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75 Cards in this Set
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when referring to "upper-airway"; does this include the lungs?
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NO
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Upper respiratory tract infections
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Otitis media
Sinusitis Pharyngitis |
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Lower respiratory tract infections
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Bronchitis (acute vs. chronic)
Pneumonia (community-acquired) |
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acute pharyngitis (def)
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onset of pn in the throat manifested esp on swallowing, sometimes associated w/tonsil exudates
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etiology of pharyngitis
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70% viral
30% bacterial |
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viruses that may cause pharyngitis
is it exudative? |
rhinovirus, coronavirus, adenovirus, influenza virus, parainfluenza virus, Epstein-Barr virus
NON-exudative |
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Bacterial pathogens of pharyngitis
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GAS pyogenes -- major
minor: mycoplasma pneumo, chlamydophila pneumo, corynebacterium diphtheriae |
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bacterial or viral pharyngitis?
s/sx: systemic complents rarely present |
viral
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bacterial or viral pharyngitis?
s/sx:pharyngeal membrane is a "fiery red" |
bacterial
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bacterial or viral pharyngitis?
s/sx: pathcy, grayish-yellow exudates on the tonsils? |
bacterial
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bacterial or viral pharyngitis?
s/sx: tender, enlarged cervical nodes? |
bacterial
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bacterial or viral pharyngitis?
s/sx: cough, mild-mod pharyngeal discomfort (soreness, scratchiness, or irritation); nasal signs/sx, cough |
both bacterial or viral
more common w/viral* |
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viral pharyngitis is more prominent in what population?
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children under 3 years
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high risk groups for GAS pharyngitis
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children 5-15y
parents of school-aged children individuals who work w/children individuals in close contact to other w/GAS pharyngitis |
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GAS criteria
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1. absence of cough
2. history of fever >101F 3. tonsillar exudate 4. swollen, tender anterior cervical nodes |
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primary objective in diagnosis process of pharyngitis
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distinguish cases of common viral etiology from those due to s.pyogenes
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two types of tests used for diagnosis of pharyngitis
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1. rapid stret antigen test
2. throat culture |
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primary therapy for VIRAL pharyngitis
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NO direct therapy indicated
symptomatic tx (warm saline gargles for sore throat, liquids, APAP, NSAIDs f pn) children: NSAIDs over apap |
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primary therapy for GAS pharyngitis
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Abs + symptomatic as w/viral
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complication of GAS pharyngitis
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rheumatoid fever (can lead to damaged heart valves); not common
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treatment of choice for GAS pharyngitis
why? |
penicillin
cheap, safe, effective, narrow-spec |
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what else can be used for GAS pharyng.?
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amoxicillin
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can macrolides be used for tx of GAS pharyn?
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yes. but reserved for PCN allergic pts b/c resistance is a prob w/them
(erythro, azithro, clarithro) |
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summary of all ab's that can be used to treat GAS pharyngitis:
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1. PEN VK, PEN benzathine (IM)
2. Amoxacillin 3. Macrolides: Erythro, Azithro, clarithro 4. clindamycin 5. 2nd/3rd gen cephalosporins: cefuroxime, cefprozil, cefpodoxime,cefdinir |
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length of therapy for GAS pharyngitis (how long to ERADICATE bacteria?)
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10 days
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otitis media (def)
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inflammation of the MIDDLE ear
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what pt population is more susceptible to otitis media and why?
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children > adults
b/c the anatomy of their Eustachian tube is SHORTER & more HORIZONTAL |
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pathophysiology of otitis media
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upper respiratory tract infection --> eustachian tube dysfunction & mucosal swelling in the middle ear + bacteria and viruses that colonize the nasopharynx are not cleared properly
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most common bacterial pathogens of otitis media
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streptococcus pneumoniae
haemophilus influenzae moraxella catarrhalis |
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is there a viral etiology to otitis media?
does a bacterial pathogen have to present in otitis media? |
viral etiology found in up to 40-45% of cases
no bacterial pathogen found in 20-30% of the cases |
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specific symptoms of otitis media
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fever, tugging of the ear, pn
redness, bulging tympanic membrane |
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non-specific sx of otitis media (OM)
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rhinorrhea, cough, irritability, anorexia, HA, vomiting, diarrhea
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2 diagnostic procedures done to identify OM
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1. otoscope
2. tympanocentesis (done in pts w/previous ab exposure who have failed tx after 3 days) |
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BIG POINT goal of treatment
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avoidance of unnecessary ab use and prevention of resistance
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two types of treatment for OM
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1. antibiotics (contreversial; big placebo reponse)
2. symptomatic therapy (APAP, NSAIDs f pn and malaise + decongestants, antihistamines, topical corticosteroids, expectorants) |
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why do haemophilus influenzae and moraxella catarrhalis exhibit ab resistance?
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they are b-lactamase producers
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which ab's are effective in overcoming resistance of b-lactamase producing organisms?
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1. cephalosporins
2. B-lactam/B-lactamase inhibitor 3. macrolides 4. tetracyclines 5. fluoroquinolones |
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Ab tx of OM -- is it empiric or specific??
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EMPIRIC w/stepwise approach
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if NO abs were given in last mo to a pt that presents w/OM -- what are PREFERRED treatment options available?
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standard dose: Amox 40-45mg/kg
OR high dose: Amox 80-90mg/kg |
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NO prior ab's given, pt exhibits tx failure at day 3 -- what do we give them now?
