The following was posted in my exam rooms today.  Feel free to copy/distribute it.

Upper Respiratory Infection

  • Symptoms:  Stuffy/runny nose, cough, sneezing, sore/scratchy throat, fever
  • Cause:  Viruses - Can happen any time of the year
  • Course: Lasts for 3-7 days
  • Treatment (Over 2 years of age)
    • Decongestants (Pseudoephedrine, phenylephrine)
    • Cough suppressants
    • Tylenol/Ibuprofen
    • Mucinex to loosen phlegm
    • Antibiotics do not help an upper respiratory infection.
  • Contagiousness: Viruses are transmitted through direct contact with someone who is carrying the virus.  Washing hands is the best way to prevent spread.

Sinus Infection

  • Symptoms:  Pressure/pain on the cheeks below the eyes and/or on the forehead immediately above the eyes upper teeth hurting, nasal congestion, fever and sore throat.
  • Cause:  Bacteria or Viruses - The sinuses are filled with mucous when a person gets an upper respiratory infection or has bad allergies, and the symptoms of sinusitis are not uncommon in this case.  If the fluid becomes infected with a bacteria, the fluid becomes thicker, and the pain can become more intense.
  • Course: If viral, will go away within a week.  If bacterial, will take longer.
  • Treatment
    • Decongestants (Pseudoephedrine, phenylephrine)
    • Antihistamines can thicken the phlegm, so can make things worse.
    • Over the counter nasal sprays (Afrin, etc) can help, but should never be used for more than 5 consecutive days.
    • Mucinex to loosen phlegm
    • Saline rinses of the nasal passages can loosen phlegm
    • Prescription nasal sprays like Flonase can help; they can also prevent sinus infections in people who are prone to it.
    • Antibiotic use is debatable (although it is standard practice).  Many studies show that the addition of antibiotics to the above treatments does not speed up improvement.  If an antibiotic is prescribed, we strongly prefer to wait until symptoms have been there for 1 week and the other treatments have been tried.  We do not give antibiotics “just to be on the safe side,” or “because it always turns into a sinus infection.”  This is the type of prescribing that has caused antibiotic resistance to occur.
  • Contagiousness:  The viruses that cause sinus infections have similar contagiousness to the upper respiratory infection.  The bacteria infection is not contagious.

Bronchitis

  • Symptoms:  Persistent loose cough
  • Cause:  Viruses are the most likely cause of bronchitis, not bacteria (as is widely thought).
  • Course: Viral bronchitis lasts for 3-7 days
  • Treatment
    • Humidifier
    • Cough suppressants
    • Mucinex to loosen phlegm
    • Antibiotics do not help viral bronchitis.  We strongly prefer to not treat bronchitis with an antibiotic until the symptoms have been there over a week.  We will use them sooner to people who have chronic lung problems or are particularly frail.  If it lasts over a week, the likelihood it is bacterial is much higher, so an antibiotic may help.
  • Contagiousness: The viruses and bacteria that cause bronchitis have similar contagiousness to upper respiratory infections, although some are more prone to become airborne (because of the coughing).

Influenza

  • Symptoms:  High fever, body aches, and headaches are the hallmark symptoms of flu.  The patient also can have cough, upper respiratory symptoms and mild intestinal tract symptoms.  The fever tends to run higher than with other infections (102-105 range).   People who have influenza look like they’ve been hit by a truck.
  • Cause:  Influenza virus - there are two types, A and B - A being more serious.  This occurs between December and April - usually in January through March, and it occurs in epidemics.
  • Course: Lasts for 5-7 days
  • Treatment
    • Ibuprofen/Tylenol for body aches and fever.
    • Symptomatic treatment of other symptoms (Medications like Thera-Flu can help).
    • Rest and lots of fluids.
    • There are anti-viral medications for influenza, but these are reserved for people with Influenza A who are at increased risk of complications (the very old or very young, and people with lung or heart problems).
  • Complications - Influenza is a very dangerous infection for people who are at risk (infants and elderly).  The major complication is pneumonia caused by the Staph bacteria.  If someone is diagnosed with influenza and develops the symptoms of pneumonia (productive cough and shortness of breath), they need to see the doctor immediately and are generally hospitalized.
  • Contagiousness - Flu is very contagious during epidemics.  Hand washing can help, but the best preventive measure is to get an influenza vaccine in the fall.  Even if the strain of influenza is not the one in the vaccine, people who get a flu shot are less likely to have a serious case.

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