Upper respiratory tract infections - children

Question 1

What are some examples of URTIs?

Answer 1

Otitis media
Rhinitis
Laryngitis
Pharyngitis
Epiglottitis

Question 2

What is the current perspective on respiratory infections - viruses and bacteria?

Answer 2

Virus invasion repelled
Bacteria can act like civil war as some are an overgrowth from carrying the bacteria - pneumococcus, haemophilus, staph., Moraxella
Bacteria also can be an invasion - pertussis

Question 3

What is the fine line between bacterial colonisation and infection?

Answer 3

Epithelium

Question 4

What are some side effects of antibiotics for URTIs?

Answer 4

Diarrhoea, Oral thrush, Nappy rash, Allergic reaction and Multi resistance

Question 5

Do the benefits from antibiotics justify the harm?

Answer 5

No

Question 6

What fraction of hospital admissions in Scotland for children are due to URTIs and LRTIs?

Answer 6

Around 1/3 of hospital admissions

Question 7

Explain about the natural history of UTRIs

Answer 7

They are very common
Child presents with a fever
Doctor can advise on what do to in future and symptoms of worsening to look out for
The child could be on the stabilising, worsening or about to stabilise so need to review them

Question 8

Explain Rhinitis

Answer 8

Very common, happens during winter months
Its a self-limiting condition and could be a prodrome to other illnesses - pneumonia, bronchiolitis, meningitis and septicaemia
Main symptom is runny nose which usually lasts 11 days but some children may have it for 14 days

Question 9

Explain Otitis Media

Answer 9

Middle ear infection - main symptom is pain (earache)
The tympanic membrane is now red and ready to pop instead of semi-transparent
Spontaneous rupture of the drum
Primary viral infection then secondary infection with pneumococcus/H’flu

Question 10

What is the duration of earache in otitis media?

Answer 10

3 days if normal
But can last 7 days in 20% of children

Question 11

What are the benefits of deferred treatment compared to immediate antibiotics?

Answer 11

Fewer patients treated
Fewer side effects
No benefit from deferred treatment compared to no antibiotics

Question 12

What is the treatment for otitis media?

Answer 12

Analgesia works as pain relief
Give no antibiotics - as work after 24hrs so give no pain relief
End point works out being the same and the patients symptoms have gone

Question 13

Explain tonsillitis/pharyngitis?

Answer 13

Very common
Dilemma between whether it is viral or bacterial
Throat swab is taken
Treatment is either do nothing or give penicillin
Do not give amoxycillin

Question 14

How long does symptoms of tonsillitis and pharyngitis last?

Answer 14

Symptoms of sore throat usually last 3 days but some children can have sore throat for a week

Question 15

Does glandular fever need antibiotics?

Answer 15

No is viral infection

Question 16

Does Group A strep. in throat need antibiotics?

Answer 16

Yes

Question 17

Explain Croup

Answer 17

Common and child presents well - Para’ flu I
Wake up during night, stridor, hoarse voice and barking cough
Treatment - oral dexamethasone

Question 18

Explain epiglottitis

Answer 18

Rare and toxic - H.influenzae type B
Stridor and drooling as cant swallow
Treatment - intubation and antibiotics

Question 19

What is the duration of symptoms in croup?

Answer 19

Symptoms usually last 1 day but 20% last more than 3 days

Question 20

What percentage of URTIs are self-limiting?

Answer 20

more than 99%
and antibiotics don’t usually help