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Upper respiratory tract infection pharmacotherapy
Upper respiratory tract infections (URTIs) commonly include otitis media, sinusitis, and pharyngitis. They are usually caused by viruses but can sometimes be caused by bacteria like Streptococcus pneumoniae. The main symptoms include ear pain, nasal congestion, sore throat, and fever. The goals of treatment are to relieve symptoms, eradicate bacterial infections if present, and prevent complications. Treatment involves recommendations like rest, fluids, pain relief medications, and sometimes antibiotics targeted at common bacterial pathogens for a defined period. More serious cases may require procedures like myringotomy or referral to a specialist.
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Upper respiratory tract infection pharmacotherapy
- 1. Upper Respiratory Tract Infection: Pharmacotherapy Dr.Pravin Prasad MBBS, MD Clinical Pharmacology Assistant Professor, Department of Clinical Pharmacology Maharajgunj Medical Campus, Kathmandu 16 June 2020 (2 Asar 2077), Tuesday 1
- 2. By the endof this discussion, B. Pharm 3rd Year students will be able to: List the conditions included in Upper respiratory tract infections (URTIs) List the aetiology of URTIs Outline the pathophysiology of URTIs List the clinical presentation of URTIs Explain the therapeutic objectives for URTIs Justify the role of pharmacotherapy in treatment of URTIs 2
- 3. Introduction Infection of upperrespiratory tract common Commonly includes: Otitis media Sinusitis Pharyngitis Also includes Rhinitis, Laryngitis and Epiglottitis 3
- 4. Etiology and Pathophysiology:Otitis media Viral Bacteria: Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis 4
- 5. Clinical Presentation: Otitismedia History: Acute onset of signs and symptoms Ear pain and fever Children: irritable, tug on the involved ear, difficulty sleeping Ear Examination: Discolored (gray), thickened, bulging, eardrum Immobile eardrum Fluid coming from middle ear Previous history of cold symptoms of runny nose, nasal congestion, or cough 5 • Laboratory Tests: • Gram stain, culture, and sensitivities of draining or aspirated fluid
- 6. Therapeutic Objectives: OtitisMedia Primary prevention of disease Confirm the bacterial aetiology and provide antibiotics Provide symptomatic relief 6
- 7. Therapeutic Options: Otitismedia General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy Stay away from cold Do not put anything in the ear Do not blow nose forcefully Drink warm fluids 7
- 8. Therapeutic Options: Otitismedia General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy Ear toileting Cleaning the ear if discharge present Myringotomy To drain the fluid in the middle ear As secondary prophylaxis 8
- 9. Therapeutic Options: Otitismedia General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy Vaccines Seven valent pneumococcal conjugate vaccine Influenza vaccine Pain management Local anaesthesia (drops) Oral analgesics Antibiotics 9
- 10. Therapeutic Options: Otitismedia General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy If complications develop Mastoiditis, Bacteremia Meningitis Auditory sequelae 10
- 11. Pharmacotherapy: Otitis media Antibiotics 5-7days, up to 14 days Amoxicillin High dose if resistant strept. Infection suspected (90mg/kg/day) Amoxicillin + Clavulanic acid Resistant H. influenzae or M. catarrhalis suspected Amoxicillin- 90mg/kg/day, Clavulanic acid- 6.4mg/kg/day Intramuscular ceftriaxone, clindamycin, azithromycin, 11 • Can also be used for secondary prophylaxis in recurrent infection with seasonal variation • Other option: Tympanostomy with tube insertion
- 12. Aetiology and pathophysiology:Acute bacterial sinusitis Viral Bacteria: Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Uncommon: Streptococcus pyogenes, Staphylococcus aureus, fungi, anaerobes 12
- 13. Clinical Presentation: AcuteBacterial Sinusitis Signs and Symptoms Nasal discharge/congestion Maxillary tooth pain, facial or sinus pain that may radiate (unilateral in particular), as well as deterioration after initial improvement Severe or persistent (>7 days) signs and symptoms: most likely bacterial Rhinorrhoea, chronic unproductive cough, laryngitis, headache 13
- 14. Therapeutic Objective: AcuteBacterial Sinusitis Reduce signs and symptoms Achieve and maintain patency of the ostia, Eradicate the bacterial infection Minimize the duration of illness Prevent complications and progression to chronic disease 14
- 15. Therapeutic Options: AcuteBacterial Sinusitis General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy Use mask Avoid dust and cold Do not blow nose forcefully Drink warm fluids 15
- 16. Therapeutic Options: AcuteBacterial Sinusitis General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy Steam Inhalation Irrigation of nasal cavity with saline 16
- 17. Therapeutic Options: AcuteBacterial Sinusitis General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy Antibiotics Decongestants Local Oral 17
- 18. Therapeutic Options: AcuteBacterial Sinusitis General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy If complications develop Mental status changes Immunosuppressive illness, significant coexisting illnesses, risk factors for β -lactam-resistant strains Isolated frontal or sphenoid sinusitis, or intense periorbital swelling, erythema, and facial pain Unilateral findings History of antibiotic failure 18
- 19. Decongestants in AcuteBacterial Sinusitis Helps by decreasing nasal blockade and improve aeration to sinuses Acts by causing vasoconstriction Local decongestants: oxymetazoline, phenylephrine Oral decongestants: pseudoephedrine, phenylephrine Intra-nasal glucocorticoids Antihistamines: NOT recommended 19
