URI Flashcards
1
Q
URI
A
- Upper respiratory infections
- Usually caused by viruses
- Have non specific symptoms
- Resolve spontaneously
2
Q
Acute Otitis Media
A
- Impaired mucociliary apparatus leading to Eustachian tube dysfunction
- Middle ear becomes blocked with fluid and tympanic membrane swells
- Bacteria then isn’t cleared and proliferates and causes infection
3
Q
Why is AOM more common in children?
A
Eustachian tubes are shorter, narrower, and more horizontal than adults
4
Q
AOM Etiology
A
- 40-75% are viral
- Common bacterial pathogens: S. pneumoniae, H. influenzae, Morazella catarrhalis
5
Q
AOM Clinical Presentation
A
- Usually follows viral URI: fever, difficulty sleeping, and tugging at ear
- Bulging of tympanic membrane
- Otorrhea (discharge), otalgia (earache)
- Erythema of tympanic membrane
6
Q
Non-Severe AOM
A
- Mild otalgia < 48 hours
- Temperature: <39 degrees C
- NEED BOTH
7
Q
Severe AOM
A
- Moderate-severe otalgia for >= 48 hours
- Temperature >= 39 degrees C
- EITHER
8
Q
AOM Treatment: < 6 mo
A
10 days of antibiotics
9
Q
AOM Treatment: 6-23 months
A
- Severe/Non-severe bilateral: 10 days antibiotics
- Nonsevere unilateral: Observe or 10 days of antibiotics
10
Q
“Observe”
A
- Watchful waiting x 48-72 hours with follow-up
- Access to doctor/antibiotics if symptoms don’t improve in 2-3 days or worse at any time
11
Q
AOM Treatment: 2+ Years
A
- Severe: 10 days of antibiotics
- Non-severe: observe or 7 days of antibiotics
12
Q
AOM: First Line Treatment
A
- Amoxicillin: 80-90 mg/kg/day PO q12h
- Augmentin: Amox - 90 mg/kg/day and Clav - 6.4 mg/kg/day PO q12h
13
Q
AOM Alternative Treatment
A
- Cefdinir: 14 mg/kg/day PO q 12-24h
- Cefuroxime: 30 mg/kg/day PO q12h
- Cefpodoxime: 10 mg/kg/day PO q12h
14
Q
AOM Pain Management
A
- Ibuprofen: 10 mg/kg q6h PRN
- Tylenol: 15 mg/kg q4-6h PRN
15
Q
AOM Treatment Failure
A
- Should see improvement in 48-72 hours
- Symptoms could worsen right after diagnosis
- Switch antibiotics if no improvement: Amox => Aug => Ceftrixone
- Consider tympanocentesis if still no improvement - Gram stain, culture, susceptibilities
16
Q
AOM Treatment Failure Succession
A
- 1st Line: Augmentin and Ceftriaxone
- Alternative/Failure of 2nd: Clindamycin: 30-40 mg/kg/day PO q8h +/- 3rd gen ceph.
- Failure of 2nd: also consider tympanocentesis
17
Q
Acute Bacterial Rhinosinusitis
A
Inflammation of contiguous nasal mucosa/paranasal sinuses
18
Q
ABR Risk Factors
A
- Anatomic abnormalities (septal defect)
- Allergies/allergic rhinitis
- Tobacco smoke
- Intranasal medications
- Viral respiratory tract infections/winter months
- Swimming/diving
19
Q
ABR Etiology
A
- 90-98% are viral
- Bacterial causers: S. pneumoniae, H. influenzae, Moraxella catarrhalis
20
Q
ABR Diagnosis
A
- Persist signs/symptoms for 10+ days with no improvement
- Severe signs/symptoms: Temp >= 39 C AND purulent nasal discharge/facial pain for 3-4+ consecutive days at the start of illness
- Worsening/”double-sickening” signs/symptoms like new fever onset, headache, or increased nasal drainage after a typical 5-6 typical viral URI with improving symptoms
21
Q
Empiric ABR Children Treatment
A
- Augmentin: 45 mg/kg/day PO q12h
- Augmentin: 90 mg/kg/day PO q12h
22
Q
ABR Children Treatment + Beta Lactam Allergy
A
-Levofloxacin: 10-20 mg/kg/day PO q12-24 hr
-Clindamycin: 30-40 mg/kg/day PO q8h AND -Cefixime: 8 mg/kg/day PO q12h OR -Cefpodoxime: 10 mg/kg/day PO q12h
23
Q
Children ABR Treatment + Severe Hospitalization
A
- Unasyn: 200-400 mg/kg/day IV q6h
- Ceftriaxone: 50 mg/kg/day IV q12h
- Levofloxacin: 10-20 mg/kg/day IV q12-24h
24
Q
High Dose Augmentin + ABR
A
Need at least one risk factor:
- High endemic rates of penicillin non-susceptible S. pneumoniae
- Severe infection: systemic toxicity, T >= 39 C, threat of suppurative complications
- Attending daycare
- <2 y.o. or >65 y.o.
