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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
signs and symptoms of pharyngitis (group A strep etiologic agent)
- 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
why do we treat group A strep?
- avoid post-pharyngitis complications - improve symptoms - cause for "sick days" - prevent transmission
27
when do we start treatment for pharyngitis?
AFER SYMPTOM ONSET -> patients MUST be SYMPTOMATIC to treat
28
sequence of treatment for a symptomatic adult
throat swab RADT - if negative: do not treat - if positive: treat
29
sequence of treatment for a symptomatic child
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
what is the drug of choice for pharyngitis?
penicillin VK or amoxicillin
31
duration of therapy for pharyngitis
10 days
32
what if a patient with pharyngitis is ALLERGIC to penicillin?
if mild allergy (rash) - first generation cephalosporin - cephalexin x 10 days if severe allergy (anaphylaxis) - clindamycin x 10 days - azithromycin x 5 days
33
what do we give if a patient with pharyngitis is unlikely to adhere to treatment?
benzathine penicillin IM x 1
34
is acute otitis media predominantly viral or bacterial?
BACTERIAL -> S. pneumoniae -> H. influenzae
35
signs and symptoms of otitis media
- fluid in middle ear - inflammation/erythema of mucosa of middle ear - ear pain - ear drainage (rare) - hearing loss (rare) - nonspecific: fever, lethargy/irritability
36
how should we manage pain for acute OM?
PO acetaminophen or ibuprofen PRN for up to 1 week
37
when would we use antibiotics to treat acute OM?
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
what is a risk of using antibiotics for infants/children?
diarrhea -> dehydration
39
what is the first-line therapy for treating acute OM? (drug AND dose)
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
what is the typical sequence of treatment for acute OM?
amoxicillin (80-90 mg/kg/day in 2 divided doses) -> amox/clav -> cephalosporins
41
what are the empirical choices for treating acute OM?
amoxicillin or amoxicillin-clavulanate with HIGH DOSE amoxicillin (80-90 mg/kg/day in 2 divided doses) being recommended!
42
what are the empirical choices for treating rhinosinusitis?
amoxicillin/clavulanate
43
what are the empirical choices for treating pharyngitis?
amoxicillin or penicillin VK
44
what is the clinical significance of many URTIs being viral?
don't always require antibiotics and we try to not give as to not spread antibiotic resistance!

phm603 (6 decks)

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