Antibiotic Use In Respiratory Tract Infections (5)

1. True regarding the treatment of acute rhinosinusitis

Azithromycin is recommended as an option for first-line treatment

Doxycycline or a respiratory fluoroquinolone should be instituted in most uncomplicated cases

Fidaxomicin is now indicated as a primary treatment option

Antibiotic use is frequently ineffective, given that most cases are viral

Watchful waiting is encouraged in uncomplicated cases.

Macrolides (eg, azithromycin, fidaxomicin) are not recommended because resistance in Streptococcus pneumoniae.

First-line therapy is typically amoxicillin or amoxicillin/clavulanate. However, 90%-98% of rhinosinusitis cases are viral, meaning that antibiotics are not effective. Even in cases when the causative agent is bacterial, antibiotics may not be helpful.

Explanation

Watchful waiting is encouraged in uncomplicated cases.

Macrolides (eg, azithromycin, fidaxomicin) are not recommended because resistance in Streptococcus pneumoniae.

First-line therapy is typically amoxicillin or amoxicillin/clavulanate. However, 90%-98% of rhinosinusitis cases are viral, meaning that antibiotics are not effective. Even in cases when the causative agent is bacterial, antibiotics may not be helpful.

2. Not an indication for antibiotic treatment in patients with acute rhinosinusitis

Temperature >101.1°F (38.39°C)

Facial pain lasting 3 days or longer

Worsening symptoms after an illness lasting 5 days had begun improving

Persistent symptoms lasting longer than 10 days

Antibiotic treatment should be reserved for those patients with onset of severe symptoms and those who have persistent symptoms lasting longer than 10 days, who experience double sickening (worsening symptoms after a typical viral illness lasting 5 days had begun improving), who have facial pain or purulent nasal discharge lasting at least 3 consecutive days, or who have a temperature higher than 102.2°F (39°C).

Explanation

Antibiotic treatment should be reserved for those patients with onset of severe symptoms and those who have persistent symptoms lasting longer than 10 days, who experience double sickening (worsening symptoms after a typical viral illness lasting 5 days had begun improving), who have facial pain or purulent nasal discharge lasting at least 3 consecutive days, or who have a temperature higher than 102.2°F (39°C).

3. True regarding the treatment of streptococcal pharyngitis

First-line treatment includes azithromycin and clindamycin

Initiation of antibiotic treatment prior to the results of a rapid antigen detection test is recommended in symptomatic patients

Penicillin V remains a first-line therapy due to its reliable antibiotic activity against group A beta-hemolytic streptococcal (GAS) infection

Severe, persistent sore throat alone is an indication for antibiotic therapy

Do not administer antibiotics until rapid antigen detection test findings confirm diagnosis of GAS infection.

Amoxicillin and penicillin V are first-line treatments thanks to their reliable antibiotic activity against GAS infection.

Resistance to clindamycin and azithromycin has increased.

Antibiotics are usually unnecessary, even in those with sore throats; reassure patients that symptomatic treatment is usually sufficient, and symptoms usually last less than 1 week.

For more visit www.rimemcq.com

Explanation

Do not administer antibiotics until rapid antigen detection test findings confirm diagnosis of GAS infection.

Amoxicillin and penicillin V are first-line treatments thanks to their reliable antibiotic activity against GAS infection.

Resistance to clindamycin and azithromycin has increased.

Antibiotics are usually unnecessary, even in those with sore throats; reassure patients that symptomatic treatment is usually sufficient, and symptoms usually last less than 1 week.

For more visit www.rimemcq.com

4. True regarding treatment of the common cold or nonspecific upper respiratory tract infection (URI)

Antihistamines and nasal saline irrigation are proven treatments for cold symptom relief

NSAIDs are contraindicated if antibiotic treatment is initiated

A change in nasal discharge color is an indication for antibiotic initiation

Educate patients that symptoms may last as long as 2 weeks and do not initiate antibiotics

Antibiotics are ineffective in treating the common cold.

NSAIDs may be given for symptomatic relief.

Although antihistamines, nasal saline irrigation, opioids, and intranasal steroids have been used, evidence to support their use is lacking.

Change in nasal discharge color is not an indication for antibiotic treatment.

Explanation

Antibiotics are ineffective in treating the common cold.

NSAIDs may be given for symptomatic relief.

Although antihistamines, nasal saline irrigation, opioids, and intranasal steroids have been used, evidence to support their use is lacking.

Change in nasal discharge color is not an indication for antibiotic treatment.

5. True regarding the treatment of bronchitis?

Colored sputum indicates bacterial infection necessitating antibiotic treatment

Longer cough duration suggests a need for antibiotic treatment

Suspicion of pneumonia is the primary indication to initiate antibiotic treatment

Routine chest x-ray is indicated in all cases to determine the need for antibiotic treatment

Testing and the initiation of antibiotic therapy are not recommended in patients with bronchitis unless pneumonia is suspected. Treatment of symptoms includes cough suppressants, decongestants, beta-agonists, and first-generation antihistamines.

Explanation

Testing and the initiation of antibiotic therapy are not recommended in patients with bronchitis unless pneumonia is suspected. Treatment of symptoms includes cough suppressants, decongestants, beta-agonists, and first-generation antihistamines.