A 4-year-old girl who attends day care presents with rhinorrhea and a daytime cough that have been present for 12 days. She has not had fever, but her appetite is poor and her interest in activities is diminished. On physical examination, there is clear rhinorrhea present in the nasal passages. The remainder of the examination is unremarkable. Should she be treated with an antibiotic?
"Although uncommon (the reported incidence in specialised tertiary centres is 0.3-1.3 cases per month)
, the disease processes may lead to serious complications, including vision loss and a predisposition for life-threatening events such as cavernous sinus thrombophlebitis or other intra-cranial complications
[3,4,6,7]. The incidence of associated complications was especially high in the pre-antibiotic era, with 17% mortality due to meningitis and a 20% rate of blindness
, the rates of vision loss and overall mortality are now respectively 11% and 2.5%
[Show abstract][Hide abstract] ABSTRACT: Orbital cellulitis is an infrequent complication of acute ethmoiditis possibly leading to life- or visual-threatening complications. Despite its natural history is well known, its clinical evolution may widely vary among patients, and even in the most favourable cases long-term sequelae may persist. We here provide a step-by-step iconographic description of a periorbital and orbital cellulitis occurring in a child with ipsilateral acute rhinosinusitis. Our report shows that an unusual long-term evolution of periorbital and orbital cellulitis is possible also in apparently favourable cases.
Italian Journal of Pediatrics 03/2014; 40(1):25. DOI:10.1186/1824-7288-40-25 · 1.52 Impact Factor
"This may have resulted from including those with allergic rather than an infective cause or an inappropriate antibiotic dosage. In the other two studies using amoxicillin-clavulanate showed considerable benefit although at the cost of increased side-effects [26,27]. "
[Show abstract][Hide abstract] ABSTRACT: Cough is one of the most common symptoms that patients bring to the attention of primary care clinicians. Cough can be designated as acute (<3 weeks in duration), prolonged acute cough (3 to 8 weeks in duration) or chronic (> 8 weeks in duration). The use of the term 'prolonged acute cough' in a cough guideline allows a period of natural resolution to occur before further investigations are warranted. The common causes are in children with post viral or pertussis like illnesses causing the cough. Persistent bacterial bronchitis typically occurs when an initial dry acute cough due to a viral infection becomes a prolonged wet cough remaining long after the febrile illness has resolved. This cough responds to a completed course of appropriate antibiotics.
[Show abstract][Hide abstract] ABSTRACT: Disorders of the respiratory system are commonly encountered in the primary care setting. The presentations are myriad and this review will discuss some of the more intriguing or vexing disorders that the clinician must evaluate and treat. Among these are dyspnea, chronic cough, chest pain, wheezing, and asthma. Dyspnea and chest pain have a spectrum ranging from benign to serious, and the ability to effectively form a differential diagnosis is critical for reassurance and treatment, along with decisions on when to refer for specialist evaluation. Chronic cough is one of the more common reasons for primary care office visits, and once again, a proper differential diagnosis is necessary to assist the clinician in formulating an appropriate treatment plan. Infant wheezing creates much anxiety for parents and accounts for a large number of office visits and hospital admissions. Common diagnoses and evaluation strategies of early childhood wheezing are reviewed. Asthma is one of the most common chronic diseases of children and adults. The epidemiology, diagnosis, evaluation, treatment, and the patient/parent education process will be reviewed. A relatively new topic for primary care clinicians is cystic fibrosis newborn screening. The rationale, methods, outcomes, and implications will be reviewed. This screening program may present some challenges for clinicians caring for newborns, and an understanding of the screening process will help the clinician communicate effectively with parents of the patient.
Current problems in pediatric and adolescent health care 07/2013; 43(6):130-56. DOI:10.1016/j.cppeds.2013.05.001 · 1.63 Impact Factor
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