L20 Upper respiratory tract infections

Match the cause of a sore throat to it's likeliness to present in community pharmacy:
❌ - Most likely (70-90%)
❌ - Likely
❌ - Unlikely
❌ - Very Unlikely

Red flags for referral of sore throat:
- Duration of more than ❌ weeks
- Marked tonsillar ❌ accompanied by high ❌ and ❌ glands
- Adverse drug reaction risk
- Dysphagia (❌ difficulty) and/or dysphonia (❌ voice)
- Higher risk ❌ 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 ❌ like ARF, if the patient appears very ❌, if the patient ❌ to be prescribed antibiotics, etc.

Antibiotics are recommended if there is a high ❌ of rheumatic fever, i.e. personal, family or household ❌, OR 2+ of the following:
- ❌ ethnicity
- Aged ❌ years
- Living in ❌ circumstances or in ❌ socioeconomic areas

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

Local anaesthetics like ❌ are fine for adults and children over ❌ years. They all have a ❌ 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 (❌yrs+)
- Pregnancy – limit use after ❌ weeks, breast feeding okay

2. Flurbiprofen
- For adults and children (❌yrs+)
- Avoid/caution: peptic ❌, asthma, ❌ impairment, ❌ failure
- Avoid in ❌ (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 ❌, cough, throat clearing, feeling of ❌ in throat (globus pharyngeus).
Most common cause is viral. The pain is ❌ to mucosa appearance. Bacterial causes ❌. 10% of causes are ❌ and this is under diagnosed, causes ❌ speckling of glottis or supraglottis but can show erythema and oedema without these plaques. It can also be caused by ❌.

Laryngitis treatment: Voice ❌ (until its comfortable to hum), hydration (250ml per waking hour, chewing ❌), humidification, limiting ❌ intake (dehydration and encourages reflux), alcohol and smoking intake ❌.
If acute airways ❌ – urgent referral. Otherwise, most cases are self-limiting and typically resolve within ❌.

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