Prescribing Antibiotics
Upper respiratory infections (URIs) are the most common forms of acute illnesses among people in the world. Primary care givers have a tendency to mismanage these illnesses due to the fact that they are self limiting. Mr. Smith and his family should understand that upper respiratory diseases are a group of illnesses which include rhinitis, sinusitis, acute pharyngitis, laryngitis and tonsillopharyngitis. Grimaldi-Bensouda et al. (2014) found out that majority of these illnesses are viral in nature and would cause severe complications if they are not managed promptly.
Upper respiratory infections have been found to be the number one cause of ear infections among children under the age of five which eventually results in deafness.
Most physicians have for a long time been prescribing antibiotics as the most definitive treatment for URIs. Antibiotics are only effective in bacterial causing microbes and not viruses as is the case. Bacteria only come in secondary to the viral infections and may lead to cases such as otitis media and sinusitis. It is paramount to understand the causative viral agent before management may be initiated. Common colds may be caused by any of the following four viruses: adenovirus, rhinovirus, respiratory syncytial virus and coronavirus. These viruses produce symptoms that may appear similar, necessitating a prompt intervention. In as much as the illnesses may only warrant an outpatient form of management does not mean that appropriate care should not be offered.
Mechanisms through which the viral infections are transmitted are not well established. However, most of these colds are thought to be spread when hands become contaminated by secretions. Symptoms of URIs may take between 3 to 14 days, or even much longer. The symptoms are self limiting; hence most care givers do not see the essence of bringing their children to hospital. Whichever the practice, it is advisable for parents to take their children for professional medical care once symptoms of the infections take more than two weeks to resolve. Mr. Smith’s case is not a severe one as his kid does not present with symptoms of secondary infections.
Management of Acute Respiratory Infections
As earlier explained, there is no specific drug regimen for management of acute respiratory infections that are viral in nature. The illnesses are self-limiting and would resolve on their own. Besides, the illness is common among children in many US homes and they have been dealt with using over the counter medication without there being a problem. It should be remembered however, that it is prudent for all health concerns among children and any member of the public to be investigated by a healthcare practitioner who will further direct the required management. Management for acute URIs is can be divided into two broad categories; namely prescriptive and non-prescriptive management.
Mr. Smith seems to be in a hurry for a trip out of town with members of his family. Just like what numerous literate people would do, he requests for a drug that will be administered to his son, so that the normal program may not be tampered with. He suggests that an antibiotic would do all the work. According to Hersh et al. (2013) the problem with overusing antibiotic therapy is that the body will become used to it and develop what is commonly referred to as antibiotic resistance. This is a terrible situation one can ever be diagnosed with. It means that the body becomes so used to the drug such that it will not be in a position to respond to it later on when a bacterial infection attacks.
Non-pharmacologic therapies that Mr. Smith should consider include adequate rest for the child. During the trip, the child can only be allowed to perform light activities such as walking as may be tolerated by the body. In as much as the child may appear well hydrated, it will be prudent for him to be given oral fruits to counter some of the symptoms that have been brought about by the infections. Management of the symptoms must be continued until the time when the health care practitioner is satisfied that the infections have completely been eradicated. Last but not least, honey can be used in the event that the child is coughing. The non-pharmacologic therapies would best work when the family event is postponed to a later date. The entire activity would only make the ailing child uncomfortable and not respond to recovery options appropriately.
Home remedies have also been known to eradicate the infections. Mr. Smith should consider applying the magic of warm moist air. Warm moist air may come in a variety of ways such as drinking warm beverages, creating humidity in the room by using a vaporizer and turning hot water on in the shower and inhaling the steam. Of course these remedies may appear strange to a 4 year old. Mr. Smith or any other senior member of the family may be instructed to perform the home remedies to the minor. Mangione-Smith et al. (2015) noted that both cold and dry air should be avoided at all costs since they would work to worsen the symptoms. This makes the family retreat unsuitable for the sick child.
Recent studies have indicated that saline water is beneficial in the management of upper respiratory infections. The saline functions to decongest the nasal cavity. Saline sprays are also available at the counter and can as well be made in the home environment. Mr. Smith needs to consider application of warm packs on the face of his son to ease the congestion. A clean towel can be dipped into warm water and applied on the face after every few hours until when it resolves.
Prescriptive Management
Prescriptive management can be classified into four major categories. They include anti-histamines, decongestants, expectorants and antitussives. Each of these drugs plays a crucial role in seeing to it that the symptoms of common cold are put under control. For the dosage, Mr. Smith will be expected to adhere to the instructions issued by the attending physician. All the drugs have side effects that he will be informed of so that he does not become alarmed when he arrives at his premise. It is important for all members of his family to be involved in the care since the illness of one person affects each one of them.
