Management of URTI

Question 1

What is the most common cause of acute bronchitis?

Answer 1

Respiratory viruses.

Question 2

When is antibiotic therapy indicated in acute bronchitis?

Answer 2

Almost never; it is usually viral and self-limiting.

Question 3

How can clinicians reduce unnecessary antibiotic prescribing for acute bronchitis?

Answer 3

Delayed prescribing, empathy, educate on symptom duration (up to 2–3 weeks), emphasize viral nature.

Question 4

What are the hallmark signs of acute exacerbation of chronic bronchitis?

Answer 4

Increased sputum purulence, increased sputum volume, increased dyspnea or cough.

Question 5

Which organisms are most common in AECB?

Answer 5

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.

Question 6

Which organisms should be considered in AECB with frequent prior antibiotic use?

Answer 6

Enterobacterales, Pseudomonas aeruginosa.

Question 7

What is the first-line treatment for AECB?

Answer 7

Amoxicillin-clavulanate, cefuroxime, cefpodoxime for 5–7 days.

Question 8

What is the most common bacterial cause of acute pharyngitis?

Answer 8

Streptococcus pyogenes (Group A strep).

Question 9

What is the preferred diagnostic test for acute pharyngitis due to Group A strep?

Answer 9

Rapid antigen detection test (RADT), with backup throat culture if negative.

Question 10

What is the first-line treatment for Group A strep pharyngitis?

Answer 10

Penicillin VK or amoxicillin for 10 days.

Question 11

What are alternatives for penicillin-allergic patients with strep pharyngitis?

Answer 11

Non-anaphylactic: cephalexin, cefadroxil. Anaphylactic: azithromycin, clindamycin.

Question 12

What criteria help differentiate ABRS from viral rhinosinusitis?

Answer 12

Persistent symptoms ≥10 days, severe symptoms (fever, facial pain), or worsening after initial improvement.

Question 13

What are the most common pathogens in ABRS?

Answer 13

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.

Question 14

What is the first-line treatment for ABRS?

Answer 14

Amoxicillin-clavulanate 875/125 mg BID for 5–7 days.

Question 15

What is the second-line treatment for ABRS or patients with resistance risk?

Answer 15

Doxycycline, levofloxacin, or moxifloxacin.

Question 16

What symptomatic management options are helpful for ABRS?

Answer 16

Saline irrigation, NSAIDs, acetaminophen, hydration; avoid antihistamines and overuse of decongestants.

Question 17

What types of infections are classified as upper respiratory tract infections (URTIs)?

Answer 17

Acute bronchitis, acute exacerbation of chronic bronchitis (AECB), acute pharyngitis, and acute bacterial rhinosinusitis (ABRS).

Question 18

What are the most common pathogens that cause URTIs?

Answer 18

Primarily viruses; bacterial causes include Streptococcus pyogenes (pharyngitis), Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis (ABRS and AECB).

Question 19

How can you distinguish bacterial from viral infections in URTIs?

Answer 19

Use clinical criteria: symptom duration ≥10 days, worsening after initial improvement, high fever, and purulent nasal discharge (ABRS); RADT for strep pharyngitis.

Question 20

What is the recommended treatment for Group A strep pharyngitis?

Answer 20

Penicillin VK or amoxicillin for 10 days. Alternatives: cephalexin or azithromycin in penicillin allergy.

Question 21

What is the first-line treatment for acute bacterial rhinosinusitis (ABRS)?

Answer 21

Amoxicillin-clavulanate 875/125 mg BID for 5–7 days.

Question 22

What is the first-line treatment for acute exacerbation of chronic bronchitis (AECB)?

Answer 22

Amoxicillin-clavulanate, cefuroxime, or cefpodoxime for 5–7 days.

Question 23

When should antibiotics be avoided in URTIs?

Answer 23

In most cases of acute bronchitis (typically viral), and viral rhinosinusitis. Focus on symptomatic treatment unless red flag criteria are met.

Question 24

What strategies can reduce inappropriate antibiotic prescribing in URTIs?

Answer 24

Patient education, delayed prescribing, emphasizing viral cause and symptom course, and applying clinical guidelines.

Question 25

Is antibiotic therapy recommended for acute bronchitis?

Answer 25

No; acute bronchitis is usually viral and self-limiting. Antibiotics are not recommended.

Question 26

What are first-line antibiotics for AECB in low-risk patients?

Answer 26

Amoxicillin-clavulanate, cefuroxime, or cefpodoxime for 5–7 days.

Question 27

What are options for AECB in high-risk patients or with resistance concerns?

Answer 27

Respiratory fluoroquinolones (e.g., levofloxacin), or amoxicillin-clavulanate with broader Gram-negative activity.

Question 28

What is the first-line antibiotic for Group A strep pharyngitis?

Answer 28

Penicillin VK or amoxicillin for 10 days.

Question 29

What is the antibiotic alternative for strep pharyngitis in non-anaphylactic penicillin allergy?

Answer 29

Cephalexin or cefadroxil.

Question 30

What is the antibiotic alternative for strep pharyngitis in anaphylactic penicillin allergy?

Answer 30

Azithromycin or clindamycin.

Question 31

What is the first-line antibiotic for ABRS?

Answer 31

Amoxicillin-clavulanate 875/125 mg BID for 5–7 days.

Question 32

What is second-line therapy for ABRS or if resistance risk factors are present?

Answer 32

Doxycycline, levofloxacin, or moxifloxacin.

Question 33

Which antibiotics should be avoided in ABRS due to high resistance?

Answer 33

Macrolides and TMP-SMX are not recommended due to resistance.

Question 34

How should you approach treating a patient with acute bronchitis?

Answer 34

Avoid antibiotics; provide symptomatic care. Educate on viral cause and expected symptom duration.

Question 35

What are the criteria for diagnosing bacterial sinusitis?

Answer 35

Persistent symptoms ≥10 days, severe symptoms ≥3–4 days (fever ≥102°F, purulent discharge, facial pain), or worsening after initial improvement.

Question 36

What is the first-line therapy for bacterial sinusitis per IDSA?

Answer 36

Amoxicillin-clavulanate 875/125 mg BID x 5–7 days.

Question 37

What are counseling points when prescribing doxycycline?

Answer 37

Take with food and water, remain upright for 30 min, avoid in pregnancy and children <8 years (tooth discoloration).

Question 38

What is the mechanism of action of penicillins?

Answer 38

Inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs).

Question 39

Why is penicillin not effective against M. catarrhalis and H. influenzae?

Answer 39

These organisms often produce beta-lactamase enzymes, which inactivate penicillin.

Question 40

What is a benefit of using amoxicillin-clavulanate over amoxicillin alone?

Answer 40

Clavulanate inhibits beta-lactamases, extending coverage to beta-lactamase-producing pathogens.

Question 41

What is a typical duration of therapy for group A strep pharyngitis?

Answer 41

10 days to ensure eradication and prevent rheumatic fever.

Question 42

What is the role of supportive care in URTIs?

Answer 42

NSAIDs, acetaminophen, fluids, rest, nasal irrigation, humidifiers can all reduce symptoms without antibiotics.