8p. Upper Respiratory Tract Infection (URTI) The upper respiratory tract includes the nose, throat, larynx and upper trachea. An URTI is the most common reason for consulting a GP and includes common colds, tonsillitis, sore throat, sinusitis, laryngitis and croup. The majority are caused by viruses and are rarely serious. It is important to advise patients about how long they should expect their illness to last so that they do not have unrealistic expectations. Condition Acute sore throat/acute pharyngitis/acute tonsillitis Common cold Acute rhinosinusitis Acute cough/acute bronchitis Average total illness length 1 week 1.5 weeks 2.5 weeks 3 weeks See below for the current NICE guidelines for care pathways of RTIs. Acute Sore Throat At any time 12% of the population complain of a sore throat. It is a symptom and can be further characterised as: . Tonsillitis - inflammation of the tonsils · Acute pharyngitis - inflammation of the part of the throat behind the soft palate Infectious causes 1. Common cold viruses e.g. rhinovirus - 25% 2. Bacterial - most commonly group A beta-haemolytic streptococcus (GABHS) (15- 30% in children, 10% in adults) 3. Influenza 4. Herpes simplex 5. Epstein Barr virus <1% (peak incidence in 15-25 year olds) History: Most people do not see their doctor if they have a sore throat so remember to ask why the patient has attended. The history should also include: . Duration of symptoms · Systemic symptoms - fever, malaise · Dysphagia? · Rash? · History of previous episodes. Examination General examination should include temperature, pulse, inspection of the throat and palpation for cervical lymph nodes. Also examine any rash - consider infectious mononucleosis or scarlet fever or guttate psoriasis If there is stridor do not examine the throat as it may provoke acute airways obstruction from epiglottitis. /home/www-data/deploy-task-2021-04-30_13_15_25/storage/pdfconv/c0cfe4cb8debef1003176a454e6d294d/c0cfe4cb8debef1003176a454e6d294d.doc
Investigations In the majority of patients no investigations are required. Throat swabs are not routinely indicated. 20% of people carry group A beta-haemolytic streptococcus (GABHS) as a commensal and there is no way to distinguish between carriage and infection. If Epstein Barr virus is suspected a monospot blood tests can be used for diagnosis plus a FBC and LFTs. Management Reassure that most sore throats are self limiting and resolve within 7 days with or without antibiotic treatment. It is not possible to tell by looking at a sore throat whether it is caused by a virus or bacteria. Antibiotics should not be prescribed routinely and, in particular, should not be used to secure symptomatic relief or to aim to prevent complications in otherwise healthy individuals. However, there are Centor criteria to aid diagnosis of GABHS as the cause of the sore throat: Tonsillar exudate · Tender anterior cervical lymph nodes · Absence of cough · History of fever Presence of 3 or 4 of these clinical signs suggests that the chance of the patient having group A beta-haemolytic streptococcus (GABHS) is between 40% and 60%, so the patient may benefit from antibiotic treatment. Absence of 3 or 4 of the signs