p.8
Treatment Plans for Acute Otitis Media
When are antibiotics recommended for COPD patients?
When patients require mechanical ventilation, whether invasive or non-invasive.
p.8
Treatment Plans for Acute Otitis Media
What is the recommended duration of antibiotic therapy during a COPD exacerbation?
5-7 days, with outpatients benefiting from shorter courses, typically ≤5 days.
p.7
Treatment Recommendations for Rhinosinusitis
What can be used as monotherapy for inpatient treatment?
Respiratory fluoroquinolones (e.g., Levofloxacin, Moxifloxacin).
p.4
Treatment Recommendations for Rhinosinusitis
What is the first-line treatment for Acute Bacterial Rhinosinusitis (ABRS) in adults?
Amoxicillin-clavulanate (500 mg/125 mg PO TID or 875 mg/125 mg PO BID).
p.3
Diagnosis of Viral vs. Bacterial Rhinosinusitis
What are the symptoms of bacterial sinusitis?
More severe symptoms with persistent or worsening fever (≥102°F) for 3-4 days.
p.6
Treatment Recommendations for Rhinosinusitis
When are empiric antibiotics usually started for pneumonia?
When clinical and radiological evidence of pneumonia is present.
p.1
Pathogens Associated with Acute Otitis Media
What is an emerging bacterial pathogen in adults associated with AOM?
Methicillin-resistant Staphylococcus aureus.
p.2
Signs and Symptoms of Acute Otitis Media
What is a common symptom of Acute Otitis Media in children?
Rapid onset of otalgia (ear pain).
p.2
Signs and Symptoms of Acute Otitis Media
What behavior might younger or non-verbal children exhibit if they have Acute Otitis Media?
Tugging, rubbing, or holding the ear.
p.3
Classification and Pathophysiology of Rhinosinusitis
What is chronic rhinosinusitis?
Symptoms persist for more than 12 weeks.
p.3
Classification and Pathophysiology of Rhinosinusitis
What characterizes recurrent rhinosinusitis?
Four or more episodes per year, each separated by at least 10 symptom-free days.
p.3
Diagnosis of Viral vs. Bacterial Rhinosinusitis
What are the symptoms of viral sinusitis?
Mild to moderate symptoms including purulent nasal discharge, nasal obstruction, facial pain, headache, ear pain, cough, and fatigue.
p.6
Impact of Antimicrobial Resistance on Treatment
What underlying conditions increase the risk for resistant pathogens?
Chronic obstructive pulmonary disease (COPD), heart disease, or structural lung diseases.
p.1
Pathogens Associated with Acute Otitis Media
Name a bacterial pathogen associated with AOM.
Streptococcus pneumoniae.
p.1
Signs and Symptoms of Acute Otitis Media
What are the signs of acute otitis media?
Cloudy and bulging tympanic membrane, impaired mobility, and hemorrhagic or moderate/severe erythema of the tympanic membrane.
p.7
Treatment Recommendations for Rhinosinusitis
What are the alternatives to Amoxicillin for outpatient treatment without comorbidities?
Doxycycline 100mg BID or Macrolides (Azithromycin or Clarithromycin) in regions with pneumococcal resistance <25%.
p.2
Treatment Plans for Acute Otitis Media
What is the first-line antibiotic for treating Acute Otitis Media?
Amoxicillin: 80-90 mg/kg/day PO, divided every 12 hours.
p.7
Treatment Recommendations for Rhinosinusitis
What is included in standard inpatient treatment regimens?
A Beta-lactam combined with a Macrolide or Respiratory Fluoroquinolones as monotherapy.
p.2
Treatment Plans for Acute Otitis Media
What is a recommended pain management option for children with Acute Otitis Media?
Acetaminophen: 10-15 mg/kg/dose PO every 4-6 hours.
p.7
Treatment Recommendations for Rhinosinusitis
What must empiric therapy for HAP/VAP cover?
MRSA and Pseudomonas aeruginosa.
p.4
Treatment Recommendations for Rhinosinusitis
What is the recommended treatment for Acute Viral Rhinosinusitis (AVRS)?
Supportive care including analgesics, saline irrigation, and intranasal glucocorticoids.
p.9
Treatment Plans for Acute Otitis Media
What is the role of systemic corticosteroids in COPD exacerbations?
They reduce airway inflammation, improve oxygenation, and shorten recovery time.
p.3
Classification and Pathophysiology of Rhinosinusitis
What defines subacute rhinosinusitis?
It resolves between 4 and 12 weeks.
p.4
Impact of Antimicrobial Resistance on Treatment
What is a major concern regarding antibiotic prescriptions for sinusitis?
Over-prescription, with 81% of diagnosed adults receiving antibiotics despite most cases being viral.
p.1
Risk Factors for Acute Otitis Media
What are common risk factors for acute otitis media (AOM)?
Day care attendance, presence of siblings, cigarette smoke exposure, lack of breastfeeding, younger age, anatomic malformations, seasonal allergies, and winter months.
p.8
Treatment Plans for Acute Otitis Media
What are the indications for antibiotics in COPD exacerbations?
