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:
http://www.cochrane.org/
 Clinical Evidence:
http://www.clinicalevidence.org

6. Examples

7. Evidence Based approach
 What are the Evidence for the role of
antibiotic in common cold?
 Cochrane http://www.cochrane.org/
 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:

http://www.clinicalevidence.org
 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 http://www.cochrane.org/
 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 http://www.cochrane.org/
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
http://www.clinicalevidence.org
 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