Lecture 22: Treatment of Upper Respiratory Tract Infections | Quizlet

Acute Otitis Media

Otitis Media with rapid onset of inflammatory symptoms

Uncomplicated Acute Otitis Media

Otitis Media with absence of otorrhea

Otitis Media with Effusion (OME)

Otitis Media: middle ear inflammation with fluid present but no symptoms of infection

Bilateral Infection and/or Severe Symptoms

When to treat with antibiotics (otitis media):

6-24 mo with ________________________________

Amoxicillin and Clavulanate

alternative for high dose amoxicillin

High Dose Amoxicillin

-treatment of choice for acute otitis media

-treatment for 5-10 days and improvement in 48-72 hours

3rd Generation Cephalosporin

alternative treatment for acute otitis media if pt has a penicillin allergy

• Pneumococcal conjugate

• Annual influenza

vaccines that can help prevent acute otitis media

Prophylatic Antibiotics

what should NOT be prescribed for an individual with recurrent acute otitis media

Bacterial

signs that are suggestive of __________________ infection:

-persistens symptoms lasting > 10 days without improvement

-severe symptoms

-unilateral cheek or maxillary tooth pain and purulent nasal discharge

-worsening symptoms after initial improvements

-Acetaminophen

-NSAIDs

-Topical Analgesics

medications for throat pain in acute bacterial pharyngitis

if GAS positive or GAS negative with high suspicion

when should you use antibiotics for acute bacterial pharyngitis?

Penicillin or Amoxicillin

Ac(for 10 days)

Treatment of choice for acute bacterial pharyngitis

Cephalexin or Cefadroxil

treatment for acute bacterial pharyngitis if pt has a nonsevere penicillin allergy

-Azithromycin

-Clindamycin

-Clarithromycin

treatment for acute bacterial pharyngitis if pt has a severe penicillin allergy

Parainfluenza Type I

most common virus causing Croup

Dexamethasone (single dose)

steroid of choice for Croup

Epinephrine

along with Dexamethasone for group, if there are severe respiratory symptoms, you can add nebulized ____________________

Beta-Lactam Antibiotics

-inhibit cell wall synthesis by inhibiting peptidoglycan crosslinking

-synergistic interactions with aminoglycosides

-augmentative interactions with probenecid

-Chelation

-Methicillin

-Nafcillin

-Oxacillin

-Dicloxacillin

-Antistaphylococcal penicillins

-staphylococci and streptococci only

-resistant to some beta-lactamases

-Penicillin V

-Penicillin G

-Penicillin VK

Penicillins that cover Gram positive, gram negative cocci, and anaerobes

Amoxillin and Ampicillins

-Aminopenicillins

-G+, Enhanced G- coverage due to increased outer membrane penetration

-Often used in combination with a b-lactamase inhibitor

Ticarcillin an Piperacillin

-Antipseduomonal Penicillins

-G+, Enhanced G- coverage due to increased outer membrane penetration

-Often used in combination with a b-lactamase inhibitor

Beta-lactamase inhibitors

What type of drug:

-Clavulanic Acid

-Sulbactam

-Tazobactam

Beta-lactamase inhibitors

-inhibit specific bacterial beta-lactamases

-use with an extended spectrum penicillin to treat bacterial infection caused by susceptible pathogens

-ADRs: diarrhea and hypersensitivity

Cephalexin

Cefazolin

Cephadroxil

First Generation Cephalosporins

Cefaclor

Cefprozil

Cefuroxime

Cefotetan

Cefoxitin

Second Generation Cephalosporins

Cefdinir

Cefixime

Cefpodoxime

Cefotaxime

Ceftriaxone

Ceftazidime

third generation cephalosporins

First Generation Cephalosporins

Spectrum of activity:

-G+ cocci

- G- : P. mirabilis, E. coli, K. pneumoniae = PEcK

-Anaerobic cocci (NOT B. fragilis)

Second Generation Cephalosporins

Spectrum of Activity:

-First generation pathogens

-Extended G-

- Anaerobes (some against B. fragilis)

Third Generation Cephalosporins

Spectrum of Activity:

-Second generation pathogens

- Extended G-; some b-lactamase-producers

- Ceftazidime- Pseudomonas

Fluoroquinolones

-inhibition of bacterial replication via inhibition of topoisomerases II and IV

-for RTI, UTI, bacterial diarrhea, and osteomyelitis

-can be used against G+, G-, Pseudomonas, intracellular pathogens, and atypical pathogens

Fluoroquinolones

What type of drug:

-Ciprofloxacin

-Levofloxacin

-Gatifloxin

-Moxifloxacin

-Ofloxacin

Fluoroguinolones

ADRs:

• Phototoxicity

• QT prolongation

• Cartilage damage (especially in children)

• Superinfections

-Tendinitis and Tendon Rupture

-Exacerbation of Myasthenia Gravis

-Limit use in bacterial rhinosinusitis, chronic bronchitis exacerbation, uncomplicated UTI

Boxed warning for Fluoroquinolones

Macrolides

-inhibit protein synthesis

-bind to 50S subunit thereby inhibiting peptide bond formation

-bacteriostatic and batericidal

Tetracyclines

-inhibits protein synthesis

-binds to 30S subunit, inhibiting binding of charged tRNA to the A site

-bacteriostatic

Tetracyclines

-alternative treatment for adults with bacterial rhinosinusitis

-Spectrum: G+/G-, anaerobes, rickettsiae, chlamydiae, and mycoplasma

-ADRs: impaired bone development, teeth discoloration, and phototxicity

Macrolides

what type of drugs:

-Azithromycin

-Clarithromycin

-Erythromycin

-Telithromycin

Macrolides

-alternative therapy for severe penicillin allergy in Otitis media and acute bacterial pharyngitis

-also for skin/skin structure infection, and respiratory infections

-Spectrum: G+ cocci, intracellulars, and atypicals

Erythromycin

-macrolide

-promotility agent

-pronounced GI Effects

Clarithromycin

-macrolide

-increased activity against myobacteria

-improved tolerability

Azithromycin

-macrolide

• Well-tolerated

• No CYP effects

• Lower staphylococci and streptococci activity

• Improved H. influenzae and high Chlamydiae activity

• long elimination half-life

Telithromycin

-macrolide

-associated with hepatitis/liver failure

-only indicated for community acquired pneumonia

-contraindicated in myasthenia gravis

Clindamycin

-inhibits bacterial protein synthesis by binding to 50S ribosomal subunit

-alternative therapy for penicillin allergy in rhinosinusitis and acute bacterial pharyngitis

-penetrates abscesses

Development of CDAD

boxed warning for Clindamycin