Epiglottitis/Tracheitis

Question 1

Bacteria that cause epiglottitis

Answer 1

Hib
NTHi
GAS
S. aureus
S. pneumoniae

Question 2

Bacteria that cause tracheitis

Answer 2

S. aureus
GAS
S. pneumoniae
Moraxella catarrhalis
Hib
NTHi

Question 3

Moraxella characteristics

Answer 3

gram -, diplococci, strict aerobe, oxidase +, commensal

-no growth on Thayer-Martin agar, hockey puck sign

Question 4

H. influenzae characteristics

Answer 4

gram - pleomorphic coccobacilli, oxidase +, non-motile, growth requires factor X and V

Question 5

S. pneumoniae characteristics

Answer 5

g+ cocci, catalase -, alpha-hemolytic

Question 6

S. pyogenes characteristics

Answer 6

g+ cocci, catalase -, beta-hemolytic, bacitracin sensitive

Question 7

S. aureus characteristics

Answer 7

g+ cocci, catalase +, coagulase +, beta-hemolytic

Question 8

Which H. influenzae is a commensal in the respiratory tract?

Answer 8

Nontypeable

Question 9

What is a major virulence factor for Hib and is the target of the vaccine?

Answer 9

Polyribosylribitol phosphate (PRP)

Question 10

What virulence factor of Hib facilitates colonization by reducing detection by mucosal IgA?

Answer 10

IgA protease

Question 11

Treatment of epiglottitis

Answer 11

Empiric antibiotic regimens
Primary: 3rd gen cephalosporins plus anti-MRSA if MRSA susceptible
Alternative: extended-spec penicillin + beta-lactamase inhibitor (ampicillin+sulbactam, amoxicillin+clavulanic acid)
Patients allergic to beta-lactams: levofloxacin

Question 12

MRSA drugs

Answer 12

Vanco

Clindamycin

Question 13

Vanco MOA

Answer 13

Prevents peptidoglycan synthesis and elongation

Question 14

Clindamycin MOA

Answer 14

Binds 50S ribosomal subunit to inhibit translocation

Question 15

Clindamycin side effects

Answer 15

Fever, diarrhea, superinfection with pseudomembranous colitis

Question 16

Extended-spectrum penicillins side effects

Answer 16

Hypersensitivity reaction, rash, superinfection

Question 17

Extended-spec peniciilins

Answer 17

Ampicillin, amoxicillin

Question 18

Beta-lactamase inhibitors

Answer 18

Clavulanic acid, sulbactam, tazobactam

Question 19

3rd gen cephalosporins

Answer 19

Ceftriaxone, cefotaxime, ceftazidime, cefdinir

Question 20

3rd gen cephalosporins pharmacokinetics

Answer 20

Most given parenterally, readily cross BBB, longer half-life, almost all excretion kidney (except ceftriaxone - biliary)

Question 21

3rd gen cephalosporins MOA

Answer 21

beta-lactam drugs, inhibit cell wall synthesis via inhibition of peptidoglycan cross-link (target PBPs)

Question 22

What happens as cephalosporins increase generations?

Answer 22

Increasing activity against g-, beta-lactamase producing bacteria, pseudomonas, anaerboes; increasing ability to cross BBB

Question 23

Treatment of tracheitis if patient is not hypersensitive to penicillin or cephalosporins

Answer 23

• Vanco or Clinda PLUS

- ceftriaxone or cefotaxime, or ampicillin-sulbactam

Question 24

Treatment of traceitis if patient has a potential severe hypersensitivity to beta-lactams

Answer 24

• vanco or clinda PLUS

- levofloxacin, ciprofloxacin

Question 25

Treatment of tracheitis if patient has non-anaphylactic hypersensitivity to penicillin and cephalosporins

Answer 25

vanco or clinda PLUS

aztreonam or meropenem

Question 26

Antibiotics for moraxella

Answer 26

●Amoxicillin-clavulanic acid
●Sulfamethoxazole-trimethoprime
●Cephalosporins
●Macrolides
●Tetracyclines
●Fluoroquinolones