Dialogue Volume 14 Issue 4 2018 - Page 38

PRACTICE PARTNER Key Practice Changes for Upper Respiratory Tract Infections in Primary Care Setting Uncomplicated otitis media DON’T prescribe antibiotics in vaccinated chil- dren more than six months old and adults in whom you suspect acute otitis media, unless there is either a perforated tympanic mem- brane with purulent discharge or a bulging tympanic membrane with one of the three following criteria: 1. Fever (≥39°C). 2. Moderately or severely ill. 3. Significant symptoms lasting > 48 hours. Uncomplicated pharyngitis routinely prescribe antibiotics unless the patient’s modified Centor score is ≥ 2 AND throat swab culture (or rapid antigen test if available) confirms presence of Group A Streptococcus. DON’T perform throat swabs at all for patients with Centor score ≤ 1, OR if there are symp- toms of a viral infection such as rhinorrhea, oral ulcers or hoarseness. DON’T Uncomplicated sinusitis DON’T prescribe antibiotics unless symptoms have persisted for greater than 7-10 days without improvement. Differentiating viral rhinosinusitis (VRS) from acute bacterial rhinosinusitis (ABRS) can be challenging. Patients not meeting the below criteria are best managed with a viral prescription. Antibiotics should only be con- sidered if the patient has at least two of the below PODS symptoms, one of those being O or D, AND the patient meets one of the following criteria: 1. The symptoms are severe. 2. The symptoms are mild to moderate symp- toms if there is no response after a 72 hours trial with nasal corticosteroids. P: Facial Pain/pressure/fullness; O: Nasal Obstruction; D: Purulent/discolored nasal or postnasal Discharge; S: Hyposmia/anosmia (Smell) Pneumonia prescribe antibiotics for pneumonia unless there is objective evidence. If access to a chest x-ray is available near your clinic, don’t routinely prescribe antibiot- ics for suspected pneumonia without con- firming the presence of a new consolidation. Physical examination alone, demonstrat- ing respiratory crackles, is not sufficient to 38 DIALOGUE ISSUE 4, 2018 DON’T