- Recent hospitalization
- Antibiotic use within past month
- Immunocompromised
25
ABR Empiric Adult Treatment
- Augmentin: 500/125 mg PO q8h OR 875/125 mg PO q12h
- Augmentin: 2000/125 mg PO q12h
- Doxycycline: 100 mg PO q12h
26
ABR Adult Treatment + B-lactam Allergy
- Doxycycline: 100 mg PO q12h
- Levofloxacin: 500 mg PO q24h
- Moxifloxacin: 400 mg PO q24h
27
ABR Adult Treatment + Severe Hospitalization
- Unasyn: 1.5-3g IV q6h
- Levofloxacin: 500 mg PO/IV q24h
- Moxifloxacin: 400 mg PO/IV q24h
- Ceftriaxone: 2g IV q24h
28
ABR Adjunctive Therapy
- Nasal irrigation with saline
- Analgesics: NSAIDs, APAP
- Intranasal corticosteroids
- Decongestants and antihistamines = NOT recommended
29
Pharyngitis
- Acute, painful inflammation of throat
- Most commonly effects children 5-15 y.o.
- Occurs most in winter and early spring months
30
Pharyngitis Etiology
- Virus: causes majority of cases
| - Bacterial causers: GAS (S. pyogenes)
31
Pharyngitis + Viral Symptoms
- Conjunctivitis
- Coryza
- Oral ulcers
- Hoarseness
- Diarrhea
- Rash
32
Pharyngitis + Bacterial Symptoms
- Abrupt onset of sore throat
- Fever
- Headache
- GI upset
- Patchy exudates
- Palatal petechiae
- Scarlatiniform rash
- Anterior cervical adenitis
- Exposure to GAS pharyngitis
33
Pharyngitis Patho
- Possible alteration in host immunity
- Flora of orotharynx may migrate to cause infection
- Pathogenic factors: pyrogenic toxins, streptokinases, proteinases
34
Pharyngitis Diagnosis
- Throat cultures if presentation isn't consistent with viral pharyngitis
- Rapid detection tests are highly specific but not sensitive and a negative reading would need to be confirmed by a culture
35
Centor Criteria
- Temp > 38 C: 1
- Absence of cough: 1
- Swollen/tender anterior cervical nodes: 1
- Tonsillar swelling/exudate:1
Age
- 3-14 y.o.: 1
- 15-44 y.o.: 0
- >=45 y.o.: -1
36
Pharyngitis Treatment: Penicillin
- Children: 250 mg PO q8-12hr
- Adults: 250 mg PO q6h OR 500 mg PO q12h
- Duration: 10 days
37
Pharyngitis Treatment: Amoxicillin
- Children: 50 mg/kg/day PO q12-24 h
- Adults: 1000 mg PO q24h OR 500 mg PO q12h
- Duration: 10 days
38
Pharyngitis Treatment: Benzathine Penicillin
- <27 kg: 600,000 units IM
- >= 27 kg: 1,200,000 units IM
- 1 dose
39
Pharyngitis Treatment: Cephalexin
- Used for penicillin allergies
- Children: 20 mg/kg PO q12h
- Adults: 500 mg PO q12h
- Duration: 10 days
40
Pharyngitis Treatment: Clindamycin
- Used for penicillin allergies
- Children: 7 mg/kg PO q8h
- Adults: 300 mg PO q8h
- Duration: 10 days
41
Pharyngitis Treatment: Azithromycin
- Used for penicillin allergies
- Children: 12 mg/kg PO q24h
- Adults: 500 mg day 1, 250 mg days 2-5
- Duration: 5 days
42
Pharyngitis Treatment: Clarithromycin
- Used for penicillin allergies
- Children: 7.5 mg/kg PO q12h
- Adults: 250 mg q12h
- Duration: 10 days
43
Centor Criteria: =<1
- =< 0: 1-2.5% risk of strept infection
- 1: 5-10% risk of infection
- No further testing or antiobiotics
44
Centor Criteria: 2-3
- 2: 11-17% risk of strept infection
- 3: 28-35% risk of infection
- Culture all
- Antibiotics for positive culture results only
45
Centor Criteria: >=4
- >= 4: 51-53% risk of strept. infection
| - Treat empirically with antibiotics and/or culture
