What is the appropriate diagnosis and treatment approach for respiratory infections in adolescents?

From the Guidelines

Nurse practitioners should diagnose respiratory infections in adolescents through a comprehensive approach combining clinical assessment, targeted testing, and appropriate treatment selection, prioritizing the most recent and highest quality evidence from the European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis 1.

Diagnosis and Treatment Approach

The diagnosis of respiratory infections in adolescents should begin with a thorough history and physical examination, noting symptoms like fever, cough, sore throat, nasal congestion, and breathing difficulties. Vital signs, lung auscultation, and assessment of hydration status are essential.

• For suspected bacterial infections, rapid strep testing or throat cultures for pharyngitis, and possibly chest X-rays for pneumonia may be indicated.
• Viral infections typically require supportive care including rest, adequate hydration, and antipyretics like acetaminophen (10-15 mg/kg/dose every 4-6 hours, maximum 3,000 mg daily) or ibuprofen (10 mg/kg/dose every 6-8 hours, maximum 3,200 mg daily).

Antibiotic Treatment

For bacterial infections, appropriate antibiotics are necessary:

• Amoxicillin (45-90 mg/kg/day divided twice daily for 10 days) for streptococcal pharyngitis;
• Amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component divided twice daily for 5-7 days) for sinusitis;
• Amoxicillin (90 mg/kg/day divided twice daily) or azithromycin (10 mg/kg on day 1, then 5 mg/kg daily for 4 days) for community-acquired pneumonia, as recommended by the British Thoracic Society guidelines for the management of community-acquired pneumonia in childhood 1.

Education and Follow-up

Educate patients and families about completing full antibiotic courses, expected symptom duration, and warning signs requiring follow-up. This approach balances effective treatment with antibiotic stewardship principles to address the specific pathogens common in adolescent respiratory infections. In cases of bronchiectasis, the European Respiratory Society guidelines recommend a systemic course of an appropriate antibiotic for 14 days to treat an acute respiratory exacerbation, with amoxicillin-clavulanate as the empiric antibiotic of choice 1. Regular airway clearance techniques and long-term macrolide antibiotics may also be considered in certain cases, as suggested by the European Respiratory Society guidelines 1.

From the FDA Drug Label

Adolescents and Adults with Chronic Cardiac or Respiratory Disease A double-blind, placebo-controlled, multicenter trial was unable to demonstrate efficacy of oseltamivir phosphate (75 mg twice daily for 5 days) in the treatment of influenza in adult and adolescent subjects (13 years or older) with chronic cardiac (excluding chronic idiopathic hypertension) or respiratory diseases, as measured by time to alleviation of all symptoms.

The appropriate diagnosis and treatment approach for respiratory infections in adolescents is not directly addressed in the provided FDA drug label. However, for adolescents with influenza, oseltamivir phosphate may be considered as a treatment option, but its efficacy in this population, especially those with chronic cardiac or respiratory disease, is not well established 2.

• The diagnosis of respiratory infections in adolescents should be based on clinical evaluation and laboratory tests, but the label does not provide specific guidance on this.
• Treatment with oseltamivir phosphate may be considered for adolescents with influenza, but the label notes that no increased efficacy was demonstrated in subjects who received higher doses.
• The label also notes that in patients treated with oseltamivir phosphate, there was a more rapid cessation of febrile illness, but no difference in the incidence of influenza complications was observed between the treatment and placebo groups.

From the Research

Diagnosis of Respiratory Infections

• The diagnosis of respiratory infections in adolescents involves evaluating the patient's symptoms, medical history, and performing physical examinations 3, 4.
• Laboratory tests, such as blood work and imaging studies, may also be necessary to confirm the diagnosis and determine the severity of the infection 4, 5.
• In patients with severe neurological impairment, comprehensive multidisciplinary care and antibiotic stewardship are crucial in managing lower respiratory tract infections 6.

Treatment Approach

• The treatment approach for respiratory infections in adolescents depends on the severity and type of infection, as well as the patient's overall health status 3, 4.
• Supportive care, including hydration, antipyretics, oxygen therapy, and respiratory support, is often the initial treatment for mild to moderate infections 6, 4.
• Antibiotic therapy may be necessary for bacterial infections, with the choice of antibiotic depending on the severity of the infection and the patient's medical history 6, 4.
• In patients with severe neurological impairment, antibiotic therapy should be initiated based on the severity of the infection, with aminopenicillin plus a beta-lactamase inhibitor recommended for community-acquired infections and piperacillin-tazobactam for patients with chronic lung disease or tracheostomy 6.

Special Considerations

• Adolescents with severe neurological impairment require specialized care due to their complex medical needs, and are at increased risk for severe and recurrent lower respiratory tract infections 6.
• The indication and choice of antibiotic therapy for bacterial lower respiratory tract infections in this patient population can be challenging, and requires careful consideration of the patient's medical history and the potential for antibiotic resistance 6.
• Ethical and palliative care aspects should also be taken into account when managing lower respiratory tract infections in adolescents with severe neurological impairment 6.