Viral vs. Baterial Upper Respiratory Infection: Do you need antibiotics?

When someone is not feeling well, it is common to seek help from a primary care provider (PCP) and request an antibiotic. Unfortunately, some of these individuals do not require an antibiotic and this can cause health issues within the community. Vinnard et al. (2013) indicate prescribing antibiotics when not needed can cause the individual to develop a resistance to certain antibiotics, as well as adverse drug reactions and unnecessary cost. Vinnard et al. (2013) found that providing patient education about their expectation of antibiotics in unnecessary cases, coupled with provider educational mailings, helped decrease antibiotic prescribing for URIs from 23.6% to 12.8%. The goal of this blog is to provide some input into when symptoms may indicate the need for an antibiotic and when they may just be the common cold or bronchitis (which are both viral).

Viral URI is caused by a virus and does NOT require an antibiotic.

Symptoms Include:

• A dry cough or with white/clear sputum likely caused by postnasal drip
• Runny nose (rhinorrhea)
• Sneezing
• General tiredness (fatigue)
• Symptoms less than 5 days
• Sore throat

Bacterial URI is caused by bacteria and may require antibiotics.

Symptoms Include:

• A productive cough or coughing up colored sputum (yellow or green)
• Fever
• Increasing tiredness (fatigue)
• Last 5 days or more
• Change in appetite
• Shortness of breath 
•  Decreased appetite 

                                                      Source: Parolini, E. (N.d.). Retrieved from cartoonstock.com

Recommended Treatment

Viral URI

• Over the counter cold, allergy, or sinus medications
• Rest (plenty of sleep)
• Stay hydrated with plenty of water
• Vitamin C

                                       Source: Retrieved from Google search at visualizing.org

Bacterial URI

• See your health care provider for evaluation and more than likely an antibiotic, which covers most bacterial infections.
• Rest (plenty of sleep)
• Stay hydrated with plenty of water
• If symptoms worsen, go to the emergency room or return to your PCP as instructed.

                                                                        Reference

Vinnard, C., Linkin, J. R., Localio, A. R., Leonard, C. E., Teal, V. L., Fishman, N. O., & Hennessy, S. (2013). Effectiveness of interventions in reducing antibiotic use for upper respiratory infections in ambulatory care practices. Population Health Management, 16(1), 22-27. http://dx.doi.org/10.1089/pop.2012.0025

Well Child Visits

Preventive medicine is the key to overall wellness. If parents stress the importance of seeing a primary care provider (PCP) when their children are young there is a good chance the children will continue to see a PCP as they get older. Cogan, Josberger, Gesten, and Roohan (2012) performed a study in a low-income New York City area that showed a positive correlation between prenatal care and Well-Child Visits (WCVs). The American Academy of Pediatrics (AAP, 2015) recommends at least nine WCVs in the first two years of life, then annually thereafter. Cogan et al. concluded that women who receive intensive or adequate prenatal care were more likely to bring their children for WCVs.

One area of focus at the Michigan State University Institute for Health Policy (IHP) is maternal and child health. According to the IHP (2015), WCVs should include a physical exam, shots (immunizations), blood lead testing, growth and developmental checks, hearing and vision checks, and dental referrals. The actual Early Periodic Screening, Diagnosis, and Treatment (EPSDT) form guides the PCP as to what screenings are recommended at what age, including safety, nutrition, physical activity, oral health, development and behavior, family relationships/support, substance abuse risk, and psychosocial/behavior assessment.

The EPSDT forms consist of four sections: the physical exam, the developmental surveillance checklist, a form for foster care children, and educational materials for the parent.

Examples of the first two forms are shown below for adolescents/young adults 15-18:

References

American Academy of Pediatrics. (2015). Well-child care: A check up for success. Retrieved from www.healthychildren.org/English/family-life-health-management/Pages/well-child-care-a-check-up-for success.aspx

Cogan, L., Josberger, R., Gesten, F., & Roohan, P. (2012). Can prenatal care impact future well-child visits? The experience of a low-income population in New York State Medicaid     managed care. Maternal and Child Health Journal, 16(1), 92-99. http://dx.doi.org/10.1007/s10995-010-0710-8

Institute for Health Policy. (2015). Early Periodic Screening, Diagnosis, and Treatment (EPSDT) form. Retrieved from ihp.msu.edu/index.php/2-general/7-epsdt-clinician-toolkit

High Cholesterol (Dyslipidemia)

                                  Source: Retrieved from healthmeup.com

This condition relates to an increased amount of fat circulating in your blood that causes plaque to build in your arteries over time causing heart disease that could lead to a heart attack or stroke.

