Beruflich Dokumente
Kultur Dokumente
(IRA) ATAS
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...COMMON COLD
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...COMMON COLD
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...COMMON COLD
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Viral cause of the common cold
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...COMMON COLD
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...COMMON COLD
Infected cells undergo apoptosis Signalling within cells occur via NF-kB
and are extruded from the mucosa (and perhaps other pathways)
Pappas DE, Hendley JO. Epidemiology, clinical manifestations, and pathogenesis of rhinovirus infections.
Up to date. Last updated February 2008 10
...COMMON COLD
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...COMMON COLD
TREATMENT
• Supportive therapy is the only recommended
treatment
• Antihistamines, decongestants, antitussives, and
expectorants, singly and in combinations, are all
marketed for symptomatic relief in children.
• few clinical trials of these products in infants and
children and none that demonstrate benefit for
treatment of the symptoms
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...COMMON COLD
• Symptomatic therapy
– may include antipyretics, saline nasal irrigation,
adequate hydration, and the use of a humidifier
– Children with reactive airway disease or asthma
should use beta-agonist medications to relieve
associated bronchospasm.
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...COMMON COLD
• Antipyretics
– Acetaminophen (or ibuprofen, in children greater
than 6 months of age) may be used to alleviate
fever during the first few days
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...COMMON COLD
• Saline irrigation
– In infants, bulb suction with saline nose drops may
help to temporarily remove nasal secretions
– in the older child, a saline nose spray may be
used.
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...COMMON COLD
• Antihistamines
– The anticholinergic effects of 1st generation AH (eg,
diphenhydramine) may help to reduce the
secretions
– in controlled trials, AH have been ineffective in
relieving the symptoms, in combination with
decongestants or as monotherapy
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...COMMON COLD
• Antitussives
– Cough is a common complaint during the
course
– For many children, effective cough suppression
could result in mucus plugging
– No cough suppressants have proven effective
in children.
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...COMMON COLD
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...COMMON COLD
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• Decongestants
– sympathomimetic medications that cause
vasoconstriction of the nasal mucosa.
– available in oral and topical formulations.
– pseudoephedrine HCl, and phenylephrine HCl, and
oxymetazoline.
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...COMMON COLD
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...COMMON COLD
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...COMMON COLDv
• Zinc
– The efficacy for treatment of the common cold
remains unclear.
– for every study that demonstrates benefit,
there is another that shows none.
– Randomized trials in children also have shown
conflicting results,
– Side effects may include bad taste, nausea,
throat irritation, and diarrhea
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...COMMON COLD
• Other treatments
– Echinacea
– Vitamin C
– Honey
– Antibiotics
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...COMMON COLD
• Antibiotic therapy
– There is no role for antibiotics in the treatment
– does not prevent secondary bacterial infection
– may cause significant side effects, contribute to
increasing bacterial antimicrobial resistance.
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• The use of antibiotics should be reserved for
clearly diagnosed secondary bacterial
infections, including bacterial otitis media,
sinusitis, and pneumonia
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...COMMON COLD
• PREVENTION
– The best methods for preventing transmission
from one person to another are to practice
frequent handwashing and to avoid touching
one's nose and eyes.
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ALLERGIC RHINITIS
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...allergic rhinitis
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...allergic rhinitis
• Allergic rhinitis
– associated with a symptom complex characterized
by paroxysms of sneezing, rhinorrhea, nasal
obstruction, and itching of the eyes, nose, and
palate.
– It is also frequently associated with postnasal drip,
cough, irritability, and fatigue
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...allergic rhinitis
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...allergic rhinitis
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...allergic rhinitis
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...allergic rhinitis
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...allergic rhinitis
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...allergic rhinitis
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...allergic rhinitis
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...allergic rhinitis
• "Intermittent" – symptoms are present less than four days per week or for
less than four weeks
• "Persistent" – symptoms are present more than four days per week and
for more than four weeks
• "Mild" – None of the items listed below for "moderate-severe" are present
• "Moderate-severe" – One or more of the following items is present:
– - Sleep disturbance
– - Impairment of school or work performance
– - Impairment of daily activities, leisure and/or sport activities
– - Troublesome symptoms
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...allergic rhinitis
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...allergic rhinitis
• Allergen-specific testing
– properly performed skin testing may provide an in
vivo assessment of biologically relevant IgE
antibodies. It is the most convenient and least
expensive screening method to detect allergic
sensitization. Other tests are less useful.
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...allergic rhinitis
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...allergic rhinitis
Allergen
identification
> 1 of the 4 major
allergen categories that
trigger allergic rhinitis
careful environmental Pollens
history Insects
Reviewing home and Animal allergens
work environments Molds
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...allergic rhinitis
• PHARMACOLOGIC OPTIONS
– Most patients require pharmacotherapy, in
addition to allergen avoidance, for satisfactory
symptom control
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...allergic rhinitis
Therapy
• topical intranasal corticosteroids
• oral antihistamines
• topical nasal antihistamines
• mast cell stabilizers
• leukotriene modifiers
• ipratropium
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...allergic rhinitis
Intranasal glucocorticoids
( INGCs)
• Topical INGCs are presently the most effective single
maintenance therapy and cause few side effects at
the recommended doses.
• particularly effective in the treatment of nasal
congestion.
• beclomethasone, flunisolide, budesonide, fluticasone
propionate, mometasone furoate, and fluticasone
furoate.
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...allergic rhinitis
Second generation
antihistamines
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ACUTE BACTERIAL SINUSITIS IN
CHILDREN
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...acute bacterial sinusitis
DEFINITIONS
• Sinusitis is inflammation of the mucosal lining of
one or more of the paranasal sinuses
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...acute bacterial sinusitis
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...acute bacterial sinusitis
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...acute bacterial sinusitis
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...acute bacterial sinusitis
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...acute bacterial sinusitis
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...acute bacterial sinusitis
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...acute bacterial sinusitis
Risk factors
• Viral URI is the most important
• children who attend day care
• Allergic rhinitis
Anatomic obstruction ( septal
deformities; craniofacial anomalies;
adenoidal hypertrophy)
Mucosal irritants (dry air, tobacco smoke, Less
chlorinated water) common
Sudden changes in atmospheric pressure
(descent in an airplane)
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...acute bacterial sinusitis
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...acute bacterial sinusitis
Antibiotics
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...acute bacterial sinusitis
Antibiotics
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...acute bacterial sinusitis
Antibiotics
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...acute bacterial sinusitis
Antibiotics
• Seriously ill children with ABS should be hospitalized for
intravenous antibiotics.
• Empiric therapy should provide coverage for highly resistant
pneumococci and penicillin resistant H. influenzae and M.
catarrhalis.
• Appropriate regimens include:
– Cefotaxime (100 - 200 mg/kg /day divided every 6 hs)
– Ceftriaxone (100 mg/kg /day divided every 12 hs)
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