Common Respiratory tract infections Flashcards
(24 cards)
Cause of Rhinosinusitis
95% Viral
- Rhinovirus, Influenza, Parvainfluenza, RSV
5% Bacterial
- Strep Pneumo
- H. Influenza
- M. Catarrhalis
- S. Aureus
Key mainstay of care for rhinosinusitis
Supportive care
When to consider bacterial cause of rhinosinusitis
- S/Sx persist for >10 days
- Severe Sx at onset ( High fever, Discharge, facial pain >3 days)
- Double sickening (Recovery from initial sx followed by worse illness)
Abx therapy for suspected bacterial sinusitis
- Augmentin (amoxicillin clavulanate)
Alternate: - Doxycycline, Levofloxacin, Moxifloxacin
AVOID macrolides (Azithro, clarithro) due to S. Pneumo resistance
Abx therapy for severe rhinosinusitis requiring hospitalization
IV Unasyn (ampicillin sulbactam), Levofloxacin/moxifloxacin/ceftriaxone
Petechiae in pharyngitis is suggestive of which cause
Group A strep cause
Pharyngitis is typically associated with which symptoms
- Low grade fever
- Sore throat worse with swallowing
- Inflammed pharynx, tonsils, palate
- Gray exudate
- Tender anterior cervical lymphadenopathy
- NOT usually Cough
Pharyngitis cause
Viral 90% of the time (Rhinovirus, adenovirus, influenza)
Bacterial 10% of the time ( S. Pyrogenes, Group A strep, Group B strep) if >3 years old
- Chlamydia pneumoniae, Mycoplasma pneumoniae, Sexually transmitted gonorrhea.
Which 2 organisms are not tied to pharyngitis
S. pneumoniae and h influenza
What is the main clinical diagnostic goal with pharyngitis
Determine if its GAS since this is easily treatable with Abx, and prevention of Acute rheumatic fever/heart disease)
- Rapid antigen test, Rapid PCR
Sx that are more likely associated with GAS
- No cough
- 3-14 years old (RARE under 3 or >45)
- Exudate and swelling on tonsils
- Tender anterior cervical LN
- Temp >38
GAS pharyngitis Tx
- PCN IM (Bicillin x 1 dose)
- PO Penicillin VK x 10 days
- PO Amoxicillin x 10 days
OR
Cephalexin / Axithromycin
Supportive care for pharyngitis
- Saltwater gargle
- Benzocaine losanges
- Analgesics (acetaminophin, NSAIDS)
NOT corticosteroids
Describe Scarlet Fever s/sxs and Tx
- Accompanies strep in 1/10 cases
- Mediated by strep pyrogen exotoxin
- Sandpaper-like rash by 2nd day of illness that spreads from trunk to extremities. Pastia’s lines, Strawberry tongue
- Treat how you would treat strep (PCN or Cephalexin or azithro)
Peritonsilar Abscess Tx
- Needle Aspiration, I&D
- ABX tx- Augmentin (amoxicillin-clavulanate) or IV ampicillin/sulbactam (Unasyn)
Alternate: Clindamycin
Acute otitis media diagnosis
Hx: Recent URI or Allergic rhinitis
- Otalgia, aural pressure, decreased hearing, nasal congestion, headache, fever
TM has loss of light reflex, opacification, bulging
Most common causes of AOM
Viral (RSV, influenza, rhinovirus)
Bacterial (S. Pneumo in 35%), H influenza, M. Catarrhalis
Tx for AOM
- MOST require supportive care only
- Watch and wait for 2-4 days
- DO NOT prescribe just in case abx
Who is NOT a cantidate to observe in AOM and who definitely requires ABX
Someone <6 months who has severe sx, bilateral AOM, or Unilateral AOM
ABX of choice for AOM
-HIGH DOSE amoxicillin or Augmentin (if recieved amoxicillin in last 30 days or previously failed it)
Alt: Cefdinir, ceftriaxone
Duration:
<2: 10 days
2-5: 7 days
>6: 5-7 days
Which patients are you concerned might develop a severe case of acute otitis exerna
- Diabetic patients or immunocompromized patients are at risk for osteomyelitis of the skull base.
Which organisms to expect in otitis externa
Pseudomonas or Proteus
If you are worried a patient has malignant otitis externa, what are you going to treat them with
- Systemic abx with pseudomonas coverage (and ct of head to r/o bone involvement)
- Aminoglycosides (neomycin, polymyxin B)
Fluoroquinolones (Cipro or ofloxacin) if you think that they have a TM perforation and need something not ototoxic.
Medications for otitis externa that are not abx
Acetic Acid or Isopropyl alcohol and white vinegar
Corticosteroids (Hydrocortisone, Dextramethazone, flucinolone)
