Acute Respiratory infections in Children

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Acute Upper Respiratory Infections (AURI)
Site Common Organisms Pattern Recognition Therapy
Naso-Pharyngitis (Common cold) VIRAL: (commonest)
Rhinovirus,
Adenovirus,
Coronavirus Coxsackie virus Influenza virus

BACTERIAL:
Gp. A.. Hemolytic-
streptococci
Mycoplasma
coryne bacteria
H. Influenza
Strep. Pneumonia

* Seasonal (winter)

* Outbreaks in community

* Prodrome: Fever sneezing, rhinorrhea, lacrimation, nasal obstruction

* Worsening of above symptoms

* Increasing fever and constitutional symptoms

* Purulent nasal discharge

* Poor activity and appetite
Self limiting Paracetamol 50 mg/kg in 3-4 div doses

Normal saline nasal drops/spray 3-4 times a day. In infants, ten minutes before feeding.

Penicillins (Amoxycillin 50mg /kg/d in 3-4 divided doses for 5 days) OR Macrolides (Erythromycin 50 mg /kg/d in 3-4 divided doses for 5 days)
Pharyngo Tonsillitis > VIRAL: (commonest) Rhinovirus, Adenovirus, Coronavirus Coxsackie virus Influenza virus BACTERIAL: Gp. A.. Hemolytic Streptococci Mycoplasma coryne bacterium Diphtheria * Seasonal (winter)

* Prodrome: Fever, cough, sore throat rhinitis

* Throat: exam: Pharynx inflammed,exudates on the lymphoid follicles on hard palate and tonsils, cervical adenopathy, lymphocytosis

* Over crowding

* Prodrome: Headache vomiting, abdominal pain, fever > 40C, poor appetite & activity

* Throat exam: Tonsils enlarged, anterior pillar flushing, anterior cervical adenopathy, petichiae over the soft palate.

* Neutrophilic leuco-cytosis. (Throat swab culture and sensitivity is warranted)
Warm liquid diet Saline gargle Paracetamol 50 mg /kg/d 3-4 divided doses to reduce pain

Steam inhalation Penicillins (Penicillin V 50 mg /kg/d 3-divided doses for 5 days) before food or Macrolides Erythromycin

50 mg/kg/d 3-4 divided doses x 5 days
Note:
  • Rhinitis, hoarseness of voice and cough rarely occurs in bacterial and presence of 2 out of these indicates viral origin.
  • Examination of the throat using tongue depressor
    is mandatory in all cases presenting with soreness of throat (exception acute epiglottitis).
  • Presence of membranous exudate over the tonsils indicates conditions like diphtheria, herpangina, infectious mononucleosis,
    and agranulocytosis and warrants investigation (CBC, throat swab).
  • Beware of complications like otitis media, chronic pharyngeal ulcers, peritonsillar abscess following attack of pharyngotonsillitis.
  • Rheumatic fever and acute post streptococcal glomerular nephritis are Immunological complications of Gp A hemolytic streptococcal pharyngotonsillitis and hence whenever suspected, treatment with penicillin V for 10 days (Primary chemoprophylaxis for rheumatic fever) is mandatory.
Otitis Media:
It is a common pediatric ailment. Frequent respiratory infections often leads to otitis media. The other predisposing factors include bottle feeding, recurrent tonsillitis, anatomical and physiological anomalies like cleft palate and cranio facial defects. Hearing defects,perforation and middle ear problems are common complications occurring due to lack of timely administration of medications.

Acute Upper Respiratory Infections
Otitis Media
Site Common Organisms
Otitis Media Bacterial:
Streptococcus pneumoniae
H. Influenza
Moraxella catarrhalis
Streptococcus Group A
Staphylococcus

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tinaannjohn 

good info

dinesh-RML 

good material. references should be given.

palakkmc 

good site

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