Upper Respiratory Infections: When to Use an Antibiotic
Colds, sinus infections, pharyngitis / tonsillitis and bronchitis are included among the category of Upper Respiratory Infections (URI). Sinus infections often have symptoms of nasal drainage, sinus pressure, cough and fever. Pharyngitis symptoms may include sore throat, fever, headaches and abdominal pain. Bronchitis mostly shows up as a cough with little or no drainage nor headache. It is often difficult to tell which of these you might have, because there can be overlapping of symptoms.
These complaints are among the most frequent causes for visits to an Urgent Care Clinic. Viruses, not bacteria, cause the vast majority of these infections. This is important to know because we cannot treat a virus with an antibiotic, only bacteria respond to antibiotic treatment. The major task of the physician is to determine if a virus or bacterial infection brings on the illness. In addition to the symptoms, the physician relies on the physical exam to confirm which type of organism is the cause of the symptoms.
The use of antibiotics in these infections has become a hot topic in the medical field over the last several years because bacteria have developed increasing resistance to antibiotics. Resistances to drugs shows up when bacteria can’t be killed by antibiotics and take over when the weaker bacteria are killed. This is largely due to the overuse of antibiotics – that is, using an antibiotic to treat a viral infection or using an antibiotic that is not effective against the bacteria causing the infection.
How can we best determine if a bacterial infection is present and an antibiotic may be helpful? No matter how severe the symptoms, antibiotics are indicated only when:
- Symptoms persist longer than 7 - 10 days, or
- Symptoms are progressively worse after 7 days, or
- Fever is present after 5 days, or
- Patients have a poor immunity to infection (e.g. HIV/AIDS, cancer), or
- Patients have poorly controlled diabetes.
- Pharyngitis is caused by Streptococcal infection (this is detected by the rapid strep test often done in the doctor’s office).
As you can see, it is important, when visiting the doctor’s office, to make sure to ask for and expect an antibiotic only when it is indicated by the presence of a bacterial infection. You will have a much higher chance of getting better now and in the future.
References: www.aafp.com | www.aware.com
www.cdc.gov/drugresistance/community
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Burns: What to Do Immediately to Minimize the Injury
Burns are common injuries and can happen daily in our life. We need to know what to do immediately to minimize the injury when it happens and how to distinguish a minor burn from severe burn. The treatment of a burn injury depends on the cause, the depth, the size and the location.
CAUSES
The common causes include heat (flame, tar, melted synthetics, molten metal and liquid), electricity, chemical agents (melt tissues) and radiation.
DEGREE
The skin has two layers: epidermis and dermis. First-degree burn is superficial and only the epidermis (outer layer of skin) is burned. The skin appears red, swollen and painful. Second-degree burn injury may look similar to the first-degree burn early on, but both epidermis and dermis (inner layer of skin) are burned. Blisters develop and the pain is more intense. Third-degree burn involves the full thickness of skin. The skin appears dry, pearly white, charred, leathery and loses its sensation, becoming numb.
TREATMENT
First-degree burns and some second-degree burns (less than 2-3 inches in diameter and not on hands, feet, face, groin, buttocks or joints), the following steps should be taken as the initial management:
- Remove any constricting jewelry and contaminated clothing.
- Cool the burn with cold running water for at least 5 minutes or until pain subsides. Chemical burn should be washed with tap water for at least 15 and preferably 30 minutes. DO NOT put ice on the burn.
- Cover with a sterile gauze bandage.
- DO NOT put butter or oils on the burn.
First-degree burns can be treated with local skin care such as aloe vera, over-the-counter topical antibiotics and antiseptics. The skin will heal, but may show some increased color. It should be noted to watch for any signs of infection such as increased pain, swelling, redness, fever and oozing. Further medical evaluation and treatment should be obtained when needed. A tetanus booster should be obtained if not received within the previous 5 years.
All third degree burns and second degree burns which are located on hands, feet, face, groin, buttocks and joints need immediate medical evaluation. The patient should be treated in an adequate medical facility. Special topical antiseptic creams (silver sulfadiazine and mafenide acetate creams) are used for more severe burns.
Sources: The Family Practice Handbook, University of Iowa, Mosby and www.Mayoclinic.com
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Sports Physical: What is It and Why Does My Child
Need One?
The Requirement
A sports physical is also known as the pre-participation examination (PPE). The Michigan High School Athletic Association (MHSAA) requires all students who participate in Middle School or High School athletics to have a sports physical on file before participation. The major medical societies* that make recommendations for the medical care of youth agree there is value in having yearly sports physicals.
The Purpose
The sports physical is not a random requirement of the MHSAA but rather a very purposeful, focused visit with a physician. The goal of the sports physical is to identify health issues of student-athletes to avoid placing them at risk during practice or competition. Examples include: an undiagnosed heart murmur, an ankle sprain that has not fully healed, untreated exercise-induced asthma, or a history of multiple concussions. On the rare occasion that a health condition is identified, the next step is to provide appropriate referral for further evaluation and treatment in preparation for participation in sport.
Timing
The ideal time to have a sport physical is 1-2 months prior to tryouts or practice. This provides time for any problem that may arise, to be further evaluated or treated; allowing the student-athlete to begin participation on time.
The Form
Often, your school will provide you with a form to be completed both by the student-athlete’s parent and the physician. It is helpful to have your portion of the card completed when you arrive for your physical. If you do not have a form, we can provide you with one.
