1 / 52

Theater Training Center for Excellence

DELETE THIS TEXT BOX BEFORE USE: Use this slide for the FIRST SLIDE of any module AFTER the first module of your course. Theater Training Center for Excellence. Remote Duty Medic Antimicrobial Therapy. CASE STUDY: 1. 49 year old male, non-smoker

dfarrow
Download Presentation

Theater Training Center for Excellence

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DELETE THIS TEXT BOX BEFORE USE: Use this slide for the FIRST SLIDE of any module AFTER the first module of your course Theater Training Center for Excellence Remote Duty Medic Antimicrobial Therapy

  2. CASE STUDY: 1 49 year old male, non-smoker S: 3 day HX cough, fever, pleuritic chest pain, exertional dyspnea O: rales right lower lobe, 39.0, 138/98, 98 regular, 16, 94% room air A: P:

  3. Community Acquired Pneumonia (CAP) EPIDEMIOLOGY • More common in winter months • Influenza and pneumonia the 7th most common cause of death • The most common cause of death from infectious disease

  4. Community Acquired Pneumonia (CAP) PATHOGENESIS Modes of acquisition • Microaspiration • Aerosolized organisms inhaled Contributors • Defect in host mechanisms • Virulence of organism

  5. Community Acquired Pneumonia (CAP) HOST DEFENSES Mechanical factors • Nasal hair • Turbinates • Mucocilliary apparatus • Cough • Airway branching

  6. Community Acquired Pneumonia (CAP) CLINICAL FEATURES • Cough, fever, pleuritic chest pain • Dyspnea, rigors, rales, fatigue • Sputum • Mucopurulent = bacterial • Scant / Watery = atypical pathogen

  7. Community Acquired Pneumonia (CAP) MICROBIOLOGY • Streptococcus pneumoniae 20-60% • Gram Positive Aerobic Cocci • Haemophilus influenza • Gram Negative Coccobacilli • Mycoplasma pneumoniae • Defective Cell Wall Bacteria

  8. Community Acquired Pneumonia (CAP) INITIAL TREATMENT PLAN No cardiovascular history • Macrolide (first choice) 2. Doxycycline

  9. Community Acquired Pneumonia (CAP) INITIAL TREATMENT cont. With preexisting cardiovascular history or other comorbidities • Augmentin + Macrolide or Doxycycline • Ceftriaxone + Macrolide or Doxycycline • Levofloxacin as monotherapy (top cover)

  10. Community Acquired Pneumonia (CAP) SUPPORTIVE TREATMENT • Antipyretics • Hydration • Antihistamine / Decongestants • Mucolytics • Steroids • Bronchodilators • Antitussives

  11. CASE STUDY: 2 27 year old female, non-smoker S: 6 day HX “head cold” with worsening of symptoms + headache O: T: 39.5, Rhinorrhea, purulent nasal secretions, maxillary tooth pain A: P:

  12. Acute Bacterial Rhinosinusitis (ABRS) PATHOPHYSIOLOGY A pyogenic complication of a viral URI Estimated that only 0.2 – 2.0 % of all viral URI’s are complicated by ARBS Syndrome: • Viral URI > mucocilliary dysfunction > bacteria from nasopharynx colonize the sinuses = bacterial invasion

  13. Acute Bacterial Rhinosinusitis (ABRS) VIRAL URI NATURAL HISTORY Most are well or nearly well at 10 days Question: How do we distinguish bacterial infection from viral URI

  14. Acute Bacterial Rhinosinusitis (ABRS) CLINICAL FEATURES • Purulent nasal discharge • Maxillary tooth or facial pain • Maxillary sinus tenderness • Fever / Headache • Symptoms worsening after 5-7 days

  15. Acute Bacterial Rhinosinusitis (ABRS) CLINICAL DIAGNOSIS Best way to diagnose ABRS is: • Sxs of URI not improved in 10 days • Sxs worsen after 5-7 days • Unlikely is Sxs present for < 7 days

  16. Acute Bacterial Rhinosinusitis (ABRS) MICROBIOLOGY • Streptococcus pneumoniae 30-35% • Gram Positive Aerobic Cocci • H. influenzae 15-25% • Gram Negative Coccobacilli • Moraxella catarrhalis • Gram Negative Coccobacilli

  17. Acute Bacterial Rhinosinusitis (ABRS) INITIAL TREATMENT • Amoxicillin / Clavulanic Acid • Azithromycin • Levofloxacin: if first line TX fails, (topcover)

  18. Acute Bacterial Rhinosinusitis (ABRS) SUPPORTIVE TREATMENT • Antipyretics • Hydration • Decongestants / Antihistamines

  19. CASE STUDY: 4 25 year old male, labor foreman S: “Muffled” hearing R ear x 4 days O: Swelling, pus in external canal, pain upon tugging of tragus A: P:

  20. Otitis Externa (Swimmer’s ear)

  21. Otitis Externa (Swimmer’s ear) CLINICAL FEATURES • Pain with tragal pressure • Erythema • Pruritis • Hearing impairment

  22. Otitis Externa (Swimmer’s ear) MICROBIOLOGY • Pseudomonas aeruginosa • Gram Negative Aerobic Bacilli • Staphylococcus aureus • Gram Positive Aerobic Cocci • Fungal infections 2-10% (Otomycosis) • Candida

