ID class

• Benefits:
• Improve outcomes in patients with susceptible bacterial infections
• Shorten illness
• Prevent complications
• Save lives

• Risks
• Resistance
• Super infections
• MRSA
• Side effects
• Cost

Infections of the upper-airway (not including the lungs)

Typically include rhinitis, pharyngitis, otitis, laryngitis, and bronchiti

The vast majority of new antibiotic prescriptions (not refills) written in ambulatory care clinics are for URIs

• Huge resistance risks
• Significant healthcare costs

Viruses predominate



Virus itself does not typically cause toxicity

Bacteria may cause host destruction

onset of pain in the throat manifested especially on swallowing, sometimes associated with tonsil exudates

• Rhinovirus, coronavirus, adenovirus, influenza virus, parainfluenza virus, and Epstein-Barr virus
• Not exudative

• Group A Streptococcus pyogenes (GAS) is the major cause of bacterial pharyngitis
• Other less common bacteria include:

Mycoplasma pneumoniae, Chlamydophila pneumoniae, Corynebacterium diphtheriae

Viral:

• Mild to moderate pharyngeal discomfort
• Soreness, scratchiness, or irritation
• Nasal signs and symptoms
• Cough
• Systemic complaints rarely present
• Low fever, no chills

Bacterial:

• All of the above remain possible
• Systemic complaints more prominent
• Fever, headache, chills, abdominal pain
• Pharyngeal membrane is a “fiery red”
• Patchy, grayish-yellow exudates on the tonsils
• Tender, enlarged cervical nodes

• Rapid streptococcal antigen test
• >95% specificity; 60%-90% sensitivity
• Negative results may need to be confirmed with culture
• Quickà can be don’t right in the drs office.
• 1/4th of the time in can miss it if its there
• Usually do this then if it doesn’t get better they will use a culture or order ab

Throat culture

• 95% sensitivity
• Typically takes 1 to 2 days
• Used to confirm negative results from the rapid streoptococcal antigen test

Viral cause suspected:

• No direct therapy indicated
• Symptomatic treatment (should initiate immediately to get symptomatic relief)
• Warm saline gargles
• Liquids
• APAP or NSAIDS for pain

• Caused by antibody cross-reactivity
• May cause damage to heart valves, joints, skin, brain
• Body produces specific antigens that causes cross reactivity that damages organs

Penicillin is still the treatment of choice

• Cheap, effective, safe, narrow-spectrum
• Amoxicillin may be used (generally more palatable)

Macrolides (generally reserved for PCN allergic patients) – RESISTANCE IS A PROBLEM

• Erythromycin- used less--- qid and GI side effects
• Azithromycin—used a lot---qd and lasts longer and less side effects
• Clarithromycin
• Group A strep is very sensitive so that’s good. Very little resistant with penicillin products

• Generally takes 10 days to eradicate bacteria
• Shorter courses have been studied with success
• Length is always a guessing game

Clinical classification

1. Acute otitis media (AOM) : The first infection

2. Recurrent AOM : Get it and it gets better but it never really goes away

3. OM with effusion : When children have a lot of fluid build up that’s causing pressure

4. Chronic purulent OM : drainage issue

• Streptococcus pneumoniae 20%-35%
• Haemophilus influenzae 20%-30%
• Moraxella catarrhalis <20%

• No bacterial pathogen found in 20%-30% of cases
• Viral etiology found in up to 40%-45% of cases

• Fever, tugging of the ear, pain
• Redness and bulging of tympanic membrane
• Runny nose

• Rhinorrhea, cough, irritability, anorexia, headache, vomiting, diarrhea
• Suction to take milk out of bottle hurts – stop eating

• Otoscope (redness and bulging present)
• Tympanocentesis (recovery of organism)

• abs
• symptomatic therapy

• Mild illness
• high dose amoxicillin (80-90 mg/kg/day) divided twice daily

Moderate-severe illness

High dose amoxicillin- clavulanate (80-90 mg/kg/day of amoxicillin component) divided twice daily

Excess nasal secretions, posterior nasal drip, facial pain, and pain in the vertex of the head

• Streptococcus pneumoniae and Haemophilus influenzae predominate (>70% of cases)
• Moraxella catarrhalis third likely bacterial pathogen
• Less likely pathogens seen:

Staph aureus, Streptococcus pyogenes, fungi, anaerobes

early, mild disease:

• Initiate therapy for symptoms
• Decongestants, nasal saline

If patient has moderate to severe disease for ≥7 days

Begin antimicrobial therapy

Amoxicillin 500mg PO TID

• allergies:
• Azithromycin, clarithromycin, quinolone, doxycycline
• 2nd generation cephalosporin? (non-type 1 allergy)
• Cefprozil, cefuroxime

rug resistant S. pneumoniae suspected?

High dose amoxicillin: 1000mg PO TID

• This is being used more and more when pneumo is resistant
• Clindamycin
• Respiratory fluoroquinolone (levofloxacin, moxifloxacin,)

7-14 days

z-pac: 5 days

inflammation of the large elements of the tracheobronchial tree

S/s: cough

• Acute:
• Generally occurs as single episodes
• Common in children and adults

Chronic:

• Production of sputum on most days for at least 3 months per year for more than 2 years
• Primarily affects adults
• Wont occur in a healthy--- usually have other issues

Acute bronchitis:

Viruses cause most cases

• Rhinoviruses, influenzae, parainfluenza, adenoviruses
• Bacterial infection possible

S. pneumoniae, H. influenzae, atypical pathogens

cough fever

Directed against most common bacterial pathogens

Streptococcus pneumoniae, H. influenzae, M. pneumoniae

• Macrolides, doxycycline, fluoroquinolones
• Need to treat for atypical