Drug Topics- August 11, 2008

51 a week, but 25% of patients will experience symptoms for two weeks. Rarely do individuals go on to experience secondary bacterial infections of the sinuses or middle ear in which antibiotic therapy is required. Thus, treatment currently remains limited to symptomatic relief. Effective therapeutic options for symptomatic relief of sore throat, congestion, and cough in adults include local anesthetics, throat lozenges, systemic or topical decongestants, such as pseudoephedrine and phenylephrine, respectively, and firstgeneration antihistamines, such as diphenhydramine. Recent guidelines from the American College of Chest Physicians (ACCP) state that using dextromethorphan and guaifenesin for coughing associated with colds is not effective and may increase morbidity and mortality in patients, especially in children less than 14 years of age. Codeine and homatropine (Hycodan) have also been used as cough suppressants in patients, but their effectiveness has been questioned in treating cough due to colds. Alternative therapies, such as Echinacea, zinc, humidified air, and fluid intake, have not been proven to reduce the severity of symptoms either. High-dose vitamin C (> 2 grams) in some studies has reduced the severity and duration of symptoms in some adults. Additionally, patients with comorbid conditions, particularly hypertension, should be counseled on potential adverse effects associated with pharmacological therapies, particularly oral decongestants. Use of expectorants, antihistamines, decongestants, and cough suppressants is not recommended in children less than two years of age as a result of limited effectiveness and in some cases increased risk of adverse effects. The FDA is still reviewing the safety and effectiveness of these drugs in children between the ages of two and 11 years and these drugs should be used with caution. Non-pharmacological methods of symptomatic relief, such as a rubber suction bulb or saline nose drops, may be used as an alternative. GOAL To educate pharmacists about the etiology and potential treatment options of upper respiratory infections, the realistic expectations of antibiotics in these infections, general prevention methods, and when referrals to a physician are appropriate. CREDIT This lesson provides two hours of CE credit and requires a passing grade of 70%.* OBJECTIVES Upon completion of this article, the pharmacist should be able to: 1. Associate symptoms of common respiratory illnesses with the identified infection 2. Identify and list the common pathogens responsible for each infectious process 3. Ascertain which infections need immediate antimicrobial therapy versus those that may be treated symptomatically 4. Identify the potential first-line treatment options available for each infection 5. Correlate risk factors for disease with general prevention mechanisms that may reduce outbreaks or transmission to others. Pharyngitis Acute pharyngitis is an inflammatory process more commonly referred to as a “sore throat.” It accounts for 19 million clinic visits annually in the United States. Pharyngitis may be a result of viral or bacterial origin. Approximately 50% of sore throats are attributed to the same viral agents linked to the common cold. Other viral agents associated with pharyngitis include influenza, Epstein-Barr virus, herpes simplex virus, and acute retroviral syndrome with human immunodeficiency virus (HIV-1). Streptococcus pyogenes (Group A streptococci or GAS) is frequently associated with pharyngitis and is the etiologic agent in 10% of adults and between 10% and 30% of infections in children. Streptococcal Group C is often associated with pharyngitis in college students. Streptococcal Group G, Neisseria gonorrhea, Corynebacterium diptheriae, and a few chlamydial species are offending pathogens in exceptional cases. The origin of the infection may be influenced by the season of the year, patient age, severity of illness, and comorbid conditions. While symptoms are often nonspecific, the presence of exudate on the tonsils or throat, a fever greater than 100.9°, and cervical lymph node tenderness tend to indicate pharyngitis due to GAS in patients greater than three years of age. The presence of sore throat and cough would prompt consideration of a viral infection. For patients less than three years of age, nasal inflammation and crusting may be a presenting symptom of GAS. Diagnosis and treatment of GAS is important in order to avoid complications of acute rheumatic fever, acute glomerulonephritis, and invasive infection. Some current guidelines recommend a clinical prediction model or “scoring” system, based on symptoms to identify those patients who should be tested and treated. Others suggest a “test and treat” model by which only those who test positive by a rapid-detection method receive treatment. Diagnosis by a rapid-detection test has a reported specificity rate of 90% but offers a more variable sensitivity rate. The gold standard of detection is a throat culture, but the use of a backup throat culture after a negative rapid test is no longer recommended. In severe cases of pharyngitis, the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) guidelines suggest empiric therapy, while the Infectious Diseases Society of America (IDSA) opposes this decision, citing the risks of unnecessary antibiotic use.

Table of Contents Feed for the Digital Edition of Drug Topics- August 11, 2008

Drug Topics- August 11, 2008 Contents Latebreakers Letters DEA Proposes Rule To Allow Electronic Prescriptions for Controlled Substances Merger, Medicare Reform Could Mean Broader E-Prescribing Adoption New Combination Pill Approved for Type 2 Diabetes New Eczema Guildlines Promote Use of Emollients, Then Topical Corticosteroids Agencies Flush Original Strategies in Favor of Promoting Drug Take-Back Programs JP at Large: You Laughing at Me? Pharmacists Find Themselves at Mercy of Prior Authorization State Law Requiring PBM Transparency See Some Gains, Some Losses Global Counterfeiting Still Growing, Says U.S. Commerce Official FDA Saftey Page: Prophylthiouracil Still Confused with Purinethol (mercaptopurine) New Products Bring Lice Treatment to a Head NACDS Marketplace Showcases New Product that Fill Unmet Needs Update on Respiratory Tract Infections Execs Share War Stories About Adopting Technology in their Stores New Products Advertisters Index Classified Viewpoint: Medicare Part D Revisions sorely needed

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.