Upper Respiratory Tract Infections in Children

Question 1

where do URTI affect?

Answer 1

Question 2

Do the benefits from antibiotics justify the harm?

Answer 2

• Diarrhoea
• Oral thrush
• Nappy rash
• Allergic reaction
• Multi resistance

There’s no doubt that the overall burden of harm from antibiotics given to the population is greater than the overall benefit

Question 3

Putting URTI into context - how common are they?

Answer 3

very very common

Question 4

URTIs - what are the mian features of them?

Answer 4

• They’re common!!
• Fever (Often associated with fever):
• Antibiotics or not?
• Prodrome to serious illness?

Question 5

Natural history - is it important

Answer 5

yes

Question 6

what is rhinitis?

Answer 6

Rhinitis is inflammation and swelling of the mucous membrane of the nose, characterized by a runny nose and stuffiness and usually caused by the common cold or a seasonal allergy

• Very common, 5-10 per year
• Winter months
• Self-limiting condition

The dilemma here is..… - Prodrome to other illnesses - Pneumonia, bronchiolitis, Meningitis, Septicaemia

•Review if not sure

Question 7

how long does a runny nose last normally?

Answer 7

Days from onset of symptoms

Some individuals, symptoms last longer

Question 8

what is Otitis media?

Answer 8

• Common, self-limiting
• Not “a bit pink” - its red
• Primary viral infection
• Secondary infection with Pneumococcus/H’flu
• Spontaneous rupture of drum
• Antibiotic treatment usually doesn’t help……

Question 9

what is the duraiton of ear ache?

Answer 9

20% of individuals can last upto 7 days

Question 10

how do you treat otitis media?

Answer 10

1. Analgesia works for sure (Prominent symptoms in otitis media is pain)
2. The jury is out for antibiotics
   - Antibiotics may work >24 hours (Antibiotics don’t do any good in first 24 hours)
   - First do no harm?
3. The end point is the same (End point is same for 99.999% of individuals so don’t use antibiotics)

Question 11

Tonsillitis/pharyngitis - what is it, how common and how do you manage it?

Answer 11

•Common

The dilemma is….

• Viral or bacterial?
• Throat swab
• Either nothing or 10 days penicillin
• Don’t give amoxycillin

Question 12

Croup/epiglottitis: what are they, what causes them, how common are they, how do patient present

Answer 12

Question 13

Take home messages:

• URTIs are very common in children
• >99% URTIs are self-limiting (don’t say “viral”)
• Antibiotics do not usually help
• Understand what is normal
• If in doubt, review