Upper Respiratory Tract Infections

Question 1

Examples of Upper Respiratory Infections

Answer 1

Acute otitis media
Sinusitis
Pharyngitis

Question 2

Most Specific Sign of Acute Otitis Media

Answer 2

Bulging tympanic membrane

Question 3

Common bacteria that cause acute otitis media

Answer 3

Streptococcus pneumoniae

Haemophilus influenzae

Question 4

Non-Severe Acute Otitis Media (AOM)

Answer 4

Presence of mild otalgia (earache) < 48 hrs and temperature < 39 degrees C

Question 5

Severe Acute Otitis Media (AOM)

Answer 5

Presence of moderate to severe otalgia or temperature at least 39 degrees C or otorrhea

Question 6

Treatment of Mild to Moderate Otalgia

Answer 6

Acetaminophen

Ibuprofen (only in > 6 months)

Question 7

Treatment of Moderate to Severe Otalgia

Answer 7

Tylenol #3

Question 8

Topical Options of Otalgia

Answer 8

Benzocaine, lidocaine, procaine (only for ages 2+ and do not use in children with tympanic membrane perforation)

Question 9

Treatment of AOM in < 6 months

Answer 9

ALWAYS give antibiotic therapy in patients in < 6 months regardless of severity

Question 10

Treatment of Severe AOM + Otorrhea

Answer 10

Give antibiotic therapy, regardless of age

Question 11

Treatment of Bilateral AOM without Otorrhea in 6 months to 2 years

Answer 11

Give antibiotic therapy

Question 12

Treatment of Bilateral AOM without Otorrhea > 2 years

Answer 12

Observe for 48-72 hours before giving antibiotics

Question 13

Treatment of Unilateral AOM without Otorrhea in > 6 months

Answer 13

Observe for 48-72 hours before giving antibiotics

Question 14

DOC for AOM

Answer 14

High-dose amoxicillin (90 mg/kg/day in divided doses q12h)

DOC because overcomes S. pneumo resistance

Question 15

Tx of AOM if Recent Beta-Lactam Therapy, Conjunctivitis, or Hx of Prior AOM

Answer 15

Augmentin (90 mg/kg/day of amoxicillin + 6.4 mg/kg/day of clavulanate in divided doses q12h)

Question 16

Tx of AOM if PCN Allergy

Answer 16

2nd gen PO CEPHS: Cefuroxime, Cefpodoxime, Cefdinir

Ceftriaxone IM

Question 17

Treatment Failure of AOM After 48-72 Hours

Answer 17

If initially treated with high-dose amoxicillin: Augmentin

If initially treated with Augmentin or PO Cephalosporin: Ceftriaxone 50 mg IM or IV x 3 days

Question 18

Duration of Therapy for AOM

Answer 18

10 days if < 2 yo or severe sxs
7 days if 2-5 years without severe sxs
5-7 days if at least 6 years without severe sxs

Question 19

Recurrent Otitis Media

Answer 19

Definition: At least 3 episodes in 6 months or at least 4 episodes in 1 year
Vaccination (pneumococcal, H. influenzae)
NO antibiotic prophylaxis
Tympanostomy Tube

Question 20

Common pathogens causing sinusitis

Answer 20

Strep pneumo

H. influenzae

Question 21

DOC for Sinusitis

Answer 21

Augmentin (500/125 mg PO TID or 875/125 mg PO BID)

Question 22

Tx of Sinusitis if PCN Allergy

Answer 22

Doxycycline (avoid in children)
PO 2nd gen cephs: Cefixime or Cefpodoxime +/- clindamycin
Levofloxacin or moxifloxacin

Question 23

Duration of Tx for Sinusitis

Answer 23

Adults: 5-7 days
Children: 10-14 days

Question 24

Tx Failure of Sinusitis After 48-72 Hours

Answer 24

Augmentin -> doxycycline or respiratory fluoroquinolone (levofloxacin or moxifloxacin)

Question 25

Adjunctive Therapy for Sinusitis

Answer 25

Intranasal corticosteroids for pts with hx of allergic rhinitis Nasal irrigation for congestion sxs NO systemic or oral corticosteroids

Question 26

DOC for Pharyngitis/Strep Throat

Answer 26

Penicillin VK x 10 days

Question 27

Alternative Tx for Pharyngitis/Strep Throat

Answer 27

Amoxicillin x 10 days | Penicillin G IM x 1 dose

Question 28

Tx for Pharyngitis/Strep Throat if PCN Allergy

Answer 28

Cephalexin x 10 days Clindamycin x 10 days Z Pak x 5 days Clarithromycin x 10 days

Question 29

Common Pathogens Causing Acute Exacerbation of COPD

Answer 29

H. influenzae S. pneumoniae P. aeruginosa

Question 30

Indications for Antibiotic Therapy of Acute Exacerbation of COPD

Answer 30

``` At least 65 yo History of exacerbations Presence of comorbidities Prior antibiotic use Culture data from past exacerbations ```

Question 31

Outpatient Tx of Acute Exacerbation of COPD if Low Risk of Pseudomonas

Answer 31

Beta-lactam (Augmentin, 2nd gen PO CEPH - cefuroxime, cefpodoxime, cefdinir) Tetracycline Macrolide

Question 32

Outpatient Tx of Acute Exacerbation of COPD if High Risk of Pseudomonas

Answer 32

If recent antimicrobial therapy, recent hospitalization, or bronchiectasis Levofloxacin or ciprofloxacin

Question 33

Duration of Outpatient Tx of Acute Exacerbation of COPD

Answer 33

5-7 days

Question 34

Prevention of Acute Exacerbation of COPD

Answer 34

Vacciniations (pneumococcal, influenza) | If > 2 exacerbations/year despite optimal management, antimicrobial prophylaxis: azithromycin or erythromycin x 1 year