Acute Upper Respiratory Tract Infections

Acute rhinitis (“The common cold”)
  • Most common ailment: coryza, cough, malaise
  • Rarely life-threatening
  • Management:
    • >90% viral
    • NO antibiotics
    • Symptomatic management
    • Coloured nasal discharge is not indicative of bacterial infection
    • Adequate fluids especially in the very young
  • Prevention
    • Good handwashing practices
    • Clean and disinfect toys and surfaces
    • Good ventilation
    • Avoid crowding
    • Teach children to cover coughs and wipe noses

Pharyngitis and tonsillitis
Epidemiology
  • 4 to 10 years old
  • Predominantly viral
  • Bacterial: Group A b-haemolytic Streptococcus
Clinical features
  • Viral
    • Sorethroar
    • Fever
    • Malaise
  • Group A b-haemolytic Streptococcus
    • Extreme sore throat, high fever, pharyngeal exudate, >4 years old
    • Tender cervical lymphadenopathy
    • No significant coryza or cough
Management
  • Symptomatic treatment
  • Swallowing can be so painful that it affects eating à change the child’s diet to include more liquids and soft foods. Include soothing liquids and warm nutritious soups, or cool soft drinks, milk shakes, ice-cream and popsicles.
  • Make sure that child drinks plenty of fluids.
  • Let the child rest in bed or play quietly.
  • Children who are old enough to gargle can try gargles.
  • Group A b-haemolytic Streptococcus: treat with penicillin
Prevention of spread
  • All forms of tonsillitis, bacterial or viral, are contagious
  • Spreads from person to person by contact with the throat or nasal fluids
  • Regular hand washing for person caring for sick child
Indications of tonsillectomy and adenoidectomy
  • Recurrent tonsillitis (>5-6x/year)
  • Peritonsillar abscess
  • Obstructive sleep apnea



Acute Otitis Media

Epidemiology
  • Viral
  • Streptococcus pneumoniae, Group A b-haemolytic Streptococcus

Clinical features
  • Fluid in the middle ear
  • Bulging ear drum
  • Pain
  • Perforated ear drum
  • Drainage of purulent material

Management
  • Amoxicillin is the first line antibiotic of choice
  • 2nd line: Augmentin, cefuroxime
  • Symptomatic treatment
  • Earache may subside within 8h of treatment
Acute Otitis Media with Effusion

Clinical features
  • Fluid in the middle ear without signs or symptoms of ear infection
  • May be identified following an acute infection
  • Or an incidental finding
Management
  • Antibiotics NOT indicated
  • By 3 months , >50% spontaneously resolve
  • If persistent >3 months, refer to ENT.
  • There is risk of hearing impairment.
Otitis Externa

Epidemiology
  • Usually caused by Staphylococcus aureus
Clinical features
  • Ear and canal inflamed
  • May be tender to touch
  • Ear discharge
  • Itchy
Management
  • Mild infections: topical ear drops
  • Severe infections: oral cloxacillin
Acute Sinusitis
Epidemiology
  • Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarhalis are the most common causative organisms

Clinical features
  • No clinical finding is diagnostic
  • Suggestive features include:
    • Purulent nasal discharge, post-nasal drip
    • Facial pain/tenderness
    • Fever
    • Foul-smelling breath
    • Peri-orbital swelling
  • Features should be present > 7 days
  • X-rays are not useful
Management
  • Antibiotics ARE indicated.
  • Amoxicillin, bactrim, augmentin unasyn, cephalosporin
  • Topical decongestants
  • Surgical drainage rarely indicated
  • IV antibiotics if infection spreads