URTI Flashcards
Acute Bronchitis – Pathogens and Clinical Presentation
Most common pathogens
- respiratory ___
Clinical presentations
- cough
- sore throat
- ___ (runny/stuffy nose, sneezing, post-nasal drip)
- malaise
- headache
- ___
- normal chest imaging
- viruses
- coryza
- fever
Acute Bronchitis – Treatment
Treatment
- ___
- Symptomatic management
- Corticosteroids not necessary
- Antibiotic therapy not necessary (please!)
Methods to reduce antibiotic prescribing
- Delayed antibiotic prescribing
- Show empathy/listen to patient
- Provide patient education on duration of illness (up to 2-3 weeks)
- Provide patient education on the futility of antibiotic therapy
- Discuss treatment plan with symptomatic management
- Use terms related to viral infection when discussing with patient
Number needed to harm: ___ pts
- Self-limiting
- 5
Acute Exacerbation of Chronic Bronchitis – Clinical Presentation
Established diagnosis of chronic bronchitis
- Chronic cough with productive sputum on most days for ≥ 3 consecutive months for __ consecutive years
Hallmark signs of acute exacerbation
▪Increased sputum ___
▪Increased sputum ___
▪Increased ___ or ___
- 2
- purulence
- volume
- cough, SOB
Acute Exacerbation of Chronic Bronchitis – Pathogens
Most common organisms (3)
Patients with frequent antibiotic use (2)
Most common:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Frequent Abx Use:
- Enterobacterales
- Pseudomonas aeruginosa
Acute Exacerbation of Chronic Bronchitis – Treatment
Preferred Treatment Options
- ___ 875/125 mg PO q12h
- ___ 500 mg PO q12h
- ___ 200 mg PO q12h
Treatment Duration: __ - __ days
- Amoxicillin/clavulanate
- Cefuroxime
- Cefpodoxime
5-7
Acute Exacerbation of Chronic Bronchitis – Treatment
Alternative Treatment Options
- ___ 100 mg PO q12h
- ___ / ___ 1 DS PO q12h
- ____ 500 mg PO day 1, then 250 mg daily on days 2-5
Risk for P. aeruginosa
- ___ 750 mg PO daily
- Doxycycline
- TMP/SMX
- azithromycin
- levofloxacin
Acute Pharyngitis – Pathogens and Considerations
Most common pathogens
- Respiratory ___ – rhinovirus, coronavirus, adenovirus most common
- Bacteria – Streptococcus ___ (group A)
Concern for complications with bacterial cause
- Rheumatic ___
- Glomerulonephritis
- Peritonsillar or retropharyngeal abscess
- Mastoiditis
- Otitis media
- Rhinosinusitis
- viruses
- pyogenes
- fever
Acute Pharyngitis – Clinical Presentation
- Sudden onset of ___ ___ with dysphagia and fever
- Pharyngeal hyperemia and ___ swelling (may have exudates)
- Enlarged, tender lymph nodes
- Red, swollen ___
- Petechiae on soft palate
- sore throat
- tonsillar
- uvula
Acute Pharyngitis – Testing
Historically, culture of the throat was the diagnostic standard
- Limitation – takes __ - __ hours to return
Rapid antigen detection tests (RADT) have gained popularity
- Limitation – sensitivity 70-90% compared to culture (chance for false-negative)
Back up testing with ___ or ___ based test needed if RADT negative
- 24-48
- culture, PCR
Acute Pharyngitis – Treatment
Targeted treatment for Streptococcus pyogenes (Group A)
- ___ ___ 250 mg PO TID - QID or 500 mg PO BID x __ days
- ___ 500 mg PO TID or 875 mg PO BID x __ days
- penicillin VK, 10
- amoxicillin, 10
Acute Pharyngitis – Treatment
Alternatives if penicillin allergy
Non-anaphylactic reaction
- ___ 500 mg PO BID x 10 days
- ___ 500 mg PO BID or 1 gram PO once daily x 10 days
- ___ 500 mg PO BID x 10 days
- ___ 200 mg PO BID x 5-10 days
Anaphylactic reaction
- ___ 500 mg PO on day 1, then 250 mg PO daily on days 2-5
- ___ 300 mg PO TID x 10 days
Non-anaphylactic
- cephalexin
- cefadroxil
- cefuroxine
- cefpodoxime
Anaphylactic
- azithromycin
- clindamycin
Acute Bacterial Rhinosinusitis – Common Terms
Acute rhinosinusitis
- ___ nasal drainage
- nasal obstruction, facial pain/ ___
- may last ≥ __ weeks
- purulent
