EFFECTIVE MANAGEMENT OF RESPIRATORY TRACT INFECTIONS ADIL WARIS
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EFFECTIVE MANAGEMENT OF RESPIRATORY TRACT INFECTIONS ADIL WARIS KPA 2019 MOMBASA SLIDES COURTESY DR RA’ANA HUSSAIN
Six packs in Mombasa
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
TONSILLITIS/ COMMON COLD • Aromatic vapors for external rub XX • eg menthol, 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).
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: CD 001955.
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
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.
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, Lo. Vecchio 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.
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 3 rd 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
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 • • • Uranga A, 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.
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
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.
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.
SUMMARY THE ART OF WAITING…. . AND ADDING A TINCTURE OF TIME
- Dr adil waris
- Difference between pyramidal and extrapyramidal tract
- Anterior spinothalamic tract
- Upper respiratory labeled
- Classification of upper respiratory tract infection
- Air passage
- Classification of pneumonia
- Upper and lower respiratory system
- Anatomy of the upper respiratory tract
- Common cold meaning
- Upper rti
- Upper respiratory tract
- Carina nasal
- Conclusion of respiratory tract infection
- Normal flora of respiratory tract
- Respiratory zone vs conducting zone
- Susunan faraid