beta Lactam Allergy

A

-Levofloxacin: 10-20 mg/kg/day PO q12-24 hr

-Clindamycin: 30-40 mg/kg/day PO q8h
AND
-Cefixime: 8 mg/kg/day PO q12h 
OR
-Cefpodoxime: 10 mg/kg/day PO q12h
23
Q

Children ABR Treatment + Severe Hospitalization

A
  • Unasyn: 200-400 mg/kg/day IV q6h
  • Ceftriaxone: 50 mg/kg/day IV q12h
  • Levofloxacin: 10-20 mg/kg/day IV q12-24h
24
Q

High Dose Augmentin + ABR

A

Need at least one risk factor:

  • High endemic rates of penicillin non-susceptible S. pneumoniae
  • Severe infection: systemic toxicity, T >= 39 C, threat of suppurative complications
  • Attending daycare
  • <2 y.o. or >65 y.o.
  • Recent hospitalization
  • Antibiotic use within past month
  • Immunocompromised
25
Q

ABR Empiric Adult Treatment

A
  • Augmentin: 500/125 mg PO q8h OR 875/125 mg PO q12h
  • Augmentin: 2000/125 mg PO q12h
  • Doxycycline: 100 mg PO q12h
26
Q

ABR Adult Treatment + B-lactam Allergy

A
  • Doxycycline: 100 mg PO q12h
  • Levofloxacin: 500 mg PO q24h
  • Moxifloxacin: 400 mg PO q24h
27
Q

ABR Adult Treatment + Severe Hospitalization

A
  • Unasyn: 1.5-3g IV q6h
  • Levofloxacin: 500 mg PO/IV q24h
  • Moxifloxacin: 400 mg PO/IV q24h
  • Ceftriaxone: 2g IV q24h
28
Q

ABR Adjunctive Therapy

A
  • Nasal irrigation with saline
  • Analgesics: NSAIDs, APAP
  • Intranasal corticosteroids
  • Decongestants and antihistamines = NOT recommended
29
Q

Pharyngitis

A
  • Acute, painful inflammation of throat
  • Most commonly effects children 5-15 y.o.
  • Occurs most in winter and early spring months
30
Q

Pharyngitis Etiology

A
  • Virus: causes majority of cases

- Bacterial causers: GAS (S. pyogenes)

31
Q

Pharyngitis + Viral Symptoms

A
  • Conjunctivitis
  • Coryza
  • Oral ulcers
  • Hoarseness
  • Diarrhea
  • Rash
32
Q

Pharyngitis + Bacterial Symptoms

A
  • Abrupt onset of sore throat
  • Fever
  • Headache
  • GI upset
  • Patchy exudates
  • Palatal petechiae
  • Scarlatiniform rash
  • Anterior cervical adenitis
  • Exposure to GAS pharyngitis
33
Q

Pharyngitis Patho

A
  • Possible alteration in host immunity
  • Flora of orotharynx may migrate to cause infection
  • Pathogenic factors: pyrogenic toxins, streptokinases, proteinases
34
Q

Pharyngitis Diagnosis

A
  • Throat cultures if presentation isn’t consistent with viral pharyngitis
  • Rapid detection tests are highly specific but not sensitive and a negative reading would need to be confirmed by a culture
35
Q

Centor Criteria

A
  • Temp > 38 C: 1
  • Absence of cough: 1
  • Swollen/tender anterior cervical nodes: 1
  • Tonsillar swelling/exudate:1

Age

  • 3-14 y.o.: 1
  • 15-44 y.o.: 0
  • > =45 y.o.: -1
36
Q

Pharyngitis Treatment: Penicillin

A
  • Children: 250 mg PO q8-12hr
  • Adults: 250 mg PO q6h OR 500 mg PO q12h
  • Duration: 10 days
37
Q

Pharyngitis Treatment: Amoxicillin

A
  • Children: 50 mg/kg/day PO q12-24 h
  • Adults: 1000 mg PO q24h OR 500 mg PO q12h
  • Duration: 10 days
38
Q

Pharyngitis Treatment: Benzathine Penicillin

A
  • <27 kg: 600,000 units IM
  • > = 27 kg: 1,200,000 units IM
  • 1 dose
39
Q

Pharyngitis Treatment: Cephalexin

A
  • Used for penicillin allergies
  • Children: 20 mg/kg PO q12h
  • Adults: 500 mg PO q12h
  • Duration: 10 days
40
Q

Pharyngitis Treatment: Clindamycin

A
  • Used for penicillin allergies
  • Children: 7 mg/kg PO q8h
  • Adults: 300 mg PO q8h
  • Duration: 10 days
41
Q

Pharyngitis Treatment: Azithromycin

A
  • Used for penicillin allergies
  • Children: 12 mg/kg PO q24h
  • Adults: 500 mg day 1, 250 mg days 2-5
  • Duration: 5 days
42
Q

Pharyngitis Treatment: Clarithromycin

A
  • Used for penicillin allergies
  • Children: 7.5 mg/kg PO q12h
  • Adults: 250 mg q12h
  • Duration: 10 days
43
Q

Centor Criteria: =<1

A
  • =< 0: 1-2.5% risk of strept infection
  • 1: 5-10% risk of infection
  • No further testing or antiobiotics
44
Q

Centor Criteria: 2-3

A
  • 2: 11-17% risk of strept infection
  • 3: 28-35% risk of infection
  • Culture all
  • Antibiotics for positive culture results only
45
Q

Centor Criteria: >=4

A
  • > = 4: 51-53% risk of strept. infection

- Treat empirically with antibiotics and/or culture

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