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EFFECTIVE MANAGEMENT OF RESPIRATORY TRACT INFECTIONS

Explore optimal strategies for Tonsillitis, Common Cold, Laryngitis, Bronchitis, Bronchiolitis, Pneumonia, and Bronchiectasis through antibiotics rotation, nebulization, and more. Learn about prompt diagnostics, treatment escalation, and follow-up care.

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EFFECTIVE MANAGEMENT OF RESPIRATORY TRACT INFECTIONS

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  1. EFFECTIVE MANAGEMENT OF RESPIRATORY TRACT INFECTIONS ADIL WARIS KPA 2019 MOMBASA SLIDES COURTESY DR RA’ANA HUSSAIN

  2. Six packs in Mombasa

  3. TONSILLITIS/ COMMON COLD • Throat swab • Salt gargles vs iodinated compounds • Lozenges mild benefit but choke risk • Honey • Rotation of antibiotics penicillin/ first generation cephalo / macrolides • Antihistamines XX • Cough mixtures… mucolytics ,expectorants and antitussives

  4. TONSILLITIS/ COMMON COLD • Aromatic vaporsfor external rub XX • egmenthol, camphor, eucalyptus oil • Zinc XX • Vitamin C XX • Echinacea purpurea XX • Kelly LF. Pediatric cough and cold preparations. Pediatr Rev 2004; 25:115. • Saketkhoo K, Januszkiewicz A, Sackner MA. Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance. Chest 1978; 74:408. • World Health Organization. Cough and cold remedies for the treatment of acute respiratory infections in young children, 2001. http://whqlibdoc.who.int/hq/2001/WHO_FCH_CAH_01.02.pdf (Accessed on August 31, 2011).

  5. LARYNGITIS • Stridor inspiratory vs expiratory • Cold mist has marginal effect • Nebulised steroids if vomiting and no IV access • Oral vs IM dexamethasone … SINGLE DOSE • Nebulised adrenaline can be repeated • Intubation if needed at least 3 days • Herpetic laryngitis /HIV if recurrent or refractory Gates A, Gates M, Vandermeer B, et al. Glucocorticoids for croup in children. Cochrane Database Syst Rev 2018; 8:CD001955.

  6. BRONCHITIS • Persistent bacterial bronchitis (PBB) • Lower airways are NOT sterile • Even viruses can cohabit in the lower airways • Chronic moist cough • 14 days of antibiotics • Similar presentation to asthma • CXR mild peribronchial cuffing • Bronchoscopy reveals mucopurulent discharge in the bronchi 

  7. RECURRENT PBB • >3 episodes/year beware and investigate • Retained foreign body • Congenital abnormalities such as cystic fibrosis, primary ciliary dyskinesia, malacia in airways • Immune deficiencies such as selective antibody deficiency • Bronchoscopy, chest CT scan, sweat test, and an immune evaluation Chang AB, Oppenheimer JJ, Weinberger M, et al. Etiologies of Chronic Cough in Pediatric Cohorts: CHEST Guideline and Expert Panel Report. Chest 2017; 152:607.

  8. BRONCHIOLITIS • Shallow nasal suctioning • Oxygen • Salbutamol trial … usually poor response • Hypertonic saline now questionable • Steroids in any form XX • Antihistamines XX • Cough mixtures /mucolytics /expectorants XX • Chest physiotherapy only for atelectasis O'Donnell K, Mansbach JM, LoVecchio F, et al. Use of Cough and Cold Medications in Severe Bronchiolitis before and after a Health Advisory Warning against Their Use. J Pediatr 2015; 167:196.

  9. PNEUMONIA • Clinical features confirm • Role of oral high dose Amoxil (90 to 100 mg/kg per day divided into two or three doses; maximum dose 4 g/day) • Choice of antibiotics and how to escalate • Role of 3rd generation cephalosporin with amikacin • Chest physiotherapy only for atelectasis • Inappropriate secretion of antidiuretic hormone (SIADH) • Serum electrolytes, fluid balance, and urine specific gravity should be monitored

  10. PNEUMONIA 2 • Follow-up CXR are not necessary in asymptomatic children • With complicated CAP/ that required intervention/ • Recurrent pneumonia, persistent symptoms / • severe atelectasis, or unusually located infiltrates • Repeat 2-3 weeks after hospital discharge  • Step down to Oral therapy typically is initiated when the patient has been afebrile for 24 to 48 hours and can tolerate oral intake. • The total duration of antibiotic therapy is usually 7 to 10 days for uncomplicated CAP and up to four weeks in complicated CAP UrangaA, España PP, Bilbao A, et al. Duration of Antibiotic Treatment in Community-Acquired Pneumonia: A Multicenter Randomized Clinical Trial. JAMA Intern Med 2016; 176:1257.

  11. BRONCHIECTASIS 1 • Not a disease but complication of .. • Copius daily purulent sputum with finger clubbing • Identify the primary lung condition • Good nutrition • Vaccines .. Influenza/pneumococcal • Biomass free environment • Reduce possible viral aerosols… role of home school? • Rule out pulmonary hypertension

  12. BRONCHIECTASIS 2 • Airway clearance techniques eg postural drainage and percussion, breathing and coughing techniques, airway oscillating devices, external percussion vests • EARLY antibiotics for 10 day minimum • Azithromycin on Mon/Wed/Friday • Chest physio beware in hemoptysis • Nebulised antibiotics especially for pseudomonas Chang AB, Bush A, Grimwood K. Bronchiectasis in children: diagnosis and treatment. Lancet 2018; 392:866.

  13. BRONCHIECTASIS 3 • Salbutamol role limited • Hypertonic saline … negative trials • Nebulised steroids.. Case by case scenario • Surgery for localized disease • Lung transplant when all fails Sethi GR, Batra V. Bronchiectasis: causes and management. Indian J Pediatr 2000; 67:133.

  14. SUMMARY THE ART OF WAITING…..AND ADDING A TINCTURE OF TIME

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