URTI Flashcards
Acute Bronchitis
Common Pathogen and Clinical presentation
Respiratory Viruses
Presentation
- NORMAL chest imaging
- Cough
- Sore throat
- Coryza (runny/ stuffy nose, sneezing, post nasal drip)
- Malaise
- Headache
- Fever
Acute Bronchitis Treatment
Self limiting
symptomatic management
DO NOT TREAT WITH ANTIBIOTICS
Acute exacerbation of Chronic Bronchitis
Clinical presentation
Hallmark signs
chronic cough with Productive Sputum on most days for > or equal to 3 CONSECUTIVE months for 2 consecutive years
Hallmark signs
- increased sputum purulence
- increased sputum volume
- increased cough or shortness of breath
Acute exacerbation of Chronic Bronchitis
Common pathogens
Streptococcus
H. Flu
Moraxella
Patient with frequent antibiotic use
Enterobacterales (CEEK)
Pseudomonas aeruginosa
Acute exacerbation of Chronic Bronchitis
Treatment
Duration of tx
and treatment with risk of pseudomonas aeruginosa
Duration of therapy should be for 5-7 days
Preferred treatment options
- Amoxicillin/ Clavulanate 875/125mg PO Q12H (#1 tx)
- Cefuroxime 500mg PO Q12H
-Cefpodoxime 200mg PO Q12H
Alternative
- Doxycycline 100mg PO Q12H
- TMP/SMX 1 DS PO Q12H
- Azithromycin 500mg PO day 1, then 250mg daily on days 2-5 (LAST LINE)
Risk of Pseudomonas
- Levofloxacin 750mg PO daily
Acute Pharyngitis
common pathogens
and concerns for complications with bacterial cause
Bacteria - Streptococcus pyogenes
Respiratory viruses - rhinovirus, coronavirus, adenovirus most common
concerns for complications with bacterial cause
- Rheumatic fever
- Glomerulonephritis
- peritonsillar or retropharyngeal abscess
- Mastoiditis
- Otitis media
- Rhinosinusitis
Acute Pharyngitis
Clinical presentation
-sudden onset of sore throat with dysphagia and fever (pain w/ swallowing)
- pharyngeal hyperemia and tonsillar swelling
- enlarged, tender lymph nodes
- red swollen uvula
- petechiae on soft palate
Acute Pharyngitis
Treatment and duration of treatment
goal is to target streptococcus pyogenes
- Penecillin VK 250mg PO TID-QID or 500mg PO BID x 10 days
- Amoxicillin 500mg PO TID or 875mg PO BID x 10 days
Acute Pharyngitis
If penicillin allergy
Treatment and duration of treatment
Non anaphylactic
Cephalexin 500mg PO BID x 10 days
Cefuroxime 500mg PO BID x 10 days
Cefpodoxime 200mg PO BID x 5-10 days
Anaphylactic reaction
Azithromycin 500mg PO on day 1, then 250mg PO on days 2-5
- Clindamycin 300mg PO TID x 10 days
Acute Bacterial rhinosinusitis
(ABRS)
how is it defined
what are the symptoms
Persistent symptoms > or equal to 10 days with no improvement
Severe symptoms
- fever, purulent nasal discharge, facial pain for 3-4 consecutive days at beginning of illness
Worsening symptoms
- new onset of symptoms after initial improvement in symptoms
Chronic rhinosinusitis
> or equal to 2 signs/symptoms for 12 weeks or longer
Acute Bacterial rhinosinusitis
(ABRS)
Common pathogens and those seen in patients with frequent antibiotic use
Streptococcus Pneumoniae
H. Flu
Moraxella
Seen in patients with frequent antibiotic use
- Staph aureus MSSA, MRSA
- Pseudomonas aeruginosa
Acute Bacterial rhinosinusitis
(ABRS)
Major and minor symptoms
Major symptoms
- purulent anterior and/ or posterior nasal discharge
- nasal congestion and obstruction
- facial congestion and fullness
- facial pain and pressure
- hyposmia or anosmia
- fever
Minor symptoms
- HA
- ear pain, pressure or fullness
- halitosis
- dental pain
- cough
- fatigue
Acute Bacterial rhinosinusitis
(ABRS)
Treatment and duration
treatment for MRSA
Treatment for P. aeruginosa
watchful waiting up to 7 days to observe if improvement occurs without antibiotic therapy
First line treatment
- Augmentin 500/125 PO TID or 875/125mg PO BID x 5-7 days
-Augmentin 2000/125mg PO BID if concern for penicillin resistance x 5-7 days
Second line treatment
- Doxycycline 100mg PO BID x 5-7 days
- Levofloxacin 500mg PO once daily x 5-7 days
- Moxifloxacin 400mg PO once daily x 5-7 days
treatment for MRSA
ADD doxycycline, TMP/SMX, Linezolid, clindamycin
- maintain coverage of common organism unless culture suggest monomicrobial infection with MRSA
Treatment for P. aeruginosa
Levofloxacin 750mg PO daily
- maintain coverage of common organism unless culture suggest monomicrobial infection with P. aeruginosa
Acute Bacterial rhinosinusitis
(ABRS)
Supportive care
- intranasal saline irrigation
- warm facial packs
- NSAID
- Hydration
- Avoid antihistamines
- Caution with decongestants
Patient case 1
BD is a 42-year-old female who presents to primary care for a hypertension
management appointment with you.