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amox+clav 80-90mg/kg/day (based on amox dose)
OR cefuroxime axetil OR IM ceftriaxone |
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NO prior ab's given, pt exhibits tx failure at day 10-28
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repeat tx:
amox+clav 80-90mg/kg/day (based on amox dose) OR cefuroxime axetil OR IM ceftriaxone |
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pt was treated w/ab in prior mo, presents w/OM...what is treatment of choice?
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high dose: amox 80-90mg/kg/d
OR amox-clav (high dose amox component) OR cefuroxime axetil |
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pt was treated w/ab in prior mo, presents w/OM...exhibits tx failure at day 3 --what do we give them now?
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IM ceftriaxone
OR clindamycin +? tympanocentesis |
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pt was treated w/ab in prior mo, presents w/OM...exhibits tx failure at day 10-28 --what do we give them now?
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amox-clav (high dose amox component)
OR cefuroxime axetil OR IM ceftriaxone and? tympanocentesis |
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length of Ab therapy for otitis media????
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7-10 days
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if pt presents w/recurrent acute otitis media -- how often are they having otitis media?
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at least 3 episodes w/in 6mo
OR 4 episodes/year |
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if pt presents w/recurrent acute otitis media, is chemoprophylaxis warranted?
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questionable; but if decided to initiate - do so during winter and early spring; LIMIT to 6mo frame
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regimen for chemoprophylaxis of AOM (acute otitis media):
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amox 20-30mg/kg/d HS or divided Q12H
OR Sulfisoxazole 80-100mg/kg/d Q24H OR TMP/SMX (equiv to 4mg/kg/d TMP) Q24H OR maringotomy and/or tympanostomy tubes |
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AOM usually resolves in children in what time frame?
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24-72 hours
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persistance of effusion of AOM can be subacute or chronic -- give time frame for each
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subacute: 3wks-3mo
chronic: >3mo |
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treatment options for persistence of effusion with AOM
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amox 20mg/kg/d or TMP/SMX
+ appropriate ab tx for each episode of AOM +/- myringotomy or tympanostomy tubes |
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inflammation and/or infection of the parnasal sinus mucosa is known as
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sinusitis
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etiology of sinusitis: viral or bacterial?
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both
viruses predominant (esp in early disease) bacterial more prominent late (when symptoms persist >7d) |
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two categories of sinusitis?
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acute or chronic
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3 likely causative agents of sinusitis?
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similar to otitis media
#1. strept pneumo, haemophilus influenzae #2. moraxella catarrhalis other: (not part of empiric tx) staph aureus, strept pyogenes, fungi, anaerobes |
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treatment of sinusitis?
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symptomatic treatment (nasal saline, decongestants)
and/or Ab |
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when should one initiate ab therapy for sinusitis?
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if patient has moderate to severe disease for at least 7 days
try NOT to use ab's for acute, early, mild dx* |
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treatment of choice for sinusitis?
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amox 500mg po TID
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what if pt is PCN allergic; what treatment is there for sinusitis?
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#1. azithro OR claritho
#2. quinolone if not true allergy, can give 2nd gen cephalosporin (cefprozil, cefuroxime) |
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what if drug resistant S. pneumo is suspected in sinusitis pt?
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give high dose amox 1000mg po TID
or Clindamycin (but be careful with this, it does not cover gram -) |
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inflammation of the large elements of tha tracheobronchial tree is known as
(damaged cilia, narrowed airway, inflamed lining of the bronchial tube, thick mucus) |
acute bronchitis
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causative agents???
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predominantly virus
bacteria maybe |
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acute vs chronic bronchitis:
this generally occurs as single episodes + common in children and adults |
acute
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acute vs. chronic bronchitis: this type includes production of sputum on most days for at least 3 mo/yr x >2yrs + primarily affects adults
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chronic
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exacerbations of chronic bronchitis can be influenced by:
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environmental factors i.e. smoking, pollutants, fumes, polens, respiratory viruses, bacteria
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causative viral pathogens of acute bronchitis
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rhinoviruses, influenzae, parainfluenza, adenovirus
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causative bacterial pathogens of acute bronchitis
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S. pneumo
H. influenzae atypical pathogens* |
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pathogenesis of acute bronchitis
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infection of trachea+bronchi --> hyperemic and edematous mucous membranes --> increased bronchial secretions, destruction of the respiratory epithelium, impaired mucociliary activity
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acute bronchitis, non-specific complaints
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cough (chronic, wont go away for 3-4d), fever (not exceeding 39C)
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diagnostic tests used for acute bronchitis
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clinical (s/sx), sputum (of limited value - rules out pneumo), viral antigen-detection (rare)
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treatment of choice for acute bronchitis
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symptomatic!!!
ab's ONLY when necessary |
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symptomatic tx of acute bronchitis
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tx dehydration+respiratory compromise
cough: dextromethorphan, codeine fever: APAP, NSAIDs, ASA respiratory dysfunction: B2-agonist (albuterol inhaler) prn |
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when should ab's be initiated in pts w/acute bronchitis?
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pts w/persistent fever and/or respiratory sx lasting >4-6d
pts w/significant co-morbid disease + elderly |
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Abs for acute bronchitis are directed at which pathogens?
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S. pneumo
H. influenzae M. pneumo |
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what are common therapy options for acute bronchitis?
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macrolides (azithro, erythro, clarythro)
fluoroquinolones (levo, moxi, NOT cipro) |
