URI Exam 4

Question 1

Mild illness for otitis media

Answer 1

• Temp < 39C

- Mild ear pain

Question 2

Severe illness for otitis media

Answer 2

• Temp >= 39C

- Moderate to severe ear pain or duration of pain >= 48h

Question 3

For otitis media, when is treatment indicated?

Answer 3

• All with severe illness or otorrhea

- < 24 months with bilateral, mild illness

Question 4

For otitis media, when is observation indicated?

Answer 4

• All with unilateral, mild illness

- > 24 months with bilateral, mild illness

Question 5

What is the dose for high-dose amoxicillin for otitis media?

Answer 5

45 mg/kg po BID

Question 6

What is the dose for high-dose amoxicillin / clavulanate otitis media?

Answer 6

45 mg/kg po BID

Question 7

Why would you use high dose amoxicillin in otitis media?

Answer 7

high dose helps concentration in middle ear fluids exceed MIC of intermediately resistant strains of S. pneumoniae

Question 8

Why would you use high dose amoxicillin / clavulanate in otitis media?

Answer 8

• If amoxicillin given in last 30 days
• Presence of concomitant conjunctivitis (indicates H. influenzae likely pathogen)
• Use ES formulation (600mg/5mL)

Question 9

If patient has PCN allergy, what can be used in otitis media?

Answer 9

• CEFDINIR

- 2nd and 3rd generation cephalosporins

Question 10

What are agents that can be used to treat otitis externa?

Answer 10

• Antibiotic drops

- Steroid drops: reduce inflammation and swelling; rapid relief of symptoms

Question 11

Treatment of otitis externa: antibiotic drops

Answer 11

• Acetic acid / hydrocortisone (Acetasol HC®)
• Neomycin, polymyxin B, hydrocortisone (Cortisporin®)
• Ciprofloxacin (Cetraxal®)
• Ciprofloxacin and dexamethasone (Ciprodex®)
• Ciprofloxacin and hydrocortisone (Cipro HC®)
• Ofloxacin 0.3% (Floxin®)

Question 12

Treatment of otitis externa: special considerations

Answer 12

For patients who have a perforated tympanic membrane

• Avoid neomycin and acetic acid – ototoxic risks outweigh potential benefit
• Avoid Cipro HC – preparation is not sterile

Question 13

Duration for treatment of otitis externa

Answer 13

3 days after symptom resolution

Question 14

When would you need to use oral antibiotics for otitis externa?

Answer 14

• Persistent cases
• Temperature >38.3C
• Immuno-compromised patients: diabetics, HIV+, those on chemotherapy

Question 15

What is the treatment for sinusitis?

Answer 15

• For adults: Amoxicillin / clavulanate

- For children: either Amoxicillin by itself or Amoxicillin / clavulanate

Question 16

Dose of Amoxicillin / clavulanate for adults in sinusitis

Answer 16

• Standard dose: 875/125mg PO BID

- High dose: 2000 mg PO BID

Question 17

Dose of Amoxicillin or Amoxicillin / clavulanate for adults in sinusitis

Answer 17

45 mg/kg PO BID

Question 18

When should you consider high doses of amoxicillin (by itself or with clav) in sinusitis?

Answer 18

• For adults: Recent abx or hospitalization, age > 65, immuno-compromised
• For children: always

Question 19

When should you consider using amoxicillin with clav as opposed to using it by itself in sinusitis?

Answer 19

• Severe onset (temp > 39C or purulent nasal discharge > 3 days)
• Children < 2 years of age
• Daycare attendees
• Recent antibiotics

Question 20

What is first line for bacterial infection in sinusitis?

Answer 20

• For adults: Amoxicillin / clavulanate

- For children: either Amoxicillin by itself or Amoxicillin / clavulanate

Question 21

Symptoms of sinusitis: bacterial

Answer 21

• Nasal discharge: Purulent at onset, lasts 3-4 days
• Fever: >39C
• Time course: Over 10 days without improvement

Question 22

Symptoms of sinusitis: viral

Answer 22

• Nasal discharge: Clear and watery at onset, progressing to purulent by day 5, then back to clear and watery
• Fever: Absent or only within first 48h
• Time course: Symptoms peak by day 6, then improve and resolve by day 10

Question 23

For sinusitis, what should be used if pt has PCN allergy?

Answer 23

• Adult: Doxycycline, levofloxacin

- Children: cefdinir

Question 24

Treatment for pharyngitis

Answer 24

Amoxicillin has a once daily dosing option

Question 25

primary bacterial pathogen for pharyngitis

Answer 25

Group A streptococcus

Question 26

Treatment of pharyngitis caused by Group A streptococcus

Answer 26

• 1st line: Penicillin or amoxicillin
• Pain management: acetaminophen, ibuprofen
• Supportive care: Hydration, salt water gargles, lozenges, viscous lidocaine

Question 27

For pharyngitis, what should a patient receive if they have a PCN allergy?

Answer 27

• Type I penicillin allergy: clindamycin or azithromycin

- Non-type I penicillin allergy: 2nd or 3rd generation cephalosporin -> cefdinir*, cefuroxime, cefpodoxime

Question 28

contraindications associated with Bactrim

Answer 28

• Bilirubin displacement can lead to hyperbilirubinemia and kernicterus
• Avoid in infants < 2 months of age

Question 29

contraindications associated with tetracyclines

Answer 29

• Causes permanent tooth discoloration and retardation of skeletal development
• Avoid in children < 8 years of age

Question 30

contraindications associated with fluoroquinolones

Answer 30

• Can cause tendon rupture and cartilage erosion in weight-bearing joints
• Avoid in children < 18 years of age