Effect of diurnal temperature range on emergency room visits for acute upper respiratory tract infections

BACKGROUND@#An acute upper respiratory tract infection (URI) is the most common disease worldwide, irrespective of age or sex. This study aimed to evaluate the short-term effect of diurnal temperature range (DTR) on emergency room (ER) visits for URI in Seoul, Korea, between 2009 and 2013.@*METHODS@#Daily ER visits for URI were selected from the National Emergency Department Information System, which is a nationwide daily reporting system for ER visits in Korea. URI cases were defined according to International Classification of Diseases, 10@*RESULTS@#There were 529,527 ER visits for URI during the study period, with a daily mean of 290 visits (range, 74-1942 visits). The mean daily DTR was 8.05 °C (range, 1.1-17.6 °C). The cumulative day (lag 02) effect of DTR above 6.57 °C per 1 °C increment was associated with a 1.42% (95% confidence interval [CI] 0.04-2.82) increase in total URI. Children (≤ 5 years of age) were affected by DTR above 6.57 °C per 1 °C, with 1.45% (95% CI 0.32-2.60) at lag 02, adults (19-64 years) with 2.77% (95% CI 0.39-5.20) at lag 07. When the DTR (lag02) was 6.57 °C to 11.03 °C, the relative risk was significant at 6.01% (95% CI 2.45-9.69) for every 1 °C increase in youth subjects aged for 6 to 18 years.@*CONCLUSIONS@#DTR was associated with a higher risk for ER visits for URI. In addition, the results suggested that the lag effects and relative risks of DTR on URI were quite different according to age.

A Prevalence Study of Pharyngitis and Its Associated Factors Among Adults With a Sore Throat in Three Primary Clinics in Selangor, Malaysia

@#Introduction: Since pharyngitis in adults is one of the most common infectious diseases seen in general practitioner consultations in Malaysia, data on pharyngitis among adults concerning to its prevalence, socio-demographic, risk factors and clinical manifestations is very much lacking. This study aims to determine the prevalence of pharyngitis among adults in Sepang, Selangor, Malaysia from 2016 to 2017 and its associated demographic and risk factors. Methods: We conducted a cross-sectional study on 215 adult patients with a sore throat as the main symptom and who did not receive any antibiotic treatment within two weeks at three Malaysian primary care clinics. The researchers assessed the participants’ clinical manifestations and collected throat swabs for culture to determine the presence of group A streptococcus (GAS). Data on demographic characteristics, clinical manifestation and throat swab culture results were analyzed using chi-square test and multivariate logistic regression. Results: Pharyngitis was diagnosed in 130/215 (65%) adults with a sore throat. Only six isolates (2.8%) were identified as GAS. The overall mean age ± S.D was 36.43 ± 15.7. The majority of the participants were in the age group of 18-28 years. There were 42.3% males and 57.7% females; most participants were Malay 62.8%, followed by 30.2% Indian, 5.1% Chinese, and 1.9% other ethnicities. The most common symptom among the participants was cough 196 (91.2%), followed by rhinorrhea 161 (74.8%), tonsillar swelling or exudates 68 (31.6%), inflamed or reddish of pharynx 62 (28.8%), swollen anterior cervical lymph nodes 50 (23.3%), and fever ≥37.5°C 28 (13.0%). Conclusion: Besides, there was no significant association between pharyngitis and the demographic variables; the current findings emphasized that inflamed or reddish pharynx, tonsillar swelling or exudates were among the factors associated with pharyngitis.

