Clin Pharm - Upper Respiratory Tract Infection

Disease Subtypes:
Rapid onset of acute infection.

Acute Otitis Media (AOM)

Disease Subtypes: Fluid present without acute signs

Otitis Media with Effusion (OME)

Disease Subtypes: Persistent inflammation/effusion.

Chronic Otitis Media

Microbial Pathogenesis

S. pneumoniae (High Penicillin Resistance)

H. influenzae (β-lactamase producer)

M. catarrhalis (β-lactamase producer)

Pathophysiology: Viral URIs impair mucociliary clearance, leading to ___and bacterial proliferation.

Eustachian tube dysfunction

Diagnostic Criteria AOM

Moderate-to-severe bulging of the tympanic membrane.

New onset otorrhea (not due to externa).

Intense erythema with ear pain within 48 hours.

Severe Fever Threshold: (102.2°F) T ≥ 39 • C

What is the Recommended Antibiotic for AOM?

Clinical Situation: Initial Diagnosis (1st Line)

Dosing/Notes:80-90 mg/kg/day (divided twice daily)

Amoxicillin

What is the Recommended Antibiotic AOM?

Clinical Situation: Amoxicillin failure/Recurrent

Dosing/Notes: 90 mg/kg/day Amox + 6.4 mg/kg/day Clav

Amoxicillin-Clavulanate

What is the Recommended Antibiotic?

Clinical Situation: Penicillin Allergy

Dosing/Notes: Oral cephalosporins are safe for non-Type 1 allergies

Cefdinir / Cefuroxime

What is the Recommended Antibiotic?

Clinical Situation: Treatment Failure (48-72h)

Dosing/Notes:50 mg/kg IM or IV for 3 days

Ceftriaxone

ote: Observation without antibiotics is appropriate for non-severe unilateral AOM in children __months

6-23 months

Pharyngitis Epidemiology

Viral (Most Common): Rhinovirus, Coronavirus, Adenovirus.

Bacterial: GABHS (10-30% pediatric; 5-15% adult cases).

Pharyngitis Critical Complications

Acute Rheumatic Fever, Post-streptococcal Glomerulonephritis, Peritonsillar Abscess, and Mastoiditis.

Differentiating Bacterial Etiology of pharyngitis

GABHS Presentation

• Sudden onset sore throat

• Tonsillar exudates

• Petechiae on soft palate

• Scarlatiniform rash

Viral Presentation

• Conjunctivitis

• Coryza (Runny nose)

• Cough

Gold standard for confirmation of pharyngitis

Confirmation via Throat Swab Culture or RADT.

Eradication Strategies for GABHS

Penicillin V (Preferred), Amoxicillin, Azithromycin (Allergy), Cephalexin (Allergy)

Goal: Prevent Acute Rheumatic Fever and transmission. Symptoms resolve___ days earlier with therapy

0.5–2.5

Acute Bacterial Rhinosinusitis, When is it Bacterial?

Diagnostic Indicators

• Persistence: Lasting ≥ 10 days without improvement.

• Severity: Fever ≥ 39°C and purulent discharge ≥ 3-4 days.

• "Double Sickening": Worsening after initial URI improvement.

• Common Pathogens: S. pneumoniae and H. influenzae

(50–70% of cases).

Rhinosinusitis Therapy Guidelines Adjuvant Care

• Nasal Saline Irrigation.

• Steam Inhalation.

• Avoid: Antihistamines (dries mucosa, hinders clearance).

• Limit decongestants to ≤ 3 days.

Rhinosinusitis Therapy Guidelines Antibiotic Selection

1st line: Amoxicillin-Clavulanate

2nd line: High-dose Augmentin

Allergy: Doxycycline (Adults only)