Antibiotics are indicated when patients exhibit at least two of the following: increased dyspnea, increased sputum volume, or increased sputum purulence.
p.8
Treatment Plans for Acute Otitis Media
What is the purpose of targeted antibiotic therapy in COPD exacerbations?
To shorten recovery time, reduce the risk of early relapse, and decrease hospital stays.
p.4
Treatment Recommendations for Rhinosinusitis
What treatments are not recommended for Acute Viral Rhinosinusitis (AVRS)?
Oral decongestants, antihistamines, and mucolytics.
p.3
Classification and Pathophysiology of Rhinosinusitis
What is the pathophysiology of sinusitis?
Sinusitis occurs due to obstruction of the sinuses, often caused by local edema from an upper respiratory infection or allergies, leading to viscous secretions and decreased mucociliary clearance.
p.6
Impact of Antimicrobial Resistance on Treatment
What is a strong risk factor for antibiotic resistance?
Prior antibiotic use within 90 days.
p.1
Pathogens Associated with Acute Otitis Media
List a viral pathogen associated with AOM.
Respiratory Syncytial Virus (RSV).
p.7
Treatment Recommendations for Rhinosinusitis
What is recommended for outpatient treatment with comorbidities?
Amoxicillin/clavulanate or a Cephalosporin combined with a macrolide or Doxycycline.
p.2
Treatment Plans for Acute Otitis Media
What should be administered if there is Amoxicillin resistance or complications?
Amoxicillin-Clavulanate: 80-90 mg/kg/day amoxicillin with 6.4 mg/kg/day clavulanate.
p.2
Treatment Plans for Acute Otitis Media
What are some alternative antibiotics for patients with a penicillin allergy?
Cefdinir, Cefuroxime, Cefpodoxime, Ceftriaxone, Clindamycin.
p.7
Treatment Recommendations for Rhinosinusitis
What additional coverage is required for severe CAP or suspicion of drug-resistant pathogens?
Vancomycin for MRSA or Piperacillin-Tazobactam for Pseudomonas.
p.2
Vaccines Preventing Acute Otitis Media
Which vaccine may help prevent Acute Otitis Media?
Pneumococcal vaccine (PCV 15, PCV 20).
p.9
Treatment Plans for Acute Otitis Media
What is the standard corticosteroid dose for severe COPD exacerbations?
Prednisone 40 mg daily for 5 days.
p.2
Vaccines Preventing Acute Otitis Media
What is another vaccine that can help prevent Acute Otitis Media?
Haemophilus influenzae type b (Hib) vaccine.
p.7
Treatment Recommendations for Rhinosinusitis
What is the typical duration of pneumonia treatment?
5-7 days, with extended durations for MRSA or Pseudomonas infections.
p.9
Treatment Plans for Acute Otitis Media
What are the common bronchodilators used for immediate relief during COPD exacerbations?
Short-acting beta-agonists (SABA) and short-acting muscarinic antagonists (SAMA).
p.2
Vaccines Preventing Acute Otitis Media
What annual vaccine is recommended to help prevent Acute Otitis Media?
Annual Influenza vaccine.
p.4
Diagnosis of Viral vs. Bacterial Rhinosinusitis
What are the criteria for diagnosing acute rhinosinusitis?
Presence of at least two major symptoms or one major and two minor symptoms.
p.9
Treatment Plans for Acute Otitis Media
How does Albuterol (SABA) work?
By stimulating beta-2 adrenergic receptors, causing bronchodilation.
p.3
Classification and Pathophysiology of Rhinosinusitis
What is rhinosinusitis?
Rhinosinusitis occurs when sinus openings become blocked, leading to inflammation of the mucosal lining of the nasal passage and paranasal sinuses due to mucus buildup.
p.3
Classification and Pathophysiology of Rhinosinusitis
What are the common causes of rhinosinusitis?
Allergens, environmental irritants, and infections (viral, bacterial, or fungal).
p.3
Classification and Pathophysiology of Rhinosinusitis
How is acute rhinosinusitis classified?
It resolves in less than 4 weeks.
p.9
Treatment Plans for Acute Otitis Media
Which antibiotics are commonly used to treat bacterial infections in COPD exacerbations?
Aminopenicillins with clavulanic acid (e.g., Amoxicillin/clavulanate) and macrolides (e.g., Azithromycin).
p.9
Treatment Plans for Acute Otitis Media
What is the benefit of using Azithromycin in COPD treatment?
It has anti-inflammatory properties and helps reduce airway inflammation and mucus production.
p.4
Treatment Recommendations for Rhinosinusitis
What is the second-line therapy for Acute Bacterial Rhinosinusitis (ABRS)?
Higher dose amoxicillin-clavulanate, doxycycline, levofloxacin, or clindamycin + cefixime/cefpodoxime in children.
p.4
Impact of Antimicrobial Resistance on Treatment
What factors increase the risk for antimicrobial resistance in patients?
