Symptomatic treatment of upper respiratory tract symptoms in children

Abstract

Most upper respiratory tract infections are viral and require symptomatic treatment. Antibiotics are commonly overused, even though they should be thought of as being contra-indicated due to the rapid emergence of antimicrobial resistance. Acute bacterial sinusitis may complicate a viral URTI, but special investigations for diagnosing acute sinusitis are unhelpful. Treatment of pain and fever is usually the only non-specific measure that helps. Antimicrobial treatment has become the chief treatment of acute sinusitis, but there are studies that suggest that these agents do not alter the course of the disease. Since hearing loss is a risk of untreated and severe acute otitis media, this condition is usually treated with antibiotics. However, a recent Cochrane Review has concluded that the number of patients needed to treat for one patient to benefit is 15. The picture of itching, sneezing and profuse rhinorrhoea is typical of early allergic rhinitis, but nasal obstruction becomes more prominent over time, especially in perennial allergic rhinitis. This gives rise to the classic facial appearance of children with perennial allergic rhinitis and to the many complications. The most effective therapy for allergic rhino-sinusitis involves topical nasal steroids.