[05.45b] Antimicrobials for Respiratory Infections (Part 2) V2.pdf

Exudative or diffuse erythematous

What type of pharyngitis or tonsillitis is characterized as exudative and very red, reaching the posterior pharyngeal wall?

Viral

What is the most common cause of exudative pharyngitis if associated with cough, rhinorrhea, hoarseness, or oral ulcers?

Symptomatic treatment

What is the therapy for viral pharyngitis, often including gargles, sprays, and increasing oral fluid intake?

Rapid antigen detection test (RADT)

What test is used to diagnose Group A Streptococcus (GAS) pharyngitis?

Acute respiratory failure (ARF), Post-streptococcal glomerulonephritis (PSGN), Peritonsillar abscess

Name two complications of GAS pharyngitis if not treated immediately.

Group A, C, G Streptococci

Name the three main Streptococci groups causing pharyngitis.

Modified Centor score (McIsaac Score)

What assessment tool is useful for determining the use of antibiotics for pharyngitis treatment?

3

What Modified Centor score threshold generally indicates the use of antibiotics?

Tonsillar exudate or swelling

Name one clinical manifestation criterion for the Modified Centor score.

Absence of cough

What symptom gives 1 point on the Modified Centor score because it is more related to viral infection?

3-14 years old

What age range scores 1 point on the Modified Centor score?

0

What score is assigned to patients aged 15-44 years on the Modified Centor score?

-1

What score is assigned to patients aged 45 years or older on the Modified Centor score?

Symptomatic treatment

What treatment is given if the Modified Centor score is ≥3 but the RADT is negative?

Amoxicillin

Which antibiotic is preferentially recommended if the Modified Centor score is ≥3 and RADT is positive?

Penicillins

What drug class is typically the treatment for bacterial pharyngitis in both pediatrics and adults?

Macrolides

What drug class is the primary choice for pharyngitis treatment in patients with penicillin allergies?

Clindamycin

What specific drug is given as an alternative for severe penicillin allergies in pharyngitis treatment?

Phenoxymethylpenicillin or Pen V PO x 10d

What is the first-line oral penicillin treatment duration for pharyngitis in adults?

Benzathine Penicillin G IM x 1 dose

What is the first-line intramuscular treatment for exudative pharyngitis in adults?

Amoxicillin trihydrate 50mkday PO x 10d

What is the first-line oral Amoxicillin regimen for pediatric pharyngitis?

Azithromycin PO x 5d

What is the recommended macrolide regimen duration for pharyngitis using Azithromycin?

Tonsillectomy

What surgical procedure is NOT recommended to decrease streptococcal infection in recurrent pharyngitis?

Cefuroxime axetil PO x 10d and Co-Amoxiclav PO x 10d

Name the two alternative second-line drugs used for recurrent pharyngitis.

Unilateral erythematous swelling of tonsillar area

How is peritonsillar abscess characterized?

Fusobacterium necrophorum

What bacteria is the most frequent etiology (44%) of peritonsillar abscess?

Surgical drainage

What procedure is required for peritonsillar abscess treatment, alongside antibiotics?

Ampicillin-Sulbactam IV/IM

What is the first-line initial drug treatment for peritonsillar abscess?

Co-Amoxiclav PO x 10d

What is the step-down oral drug treatment for peritonsillar abscess?

Ceftriaxone IV plus Metronidazole IV/PO

What is the second-line drug regimen for peritonsillar abscess?

Polymicrobial

What is the etiology type for Deep Neck Abscess (DNA)/Retropharyngeal Abscess?

S. aureus, Streptococcus spp., Bacteroides spp.

Name two microbial etiologies of deep neck abscess.

IV first then step down to oral medications

What is the general rule for antibiotic administration when treating deep neck abscess?

Cefuroxime axetil PO plus Metronidazole PO

What is the final step-down oral drug treatment regimen for deep neck abscess in adults?

Vancomycin or Clindamycin

Which two drugs should be considered if MRSA is suspected in deep neck abscess treatment (2nd Line)?

Antibiotic therapy in the preceding 90 days

Name one risk factor suggesting MRSA suspicion in hospitalized patients.

Intensive surveillance and immediate notification to the DOH

What actions are necessary for Membranous Pharyngitis (Diphtheria)?

C. diphtheriae

What is the primary etiology of membranous pharyngitis transmitted human to human?

Ensure adequate airway first

What critical step must be performed early in the management of Membranous Pharyngitis?

Decrease toxin production and Decrease spread of organisms

Name one way antibiotics assist in Diphtheria treatment.

Pen G IV or Procaine penicillin IM

What is the first-line initial drug treatment for Membranous Pharyngitis?

Phenoxymethylpenicillin PO, 14 days

What is the step-down oral drug treatment duration for Diphtheria?

Benzathine Pen G IM x 1 dose or oral Erythromycin

What is the treatment for Diphtheria carrier states?

Viral

What is the usual etiology of Vesicular, Ulcerative Pharyngitis ("singaw-singaw")?

< 3 years

In which age group is Vesicular, Ulcerative Pharyngitis more common?

Aciclovir or Valaciclovir

What drug is given for HSV 1 and 2 in an immunocompromised host presenting with vesicular pharyngitis?

N. gonorrhoeae

What is the etiology of Gonococcal Pharyngitis?

Ceftriaxone IM x I dose

What is the preferred regimen for Gonococcal Pharyngitis (Peds and Adults)?

Doxycycline or Azithromycin

What two drugs are combined with Ceftriaxone IM when treating Chlamydia alongside Gonococcal Pharyngitis?

