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Upper Respiratory Infection - Coggle Diagram
Upper Respiratory Infection
Acute Otitis Media
S/SX: bulging of tympanic membrane, otorrhea, otalgia, fever, vomiting or poor eating
Treatment goal: pain management, eliminate infection with antimicrobial stewardship
Prevention: pneumococcal conjugate vaccine and annual flu vaccine
Treatment
Nonpharmacologic
acetaminophen or ibuprofen for pain
eardrops with local anesthetic for pain
Pharmacologic
amoxicillin
avoid in patients who took amoxicillin in the last 30 days, have purulent conjunctivitis, have history of recurrent infection that does not respond to amoxicillin - use amoxicillin-clavulanate instead
80-90 mg/kg/day in 2 divided doses
narrow spectrum of activity - S. pneumoniae
amoxicillin-clavulanate
90 mg/kg/day amoxicillin, 6.4 mg/kg/day clavulanate in two divided doses
spectrum of activity - H. influenzae and M. catarrhalis and S. pneumoniae
cefdinir, cefuroxime, cefpodoxime, ceftriaxone
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more adverse effects
Recurrent: 3 cases in 6 months or 4 cases in 1 year with 1 case in 6 months prior
Acute Bacterial Rhinosinusitis
Epidemiology
Viral etiology (common pathogens: S. pneumoniae, H. influenzae & M. Catarrhalis)
Pathophysiology
Viral URT causes mucosal inflammation that leads to obstruction of sinuses.
Signs & Symptoms
nasal discharge & constitutional symptoms
Diagnostic Criteria
Persistent for >10 days, severe for 3-4 days or worsening of symptoms with new onset of fever.
Pharmacological Therapy
Amoxicillin-Clavulanate
90mg/kg/day amoxicillin, 6.4 mg/kg/day clavulanate in 2 divided doses
Spectrum: H. influenzae, M. catarrhalis & S. pneumoniae
Monitoring
Refer to specialist for mental status changes or worsening of infection.
Acute Pharyngitis
epidemiology
children 5-15 yo are most susceptible and parents of school-age children are at increased risk.
etiology
viral causes are most common; GABHS is the primary bacterial cause
pathophysiology
exact mechanism unclear; possible alteration in host immunity. Pathogenic factors (e.g. pyrogenic toxins) may play a role.
clinical presentation
General: sudden onset of sore throat, fever; GABHS: pain on swallowing, n/v, abdominal pain, swollen uvula; viral origin: conjunctivitis, coryza, cough
pharmacologic tx
acute GAGHS
PCN V: 250 mg BID-TID QD PO for children; 250 mg 4 times daily or 500 mg BID for adults
PCN G: 0.6 million units if <27 kg; 1.2 million units IM if ≥27 kg
amoxicillin: 50 mg/kg QD or 25 mg/kg BID
If allergic to PCN
cephalexin 20 mg/kg/dose BID PO
cefadroxil: 30 mg/kg PO QD
clindamycin: 7 mg/kg/dose PO TID
azithromycin: 12 mg/kg PO QD for day 1 and then 6 mg/kg PO QD for 4 days
clarithromycin: 15 mg/kg PO per day divided in 2 doses
non-pharmacologic therapy
limited evidence for nonpharmacologic therapies; may consider
antipyretic medications, analgesics, nonprescription lozenges and sprays for pain relief