Prescribing pattern of antibiotics and susceptibility of pathogens in upper respiratory tract infections: a study from a tertiary care hospital

Background: Upper respiratory tract infections are mostly caused by viruses and are self-limiting. But it is seen that drug therapy is restored to many of them without adequate justifications. Sometimes multiple drug therapy imposes high cost burden on patients. Use of antibiotics in URTI patients have led to rise in bacterial resistance. So, this study was aimed to analyse the prescription pattern in upper respiratory tract infections and the antibiotic susceptibility of the isolated organisms.Methods: An observational cross-sectional study was conducted in a tertiary care hospital for a period of three months. Based on the inclusion and exclusion criteria sixty patients were selected. Prescriptions of these patients were collected and analysed for the various WHO prescription indicators like average number of drugs per encounter, percentage of drugs prescribed by generic names, percentage of drugs prescribed as injection, drugs form the essential drug list etc. The swabs were collected from the site of infections and were analysed for the bacterial growth. Also, the antibiotic susceptibility of these organisms was tested.Results: A total of sixty prescriptions were collected and analysed. The average number of drugs per prescription was 2.21. Antimicrobials were prescribed in 90% of cases. Approximately 50% cases the combination of amoxicillin and clavulanic acid was prescribed. The percentage of drugs prescribed by generic names was 87% and 68% drugs were form the essential drug list. The culture report of the specimen collected from the swabs showed that only 50% of cases were of some bacterial origin. And the organisms isolated were less susceptible to the antibiotics that were prescribed.Conclusions: This study of prescribing patterns in patients gives appropriate feedback and awareness among health care providers. Rationale prescribing practice will prevent antibiotic resistance and reduction in the adverse drug reactions.

A cross sectional study on prescription pattern of drugs in upper respiratory tract infections in a tertiary care hospital

Background: Upper respiratory tract infections are one of the leading causes of hospital visits worldwide. Judicious use of antibiotics is challenging for upper respiratory tract infections (URTIs) in developing countries like India. This leads to inappropriate use of antibiotics causing many dreaded conditions like antibacterial resistance among other things. Hence rational use of drugs, mainly antibacterial, is a priority to reduce the burden of treatment failure. The objective of this study is to study the prescribing patterns and rationality of drugs prescribed in the management of URTIs.Methods: This was a cross-sectional study. Data was collected from records of 300 outpatients clinically diagnosed as URTIs from SSIMS and RC Hospital, Davangere between January 2015 and June 2016. The prescribing patterns, approval status and listing of drugs in World Health Organization (WHO) essential medicines list/ National List of Essential Medicines (NLEM) were analysed. The data was presented as percentages, mean and standard deviations.Results: A total of 300 cases were studied. Among these, acute pharyngitis (29%) and acute sinusitis (26%) are the most common infections. Of the 300 cases studied, 283 (94.3%) were prescribed antimicrobials. Of the total 740 medications prescribed, 393 (53.1%) were fixed-dose combinations (FDCs). A total of 724 medications (97.8%) were approved by Drugs Controller General of India and 248 (33.5%) by Food and Drug Administration. Only 5.8% of the prescribed drugs have been listed in WHO’s and NLEM. The most common class of antibacterials prescribed was Beta-lactams.Conclusions: Oral formulations were preferred over parenteral formulations and FDCs were preferred over single drug formulations. Beta-lactams comprised the major class of antibacterial prescribed.

How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel / Como evitar o uso inadequado de antibióticos nas infecções de vias aéreas superiores? Posição de um painel de especialistas

Abstract Introduction: Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. Objectives: To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. Methods: A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Results: Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Conclusions: Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use.

