INFECTIOUS DISEASE REVIEW Upper Respiratory Tract Infections

. check Hx of beta lactam usage
c. check for the intended use (Throat vs. Ears vs. Sinus vs. All)
d. All of the above
The correct answer is d.
Complications of Group A beta hemolytic strep infection include scarlet fever (rare), glomerulonephritis
(treatment does not prevent), acute and chronic rheumatic fever (RF) and endocarditis are complications that
can occur. Manifestations and Evidence for RF diagnosis include heart damage which is primarily valvular and
results in murmurs and polyarthritis. Prophylactic regimen drugs for prevention of bacterial endocarditis (JAMA
1997;277:1794-1801) may include amoxicillin, a macrolide or cephalosporin.
The American Heart Association’s Endocarditis Committee, together with national and international experts on
Bacterial Endocarditis (BE), extensively reviewed published studies to determine whether dental,
gastrointestinal (GI) or genitourinary (GU) tract procedures are possible causes of BE. These experts
determined that no conclusive evidence links dental, GI or GU tract procedures with the development of BE.
The current practice of giving patients antibiotics prior to a dental procedure is no longer recommended
EXCEPT for patients with the highest risk of adverse outcomes resulting from BE. The committee cannot
exclude the possibility that an exceedingly small number of cases, if any, of BE may be prevented by antibiotic
prophylaxis prior to a dental procedure. The Committee recognizes the importance of good oral and dental
health and regular visits to the dentist for patients at risk of BE.
The committee no longer recommends administering antibiotics solely to prevent BE in patients who undergo a
GI or GU tract procedure.
Changes in these guidelines do not change the fact that the patient’s cardiac condition puts him at increased
risk for developing endocarditis. If he should develop signs or symptoms of endocarditis – such as unexplained
fever – refer him to his doctor right away. If blood cultures are necessary (to determine if endocarditis is
present), it is important for the doctor to obtain these cultures and other relevant tests BEFORE antibiotics are
started.
SORE THROAT PATIENT EDUCATION CONSIDERATIONS
A sore throat should be a transitory problem as part of a cold, post-nasal drip, or seasonal allergy. If prolonged
and fever OR SWOLLEN NECK is present, a more serious problem may exist and you need to consult your
doctor. If an occasional sore throat bothers you, a pinch of salt in a half glass of warm water with a deep gargle
4 to 6 times a day frequently brings relief. Mouthwashes such as Listerine and Lavoris may also be gargled. If
throat pain is very uncomfortable, a spray or lozenge such as Chloraseptic may be used for a short period of
time (24-48 hours). Patients who use inhaled steroids such as those found in Advair, Symbicort, Vanceril,
AeroBID, Azmacort etc. may get a sore throat and/or hoarseness if they do not thoroughly gargle after each
inhalation of the steroid.
CASE 6- An elderly man wants something for his cold. You notice a harking and barking deep productive cough
and a pack of cigarettes in his front pocket. What questions do you ask him or check in his profile?
a. Has he had any antibiotics in the last weeks to months?
b. Does he have any COPD meds?
c. has he had a cold or allergies recently; check for fever, sputum color change and amount and check
for HBP and cardiovascular problems
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