Treatment regimen for upper respiratory tract infection in children

Due to the weak resistance, upper respiratory tract infections in children are very common. The common upper respiratory tract infections are acute rhinitis, acute pharyngitis, acute sinusitis and acute otitis media. Children need to be examined and treated promptly.

The upper respiratory tract is the first organs of the respiratory system including the nose, pharynx, pharynx, sinuses, larynx. Due to direct contact with the air, when there are adverse changes in the environment, upper respiratory infections are very likely to occur. The common upper respiratory tract infections in children are acute rhinosinusitis, acute pharyngitis, and acute otitis media. The cause of the disease is usually viral (Rhinovirus, Adenovirus, respiratory syncytial virus RSV,...); some bacteria such as group A hemolytic streptococci, pneumococcus, Haemophilus influenzae,... and some fungi.
Children are very susceptible to upper respiratory tract infections, in addition to erratic weather, favorable factors for the occurrence of upper respiratory tract infections in children and upper respiratory tract infections in infants are:
Children Premature birth, low birth weight Age: the younger the child, the more susceptible to disease, especially those under 1 year old Children with malnutrition, rickets, vitamin A deficiency, immunocompromised children due to HIV disease, treatment Long-term corticosteroids,... Children live in a humid, cramped environment with poor sanitation, often exposed to cigarette smoke, honeycomb charcoal,...

2.1. Acute rhinitis and complications of acute sinusitis
2.1.1. Causes and manifestations of the disease
Common causes of acute rhinitis are 6 groups of viruses including: Rhinovirus, Parainfluenza virus, Coronavirus, Influenza virus, Respiratory syncytial virus and Adenovirus.
After being infected with the virus, sick people usually incubate for 2-3 days. After the incubation period, the patient will have symptoms such as runny nose, stuffy nose, sneezing, cough, sore throat, mild fever 38-39 degrees, red nasal mucosa, red throat mucosa. Nasal discharge is initially clear, but may turn cloudy if a secondary infection is present. The disease is diagnosed based on the seasonal nature, spreads quickly, many people get it, and the virus is found in the nasal secretions.
Differential diagnosis of acute rhinitis with diseases with similar symptoms such as vasomotor rhinitis and allergic rhinitis. Allergic rhinitis is only symptomatic with itchy nose, sneezing with nasal congestion. While vasomotor rhinitis, although the symptoms are similar to acute rhinitis, it is not contagious, not seasonal, disease or recurrent.

2.1.2. Treatment of acute rhinitis
If there is no superinfection, only symptomatic treatment, do not use antibiotics:
Clean the nose with physiological saline, regularly suck the nose to clear the airway. For children > 2 years old, nasal drops with 0.25% Phenylephrine solution can be used to reduce nasal congestion symptoms. Usually 3 times, each time 1 minute apart, every 4 hours for 3-4 days in a row. Gargle with physiological saline regularly to relieve sore throat symptoms. Cough relief with Dextromethorphan. 2.1.3. Complications of acute sinusitis
2.1.3.1. Causes and clinical symptoms
Acute sinusitis often forms during the period of acute rhinitis . This is a complication of acute rhinitis when there is a secondary infection with bacteria such as staphylococcus aureus, Haemophilus influenzae, Branhamella catarrhalis, anaerobic bacteria, etc. The more viral rhinitis the patient has, the higher the risk of inflammation. the higher the sinus level.
In addition to headache, nasal congestion, loss of smell, depending on the inflamed sinuses, there will be different symptoms:
Acute maxillary sinusitis: Pus draining into the middle slit. edema, conjunctival regurgitation, limited eye movement, then red and purulent drainage under the eyes. Frontal sinusitis: Headache in the morning sphenoid sinusitis: A dull ache in the deep at night.

2.1.3.2. Treatment of acute sinusitis
Treatment of headache: Paracetamol 10-15mg/kg Nasal congestion: Use a vasoconstrictor Phenylephedrine 0.25% for nasal drops Antibiotics: Amoxicillin 80-100mg/kg/day, can be replaced by Amoxicillin + clavulanic acid, cefaclor, cefuroxime for 3 weeks. In case of allergy to beta lactams can be replaced with Erythromycin, Azithromycin, Clarithromycin. Surgery may be indicated if medical treatment fails, only sinus surgery in children over 6 years old.

