Podcast
Questions and Answers
What is the most common bacterial cause of pharyngitis?
What is the most common bacterial cause of pharyngitis?
Which antibiotic is recommended for treating acute sinusitis caused by bacterial infections if amoxicillin was prescribed in the last 30 days?
Which antibiotic is recommended for treating acute sinusitis caused by bacterial infections if amoxicillin was prescribed in the last 30 days?
What is the primary reason for prescribing fluoroquinolone drops in children with chronic otitis media?
What is the primary reason for prescribing fluoroquinolone drops in children with chronic otitis media?
Which antibiotic class is suggested for patients with penicillin allergies who require treatment for acute sinusitis?
Which antibiotic class is suggested for patients with penicillin allergies who require treatment for acute sinusitis?
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What percentage of upper respiratory tract infections are caused by bacterial infections?
What percentage of upper respiratory tract infections are caused by bacterial infections?
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What is the typical duration of treatment with high dose amoxicillin for acute sinusitis?
What is the typical duration of treatment with high dose amoxicillin for acute sinusitis?
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Which group of bacteria is primarily responsible for rheumatic fever following strep throat?
Which group of bacteria is primarily responsible for rheumatic fever following strep throat?
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What is the main limitation of antibiotic treatment for chronic sinusitis?
What is the main limitation of antibiotic treatment for chronic sinusitis?
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Which of the following pathogens is NOT commonly associated with upper respiratory tract infections?
Which of the following pathogens is NOT commonly associated with upper respiratory tract infections?
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When might a clinician consider prescribing intravenous ceftriaxone for a child with complicated sinusitis?
When might a clinician consider prescribing intravenous ceftriaxone for a child with complicated sinusitis?
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Which antibiotic is commonly prescribed for neonatal conjunctivitis caused by N.gonorrhoeae?
Which antibiotic is commonly prescribed for neonatal conjunctivitis caused by N.gonorrhoeae?
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What is the recommended treatment duration for oral phenoxymethylpenicillin in cases of pyogenic infection?
What is the recommended treatment duration for oral phenoxymethylpenicillin in cases of pyogenic infection?
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In the presence of a penicillin allergy, which antibiotic is generally used for treating infections caused by Streptococcus pyogenes?
In the presence of a penicillin allergy, which antibiotic is generally used for treating infections caused by Streptococcus pyogenes?
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What is the first line of treatment for purulent conjunctivitis caused by S.pneumoniae?
What is the first line of treatment for purulent conjunctivitis caused by S.pneumoniae?
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Which of the following is true regarding bacterial bronchitis?
Which of the following is true regarding bacterial bronchitis?
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For patients with chronic obstructive pulmonary disease (COPD) experiencing an acute exacerbation of bronchitis, which antibiotic would be appropriate?
For patients with chronic obstructive pulmonary disease (COPD) experiencing an acute exacerbation of bronchitis, which antibiotic would be appropriate?
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What differentiates bacterial pneumonia from acute bronchitis?
What differentiates bacterial pneumonia from acute bronchitis?
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In cases of conjunctivitis outlined, what is the course of treatment for inclusion conjunctivitis caused by C.trachomatis?
In cases of conjunctivitis outlined, what is the course of treatment for inclusion conjunctivitis caused by C.trachomatis?
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For severe cases of purulent conjunctivitis, what should be considered if there is no response to initial topicals?
For severe cases of purulent conjunctivitis, what should be considered if there is no response to initial topicals?
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Which of the following is true regarding the treatment of epiglottitis caused by Haemophilus influenzae?
Which of the following is true regarding the treatment of epiglottitis caused by Haemophilus influenzae?
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What is the appropriate treatment for a pediatric patient with bacterial pneumonia who has a poor clinical response?
What is the appropriate treatment for a pediatric patient with bacterial pneumonia who has a poor clinical response?
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Which antibiotic regimen is used for adults with bronchiectasis showing symptoms of sepsis?
Which antibiotic regimen is used for adults with bronchiectasis showing symptoms of sepsis?
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What is the first-line empiric therapy for pediatric respiratory distress in neonates requiring hospitalization?
What is the first-line empiric therapy for pediatric respiratory distress in neonates requiring hospitalization?
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What treatment is indicated for children with lung abscess and a poor clinical response?
What treatment is indicated for children with lung abscess and a poor clinical response?
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For a patient diagnosed with hospital-acquired pneumonia with no prior IV antibiotics within 90 days, which regimen is appropriate?
For a patient diagnosed with hospital-acquired pneumonia with no prior IV antibiotics within 90 days, which regimen is appropriate?
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Which treatment is recommended for children with purulent effusion?
Which treatment is recommended for children with purulent effusion?