Resumo Introdução: A resistência bacteriana a antibióticos nos processos infecciosos é um fato crescente nos últimos anos, especialmente devido ao seu uso inapropriado. Ao longo dos anos vem se tornando um grave problema de saúde pública devido ao prolongamento do tempo de internação, elevação dos custos de tratamento e aumento da mortalidade relacionada às doenças infecciosas. Quase a metade das prescrições de antibióticos em unidades de pronto atendimento é destinada ao tratamento de alguma infecção de vias aéreas superiores, especialmente rinossinusites, otite média aguda supurada e faringotonsilites agudas, sendo que uma significativa parcela dessas prescrições é inapropriada. Nesse contexto, os otorrinolaringologistas têm um papel fundamental na orientação de pacientes e colegas não especialistas, para o uso adequado e racional de antibióticos frente a essas situações clínicas. Objetivos: Realizar uma revisão das atuais recomendações de utilização de antibióticos nas otites médias, rinossinusites e faringotonsilites agudas adaptadas à realidade nacional. Método: Revisão na base PubMed das principais recomendações internacionais de tratamentos das infecções de vias aéreas superiores, seguido de discussão com um painel de especialistas. Resultados: Os antibióticos devem ser utilizados de maneira criteriosa nas infecções agudas de vias aéreas superiores não complicadas, a depender da gravidade da apresentação clínica e dos potenciais riscos associados de complicações supurativas e não supurativas. Conclusões: Constantes revisões a respeito do tratamento das principais infecções agudas são necessárias para que sejam tomadas medidas coletivas no uso racional e apropriado de antibióticos. Somente com orientação e transformações no comportamento de médicos e pacientes é que haverá mudanças do paradigma de que toda infecção de vias aéreas superiores deva ser tratada com antibióticos, minimizando por consequência os efeitos de seu uso inadequado.

Uso de probióticos en otorrinolaringología / Use of probiotics in otolaryngology

En los humanos las infecciones más frecuentes son las respiratorias, siendo la principal indicación de antibióticos en niños. El uso indiscriminado de antibióticos lleva a la aparición de gérmenes multirresistentes. Uno de los objetivos actuales en salud es la prevención de las enfermedades infecciosas para disminuir el uso de antibióticos. Una estrategia postulada recientemente para prevenir infecciones respiratorias es el uso de probióticos.

In humans, the most frequent infections are respiratory, being the main indication of antibiotics in children. The indiscriminate use of antibiotics leads to the emergence of multi-resistant germs. One of the current health objectives is the prevention of infectious diseases so we can reduce the use of antibiotics. A potential strategy for preventing respiratory infections is the use of probiotics.

¿Las infecciones respiratorias virales agudas causan mayor ausentismo laboral? un análisis en la planta pasteurizadora Quito / Do acute viral respiratory infections cause more work absenteeism? an analysis in the Quito pasteurization plant

Contexto: las IRAs afectan indistintamente a todo trabajador, independientemente de la edad, sexo, años de trabajo o lugar producción; su frecuencia oscila entre 1 a 3 episodios anuales; la incidencia es anual con brotes que coinciden con la época invernal. Material y métodos: investigación cuantitativa, epidemiológica, descriptiva y transversal en una población de 80 trabajadores, del área de producción. Resultados: el 90% de los trabajadores se encuentra en edad productiva (18 a 50 años), todos son hombres, el 65% tiene una antigüedad laboral entre 0 a 5 años; el 17,5% reporta antecedentes patológicos respiratorios y el 77,5% de empleados se concentra en la sub-área de envasado de funda y UHT. El 82,5% presentó IRAs, el 53,8% informa entre 1 a 3 episodios en el año 2014. La duración de la IRA fue 1 a 3 días en el 52,5% de trabajadores, observándose manifestaciones crónicas en el 10% de empleados. La enfermedad provocó ausentismo de 1 a 3 días en el 10% de trabajadores. En la subárea de producción existe ausentismo del 1 a 3%, determinándose que en el ausentismo global, el 13% se debe a otras causas médicas y el 7,5% por infecciones virales con una duración entre 1 a 3 días. Conclusión: la mayoría de trabajadores no se ausenta a su trabajo. Más de la mitad de los trabajadores afectados por una EVVRS requiere entre 1 a 6 días para recuperarse; además, en caso de enfermedad no se dispone de un reemplazo para el trabajador enfermo. (AU)

