Wk 26: Respiratory tract infections + pneumonia Flashcards
What does the upper respiratory tract consist of?
- Nasal passage
- Pharynx
- Larynx
What is sinusitis?
Inflammation of paranasal sinuses
- Nasal discharge, facial pain, headache, anosmia
- Referral: orbital + intracranial involvement
Which patients require referral for sinusitis?
- > 10 days
- Young + elder
- Immunocompromised
- Persisting fever
- Chest pain
- Neurological changes
- Caution: diabetes + asthma
What antibiotics are given for sinusitis?
- Phenoxymethylpenicillin: less resistance bc narrow spec - 500mg QDS 5 days
- Severe: co-amox - 500mg TDS 5 days
What are the treatment for acute otitis media in patients not requiring admission?
- Paracetamol/NSAIDs
- W/o antibiotic: symptoms improve w/in 24hrs (60%)
What antibiotics are given for acute otitis media?
- Amox 5-7 days
- Worsening despite 2-3 days of abx: co-amox
- Allergic: eryth/clarith 5-7 days
Define penumonia
- Tissue inflammation in lungs
- Alveoli filled w/ pus
- Confirmed: new shadowing on x-ray
What is inflammation of the lung parenchyma in pneumonia?
- Consolidation
- Alveolar air spaces filled w/ exudate, inflammatory cells + fibrin
What are the classifications of pneumonia?
- Community acquired
- Hospital acquired
- Healthcare associated
- Aspiration
- Ventilator associated
What are the features of community acquired pneumonia?
- Cough
- Sputum, wheeze, dyspnoea or pleuritic pain
- Focal chest signs: dullness on percussion, crepitations + fremitus
- Sweats, fever, myalgia + fever above 38
- Chest xray abnormal
Which groups are at risk of pneumonia?
- Smokers
- Chronic lung disease
- Immunocompromised
- Elderly/frail
- Diabetes
What are common causes of pneumonia?
- Streptococcus pneumoniae
- Haemophilus influenzae
- Mycoplasma pneumonia
What is streptococcus pneumoniae?
- Most common cause CAP
- Gram +ve diplococci
- Affect virulence of organism
- Affects hx viral infection
What is haemophilus influenzae?
- Gram -ve rod
- Affects: COPD
- Antibiotic sensitive
- Segmental, wide spread consolidation
What is mycoplasma pneumonia?
- Lacks cell wall tf resistant to beta lactam antibiotics
- Affects young
- Don’t elevate WBC
- Patchy opacities lower/middle lobes
How do you assess for severity?
CURB 65 + obs
When would you treat according to CURB-65?
- 0: home based care
- 2/more: hospital
When would you offer microbiology tests for CAP?
Mod/severe:
- Blood + sputum cultures AND
- pneumococcal + legionella urinary antigen tests
What is the management for low severity community acquired pneumonia?
5 days treatment:
- Amox 500mg TDS
Allergic:
- Clarith 500mg BD
- Doxy 200mg 1st day + 100mg OD 4 days
No improvement in 3 days: GP
What is the management for mod/severe severity community acquired pneumonia?
- 7-10 days treatment
- Mod: amox + macrolide
- Severe: beta lactamase stable + macrolide (IV)
What happens if a patient is admitted to hospital after CAP?
- Chest x-ray + blood test
- Admin Ax w/in 4 hrs
- CRP conc on admission + repeat after 48-72 hrs
What would you need to consider before switching from IV to oral?
- Resolution of fever >24hrs
- <100bpm
- Resolution of tachypnoea
- Hydrated + fluids
- Absence of hypoxia
- Improving WBC
- Non-bacteremic infection
What are other treatments available for CAP after hospital admission?
- Oxygen
- Bronchodilators
- Steroids
- Asses risk of VTE
- Pain management
When would a patient not be ready for discharge?
Past 24 hrs: 2/more:
- Temp >37.5
- RR: 24
- HR: >100
- Systolic: <90
- O2: <90
- Abnormal mental status
- Inability to eat w/o assistance
Outline the recovery of someone w/ CAP
- Wk 1: fever resolved
- Wk 4: chest pain + sputum prod red
- Wk 6L cough + breathlessness red
- 3 months: most symptoms resolved but fatigue present
- 6 months: normal
What is the common cause of URTI infection?
Rhinovirus
What are pharmacy red flags of urti?
- Cough >3wks
- Chest pain
- Unexplained weight loss
- Dyspnoea