Urgent hospitalization

What is required for the treatment of Acute Epiglottitis?

Life-threatening upper airway obstruction

What major complication can Acute Epiglottitis present with?

H. influenzae type b (Hib) and S. pneumoniae

Name the two main etiologies of Acute Epiglottitis.

Hib immunization

What prevention measure is required and recommended for Acute Epiglottitis?

Ceftriaxone IV x 7-10 days

What is the first-line drug treatment duration for Acute Epiglottitis?

Levofloxacin IV plus Clindamycin IV x 7-10 days

What is the second-line drug regimen for adult Acute Epiglottitis?

Patients < 18 years old

In which age group is Levofloxacin generally not recommended due to potential cartilage damage?

S. pneumoniae, H. influenzae, M. catarrhalis

Name the three most common etiologies of Acute Bacterial Rhinosinusitis (ABRS).

High Fever and purulent nasal discharge or facial pain for >3 days

What is one clinical presentation indicating antibiotic use in ABRS?

Still symptomatic after 10 days with no antibiotic

What duration-based criterion indicates antibiotic use in ABRS?

Co-amoxiclav, 10-14 days

What is the first-line drug regimen duration for pediatric ABRS?

Doxycycline, 5-7 days

What is the second-line drug regimen duration for adult ABRS?

Clarithromycin

What drug is recommended for ABRS in patients with Type 1 severe penicillin allergy?

Poor coverage for Gram-negative bacteria (H. influenza and M. catarrhalis)

Why are Erythromycin and Clindamycin generally avoided for ABRS?

Co-trimoxazole

What antibiotic should be avoided in ABRS due to increasing rate of resistance?

Cefuroxime PO x 7-10 days

What is the first-line treatment for acute sinusitis with clinical failure after 3 days in adults (Mild/Moderate)?

Levofloxacin PO x 5 days

What is the second-line treatment for acute sinusitis with clinical failure after 3 days in adults (Severe disease)?

Rapidly fatal without treatment

What is the prognostic characteristic of Mucormycosis if untreated?

Palatal ulcers and/or black eschars and unilateral blindness

Name two symptoms suggesting Mucormycosis in immunocompromised or diabetes mellitus patients.

Rhizopus sp. (Mucor) and Aspergillus

Name the two fungal etiologies of Mucormycosis.

Amphotericin B OR Liposomal Amphotericin B

What is the first-line preferred regimen for Mucormycosis?

Posaconazole

What is the second-line preferred regimen for Mucormycosis?

Gram-negative bacilli (47%)

What is the most common category of etiology in acute sinusitis in hospitalized patients with NT/NGT?

Pseudomonas spp.

Name one specific Gram-negative bacilli found in acute sinusitis in hospitalized patients.

Fluconazole

What drug should be given if yeast cells are seen in the Gram Stain of sinus aspirate in a hospitalized patient with acute sinusitis who is not responding well to antibiotics?

Piperacillin-Tazobactam or Meropenem

What is the first-line drug regimen for acute sinusitis in adult hospitalized patients with NT/NGT?

ADD Vancomycin

What action is required if MRSA is suspected in acute sinusitis in hospitalized patients treated with Pip-Tazo or Meropenem?

Symptoms of more than 6 weeks

What duration characterizes Chronic Rhinosinusitis (CRS)?

CT scan of the maxilla

What diagnostic procedure is done if an odontogenic source is suspected in CRS?

Viral

What is the usual etiology of Laryngitis (around 90% of the time)?

Wheezy bronchitis

What is another name for Bronchiolitis?

RSV (Respiratory Syncytial Virus) in 50%

What is the most common etiology of Bronchiolitis?

Palivizumab

What monoclonal antibody is used for the prevention of bronchiolitis in high-risk infants?

Ribavirin

What drug is used for severe Bronchiolitis (e.g., patients requiring mechanical ventilation)?

Antibiotics are not indicated

What is the general recommendation regarding antibiotics for Bronchiolitis?

Adenovirus

What virus causes Acute Bronchitis in infants and children < 2 years old?

M. pneumoniae

What bacteria may cause acute bronchitis in adolescents and adults (in 5% of cases)?

No improvement in 1 week

What duration criterion indicates antibiotic use for acute bronchitis in children < 5 years old?

Doxycycline

What is the treatment for Mycoplasma infection in adults with acute bronchitis?

Not a basis of severity of condition

What is the clinical relevance of purulent sputum color?

Green

What color sputum suggests a higher concentration of immune cells and intensified fighting of infection?

Red, frothy

What color and texture sputum may indicate the presence of blood and a serious condition like Pulmo TB?

Bordetella pertussis

What is the main etiology of Pertussis (whooping cough)?

Catarrhal stage (1-2 weeks), Paroxysmal stage (1-6 weeks), Convalescence stage (weeks to months)

Name the three stages of Pertussis infection.

Eradication of nasopharyngeal carriage

What is the aim of antibiotic treatment for Pertussis?

Macrolides

What drug class is used for Pertussis treatment in neonates < 2 months?

Azithromycin

What is the preferred treatment for Neonates < 1 month with Pertussis?

Increased dyspnea, sputum viscosity/purulence, and sputum volume

What are the three cardinal symptoms of COPD exacerbations that may warrant antibiotics?

Inhaled anticholinergic bronchodilator

Name one non-antibiotic pharmacologic treatment for ABECB management.

Amoxicillin or Doxycycline or Cefuroxime PO

What is the preferred regimen for mild to moderate ABECB infection?

Co-amoxiclav or Azithromycin x 3d or Clarithromycin PO or Levofloxacin PO

What is the preferred regimen for severe ABECB infection?