Internal Medicine/Upper Respiratory Symptoms

Upper Respiratory Infections

Improving Ambulatory Antibiotic Prescribing

Inappropriate antibiotic prescribing in ambulatory care settings contributes to the emergence of antibiotic-resistant bacteria and unnecessary healthcare costs. Strategies to improve ambulatory antibiotic prescribing include:

• Education: Healthcare providers can benefit from ongoing education about the appropriate use of antibiotics, including when not to prescribe them.
• Clinical Decision Support Systems: Implementing clinical decision support systems in electronic health records can provide real-time guidance to clinicians, promoting evidence-based prescribing.
• Antibiotic Stewardship Programs: Establishing antibiotic stewardship programs in ambulatory care settings can help monitor antibiotic use, track resistance patterns, and implement interventions to improve prescribing practices.
• Patient Education: Educating patients about the appropriate use of antibiotics, the importance of completing prescribed courses, and the potential risks of unnecessary antibiotics can reduce patient demand for these drugs.

Ambulatory Antibiotic Stewardship

Ambulatory antibiotic stewardship programs aim to optimize antibiotic use in outpatient settings. Key components of such programs include:

• Guideline Development: Developing evidence-based guidelines for common infections can provide clear recommendations to clinicians.
• Audit and Feedback: Regularly auditing antibiotic prescribing practices and providing feedback to healthcare providers can help identify areas for improvement.
• Antibiotic Restrictions: Implementing restrictions on certain high-risk antibiotics can prevent their overuse.
• Provider Education: Continuous education for healthcare providers on antibiotic prescribing guidelines and resistance patterns is essential.
• Public Awareness Campaigns: Engaging the public through awareness campaigns can reduce patient expectations for antibiotics when they are not needed.

Nonspecific Upper Respiratory Infection (“The Common Cold”)

Definition and Etiology

The common cold, or nonspecific upper respiratory infection (URI), is a viral infection primarily caused by rhinoviruses. Other viruses, such as coronaviruses and adenoviruses, can also contribute to URIs. These infections are highly contagious and primarily spread through respiratory droplets.

Symptoms and Signs

Patients with nonspecific URIs typically experience:

• Runny or Stuffy Nose: Nasal congestion or discharge is a hallmark symptom.
• Sneezing: Frequent sneezing is common as the body attempts to expel the virus.
• Sore Throat: Throat irritation and discomfort can occur.
• Cough: A dry or productive cough may develop.
• Mild Fever: Some individuals may experience a low-grade fever.
• Fatigue: Feeling tired or rundown is typical during a URI.

Treatment

There is no cure for the common cold, and antibiotics are ineffective against viral infections. Management focuses on symptom relief and includes:

• Rest: Adequate rest helps the body's immune system combat the virus.
• Hydration: Staying well-hydrated thins mucus and soothes a sore throat.
• Pain and Fever Relief: Over-the-counter pain relievers like acetaminophen or ibuprofen can alleviate discomfort and reduce fever.
• Cough Suppressants: Cough medicines may be used to control a persistent cough.
• Saline Nasal Sprays: These can help relieve nasal congestion.
• Antiviral Medications: In some cases, antiviral drugs may be prescribed, but they are typically reserved for severe cases or individuals at high risk of complications.

This sub-section provides a detailed exploration of nonspecific upper respiratory infections (common cold), including their definition, causes, symptoms, and treatment options. It emphasizes the importance of appropriate antibiotic use and ambulatory antibiotic stewardship in managing such infections.

Ear Pain

Otitis Externa

Otitis externa, commonly known as "swimmer's ear," is an infection or inflammation of the external ear canal. It typically occurs when water, often contaminated with bacteria or fungi, becomes trapped in the ear canal, creating a favorable environment for infection. Key features of otitis externa include:

Patients with otitis externa may experience ear pain, itching, hearing loss, and a feeling of fullness in the ear. In severe cases, there may be drainage of pus or discharge from the ear.

Management involves keeping the ear dry, using antibiotic or antifungal ear drops, and addressing any underlying factors such as excessive moisture or trauma to the ear canal.

Acute Otitis Media

Acute otitis media (AOM) is a common childhood infection involving the middle ear. It often follows an upper respiratory tract infection, and its hallmark is the presence of fluid and inflammation behind the eardrum.

Children with AOM may present with ear pain, fever, irritability, and difficulty hearing. In severe cases, the eardrum may rupture, leading to drainage of pus.

Antibiotics are typically prescribed for bacterial AOM. Pain management and close follow-up are essential, as some cases may require drainage of fluid from the middle ear.

Otitis Media with Effusion

Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear without signs of infection. It is common in children and often follows AOM. Key points about OME include:

Unlike AOM, OME may be asymptomatic or associated with mild hearing loss and a feeling of fullness in the ear.

OME often resolves on its own, but persistent cases may require monitoring and, in some instances, the placement of ear tubes to drain accumulated fluid.

Acute Mastoiditis

Acute mastoiditis is a rare but serious complication of AOM in which infection spreads to the mastoid bone behind the ear. It presents with severe ear pain, swelling, fever, and redness behind the ear. Immediate medical attention and intravenous antibiotics are necessary to manage this condition.

Sinus Symptoms

Acute sinusitis involves inflammation and infection of the paranasal sinuses, often following a viral upper respiratory infection. Patients with acute sinusitis may experience facial pain or pressure, nasal congestion, thick nasal discharge, and a reduced sense of smell. Fever can also be present. Treatment options include saline nasal irrigation, decongestants, pain relievers, and antibiotics in some cases, particularly if symptoms persist or worsen.

Chronic sinusitis is diagnosed when symptoms persist for at least 12 weeks. It is often characterized by nasal congestion, postnasal drip, facial pain, and reduced smell. Management includes saline irrigation, corticosteroid nasal sprays, and, in some cases, surgery to improve sinus drainage.

Sore Throat and Neck Pain

Streptococcal pharyngitis, commonly known as strep throat, is a bacterial infection caused by group A Streptococcus bacteria. Patients with strep throat typically experience a sore throat, fever, swollen tonsils, and white or yellow spots on the tonsils or throat. It can cause significant discomfort. Antibiotics, such as penicillin or amoxicillin, are the primary treatment for strep throat to prevent complications and reduce contagiousness. Pain relievers and rest are also recommended.

Nonstreptococcal pharyngitis encompasses various viral and bacterial causes of sore throat, including viral infections like the common cold and bacterial infections like those caused by Haemophilus influenzae or Mycoplasma pneumoniae. Management depends on the specific underlying cause.

Abscesses in the head and neck region, such as peritonsillar abscesses and retropharyngeal abscesses, require prompt evaluation and treatment. They can cause severe pain, difficulty swallowing, and even airway compromise. Management involves surgical drainage and antibiotics.

Epiglottitis is a rare but potentially life-threatening infection of the epiglottis. It presents with severe throat pain, difficulty swallowing, drooling, and a high fever. Immediate medical attention, often including intubation, is necessary.

Laryngitis is characterized by inflammation of the larynx, resulting in hoarseness or loss of voice. It can be caused by viral infections, vocal strain, or irritants. Treatment includes vocal rest, hydration, and addressing the underlying cause.