Fever, cough, cold and runny nose in children: When do they need antibiotics and cough syrup?

Fever, cough, cold and runny nose are common problems in children especially for the ones who are school going. It is usually caused by an infection of the upper part of the breathing pipe, which includes the nose and throat. It is called Upper Respiratory Tract Infection (URTI). This is usually caused by a virus, so antibiotics are not needed in most of the situations. 

What is upper Respiratory tract infection?

URTIs are usually self-limiting. Antibiotics cannot kill viruses. In rare cases it can be due to bacteria or secondarily infected by bacteria. In these situations antibiotics are useful. They are very common in a young child.

One can expect about 3-8 URTIs a year. Children tend to get more upper respiratory tract infections than adults because they have not yet built up immunity (resistance) to the many germs that can cause these infections.

These conditions usually resolve on their own. They are:

• Common cold
• Laryngitis (infection of the voice box,
  larynx)
• Tonsillitis (infection of the tonsils)
• Acute rhinitis (runny nose)
• Acute sinusitis (The sinuses are a connected
  system of hollow cavities in the skull)
• Acute otitis media (ear infection)
  

What are the signs and symptoms of an upper respiratory tract infection? 

• Fever
• Sore throat and cough. Vomiting may follow a bout of coughing Hoarse voice.
• Nasal irritation and congestion may interfere with feeding, breathing and sleep – particularly in small babies.
• There may be a lot of nasal discharge which is usually clear at first, but becomes thicker and darker as the infection progresses
• General feeling of tiredness and weakness, being unwell, restlessness or irritability especially in small babies.
• Presence of tonsillar swelling,
• Presence of swollen and tender lymph glands in the neck and under the jaw.

Usually, How long do the symptoms of URTI stay in children?

What investigations could be done?

• Group A Streptococcal antigen testing of throat swab 
• Throat swab culture
•  Influenza A and B, RSV- nasal secretions.

What are the treatments for URTI in children?

Comfort measures and rest is the most appropriate management of URTIs. Ensure the child takes regularly hydrated throughout the day. Paracetamol or Ibuprofen is a suitable treatment for pain and fever. Saline drops in the nose for congestion can achieve some relief from these symptoms.

There is usually no need for any antibiotic treatment, as it usually caused by virus. Judicious antibiotic prescribing is challenging as it is difficult to find exact cause.

What are the factors we should consider while considering antibiotics in URT infection

• Complications of antibiotics 
• Complication of URTI’s

What are the complications?

Secondary bacterial infection of sinus, ear, chest, larynx, tonsil, bronchus, bronchioles, eye, brain and worsening of existing asthma symptoms.

What are the side effects of antibiotics?

Diarrhoea, vomiting, rash and development of antibiotics resistance (ineffectiveness of antibiotics when used in future).

When to consider antibiotics?

•  If the patient is very unwell
• if the patient has symptoms and signs suggestive of serious illness and/or complications
• If the patient is at high risk of serious complications because of pre-existing co-morbidity. These include patients with significant heart, lung, renal, liver neuromuscular disease, immunosuppression, and young children who were born prematurely.

When to seek medical advice? When to consider antibiotics?

When there is a worsening of symptoms such as :

•  Fast breathing
• Very high grade fever & unresponsive to paracetamol
• Becoming drowsy
• Any other symptoms that you are concerned about

How does URTI spread?

Whenever a patient sneezes or coughs, tiny droplets of fluid containing the virus are launched into the air. If another person breathes this air in, they may also become infected.
URTI can also spread through indirect contact. If a patient touches an object, e.g. a door handle, the virus may be passed to someone else when they touch the same thing.

 Whenever a patient sneezes or coughs, tiny droplets of fluid containing the virus are launched into the air.

Can URTI be prevented?

Prevention is difficult. Many germs (viruses) can cause a URTI, which you cannot avoid. People in the household should wash their hands frequently with soap and water. Avoid sharing towels, toys, etc. 

When to seek medical advice? When to consider antibiotics?

When there is a worsening of symptoms such as :

•  Fast breathing
• Very high grade fever & unresponsive to paracetamol
• Becoming drowsy
• Any other symptoms that you are concerned about

What is the role of cough medicine in Pediatric URTI?

The FDA recommended against the use of Over The Counter products for coughs and colds in infants and young children. Furthermore, the American Academy of Pediatrics has advised against using dextromethorphan as well as codeine for treating any type of cough in the pediatric population.