Viral Upper Respiratory Infection

The upper respiratory tract includes the sinuses, nasal passages, pharynx, and larynx, and is susceptible to a variety of pathogens including many viruses. Although other pathogens can also cause infections of the upper respiratory tract, we are focusing on viral illnesses for the purposes of this review. Upper respiratory tract infections (URIs) include sinusitis, nasopharyngitis (common cold), pharyngitis, epiglottitis, and tracheitis. URI’s are one of the most frequent causes for visits to see a physician in the United States. Despite the fact that many URIs are caused by viral pathogens, more than half of patients in both the clinic and the emergency department setting with a diagnosis of URI received antibiotics. URIs are generally mild, and self-limited illnesses; however, it is important to recognize clinical entities that may be severe and warrant more extensive diagnostic workup and treatment such as epiglottitis and tracheitis. This review covers the pathophysiology, diagnosis, treatment, disposition and outcome for multiple viral URIs seen commonly in the emergency department setting. This review contains 3 figures, 8 tables, and 87 references. Key words: Common cold, epiglottitis, nasopharyngitis, pharyngitis, sinusitis, tracheitis, upper respiratory tract infection

Education campaign reduces antibiotic prescribing by emergency department physicians for upper respiratory tract infections

PsycEXTRA Dataset ◽

10.1037/e504292010-033 ◽

2008 ◽

Cited By ~ 2

Keyword(s):

Emergency Department ◽

Respiratory Tract ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Education Campaign ◽

Upper Respiratory ◽

Principles of Judicious Use of Antimicrobial Agents for Pediatric Upper Respiratory Tract Infections

PEDIATRICS ◽

10.1542/peds.101.s1.163 ◽

1998 ◽

Vol 101 (Supplement_1) ◽

pp. 163-165 ◽

Cited By ~ 11

Author(s):

Scott F. Dowell ◽

S. Michael Marcy ◽

William R. Phillips ◽

Michael A. Gerber ◽

Benjamin Schwartz

Keyword(s):

Respiratory Tract ◽

Antimicrobial Agents ◽

Respiratory Infections ◽

The United States ◽

Antimicrobial Treatment ◽

Antimicrobial Use ◽

Upper Respiratory Tract ◽

Oral Agents ◽

Upper Respiratory ◽

This article introduces a set of principles to define judicious antimicrobial use for five conditions that account for the majority of outpatient antimicrobial use in the United States. Data from the National Center for Health Statistics indicate that in recent years, approximately three fourths of all outpatient antibiotics have been prescribed for otitis media, sinusitis, bronchitis, pharyngitis, or nonspecific upper respiratory tract infection.1Antimicrobial drug use rates are highest for children1; therefore, the pediatric age group represents the focus for the present guidelines. The evidence-based principles presented here are focused on situations in which antimicrobial therapy could be curtailed without compromising patient care. They are not formulated as comprehensive management strategies. For most upper respiratory infections that require antimicrobial treatment, there are several appropriate oral agents from which to choose. Although the general principles of selecting narrow-spectrum agents with the fewest side effects and lowest cost are important, the principles that follow include few specific antibiotic selection recommendations.

Bacterial Infections of the Adult Upper Respiratory Tract

10.2310/fm.1237 ◽

2019 ◽

Author(s):

Laura K Certain ◽

Miriam B Barshak

Keyword(s):

Respiratory Tract ◽

Bacterial Infections ◽

Respiratory Infections ◽

Group A Streptococcus ◽

The United States ◽

Controlled Study ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Upper respiratory tract infections are the most common maladies experienced by humankind.1 The majority are caused by respiratory viruses. A Dutch case-controlled study of primary care patients with acute respiratory tract infections found that viruses accounted for 58% of cases; rhinovirus was the most common (24%), followed by influenza virus type A (11%) and coronaviruses (7%). Group A streptococcus (GAS) was responsible for 11%, and 3% of patients had mixed infections. Potential pathogens were detected in 30% of control patients who were free of acute respiratory symptoms; rhinovirus was the most common.2 Given the increasing problem of antibiotic resistance and the increasing awareness of the importance of a healthy microbiome, antibiotic use for upper respiratory infections should be reserved for those patients with clear indications for treatment. A recent study of adult outpatient visits in the United States found that respiratory complaints accounted for 150 antibiotic prescriptions per 1,000 population annually, yet the expected “appropriate” rate would be 45.3 In other words, most antibiotic prescriptions for these complaints are unnecessary. Similarly, a study in the United Kingdom found that general practitioners prescribed antibiotics to about half of all patients presenting with an upper respiratory infection, even though most of these infections are viral.4 This review contains 5 figures, 16 tables, and 82 references. Keywords: infection, airway, sinusitis, otitis media, otitis externa, pharyngitis, epiglottitis, abscess

