My Synopsis of: "Antibiotic Use in Acute Upper Respiratory Tract Infections"

My Synopsis of:
Antibiotic Use in Acute Upper Respiratory Tract Infections
ROGER ZOOROB, MD, MPH; MOHAMAD A. SIDANI, MD, MS; RICHARD D. FREMONT, MD; and COURTNEY KIHLBERG, MD, MSPH, Meharry Medical College, Nashville, Tennessee
Am Fam Physician. 2012 Nov 1;86(9):817-822.
http://www.aafp.org/afp/2012/1101/p817.pdf

     Most URIs are viral and do not need antibiotic treatment. The End.
     Overuse of antibiotics causes.....you know the rest.


     You're still here? ok well, I guess i'll give you the long version. The common cold is almost exclusively viral. Symptoms are sore throat, runny nose (regardless of color), cough, sneezing, and nasal congestion.
     Influenza is viral. The best treatment is vaccination prophylaxis. Patients who are older than 65, younger than 2, pregnant, or have severe or chronic illness should be treated with antivirals (neuraminidase inhibitors).
     Rhinosinusitis is inflammation of the nasal mucosa. If the infection is bacterial, there will be purulent nasal discharge, maxillary tooth pain, maxillary sinus pain, and symptoms which have worsened after an initial period of improvement. The clinician should wait for the symptoms to be present for 10 days before considering the infection to be bacterial. The primary bugs in rhinosinusitis are S. pneumoniae, H. influenzae, and M. catarrhalis. First line medication is amoxicillin, or TMP/SMX if the patient allergic to penicillin. A short course of therapy is as effective as a 10 day course.
     Otitis media is an infection of the middle ear. The most common bugs are H. influenzae, S. pneumoniae, and M. catarrhalis. Infants (less than 8 weeks old) may be infected by GBS, gram-negative enterococcus, or C. trachomatis. This group should get a full sepsis workup. Patients less than two years old with bilateral OM should be started on antibiotics (amoxicillin) immediately. Ceftriaxone is a good second line medication. If there is no improvement after 3 days, the patient should be assessed and given amoxicillin/clavulanate.  
     Most pharyngitis infections are viral. If it is viral, it is most likely group A beta-hemolytic strep. The modified centor criteria can help guide treatment. The parameters are:
no cough (1)
age 3-14  (1) or above 45 years old (-1)
anterior cervical lymph node inflammation (1)
fever (1)
tonsillar redness or fever (1)
In a person with a score of 1, testing should be done. If the score is 2-3, then rapid antigen testing should be performed. A person with a score of 4 or higher should get antibiotics (amoxicillin, azithromycin, or first generation cephalosporins).
     Laryngitis is inflammation of the vocal cords or larynx. Symptoms include cough, fever, runny nose, muffled voice, and headache. It is almost always viral and self limited.
     Epiglottitis affects the epiglottis and can cause death if it closes off the throat. The most common bug is S. aureus and MRSA (H. influenzae B is no longer a significant problem because of vaccination). Antibiotic treatment includes ceftriaxone, cefotaxime, or ampicillin/sulbactam.
     Bronchitis is inflammation of the trachea and large airways. The most common bugs are B. pertussis, C. pneumonia, and M. pneumonia. The infections are self limiting and do not require antibiotics unless pneumonia develops, or the patient is immunocompromised.