Urti Antibiotics

1. Family Medicine
Department
Dr. Eman
Ahmad Marei
Husam Salhab
URTI & Antibiotics

2. ميحرلا نمحرلا لا مسب
•Definition
• Epidemiology
• Types and causative agents
• Management principles
• Effects of Rx
• Antibiotic in specific URTI
• Factors affect prescription
Objectives

3. Definition
URTI inflammation of respiratory mucosa from
the nose to the lower respiratory tree not
including the alveoli.

4. Symptoms
•Sore throat
•Rhinorrhea
•Facial fullness and Pain
•Headache
•Cough
•Fever
•Tender lymph nodes
•Ear Pain

5. Epidemiology
•In average Children will have 5 URTI/Year, & adults 2-
3/Year
•Acute rhinitis is by far the most common cause of doctors
visit.
•Otitis media is the most common cause for a child under
age 15 to visit a physician.
•Acute Otitis Media, the most common condition for
antibiotics (50%).
•Group A beta-hemolytic streptococcus is only found in
15% to 36% of children with sore throat.

6. Types and causative agents

7. Management Principles
Viral infections need only symptomatic treatment:
-Analgesics (Paracetamol, Aspirin, Ibuprofen)
-Anti-histamines
-Cough suppressants
-Nasal decongestants
-Vitamin C
-Increase fluid intake
Bacterial Infections need antibiotics in addition of
symptomatic treatment

8. Management Principles
Viral (Don’t Use Antibiotics)
Why?
-Promotes antibiotic resistance
-Adverse reactions such as allergy
and anaphylaxis
-Costly
-Patients do not need antibiotics to
feel satisfied
Bacterial (Use antibiotics)
Why?
- To prevent rheumatic fever
- To prevent suppurative
complications (e.g., peritonsillar
abscess)
- To speed up recovery
- To reduce spread to others

9. Management Principles
Viral (Don’t Use Antibiotics)
-Influenza, Common Cold
-Viral Pharyngitis
-Mild Acute Sinusitis
-Mild Acute Otitis Media
Bacterial (Use antibiotics)
-GABHS Pharyngitis
-Moderately to severe Acute
Sinusitis
-Moderately to severe Acute
Otitis Media
-Special Cases (Pertussis,
Croup)

10. But how can we differentiate between Viral and
?Bacterial Pharyngitis, Sinusitis & Otitis Media

11. Acute Pharyngitis (Sore Throat)
Viral
Erythema

12. Acute Pharyngitis
-No Evidence that bacterial sore throat are more severe
than viral ones or that the duration of the illness is
significantly different in either cases.
-Based on symptoms , bacterial and viral sore throat
are limited to be distinguished. Clinical examination
should not be relied upon to differentiate between viral
and bacterial sore throat.
-Sensitivity and Specificity suggest that reliance on
clinical diagnoses will miss 25-50% of GABHS
Pharyngitis cases.

13. Acute Pharyngitis
To determine bacterial Pharyngitis
Strep. Score
McIsaac Criteria

15. Acute Pharyngitis
Rapid Antigen Test (RAT)
Sensitivity of RAT against culture varies between 61-95%.
Specificity of RAT 88-100%
Takes 10 min to be performed
-ve results should be confirmed by culture.
Not found in Jordan

16. Acute Pharyngitis
Throat Culture
20-40% of those with negative throat culture will be labeled as having
GABHS.
+ve culture makes the Dx of GABHS likely , but –Ve culture does not
rule out.

17. Acute Pharyngitis (Drug Of choice)

-Oral penicillin or erythromycin (in penicillin-
allergic individuals), given for 10 days.
-Fortunately, no resistance to penicillin has been
reported, so far, among GABHS-related
Pharyngitis patients.