Respiratory viruses

Revision Notes for MCEM Part A ◽

10.1093/med/9780199583836.003.0027 ◽

2011 ◽

pp. 208-211

Author(s):

Dr Mark Harrison

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Tract ◽

Common Cold ◽

Respiratory Viruses ◽

Upper Respiratory Tract ◽

The Common ◽

Upper Respiratory ◽

Syncytial Virus ◽

15.1 Rhinovirus, 209 15.2 Influenza, 210 15.3 Parainfluenza, 211 15.4 Respiratory syncytial virus (RSV), 211 • There are more than 100 different serotypes of rhinovirus. • Rhinovirus is chiefly limited to upper respiratory tract infections and is the major cause of the common cold....

Effectiveness of clinical pathway for upper respiratory tract infections in emergency department

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2019.04.022 ◽

2019 ◽

Vol 83 ◽

pp. 154-159

Author(s):

Bahar Madran ◽

Şiran Keske ◽

Soner Uzun ◽

Tolga Taymaz ◽

Emine Bakır ◽

...

Keyword(s):

Emergency Department ◽

Respiratory Tract ◽

Clinical Pathway ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

PRS40 TRENDS IN ANTIBIOTIC PRESCRIBING RATES IN AMBULATORY CARE SETTINGS FOR ADULTS IN THE UNITED STATES WITH NASOPHARYNGITIS, UPPER RESPIRATORY TRACT INFECTIONS AND BRONCHITIS FROM 2006 TO 2008

Value in Health ◽

10.1016/j.jval.2011.02.801 ◽

2011 ◽

Vol 14 (3) ◽

pp. A144

Author(s):

R. Agrawal ◽

J. Shah ◽

P. Chopra ◽

R.R. Aparasu

Keyword(s):

United States ◽

Respiratory Tract ◽

Ambulatory Care ◽

The United States ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Misconceptions and Malpractices Toward Antibiotic Use in Childhood Upper Respiratory Tract Infections Among a Cohort of Lebanese Parents

Evaluation & the Health Professions ◽

10.1177/0163278716686809 ◽

2017 ◽

Vol 41 (4) ◽

pp. 493-511 ◽

Cited By ~ 5

Author(s):

Ghada El Khoury ◽

Elsy Ramia ◽

Pascale Salameh

Keyword(s):

Respiratory Tract ◽

Common Cold ◽

Pediatric Population ◽

Antibiotic Use ◽

Upper Respiratory Tract ◽

Cross Sectional ◽

Upper Respiratory ◽

Antimicrobial resistance is an emerging global health threat. Misuse and abuse of antibiotics are of particular concern in the pediatric population. Since management of childhood illnesses depends considerably on parents’ perceptions, the objectives of this study were to report parents’ perspectives and assess their practices toward antibiotics used for upper respiratory tract infections (URTIs) in children. Using a cross-sectional design, anonymous structured questionnaires were completed by 1,037 parents in public and private schools across Lebanon’s largest governorate. Descriptive statistics were used to report participants’ responses. A multivariate analysis was performed to identify factors affecting knowledge and malpractice related to antibiotic use. Significant misconceptions and malpractices were identified among parents. For instance, 33.9% of parents considered that antibiotics are helpful in treating common cold among children and 36.2% believed antibiotics expedite the recovery of their child with common cold infection. Moreover, there was a lack of knowledge concerning antibiotic coverage, since 37.9% of the respondents believed that antibiotics treat viral infections and 21.5% were neutral toward this question. Around 20% of the participants believed they can reduce the dose of antibiotics if the child gets better. Significant factors associated with poor knowledge and misuses were parents’ lower educational and socioeconomic levels. Despite extensive evidence on the limited role of antibiotics in URTIs, parents in Lebanon continue to misuse them. More concerted efforts are needed to improve parents’ knowledge and practices with regard to the rational use of antibiotics.