- 20. Antibiotics: Acute BacterialSinusitis 20
- 21. Aetiology: Acute Pharyngitis Viruses Rhinovirus Coronavirus Influenza,parainfluenza virus Adenovirus Herpes simplex virus, Epstein- Barr virus Bacteria Group A beta haemolytic Streptococci (S. pyogens, GABHS) Others: C and G Streptococcus, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Mycoplasma pneumoniae, Arcanobacterium haemolyticum, Yersinia enterocolitica, and Chlamydia 21
- 22. Aetiology and Pathophysiology:Acute Pharyngitis 22 Asymptomatic carrier (GABHS) Altered host immunity • Invasion of pharyngeal mucosa • Colonisation of mucosa with bacteria
- 23. Clinical Presentation: AcutePharyngitis Signs and Symptoms Sore throat, Pain on swallowing Fever, headache, nausea, vomiting, and abdominal pain Conjunctivitis, Coryza, Cough, Diarrhoea Suggestive of Viral Pharyngitis 23
- 24. Clinical Presentation: AcutePharyngitis Local Examination: Erythema/inflammation of the tonsils, pharynx +/- patchy exudates Enlarged, tender lymph nodes Red swollen uvula, petechiae on the soft palate Laboratory Tests: Throat swab and culture Rapid antigen detection testing (RADT) 24
- 25. Therapeutic Objectives: Acute Pharyngitis Improveclinical signs and symptoms Minimize adverse drug reactions Prevent transmission to close contacts, Prevent acute rheumatic fever and suppurative complications 25
- 26. Therapeutic Options: AcutePharyngitis General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy Avoid cold Do not shout or scream Drink warm fluids Use mask 26
- 27. Therapeutic Options: AcutePharyngitis General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy Non-prescription lozenges and sprays Menthol Topical anaesthetics Tonsillectomy 27
- 28. Therapeutic Options: AcutePharyngitis General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy Antipyretic, analgesic management Acetaminophen Antibiotics 28
- 29. Therapeutic Options: AcutePharyngitis General information and advice Non pharmacological therapy Pharmacological therapy Referral therapy If suppurative complications develops 29
- 30. Antibiotics: Acute Pharyngitis BenzathinePenicillin Amoxicillin in children Penicillin allergic patients: Cephalosporins (Cefalexin), Macrolides (Erythromycin, Azithromycin) Macrolide resistant: Clindamycin Recurrent episodes: Amoxicillin-clavulanic acid, clindamycin Chronic prophylaxis: benzathine penicillin, sulfadiazine 30
- 31.
- 32. Conclusion URTIs commonly includesotitis media, sinusitis and pharyngitis Viral causes are more common aetiology for URTIs Blockade of normal drainage is critical in development of Otitis media and Sinusitis; host compromise in critical for pharyngitis Symptoms are commonly local and are associated with systemic signs Control of bacterial infection is pivotal for the management of URTIs Due to better efficacy, safety, cost-effectiveness and experience, penicillins are preferred for treatment of URTIs 32
- 33.
Editor's Notes
- #4 Otitis media (Middle ear infection) Sinusitis (Infection of paranasal sinuses) Pharyngitis Rhinitis (Nose infection) Laryngitis Epiglottitis
- #6 Acute onset of signs and symptoms of middle ear infection following cold symptoms of runny nose, nasal congestion, or cough
- #14 Maxillary tooth pain, facial or sinus pain that may radiate (unilateral in particular), as well as deterioration after initial improvement Children: Nasal discharge and cough for longer than 10 to 14 days or severe signs and symptoms such as temperature above 39°C (102°F) or facial swelling or pain are indications for antibiotic therapy Chronic Symptoms are similar to acute sinusitis but more nonspecific Rhinorrhea is associated with acute exacerbations Chronic unproductive cough, laryngitis, and headache may occur Chronic/recurrent infections occur three or four times per year and are unresponsive to steam and decongestants
- #15 Reduce signs and symptoms, Achieve and maintain patency of the ostia, Limit antibiotic treatment to those who may benefit Eradicate the bacterial infection with appropriate antibiotic therapy, Minimize the duration of illness, prevent complications, and prevent progression from acute disease to chronic disease.
- #24 General A sore throat of sudden onset that is mostly self-limited Fever and constitutional symptoms resolving in about 3 to 5 days Clinical signs and symptoms are similar for viral causes and nonstreptococcal bacterial causes
- #25 General A sore throat of sudden onset that is mostly self-limited Fever and constitutional symptoms resolving in about 3 to 5 days Clinical signs and symptoms are similar for viral causes and nonstreptococcal bacterial causes
- #26 suppurative complications, such as peritonsillar abscess, cervical lymphadenitis, and mastoiditis.
- #31 Patients with documented histories of rheumatic fever (including cases manifested solely by Sydenham chorea) and those with definite evidence of rheumatic heart disease should receive continuous prophylaxis initiated as soon as the patient is diagnosed and the initial infection has been treated. The duration of secondary prophylaxis is individualized based on patient risk of recurrence of rheumatic fever and/or rheumatic heart disease. Intramuscular benzathine penicillin G every 4 weeks is the recommended regimen for secondary prevention in the United States in most circumstances. Additional options for secondary prophylaxis include oral penicillin V and sulfadiazine. Medication adherence is key to successful secondary prevention