- pressure
- 4
Acute Bacterial Rhinosinusitis – Common Terms
Viral rhinosinusitis
- Acute rhinosinusitis thought to be due to viral pathogen
- Symptoms present < ___ days, not worsening
- 10
Acute Bacterial Rhinosinusitis – Common Terms
Acute bacterial rhinosinusitis (ABRS)
- Acute rhinosinusitis thought to be due to bacterial pathogen
- Persistent symptoms ≥ ___ days with no improvement
- Severe symptoms – ___ , purulent nasal discharge, facial ___ for 3-4 consecutive days at beginning of illness
- Worsening symptoms – new onset of symptoms after initial improvement in symptoms
- 10
- fever, pain
Acute Bacterial Rhinosinusitis – Common Terms
Recurrent acute rhinosinusitis
- ___ or more episodes of ABRS per year
4
Acute Bacterial Rhinosinusitis – Common Terms
Chronic rhinosinusitis
- ≥ 2 signs/symptoms for ___ weeks or longer
12
Acute Bacterial Rhinosinusitis – Pathogenesis
1) ___ upper respiratory tract infection - mucosal inflammation
2) ___ sinus drainage - Mucosal secretions trapped
3) ___ bacteria proliferate - Bacterial infection established
1) viral
2) decreased
3) local
Acute Bacterial Rhinosinusitis – Common Pathogens
Most common pathogens similar to other respiratory infections (3)
Additional pathogens in patients with frequent antibiotic use (2)
Most common
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Additional pathogens in pts with frequent Abx use
- Staphylococcus aureus (MSSA, MRSA)
- Pseudomonas aeruginosa
Acute Bacterial Rhinosinusitis – Clinical Presentation
Major Symptoms
- Purulent anterior and/or posterior nasal
discharge - Nasal congestions and obstruction
- Facial congestion and fullness
- Facial pain and pressure
- Hyposmia or anosmia
- Fever
Acute Bacterial Rhinosinusitis – Clinical Presentation
Minor Symptoms
- headache
- ear pain, pressure, or fullness
- halitosis
- dental pain
- cough
- fatigue
Acute Bacterial Rhinosinusitis – Diagnostic Consideration
Clinical presentation with symptoms suggestive of ABRS
- ___ symptoms
- ___ symptoms
- ___ symptoms (after initial improvement)
Sinus radiograph or CT scan
Culture from nasal secretions or cavity
Sinus puncture and culture (ouch!)
- persistent
- severe
- worsening
Acute Bacterial Rhinosinusitis – Treatment
Two approaches to ABRS treatment
1. Initiate antibiotic therapy as soon as bacterial infection established
2. Watchful waiting up to __ days to observe if improvement occurs without antibiotic therapy
First-line treatment options
- ___ / ___ 500/125 mg PO TID or 875/125 mg PO BID x 5-7 days
- ___ / ___ 2000/125 mg PO BID if concern for penicillin resistance x 5-7 days
Second-line treatment options
▪___ 100 mg PO BID x 5-7 days
▪___ 500 mg PO once daily x 5-7 days
▪___ 400 mg PO once daily x 5-7 days
- 7
- Amoxicillin/clavulanate, Amoxicillin/clavulanate
- doxycycline
- levofloxacin
- moxifloxacin
T or F
Oral 2nd and 3rd generation cephalosporins, macrolides, and TMP/SMX are used in the treatment of Acute Bacterial Rhinosinusitis
FALSE
not
recommended due to concern
for S. pneumoniae resistance
Acute Bacterial Rhinosinusitis – Treatment
Concern for MRSA
- Add agent with MRSA coverage (e.g., ___ , ___ , ___ , clindamycin?)
- Maintain coverage for common organisms unless cultures suggest ___ infection with MRSA
Concern for P. aeruginosa
- ___ – consider higher dose with 750 mg PO daily
- Maintain coverage for common organisms unless cultures suggest ___ infection with P. aeruginosa
- doxycycline, TMP/SMX, linezolid
- monomicrobial
- levofloxacin
- monomicrobial
Acute Bacterial Rhinosinusitis – Supportive Care
- Intranasal saline irrigation
- Warm facial packs
- NSAIDs and/or acetaminophen
- Maintain ___ – thin secretions
- Avoid ___ – thickens mucus, more difficult to clear
- Caution with ___ – concern for rebound congestion
- hydration
- antihistamines
- decongestants
