URTI/LRTI

Question 1

Abx for influenza

Answer 1

Oseltamivir po 75mg bd x 5d
Vaccinations recc

Question 2

Viral vs bac pharyngitis

Answer 2

Viral: low fever, malaise, fatigue rhinorrhea, cough, hoarseness, orophyaryngeal lesions
Bac: fever, sore throat w tonsillar exudates, cervical lymphadenopathy wo viral sx

Question 3

Abx for s. Pyogenes pharyngitis

Answer 3

Criteria: at least have 2 sx: faver >38, swollen tender anterior cervical lymph nodes, absence of cough, tonisillar exudate, 3-14yo=1 , 15-44yo=0, >45yo=-1

First line:
PO Pen V 250mg q6h or
Amoxicillin 500mg q12h
(Pen-all)
Non sev: PO Cephalexin 500mg q12h
PO Azithromycin 500mg od
PO Clarithromycin 250 q12h
PO Clindamycin 300mg q8h
Duration: 10d (5d for azithromycin)

Question 4

RED FLAGS for sinusitis

Answer 4

Sx of orbital cellulitis or cns infection:
- limited ocular movements
- acute vision changes
- confusion
- unilateral weakness

Question 5

When to treat sinisitis with abx?

Answer 5

Sx persis >10d wo improvement
-Sx are severe(fever >39, purulent nasal discharge, facial pain>3 consecutive days)
- sx worsen

Question 6

Abx for sinusitis?

Answer 6

PO Amoxicillin 500mg q8h (/clavulanate 625mg q8h)
(Pen-all)
po cefuroxime 500mg q12h or
Po levofloxacin 500mg od or
Po moxifloxacin 400mg od
Duration: 5-7d

Question 7

Abx for CAP Pneumonia

Answer 7

Outpt wo comorbidities: beta lactam (Amoxicillin) or respiratory quinolones (levofloxacin/moxifloxacin)

Outpt w comorbidities: beta lactam (Amoxicillin-clavulanate/ cefuroxime) + macrolides(clarithromycin/azithromycin) or doxycycline or respiratory quinolones (levofloxacin/moxifloxacin)

Inpt, non sev: beta lactam (Amoxicillin-clavulanate/ cefuroxime/ceftriaxone) + macrolides(clarithromycin/azithromycin) or doxycycline or respiratory quinolones (levofloxacin/moxifloxacin)
+(mrsa coverage if needed) iv vancomycin/linezolid
+ pseudomonas coverage: piptazo, ceftazidime, cefuroxime, meropenem, levofloxacin

Inpt, sev: beta lactam (Amoxicillin-clavulanate/ pen G) + ceftazidime(burkholderia pseudomallei coverage) + macrolides(clarithromycin/azithromycin) or respiratory quinolones (levofloxacin/moxifloxacin) + ceftazidime
+(mrsa coverage if needed) iv vancomycin/linezolid
+ pseudomonas coverage included alr
+ anaerobic cover if lung abcess, empyema: metronidazole iv/po OR
Clindamycin
+ empiric oseltamivir 75mg x 5d

Question 8

Abx for HAP/VAP?

Answer 8

Antipseudo BL(piptazo/cefepime/ceftazidime/meropenem/imipenem)
AND/OR
antipseudo FQ (Levo/ciprofloxacin)
OR
Aminoglycoside (amikacin) dn use as sole antipseudo agent

PLUS (MRSA coverage):
Vabcomycin or linezolid

Duration: 7dregardless of pathogen

Question 9

Abx for burkholderia pseudomallei?

Answer 9

Ceftazidime