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Tuesday, September 18, 2007

Urti Antibiotics

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Urti Antibiotics Slideshow Transcript

Slide 1: URTI & Antibiotics Family Medicine Department Dr. Eman Ahmad Marei Husam Salhab

Slide 2: Objectives •Definition • Epidemiology • Types and causative agents • Management principles • Effects of Rx • Antibiotic in specific URTI • Factors affect prescription

Slide 3: Definition URTI inflammation of respiratory mucosa from the nose to the lower respiratory tree not including the alveoli.

Slide 4: Symptoms •Sore throat •Rhinorrhea •Facial fullness and Pain •Headache •Cough •Fever •Tender lymph nodes •Ear Pain

Slide 5: Epidemiology •In average Children will have 5 URTI/Year, & adults 2- 3/Year •Acute rhinitis is by far the most common cause of doctors visit. •Otitis media is the most common cause for a child under age 15 to visit a physician. •Acute Otitis Media, the most common condition for antibiotics (50%). •Group A beta-hemolytic streptococcus is only found in 15% to 36% of children with sore throat.

Slide 6: Types and causative agents

Slide 7: Management Principles Viral infections need only symptomatic treatment: -Analgesics (Paracetamol, Aspirin, Ibuprofen) -Anti-histamines -Cough suppressants -Nasal decongestants -Vitamin C -Increase fluid intake Bacterial Infections need antibiotics in addition of symptomatic treatment

Slide 8: Management Principles Viral (Don’t Use Antibiotics) Bacterial (Use antibiotics) Why? Why? - To prevent rheumatic fever -Promotes antibiotic resistance - To prevent suppurative -Adverse reactions such as allergy complications (e.g., peritonsillar and anaphylaxis abscess) -Costly - To speed up recovery -Patients do not need antibiotics to - To reduce spread to others feel satisfied

Slide 9: Management Principles Viral (Don’t Use Antibiotics) Bacterial (Use antibiotics) -Influenza, Common Cold -GABHS Pharyngitis -Viral Pharyngitis -Moderately to severe Acute Sinusitis -Mild Acute Sinusitis -Moderately to severe Acute -Mild Acute Otitis Media Otitis Media -Special Cases (Pertussis, Croup)

Slide 10: But how can we differentiate between Viral and ?Bacterial Pharyngitis, Sinusitis & Otitis Media

Slide 11: Acute Pharyngitis (Sore Throat) Viral Erythema

Slide 12: Acute Pharyngitis -No Evidence that bacterial sore throat are more severe than viral ones or that the duration of the illness is significantly different in either cases. -Based on symptoms , bacterial and viral sore throat are limited to be distinguished. Clinical examination should not be relied upon to differentiate between viral and bacterial sore throat. -Sensitivity and Specificity suggest that reliance on clinical diagnoses will miss 25-50% of GABHS Pharyngitis cases.

Slide 13: Acute Pharyngitis To determine bacterial Pharyngitis Strep. Score McIsaac Criteria

Slide 15: Acute Pharyngitis Rapid Antigen Test (RAT) Sensitivity of RAT against culture varies between 61-95%. Specificity of RAT 88-100% Takes 10 min to be performed -ve results should be confirmed by culture. Not found in Jordan

Slide 16: Acute Pharyngitis Throat Culture 20-40% of those with negative throat culture will be labeled as having GABHS. +ve culture makes the Dx of GABHS likely , but –Ve culture does not rule out.

Slide 17: Acute Pharyngitis (Drug Of choice) -Oral penicillin or erythromycin (in penicillin- allergic individuals), given for 10 days. -Fortunately, no resistance to penicillin has been reported, so far, among GABHS-related Pharyngitis patients.