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When treating a child with bronchiectasis and a worsening cough, what initial therapy should be given?
When treating a child with bronchiectasis and a worsening cough, what initial therapy should be given?
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In cases of severe penicillin allergy and bronchiectasis, which antibiotic is recommended?
In cases of severe penicillin allergy and bronchiectasis, which antibiotic is recommended?
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What is the treatment approach for patients with jirovecii pneumonia in HIV-positive individuals?
What is the treatment approach for patients with jirovecii pneumonia in HIV-positive individuals?
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Which of the following treatments is indicated for adults who are severely ill with bronchiectasis?
Which of the following treatments is indicated for adults who are severely ill with bronchiectasis?
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What is the primary treatment for patients with Streptococcus pneumoniae who are under 65 years and have no co-morbidities?
What is the primary treatment for patients with Streptococcus pneumoniae who are under 65 years and have no co-morbidities?
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Which condition is considered more severe and necessitates hospitalization?
Which condition is considered more severe and necessitates hospitalization?
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In the treatment of bacterial pneumonia, when should a macrolide or azalide be added?
In the treatment of bacterial pneumonia, when should a macrolide or azalide be added?
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What is the appropriate treatment strategy for patients with severe pneumonia caused by S.pneumoniae or S.aureus?
What is the appropriate treatment strategy for patients with severe pneumonia caused by S.pneumoniae or S.aureus?
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Which antibiotic is recommended for the treatment of atypical pneumonia due to Mycoplasma pneumoniae?
Which antibiotic is recommended for the treatment of atypical pneumonia due to Mycoplasma pneumoniae?
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What should be considered when choosing an antibiotic for pneumonia treatment?
What should be considered when choosing an antibiotic for pneumonia treatment?
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What type of pneumonia is commonly known as 'walking pneumonia'?
What type of pneumonia is commonly known as 'walking pneumonia'?
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Which antibiotic option is appropriate for patients with a penicillin allergy and severe pneumonia?
Which antibiotic option is appropriate for patients with a penicillin allergy and severe pneumonia?
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Patients older than 65 years with pneumonia and co-morbidities should be treated with which of the following?
Patients older than 65 years with pneumonia and co-morbidities should be treated with which of the following?
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What is the typical duration of treatment for bacterial pneumonia?
What is the typical duration of treatment for bacterial pneumonia?
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Study Notes
Treatment of Respiratory Infections
- Respiratory infections are frequently treated with antibiotics.
- Antibiotics are categorized as typical or atypical.
- Understanding antibiotic pharmacokinetics and mechanisms of action is crucial.
- Common adverse effects vary by antibiotic class.
- Precautions, contraindications, and potential drug interactions of antibiotics need careful consideration.
- Alternative antibiotics are often considered if patients experience resistance or allergies.
Upper Respiratory Tract Infections (URTI)
- URTIs are typically caused by viruses, with bacterial causes less common (~2%).
- Common bacterial URTIs include sinusitis, pharyngitis, tonsillitis, epiglottitis, laryngitis, and acute otitis media.
- The most common bacterial causes of URTIs generally include Streptococcus pyogenes (Group A strep), Streptococcus pneumoniae, Haemophilus influenzae, viridans streptococci, and Moraxella catarrhalis.
- Streptococcus pyogenes can lead to rheumatic fever.
Acute Sinusitis/Otitis Media Treatment
- High-dose amoxicillin (oral, 8-12 hourly, 5-10 days), co-amoxiclav (oral, 8-12 hourly, 5-10 days) are common initial treatments.
- Macrolide/azalide antibiotics (such as erythromycin or azithromycin) may be used if there's a penicillin allergy.
Chronic Sinusitis Treatment
- Antibiotic treatment for chronic sinusitis isn't always successful.
- Group A β-hemolytic streptococci (e.g., S. pyogenes) may require IM benzathine benzylpenicillin or oral phenoxymethylpenicillin (10-12 days).
- Oral amoxicillin or co-amoxiclav (10 days) is also an option, however, avoid if Epstein Barr virus infection is suspected.
- Macrolides/azalides like clarithromycin or azithromycin (oral, 3 days) are alternatives in case of penicillin allergy.
Epiglottitis Treatment
- Haemophilus influenzae is commonly associated with this condition.
- Three generations of cephalosporin (ceftriaxone by IM injection, cefotaxime)are typically followed by co-amoxiclav (10 days).
- Azithromycin/Erythromycin (3 days) is considered in case of penicillin allergy
Conjunctivitis Treatment
- Purulent conjunctivitis can be treated with topical chloramphenicol ointment (5–7 days).
