Outcome of upper respiratory tract infections in healthy children: Antibiotic stewardship in treatment of acute upper respiratory tract infections.

OBJECTIVE: The objective of the study was to assess the outcome of upper respiratory tract infections (URTI) in healthy children. METHODS: This descriptive study was conducted on 314 children aged 3-36 months in the paediatric outpatient clinic and emergency department with symptoms of URTI (fever, cough, rhinorrhoea) for ≤5 days. Patient's demographics, clinical features, laboratory data and outcome were recorded. Follow up phone calls were made to parents on day 7 (response 93.6%) and day 14 (response 94.6%) to record outcome. RESULTS: A total of 314 children with URTIs were included. Majority (57.6%) were males and <1year of age (40%). Common manifestations of URTI were fever (89%), cough (79%), rhinorrhoea (62%), pharyngitis (79%) and conjunctivitis (46%). More than half (53%) had history of contact with URTI in a family member. Mean duration of symptoms was 2.7±1.3 days. Majority (93%) of children were given supportive treatment and only 6.7% received antibiotics initially. Most of children (76%) recovered within one week and 91.8% within two weeks with supportive care only. Only 4% children were hospitalized and 12% required follow up visit of which 16% needed oral antibiotics. Complications or deaths did not occur. CONCLUSIONS: Majority of URTIs in healthy children resolved with supportive treatment and do not require antibiotics. Antibiotic stewardship in simple URTIs should be practiced using awareness and advocacy campaigns.

A rare congenital cardiovascular abnormality presenting as respiratory distress in an infant.

Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is a rare congenital cardiovascular anomaly which presents in early infancy with congestive cardiac failure, sometimes precipitated by inter current respiratory tract infections. We report a case of an eight week old baby boy, with a short history of cough, difficulty in breathing, marked tachycardia and signs of respiratory distress. He was managed for bronchiolitis but eight hours later had major desaturation during feeding which needed intubation and mechanical ventilation. He improved over the next few hours and self extubated but after 12 hours needed reintubation and ventilation following a similar event of desaturation as observed previously. The chest x ray revealed cardiomegaly and diuretics were added in the on going management and he was gradually weaned off from the ventilator. The echocardiography examination revealed ALCAPA, resulting in myocardial ischaemia. Surgical revascularization was performed and baby was discharged after ten days on regular anti failure medication in a stable condition.