What are the guidelines for treating common illnesses such as upper respiratory tract infections, gastrointestinal issues, and skin conditions?

Guidelines for Treating Common Illnesses: Upper Respiratory Tract Infections, Gastrointestinal Issues, and Skin Conditions

Most common illnesses such as upper respiratory tract infections, gastrointestinal issues, and skin conditions should be managed with symptomatic treatment first, reserving antibiotics only for specific bacterial infections with clear diagnostic criteria. 1

Upper Respiratory Tract Infections (URTIs)

Common Cold

• Management approach:

  • Symptomatic treatment only - antibiotics are not justified for uncomplicated acute common cold 2
  • Recommend adequate hydration, rest, over-the-counter analgesics, and saline nasal irrigation 1
  • Inform patients about the viral origin, median duration (7-10 days), and favorable outcome 2
  • Cough suppressants, expectorants, mucolytics, antihistamines, and bronchodilators should NOT be prescribed 2

• When to suspect bacterial complications:

  • Fever persisting >3 days or occurring after initial improvement
  • Symptoms persisting >10 days with no improvement
  • Respiratory discomfort, irritability, nocturnal awakening
  • Ear pain, purulent conjunctivitis, palpebral edema 2

Pharyngitis

• Diagnostic approach:

  • Most cases are viral in origin
  • Group A beta-hemolytic streptococcus (GAS) accounts for 25-40% of cases in children, 10-25% in adults 2
  • Clinical signs alone cannot reliably determine streptococcal origin
  • Rapid antigen tests (RAT) are recommended to confirm GAS-pharyngitis 2

• Treatment:

  • Viral pharyngitis: Symptomatic treatment only
  • GAS-pharyngitis: Penicillin for 10-14 days is first-line therapy 3
  • Alternative medications: Oral cephalosporins (cefaclor, cephalexin), amoxicillin, or macrolides for penicillin-allergic patients 3

Sinusitis

• Management approach:
  • Most cases are viral and resolve spontaneously without antibiotics
  • Common bacterial pathogens: S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes 3
  • First-line antibiotic: Amoxicillin
  • Alternative options: Cefaclor or cephalexin (first-line if sinusitis is recurrent or chronic) 3
  • Amoxicillin-clavulanate (875/125 mg twice daily for 7 days) for persistent purulent sputum lasting 3 weeks 1

Lower Respiratory Tract Infections

• When to suspect pneumonia:

  • New focal chest signs, dyspnea, tachypnea, pulse rate >100, or fever >4 days
  • C-reactive protein (CRP) >100 mg/L makes pneumonia likely
  • Consider chest X-ray when diagnosis is uncertain 2

• Antibiotic selection:

  • Amoxicillin or tetracycline as first choice
  • For hypersensitivity: Tetracycline or macrolide (azithromycin, clarithromycin, erythromycin, roxithromycin) 2

Special Considerations for High-Risk Patients

• High-risk factors:

  • Age >65 years
  • COPD, diabetes, heart failure
  • Previous hospitalization in past year
  • Taking oral glucocorticoids
  • Antibiotic use in previous month
  • General malaise, confusion/diminished consciousness 2, 1

• Management of high-risk patients:

  • Lower threshold for antibiotic therapy
  • Consider earlier referral to hospital 2, 1

Gastrointestinal Issues

Acute Gastroenteritis

• Management approach:
  • Most cases are viral and self-limiting
  • Focus on hydration and electrolyte replacement
  • Antibiotics only indicated for specific bacterial pathogens with positive stool cultures

Irritable Bowel Syndrome

• Management approach:
  • Dietary modifications (low FODMAP diet)
  • Antispasmodics for abdominal pain
  • Loperamide for diarrhea
  • Fiber supplements for constipation
  • Consider probiotics

Skin Conditions

Bacterial Skin Infections

• Impetigo:

  • Topical mupirocin for limited lesions
  • Oral antibiotics (dicloxacillin, cephalexin) for extensive disease 4, 5

• Cellulitis:

  • Oral antibiotics covering Streptococcus and Staphylococcus
  • First-line: Dicloxacillin or cephalexin 5, 4
  • For penicillin allergy: Clindamycin or trimethoprim-sulfamethoxazole

Fungal Skin Infections

• Dermatophyte infections:
  • Topical antifungals (terbinafine, clotrimazole) for localized infections
  • Oral terbinafine or itraconazole for extensive disease or onychomycosis

Viral Skin Conditions

• Herpes simplex:
  • Oral acyclovir, valacyclovir, or famciclovir
  • Topical acyclovir for limited disease

Common Pitfalls to Avoid

1. Unnecessary antibiotic use:

   • Antibiotics do not benefit viral URTIs and increase risk of adverse effects 6
   • Overuse contributes to bacterial resistance 2

2. Inadequate follow-up:

   • Advise patients to return if symptoms persist beyond 3 weeks 1
   • Clinical effects of antibiotic treatment should be expected within 3 days 1

3. Inappropriate diagnostic testing:

   • Routine microbiological tests such as cultures and gram stains are not recommended in primary care 2
   • Biomarkers to assess bacterial pathogens are not recommended in primary care 2

4. Failure to recognize high-risk patients:

   • Immunocompromised patients require special consideration and may need prophylactic antimicrobials 7
   • Elderly patients with comorbidities need closer monitoring 1

5. Incomplete treatment courses:

   • Ensure patients complete the full course of antibiotics even if symptoms improve quickly 1
   • Standard treatment duration for most antibiotics is 7 days (except azithromycin: 3-5 days) 1