Term
| What are the aims of infection guidance? |
|
Definition
1. Provide a simple, empirical approach to the treatment of common infections
2. Pomote the safe, effective and economic use of antibiotics
3. Minimise the emergence of bacterial resistance in the community |
|
|
Term
| What are the principles of treating common infections in the community? |
|
Definition
Only prescribe A/B's likely a clinical benefit.
Consider no/delayed A/B treatments for acute URTI inf.
Use simple generic A/Bs where possible
Avoid broad spectrum
Avoid widespread topical A/B's use.
In Pregnancy AVOID
- Tetracyclines
- Aminoglycosides
- Quinolones or High Dose Metronidazole (>2g). |
|
|
Term
| What alternative A/B strategies should be considered in acute URTI infections in general practice? |
|
Definition
| No OR Delayed A/B strategy |
|
|
Term
| Which A/B Classes should be avoided in Pregnancy? |
|
Definition
In Pregnancy AVOID
- Tetracyclines
- Aminoglycosides
- Quinolones
- High Dose Metronidazole (>2g).
“To Offer Aminoglycosides Hurts” |
|
|
Term
What treatment decision aids are used for A/B use in Tonsillitis/Pharyngitis?
For which patients are they valid? |
|
Definition
Centor Criteria (Adults)
FeverPAIN score. |
|
|
Term
What is/are the Centor Criteria?
What management does it dictate? |
|
Definition
Screen for likely Group A streptococcal infection or Streptococcal Pharyngitis in adult patients. Application of CC to Children appears to be ineffective.
Negative Predictive Value of circa 80% (i.e. Good for ruling out, not ruling in).
History of fever +1
Tonsillar exudates +1
Tender anterior cervical adenopathy +1
Absence of cough +1
(Unofficially - Hx of Otits Media = +1)
Modified Centor Criteria (not really used)
<15yrs +1
>44yrs -1
Management (Pure Centor)
1= Strep Risk <10%
No A/B. No Throat Culture. Give Paracetamol + Supportive Tx
2-3 = Strep Risk 15%
Throat Culture +/- A/B based on Culure
4 = Strep Risk 55%
Give Empirical A/B. No Culture. |
|
|
Term
| What is the FeverPain score? |
|
Definition
Risk of GAS in tonsillitis/pharyngitis.
/Need for A/B's
Can be used for ≥3yrs
The score consist of five items:
1. Fever during previous 24 hours;
2. Purulence;
3. Present ≤3 days
4. Very Inflamed tonsils;
5. No cough/coryza (FeverPAIN) |
|
|
Term
| Clinical Features of Pharyngitis/Tonsillitis? |
|
Definition
Examination along will not distingush between pathogens
Sore throat when swallowing (Odonophagia)
Fever (esp. In Bacterial Infection)
Headache
Malaise
Lymphadenopathy (Anterior Neck Pain)
Likely Bacterial = Fever, Headache, Malaise
Likely Viral = Signs of URTI (Cough, congestion, sinusitis, ear pain)
Serious Symptoms
Secretions, drooling, dysphonia, muffled "hot potato" voice, or neck swelling, difficulty swallowing. |
|
|
Term
| What dangerous conditions should be ruled out for patient with serious symptoms of pharyngitis/tonsillitis? |
|
Definition
Serious Symptoms
Secretions, drooling, dysphonia, muffled "hot potato" voice, or neck swelling, difficulty swallowing.
Conditions
Epiglottitis – Severity of sore throat out of proportion to the oropharygneal exam.
Peritonsillar Abscess – Visually, Trismus, reflex spasm of pterygoid (2/3)
Submandibular Infection – E.g. Ludwigs Angina, fever, chills, and malaise. Leaning forward to max airway, no lymph, submand woody induration, tender, orofloor erythema+elevation.
Retropharyngeal Infections – Common in penetrating trauma e.g. Chicken bone.
Primary HIV – Sore throat is common manifestation of acute HIV infection. Painful mucocutaneous ulceration along with other signs of inf, fever, adenopathy, faigue, rash. |
|
|
Term
| Discuss the diagnostic tests available for evaluation of pharyngitis/tonsillitis? |
|
Definition
Rapid Antigen Detection Test
Used for identification of GAS.
Indicated for patients with a centor score of ≥3
Postive RADT = Rapid A/B initiation.
Sensitivity = 70-90%, Specificity = 90-100%
Throat Culture
Gold Standard but slow
24-48hrs to culture
Primarily used as back-up where GAS suspicion high
Also standard in vulnerable groups, even if RADT -ve
e.g. Immunocomp, Steroids users, Poor DM.
DNA Probes
Rarely but 95% spec+sens.
Alternative to throat culture |
|
|
Term
| Discuss the Management of Patients who are do have non-GAS pharyngitis/tonsillitis. |
|
Definition
Pharyngitis will resolve in a few days (circa 8) w/o sequelae and no further diagnostic measures are required.
Symptomatic treatment should be offered.
- Systemic Analgesia (Aspirin, acetaminophen, NSAIDs (ibuprofen best).
- Sucked Lozenges/Tablets (OTC or Medicated e.g. Lidocaine)
- Phenol Sprays (less evidence)
- Controversial. Glucocorticoids. None unless severe swelling. |
|
|
Term
| Discuss the antimicrobial treatment of step throat in adults and children. |
|
Definition
Emprical Antibiotic treatment is indicated for:
- Patients with high clincial suspicion (Centor ≥3)
- Patients with a +ve RADT/Throat Culture
Adults
Oral Penicillin V (Phenoxymethylpenicillin) 10 days 333-666 QDS
If allergic: Clarithromycin 5 days 250-500 BD
Children
Phenoxymethylpenicillin suspension 7-10 days(variable doses)
If Allergic: Erythromycin or Clarithromycin.
Note: Amoxicillin often used since it is more palatable orally.
Intramuscular penicillin G benzathine may be administered to patients who cannot complete a 10-day course of oral therapy. |
|
|