Being under 2 or over 65, recently hospitalized, or immunocompromised.
p.6
Diagnosis of Viral vs. Bacterial Rhinosinusitis
What does a CURB-65 score of 0-1 indicate?
The patient can typically be treated as an outpatient.
p.9
Treatment Plans for Acute Otitis Media
What is the role of magnesium sulfate in COPD exacerbations?
It helps with bronchodilation and has anti-inflammatory properties.
p.9
Treatment Plans for Acute Otitis Media
What non-pharmacologic therapies are considered in severe COPD cases?
Oxygen therapy, non-invasive ventilation (NIV), and invasive mechanical ventilation.
p.3
Diagnosis of Viral vs. Bacterial Rhinosinusitis
How long does fever typically last in viral sinusitis?
Fever typically resolves within 48 hours.
p.6
Diagnosis of Viral vs. Bacterial Rhinosinusitis
What is the significance of a CURB-65 score of 3 or more?
It often results in ICU admission.
p.5
Causative Pathogens and Risk Factors for Pneumonia
What are the risk factors for Hospital-Acquired Pneumonia (HAP)?
Prior antibiotic use, mechanical ventilation, and prolonged hospitalization.
p.4
Impact of Antimicrobial Resistance on Treatment
What resistance mechanism is associated with Streptococcus pneumoniae?
Penicillin-binding protein mutations.
p.3
Diagnosis of Viral vs. Bacterial Rhinosinusitis
How long do symptoms last in bacterial sinusitis?
Symptoms last more than 10 days or worsen starting around days 5-6.
p.6
Causative Pathogens and Risk Factors for Pneumonia
What are common pathogens causing Community-Acquired Pneumonia (CAP)?
Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Legionella species, Staphylococcus aureus, Chlamydia pneumoniae.
p.6
Impact of Antimicrobial Resistance on Treatment
How do extended hospital stays affect antibiotic resistance?
They increase the risk for resistant infections, especially in the ICU.
p.5
Causative Pathogens and Risk Factors for Pneumonia
What are common pathogens associated with HAP?
Pseudomonas aeruginosa, MRSA, and Gram-negative bacteria.
p.5
Causative Pathogens and Risk Factors for Pneumonia
What is Ventilator-Associated Pneumonia (VAP)?
VAP occurs more than 48 hours after endotracheal intubation and mechanical ventilation, increasing the risk of infection by drug-resistant bacteria.
p.5
Impact of Antimicrobial Resistance on Treatment
What are the Pneumonia Severity Index (PSI) and CURB-65 used for?
They are clinical prediction tools that guide treatment decisions based on patient risk factors and pneumonia severity.
p.9
Treatment Plans for Acute Otitis Media
Why are vaccinations important for COPD patients?
They prevent infections that could lead to COPD exacerbations.
p.6
Diagnosis of Viral vs. Bacterial Rhinosinusitis
What does CURB-65 assess?
It focuses on Confusion, Urea levels, Respiratory rate, Blood pressure, and Age (≥65).
p.3
Diagnosis of Viral vs. Bacterial Rhinosinusitis
What is the duration of symptoms in viral sinusitis?
Less than 10 days with improvement.
p.5
Causative Pathogens and Risk Factors for Pneumonia
What are common pathogens associated with VAP?
Similar to HAP, but with a higher risk of resistant organisms like Acinetobacter and Pseudomonas aeruginosa.
p.5
Impact of Antimicrobial Resistance on Treatment
What factors does the Pneumonia Severity Index (PSI) consider?
Age, comorbidities, respiratory rate, blood pressure, and level of consciousness.
p.6
Causative Pathogens and Risk Factors for Pneumonia
What are common pathogens associated with Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP)?
Pseudomonas aeruginosa, Staphylococcus aureus (including MRSA), Acinetobacter baumannii, Gram-negative bacilli (e.g., Klebsiella, Escherichia coli).
p.5
Causative Pathogens and Risk Factors for Pneumonia
What are common pathogens associated with CAP?
Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae.
p.5
Causative Pathogens and Risk Factors for Pneumonia
What is Hospital-Acquired Pneumonia (HAP)?
HAP occurs 48 hours or more after hospital admission and is not present at the time of admission, often involving multi-drug resistant pathogens.
p.5
Impact of Antimicrobial Resistance on Treatment
How are patients classified in the Pneumonia Severity Index (PSI)?
Patients are classified into five risk classes, with Class I being the lowest risk (typically treated as outpatient) and Class IV or V being the highest risk (often requiring ICU care).
p.5
Causative Pathogens and Risk Factors for Pneumonia
What is Community-Acquired Pneumonia (CAP)?
CAP is pneumonia that occurs in an outpatient setting or within the first 48 hours of hospital admission, primarily caused by pathogens encountered outside healthcare facilities.
p.5
Causative Pathogens and Risk Factors for Pneumonia
What are the risk factors for Community-Acquired Pneumonia (CAP)?
Chronic diseases (e.g., heart, lung disease), smoking, and immunosuppression.