The Examination
During the sports physical the medical assistant will measure height, weight, blood pressure, heart rate, and vision. The doctor will review these measurements, ask the student-athlete and parent about medical history and perform the physical exam. The student-athlete’s medical history and family medical history are very important parts of the sports physical process. It is ideal to have the student-athlete accompanied by a parent to provide a complete history. The physical exam is a brief exam of the eyes, ears, nose, throat, heart, lungs, and abdomen, as well as joints, nerves, and skin. Males (and some females) will also have a hernia exam. Because the physician needs to examine the skin and joints, it is helpful to wear shorts and for females to wear a sports bra or sleeveless shirt.
*American Academy of Family Physicians, American Academy of Pediatrics, American Medical Society of Sports Medicine, American College of Sports Medicine, and American Orthopedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.
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Sprains, Strains and Fractures: How to Treat These Common Injuries
Participating in exercise and sports is beneficial for the health of children and adults. However, athletic participation is occasionally associated with injury. Injuries also can occur due to accidents associated with daily activities. It is important to recognize when an injury is serious and requires immediate medical attention. It is also important to understand that injuries in children can be very different that those in adults.
A Strain is an injury to a muscle that occurs when it has been stretched too far. Muscle is connected to bone by tendons. Strains take about 1 week to heal.
A Sprain occurs when a ligament is over-stretched or torn. Ligaments are strong elastic bands of tissue that connect bone to bone at joints (like the elbow, knee, or ankle). Sprains often take 3 to 4 weeks to heal and may require a splint for part of the healing time.
A Fracture is a broken bone. Most fractures take 4 to 6 weeks to heal. Fractures, typically, are treated by immobilizing the injured area with a splint or cast.
RECOGNIZING SERIOUS INJURY
The following symptoms or situations may indicate a serious injury:
- Tenderness (it hurts to touch) over a bone
- Swelling
- Pain in a joint
- Decreased motion in a joint
- Unable to put weight on a foot or leg
- Numbness, tingling, or weakness of the injured part
WHAT TO DO IF YOU THINK AN INJURY IS SERIOUS – RICE:
REST: Stop or reduce use of the injured area. If injury is to leg, ankle or foot this may mean staying off of it completely.
ICE: Place an ice pack on the injured area for 15-20 minutes every 2-3 hours. A bag of ice wrapped in a thin towel works well. This is usually for the first 24-48 hours after the injury.
COMPRESSION: Compression or an injured wrist, ankle, or knee can help reduce swelling. This is often accomplished by using an elastic wrap (ACE wrap).
ELEVATION: try to keep the injured area above the heart, relative to the ground to minimize the swelling.
Do not apply heat to the area of injury for the first 48 hours. Seek immediate medical treatment. A doctor will evaluate your injury to see if an X-ray of the injured area is needed, and provide treatment and pain relief.
INJURIES IN CHILDREN
How are children’s injuries different than those in adults?
Children are actively growing. The areas in a child’s bone where growth is taking place is called a growth center or a growth plate. These growth centers often are more likely to be injured than surrounding muscles or ligaments. With an injury, in which an adult may sustain a sprain or strain, a child is much more likely to injure a growth center in a bone. A child sustaining an injury that causes pain or swelling should be examined by a physician and may need X-rays. Injury to a bone’s growth center is treated like a fracture with splinting or casting and may take several weeks to heal.
Source: American Academy of Family Physicians, American Academy of Pediatrics, American Medical Society of Sports Medicine, American College of Sports Medicine, and American Orthopedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.
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Seasonal Allergies
Seasonal allergies affect as many as 40 million Americans. Some are affected only minimally, but some allergies can be life threatening. Most seasonal allergies occur in spring with the new growth of plants, but fall can be a time of allergies also. Some allergies can be year-round (dust mites, animal dander and molds).
WHAT IS AN ALLERGY?
An allergy is an exaggerated reaction to something – in this case, in the environment. Mild allergic reactions include sneezing, itching, watering eyes and rash. More severe reactions include asthma, shortness of breath and collapse of your blood vessels causing shock. It is often hard to tell the difference between allergies and a cold. If you have a fever, it cannot be allergies (hay fever does not cause a fever, despite its nickname). A cold will run its course in 7-10 days, whereas allergies can last for months.
TREATMENT
Mild cases of allergies can be treated with some over-the-counter antihistamines, such as diphenhydramine, loratadine, or chlortrimeton. More severe cases require a doctor’s care. Sometimes your personal physician can take care of this, but for more intense allergies, you may need to see an allergist.
The allergist will probably perform a series of skin and blood tests to determine what you may be allergic to. Once your allergies are determined, the easiest form of treatment is to avoid the substance(s) to which you are allergic.
To avoid the substance which you are allergic to, shut your window and use an air conditioner if you are allergic to plants and trees. Air filters can reduce your exposure to dust, molds and pollens. Install wood, tile or vinyl floors in place of carpet because they can be mopped regularly. If you do keep your carpeting, have someone else do the vacuuming or buy a vacuum with a special filter to reduce dust emissions. Avoid clutter to minimize dust. Keep pets outside or bathe them regularly, if they are indoor pets. Do not let them sleep with you. A mattress cover is helpful to reduce dust mite exposure. In addition, there is a carpet spray, sold under the brand names Allersearch® ADMS Anti-Allergen Dust Mite Spray and DustMiteX® to kill dust mites.
If all of the above steps have not controlled the allergy symptoms, prescription medications may also be used. Most commonly, antihistamines (Allegra® and Zyrtec®, for example) are used first. The next line of medication is a nasal spray. There are 3 categories of nasal sprays: antihistamines (such as Astelin®), steroids (such as Flonase®) and mast cell stabilizers (Nasalcrom®). The nasal medications are used mainly to prevent symptoms, whereas the antihistamines treat symptoms.
For those allergies that do not respond to the above forms of allergy treatments, allergy shots are available.
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