Upper Respiratory Tract Infections in Children

Question 1

Examples of URTIs

Answer 1

Rhinitis
Otitis media
Tonsillitis
Pharyngitis
Laryngitis
Epiglottitis
Croup aka laryngotracheobronchitis

Question 2

Microbiological infective agents

Answer 2

Viral:

• Adenovirus
• Infleunza A,B
• Parainfluenzae, (1,3)
• RSV
• Rhinovirus

Bacterial:
H. influenzae
M. catarrhalis
Streptococci
Beta haemolytic S pyogenes
Non-haemolytic S pneumoniae
Mycoplasma
Staph Aureus

Question 3

Details of Rhinitis

Answer 3

Very common
Winter months
Self-limiting
Prodrome to other illnesses:
- pneumonia/bronchiolitis
- meningitis
- septicaemia

Question 4

Details of Otitis Media

Answer 4

Bulging ear drum
Common and self-limiting
Secondary with pneumococcus/H’flu
Antibiotics don’t usually help

Question 5

When should Otitis media be treated?

Answer 5

Treat if severe uni or bilateral for over 6 months, or severe pain >48 hours.

Treat if non severe but bilateral for 6-23 months.

Augmentin vs placebo
Double the benefit but double the adverse effects

Question 6

What are the benefits of deferring treatment?

Answer 6

Fewer side effects

Analgaesia definitely works
Antibiotics have questionable benefit

Question 7

Tonsillitis/Pharyngitis details and treatment

Answer 7

Common
Viral or bacterial?
Do throat swap
Either give nothing or 10 days of penicillin
DON'T give amoxicillin

Question 8

Croup/Epiglottitis details and treatment

Answer 8

Croup common (parainfluenza I)
Epiglottitis rare (H. flu type B), more dangerous

Need to differentiate
Croup 50% gone in 2 days, 80% gone in 3

Treat croup with oral dexamethasone
Treat epiglottitis with antibiotics and intubation