Ears
Why do kids experience a lot more ear infections than adults?
eustachian tube is more horizontal
What is the duration of treatment for children <2 or with severe AOM? > 2 with mild to moderate? On azithromycin? On ceftriaxone?
10 days
5-7
5
1-3
What classifies sinusitis as persistent, severe, or worsening? What is double sickening?
persistent: lasting more than 10 days without improvement
severe: high fever, purulent nasal discharge, facial pain lasting more than 3-4 consecutive days
worsening: double sickening (worsening signs or symptoms characterized by new-onset fever, headache, or increase in nasal discharge following a typical viral URI that lasted 5 to 6 days and were initially improving)
What is pharyngitis? What is the primary risk factor?
infection that causes pain and inflammation of the oropharynx or nasopharynx
exposure to infected person
What are the 2 surface antigens for influenza A virus?
hemagglutinin and neuraminidase
What is the difference between acute otitis media, otitis media with effusion, chronic otitis media?
AOM: acute illness marked by presence of middle ear fluid and inflammation that lines middle ear space (common in kids)
OME: presence of fluid without inflammation, usually follows AOM or during URI due to poor eustachian tube drainage
Chronic: recurrent infection of middle ear in presence of tympanic membrane perforation
What should be used for symptomatic therapy? What is not recommended?
analgesics: APAP, ibuprofen
decongestants, antihistamines, corticosteroids
What considers a pt with sinusitis at risk of resistance?
severe infection, age <2 or >65, prior hospitalization <5 days, antibiotic use in the past month, immunocompromised
For pharyngitis, what is antibiotic therapy only indicated for?
group A strep (pyogenes)
What differs flu from the common cold?
What are the typical bacterial pathogens? Risk factors?
Strep pneumoniae, non-typeable H. influenzae
positive family history of AOM, day care, parental smoking, use of pacifier, lack of breast feeding
What are AEs for beta lactams, azithromycin, clindamycin (BBW)? When should pt be reevaluated? What are some tips for prevention?
reevaluate within 48-72 hours if s/sx persist or worsen
beta lactams: N/V/D, rash
azithromycin: N/V/D, QT prolongation
Clindamycin: N/V/D, BBW of C. difficile
prevention: initiate breastfeeding early, avoid pacifier use after 6 months, eliminate second hand smoke, withdrawal from daycare if recurrent cases, vaccines
What is first line for adults with sinusitis? 2nd line? PCN allergy? Duration for adults? Children?
augmentin
increase dose of augmentin and symptomatic therapy or doxy
PCN allergy: doxy, levo, moxi
Adults 5-7 days, kids 10-14 days
What is the clinical presentation and diagnosis of pharyngitis?
inflammation of the tonsils/pharynx, white and patchy exudate, HA, GI, tender lymph nodes
lab testing should be done in all pts w/ s/sx
do a rapid antigen detection test or throat swab (gold standard)
Patient at high risk of flu complications? How do we diagnose?
<5 and >65 years old, pregnancy and 2 weeks postpartum, nursing homes, BMI>40, comorbidities
rapid antigen detection or conventional RT-PCR or just based on clinical symptoms
What is the clinical presentation? How is it diagnosed?
otorrhea (drainage), ear pain, diminished hearing, fever, middle ear effusion, rupture of tympanic membrane can occur
Middle ear effusion present and either bulging of tympanic membrane or new onset otorrhea, sever is fever>39c or otalgia >48 hours
What is sinusitis? What is classified as acute, subacute, chronic?
inflammation of the mucous membrane that lines the paranasal sinuses
acute: lasts for about 4 weeks
subacute: 4-12 weeks
Chronic: more than 12 weeks
about 7 days
reevaluate if s/sx persist after 7 days
doxy: do not use in kids <8, pregnancy, breast feeding, GI inflammation, photosensitivity
levo/moxi: tendon rupture, peripheral neuropathy, avoid in children
What are some complications of untreated pharyngitis? With out antibiotics, how long do symptoms last and how long is pt contagious? With antibiotics?
Suppurative: local extension of infection resulting in abscess on peritonsillar, rarely brain
Nonsuppurative: immune system responding, causes acute rheumatic fever, scarlet fever, acute glomerulonephritis
Without: symptoms 3-10 days, contagious during symptoms and 7 days after
With: symptoms 1-4 days, contagious 1-2 days post antibiotic
Who should receive antiviral therapy?
initiate therapy promptly in pts who are hospitalized, have severe, complicated, or progressive illness, or is at higher risk for flu complications
Consider therapy for previously healthy pts who has symptoms onset <2 days, loved ones at high risk for complications, or healthcare worker who treats pts at high risk
If pt is <2 years old, has Otorrhea, severe symptoms, or uncertain of follow up, what is the treatment? If none of those are present? When should augmentin be given? If mild PCN allergy? Severe?
symptomatic therapy + amoxicillin
Symptomatic therapy + observation for 48-72 hours or amoxil
If given amoxil <30 days ago, purulent conjunctivitis, recurrent AOM unresponsive to amoxil
Mild: 2nd or 3rd gen cephalosporins
Severe: azithromycin, clindamycin
What are bacterial pathogens that can cause sinusitis? Risk factors? Clinical presentation (3 cardinal symptoms)?
S. pneumoniae, non typeable H influenzae
Female, older, immunodeficient, allergies, asthma, tobacco exposure, poor air quality
*prulent nasal discharge, nasal congestion, facial pressure*
others can include fever, HA, ear pain/pressure/fullness)
What is symptomatic therapy for sinusitis?
intranasal saline irrigation
intranasal corticosteroids (reserved for pts with allergic rhinitis)
topical or oral decongestants or antihistamines are not recommended due to risk of rebound congestion
What are 1st line agents? mild PCN allergy? Severe? Duration? Symptomatic treatment?
PCN (V), Amoxil (10), PCN G (IM 1 dose)
Keflex, cefadroxil (10 days)
clindamycin (10 days), azithromycin (5 days), clarithromycin (10 days)
Symptomatic: systemic pain relief (tylenol, ibuprofen), local (menthol, topical anesthetics, corticosteroids NOT recommended)
What is drug of choice for flu? What class does it belong to? What are some main AEs? What is the benefit of antiviral therapy?
Oseltamivir (tamiflu)
Neuraminidase inhibitors
N/V, HA, transient neuropsychiatric disease
Shortens duration of illness, reduce risk of complications, benefit is greatest when given within 48 hrs of onset