Acetaminophen is the drug of choice in the reduction of fever and aches on the body. On initial contact with the child, it became clear that the child had escalated body temperature. Another drug of choice to lessen this symptom would be nonsteroidal anti-inflammatory drugs such as ibuprofen. Anti-histamines on the other hand are known to decrease secretions from the nasal mucosa. This would not be a drug of choice for Mr. Smith’s case since his son has not reached that point. Antitussive drugs are known for their ability to reduce cough in URIs. Drugs in this category that Mr. Smith should be advised to give to his child include codeine and guaifenesin. Inflammation on the airway can be managed effectively by using steroids such as prednisolone and dexamethasone. All these drugs are commercially available both in the oral and nasal forms. In addition to putting inflammation in check, these drugs significantly reduce swelling and congestion of the airway (Rún Sigurðardóttir, Nielsen, Munck & Bjerrum, 2015).
Decongestants are indicated in the management of the infections. Here, pseudoephedrine and phenylephrine are recommended. The only situation where these decongestants should never be contemplated is in those below two years and clients known to have hypertension. Oxymetazoline is a short-term decongestant that can as well be administered to the child. A combination of these drugs has been found to yield beneficial outcomes in patients. Certain cough and cold medications are known to result in drowsiness especially among children below the age of 4 years. When being administered, sufficient caution need to be taken.
Mustafa et al. (2014) noted that in as much as antibiotic therapy is highly contraindicated in infections of the upper respiratory tract, there are certain exceptions. There exist infections in the upper respiratory tract that must be managed used antibiotics. They include but not limited to epiglottitis, sore throat and bacterial sinusitis. In these situations, antiviral drugs may only be prescribed when the patient is immune-compromised. It will be up to the attending physician to determine the most appropriate antibiotic regimen to use in the management. Care need to be taken so that the patient’s condition will not be complicated by resistance.
Irritation of the throat can also be managed by use water gurgles and lozenges. Besides, Mr. Smith should consider staying in an irritant free place so that his son’s throat may not become painful. The irritants in this case can be brought about by cigarette smoke, pollution, dust and a cold weather. Mr. Smith should understand that infections of the respiratory tract pose a major risk to children whose bodies are growing fast. Children at such an age are exploring their environment hence they would not escape URIs. He should ensure that his son plays in a safe environment to avoid recurrence. The house should be kept clean at all the time to minimize incidences of hand to nose infections.
According to Yeh et al (2016), other than prescriptive and non prescriptive therapies, herbal medicine has been used for long in managing upper respiratory infections. Though little is known about how these drugs heal infections, many people have reported good outcomes for a family member once or twice in the past. In as much as the success rate of herbal remedies cannot be determined, they continue to be an option for those who would not want to take their children to hospital and would never try non prescriptive remedies.
Upper respiratory infections are illnesses that need to be handled with seriousness just like other conditions. Other than the management that Mr. Smith’s son would get, I have provided links of the articles that he will read to get more information on the management of acute upper respiratory infections. He can read at his own time after he leaves the facility.
References
Grimaldi-Bensouda, L., Bégaud, B., Rossignol, M., Avouac, B., Lert, F., Rouillon, F., … & Abenhaim, L. (2014). Management of upper respiratory tract infections by different medical practices, including homeopathy, and consumption of antibiotics in primary care: the EPI3 cohort study in France 2007–2008. PloS one, 9(3), e89990. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089990
Hersh, A. L., Jackson, M. A., Hicks, L. A., & Committee on Infectious Diseases. (2013). Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics, 132(6), 1146- 1154. http://pediatrics.aappublications.org/content/132/6/1146
Mangione-Smith, R., Zhou, C., Robinson, J. D., Taylor, J. A., Elliott, M. N., & Heritage, J. (2015). Communication practices and antibiotic use for acute respiratory tract infections in children. The Annals of Family Medicine, 13(3), 221-227. http://www.aafp.org/afp/2012/1101/p817.html
Mustafa, M., Wood, F., Butler, C. C., & Elwyn, G. (2014). Managing expectations of antibiotics for upper respiratory tract infections: a qualitative study. The Annals of Family Medicine, 12(1), 29-36. https://www.ncbi.nlm.nih.gov/pubmed/24445101
Rún Sigurðardóttir, N., Nielsen, A. B. S., Munck, A., & Bjerrum, L. (2015). Appropriateness of antibiotic prescribing for upper respiratory tract infections in general practice: Comparison between Denmark and Iceland. Scandinavian journal of primary health care, 33(4), 269-274. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750736/
Yeh, Y. H., Chou, Y. J., Huang, N., Pu, C., & Chou, P. (2016). Seasonal variations of prescriptions for the major syndrome types and manifestations of upper respiratory tract infection in tradition Chinese medicine. Complementary Therapies in Medicine, 29, 213-218. https://www.ncbi.nlm.nih.gov/pubmed/27912949
