1. SORE THROAT & OTITIS MEDIA
DR.YOUSEF ABDULLAH AL TURKI
MBBS,DPHC,ABFM
Consultant Family Medicine
Associate professor
King Khalid University Hospital
College of Medicine
King Saud University

2. CASE SCENARIO
Ahmed come to the PHC clinic with his son Khalid, 8 year of age. Khalid had history of sore throat, fever, runny nose, and cough for the last 2 days. His father worries about his symptoms. At the end of the consultation, the father request antibiotic prescription to his son.
HOW YOU WILL PROCEED DURING THIS CONSULTATION?

3. COMMON COLD What are the causes of common cold?
Do you need to prescribe antibiotic?
Why?
How to convince patient and family?

4. Why there are over prescribe of antibiotic ?
Doctor Factors
Patient factors
What other Factors could contribute?

5. Evidence Based Medicine
Cochrane Site:
Clinical Evidence:

6. Examples

7. Evidence Based approach
What are the Evidence for the role of antibiotic in common cold?
Cochrane
There is not enough evidence of important benefits from the treatment of upper respiratory tract infections with antibiotics to justify routine use. There is a significant increase in adverse effects associated with antibiotic use.

8. Evidence Based approach
Clinical evidence:
Systematic reviews found no significant difference between antibiotics and placebo in cure or general improvement at 6-14 days in people with colds.

9. Evidence Based approach
What are the evidence for the role of Anti histamine in common cold?
Cochrane
Antihistamine in monotherapy in children as well as in adults do not alleviate to a clinical extend nasal congestion, rhinorrhea and sneezing, or subjective improvement of the common cold.

10. Evidence based approach
First generation antihistamine also cause more side effct than placebo, in particular they increase sedation in cold sufferers. Combination of antihistamine with decongestives are not effective in small children. In older children and adults most trials show a beneficial effect on general recovery as well as on nasal symptoms. It is however not clear whether these effects are clinically significant.

11. Evidence Based approach
What are the role of Vitamen C in common cold?
Cochrane
Long term daily supplementation with vitamen C in large doses daily does not appear to prevent colds. There appears to be a modest benefits in reducing duration of cold symptoms from ingestion of relatively high doses of vitamin C. The relation of dose to therapeutic benefit needs further exploration.

12. Evidence Based approach
Clinical Evidence
One systematic review found that vitamin C slightly reduced the duration of cold symptoms compared with placebo. However, the beneficial effect is small and may be explained by publication bias.

13. What you will prescribe?
Anti pyretic
Paracetamol in proper dose:
Children
Adult
Acute follicular tonsillitis: could be viral or bacterial
When to prescribe antibiotic to prevent complications?

14. Modification of Help seeking Behaviour
Health Education
Self limited disease
When to call family physician?
Cost of medications?

16. Case scenario
A mother presents to the clinic with her 4 year old boy. The child had a fever for the past 48 hours, and developed a left sided earache 12 hours ago. The child had a respiratory tract infection for 1 week. The boy is extremely irritable and examination of tympanic membrane is difficult. You are, however, able to see a bulging, red, tympanic membrane. The right tympanic membrane is normal and the rest of the examination is normal.
DESCRIBE YOUR APPROAH TO THIS CONSULTATION?

17. ACUTE OTITIS MEDIA Common illness in Primary care
What are the clinical features
Symptoms and signs
Proper Interpretation

18. ACUTE OTITIS MEDIA How To Manage? Do You Prescribe antibiotic or not?
Follow Up

19. CONCLUSION
Upper respiratory tract infections are common health problem in primary care setting.
Evidence based approach will improve the proper utilization of resources.
Modification of help seeking behaviour.
Consultation skills to improve patients and family satisfaction.

20. THANK YOU