L20 Upper respiratory tract infections

Choose the incorrect statement about pharyngitis.

Match the cause of a sore throat to it's likeliness to present in community pharmacy: [blank_start]Viral infection[blank_end] - Most likely (70-90%) [blank_start]Streptococcal infection[blank_end] - Likely [blank_start]Glandular fever, trauma[blank_end] - Unlikely [blank_start]Carcinoma, medicines[blank_end] - Very Unlikely

Select all the features of a sore throat which indicate it is bacterial, not viral.

Red flags for referral of sore throat: - Duration of more than [blank_start]2[blank_end] weeks - Marked tonsillar [blank_start]exudate[blank_end] accompanied by high [blank_start]temperature[blank_end] and [blank_start]swollen[blank_end] glands - Adverse drug reaction risk - Dysphagia ([blank_start]swallowing[blank_end] difficulty) and/or dysphonia ([blank_start]hoarse[blank_end] voice) - Higher risk [blank_start]demographic[blank_end] groups (Māori or Pacific peoples, especially 3-35 years old).

Antibiotics are overprescribed for sore throats of which 70% are viral in origin. Reasons to prescribe antibiotics for sore throats include reducing the risk of [blank_start]complications[blank_end] like ARF, if the patient appears very [blank_start]unwell[blank_end], if the patient [blank_start]expects[blank_end] to be prescribed antibiotics, etc. Antibiotics are recommended if there is a high [blank_start]risk[blank_end] of rheumatic fever, i.e. personal, family or household [blank_start]history[blank_end], OR 2+ of the following: - [blank_start]Māori or Pacific[blank_end] ethnicity - Aged [blank_start]3-35[blank_end] years - Living in [blank_start]crowded[blank_end] circumstances or in [blank_start]lower[blank_end] socioeconomic areas

People at high risk of rheumatic fever should have a throat swab taken at the same time that empiric antibiotic treatment is initiated, and those who test negative for Group A streptococcus (GAS) can discontinue antibiotic use.

Which of these antibiotics is NOT likely to be prescribed for GAS?

Corticosteroids are [blank_start]not[blank_end] proven to be effective for sore throats an are not recommended. Paracetamol and ibuprofen are [blank_start]effective[blank_end] for pain reduction. Evidence suggests they should be taken [blank_start]regularly[blank_end] in the day rather than ‘as needs’ basis. A combination is not [blank_start]more effective[blank_end] than one or the other.

Local anaesthetics like [blank_start]lignocaine and benzocaine[blank_end] are fine for adults and children over [blank_start]6[blank_end] years. They all have a [blank_start]short[blank_end] duration of action and frequent dosing is required. Minimal side effects, pregnancy & breastfeeding compatible, okay for diabetics (minimal sugar).

Local anti-inflammatories: 1. Benzydamine - For adults and children ([blank_start]6[blank_end]yrs+) - Pregnancy – limit use after [blank_start]30[blank_end] weeks, breast feeding okay 2. Flurbiprofen - For adults and children ([blank_start]12[blank_end]yrs+) - Avoid/caution: peptic [blank_start]ulcer[blank_end], asthma, [blank_start]renal[blank_end] impairment, [blank_start]heart[blank_end] failure - Avoid in [blank_start]pregnancy[blank_end] (esp. third trimester)

Laryngitis is mostly acute, a common and generally self-limiting inflammation of the larynx. Can be infective (viral, bacterial or fungal) or inflammatory (trauma e.g. coughing). Symptoms include hoarseness, pain or discomfort in [blank_start]neck[blank_end], cough, throat clearing, feeling of [blank_start]lump[blank_end] in throat (globus pharyngeus). Most common cause is viral. The pain is [blank_start]disproportionate[blank_end] to mucosa appearance. Bacterial causes [blank_start]purulence[blank_end]. 10% of causes are [blank_start]fungal[blank_end] and this is under diagnosed, causes [blank_start]whitish[blank_end] speckling of glottis or supraglottis but can show erythema and oedema without these plaques. It can also be caused by [blank_start]reflux[blank_end].

Laryngitis treatment: Voice [blank_start]rest[blank_end] (until its comfortable to hum), hydration (250ml per waking hour, chewing [blank_start]gum[blank_end]), humidification, limiting [blank_start]caffeine[blank_end] intake (dehydration and encourages reflux), alcohol and smoking intake [blank_start]reduced[blank_end]. If acute airways [blank_start]compromised[blank_end] – urgent referral. Otherwise, most cases are self-limiting and typically resolve within [blank_start]2 weeks[blank_end].

Tonsillitis: Symptoms - Sore throat (+/- other cold symptoms), difficult or painful [blank_start]swallowing[blank_end], swollen and tender [blank_start]glands[blank_end], bad breath, fever and chills, tiredness and headache, enlarged and [blank_start]reddened[blank_end] tonsils with spots of white/yellow pus, mouth breathing, noisy breathing, and/or snoring. Duration: Usually resolves after [blank_start]3-4 days[blank_end] but may last 2 weeks even with treatment Causes: Majority of cases [blank_start]viral[blank_end] (cold virus most common), 15-30% [blank_start]bacterial[blank_end] (strep). Treatment: Rest, fluids, regular meals (soft food, smoothies). Throat [blank_start]lozenges[blank_end]. Paracetamol and [blank_start]ibuprofen[blank_end]. Possibly antibiotics after culture.