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phm603 > URTIs > Flashcards

URTIs Flashcards

1
Q

what is sinusitis?

A

inflammation of sinus cavities

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2
Q

is sinusitis mostly viral or bacterial and what percentage?

A

VIRAL (rhinovirus)(>90%) while bacterial is (<10%)

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3
Q

what are some MAJOR nonspecific symptoms of sinusitis?

A
  • purulent anterior/posterior nasal discharge
  • nasal congestion or obstruction
    facial congestion/fullness
  • decreased sense of smell
  • fever
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4
Q

what are some MINOR nonspecific symptoms of sinusitis?

A
  • headache
  • ear pain, pressure, or fullness
  • halitosis
  • dental pain
  • cough
  • fatigue
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5
Q

what is the first step to treating sinusitis?

A

NON-PHARM before antibiotics

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6
Q

how do we treat viral sinusitis? (non-pharm)

A
  • decongestants
  • irrigation
  • mucolytics
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7
Q

what should we NOT use to treat bacterial sinusitis?

A

decongestants and antihistamines

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8
Q

when do we use corticosteroids to treat sinusitis?

A

reserved for more severe symptoms

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9
Q

what kind of corticosteroids would we use to treat sinusitis?

A

intranasal (allergic rhinitis
oral is controversial (systemic effects might not target sinus cavity)

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10
Q

why is the use of oral corticosteroids controversial?

A

systemic effects might not target sinus cavity

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11
Q

when would we use antibiotics?

A

PERSISTENT, SEVERE, or WORSENING symptoms

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12
Q

persistent symptoms

A

≥ 10 days WITHOUT improvement

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13
Q

severe symptoms

A

≥ 3-4 days at the beginning of illness
- fever > 102F
- purulent nasal discharge
- facial pain

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14
Q

worsening symptoms

A

typical viral URI gets better then worse (double-sickening/worsening)
- new onset of fever, headache, or increase nasal drainage

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15
Q

what is the ABX/drug of choice of sinusitis?

A

amoxicillin/clavulanate

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16
Q

what does amoxicillin/clavulanate cover?

A

S. pneumoniae and H. influenzae

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17
Q

what are some common side effects of amoxicillin/clavulanate?

A

diarrhea and rash (take with food if GI upset)

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18
Q

treatment for sinusitis

A
  1. amox/clav
  2. fluoroquinolones (levofloxacin)
  3. clindamycin PLUS cefpodoxime or Cefuroxime for MILD allergies
  4. doxycycline alternative in adults
  5. TMP/SMX and macrolides questionable efficacy (mac-erythro has QT prolongation)
19
Q

what are some concerns about using fluoroquinolones to treat sinusitis?

A

concern for cost, side effects, and resistance development (collateral resistance)

20
Q

what is a major side effect of fluoroquinolones (levofloxacin)

A
  • tendonitis in children (tendon rupture more severe)
  • QTc prolongation
21
Q

duration of antibiotic therapy in adults vs. kids

A

adults: 5-7 days
kids: 10-14 days

22
Q

definition of chronic sinusitis?

A
  • symptoms persist > 12 weeks
  • often NOT infectious (don’t routinely recommend antibacterial treatment)
  • S. pneumoniae and H. influenzae still most common
  • cultures are recommended!
23
Q

what is another name for pharyngitis

A

strep throat!

24
Q

common pathogens for pharyngitis

A

viral: rhinovirus (20%)
bacterial: group A strep (most often strep. pyogenes)(15%)

25
Q

signs and symptoms of pharyngitis (group A strep etiologic agent)

A
  • sudden onset of sore throat
  • age 5-15 years
  • fever (not always)
  • headacche
  • tonsillopharyngeal inflammation
  • tender lymph nodes
  • winter and early spring presentation
  • hx of exposure to strep pharyngitis

children will often be moody, have sleep disturbances, eating reduction, and have rashes (not always)

26
Q

why do we treat group A strep?

A
  • avoid post-pharyngitis complications
  • improve symptoms
  • cause for “sick days”
  • prevent transmission
27
Q

when do we start treatment for pharyngitis?

A

AFER SYMPTOM ONSET -> patients MUST be SYMPTOMATIC to treat

28
Q

sequence of treatment for a symptomatic adult

A

throat swab RADT
- if negative: do not treat
- if positive: treat

29
Q

sequence of treatment for a symptomatic child

A

throat swab RADT
- if negative -> can be potential false negative: perform a throat culture
- if negative: do not treat
- if positive: treat

  • if positive: treat
30
Q

what is the drug of choice for pharyngitis?

A

penicillin VK or amoxicillin

31
Q

duration of therapy for pharyngitis

A

10 days

32
Q

what if a patient with pharyngitis is ALLERGIC to penicillin?

A

if mild allergy (rash)
- first generation cephalosporin
- cephalexin x 10 days

if severe allergy (anaphylaxis)
- clindamycin x 10 days
- azithromycin x 5 days

33
Q

what do we give if a patient with pharyngitis is unlikely to adhere to treatment?

A

benzathine penicillin IM x 1

34
Q

is acute otitis media predominantly viral or bacterial?

A

BACTERIAL
-> S. pneumoniae
-> H. influenzae

35
Q

signs and symptoms of otitis media

A
  • fluid in middle ear
  • inflammation/erythema of mucosa of middle ear
  • ear pain
  • ear drainage (rare)
  • hearing loss (rare)
  • nonspecific: fever, lethargy/irritability
36
Q

how should we manage pain for acute OM?

A

PO acetaminophen or ibuprofen PRN for up to 1 week

37
Q

when would we use antibiotics to treat acute OM?

A

6 mo-12 years PLUS mod-severe pain OR temperature 102.2
6-23 mo PLUS nonsevere bilateral acute OM

consider in:
6-23 mo PLUS nonsevere unilateral
2-12 years PLUS acute nonsevere OM

38
Q

what is a risk of using antibiotics for infants/children?

A

diarrhea -> dehydration

39
Q

what is the first-line therapy for treating acute OM? (drug AND dose)

A

AMOXICILLIN FIRST
- amoxicillin (80-90 mg/kg/day in 2 divided doses)
OR
- amoxicillin/clavulanate (if amox 30 day hx, purulent conjunctivitis, or recurrent and unresponsive to amox alone)

40
Q

what is the typical sequence of treatment for acute OM?

A

amoxicillin (80-90 mg/kg/day in 2 divided doses) -> amox/clav -> cephalosporins

41
Q

what are the empirical choices for treating acute OM?

A

amoxicillin or amoxicillin-clavulanate with HIGH DOSE amoxicillin (80-90 mg/kg/day in 2 divided doses) being recommended!

42
Q

what are the empirical choices for treating rhinosinusitis?

A

amoxicillin/clavulanate

43
Q

what are the empirical choices for treating pharyngitis?

A

amoxicillin or penicillin VK

44
Q

what is the clinical significance of many URTIs being viral?

A

don’t always require antibiotics and we try to not give as to not spread antibiotic resistance!

phm603 (6 decks)

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