Slide 18: Complication Rheumatic Fever - Major Criteria: - polyarithritis - carditis - sydenham chorea - subcutaneous nodules - erythema marginatum - Minor Criteria: - fever - leukocytosis - elevated ESR,CRP - arthralgia with evidence of recent group A strep infection

Slide 19: Case A 25 year old man comes to your office with the complaint of a bad sore throat for 2 days. He has felt chills and fever today but has not measured his temperature. He has some pain on swallowing. He has a slight runny nose and denies cough and other symptoms. He was previously healthy. T= 38.5 ears - TM's normal nose – clear neck - no cervical adenopathy lungs – clear

Slide 20: How many points does our patient have? Fever over 38 C 1 Absence of cough 1 Tender ant. cervical adenopathy 0 Tonsillar swelling or exudate 1 Age< 15 y 0 Age> 45 0 Total = 3

Slide 21: What are the tests? Rapid strep test -ve Throat culture + ve Give Penicillin + Symptomatic treatment

Slide 22: Acute otitis media

Slide 23: Normal Tympanic Membrane

Slide 24: Acute otitis media Bulging Redness

Slide 25: Acute otitis media Bullae Perforation

Slide 26: Acute otitis media Dutch Guidelines -Dutch study found no difference in outcome between antibiotics, myringotomy, antibiotics combined with myringotomy and placebo. -Only 1 in 7 children under 2 year old with 1st episode of A.O.M derived significant benefit from antibiotic treatment. -Although it reduce fever faster , it does not reduce duration of pain or crying.

Slide 27: Acute otitis media Dutch Guidelines Diagnostic criteria - Recent perforation of the tympanic membrane with discharging pus - Inflamed and bulging tympanic membrane - One ear drum redder than the other - Bullae on tympanic membrane

Slide 28: TREATMENT GUIDELINES Symptomatic treatment is provided in all cases The patient or the parents are instructed to contact the general practitioner if there is an abnormal clinical course, in other words: - increasing illness or earache, decreased drinking - no improvement within 3 days

Slide 29: TREATMENT GUIDELINES (cont.) Antibiotics ,For children >2 years recurrent + Children within 12 months or Children < 6 months 6 months - 2 years + ,Down's syndrome ,cleft palate abnormal clinical course compromised immune system

Slide 30: Treatment : - Amoxcillin – Cluv acid 80-90 mg/kg per day - Clarithromycin 15 mg/kg twice per day Complication: - meningitis - brain abscess - mastoiditis - cholesteatoma

Slide 31: Acute sinusitis

Slide 32: Acute sinusitis Antibiotics Moderate symptoms Moderate symptoms not improving that worsen Severe symptoms after 10 days after 5 to 7 days -Oral amoxicillin, trimethoprim-sulfamethoxazole, or doxycycline, given for 3 to 10 days are the favored antibiotics for treatment.

Slide 33: Influenza - Antibiotics are ineffective - Amantadine and rimantadine (Antiviral) should not be used for the treatment of influenza because of widespread resistance. - Rx : Symptomatic treatment only

Slide 34: Common cold

Slide 35: Common cold -No significant difference between antibiotics and placebo in cure or general improvement at 6–14 days in people with colds. -In a subgroup of people (20%) with nasopharyngeal culture positive Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae, antibiotics increased recovery at 5 days compared with placebo. -However, we have no methods currently of easily identifying such people at first consultation. -Rx: Symptomatic treatment only

Slide 36: Pertussis (Whooping Cough)

Slide 37: Pertussis -Treating acute tracheobronchitis with antibiotics is not recommended, since most cases are viral, and thus resolve spontaneously. -In adults who report exposure to a patient with confirmed or suspected pertussis, erythromycin or trimethoprim-sulfamethoxazole should be administered for 14 days. This will decrease contagion from bacterial shedding, but is not expected to improve resolution of symptoms, unless started within 10 days of the onset of illness

Slide 38: Croup Inflammation of the larynx and upper airway.

Slide 39: Croup No systematic review, RCTs, or observational studies of sufficient quality on antibiotics in children with moderate to severe croup. Antibiotics do not shorten the clinical course of a disease that is predominantly viral in origin. This does not apply if bacterial tracheitis is suspected. Rx: - Racemic epinephine - Oral dexamethazone

Slide 40: Factors affect prescription -Patient expectation and satisfaction. -Severity. -Duration of illness -Parents demands. -Concerns about secondary bacterial infection. -Time.

Slide 41: ‫‪Thank You

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