Diagnosis and Monitoring

Your health care provider will monitor your cholesterol with four numbers called a lipid panel/profile. The American Heart Association (AHA, 2014) recommends anyone 20 or older without a diagnosis of heart disease have a lipid panel every four to six years. If there is a familial cause of high cholesterol or premature heart disease, Gotto and Moon (2012) recommend cholesterol screening start at age 2. Cassoobhoy (2014) describes the four cholesterol numbers as follows:

1.  LDL (low-density lipoprotein or “bad” cholesterol)-LDL builds in the walls of your arteries and increases the chance of heart disease. Normal level is 130 or less; if you have high blood pressure or diabetes, the goal should be less than 100 or less than 70. The lower the number, the better.
2. HDL (high-density lipoprotein or “good” cholesterol)-HDL protects against heart disease by taking “bad” cholesterol out of your blood. Normal level is greater than 40. The higher number, the better.
3. Triglycerides-the form of most of the fat in the food we eat. The higher the number, the higher the risk of clogged arteries (coronary artery disease). Normal level is less than 150.
4. Total cholesterol-a measure of LDL, HDL, and other lipid components. Normal level is less than 200. 

Recommended Lifestyle Changes:

• Increase fiber in your diet (i.e. apples with the peeling, broccoli, egg whites instead of eggs with the yolk, oatmeal, wheat bread, and sweet potatoes).
• Exercise as tolerated for weight loss.
• Decrease junk food, fried food, greasy food, and fast food.
• Take all prescribed medications.

                                          Source: Retrieved from healthyblush.com

Types of Cholesterol Medications (Cassoobhoy, 2014):

• Statins-lower the LDL and triglycerides and can slightly raise HDL. Statins block the liver from making cholesterol and are the first choice for most patients. Statins are also associated with lower risk of heart disease.
• Niacin-lowers LDL and raises HDL. Niacin is a B-complex vitamin found in food and at higher doses with a prescription. Research shows it will improve cholesterol, but does not lower your risk of heart disease.
• Bile-acid resins-lowers total cholesterol and LDL. Bile-acid resin works inside the intestines and binds to bile to prevent the bile from being reabsorbed in the blood.
• Fibrates-lower triglycerides and LDL and can increase HDL. Fibrates help breakdown triglyceride-rich particles and decrease the secretion of certain fats in the blood.
 

                                           Source: King, J. (2014). Retrieved from onlinecomicguide.com

Reference

American Heart Association. (2014). How to get your cholesterol tested. Retrieved from www.heart.org/HEARTORG/Conditions/Cholesterol/SymptomsDiagnosisMonitoring/How-To-Get-Your-Cholesterol-Tested_UCM_305595_Article.jsp

Cassoobhoy, A. (2014). Understanding cholesterol numbers. WebMD. Retrieved from  www.m.webmd.com/a-to-z-guides/understanding-numbers

Gotto, J. M., & Moon, J. E. (2012). Management of cardiovascular risk: The importance of meeting lipid targets. The American Journal of Cardiology, 110(Supplement), 3A-14A. http://dx.doi.org/10.1016 /j.amjcard.2012.04.002

"Sugar" (Diabetes Mellitus)

Diabetes is when your body cannot get rid of increased amounts of sugar in your blood. According to Caspersen, Thomas, Boseman, Beckles, and Albright (2012), diagnosed and undiagnosed diabetes affects 10.9 million U.S. adults aged 65 years and older and is expected to reach 26.7 million by 2050.

Two Kinds of Diabetes: Type I and Type II:

Type I: can start at any age but more commonly in childhood or adolescence. The pancreas (organ in your body that makes insulin) no longer produces insulin.

Type II: common in people that are overweight. The pancreas may still work, but it does not make enough insulin to remove excess sugar from your body.

Common Signs and Symptoms of Diabetes (Hillaire & Woods, 2013):

• Urinary frequency (polyuresis)
• Excessive thirst (polydipsia)
• Increased appetite (polyphagia)

                                          Source: Retrieved from a Google search at funny-pictures.picphotos.net

Complications of Uncontrolled Diabetes:

• Heart Disease and Stroke
• Hypertension (High blood pressure)
• Blindness
• Amputations
• Kidney disease
• Disease of the nerves
• Erectile dysfunction (inability to get or maintain an erection) 

 

                             Source: Randy Glasbergen. (2009). Retrieved through a Google search. Cited at www.glasbergen.com
 According to Vaccaro and Huffman (2012), patient-provider communication is a key influence in self-managed care. Vaccaro and Huffman believe providers should be aware of language, literacy, and cultural differences when explaining the plan of care to those with diabetes.