2.2. Acute pharyngitis
2.2.1. Causes and clinical symptoms
Acute pharyngitis can be caused by viruses or bacteria. When the disease is caused by a virus, the patient will have symptoms of sore throat, itchy throat, burning throat, difficulty swallowing, often accompanied by fever in children. Acute pharyngitis is often accompanied by rhinitis and cough.
If acute pharyngitis is caused by bacteria, depending on the type of bacteria causing the disease, the patient will have different symptoms:
Strep throat: Children have symptoms of high fever, can reach 40 degrees, pain The throat is severe, the mucous membrane of the throat is red, there is secretion, the white blood cell is elevated >12,000/mm3. The disease can spread to the posterior pharyngeal wall and tonsils. Pharyngitis due to diphtheria: The child has fever, cough, feeling of throat obstruction, white pseudomembranous region of the tonsils and throat. The pseudomembranous area is prone to bleeding and is located close to the mucosal area. Culture results showed diphtheria bacteria. Pharyngitis caused by rare bacteria Spirochete: Children with high fever, sore throat, difficulty swallowing, results of throat swab culture find Spirochete bacteria. 2.2.2. Treatment of acute pharyngitis
If acute pharyngitis is caused by a virus without superinfection, only symptomatic treatment, not antibiotics. Using Paracetamol to reduce fever and pain; relieve cough with Dextromethorphan.
Acute strep throat: use Amoxicillin 50-70 mg/kg/day, divided into 3-4 times a day, orally for 7-10 days. If allergic to Penicillin, can switch to Erythromycin 30-50mg/kg/day, divided 2-3 times/day, used for 7 days.
Acute pharyngitis for diphtheria: Immediately isolate the patient to avoid infecting others, treat with diphtheria antitoxin, combine antibiotics to kill bacteria, stop releasing toxins. The antibiotics that can be used are Penicillin G 300,000-500,000 UI/kg/day, intravenously for 7-10 days. If after 2 days of using antibiotics, the symptoms of the disease do not improve, it is possible to switch to cefaclor 20-40 mg/kg/day or cefuroxim 20 mg/kg/day. If there is an opportunity to make an antibiotic, use antibiotics according to the results of the antibiogram.

2.2.3. Complications of acute pharyngitis
If not treated promptly or not thoroughly, acute pharyngitis can cause many dangerous complications. Two common complications are peritonsillar abscess and posterior pharyngeal abscess, which are usually caused by staphylococcal superinfection. The method of treating these complications is incision of the abscess, aspiration, drainage of pus, then use of antibiotics sensitive to staphylococci.
2.3. Acute otitis media 2.3.1. Causes and symptoms
Acute otitis media is usually caused by pneumococcus, H.influenzae, B.catarrhalis,... Viruses such as Rhinovirus, Enterovirus,... can also be the causative agent of the disease.
The disease is common in children from 6 to 24 months old, the rate of boys is higher than that of girls, breastfed babies are less likely to get the disease. Common signs of the disease are earache, ear discharge, fever, anorexia, vomiting, diarrhea (common in infants),... On examination, the eardrum is red, congested, less mobile, and lost. light triangle, the anatomical landmarks are not clearly visible, the air-fluid level can be seen or the eardrum is aspirated.

2.3.2. Treatment of acute otitis media
The principle of treatment is to use antibiotics and anti-inflammatory drugs to reduce symptoms and reduce the risk of complications.
Antibiotics:
Amoxicillin 60-90 mg/kg divided into 3 times/day, if good response, use for 7-14 days. If no response, switch to Amoxicillin-Clavulanic or Cefuroxime for 14 days. If you are allergic to beta-lactams, you can take the Macrolides Erythromycin, Azithromycin or Clarithromycin for 14 days. Pain relief, antipyretic: Paracetamol 10-15mg/kg every 4-6 hours.
To keep the eustachian tube open, a vasoconstrictor can be added (in children older than 2 years, phenylephrine 0.25% can be administered intranasally) and an antihistamine. When the pus has broken, clean the ear canal with hydrogen peroxide 3 times / day, you can drop the ear with Neomycin but not more than 7 days.

2.3.3. Complications of otitis media
Meningitis and acute mastoiditis are two dangerous complications of otitis media.
When having meningitis, children have high fever, headache, lethargy, fear of light, cerebrospinal fluid has many multinucleated cells. This is a very serious disease that needs to be treated aggressively with antibiotics. When having acute mastoiditis: The child has a high fever, the area behind the ear is red and hot, swollen, painful to the touch, the X-ray image of the mastoid is blurry. Acute mastoiditis to untreated mastoiditis will lead to chronic mastoiditis and serious complications such as: osteomyelitis, peripheral facial paralysis, brain abscess, lateral vein inflammation,... The patient needs urgent surgery. research and use of high-dose systemic antibiotics. As a key area of ​​Vinmec Medical system, Pediatrics Department always brings satisfaction to customers and is highly appreciated by industry experts with:
Gathering a team of leading pediatricians: including leading experts with high professional qualifications (professors, associate professors, doctorates, masters), experienced, worked at major hospitals such as Bach Mai, 108.. Doctors All are well-trained, professional, with a mind - range, understanding young psychology. In addition to domestic pediatric specialists, the Department of Pediatrics also has the participation of foreign experts (Japan, Singapore, Australia, USA) who are always pioneers in applying the latest and most effective treatment regimens. . Comprehensive services: In the field of Pediatrics, Vinmec provides a series of continuous medical examination and treatment services from Newborn to Pediatric and Vaccine,... according to international standards to help parents take care of their baby's health from birth to childhood. from birth to adulthood Specialized techniques: Vinmec has successfully deployed many specialized techniques to make the treatment of difficult diseases in Pediatrics more effective: neurosurgery - skull surgery, stem cell transplantation. blood in cancer treatment. Professional care: In addition to understanding children's psychology, Vinmec also pays special attention to the children's play space, helping them to have fun and get used to the hospital's environment, cooperate in treatment, improve the efficiency of medical treatment. To register for examination and treatment with Pediatricians at Vinmec International General Hospital, please click the "Contact Us" button on the website or register online HERE.

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