Context: Upper respiratory tract infections (URTIs) affect every worker, irrespective of age, sex, years of work or place of production. Its frequency ranges from 1 to 3 episodes per year; the incidence is annual with outbreaks that coincide with the winter season. Material and methods: quantitative, epidemiological, descriptive and transversal research in a population of 80 workers from the production area. Results: 90% of workers are in productive age (18 to 50 years), all are men, 65% have a work age between 0 and 5 years; 17.5% report respiratory pathological history and 77.5% of employees are concentrated in the sub-area of packaging of UHT and sheath. 82.5% presented IRAs, 53.8% reported between 1 and 3 episodes in 2014. The duration of URTI was 1 to 3 days in 52.5% of workers, with chronic manifestations occurs in 10% of the workers. The illness caused 1 to 3 days absenteeism in 10% of workers. In the production sub-area there is absenteeism from 1 to 3%, and it is determined that in global absenteeism, 13% is due to other medical causes and 7.5% from viral infections lasting between 1 and 3 days. Conclusion: most workers are not absent from work. More than half of the workers affected by an EVVRS require between 1 to 6 days to recovering. In addition, in case of illness, there is no replacement for the sick worker.

Study of drug use in outdoor pediatric patients of upper respiratory tract infections in a tertiary care hospital.

Background: Upper respiratory tract infections (URTI) are the most common and frequent occurring infections in the pediatric population. URTI is mostly viral in origin and requires mostly symptomatic treatment. The present study was undertaken to analyze the pattern of drug use in the management of URTI in the pediatric age group. Methods: It is a retrospective study to assess the pattern of drug use in URTI in pediatric outpatient department during the 5 months period from January 2015 to May 2015. Results: A total of 2256 prescriptions were analyzed. Most of the pediatric patients belonged to 1-5 years age group and 58.33% were males, and 41.66% were females. A total of 6332 drugs were prescribed out of which the antibiotics used was 1341. The average number of drugs per prescription used was 2.81. The percentage of prescriptions containing antibiotics was found to be 59.44%. Amoxicillin (70.91%) was the most frequent prescribed antibiotic followed by cotrimoxazole (10.21%). Antihistaminic and expectorant combinations were found to be the most common prescribed class of drugs (29.34%) followed by analgesic and antipyretics (26.45%) and antibiotics (21.17%). Conclusions: The study revealed that the majority of children were below 5 years of age. The most common class of drugs prescribed was antihistaminics and expectorant combinations followed by analgesics and antipyretics. Although the majority of the patients received antibiotics, 40.55% of patients received symptomatic treatment. This is a welcome step as inappropriate use of the antibiotics can potentiate to the increasing trend of antimicrobial resistance.

Intention to Seek Medical Consultation for Symptoms of Upper Respiratory Tract Infection– A Cross-Sectional Survey

The common cold is the commonest reason for primary care encounters worldwide. This paper aims to describe the reasons that influence patients to seek medical consultation for the common cold. Methods: This was a cross-sectional survey conducted among adult patients of an urban teaching primary care clinic. An adapted bilingual survey form was administered by the researchers to obtain data regarding their decision to seek medical consultation for a cold and the reasons for their decision. Quantitative analyses were done to describe the close-ended responses. Open-ended responses were analysed using a qualitative approach and the frequencies of the themes were reported. Results: A total of 320 respondents participated in this study, with a response rate of 91.4%. They were predominantly females (59.4%), Malay (70.9%), and had tertiary education (65.9%). More than half of the patients (52.5%) said they would seek consultation for cold symptoms. Fever was the commonest symptom (57-61%) which compelled them to seek consultation. The commonest reason for seeking consultation was to get medications (41.7%), whereas the commonest reason not to seek consultation was the practice of self-medication (44.2%). Ethnicity was found to be significantly associated with the decision to seek doctor’s consultation. Conclusion: Colds are usually self-limiting and do not result in complications. Empowering patients by providing appropriate self-care knowledge can help to reduce the burden of primary care services. Patients should be taught about red flag symptoms as well as drug safety for medications commonly taken for colds.