Some Recommendations for Lifestyle Changes:

1. Decrease carbohydrates and sugar in your diet (white bread, rice, potatoes, pasta, candy, pop/soda, juice, and some fruits).
2. Exercise to build muscle and lose fat (weight loss decreases the amount of fat that demands insulin).
3. Take all your prescribed medications.
4. Attend all your doctor visits including yearly eye and foot exams.
5. Know your numbers: Hemoglobin A1C (which is a three-month average of blood sugars), blood pressure, kidney levels, and cholesterol numbers.

Diabetes animation video: Type 2 Diabetes:(Focus Medica, 2008).

https://m.youtube.com/watch?v=ZsTSoLhl3Y4  

References

Caspersen, C. J., Thomas, G. D., Boseman, L. A., Beckles, G. A., & Albright, A. L. (2012). Aging, diabetes, and the public health system in the United States. American Journal of Public Health, 102(8), 1482-1497.

Focus Medica. (2008). Type 2 diabetes [Video]. Retrieved from https://m.youtube.com/watch?v=ZsTSoLhl3Y4

Hillaire, M. L., & Woods, T. M. (2013). Type 2 diabetes: A focus on new guidelines. Formulary, 48(2), 55.

Vaccaro, J. A., & Huffman, F. G. (2012). Reducing health disparities: medical advice received for minorities with diabetes. Journal of Health and Human Services Administration, 34(4), 391-417.

High Blood Pressure (Hypertension)

                                         

According to the 2011 American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA), 72 million Americans have high blood pressure (Bertoia, Waring, Gupta, Roberts, and Eaton, 2012). When looking at blood pressure readings, the top number (systolic) measures the pressure in the arteries when the heart beats (or as the blood pressure cuff is squeezing your arm); and the bottom number (diastolic) measures the pressure in the arteries between heartbeats (or as the pressure on your arm is being released) (AHA, 2014).

AHA (2014) categorizes blood pressure as follows:

Common Signs and Symptoms of High Blood Pressure:

• Chest pains
• Shortness of breath
• Blurred vision
• Nausea and/or Vomiting
• Headaches

Complications of Uncontrolled High Blood Pressure:

• Heart Attack (Myocardial Infarction/MI)
• Stroke (Cerebrovascular Accident/CVA)
• Aneurysm-weakened or bulging walls of any blood vessels, most commonly in the brain, heart, or stomach.
• Kidney disease-can cause kidney failure that requires dialysis.

Warren (2014) reports that most guidelines indicate that in addition to medication, people with high blood pressure should be given lifestyle advice.

Some Recommendations for Lifestyle Changes:

1.  Take all medications as prescribed by the health care provider. All medications work differently and can help control your blood pressure in different ways.
2.  Decrease sodium and salt in your diet. This includes soy sauce, seasoning salt, canned soups, processed foods, and hot sauce.
3.  Increase daily water intake to 48-64 oz every day. That is three to four 16 oz bottled waters or six to eight 8 oz cups of water.
4. Keep a healthy weight by making healthier food choices (increasing fruits, vegetables, and whole grains; decreasing fried foods, fast foods, junk foods, and greasy foods), and exercise at least 20 minutes every other day.
5.  Never miss doses of medications by waiting until your prescription runs out before you go see your provider.
6. Stop or never start smoking cigarettes. 

         Source: Wolverton, M. (2013). Retrieved from caglecartoons.com

Real Life Summary of Hypertension:

Imagine turning on a water hose and there is a kink in the line so the water is only dripping out. The pressure continues to build and this may cause other holes in the line, but if you remove the kink, the water can flow easier with less pressure.

References

American Heart Association. (2014). Understanding your blood pressure readings. Retrieved www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Articel.jsp

Bertoia, M. L., Waring, M. E., Gupta, P. S., Roberts, M. B., & Eaton, C. B. (2012). Implications of new hypertension guidelines in the United States. Hypertension, 60(3), 639-644. http//dx.doi.org/10.1161/HYPERTENSIONAHA.112.193714

Chu, V. B., Seshariri, M., Serpas, S., Shaheen, C. M., & Cardenas, A. (2007). Five major effects of high blood pressure-3D medical animation [Video]. Retrieved from https://m.youtube.com/watch?v=ICLHbwBBvFc

Warren, E. (2014). Hypertension: Why we measure it, why we treat it. Practice Nurse, 44(12), 14-19.