ID Lecture 31: Pathophysiology & Therapeutics of Upper Respiratory Tract Infections in Adults | Quizlet

How much use of antibiotics for upper respiratory tract infections is inappropriate?

50%

What medications are the 2nd leading cause of ED visits due to adverse events?

Antibiotics

What antibiotic is no longer recommended for URTIs but is still commonly prescribed?

Azithromycin

Tier 1 diagnosis

antibiotics are sometimes indicated

Tier 2 diagnosis

antibiotics are sometimes indicated

Tier 3 diagnosis

antibiotics are rarely inficated

What type of diagnosis are URTIs?

Tier 2 or 3 (antibiotics are sometimes or rarely indicated)

Acute Rhinosinusitis

symptomatic inflammation of the mucousa, nasal cavity, and paranasal sinuses lasing LESS THAN than 4 weeks

What are the s/sx of acute rhinosinusitis?

Purulent rhinorrhea

Facial pressure

HA

Fever

Maxillary dental pain

Cough

What bacteria cause acute bacterial rhinosinusitis?

S. pneumoniae

H. influenzae

+/- Moraxella catarrhalis

*typical flora for the region

What are the diagnostic criteria for bacterial acute rhinosinusitis?

Presence of at least ONE of the following:

- Persistence nasal discharge or daytime cough without improvement (>10 days)

- Worsening fever, daytime cough or nasal discharge after initial improvement

- Severe: fever, purulent nasal discharge for at least 3 consecutive days

What is the preferred treatment for acute bacterial rhinosinusitis in adults?

Amoxicillin

OR

Augmentin

Plus symptom management

What is the treatment option for adult patients with severe acute rhinosinusitis?

High dose amoxicillin +/- clavulanate

Why are macrolides NOT preferred for acute bacterial rhinosinutitis?

risk of drug-resistant strep pneumo (DRSP)

Chronic rhinosinusitis

inflammatory condition involving the paranasal sinuses that lasts 12 weeks or LONGER

What are the 3 types of chronic rhinosinusitis?

w/o polyps

Allergic fungal

Nasal polyps

Chronic sinusitis is frequently _____________.

polymicrobial

When are antibiotics recommended in chronic rhinosinusitis?

in patients without nasal polyps or allergic fungal rhinosinusitis

What antibiotics are recommended in chronic rhinosinusitis?

Augmentin

Clindamycin

Moxifloxacin

Acute pharyngitis

infection of tonsils or posterior pharynx by microorganisms

What are some of the causes of acute pharyngitis?

Viral

Group A strep

Other bacteria

What is the main cause of acute pharyngitis?

Group A strep

When are antibiotics recommended in acute pharyngitis?

confirmed group A strep

(reduces chances of rheumatic fever)

What determines if a patient should be tested with a strep test?

Modified Centor Criteria:

Presence of TWO of the following:

- Temp >100.9F

- Swollen cervical nodes

- Tonsillar exudate

- Lack of cough/viral ARI symptoms

OR

Modified McIsaac Criteria:

- +1 point for ages 3-14 y/o

- -1 point for >45 y/o

- Temp >100.9F

- Swollen cervical nodes

- Tonsillar exudate

- Lack of cough/viral ARI symptoms

What are the Modified Centor Criteria?

Presence of TWO of the following:

- Temp >100.9F

- Swollen cervical nodes

- Tonsillar exudate

- Lack of cough/viral ARI symptoms

*used to determine if someone should be tested for Group A strep*

What are the Modified McIsaac Criteria?

Presence of at least TWO of the following:

- +1 point for ages 3-14 y/o

- -1 point for >45 y/o

- Temp >100.9F

- Swollen cervical nodes

- Tonsillar exudate

- Lack of cough/viral ARI symptoms

What treatment is recommended if the rapid strep test is negative?

no antibiotic therapy, only symptomatic tx

What treatment is recommended for a positive strep test?

Penicillin VK (DOC)

Amoxicillin

Benzathaine Penicillin

If allergy:

Keflex

Clindamycin

What is acute Rheumatic fever?

autoimmune reaction to infection with Group A strep

What are the s/sx of Rheumatic fever?

Polyarthritis

Myocarditis

Skin manifestations

Chorea

Long term heart damage --> CHF

When should antibiotic therapy be started for group A strep to prevent Rheumatic fever?

within 9 days of onset

What are some rare complications that can be mistaken for uncomplicated ARI?

Peritonsillar abcess

Epiglottitis

Ludwig's angina

Acute Bronchitis

infection and inflammation of bronchial airways

What is considered to the the only legitimate pathogen treated with antibiotics in acute bronchitis?

Pertussis

What is important to rule out before diagnosing for bronchitis?

pneumonia (CDC recommended)

What is the recommendation for antibiotic use in bronchitis?

Antibiotics are NOT routinely recommended for uncomplicated bronchitis

Azithromycin or Bactrim can be used if Pertussis confirmed or possible exposure

What are the criteria for using antibiotics in COPD exacerbations?

Increase in dyspnea

Increased sputum volume

Increased sputum purulence

Patient requires NIV or MV

What antibiotics are recommended for COPD exacerbations?

Augmentin

Macrolide

Doxycycline

What bacteria are we targeting in COPD exacerbations?

S. pneumoniae

H. influenzae

M. cattarhalis

Which COPD exacerbation patients recieve Quinolones?

patients that are hospitalized with respiratory failure/MV

What are the s/sx of the common cold (URI-NOS)?

Nasal congestion

Post nasal drip

Throat irritation

Sneezing

Coughing

HA

What is the recommendation of antibiotic use in URI-NOS?

antibiotics are NOT recommended, use symptomatic therapy

Patients with what ARIs should recieve antibiotics?

Pharyngitis

Bacterial Sinusitis

What antibiotics are the cornerstone of ARI therapy?

Penicillins

Penicillin-like abx

What are the reasons that antibiotics are overprescribed for ARIs?

Lack of knowledge

Diagnositc uncertainty

Patient pressure/satisfaction

Workload/habit

What are the 4 steps to managing expectations when it comes to prescribing antibiotics?

1. Communicate results of physical exam

2. Deliver a clear diagnosis

3. Negative followed by positive treatment recommendation

4. Contingency plan

What are the risks of overprescribing antibiotics?

ADEs

Abx resistance

Increased C. diff infections

Unnecessary HC resources