Assessment of a new algorithm in the management of acute respiratory tract infections in children

Abstract

Objectives: To assess the practicability of a new algorithm in decreasing the rate of incorrect diagnoses and inappropriate antibiotic usage in pediatric Acute Respiratory Tract Infection (ARTI).

Materials and methods: Children between 1 month to15 years brought to outpatient clinics of a children's hospital with acute respiratory symptoms were managed according to the steps recommended in the algorithm.

Results: Upper Respiratory Tract Infection, Lower Respiratory Tract Infection, and undifferentiated ARTI accounted for 82%, 14.5%, and 3.5% of 1 209 cases, respectively. Antibiotics were prescribed in 33%; for: Common cold, 4.1%; Sinusitis, 85.7%; Otitis media, 96.9%; Pharyngotonsillitis, 63.3%; Croup, 6.5%; Bronchitis, 15.6%; Pertussis-like syndrome, 82.1%; Bronchiolitis, 4.1%; and Pneumonia, 50%.

Conclusion: Implementation of the ARTIs algorithm is practicable and can help to reduce diagnostic errors and rate of antibiotic prescription in children with ARTIs.

Keywords: Acute respiratory tract infection; algorithm; children.

Figure 1

Acute Respiratory Tract Infection Algorithm; ψ presence of ≥2 following criteria: a) otic pain or irritability, b) redness of tympanic membrane, c) absence of tympanic membrane landmarks like incus, promontory, cone of light, d) bulging of tympanic membrane or perforated membrane; €presence of ≥2 following criteria: a) recent family history of cough ≥2 weeks, b) paroxysmal cough attacks with no sigh between them, c) post cough emesis, d) presence of whooping or apnea after cough attacks; ¥presence of ≥2 following criteria: age between 5 to 15 years old, b) exudative pharyngitis, c) tenderness of anterior neck adenitis, d) high-grade fever (tem ≥39°C)

Figure 2

Acute Respiratory tract infection frequency