▪During the visit, the patient shares she has a 3-day history of cough, sore throat, and
headache. You discuss the case with the primary care physician.
▪Rapid testing for influenza and COVID-19 returns negative. The primary care
physician has to see their next patient and asks you to discuss treatment of acute
bronchitis with the patient.
What is the recommended
treatment for this patient?
A. Azithromycin 500mg PO on day 1 and 250mg PO on days 2-5
B. Amoxicillin 500mg PO TID x 5 days
C. Admit to hospital
D. Symptomatic management
D
Patient case 1 continued
The patient explains that last time this happened 2 years ago the provider she saw
prescribed her a Z-pak and she felt so much better. She presses you to prescribe an
antibiotic.
How do you respond?
A. Prescribe Z pak
B. Tell her she is wrong and the antibiotic did nothing
C. Explain that acute bronchitis is typically due to a virus and antibiotic therapy has risk of adverse effects
D. Tell the patient you need to talk further with the provider
C
TP is a 65-year-old male who presents to the emergency department with cough,
fever (101 F), increased yellow sputum production, and headache.
▪Over the past couple of years, patient has had seasons of chronic cough and sputum
production
▪Patient has been prescribed antibiotic therapy 3 times in the last 3 months
⎻ Amoxicillin/clavulanate
⎻ Doxycycline
⎻ Azithromycin
Which bacteria is the patient
at risk for?
A.Strep agalactiae
B. Enterococcus faecalis
C. Bacteroides fragilis
D. Pseudomonas aeruginosa
D
TP is a 65-year-old male who presents to the emergency department with cough,
fever (101 F), increased yellow sputum production, and headache.
▪Over the past couple of years, patient has had seasons of chronic cough and sputum
production
▪Patient has been prescribed antibiotic therapy 3 times in the last 3 months
⎻ Amoxicillin/clavulanate
⎻ Doxycycline
⎻ Azithromycin
What is the recommended treatement for this patient
A. Levofloxacin 500mg PO once daily x 10 days
B. Augmentin 875/125 PO BID x 5 days
C. Cefpodoxime 200mg BID x 5 days
D. Levofloxacin 750mg PO QD x 5 days
D
SL is a 22-year-old female who presents to the urgent care with a 1-day history of
sore throat, pain with swallowing, fever (100.8 F). The provider performs the physical
exam, and it is consistent with acute pharyngitis.
▪Past medical history – none
▪Rapid strep (RADT) – positive
▪Allergies – amoxicillin (10 years ago, diffuse mild rash, occurred with amoxicillin when it was
prescribed when the patient has mononucleosis)
Which organism is the most
common bacterial cause of
acute pharyngitis?
A. Streptococcus agalactiae
B. Streptococcus Pyogenes
C. Streptococcus intermedius
D. Streptococcus dysgalactiae
B
SL is a 22-year-old female who presents to the urgent care with a 1-day history of
sore throat, pain with swallowing, fever (100.8 F). The provider performs the physical
exam, and it is consistent with acute pharyngitis.
▪Past medical history – none
▪Rapid strep (RADT) – positive
▪Allergies – amoxicillin (10 years ago, diffuse mild rash, occurred with amoxicillin when it was
prescribed when the patient has mononucleosis)
What is the best treatment
option for this patient? (select all that apply)
A. Amoxicillin 500mg PO TID x 10 days
B. Cephalexin 500mg PO BID x 10 days
C. Azithromycin 500mg PO on day 1, then 250mg PO on day 2-5
D. clindamycin 300mg PO TID x 5 days
A and B
You receive a call from the ENT specialist nurse practitioner regarding a patient with
recurrent ABRS. After speaking with the nurse practitioner, it sounds likely that this is
truly recurrent bacterial infection.
▪Allergies – none
▪Renal function – normal for age
▪Recent antibiotic use – amoxicillin/clavulanate x 2, levofloxacin, moxifloxacin all within the
last 4 months
▪No culture data
What would you recommend
for this patient?
A. Levofloxacin 750mg PO once daily x 7 days
B. Clindamycin 300mg PO TID + Ciprofloxacin 500mg PO BID x 7 days
C. Augmentin 875/125mg PO BID + Doxycycline 100mg PO BID x 7 days
D. Cefpodoxime 200mg PO BID + Levofloxacin 750mg PO once daily x 7 days
C
