Upper Respiratory Tract Infections URTIs

1
Upper Respiratory Tract Infections (URTIs)

• Pharmacotherapy III
• Jennifer Santee, Pharm.D.
• Winter Semester 2006

2
The Common Cold

• Children have 6-8 colds per year
• Adults have 2-3 colds per year

3
(No Transcript)
4
Acute Otitis Media Diagnosis

• Symptoms of AOM often are similar to other
  respiratory tract infections
• Need to see the following for a certain diagnosis
  of AOM
• abrupt onset of signs/symptoms
• MEE
• Inflammation of middle-ear erythema of ear drum
  or otalgia
• Just redness in the eardrum may be due to other
  things (crying, high fever)

5
Acute Otitis Media Diagnosis

• Signs of MEE
• Bulging of tympanic membrane seen on otoscopy or
• Decreased mobility of tympanic membrane seen on
  pneumatic otoscopy or tympanometry
• http//www.aap.org/otitismedia/www/vc/ear/rvw/rvw1
  .cfm
• http//www.aap.org/otitismedia/www/vc/ear/case6/ty
  mp.cfm

6
Otitis Media Definitions/Diagnosis

• Define each of the following
• Acute otitis media (AOM)
• Otitis media with effusion (OME)
• Chronic OME when effusion persists beyond 2-3
  months

7
AOM Mechanisms of Resistance

• S.pneumoniae
• Alterations in the penicillin binding protein
• Resistance may be overcome by increasing the
  concentration of the drug at the site of
  infection
• H.influenzae, M.Catarrhalis
• Produce beta lactamases
• How would you recommend overcoming resistance to
  beta lactamases?

8
AOM Risk for Resistant Organisms

• Consider the additional following factors for
  being infected with resistant organisms
• Received antibiotics in the previous 3 months
• lt 2 y/o
• Attends day care
• What is the prevalence of resistance in your
  community? What would be the problem with using a
  hospital antibiogram to judge resistance?

9
Otitis Media Influenza Vaccine

• Most of the data showing decreased episodes of
  AOM in children gt 2 y/o
• Study in children 6-23 months didnt demonstrate
  decreased episodes of AOM
• Not to say that it wont prevent other
  complications of influenza for those 6-23 months

10
AOM To Treat or Not To Treat

• Treat
• Shorten duration of symptoms
• Reduce risk for complications such as acute
  mastoiditis
• Some studies suggest rates of mastoiditis higher
  in countries that delay treatment

11
AOM To Treat or Not To Treat

• Not treat
• Is the shortening of duration of illness
  clinically significant? (for e.g. only shortening
  duration of fever by 1 day)
• Risk for complications may be low
• Studies comparing countries that treat vs. those
  that dont, fewer ADE in those that dont
• Increase use of antibiotics contributes to
  increase in resistance

12
AOM Wait to Treat?AAP/AAFP Recommendations

• Observe x 48 72 hrs before antibiotics for
  those patients who are
• Otherwise healthy, caregivers can report back to
  provider, caregivers can get antibiotics later if
  needed
• 6 23 months old with non-severe illness and
  uncertain diagnosis
• gt or 2 y/o with non-severe illness or uncertain
  diagnosis

13
AOM Wait to Treat?AAP/AAFP Recommendations

• Defining non-severe illness
• Mild otalgia
• Fever lt 102.2?F

14
AOM What Treatment to Use

• Recommendations in your text are from group of
  experts brought together by the CDC in the late
  1990s
• Also have recommendations from the AAP and AAFP
  which differ slightly (more aggressive for more
  severe symptoms)
• Just remember these are guidelines and use your
  clinical judgment

15
Formulations of Augmentin Amounts of Ingredients
Per ml

• Augmentin ES-600 600 mg amoxicillin, 42.9 mg
  clavulanate
• Augmentin amoxicillin/clavulanate
• 125 /31.25
• 200 /28.5
• 250/62.5
• 400/57

16
Otitis Media Duration of Treatment

• How long is the traditional duration of
  treatment?
• When to consider 5-7D
• gt 2 y/o
• no h/o recurrences
• underlying medical conditions
• no perforated tympanic membrane

17
Otitis Media Recurrent AOM

• May want to reserve prophylactic treatment for
  those who would most likely benefit
• lt 2 y/o
• Native American
• in day care

18
Potential Causes of Rhinitis

• Rhinitis nasal congestion, sneezing, nasal
  discharge
• Possible causes of rhinitis
• Allergies
• Infection
• Other (for e.g. vasomotor, hormonally-induced)

19
Differentiating Infectious vs. Allergic Rhinitis

• Symptoms d/t allergic rhinitis are
• Usually more chronic or recurrent
• Infrequently associated with purulent nasal d/c
• Frequently includes itching and sneezing
• Often associated with specific exposures

20
Differentiating Bacterial vs. Viral Sinusitus

• Differentiating the two can be difficult
• Purulent discharge by itself doesnt necessarily
  mean a bacterial infection

21
Bacterial Sinusitis Treatment

• Doxycycline is another treatment option
• Just hasnt been studied as much as the other
  antibiotics recommended in your text

22
Pharyngitis Using Rapid Strep Tests

• Sensitivity of rapid strep tests are lower than
  using culture
• Some will recommend to follow up with culture if
  results from rapid strep test are negative

23
Questions?