Upper Respiratory Tract Infections

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giddyupp
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63964
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Upper Respiratory Tract Infections
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2011-02-04 11:47:32
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Upper Respiratory Tract Infections PHPR523 Test2
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Upper Respiratory Tract Infections
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  1. What pathogens most commonly cause acute otitis media (AOM)?
    • H. influenzae
    • S. pneumoniae
    • M. catarrhalis
  2. What are the clinical symptoms of acute otitis media (AOM)?
    • fever
    • otalgia
    • irritability
    • tugging of the ear
    • runny nose
    • nasal congestion
    • cough
    • gray, bulging TM
    • nonmotile TM
  3. When should antibiotics be withheld for acute otitis media (AOM)?
    • 6 mo – 2 yr: uncertain dx and non-severe
    • ≥ 2 yr: uncertain dx (all) and non-severe, certain dx
  4. What are the treatment goals for acute otitis media (AOM)?
    • decrease symptoms
    • eradication of infection
    • prevention of complications
    • avoidance of unnecessary antibiotics
  5. What is the treatment for non-severe acute otitis media (AOM)?
    Amoxicillin
  6. What is the treatment for non-severe acute otitis media (AOM) with penicillin allergy?
    • Non-type I:
    • Cefdinir
    • Cefuroxime
    • Cefpodoxime
    • Type I:
    • Azithromycin
    • Clarithromycin
    • Cefuroxime axetil
    • Cefdinir
    • Clindamycin
  7. What is the treatment for severe acute otitis media (AOM)?
    Amoxicillin clavulanate
  8. What is the treatment for severe acute otitis media (AOM) with penicillin allergy?
    • Non-type I:
    • Ceftriaxone IV/IM x 1-3d (Cefdinir, Cefuroxime, Cefpodoxime if not hospitalized)
    • Type I:
    • Cefuroxime axetil
    • Cefdinir
    • Azithromycin
    • Clarithromycin
    • Clindamycin
  9. What is the duration of therapy for acute otitis media (AOM) in children < 2yo or those with severe illness?
    10d
  10. What is the duration of therapy for acute otitis media (AOM) in children at least 2yo or those with mild to moderate illness?
    5-7d
  11. What adjunctive therapies can be used to alleviate pain associated with acute otitis media (AOM)?
    • antipyretics/analgesics
    • Abiotic drops (benzocaine/antipyrene) - if membrane is intact
    • local heat and cold
    • decongestant/antihistamine or corticosteroids (generally ineffective)
  12. What pathogens most commonly cause sinusitis?
    • S. pneumoniae
    • H. influenzae
    • M. catarrhalis
  13. What are the clinical symptoms of sinusitis?
    • Common:
    • mucopurulent nasal/postnasal discharge
    • nasal congestion
    • facial pain (often unilateral
    • HA
    • maxillary toothache
    • diminished sense of smeill and/or taste
    • Less Common:
    • fatigue
    • cough
    • halitosis
    • fever
    • Children:
    • persistent cough/throat clearing
    • nasal/postnasal discharge
    • congestion and mouth breathing
    • halitosis
    • morning periorbital swelling
    • fever
  14. When should antibiotics be withheld for sinusitis?
    mild symptoms lasting < 10d
  15. What are the treatment goals for sinusitis?
    • decrease symptoms
    • achieving and maintaining patency of the ostia
    • decrease duration of symptoms
    • preventing complications
    • preventing progression to chronic status
    • limiting antibiotic use to those who need it
  16. What is the treatment for mild sinusitis lasting < 10d?
    • analgesics/antipyretics
    • nasal irrigation with saline; humidified air
    • decongestants
    • cough suppressants and expectorants (questionable)
  17. What is the treatment for mild acute sinusitis with no recent antibiotic exposure?
    • Amoxicillin
    • Amoxicillin clavulanate
    • Cefdinir
    • Cefpodoxime proxetil
    • Cefuroxime axetil
  18. What is the treatment for mild acute sinusitis with no recent antibiotic exposure with B-lactam allergy?
    • < 18:
    • Bactrim
    • Macrolide/azalide
    • At least 18:
    • Bactrim
    • Doxycycline
    • Macrolide/azalide
  19. What is the treatment for mildmoderate acute sinusitis in patients < 18yo with recent antibiotic exposure?
    • Amoxicillin clavulanate (high dose)
    • Cefdinir
    • Cefpodoxime or Cefuroxime
    • Ceftriaxone
  20. What is the treatment for mild/moderate acute sinusitis in patients < 18yo with recent antibiotic exposure with B-lactam allergy?
    • Bactrim
    • Macrolide/azalide
    • Clindamycin +/- Rifampin
  21. What is the treatment for mild/moderate acute sinusitis in patients at least 18yo with recent antibiotic exposure
    • Resp. FQ
    • Amoxicillin clavulanate (high dose)
    • Ceftriaxone
    • Combination tx
  22. What is the treatment for mild/moderate acute sinusitis in patients at least 18yo with recent antibiotic exposure with B-lactam allergy?
    • Resp. FQ
    • Clindamycin + Rifampin
  23. What is the duration of therapy for sinusitis?
    10-14d or at least 7d after symptoms are under control
  24. Acute sinusitis is usually diagnosed based on what?
    symptoms and duration of illness
  25. What pathogens most commonly cause pharyngitis?
    • Virus
    • S. pyogenes (Gp A B-hemolytic Strep - GAS)
  26. What are the clinical symptoms of pharyngitis?
    • fever > 38C
    • Exudates (tonsillar)
    • Tonsillar edema
    • Cervical lymphadenopathy (tender)
    • NO cough
  27. What are the treatment goals for pharyngitis?
    • decrease symptoms
    • minimize ADRs
    • prevent transmission
    • prevent acute rheumatic fever and complications
  28. What is the treatment for viral pharyngitis?
    • warm saline gargles
    • lozenges
    • fluids
    • analgesics
  29. What is the treatment for GAS pharyngitis?
    • DOC:
    • Pen VK
    • Penicillin benzathine IM
    • Alternatives:
    • Amoxicillin (DOC for kids - taste)
    • Macrolide/Clindamycin (Type I Pen allergy)
    • 1st gen Ceph (non-type I pen allergy)
    • FQ, Cefdinir, Cefpodoxime (5d)
  30. What are the reasons for treatment failure in GAS pharyngitis?
    • ADHERENCE
    • Re-infection
    • B-lactamases produced by throat flora
  31. What is the best way to diagnose GAS pharyngitis?
    culture (not the rapid Strep test)
  32. What is the most common mechanism of resistance to penicillin for the most common pathogens in AOM/sinusitis?
    • S. pneumoniae - change in PBP
    • H. influenzae - B-lactamases
    • M. catarrhalis - B-lactamases

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