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College of Pharmacy Advanced Clinical Pharmacology Spring 2013 Semester
Acute Otitis Media (AOM), URTI, Bronchitis, Pneumonia (CAP – Adults) Danita Dee Narciso Pharm D 1
Acute Otitis Media (OAM) The rapid onset of signs and symptoms of
inflammation in the middle ear Signs
Ear pain – holding, tugging, rubbing of the ear Intense erythema of the TM
Severe vs. non-severe Diagnosis
Moderate to severe bulging of the TM New onset otorrhea
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Upper Respiratory Tract Infections (URTI) Group A Streptococcal Pharyngitis Bacterial Rhinosinusitis in Children and
Adults (ABRS) Acute Bronchitis Community Acquired Pneumonia in
Adults
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Group A Streptococcal Pharyngitis Signs/symptoms
Usually cannot determine viral or bacterial origin Viral
Rhinorrhea, cough, oral ulcers, and/or hoarseness
Diagnosis Rapid antigen detection test (RADT)
Negative – backed up by throat culture Positive – does not require back up
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Treatment Antibiotics
Penicillin or amoxicillin – Drugs of choice ~ 10 days
First generation cephalosporin – PCN allergic (no anaphylaxis) ~ 10 days
Clindamycin – Cannot use PCN or Ceph ~ 10 days
Clarithromycin - Cannot use PCN or Ceph ~10 days
Azithromycin - Cannot use PCN or Ceph ~ 5 days
NSAIDS Fever or pain (NSAID or APAP)
Children – No ASA
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Acute Bacterial Rhinosinusitis in Children and Adults (ABRS) Diagnosis
Criteria that differentiates a bacteria from a virus Lasts greater than 10 days Onset with severe symptoms or high fever Onset with worsening symptoms or new
symptoms in a current sickness
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Acute Bacterial Rhinosinusitis in Children and Adults (ABRS) Treatment
Empiric antibiotic therapy
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Acute Bronchitis
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(Am Fam Physician. 2010;82(11):1345-1350. Copyright © 2010 American Academy of Family Physicians.)
Acute Bronchitis Antibiotic Treatment
Generally not recommended Exceptions: When pertussis is suspected Macrolide
Prevent pneumonia NNT (age 16-64) 119 NNT (age 65 or older) 39
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Community Acquired Pneumonia in Adults – s/sx Common
Dyspnea Coughing up
green or yellow sputum
Fever, sweating, chills, & shaking
Sharp or stabbing chest pain
Rapid, shallow, painful breathing
Less common Hemoptysis HA Loss of appetite Fatigue Blue skin (lack of
oxygen) Nausea, vomiting,
& diarrhea Joint pain and
muscle aches
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Community Acquired Pneumonia in Adults Sight of care decisions
Assessment of severity CURB-65
Confusion, uremia, respiratory rate, low blood pressure, & age 65 or greater
PSI – Pneumonia Severity Index 5 mortality risk classes Risk class I & II (treated as outpatient), risk III (short
hospital stay), risk IV & V (admitted into the hospital) Others
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Community Acquired Pneumonia in Adults Diagnosis
Outpatient vs. inpatient Empiric treatment alone Empiric treatment and further diagnostic
testing
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Questions ??????????????????????????????????
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