Respiratory

Question 1

Most common organism involved in sinusitis?

Answer 1

streptococcus pneumonie (gram+) Haemophilus influenza (gr - bacilli) Moraxella catarrhalis (gr - cocci) Also but not as common Streptococcus Pyogenes (gr +) Viruses

Question 2

Indications for Antibiotic therapy for sinusitis?

Answer 2

Persistent ss for more than 10 days Onset of fever+purulent nasal drainage or facial pain lasting more than 3-4 days Double sickening (2ndary bacterial infection)

Question 3

General Treatment for sinusitis?

Answer 3

Symptom relief (avoid antihistamines) Analgesics and nasal irrigation Decongestants Adjunctive intra nasal steroids (allergic rhinitis)

Question 4

Abx of choice for sinusitis?

Answer 4

Augmentin Doxycycline (if PCN allergy) 1st 2nd: fluoroquinolones Cephalosporin (if used with clinda) 3rd Macrolides (azithromycin or clarithromycin) high risk for strep pneumonie)

Question 5

Things to consider when using Bactrim?

Answer 5

Resistance to Streptococcus pneumonie and h. Influenza Sulfonamide allergy or G6PD pts Can cause bone marrow suppression Inhibitor of C450 (will increase INR) if patient is on warfarin

Question 6

Most common organism involved with Otitis Media?

Answer 6

• Streptococcus Pneumoniae most common (gr + cocci)

15-50% do NOT respond to PCN

• H. influenza (gr- bacilli)
  
  • 50% are Beta-lactamase positive
• Moraxella (gr- cocci)
• Viruses alone in 5-22%

Question 7

What is the approach to treatment in Acute Otitis Media?

Answer 7

Analgesia: treat within first 24 hrs

• Acetaminophen
• NSAIDS (mild to moderate)
• Opioids (severe)

Observation: 48-72 hrs

Then selective use of ABX

Question 8

First line Abx used to treat AOM in a non PCN allergic patient?

Answer 8

First line:

Amoxicillin80-90 mg/kg/d for susceptible and intermediate resistance pneumococci

If Severe: Amoxicillin-clavulanate (Augmentin) at 90mg/kg/d in 2 divided doses which will inhibit Beta-lactamase (+H.influenza and Moraxella catarrhalis)

Question 9

First line Abx used to treat AOM in a PCN allergic patient?

Answer 9

If allergic to PCN:

If allergy is NOT anaphylaxis or severe:

Cefdinir (Omnicef) 14 mg/kg/d in 1-2 doses
Cefpodoxime (Vantin) 10mg/kg/d
Cefuroxime(Ceftin) 30 mg/kg/d

Azithromycin 10mg/kg x1; 5mg/kg x5d
TMP/SMX (Bactrim) 6-10mg/kg/d of TMP
Ceftriaxone (Rocephin) 50mg/kg IM x1

Children <2 years of age: 10 days
Children >6 years of age: 5-7 days
If fail to respond within 48-72 hours

If initial was observation then AMX
If AMX initially, then AMX-CLA (clavulanate)
If fail AMX-CLA then Ceftriaxone 50mg/kg IM x3 days (if n/v present) or Clindamycin (mainly for pt. with PCN allergy)