upper URTI

Question 1

criteria for bacterial infection (pharyngitis)

Answer 1

modified centor criteria:
fever
lymphadenopathy (swollen lymph nodes/anterior cervical nodes)
tonsillar exudate
ABSENCE of cough
*all 1 pt each
age (3-14 1pt, 15-44 0 pt, >45 -1 pt)

0-1 unlikely bacterial
1-2 test (throat swab/ RADT)
3-4 start empiric abx

Question 2

bacterial pathogen to cover for bacterial pharyngitis

Answer 2

group a streptococcus (s. pyogenes)

Question 3

therapy for acute bacterial pharyngitis

Answer 3

1st line: pen V (250mg q6h) or PO amox (500mg q12h)

alternative: PO cephalexin 500mg q12h; (if amox allergy) PO cefuroxime 250mg q12h
severe allergy: clindamycin 300mg q8h
also possible: azithromycin 500mg OD, clarithromycin 250mg q12h (BUT increasing resistance)

DURATION: 10DAYS

Question 4

complications of acute pharyngitis

Answer 4

acute rheumatic fever - preventable by early and effective abx

acute glomerulonephritis - NOT preventable

Question 5

goal of antibiotic therapy for acute pharyngitis

Answer 5

1. reduce symptoms severity and duration
2. prevent acute complications (acute rheumatic fever & its immune sequelae)
3. prevent transmission to others - no longer infectious after 24h of abx therapy!

Question 6

clinical presentation of bacterial pharyngitis

Answer 6

SORE THROAT
fever
erythematous & inflamed pharynx & tonsils (may have patchy exudates)
tender & swollen lymph nodes

Question 7

what is the pathogenesis of acute rhinosinusitis

Answer 7

*preceded by viral URTI;
inflammation causes sinus to be obstructed -> nasal mucosa secretions trapped -> medium for bacterial growth provided

Question 8

symptoms of acute rhinosinusitis

Answer 8

facial pain & pressure
ear fullness/pressure
headache
fever
usually centred around face/head area

Question 9

is culture/imaging for acute rhinosinusitis indicated

Answer 9

NO

Question 10

when is imaging/ further evaluation indicated for acute rhinosinusitis?

Answer 10

spread of infection to orbits/ CNS:
limited ocular movements
confusion
acute vision changes
unilateral weakness

Question 11

when to treat bacterial sinusitis with antibiotics?

Answer 11

at least one of the following:
- symptoms persist for 10 days or more WITHOUT clinical improvement
- symptoms are SEVERE (fever >39, headache, purulent nasal discharge or facial pain) lasting >3 consecutive days
- symptoms WORSEN (new-onset fever, headache, increased nasal discharge) after an INITIAL period of improvement for >3days

Question 12

what is the likely pathogen for bacterial rhinosinusitis?

Answer 12

most common:
strep pneumo
haemophilus influenzae

some:
S. pyogenes
moraxella caterrhalis
anaerobic bacteria

Question 13

Goals of treatment for bacterial rhinosinusitis

Answer 13

1. reduce symptom severity & duration
2. prevent complications
3. restore quality of life

Question 14

antibiotic regimen for bacterial rhinosinusitis

Answer 14

first-line:
PO amoxicillin 500mg q8h
PO amoxi-clav 625mg q8h

alternatives:
(mild penicillin allergy) PO cefuroxime 500mg q12h
(severe penicillin allergy) PO levofloxacin 500mg OD OR PO moxifloxacin 400mg OD
*cipro DOES NOT COVER strep pneumo
*resistance (to S. pneumo): doxycycline/ macrolides/ co-trimoxazole

DURATION: 5-7d