3. Objectives
• At the end of this session, the
participants should be able to;
– List upper respiratory tract infections
– Make differential diagnosis between
URTI
– Define criteria for antibiotic use
– Apply and interpret the McIsaac
scoring
/ 42 3
4. Tonsilitis-pharyngitis
• Bacteria
– S. pyogenes
– C. diphteriae
– N. gonorrhoeae
• Viruses
– Epstein-Barr virus
– Adenovirus
– Influenza A, B
– Coxsackie A
– Parainfluenzae
/ 42 4
6. Due to streptococci:
• Spreads by close contact and through
air
• Spread more in crowded areas (KG,
school, army..)
• Most common among 5-15 age
group
• More frequent among lower socio-
economic classes
• Most common during winter and
spring
• Incubation period 2-4 days/ 42 6
7. Signs/symptoms
Sore throat
Anterior cervical LAP
Fever > 38 C
Difficulty in swallowing
Headache, fatigue
Muscle pain
Nausea, vomiting
/ 42 7
Tonsillar hyperemia /
exudates
Soft palate petechia
Absence of coughing
Absence of nose drip
Absence of hoarseness
8. Viral tonsillitis/pharyngitis
• Having additional rhinitis,
hoarseness, conjunctivitis and cough
• Pharyngitis is accompanied by
conjunctivitis in adenovirus
infections
• Oral vesicles, ulcers point to viruses
/ 42 8
11. Laboratory
• Throat swab
– Gold standard
• Rapid antigen test
– If negative need swab
• ASO
– May remain + for 1 year
• WBC count
• Peripheral smear
/ 42 11
12. Throat Culture
• Pathogens looked for
– Group A beta hemolytic streptococci
– C. diphteriae (rare)
– N. gonorrhoeae (rare)
• If GABHS do we need antibiogram?
– Is there resistence to penicilline?
12
14. Aim of Treatment
• Prevention of complications
• Symptomatic improvement
• Bacterial eradication
• Prevention of contamination
• Reducing unnecessary antibiotic use
/ 42 14
15. Treatment
• Many different antibiotics can
eradicate GABHS from pharynx
• Starting treatment within 9 days is
enough to prevent ARF
/ 42 15
16. Antibiotics NOT to be used
• Tetracycline
• Sulphonamides
• Co-trimoxasole
• Cloramphenicole
• Aminoglycosides
/ 42 16
17. GABHS
• Control culture after full dose
treatment?
– NO
• If history of ARF:
– Take control culture after treatment
• No need to screen or treat carriers
/ 42 17
18. Mc Isaac Scoring
• Developed by Mc Isaac and friends
• Decreases antibiotic usage by 48%
• No increase in throat swabs
/ 42 18
http://www.cmaj.ca/cgi/content/abstract/163/7/811
19. Antibiotics in Tonsillitis/pharyngitis due to
GABHS
ORAL
Penicilline V Children:2x250 mg or 3x250mg,10 days
Adults:3x500 mg or 4x500mg,10 days
PARENTERAL
Benzathine penicilline Adults:<27kg:600 000 U single dose, IM
>27 kg:1.200 000 U single dose, IM
ALLERGY TO PENICILLINE
Erithromycine estolate 20-40 mg/kg/day, 2x1 or 3x1, 10 days
Erithromycine ethyl succinate 40 mg/kg/day, 2x1 or 3x1, 10 days
/ 42 19
20. Acute Otitis Media
• AOM
• AOM not responding to treatment:
Sustained clinical and autoscopy findings
despite 48-72 therapy
• Recurrent otitis media: 3 AOM attacks
within 6 moths or 4 attacks within 1 year
/ 42 20
21. AOM causes
• S. pneumoniae 30%
• H. İnfluenzae 20%
• M. Catarrhalis 15%
• S. pyogenes 3%
• S. aureus 2%
• No growth 10-30%
• Chronic otitis media: P. aeruginosa, S.
aureus, anaerobic bacteria
/ 42 21
22. Acute Otitis Media
• 85% of children up to 3 years experience at
least one,
• 50% of children up to 3 years experience at
least two attacks
• AOM is usually self-limited. Rarely
benefits from antibiotics.
• 81 % undergo spontaneus resolution.
/ 42 22
33. Antibiotics for Sinusitis
• Amoxycilline (Alfoxil) 3x500mg/d PO 10 d
• Amoxycilline/clavulonate (Augmentin) 3x625
mg/d PO 10 d
• Sefprosil(Serozil) 2x1000 mg/d PO 10 d
• Sefuroxim (Zinnat) 2x250 mg/d PO 10 d
• Azithromycine (Zitromax) First day 1x500 mg,
then 1x250 mg/d PO 5 d
/ 42 33
39. Influenza
• Sudden onset after 12-24 hours
incubation
• General weakness and fatigue
• Feeling cold, shivering, temp. Up to
39-40 C
• No sore throat or running nose
• Severe back, muscle and joint pain
/ 42 39
