Common Respiratory Infections

By: Maged Taman

Common cold: no fever or low grade, nasal congestion, cough, mild sore throat.

Flu: high fever, chills, aches, exhaustion, headaches, nasal congestion, mild sore throat and cough.

Swine flu: symptoms as flu but sore throat is more severe, pain behind eyes, diarrhea or vomiting in up to 25%.

Strept pharyngitis: no significant body aches or being exhausted despite fever unlike the flu where patients are more exhausted, no nasal congestion, cough is mild and tender anterior upper cervical neck lymphnodes enlargement. Tonsills may be typically follicular or having exudate.

Infectious mononucleosis: sore throat with exudative pharyngitis, fatigue and posterior cervical lymphnodes enlargement, spleenomegaly and fatigue is highly suggestive.

Acute bronchitis: can be part of flu or follow it as a complication. Acute bronchitis alone is diagnosed by absence of nasal congestion, fever or aches. Sore throat is more in the neck of muscles less so pharynx with less soreness of throat like in strept pharyngitis. No tender anterior cervical lymph nodes as pharyngitis. Aches are related to muscles of neck and chest that involved in the cough process.

Acute bacterial Sinusitis: can part of the common cold and flu. Acute bacterial sinusitis is more symptomatic than viral with more of sinus pain and tenderness.

Acute bacterial pneumonia: Fever and chills more common cough with a lot of dark phlegm. Shortness of breath if pneumonia is severe. Lung may show localized rhonchus, rales or rub in the area of pneumonia. Mild bacterial pneumonia can be difficult to differentiate from acute bronchitis.

Treatment:
Is that of symptom and organism.
Organism:
For flu and swine flu: tamiflu 75 mg bid for 5 days.
For Pharyngitis: amoxacillin 500 mg tid for 10 days or Z-pack.
For Sinusitis or pneumonia: levaquin 500-750 daily 7-14 days according to severity. Augmentn is another choice 875 mg po q 12 h for 10 days.

Symptoms:
Aches, sore throat, sinus pain, muscle pain due to cough: Tylenol or Motrin.
Sore throat: cepacol lozenges every 2 hours as needed, gurgle with salted water 1/4 teaspoon in warm glass of water.
Nasal Congestion: antihistamines +/- psuedoephedrine. Nasal steroids may help if there is a component of nasal allergies.
Cough: robitussin DM or similar with sugar free if patient is diabetic. Robitussin AC 5-10 ml po qhs as needed for severed dry cough or Benzonatate 100 mg po tid. Also consider albuterol 2 puffs q 4 h prn for patient with wheeze or history of asthma or resistant cough. Consider whooping cough if cough is difficult to treat with typical whoop obtain nasal swap.

Note above common choices many other medications are as well effective.