- Other topical treatments that may be used include tobramycin, ciprofloxacin, fusidic acid, or bacitracin/polymyxin B ointment.
- Neonatal conjunctivitis (caused by N. gonorrhoeae) requires saline irrigation of the eyes and 3rd-generation cephalosporin ceftriaxone (IM, single dose) and if symptoms develop 24 hours after birth, IM ceftriaxone + oral azithromycin (single dose)
- Inclusion conjunctivitis/trachoma (C. trachomatis) is treated using macrolide/doxycycline
Lower Respiratory Tract Infections
- Types include acute bacterial bronchitis and bacterial pneumonia.
- Acute bacterial bronchitis is an inflammation of the airways frequently following a viral infection.
- It usually resolves without medical intervention.
- Bacterial pneumonia involves infection in the lungs (filling alveoli with pus and fluid).
- It requires treatment with antibiotics.
Acute Bacterial Bronchitis Treatment
- Antibiotics are not typically necessary unless underlying COPD is present.
- In cases of COPD exacerbation with S. pneumoniae or H. influenzae, amoxicillin (oral, 8 hourly, 5 days), doxycycline (oral, 12 hourly, 5 days), or newer fluoroquinolones (e.g., moxifloxacin/levofloxacin) may be prescribed.
Bacterial Pneumonia Treatment (Community Acquired)
- General: Rest, fluids and oral antibiotics
- Specific treatment:
- Patients under 65 with no co-morbidities: Amoxicillin (high dose) for 5 days, if ineffective a macrolide/azalide may be added .
- Patients aged 65 or over or with co-morbidities: Co-amoxiclav (oral 12 hourly 5 days), 2nd/3rd Cefuroxime or Ceftriaxone or Cefotaxime .
- Penicillin allergy: Gemifloxacin or moxifloxacin (oral, 5 days)
- Atypical pneumonia: Macrolide (azithromycin), or gemifloxacin, moxifloxacin.
- P. jirovecii : Oral co-trimoxazole for 3 weeks.
Bacterial Pneumonia Treatment (Hospital Acquired)
- Empiric treatment (10 days): IV ceftriaxone and amikacin are common.
- No prior IV antibiotics in the last 90 days.
- For allergy to penicillin: Oral/IV moxifloxacin and IV amikacin
- Prior IV antibiotic treatment is considered when choosing treatment.
Lung Abscess/Aspiration Pneumonia Treatment
- (Adults): IV co-amoxiclav (8 hourly) initially, and then oral afterward for 4-6 weeks.
- (Children): IV co-amoxiclav (8 hourly) for 14 days.
- Local pathogens should be considered if there's a poor clinical response and no culture results.
- Good clinical response allows a quicker switch to oral co-amoxiclav.
Bronchiectasis Treatment (Adults)
- Symptoms of sepsis or significant sputum purulence/volume: Co-amoxiclav (oral, 12 hourly) 10 days or longer
- Penicillin allergy: Macrolide (azithromycin)
- Severely ill: Ceftriaxone (IV daily) until apyrexial for 24 hours.
- Follow with Co-amoxiclav (oral, 12 hourly)
- Pseudomonas: Ciprofloxacin is added if confirmed (oral, 12 hourly, 7 days).
- Severe penicillin allergy: Moxifloxacin (oral, 7 days or IV).
Bronchiectasis Treatment (Children)
- Worsening cough with dyspnea/tachypnea and possible sepsis: Empiric treatment- IV ampicillin (6 hourly) + IV gentamicin (once daily).
- Good clinical response: Change to oral co-amoxiclav (45 mg/kg/dose amoxicillin component, 12 hourly).
- Total treatment duration is 14 days.
Respiratory Distress Treatment (Neonates)
- Hospital admission: Ampicillin (IV 5-7 days).
- Gentamicin (IV 5-7 days) in the first week.
- Treatment review 72 hours after initiation. Adjust gentamicin levels accordingly.
- Continue treatment for 10 days.
Pleural Disease Treatment (Children)
- Purulent effusion: co-amoxiclav (IV, 8 hourly, 10 days), followed by cefazolin (IV, 8 hourly) or cefalexin (oral, 6 hourly)/ co-amoxiclav (oral, 12 hourly), based on positive response
- When penicillin allergy is present: macrolide (azithromycin oral, 3 days)
- severe mycoplasma infection: IV azithromycin for 2 days and then followed by oral treatment for 3-5 days
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Description
This quiz covers the treatment protocols for respiratory infections, focusing on antibiotic use and their classifications. It also discusses complications related to antibiotic therapy, common bacterial causes of upper respiratory tract infections, and the importance of understanding pharmacokinetics. Join to test your knowledge on treating URTIs and managing antibiotic resistance.
