ADIL WARIS KPA 2019 MOMBASA SLIDES COURTESY DR RAANA HUSSAIN Six packs in Mombasa TONSILLITIS COMMON COLD Throat swab Salt gargles vs iodinated compounds Lozenges mild benefit but choke risk ID: 932746
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Slide1
EFFECTIVE MANAGEMENT OF RESPIRATORY TRACT INFECTIONS
ADIL WARIS KPA 2019 MOMBASA SLIDES COURTESY DR RA’ANA HUSSAIN
Slide2Six packs in Mombasa
Slide3TONSILLITIS/ COMMON COLD
Throat swabSalt gargles vs iodinated compounds Lozenges mild benefit but choke riskHoney Rotation of antibiotics penicillin/ first generation cephalo / macrolidesAntihistamines XXCough mixtures… mucolytics
,expectorants and antitussives
Slide4TONSILLITIS/ COMMON COLD
Aromatic vapors for external rub XXeg menthol, camphor, eucalyptus oilZinc 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).
Slide5LARYNGITIS
Stridor inspiratory vs expiratory Cold mist has marginal effectNebulised steroids if vomiting and no IV accessOral vs IM dexamethasone … SINGLE DOSENebulised 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:CD001955
.
Slide6BRONCHITIS
Persistent bacterial bronchitis (PBB)Lower airways are NOT sterileEven viruses can cohabit in the lower airways Chronic moist cough14 days of antibioticsSimilar presentation to asthmaCXR mild peribronchial cuffing Bronchoscopy
reveals mucopurulent discharge in the bronchi
Slide7RECURRENT PBB
>3 episodes/year beware and investigateRetained foreign bodyCongenital 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.
Slide8BRONCHIOLITIS
Shallow nasal suctioning Oxygen Salbutamol trial … usually poor responseHypertonic saline now questionableSteroids in any form XXAntihistamines XXCough mixtures /mucolytics
/expectorants XX
Chest
physiotherapy only for
atelectasis
O'Donnell
K,
Mansbach
JM,
LoVecchio
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
.
Slide9Slide10PNEUMONIA
Clinical features confirmRole 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
Slide11PNEUMONIA 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.
Slide12BRONCHIECTASIS 1
Not a disease but complication of ..Copius daily purulent sputum with finger clubbingIdentify the primary lung conditionGood nutritionVaccines .. Influenza/pneumococcalBiomass free environment Reduce possible viral aerosols… role of home school?Rule out pulmonary hypertension
Slide13BRONCHIECTASIS 2
Airway clearance techniques eg postural drainage and percussion, breathing and coughing techniques, airway oscillating devices, external percussion vestsEARLY 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
.
Slide14BRONCHIECTASIS 3
Salbutamol role limitedHypertonic saline … negative trialsNebulised 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.
Slide15SUMMARY
THE ART OF WAITING…..AND ADDING A TINCTURE OF TIME
Slide16