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Upper Respiratory Infection - Coggle Diagram
Upper Respiratory Infection
Diagnosis
Presence of bacteria causing symptoms
Fever
Sore Throat
Cough
Inflammation
Throat Swab
Culture
Rapid Antigen Detection Test
Follow-Up/Monitoring
Relief of symptoms shows efficacy
Absence of bacteria shows efficacy
Pathophysiology
Direct invasion of upper airway by bacteria, virus, or other organism. Organism is usually acquired by inhalation of infected droplets
Goals of Therapy
Relieve symptoms of URI
Treat bacterial infection
Treatment
Non-Pharmacological
Vaporizer
Hydration
Neti Pot
Warm beverages
Gargle salt water
Elevate head of bed
Pharmacological
Amoxicillin
Determinants of Health
Capsules $0.13-$5.88 each
Duration
5-7 days
Monitoring
Monitor renal, hepatic and hematologic function
Regimen
500-1000mg Q 8-12h
PK/PD
Protein binding 20%; half life 61 min (IR), 90 min (ER); 60% excreted unchanged
Adverse Effects
Headache, N&V, diarrhea
Special Populations
Dose adjust in renal impairment ; pregnancy risk B
MOA
Inhibits bacterial cell wall synthesis by binding PBPs to inhibit transpeptidation
Drug Interactions
Aminoglycosides, tetracycline, warfarin
Contraindications/Precautions
Severe hypersensitivity reactions
Counseling
IR take with or without food; XR take within 1 hour of finishing a meal
Cefdinir
Determinants of Health
$28 for 20 capsules
Duration
5-10 days
Monitoring
Monitor renal function. Observe for signs and symptoms of anaphylaxis during first dose
Regimen
600 mg daily or 300 mg BID
PK/PD
Absorption: time to peak concentration is 2-4h
Distribution: Vd (adults) = 0.35 L/kg, Vd (pediatric) = 0.67 L/kg
Not metabolized
Excretion: renal (11.6 to 18.4%)
Adverse Effects
Minor: abdominal pain, diarrhea, nausea, candida vaginitis
Major: Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridium difficile colitis, hepatitis, hepatotoxicity, hypersensitivity
Special Populations
Pregnancy/breast feeding: fetal risk cannot be ruled out
MOA
Bactericidal, semisynthetic cephalosporin; inhibits cell wall synthesis
Drug Interactions
Warfarin
Some live vaccines (cholera, typhoid, etc)
Oral contraceptives
Antacids
Contraindications/Precautions
Avoid in pts w/ hx of Clostridium difficile-associate diarrhea
Use with caution in pts with hx of colitis
Avoid in pts w/ hx of penicillin allergy
Dose reduction needed in pts with CrCl <30mL/min
Counseling
Antacids containing magnesium or aluminum interfere w the absorption of cefdinir. Iron also interferes w absorption. Separate by at least 2 hours
Counsel patient on importance of finishing antibiotic regimen
Amoxicillin/Clavulanate
Determinants of Health
$12.75
Duration
7 days
Monitoring
Monitor for elimination of pathogenic organisms
Regimen
90 mg/kg.day of amoxicillin with 6.4 mg/kg clavulanate in two divided doses
If therapy is prolonged, monitor renal, hepatic and hematologic function periodically :
PK/PD
Amoxicillin distributes readily into liver, lungs, prostate, muscle, middle ear effusions, maxillary sinus secretions, bone, gallbladder, bille and into ascitic and synovial fluids. 20% protein binding. 60% excreted unchanged in urine
Clavulanic acid has 25% protein binding, 1 hour half life elimincation, 1.5 hours to peak and 25-40% is excreted unchanged in the urine
Adverse Effects
Diarrhea, nausea, vomiting, skin rash
Special Populations
Avoid XR in patients with CrCl <30
Use with caution in hepatic impairment
Reduce frequency of dosing in CrCl <30
MOA
Amoxicillin inhibits bacterial cell wall synthesis; clavulanic acid inhibits beta-lactamases that could potentially inactive amoxicillin
Drug Interactions
Warfarin- may enhance effects
May diminish effects of certain vaccines
Contraindiactions/Precautions
Monitor for anaphylactic/hypersensitivity reactions and hepatic effects
Counseling
Counsel patient on importance of completing course of antibiotics