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Editorial

Upper respiratory tract infection

Biomedical Review-Journal of Basic and Applied Medical Science

2015 Volume 2 Number 4
Publisherwww.medresearch.in

Upper Respiratory Tract Infection- Treatment Guidelines

Patel U.1*, Gedam D.2

1* Umesh Patel, Associate Professor, Department of Pediatrics, LN Medical College, Bhopal, MP, India.

2 D Sharad Gedam, Professor, Department of Pediatrics, LN Medical College, Bhopal, MP, India.

Acute upper respiratory tract infection (AURTI) is most common public health issue and a great burden to both families and the wider society. Symptom-based therapy is the mainstay of URI treatment in immuno-competent adults. Antimicrobial or antiviral therapy is required in only few selected patients.Upper respiratory tract infection (URI) represents the most common acute illness in children evaluated in the outpatient setting. It ranges from the common cold to lifethreatening illnesses such as epiglottitis. Upper respiratory tract infections, includes the common cold, acute pharyngitis, tonsillitis, acute sinusitis, acute otitis media and acute bronchiolitis. The incidence peaks between one and five years of age, especially winter season. In 2013, 18.8 billion cases of upper respiratory infections occurred [1]. A majority of upper respiratory infections are due to self-limited viral infections. Occasionally, bacterial infections may cause upper respiratory infections.

Keywords: Upper Respiratory Tract Infection, Antimicrobials

Corresponding Author How to Cite this Article To Browse
Umesh Patel, Associate Professor, Department of Pediatrics, LN Medical College, Bhopal, MP, India.
Email: 		Umesh Patel, D Sharad Gedam, Upper Respiratory Tract Infection- Treatment Guidelines. Biomed Rev J Basic Appl Med Sci. 2015;2(4):102-104.
Available From
https://www.biomedicalreview.in/upper-respiratory-tract-infection-treatment-guidelines-editorials

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2015-10-21 2015-10-23 2015-10-30 2015-11-06 2015-11-13
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2015by Umesh Patel, D Sharad Gedamand Published by Siddharth Health Research and Social Welfare Society. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Biomedical Review-Journal of Basic and Applied Medical Science 2015;2(4)102
Patel U et al: Upper Respiratory Tract Infection- Treatment Guidelines

Editorial

Upper respiratory tract infection (URI) represents the most common acute illness in children evaluated in the outpatient setting. It ranges from the common cold to lifethreatening illnesses such as epiglottitis. Upper respiratory tract infections, includes the common cold, acute pharyngitis, tonsillitis, acute sinusitis, acute otitis media and acute bronchiolitis. The incidence peaks between one and five years of age, especially winter season. In 2013, 18.8 billion cases of upper respiratory infections occurred [1].

A majority of upper respiratory infections are due to self-limited viral infections. Occasionally, bacterial infections may cause upper respiratory infections.

Most upper respiratory tract infections (URIs) are selfdiagnosed and self-treated at home. A period of observation without immediate use of antibiotics is an option for certain children. In patients with sinus infection, acute bacterial rhino-sinusitis should be diagnosed and treated with antibiotics only, if symptoms have not improved after 10 days or have worsened after five to seven days.

In patients with sore throat, a diagnosis of group A beta-hemolytic streptococcus pharyngitis generally requires confirmation with rapid antigen testing, although other guidelines allow for empiric therapy if a validated clinical rule suggests a high likelihood of bacterial infection. Acute bronchitis in otherwise healthy child should not be treated with antibiotics; delayed prescriptions may help ease patient fears and simultaneously reduce inappropriate use of antibiotics.

Most recent principles of appropriate antibiotic prescribing for children obtaining care in an outpatient setting by CDC is following-

CDC guideline for treatment of URI-

1. Rhino-sinusitis: If a bacterial infection is established then amoxicillin or amoxicillin/clavulanate remain firstline therapy. In children who are vomiting or who cannot tolerate oral medication, a single dose of ceftriaxone can be used [2, 3].

2. Acute Otitis Media: Mild cases with unilateral symptoms in children 6-23 months of age or unilateral or bilateral symptoms in children >2 years may be appropriate for watchful

waiting. Amoxicillin remains first line therapy for children who have not received amoxicillin within the past 30 days.Amoxicillin/clavulanate is recommended if amoxicillin has been taken within the past 30 days, if concurrent purulent conjunctivitis is present, or if the child has a history of recurrent AOM unresponsive to amoxicillin. For children with a non-type I hypersensitivity to penicillin: cefdinir, cefuroxime, cefpodoxime, or ceftriaxone may be appropriate choices. Prophylactic antibiotics are not recommended to reduce the frequency of recurrent AOM [4, 5].

3. Pharyngitis: Amoxicillin and penicillin V remain firstline therapy. For children with a non-type I hypersensitivity to penicillin: cephalexin, cefadroxil, clindamycin, clarithromycin, or azithromycin are recommended. For children with an immediate type I hypersensitivity to penicillin: clindamycin, clarithyomycin, or azithroymycin are recommended [4, 6].

4. Common cold: Only symptomatic. Antibiotics should not be prescribed for these conditions. There is potential for harm and no proven benefit from over-the-counter cough and cold medications in children younger than 6 years. Low-dose inhaled corticosteroids and oral prednisolone do not improve outcomes in non-asthmatic children [4, 7].

5. Bronchiolitis: Antibiotics are not helpful and should not be used. Nasal suctioning is mainstay of therapy. Albuterol can be trialed. Nebulized racemic epinephrine has also shown some benefit in bronchiolitis. There is no role for corticosteroids, ribavirin, or chest physiotherapy [8].

When any patient takes antibiotics, he or she should follow the directions carefully. It is important to finish medicine even if patients feel better. If patient stop treatment too soon, some bacteria may survive and reinfect you.

Do not save antibiotics for later or use someone else’s rescription.

Moulin Mehta et al published his article in this issue and as per study almost 50 % prescription has antibiotics, although most of URI are caused by viruses. Proper and effective prescribing pattern of medications, for any condition, is required to improve drug efficacy, decrease cost of therapy, adverse effects, drug-drug interaction and drug resistance [9].

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Reference

  1. Global Burden of Disease Study 2013, Collaborators (22 August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet (London, England) 386 (9995): 743–800.
  2. Wald ER, Applegate KE, Bordley C,Darrow DH, Glode MP, Marsy SM et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262-80.
  3. Chow AW, Benninger MS, Brook I,Brozek JL, Goldstein EJ, Hicks LA et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112.
  4. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-99.
  5. Hersh AL, Jackson MA, Hicks LA, et al. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics. 2013;132(6):1146-54.
  6. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86–102.
  7. Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. Am Fam Physician. 2012;86(2):153-9.
  8. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118(4):1774-93.
  9. Mehta M, Banode S, Chourishi A. Pattern of medications prescribed for URI (upper respiratory tract infection) patients in medicine OPD of tertiary care teaching hospital, Ujjain. Biomed Rev: J Basic Appl Med Sci 2015;2(4)82-86. doi: 10.17511/jbams.2015.i4.03.

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