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6 Cards in this Set
- Front
- Back
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Symptoms suggestive of bacterial rhinosinusitis (rather than viral)? (7)
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10-14 day duration
congestion, purulent rhinorrhea, postnasal drainage unilateral facial or dental pain, pain on palpitation headache worse at night periorbital edema olfactory disturbances |
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Most common causative organisms of bacterial rhinosinusitis? (3)
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Streptococcus pneumonia (20-43%)
Hemophilus Influenza (22-35%) Moraxella Catarrhalis (2-10%) |
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When do you treat bacterial rhinosinusitis? With what? Duration?
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Symptoms should be present at least 10 days before treatment with antibiotics is considered.
1st Line Therapy: Amoxicillin 2nd Line Therapy: (if fails amoxicillin) Augmentin 2g Q12 hours Penicillin Allergic: 2nd or 3rd generation cephalosporin (1st gen does not cover H Flu; orals include cefuroxime, cefpodoxime,cefdinir, cefprozil) If need to aviod B-lactams entirely: TMP/SMZ or azithromycin Usual duration is 10-14 days; shorter course possible with azithromycin |
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Adjunctive therapies for bacterial rhinosinusitis? (4)
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1) Intranasal glucocorticoids (may increase clinical cure rate)
2) Consider antihistamines (1st gen anticholinergics may acutally prevent mucous clearing and prolong symptoms) 3) Mucolytic therapy (guaifenesin may be ineffective, but is harmless) 4) Nasal saline irrigation (provides symptom relief, particularly with chronic sinusitis) |
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Most frequently encountered microbe in pharyngitis? Accounts for what % of cases?
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Group A B-hemolytic strep
5-10% of cases |
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Resistance among what 4 organisms can be directly attributed to inappropriate use of antibiotics for URIs? Strategies for dealing with this resistance?
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Streptococcus pneumoniae (up to 50% PCN resistant in some places)
Haemophilus influenzae (many are now B-lactamase producers) Moraxella catarrhalis (up to 80% are now B-lactamase producers) Streptococcus pyogenes (growing resistance to macrolides and clindamycin) Appropriate usage; amoxicillin may not be used for life-threatening infections; amoxicillin must be used with a B-lactamase inhibitor if organism is a B-lactamase producer |