1466. Antibiotic utilization reports may reduce prescribing practices for Upper Respiratory Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1647 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S735-S735

Author(s):

David Augusto Terrero Salcedo ◽

Allison Kelly ◽

Victoria Tate

Keyword(s):

Emergency Department ◽

Respiratory Tract ◽

Antibiotic Prescription ◽

Upper Respiratory Tract ◽

Care Providers ◽

Post Intervention ◽

Face To Face ◽

Antibiotic Utilization ◽

Upper Respiratory ◽

Abstract Background More than 90% of Upper respiratory tract infections (URI) have a viral etiology; nonetheless, these represent the most common reason for ambulatory antibiotic prescription. This translates in higher risk of antibiotic-related adverse events and promotion of antimicrobial resistance. Methods A prospective single-center intervention surveying and providing individual, face-to-face comparative reports of antibiotic utilization, for any of the 4 diagnostic entities that constitute upper respiratory tract infection (common cold, pharyngitis, acute rhinosinusitis and acute bronchitis), was performed in our Emergency Department. Example of monthly provider reports used which included general and individualized goals. Results A total of 12 health care providers were followed for 12 months. Education, prescribing reports and individual goals were provided. The pre-intervention prescription rate from September to December 2018 averaged 74.75% (SD 20.59, 95% CI 61.6-87.8), with a post-intervention rate of 55.5% from September to December of 2019 (SD 19.20, 95% CI 43.3-67.7) that was statistically significant (p=0.0036). A higher use of antibiotic was observed in physicians when compared to non-physician providers in both pre and post intervention stages (reduction of 16.6% vs 23% after intervention respectively), with no statistical difference between the two groups (CI 95% of -38.82 to 2.395, p=0.0773). A proposed target of 50% or less was observed in 5 of 12 providers (41.6%), and 2 out of 12 (16.7%) had increase in their antibiotic utilization rate. Comparative use of antimicrobials in the pre (September-December 2018) and post (September-December 2019) - intervention periods. Average individual antimicrobial use rate before and after intervention. Conclusion Routine face-to-face utilization reports may constitute an effective approach in reducing antibiotic prescription practices in the Emergency Department, and potentially, in other outpatient healthcare settings. Disclosures All Authors: No reported disclosures

Pattern and Appropriateness of Antimicrobial Prescriptions for Upper Respiratory Tract and Dental Infections in Male Prisoners in Italy

Antibiotics ◽

10.3390/antibiotics10111419 ◽

2021 ◽

Vol 10 (11) ◽

pp. 1419

Author(s):

Gabriella Di Di Giuseppe ◽

Raffaele Lanzano ◽

Armando Silvestro ◽

Francesco Napolitano ◽

Maria Pavia

Keyword(s):

Respiratory Tract ◽

Common Cold ◽

Apical Periodontitis ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections ◽

Clinical Records ◽

Dental Infections ◽

Irreversible Pulpitis ◽

Antimicrobial Prescription

Background: This study explored the antimicrobial prescribing pattern for upper respiratory tract and dental infections in prisoners in Italy, with specific attention paid to the appropriateness of indication and its potential determinants. Methods: This investigation was conducted through the consultation of clinical records of adult male inmates in a prison in the south of Italy. Results: Prescription of antimicrobials for upper respiratory tract infections ranged from 41.9% in influenza diagnoses to 88% in pharyngitis diagnoses, with high prevalence also for bronchitis (73.5%) and common cold (57.7%), and those for dental infections ranged from 82% in pulp necrosis and symptomatic apical periodontitis/pulp necrosis and localized acute apical abscess diagnoses, to 85.7% in symptomatic irreversible pulpitis with or without symptomatic apical periodontitis diagnoses. The most frequently prescribed antimicrobial was amoxicillin and clavulanic acid (33.8%), followed by amoxicillin (26.5%), macrolides (19.8%) and third-generation cephalosporins (7.9%). The overall antimicrobial overprescription was 69.4%, whereas an antimicrobial prescription was provided in all 52 cases in which it was indicated. The inappropriate antimicrobial prescriptions were significantly less likely for bronchitis, influenza and symptomatic irreversible pulpitis with or without symptomatic apical periodontitis compared to common cold/pharyngitis/rhinosinusitis, and when the antimicrobial prescription was provided by medical specialists compared to prison physicians, whereas antimicrobial overprescriptions without indications were significantly more frequent in patients with underlying chronic clinical conditions. Conclusions: A concerning widespread practice of inappropriate antimicrobial prescriptions in prisoners was found. Diagnoses-specific monitoring of antimicrobial use and prison-focused antimicrobial stewardship policies are strongly needed.