Prevalence of Antibiotic Use for Pediatric Acute Upper Respiratory Tract Infections in Korea

This study was conducted to estimate the prevalence of antimicrobial prescribing for acute upper respiratory tract infections (URI) among pediatric outpatients and to identify the national patterns of its use from 2009 to 2011 in Korea. Using National Patients Sample database from 2009 to 2011, we estimated the frequency of antibiotics prescribing for URI in pediatric outpatients with diagnoses of acute nasopharyngitis (common cold), acute sinusitis, acute pharyngitis, acute tonsillitis, acute laryngitis/tracheitis, acute obstructive laryngitis/epiglottitis, and acute upper respiratory infections of multiple and unspecified sites. The proportions of each antibiotic class were calculated by year and absolute and relative differences were estimated. Also, we investigated daily amount of prescribed antibiotics per defined population according to the type of medical care institution, physician specialty, and geographic region. The overall antibiotic prescribing proportion was 58.7% and its annual proportion slightly decreased (55.4% in 2011 vs. 60.5% in 2009; adjusted odds ratio, 0.82; 95% confidence interval, 0.82-0.83). Variations by the type of medical care institution were observed. Tertiary hospitals (45.0%) were less likely to prescribe antibiotics than primary care clinics (59.4%), hospitals (59.0%), and general hospitals (61.2%); they showed different tendencies in choosing antibiotics. Variations by physician specialty and region were also observed. Prevalence of antimicrobial prescribing for pediatric URI is still considered higher than that of western countries and varies by the type of medical care institution, physician specialty, and geographic region.

Antibiotic prescribing for upper respiratory tract infections in the Asia-Pacific region: A brief review

This review highlights the high prevalence of antibiotic use for upper respiratory tract infections(URTIs) in a larger part of the Asia-Pacific region. Since URTIs are one of the common reasons for primary care consultations in this region, inappropriate use of antibiotic in both quantity and drug choice has greatly influenced the development of antibiotic resistance. Notwithstanding the paucity of Asia-Pacific data on the above issues, the available information suggests urgent actions needed to be taken to promote judicious antibiotic use at the point-of-care through a multipronged approach targeting the patients/consumers (or parents), healthcare providers and health care systems.

Infecções de vias aéreas superiores / The upper respiratory tract infections

Este artigo elenca os principais fatores envolvidos na instalação dos processos infecciosos das vias aéreas superiores na sua forma aguda, seus principais patógenos, os métodos de diagnóstico e tratamento, ressaltando a importância do uso criterioso da terapia antimicrobiana. Visa ainda ressaltar os métodos de prevenção, incluindo-se aí a medidas de adequação individual e ambiental, além das influências ecobiológicas na saúde das vias aéreas.

Efficacy and safety of azithromycin in the treatment of pediatric upper respiratory tract infections, an open non-comparative multicentre study.

The clinical efficacy and safety of a three-day course of azithromycin was evaluated in 39 children (aged 1-15 years) with clinical diagnosis of acute upper respiratory tract infections (acute pharyngitis and/or acute tonsillitis, acute otitis media and acute sinusitis). Patients received azithromycin in a single daily dose of 10 mg/kg (maximum 500 mg) orally for three days. Clinical assessment and throat culture were carried out before and after therapy. Overall clinical efficacy was fund to be satisfactory (cured or improved) in 37/39 (94.8 percent) of patients. Bacteriological efficacy, which was evaluated by eradication of the pathogens, was found in 16/18 (88.8 percent). In the remaining two patients, one was clinically cured despite persistent Staphylococcus aureus, while the other case of clinical failure was associated with a resistant strain of Psuedomonas seruginosa. The drug was well tolerated and treatment-related side-effects, which were reported in only 3*39 (7.69 percent) of the patients, were gastrointestinal in nature and of mild severity. The results of the study indicated that a single daily dose, in a three-day regimen, of azithromycin is effective and well-tolerated in the treatment of children with acute upper respiratory tract infections.