Wednesday, 27 November 2013

Upper respiratory tract infection – Treatments In conventional medicine perspective

Upper respiratory tract infection
Upper respiratory tract infections are considered to be the infection of the airway above the glottis or vocal cords. This includes the nose, sinuses, pharynx, and larynx, including the infection of tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, etc,.
F. Treatments
F.1. In conventional medicine perspective
1. No specific treatment if the infection is resulted of viral infection, but certain medication can be prescribed to reduce the symptoms, such as
a. Acetaminophen and Nonsteroidal used to reduce fever and body aches.
In the study to evaluate the risk factors for developing allergic reactions to alternative drugs such as acetaminophen and nimesulide in 367 patients intolerant of nonsteroidal anti-inflammatory drugs (NSAID) compared to 243 healthy controls, showed that  test doses (TD) TD was positive in 49 of 367 (14%) NSAID-allergic patients and in one (0.4%) of the controls (P<0.001). No difference was found in age and sex between the TD-positive and TD-negative subjects, although a significantly larger number of females were NSAID allergic (P<0.01)(31).
b. Antihistamines used to decrease nasal secretions and congestion
There is no evidence to determine whether the use of antihistamines, decongestants or nasal irrigation is efficacious in children with acute sinusitis(32).
c. Nasal ipratropium for diminishing nasal secretions
Rhinorrhea and nasal congestion are simultaneous symptoms associated with the common cold. Both the ipratropium combination treatments had significantly lower tissue use than the xylometazoline treatment group (p < 0.0001). Adverse events were distributed equally between the treatments, except mucus tinged with blood, epistaxis, nasal passage irritation, and nasal dryness, which had a higher incidence in the three groups that received medicines containing ipratropium(33).
d. Cough suppressants to reduce cough
In an observational study on acute cough associated with upper respiratory tract infection (URTI) in children, showed that acute cough disturbs sleep in most children and their parents. Both levodropropizine and central antitussives reduced cough intensity, with levodropropizine producing a higher cough resolution rate(34).
e. Steroids 
Intranasal corticosteroids offer a small therapeutic benefit in acute sinusitis, which may be greater with high doses and with courses of 21 days’ duration(35).
f. Etc.
2. Antibiotics
Antibiotics are used only in treating upper respiratory infections caused by bacterial infection. In the study to examine the use of antibiotics and other prescription medications for the common cold in a Medicaid population seen in ambulatory care settings, showed that majority of persons receiving medical care for the common cold are given prescriptions for an unnecessary antibiotic. Unchecked, this practice may lead to greater antibiotic resistance and unnecessary use of health care resources(36).
3.  Inhaled epinephrine
Epinephrine, a hormone and a neurotransmitter,  is sometimes used in children with bronchospasm  to reduce spasm. According to the study by Royal Aberdeen Children’s Hospital, Aberdeen, functional airway problems (laryngospasm, bronchospasm, insufficient depth of anesthesia and muscle rigidity, gastric hyperinflation, and alveolar collapse) require urgent recognition and treatment algorithms due to insufficient oxygen reserves. Early muscle paralysis and epinephrine administration aids resolution of these functional airway obstructions(37).
4. Surgery
Rarely, surgical procedures may be necessary in cases of complicated sinus infections. Maxillary sinus inflammation, when untreated or incorrectly treated, may extend locoregionally, the remaining paranasal sinuses being the first affected anatomical structures. Inflammations of the paranasal sinuses are susceptible to develop complications in certain conditions and threaten the patient’s life due to the proximity of vital structures(38).
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