The use of Antibiotics in upper respiratory infection in children

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Infections involving the sinuses, throat, airways, or lungs are examples of respiratory tract infections (RTIs), which affect the body parts involved in breathing. Children’s acute respiratory infections are a leading source of morbidity and mortality, and they are especially important in developing nations like India. Acute respiratory infections account for up to 20–40% of all outpatient attendance and 12–35% of inpatient admissions. According to a study conducted in a rural area with an estimated population of 3700, 12.1% of all children under the age of five had acute respiratory infections.

 Upper respiratory tract infections made up 2.2 of the 2.5 bouts of acute respiratory infection in children under the age of five that were observed in this age group per year.

Nasopharyngitis, pharyngitis, tonsillitis, and otitis media made up 87.5% of all infection episodes, as did other upper respiratory tract infections. The remaining 12.5% were lower respiratory tract infections, such as pneumonia and bronchiolitis.

Acute respiratory infections are a serious issue in children, with upper respiratory infections accounting for the bulk of these infections. However, the majority of acute respiratory infections are upper respiratory, and viral agents are the main causes of these illnesses. Bacterial pathogens are important when it comes to severe lower respiratory tract infections.

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Common Cold and antibiotics

Common Cold

The average child experiences 3–8 cold bouts a year. The most prevalent cause of the common cold is the rhinovirus, which accounts for up to 60% of infections. Other viral illnesses that can cause the common cold include parainfluenza, respiratory syncytial, corona, adeno, echo, coxsackie, and parainfluenza viruses. The etiological agents change depending on the host’s age and the season.

Nasal blockage, nasal discharge, and throat irritation are symptoms. Low-grade fever, malaise, sneezing, and purulent nasal discharges are frequently associated with this. The absence of any agent-specific characteristics might be seen in the symptoms. Symptoms often last for around 7 days.

The majority of the time, a common cold in children resolves on its own without the need for special treatment. Antibiotic use has no impact on how a situation develops or turns out. Contrarily, because it raises the possibility of colonization with resistant organisms, antibiotic use has the potential to be hazardous. This could lead to a subsequent bacterial infection that is resistant to common medications.

The majority of the time, a common cold has a great outcome and fully recovers, but occasionally complications can happen. These include tonsillitis, sinusitis, acute otitis media with effusion, and lower respiratory tract infections. Antibiotics should not be used for the signs and symptoms of a cold alone unless specific diagnostic criteria for the identification of these complications are met. Studies have demonstrated the futility of using antibiotics to prevent bacterial cold complications. Antimicrobial treatment of the common cold failed to prevent lower respiratory infections, according to a meta-analysis of five randomized clinical trials. Additionally, it did not reduce the length of the upper respiratory infection.

Antibiotics shouldn’t be administered to treat a normal cold. Nasal mucopurulent discharge is a characteristic of the common cold and is not by itself a sign that you need antibiotics unless it lasts for more than 10 to 14 days.

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Sinusitis and antibiotics

Upper respiratory infection

Inflammation of one or more of the paranasal sinuses’ mucosal linings is known as sinusitis. It can be brought on by non-infectious (allergic) or infectious reasons. The common cold nearly invariably leads to sinusitis in youngsters. There is inflammation and congestion of the nasal and sinus mucosa even in uncomplicated viral upper respiratory infections, such as the common cold. Therefore, rhinosinusitis should be the diagnosis for these illnesses. In the vast majority of cases, this inflammation resolves spontaneously.

Acute sinusitis complicates upper respiratory infections in between 0.5 and 10% of cases. The adoption of suitable diagnostic criteria is crucial to prevent the overuse of antibiotics because only a small portion of children with rhinosinusitis symptoms have a bacterial origin. Given that viral rhinosinusitis is 20–200 times more prevalent than bacterial sinusitis, this is an especially crucial point.

When a viral upper respiratory infection causes mucosal inflammation and blockage of the sinus Ostia, sinusitis is virtually invariably triggered.

This causes fluid to build up in the sinus cavities, which in turn encourages the typical bacterial flora of the upper respiratory system to flourish. The most frequent causes of sinusitis are S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, and S. pyogenes. However, it should be noted that the majority of rhinosinusitis is viral, and as a result, about 60% of cases resolve on their own without the need for antibiotics.

Once the diagnostic criteria are satisfied, antibiotics are the main treatment for sinusitis. For the majority of children, Amoxycillin (40 mg/kg/day) is a successful first-line treatment for acute, simple sinusitis. 2 Approximately 35% of H. influenzae non-typeable strains, and 85% of M. catarrhalis strains develop beta-lactamases and are amoxicillin resistant.

