GEM - common respiratory infections in primary care

Sinusitis

• sinusitis is the inflammation of the mucous membranes of the paranasal sinuses. It usually results from inadequate drainage of the sinuses secondary to physical obstruction, infection or allergy. The lining of the nose may be simultaneously affected producing a rhinosinusitis. Sinusitis may occur in one or more sinuses (multisinusitis), in one or both sides. It may be acute or chronic
• aetiological factors to consider are GPN reference
• general clinical features of sinusitis are GPN reference
• investigations
  • are investigations for acute sinusitis routinely indicated in primary care management?
  • regarding sinus Xrays - is a fluid level or mucosal thickening more significant?
  • regarding CT scans - are mucosal changes specific for active disease?
  • GPN reference
• management of sinusitis
  • do the majority of patients with clinically suspected sinusitis have a bacterial infection?
  • should intranasal steroids be used in acute sinusitis
  • if antibiotic treatment is indicated in an adult
    • what is the first choice antibiotic regime
    • what is an alternative to the first choice regime
    • what is the concern regarding use of erythromycin as a first choice agent
    • GPN reference

Acute otitis media

• acute otitis media is an acute inflammation of the middle ear cavity. It is a common condition, occurring most frequently in children, and is often bilateral. Acute otitis media has a peak incidence of between 3 years and six years
• 80% recover in around three days without antibiotics
• how common is acute otitis media? GPN reference
• management of acute otitis media
  • are decongestants routinely indicated?
  • are antihistamines routinely indicated?
  • the majority of cases of acute otitis media resolve without antibiotic treatment
    • in which circumstances might antibiotic treatment be indicated?
    • GPN reference
    • what is the antibiotic treatment of choice if treatment is indicated?
    • what about delayed prescriptions?
    • GPN reference

Sore throat

• when considering cause of acute sore throat
  • are the majority secondary to Group A beta-haemolytic streptococcus (GABHS) ?
  • what is the approximate asymptomatic carriage of GABHS?
  • GPN reference
  • what are the Centor criteria to aid diagnosis of Group A beta-haemolytic streptococcuss sore throat? GPN reference
  • antiobiotics in sore throat

Antibiotics and Sore Throat

• is there evidence that effectiveness of antibiotic treatment is influenced by positive throat swabs for GABHS?
• what antibiotic is suggested as first-line treatment what dose and for what period is treatment with this drug suggested is the use of delayed prescriptions appropriate?
• GPN reference

Sore throats are generally managed in primary care.

• When is referral to secondary care appropriate?
• GPN reference

With respect to quinsy: what are the clinical features of quinsy?GPN reference

Common cold

• what symptomatic treatment modalities are effective in the management of a common cold?
• are antibiotics an effective treatment modality in purulent rhinitis?
• GPN reference

Acute Bronchitis

• is antibiotic treatment of efficacious in acute uncomplicated bronchitis?
• is there evidence to support the use of inhaled or oral beta2-agonists?
• if antibiotics are considered, then what antibiotic medication should be considered in adults with acute bronchitis?
• what about delayed prescriptions?
• GPN reference

Reference:

1. RCGP. Curriculum statement 15.8. Respiratory problems.