Upper Respiratory Tract Infection URTI

Precautions

• History of GIT ulceration.

• Sever impairment functions of

− Hepatic.

− Renal.

− Cardiac.

• Porphyria.

• Blood count in long term use.

• Pregnancy.

• Lactation.

Respiratory Tract Anatomy

Challenges ?!

• The Upper Respiratory Tract Infection (URI) is one of the most common complaints in all primary care and emergency care practices.

• Even though it is considered a "self-limited" disease and relatively benign in terms of some critical illnesses that are seen in any medical practice it has a tremendous impact on the health care system and society.

• The URI is estimated to cost $3.5 BILLION a year in the US alone, and accounts for 40 percent of the time lost from jobs and as many as 23 million lost school days.

• It is an easily acquired illness that sweeps through communities and families causing mild to moderate misery and sending many to their doctor for care and advice.

Challenges ?!

• We know that greater than 90 percent of upper respiratory tract infections are viral. Viruses are sophisticated infectious agents that are self limited - meaning they resolve on their own.

• There are over 100 different types of viruses that infect the upper respiratory tract.

• First and foremost, antibiotics DON'T work.

• In the past it was common knowledge that if you were blowing out or coughing up discolored (green) mucous that you had a bacterial infection and needed antibiotics.

• More recent research indicates that the color of mucous is not necessarily related to bacterial infection.

URTI ?!

• Upper respiratory infections are common infections and include

− Pharyngitis

− Sinusitis

− Epiglottitis

− Laryngotracheitis

− Common cold

• Viruses play a significant role in the pathogenesis of many of these infections.

• Bacteria and other organisms also are responsible.

Distribution of Diagnostic Categories for Patient Encounters

19%

12%

15%17%

37%

Acute Bronchitis

Acute Sinusitis

AOM

Pharyngitis

*Nonspecific ViralURTI

*Nonspecific Viral URTI includes Colds, Croup, Laryngitis and Influenza

Symptoms

• It usually starts with a tickle in the throat and perhaps mild fatigue Just plain tired when you don't expect to be tired.

• Congestion and runny nose, sore throat and sometimes a fever and body aches follow.

• Next may come a cough that keeps you awake at night.

• With these symptoms comes the recognition and dismay that you have a "cold."

• This constellation of symptoms adds up to general inconvenience and misery.

• NSAIDs are thought to enhance the efficacy of the antibacterial agents by better penetration to the site of infection

Management

Rest and fluid intake are critical to recovering from a viral upper respiratory illness.

Over-the-counter medication is for symptom relief

Phospholipid Membrane

Arachidonic AcidArachidonic Acid

ProstacyclineProstacycline LeukotrinesLeukotrines

Cyclo-Oxygenase Cyclo-Oxygenase PathwayPathway

Lipoxygenase Lipoxygenase PathwayPathway

PGPG ThromboxaneThromboxane

Phosphlipase

Prostaglandins are released from injured cells and

cause erythema, vasodilation and hyperalgesia

Why NSAIDs ?!

• NSAIDs (including aspirin) act primarily by inhibiting the synthesis of prostaglandins from arachidonic acid.

• This anti-prostaglandin effect is thought to be the major mechanism of action of NSAIDs; it may produce analgesia by blocking prostaglandin-related pain impulse generation, or through inhibition of other pain mediators, such as bradykinin or histamine.

• Higher doses (typically prescription level) of NSAIDs also produce anti-inflammatory effects.

Mainstay Therapy

• In the common cold, symptomatic therapy remains the mainstay of treatment.

• A number of agents have been investigated in an effort to shorten the course of illness or prevent disease.

− These agents are antihistamines, zinc, vitamin C, and herbal therapy.

− Patients who use zinc have been demonstrated to experience significantly fewer days with coughing, headache, nasal congestion, nasal drainage, and sore throat.

Others Add on Therapy

• Nasal and systemic decongestants -- The goal of uncomplicated sinusitis is to relieve the obstruction.

− Antihistamines should be avoided because they thicken secretions. These drugs can be used for this purpose.

• Antibiotics -- The chosen antibiotic ideally should be

− Easy to take

− Free of adverse effects

− Affordable

− Penicillins and cephalosporins; no isolates have been identified that demonstrate in vitro resistance to these drugs.

When to Seek Medical Help

• Fever

In general, a fever of 38 C is expected during the initial 2 days of a viral illness. if:

− The fever is exceptionally high.

− The fever is prolonged or not controlled

− The fever returns during the course of the illness, especially with new symptoms.

When to Seek Medical Help

• Prolonged Course

− Most viral illnesses follow a pretty predictable course and last between 7-14 days. If your symptoms are not improving over time, or a cough is prominent and keeping you awake at night, or the course of the illness simply continues, it is important to seek medical advice.

When to Seek Medical Help

• Underlying Illness

− If you have an underlying illness like asthma, diabetes or cancer it is important to seek medical assistance or advice.

• Change of Symptoms

− Sometimes a viral infection will lead to a secondary bacterial infection. If your symptoms change or become suddenly more severe, it is important to seek evaluation.

A Multicenter, Randomized, Double-Blind, Double-Dummy, Placebo- and Active- Controlled, Parallel-Group

Comparison of Diclofenac-K and Ibuprofen for the Treatment

of Adults with Influenza-like Symptoms

RATIONAL ?

• The alleviation of influenza-like symptoms, such as fever, headache, and muscle/joint aches and pains, is important so that sufferers can return to their normal daily activities.

• This study assessed the efficacy and tolerability of diclofenac-K 12.5 mg versus ibuprofen 200 mg and placebo against influenza-like symptoms (oral temperature >38.1°C, and at least moderate headache and muscle/joint aches and pains).

RATIONAL ?

• Infection with a variety of viruses can produce an acute illness associated with influenza-like symptoms--fever, myalgia, headache, and cough.

• The median duration of fever and associated headache in influenza is 3 days, but cough and malaise often persist for 1 to 2 weeks.

• The alleviation of influenza-like symptoms, such as fever, headache, and muscle/joint aches and pains, is important in maintaining a more or less normal degree of daily activity

• With their antipyretic and analgesic activity, nonsteroidal anti-inflammatory drugs (NSAIDs) are a choice for the management of such symptoms, although they have no effect on the duration of illness or spread of the virus.

RATIONAL ?

• Cataflam, the first member of the phenylacetic acid class of NSAIDs, has been shown to effectively lower body temperature when administered as a 25-mg tablet .

• A new immediate-release formulation containing of diclofenac-K has been developed to allow safe and effective use of diclofenac-K at a low dose that could be suitable for nonprescription use.

Effect From 1st. hour

87%

1st. Day Assessment

96%

87%

94%

95%

EOS Assessment

93%

97%

Rescue Medication

The numbers of patients who took rescue medication during the entire treatment period were 1 (0.8%), and 14 (12.2%) in

the diclofenac-K, and placebo groups, respectively.

Results

• Compared to placebo, the initial dose of diclofenac-K (2 x 12.5 mg) significantly lowered body temperature as early as 30 minutes after dosing.

•The onset (within 30 minutes), duration (-4 hours), and magnitude of the antipyretic effect (peak effect, ~0.8°C) were

• In this 3-day study, diclofenac-K was effective compared with placebo in relieving influenza-like symptoms, with comparable tolerability.

At the 1st. Day of pharyngiotonsilitis

At the 4th. Day of pharyngiotonsilitis

Questions ??