Term
| What are signs and symptoms of otitis media? |
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Definition
- Signs - Bulging, immobile tympanic membrane
- Symptoms - Fever, ear pain, Irritability, ear tugging
**More common in kids due to flat eustacian tube |
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Term
| What is the difference between effusion and AOM? |
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Definition
- Effusion - no S/S of infection. Does not require tx
- AOM- bulging membrane w/ limited mobility. Inflammation |
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Term
| What causes otitis media? |
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Definition
S. pneumoniae!
**others: H. influenzae and Moraxella catarrhalis |
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Term
| When should Abx be used in otitis media? |
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Definition
- < 6 months - always use antibiotics
- 6 months - 2 years - Antibiotics if certain, or if severe
- 2+ - Antibiotics only if severe, if not observation |
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Term
| What non-Abx tx can be used for otitis media? |
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Definition
- Tylenol and NSAIDs
- Auralgan
- Ear tubes |
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Term
| What is the drug of choice in otitis media? |
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Definition
- Amoxicillin - 80 to 90mg/kg/day divided in q12h
**2nd line = Augmentin, 6.4 mg/kg |
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Term
| What are alternative treatments for Otitis media? |
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Definition
- Type 1 PCN allergy - Azith and Biaxin
- PCN rxn - 2nd or 3rd gen cephalosporin - cefuroxime, cefprozil, cefpodoxime, cefdinir |
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Term
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Definition
| Infection of the sinuses or nasal mucosa which usually viral in origin and self limiting |
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Term
| What are the sx of Sinusitis? |
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Definition
- Rhinorrhea - may be thick and colored
- Nasal congestion
- Facial pain
**Bacterial causes are S. pneumoniae, H. influenzae, M. catarrhalis |
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Term
| When should sinusitis be treated? |
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Definition
Sx over 7 days
**Amoxicillin 500 mg TID x10 days
** Augmentin for treatment failure |
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Term
|
Definition
| Strep Throat - contagious, in young children in certain seasons. Most commonly viral but also caused by S. pyogenes |
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Term
| What are the symptoms of Strep throat? |
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Definition
Sore throat, difficulty swallowing, fever, HA, Scarlatiniform rash
**Do not see rhinorrea, cough, conjunctivitis
**Diagnosis by S/S + Rapid strep or throat culture |
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Term
| What are complications from strep throat? |
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Definition
- Acute rheumatic fever - leads to valve dysfunction
- Poststrep glomerulonephritis
- Reactive arthritis |
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Term
| How is strep throat treated? |
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Definition
| Penicillin - excellent coverage of strep pyogenes. Can use injection for kids, otherwise 500 mg BID-TID x10 |
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Term
| What is acute bronchitis? |
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Definition
A LRI that has NO alveolar involvement - cough and congestion > 5 days to weeks.
**Usually viral |
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Term
| When is acute bronchitis treated? |
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Definition
- In fever/respiratory sx for 4-6 days or in elderly/immunosuppressed patients
** Macrolides (Z-pack), FQNs (Avelox or Levofloxacin), Zanamivir/Oseltamivir |
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Term
| What is chronic bronchitis? |
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Definition
A LRI - smoker's cough, most days of the week for 3+ months per year for 2 years.
**An advanced stage of right sided HF |
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Term
| What most commonly causes chronic bronchitis? |
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Definition
- Most common: H. influenzae, S. pneumniae, M. catarrhalis
- Advanced (FEV < 40): E. coli, Klebsiella, Enterobacter, P. aerug |
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Term
| When is chronic bronchitis treated? |
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Definition
Antibiotic use is controversial - treat COPD exacerbation. Avoid broad spectrum
- Amox 500 TID
- FQN po daily
- Z pack
- Doxy 100 BID |
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Term
| What is the most deadly type of infection in the US? |
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Definition
Pneumonia - inhalation, aspiration, bloodstream
**Fever, chills, SoB, a productive cough and chest pain |
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Term
| What leads to a Pneumonia diagnosis? |
|
Definition
- Chest Xray
- RR > 20, HR > 90
- Dull to percussion, Egophony
- Crackles
- Incr WBC, culture, hypoxemia |
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Term
| What cultures test for pneumonia? |
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Definition
- Sputum - least helpful. PMNs = infection
- Aspirate/BAL - from LRT |
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Term
|
Definition
- Typical: S. pneumoniae, H. influenzae, M. catarrhalis
- Atypical: Mycoplasma pnemoniae, Legionella, Chlamydia pneumoniae |
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Term
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Definition
- No previous Abx in last 3 months - Macrolide (Azith 500 QD, Clarith 500 BID) or Tetra
- Comorbidities, alcohol use, immunosuppressed, OR use of antibiotics w/n last 3 months - FQN (Levaquin 750 or Avelox) or Beta lactam + Macrolide (Augmentin + Azith)
**DO NOT USE CIPRO!!!! |
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Term
| What covers atypical pathogens in CAP? |
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Definition
| Azithromycin + Ceftriaxone |
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Term
| What vaccinations should be received by a CAP patient? |
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Definition
- Pneumovax - Over 65, high risk, smokers
- influenza |
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Term
| What are different types of nosocomial pneumonia? |
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Definition
- HCAP - Admission from long term care or nursing home, dialysis, in hospital >2 days in past 90
- HAP - acquired after 48 hours in hospital
- VAP - after intubation |
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Term
| What is the treatment regimen for nosocomial pneumonia? |
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Definition
- Beta lactam - Cefepime, Ceftazidime. Imipenem/Meropenem/Doripenem, Zosyn, Ticarcillin/Clavulanate, Aztreonam (in PCN allergy)
- AG OR FQN - Amikacin, Gent/Tobra. Levo or cipro only
- MRSA drug - Vanco or Linezolid
**Cubicin does not target lungs. Avelox does not work. |
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Term
| What is the length of dosing for nosocomial pneumonia? |
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Definition
- 7-8 days
- 14 days for pseudomonas |
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Term
| Who is at risk for aspiration pneumonia? |
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Definition
- Altered mental status, difficulty swallowing, seizures, alcoholics, periodontal disease
** Oral flora: Peptostrep, Fusobacteria, Bacteroides, Peptococcus
** Other: S. aureus, S. pneumo, gram(-) rods |
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Term
| How is aspiration pneumonia treated? |
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Definition
Typical HAP tx + anaerobic coverage:
Clinda, metronidazole |
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