By vgreene, 2 October, 2020 If suspect Group A strep (persistent fever, anterior cervical LN, tonsil exudates, cough absence): ✓RADT +/- cx (cx not routine in adults);2 don’t use abx unless confirmed dx2,3
By vgreene, 2 October, 2020 Vitamin/mineral/home remedies. Honey may improve cough vs placebo or diphenhydramine, but not better than dextromethorphan,7 per ACCP. Evidence lacking on vitamin/herbal remedies3 or nasal saline irrigation as cold tx.2 Insufficient evidence on zinc lozen
By vgreene, 2 October, 2020 Prescription sx relief. Evidence lacking for intranasal steroids, opioids.2 Avoid codeine in
By vgreene, 2 October, 2020 OTC sx relief. Don’t use OTC antitussives, expectorants, NSAIDs, antihistamines, mucolytics, or combos, per ACCP.7 ACP suggests sx relief (antitussives, analgesics); antihistamines alone have more side effects than benefits, yet relief seen in 1/4 pts on
By vgreene, 2 October, 2020 Sx: cough, fever, rhinorrhea, congestion, postnasal drip, sore throat, HA, myalgia,2 malaise, sneeze3
By vgreene, 2 October, 2020 If rhinosinusitis (>90% are viral):2 consider watchful waiting, even if acute bacterial rhinosinusitis. Most resolve in 1wk, but sx3 may last up to 33 days
By vgreene, 2 October, 2020 Mgmt: imaging not routine.2,3 Bacterial dz should meet criteria for severity, persistence, or worsening.2,3 Offer watchful waiting, even if bacterial.2 Tailor sx relief to individual rhinosinusitis sx
By vgreene, 2 October, 2020 Sx: nasal congestion/obstruction, purulent nasal d/c, maxillary tooth pain, face pain/pressure, fever, fatigue, cough, anosmia, ear pressure/fullness, HA, halitosis
By vgreene, 2 October, 2020 If acute bronchitis, defined as wet/dry cough (≤3wk per ACCP,6 ≤6wk per ACP)3 w/o clinical evidence of other dx,6 often w/ mild constitutional sx:3
By vgreene, 2 October, 2020 Sx relief: Don’t use antitussives, mucokinetics, NSAIDs, per ACCP.6 Per ACP, sx relief hasn’t been shown to ↓illness duration; though dextromethorphan, codeine, 1st-gen antihistamines, decongestants,2,3 or guaifenesin,3 might offer benefit—weigh risk