18. Complication
Rheumatic Fever
- Major Criteria:
- polyarithritis
- carditis
- sydenham chorea
- subcutaneous nodules
- erythema marginatum
- Minor Criteria:
- fever
- leukocytosis
- elevated ESR,CRP
- arthralgia
with evidence of recent group A strep infection

19. Case
A 25 year old man comes to your office with the
complaint of a bad sore throat for 2 days. He has
felt chills and fever today but has not measured his
temperature. He has some pain on swallowing. He
has a slight runny nose and denies cough and other
symptoms. He was previously healthy.
T= 38.5
ears - TM's normal
nose – clear
neck - no cervical adenopathy
lungs – clear

20. How many points does our patient have?
1
1
0
1
0
0
Fever over 38 C
Absence of cough
Tender ant. cervical adenopathy
Tonsillar swelling or exudate
Age< 15 y
Age> 45
Total = 3

21. What are the tests?
Rapid strep test -ve
Throat culture + ve
Give Penicillin + Symptomatic treatment

22. Acute otitis media

23. Normal Tympanic Membrane

24. Acute otitis media
Redness
Bulging

25. Acute otitis media
Bullae Perforation

26. Acute otitis media
Dutch Guidelines
-Dutch study found no difference in outcome between
antibiotics, myringotomy, antibiotics combined with
myringotomy and placebo.
-Only 1 in 7 children under 2 year old with 1
st
episode of
A.O.M derived significant benefit from antibiotic treatment.
-Although it reduce fever faster , it does not reduce duration
of pain or crying.

27. Acute otitis media
Dutch Guidelines
Diagnostic criteria
- Recent perforation of the tympanic membrane
with discharging pus
- Inflamed and bulging tympanic membrane
- One ear drum redder than the other
- Bullae on tympanic membrane

28. TREATMENT GUIDELINES
Symptomatic treatment is provided in all cases
The patient or the parents are instructed to
contact the general practitioner if there is an
abnormal clinical course, in other words:
- increasing illness or earache, decreased
drinking
- no improvement within 3 days

29. TREATMENT GUIDELINES (cont.)
Antibiotics
Children < 6 months
Children
6 months - 2 years +
abnormal clinical course
,For children >2 years
recurrent +
within 12 months or
,Down's syndrome
,cleft palate
compromised immune
system

30. Treatment :
- Amoxcillin – Cluv acid
80-90 mg/kg per day
- Clarithromycin
15 mg/kg twice per day
Complication:
- meningitis
- brain abscess
- mastoiditis
- cholesteatoma

31. Acute sinusitis

32. Acute sinusitis
Antibiotics
Moderate symptoms
not improving
after 10 days
Moderate symptoms
that worsen
after 5 to 7 days
Severe symptoms

-Oral amoxicillin, trimethoprim-sulfamethoxazole,
or doxycycline, given for 3 to 10 days are the
favored antibiotics for treatment.

33. Influenza
- Antibiotics are ineffective
- Amantadine and rimantadine (Antiviral) should
not be used for the treatment of influenza
because of widespread resistance.
- Rx : Symptomatic treatment only

34. Common cold

35. Common cold
-No significant difference between antibiotics and placebo
in cure or general improvement at 6–14 days in people
with colds.

-In a subgroup of people (20%) with nasopharyngeal
culture positive Haemophilus influenzae, Moraxella
catarrhalis, or Streptococcus pneumoniae, antibiotics
increased recovery at 5 days compared with placebo.
-However, we have no methods currently of easily
identifying such people at first consultation.
-Rx: Symptomatic treatment only

36. Pertussis (Whooping Cough)

37. Pertussis
-Treating acute tracheobronchitis with antibiotics
is not recommended, since most cases are viral,
and thus resolve spontaneously.
-In adults who report exposure to a patient with
confirmed or suspected pertussis, erythromycin
or trimethoprim-sulfamethoxazole should be
administered for 14 days. This will decrease
contagion from bacterial shedding, but is not
expected to improve resolution of symptoms,
unless started within 10 days of the onset of
illness

38. Croup
Inflammation of the larynx and upper airway.

39. Croup
No systematic review, RCTs, or observational
studies of sufficient quality on antibiotics in
children with moderate to severe croup.
Antibiotics do not shorten the clinical course of a
disease that is predominantly viral in origin.
This does not apply if bacterial tracheitis is
suspected.
Rx: - Racemic epinephine
- Oral dexamethazone

40. Factors affect prescription
-Patient expectation and satisfaction.
-Severity.
-Duration of illness
-Parents demands.
-Concerns about secondary bacterial infection.
-Time.

41. Thank You
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