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

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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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Tympanic Membrane (TM)

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Treatment- Assessment of pain

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Treatment - Observation

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Treatment – Antibiotics

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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

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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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Indications of GAS

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Viral indications

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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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Antibiotic treatment

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Acute Bacterial Rhinosinusitis in Children and Adults (ABRS

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Acute Bacterial Rhinosinusitis in Children and Adults (ABRS)

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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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Empiric treatment in children 20

Empiric treatment in adults 21

Treatment algorithm 22

Acute Bronchitis

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(Am Fam Physician. 2010;82(11):1345-1350. Copyright © 2010 American Academy of Family Physicians.)

Acute Bronchitis 24

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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Acute Bronchitis 26

Acute Bronchitis

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Community Acquired Pneumonia in Adults

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Community Acquired Pneumonia in Adults

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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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PSI

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PSI

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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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Most common pathogens

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Outpatient – Antibiotics (Usually empiric)

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Inpatient - Antibiotics

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Questions ??????????????????????????????????

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