Acute Sinusitis

Symptoms Headache, face pain around sinus area, yellowish discharge, sinus congestion, Cough & Loss of smell Additional symptoms may include Fever, Bad breath, Fatigue & Dental pain Acute sinusitis may be diagnosed when a person has two or more symptoms and/or the presence of thick, green, or yellow nasal discharge. Viral nasopharyngitis (common cold) commonly spreads to involve the paranasal sinuses but this usually subsides within 2 - 3 days without treatment. However, secondary bacterial infection of sinuses may occur and results in persistence of purulent nasal discharge, high fever or persistent cough. Management includes: 1 Antibiotic therapy: An oral broad-spectrum antibiotic for 10-14 days is indicated for control and eradication of bacterial infection. Choices are: . Broad spectrum penicillins as ampicillin or amoxicillin ( 50-100 mg / kg / day ). The newer drugs as sultamicillin ( ampicillin + sulbactam) or Co-amoxiclave (amoxicillin + clavulanic acid) are more effective than either drug alone. . second generation cephalosporins as cefuroxime, cefaclor or cefprozil (40 mg / kg / day) are also very effective. . New macrolides as clarithromycin or azithro mycin can be also used. 2 Nasal decongestants: Oral nasal decongestants can be used in the first 4-5 days of therapy to reduce sinus congestion. 3 Analgesic and antipyretics: paracetamol or other antipyretics may be needed in ther first few days to control fever and pain. Practical example A child, 6 years old (20 kg) with acute purulent sinusitis. R/ Augmentin or Curam suspension (457mg/5ml). One teaspoon (5ml), every 12 hours for 10 days. OR R/ Cefzil suspension (250mg/5ml). One and half teaspoon (7.5 ml), every 12 hours for 10 days. OR R/ Ceclor OR Bacticlor suspension (250mg/5ml). One and half teaspoon (7.5 ml), every 12 hours for 10 days. OR R/ Klacid suspension (250 mg /5ml). One teaspoon (5ml), every 12 hours for 10 days. + R/ Congestal syrup One teaspoon (5 ml), oral, 3 times daily for 4 days.

Congestal syrup ( Pseudoephedrine + paracetamol + chlorpheniramine + Dextromethorphane)

Acute Otitis Media

Symptoms Acute otitis media causes sudden, severe earache, deafness, and tinnitus (ringing in the ear), sense of fullness in the ear, irritability, an unwillingness to lie down, fever, headache, a change in appetite or sleeping patterns, fluid leaking from the ear, nausea and difficulty in speaking and hearing. Occasionally, the eardrum can burst, which causes a discharge of pus and relief of pain. Acute infalammation of the middle ear is acommon complication of acute nasopharyngitis especially in late infancy and early childhood. Un explained crying and irritability in a febrile infant or a child should raise the possibility. Examination of eardrums with an otoscope is esesential for diagnosis. Management of acute otitis media includes: 1 Antibiotic therapy: The use of abroad spectrum antibiotic for 7 10 days is important for control and eradication of infection. The choices of antibiotics and dosage are the same as those for acute sinusitis. 2 Nasal decongestants: These drugs may be needed in the first 3 4 days of therapy to relieve eustachain obstruction and to control the associated nasopharyngitis. 3 Analgesic and antipyretic: Paracetamol, or other antipyretics, can be used to control fever and earache. The earache usually disappears within 1 2 days of therapy. Analgesic eardrops (Otocalm drops) may be also used. 4 Myringotomy: it is rarely indicated in children. Persistent sever earache for more than 2 days is the main indication. However, some patients present initially with a spontaneous perforation and purulent ear discharge. In these cases, antibiotic ear drops (as Polyspectran eye/ear drops) for 5 days are added. Practical example An infant, 1 year old (10 kg) with acute otitis media R/ Augmentin OR Cuam OR E-moxclav suspension (156mg/5ml). One teaspoon (5ml), every 8 hours for 7 days. OR R/ Ceclor OR Bacticlor suspension (125mg/5ml). One teaspoon (5ml), every 8 hours, for 7 days R/ Cefzil suspension (125 mg/5ml). One and half teaspoon (7.5 ml), every 12 hours for 7 days. R/ Zithromax OR Zithrone OR aziwok suspension (200mg/5ml). 1/2 teaspoon (2.5 ml), once daily for 6 days. R/ Rhinomol syrup One teaspoon (5ml), once daily for 6 days. Re-examination after one week.

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