Case Presentation URTI

EBM , URTI Treatment

Presented by Dr.Ibrahim Alasmari , R1 family medicine .Supervised by

Dr.Yaia Matter , Family medicine consultant.

32 years old driver Indonesian man presented with history of cough and generalized body ache for 3 days.

:HPIPatient was well till three days back when he developed cough ; intermittent , dry ,associated with throat pain, aggravating by exposure to cold fluids and there is no relieving factors. He is smoker for 10 years . No history of fever.

No history of contact with people having chronic cough

No history of contact with T.B patient No marked decreasing the weight No history of recent travelling Family history : non remarkable No drug history

:Examination Patient looks well ; not distressed or tachypnicVital Signs : normal Neck : no cervical lymphadenopathy Throat : mildly congested Chest : clear Abdomen : NAD

Neuromuscular : grossly intact

D.Dx

Viral Pharyngitis

Common cold

Treatment : Paracetamol 1gm tab. TID for 5 days Dextromethrphan 10 ml TID for 5 days

EBM for Treatment URTI Antibiotics are not recommended for treatment C.C In children and adult .Evidence A

Dextromethorphan is a treatment option for adults with cough caused by c.c. Evidence B

Oral decongestant is the treatment for adult and adolescent for 3 days . Evidence B

Topical ipratropium (Atrovent) is ttt option for nasal congestion in children older than 6 years and adults. Evidence B

Codeine (Robitussin AC) and other narcotics, dextromethorphan (Delsym), antihistamines, andcombination antihistamine/decongestants are not recommended to treat cough or other coldsymptoms in children. Evidence B

Older first-generation antihistamines and combination antihistamine/decongestants are treatmentoptions for cough and cold symptoms in adults if the benefits outweigh the adverse effects. Evidence B

Among available complementary treatments, vitamin C prophylaxis may decrease the severity andduration of cold symptoms; however, vitamin C, zinc, and Echinacea are not recommended foractive treatment. Evidence B

Nasal irrigation is an effective adjunctive therapy for symptoms of chronic rhinosinusitis. Evidence A

Based on limited evidence, nasal irrigation may be an effective adjunctive treatment for symptoms of irritant rhinitis, allergic rhinitis, and viral upper respiratory tract infection; and for postoperative care afterendoscopic sinus surgery. Evidence B

Nasal irrigation has been recommended for mild to moderate rhinitis of pregnancy ,acute rhinosinusitis ,

sinonasal sarcoidosis,and Wegener granulomatosis.

Evidence C.