Therapeutics - Sinusitis and Epiglottitis
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What are the risk factors for acute sinusitis?
- preceding viral URI
- allergic rhinitis (Most common)
- anatomical disruption
- tobacco smoke or other irritant
What are the most common organism implicated in ACUTE sinusitis?
H. influenza, Streptococcus pneumoniae, Moraxella cattarhalis
What are the most common organism implicated in CHRONIC sinusitis?
Chronic sinusitis - H. influenzae, alpha-hemolytic streptococci, Veillonella, Corynebacterium, Bacteroides
What are the clinical manifestations of acute sinusitis?
- Dental pain
- Fever (not usually present)
- Nasal discharge
- Facial pain
- Sore throat
- Pott’s puffy tumor
- Subperiosteal tumor
What symptoms of Acute sinusitis require urgent attention?
- Visual disturbances
- Periorbital swelling/erythema
- Retro-orbital pain
How is Acute sinusitis diagnosed?
- CT (rare)
What is the antibiotic treatments for Acute sinusitis?
- Amoxacillin, Augmentin, 2nd or 3rd generation cephalosporins, clarithromycin or azithromycin
- X 10 days
What are the ancillary/symptomatic treatments for acute sinusitis?
- Humidified air
- Saline irrigation
- Antihistamines (start prophylactically)
- Topical internasal corticosteroids
What alternative treatment for Sinusitis is almost as effective as Antibiotics?
What are the topical steroids indicated for the treatment of sinusitis?
- Beclomethazone (Vancenase, Beconase)
- Flunisolide (Nasalide)
- Triamcinalone (Nasalcort)
What is the brand name for Beclomethazone?
What is the brand name for Flunisolide?
What is the brand name for Triamcinalone?
What is the generic name for Vancenase, Beconase?
What is the generic name for Nasalide?
What is the generic name for Nasalcort?
What are the common organisms implicated in Epiglottitis?
- Haemophilus influenza – Most commonly
- Streptococcus (A,B,C, and pneumoniae)
- K. pneumoniae
- N. meningitides
What are the clinical manifestations of Epiglottitis?
- respiratory distress
- dysphonia or muffled voice
- sore throat
- Thumb sign
What are the treatment options for Epiglottitis?
- Humidified O2
- Antibiotics (Ceftriaxone or Cefotaxime) x 10 days
When should you step a patient down from IV to oral in the treatment of Epiglottitis?
After afebrile for 24 hours and able to swallow
When should a patient receive epiglottitis prophylaxis?
- Household members or close contact < 4 years of age
- Rifampin 20mg/kg QD for 4 days
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