Paediatrics: Upper airway infections

Upper airway infections

Ear, sinus, nose, and throat infections account for 80% of respiratory infec-tions. The diagnosis URTI may mean any of the following.

·  Common cold (coryza): commonly due to rhinoviruses, coronaviruses, and respiratory syncytial virus (although latter more often causes acute bronchiolitis).

·  Sore throat (pharyngitis and tonsillitis): pharyngitis is usually due to viral infection with adenovirus, enterovirus, and rhinovirus. Bacterial infection with group A B-haemolytic streptococcus may be present in the older child. Tonsillitis associated with purulent exudates may be due to group A B-haemolytic streptococcus or the Epstein–Barr virus (EBV).

·  Ear infection (acute otitis media): common pathogens include viruses, pneumococcus, group A B-haemolytic streptococcus, Haemophilus influenzae, and Moraxella catarrhalis.

·  Sinusitis may occur with viral or bacterial infection.

Diagnosis

History

Children often present with a combination of:

·  Painful throat.

·  Fever (which may even induce febrile convulsions).

·  Blocked nose (which may lead to feeding difficulty in infants).

·  Nasal discharge.

·  Earache.

·  Wheeze (in children with asthma there may be an exacerbation).

Examination

A thorough examination is needed. In infants you will need to make sure that there is not a serious infection and, in those with difficulty feeding because of blocked nose, that feeding will be adequate. In older children you will need to check for possible bacterial infection and give antibiotics when the following are identified.

·  Ears: think of otitis media if there is discharge, if the tympanic membrane is not intact, if the eardrums are bright red and bulging with loss of normal light reflection.

·  Neck: think of bacterial throat infection if there is tender cervical lymphadenopathy.

·  Pharynx: think of tonsillitis if there are purulent exudates on inflamed tonsils.

Treatment

Symptom relief

·  Fever: use paracetamol or ibuprofen.

·  Earache: use paracetamol or ibuprofen.

Antibiotics

Virus infection causes the majority of URTIs and antibiotics should not be prescribed. However, if bacterial tonsillitis, or pharyngitis due to group A B-haemolytic streptococcus, or acute otitis media is suspected, then they should be given after a throat swab has been taken for bacterial culture. A positive culture will mean that a 10-day course of antibiotics is required.

·Tonsillitis and pharyngitis: avoid amoxicillin because it may cause maculopapular rash in cases of EBV infection. Use penicillin V, or erythromycin in allergic patients, for 10 days.

·Acute otitis media: co-amoxiclav will cover the common causes of otitis media and be effective against B-lactamase-producing H. influenzae and M. catarrhalis.