  23. Otitis Externa (Swimmer’s ear) INITIAL TREATMENT • Thoroughly clean the ear canal • Treat inflammation and infection • Control pain • Consider alternative diagnosis if Abx failure

  24. Otitis Externa (Swimmer’s ear) OUTPATIENT TREATMENT cont.. • Topical agent • Cortisporin Otic 4gtts/tid x 10 days • Ciprofloxacin drops • Systemic antibiotic • Ciprofloxacin • Antifungal agent • Fluconazole

  25. Otitis Externa (? Etiology)

  26. CASE STUDY: 4 31 year old male, S: L ear pain since last night, “couldn’t sleep”; HX of recent URI O: Erythema / swelling and bulging of tympanic membrane A: P:

  27. CASE STUDY: 4

  28. Otitis Media DIAGNOSIS (all three) • Acute onset of symptoms / typically following a URI • Presence of middle ear effusion (bulging TM, air / fluid level, otorrhea) • Middle ear inflammation, (distinct erythema of TM, distinct otalgia which interferes with normal activity or sleep)

  29. Otitis Media MICROBIOLOGY • Streptococcus pneumoniae • Gram Positive Aerobic Cocci • H. influenzae • Gram Negative Coccobacilli • Moraxella catarrhalis • Gram Negative Coccobacilli

  30. Otitis Media INITIAL TREATMENT (mild cases) • Antipyretics / pain control • Hydration • Antihistamines / Decongestants • Observe for changes

  31. Otitis Media INITIAL TREATMENT (moderate cases) Add the following treatment • Amoxicillin / Clavulanic Acid • Azithromycin: if PCN allergy • Levofloxacin: if first line TX fails (top cover) • Ceftriaxone IM / IV (severe cases)

  32. CASE STUDY: 5 34 year old male S: “Sore throat x 2 days”; denies coughing / runny nose / tearing O: Temp = 39. C, TM’s unremarkable, throat reveals > A: P:

  33. Streptococcal Pharyngitis CLINICAL PREDICTORS • Acute onset • Tonsillar exudate • Tender anterior cervical adenopathy • Absence of cough • History of fever

  34. Streptococcal Pharyngitis MICROBIOLOGY • Gp A Streptococcal Pharyngitis • Gram Positive Aerobic Cocci 15% • Viral • Rhinovirus, Influenza, Parainfluenza • Other (not to miss) • Para/retropharyngeal abscess, Diptheria, Ludwig's Angina, Epiglottitis

  35. Streptococcal Pharyngitis INITIAL TREATMENT • Amoxicillin / Clavulanic Acid • Azithromycin: if PCN allergy • Cephalexin • Role may be with recurring infections

  36. Streptococcal Pharyngitis SUPPORTIVE TREATMENT • Antipyretics • Saline gargles • Cepacol lozenges • Hydration • Other ?

  37. CASE STUDY: 6 53 year old male, office worker S: “Itchy, gritty” sensation to L eye with crust in the mornings O: Redness about affected sclera with discharge A: P:

  38. Conjunctivitis

  39. Conjunctivitis CLINICAL FEATURES • Highly contagious • Redness / discharge one or both eyes • Morning crust / eyes stuck shut • Purulent discharge, thick / yellow • Multiple symptoms consider viral

  40. Conjunctivitis MICROBIOLOGY • Viral etiology • Adenovirus • Staphylococcus aureus • Gram Positive Aerobic Cocci 3. Allergic Conjunctivitis

  41. Conjunctivitis OUTPATIENT TREATMENT • Erythromycin ointment • Half inch ointment qid x 5-7 days • Fluoroquinolone drops • Ciprolox • 1-2 gtts qid x 5-7 days

  42. CASE STUDY: 7 30 year old sexually active female S: Acute onset of dysuria, urgency and frequency O: Temp 37.1C, Suprapubic pain / tenderness; UA reveals……. A: P:

  43. Urinary Tract Infection CLINICAL FEATURES Cystitis • Dysuria • Urgency • Frequency • Suprapubic Pain • Suprapubic Tenderness

  44. Urinary Tract Infection CLINICAL FEATURES Pyelonephritis • Fevers • Chills • Flank pain

  45. Urinary Tract Infection CLINICAL FEATURES • Signs and SX not very specific for UTI • Cystitis / Pyelonephritis • Vaginitis - Candida, Trichomonas, Bacterial Vaginosis • STD’s – Herpes, Chlamydia, Gonorrhea

  46. Urinary Tract Infection CLINICAL FEATURES • Combinations of symptoms very suggestive: • Dysuria and frequency without vaginal discharge or irritation = 90% probability of cystitis

  47. Urinary Tract Infection MICROBIOLOGY • E coli 75-90% • Staphylococcus Saprophyticus 5-15%

  48. Urinary Tract Infection INITIAL TREATMENT • Sulphamethoxazole/Trimethoprim DS • Ciprofloxacin

  49. Urinary Tract Infection DURATION of THERAPY • TMP/SMX – 3 days • For uncomplicated UTI in otherwise healthy, non-pregnant women • TMP/SMX – 7 days • For older women, those with recurrence, immunocompromise • Men – Should not receive short course therapy

More Related