Therefore, a beta-lactamase-stable antibiotic like amoxicillin clavulanate, cephalexin, or cetactor should be taken into consideration if there is no improvement after 48 hours. If sinusitis is persistent, doesn’t go better, or has a serious illness with a high fever and face edoema, these medications should be used as a first option. A minimum of 10 days should pass between sessions.

When nonspecific upper respiratory infection symptoms persist for more than 10 to 14 days or when there are severe upper respiratory signs and symptoms, such as high fever, face pain, and edoema, a diagnosis of sinusitis should be made. Because radiographic signs of sinusitis might appear with a typical cold, radiographs should only be taken when necessary and with caution. Narrow-spectrum antibiotics should be used for sinusitis to protect against the likely infection.

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Pharyngitis and antibiotics

Upper respiratory infection

A throat condition known as pharyngitis affects the mucous membranes and supporting structures. Tonsillitis, tonsillopharyngitis, and nasopharyngitis are within the clinical diagnostic category. Nasopharyngitis, an infection with nasal symptoms, and non-nasal pharyngitis are the two kinds of pharyngitis (pharyngitis or tonsillopharyngitis).

While pharyngitis without nasal symptoms may have a variety of etiologic causes, including bacteria, viruses, fungi, and other infectious agents, nasopharyngitis almost always has a viral aetiology. The most frequent cause of nasopharyngitis is an adenovirus, with influenza, parainfluenza, and enteroviruses as secondary causes. Streptococcus pyogenes, H. influenzae, C. diphtheriae, and N. meningitides are the bacteria that cause pharyngitis.

Approximately 15% of bacterial pharyngitis and 1-2 people out of 10 with sore throats are caused by Group A streptococci. The majority of the others’ infections are caused by viruses. It is crucial to identify and treat Group A streptococcal pharyngitis as soon as possible since acute rheumatic fever can be avoided with antibiotics used within nine days of the beginning. However, because the majority of sore throats are caused by viruses, antibiotics should only be administered when a diagnosis of Group A streptococcal pharyngitis is established. This will stop people from using antibiotics excessively.

Pharyngitis is accompanied by sore throat symptoms, but their mere existence should not be utilized to make a diagnosis because the same symptoms can also be present in a common cold. The diagnosis requires the presence of objective signs of inflammation in the pharynx, such as erythema, exudate, or ulceration. However, some viral diseases like adenovirus or enterovirus can also cause the same symptoms.

Pharyngitis caused by Group A streptococcal is typically characterized by fever, dysphagia, and abrupt onset of pharyngeal pain. A viral aetiology is suggested by rhinitis, coughing, hoarseness, conjunctivitis, and diarrhea.

Group A streptococci pharyngitis is more likely to occur when there is patchy exudate on the posterior pharynx, palatal petechie, and swollen and sensitive anterior cervical lymph nodes.

However, it is difficult to reliably distinguish between viral and streptococcal pharyngitis in a single child. Streptococcal illness must therefore be taken into consideration in all cases of acute pharyngitis.

It is uncommon for bacteria other than Group A streptococci to cause pharyngitis. Furthermore, there are no side effects like acute rheumatic fever. As was already said, the majority of pediatric pharyngitis cases are caused by viruses. In the absence of a diagnosis of Group A streptococcal pharyngitis or another bacterial illness, antibiotics should not be given to a kid with pharyngitis.

The drug penicillin is used to treat Group A streptococcal pharyngitis. This is a result of its limited range of activity, low cost, and excellent efficacy. In contrast to beta-lactam antibiotic resistance, Group A streptococcal resistance to macrolide antibiotics has been documented. Resistance to macrolides such as clarithromycin or azithromycin would be comparable to erythromycin resistance. Cephalosporins outperformed penicillin in a meta-analysis of 19 investigations, eradicating GABS from the oropharynx more completely. These substances have a broad range of antibacterial activity, which promotes the development of resistance against a variety of bacterial infections. Patients with penicillin allergies, compliance problems, or penicillin therapy failure must get other therapies. Laboratory testing along with clinical and epidemiological findings should be used to determine the diagnosis of Group A streptococcal pharyngitis. Only when a Group A streptococcal infection or other bacterial infection has been diagnosed should antibiotics be administered to a child with pharyngitis. The preferred treatment for Group A streptococcal pharyngitis is penicillin.

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