chapter46 URIs

Question 1

URI symtoms

Answer 1

• nasal congestion
• rhinorrhea
• sore throat
• nasal discharge starts as thin and clear and progresses to thick yellow/green
• adults usually afebrile/children may have low-grade fever

Question 2

URI treatment

Answer 2

-symptom care: antipyretic, nasal bulb suctioning for infants, decongestants for older children and adults, expectorants, and cough supressants

Question 3

decongestants

Answer 3

-pseudo-ephedrine and phenylephrine-systemic sympathomimetics
-topical: phenylephrine and oxymetazoline
oral decongestants: action-vasoconstriction of capillary vessels, decreasing congestion
ADRs: tachycardia, htn, anxiety/restlessness/irritability
-no studies with children on systemic decongestion–assumed dangerous

Question 4

cough supressants

Answer 4

• dextromethorophan (robitusson)
• codeine
• little efficacy in cough d/t URI
• drug reaction: dextromethorophan with antidepressants could induce serotonergic syndrome
• possibility of abuse

Question 5

expectorants

Answer 5

• guifenesin
• action: stimulates respiratory tract secretions and lessens viscosity
• no evidence to support efficacy d/t URI

Question 6

sinusitis

Answer 6

• criteria: persistent not improving for at least 10 days

- common pathogens: s. pneumoniae, h.flu, moraxella catarrhalis, rarely staph

Question 7

abx choices for sinusitis

Answer 7

-first line: amoxicillin-80-90mg/kg/day in children; 500 mg TID in adults, or high dose Augmentin
-trimethoprim/sulfamethazole
-if pt allergic to PCN: nontype I: cefdinir, cefuroxime, cefpodoxime
type I: clarithromycin or azithromycin

Question 8

high risk for sinusitis

Answer 8

• daycare or abx last 90 days
  
  • amoxicillin/clavulanate 80-90 mg/kg/day
  • cefuroxime 30 mg/kg/day
  • cefpodoxime 10 mg/kg/day
• adult with child in daycare: high dose amoxicillin 1 gm QID

Question 9

second line abx for sinusitis

Answer 9

• start with amoxicillin-if symptoms improving after 3-5 days continue for 7 more days (total of 10-14 days)
• if NOT:
• augmentin 80-90 mg/kg/day
• cefuroxime 30 mg/kg/day divided BID
• cefdinir 14 mg/kg per day in 1 or 2 doses
• cefpodoxime 10 mg/kg/day once daily
• Adults: fluroquinolones-levofloxacin, moxifloxacin, gemifloxacin

Question 10

AOM

Answer 10

• caused by eustachian tube dysfunction-negative pressure causes reflux of bacteria into middle ear
• common pathogens: s. pneumoniae (decreasing)
  h. influenza (increasing)
  m. catarrhalis
• respiratory viruses account for 40-75% cases in children

Question 11

AOM diagnosis

Answer 11

criteria: hx of acute onset of symptoms; presence of middle ear effusion; and s&s of middle ear inflammation
-criteria for AOM use of abx
pt 2 yo abx if confirmed and severe illness-otherwise

Question 12

AOM abx choices

Answer 12

-amoxicillin 1st line
-if fever >39 C and/or severe otalgia: use 2nd line:
amoxicillin/clavulanate 90 mg/kg/day of amoxicillin; or ceftrixone 50 mg/kg if PCN allergy
-consider using 2nd line if at risk for resistant organism: (in day care, recent treatment of abx -30 days, younger than 2 yrs)

Question 13

AOM abx for PCN allergies

Answer 13

• if not a hypersensitivity reaction: cefdinir 14 mg/kg/day 1 or 2 doses; cefpodoxime 10 mg/day; cefuroxime 30 mg/kg/day split BID
• type 1 reactions: azithromycin (10 mg/kg/day for 1 day followed by 5 mg/kg/day for 4 days); clarithromycin 15 mg/kg day split BID; erythromycin-sulfisoxazole (50 mg/kg per day ); sulfamethoxazole-trimethoprim 6-10 mg/kg per day; ceftriaxone 50 mg/kg 1 or 3 days

Question 14

viral upper respiratory infection

Answer 14

• common viruses: adenovirus, RSV, coronavirus, enterovirus
• kids get 6-8 colds/yr more if in daycare
• adults 2-3 colds/yr-usually lasts 7-9 days

Question 15

AOM tx failure 48-72 hrs

Answer 15

• initial tx amoxicillin use augmentin; if type 1 allergy Clindamycin
• febrile >39 and/or severe otalgia–ceftriaxone x3 days; type 1 allergy, tympanocentesis or clindamycin