Would you treat this patient for his cold? Why or why not?
A number of reasons will inform my decision for treating this patient for his cold. Even though viral infection accounts for most common sinusitis, about 0.5 to 2 percent are due to bacterial infection. Viral infection, in most cases, do not require medication. In the mentioned case, the condition could have risen from complication of upper respiratory tract infection.
The patient presents with the following symptoms which have been ongoing for more than 10 days, indicative of sinusitis: cough and congestion, low body temperature, intermittent frontal headache with cold, red pharynx, greenish phlegm, inflamed turbinates, and tender frontal sinuses. According to Khoshdel et al. (2014), sinusitis presents with nasal discharge, blockage or congestion, or frequently mucopurulent postnasal drip, facial pain, and headache which could point to complication of common cold by secondary bacterial infection.
If you were to treat this patient, what would you use?
For bacterial sinusitis, I would recommend antibiotic therapy. In this case, amoxicillin-clavulanate would be the first line treatment for the patient’s cold. Also, I would prescribe saline treatment as an adjunct therapy either as irrigation or spray. Saline nasal irrigation or spray will help dislodge nasal crusts and discharge. It is also recommended for thinning the mucus. Since the patient has productive cough and no problem with nasal discharge I would only prescribe nasal spray for a 3 days or to be used when in need.
I would also prefer amoxicillin-clavulanate/high-dose amoxicillin or other β-lactams in case the patient has resistant infection. My preference for amoxicillin-clavulanate over regular amoxicillin is informed by its ability to treat penicillin resistant strains such as Streptococcus pneumoniae (Khoshdel et al., 2014; Rosenfeld, 2016). I would prescribe amoxicillin-clavulanate 500 mg 3 times for one to two weeks depending on the severity of the symptoms and assessment of the patient’s vital signs and liver function.
For headache and facial pain associated with the cold I would prescribe paracetamol 500 mg 2 tablets every six hours to be taken until the pain subsides. Besides, I would encourage the patient to increase his fluid intake and to ease sinus pain by compressing the frontal maxillae with warm handkerchief.
How would this treatment vary if the patient was a child?
Low grade temperature could be multifactorial in paediatrics hence extreme caution is needed before embarking in any treatment. However, more than 2 weeks history of frontal pain and headache would call for treatment. As noted by Woo and Wynne (2011), presence of inflamed face or pain and pyrexia greater than 39°C and lasting for more than 2 weeks with mucopurulent nasal discharge paediatric cases could be treated as sinusitis as shown in the CDC guidelines. I would prescribe nasal decongestants such as Afrin (0.025% Oxymetazoline) for 3 to 5 days to be applied only when needed. Warm nasal compression should also be used sparingly in children. As with adults I would recommend fluid intake to address dehydration from fever and improve nasal discharge. Amoxicillin would also be a drug of choice for treating paediatric sinusitis. I would recommend amoxicillin 80-90 mg per kg per day given three times per day. Amoxicillin-clavulanate would also be recommended to address the challenge of penicillin resistant infections as in the above adult case.
References
- Khoshdel, A., Panahande, G. R., Noorbakhsh, M. K., Malek Ahmadi, M. R., Lotfizadeh, M., and Parvin, N. (2014). A comparison of the efficacy of amoxicillin and nasal irrigation in treatment of acute sinusitis in children. Korean Journal of Pediatrics, 57(11), 479–483. http://doi.org/10.3345/kjp.2014.57.11.479
- Rosenfeld, R.M. (2016). Clinical Practice. Acute Sinusitis in Adults. N Engl J Med 375:962.
- Rosenfeld, R.M., Piccirillo, J.F., Chandrasekhar, S.S., et al. (2015). Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 152, S1.
