URTI

Question 1

When to initiate antiviral treatment for influenza?

Answer 1

Hospitalised patients, patients with risk factors for complications (e.g. immunocompromised), severe/complicated/progressive disease; to initiate best within 48h and no later than 5 days of symptom onset

Question 2

What is the antiviral treatment for influenza infection?

Answer 2

First line: PO Oseltamivir (Tamiflu) 75mg BD x 5 days

Question 3

When to initiate treatment for bacterial pharyngitis?

Answer 3

To use the Modified Centor Criteria to evaluate symptoms suggestive of bacterial pharyngitis (categories are: fever > 38 degrees, tonsillar exudates, swollen / enlarged anterior cervical lymph nodes, absence of cough, age within 3-14 yo –> if point 2-3 to take throat culture and start abx if positive for S. pyogenes, if point 4-5 to start empiric abx treatment for S. pyogenes

Question 4

What is the most common bacteria causing bacterial pharyngitis?

Answer 4

S. pyogenes (group A beta hemolytic streptococcus)

Question 5

What are the first line antibiotic treatment options for bacterial pharyngitis? (no penicillin allergy)

Answer 5

First line: PO Penicillin V 250mg q6h x 10 days or PO Amoxicillin 500mg q12h x 10 days

Question 6

What are the antibiotic treatment options for bacterial pharyngitis, if penicillin allergy?

Answer 6

Non-severe: PO cephalexin 500mg q12 x 10 days; Severe/others: PO Azithromycin 500mg OD x 5 days or PO Clarithromycin 250mg q12h x 10 days or PO Clindamycin 300mg q8h x 10 days

Question 7

What are the complications of bacterial pharyngitis?

Answer 7

acute rheumatic fever (can cause arthritis, endocarditis, subcutaneous nodules; preventable by early initiation of antibiotics), acute glomerulonephritis (not preventable by antibiotics)

Question 8

When to initiate treatment for bacterial sinusitis?

Answer 8

to initiate when severe symptoms of bacterial sinusitis: symptoms persist for >10 days, symptoms are severe (high fever >39 degrees, purulent nasal discharge, facial pain for >3 consecutive days), symptoms worsen (new onset headahce, fever, nasal discharge) after improving

Question 9

What are the most common bacteria causing bacterial sinusitis?

Answer 9

S. pneumoniae (more common), H. influenzae

Question 10

What are the first line treatment options of bacterial sinusitis? (non-penicillin allergy)

Answer 10

First line: PO amoxicillin 500mg q8h x 5-7 days or PO amoxicillin-clavulanate 625mg q8h x 5-7 days

Question 11

What are the treatment options of bacterial sinusitis, if penicillin allergy?

Answer 11

Non-severe: PO Cefuroxime 500mg q12h x 5-7 days; Severe: PO Levofloxacin 500mg OD x 5-7 days or PO Moxifloxacin 400mg OD x 5-7 days

Question 12

What are the complications of bacterial sinusitis?

Answer 12

orbital cellulitis, central nervous system infection; symptoms of this include: limited orbital movement, visual acuity changes, confusion, unilateral muscle weakness