cataflam & flu symptoms
Post on 07-Jul-2015
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Upper Respiratory Tract Infection URTI
Precautions
• History of GIT ulceration.
• Sever impairment functions of
− Hepatic.
− Renal.
− Cardiac.
• Porphyria.
• Blood count in long term use.
• Pregnancy.
• Lactation.
Respiratory Tract Anatomy
Challenges ?!
• The Upper Respiratory Tract Infection (URI) is one of the most common complaints in all primary care and emergency care practices.
• Even though it is considered a "self-limited" disease and relatively benign in terms of some critical illnesses that are seen in any medical practice it has a tremendous impact on the health care system and society.
• The URI is estimated to cost $3.5 BILLION a year in the US alone, and accounts for 40 percent of the time lost from jobs and as many as 23 million lost school days.
• It is an easily acquired illness that sweeps through communities and families causing mild to moderate misery and sending many to their doctor for care and advice.
Challenges ?!
• We know that greater than 90 percent of upper respiratory tract infections are viral. Viruses are sophisticated infectious agents that are self limited - meaning they resolve on their own.
• There are over 100 different types of viruses that infect the upper respiratory tract.
• First and foremost, antibiotics DON'T work.
• In the past it was common knowledge that if you were blowing out or coughing up discolored (green) mucous that you had a bacterial infection and needed antibiotics.
• More recent research indicates that the color of mucous is not necessarily related to bacterial infection.
URTI ?!
• Upper respiratory infections are common infections and include
− Pharyngitis
− Sinusitis
− Epiglottitis
− Laryngotracheitis
− Common cold
• Viruses play a significant role in the pathogenesis of many of these infections.
• Bacteria and other organisms also are responsible.
Distribution of Diagnostic Categories for Patient Encounters
19%
12%
15%17%
37%
Acute Bronchitis
Acute Sinusitis
AOM
Pharyngitis
*Nonspecific ViralURTI
*Nonspecific Viral URTI includes Colds, Croup, Laryngitis and Influenza
Symptoms
• It usually starts with a tickle in the throat and perhaps mild fatigue Just plain tired when you don't expect to be tired.
• Congestion and runny nose, sore throat and sometimes a fever and body aches follow.
• Next may come a cough that keeps you awake at night.
• With these symptoms comes the recognition and dismay that you have a "cold."
• This constellation of symptoms adds up to general inconvenience and misery.
• NSAIDs are thought to enhance the efficacy of the antibacterial agents by better penetration to the site of infection
Management
Rest and fluid intake are critical to recovering from a viral upper respiratory illness.
Over-the-counter medication is for symptom relief
Phospholipid Membrane
Arachidonic AcidArachidonic Acid
ProstacyclineProstacycline LeukotrinesLeukotrines
Cyclo-Oxygenase Cyclo-Oxygenase PathwayPathway
Lipoxygenase Lipoxygenase PathwayPathway
PGPG ThromboxaneThromboxane
Phosphlipase
Prostaglandins are released from injured cells and
cause erythema, vasodilation and hyperalgesia
Why NSAIDs ?!
• NSAIDs (including aspirin) act primarily by inhibiting the synthesis of prostaglandins from arachidonic acid.
• This anti-prostaglandin effect is thought to be the major mechanism of action of NSAIDs; it may produce analgesia by blocking prostaglandin-related pain impulse generation, or through inhibition of other pain mediators, such as bradykinin or histamine.
• Higher doses (typically prescription level) of NSAIDs also produce anti-inflammatory effects.
Mainstay Therapy
• In the common cold, symptomatic therapy remains the mainstay of treatment.
• A number of agents have been investigated in an effort to shorten the course of illness or prevent disease.
− These agents are antihistamines, zinc, vitamin C, and herbal therapy.
− Patients who use zinc have been demonstrated to experience significantly fewer days with coughing, headache, nasal congestion, nasal drainage, and sore throat.
Others Add on Therapy
• Nasal and systemic decongestants -- The goal of uncomplicated sinusitis is to relieve the obstruction.
− Antihistamines should be avoided because they thicken secretions. These drugs can be used for this purpose.
• Antibiotics -- The chosen antibiotic ideally should be
− Easy to take
− Free of adverse effects
− Affordable
− Penicillins and cephalosporins; no isolates have been identified that demonstrate in vitro resistance to these drugs.
When to Seek Medical Help
• Fever
In general, a fever of 38 C is expected during the initial 2 days of a viral illness. if:
− The fever is exceptionally high.
− The fever is prolonged or not controlled
− The fever returns during the course of the illness, especially with new symptoms.
When to Seek Medical Help
• Prolonged Course
− Most viral illnesses follow a pretty predictable course and last between 7-14 days. If your symptoms are not improving over time, or a cough is prominent and keeping you awake at night, or the course of the illness simply continues, it is important to seek medical advice.
When to Seek Medical Help
• Underlying Illness
− If you have an underlying illness like asthma, diabetes or cancer it is important to seek medical assistance or advice.
• Change of Symptoms
− Sometimes a viral infection will lead to a secondary bacterial infection. If your symptoms change or become suddenly more severe, it is important to seek evaluation.
A Multicenter, Randomized, Double-Blind, Double-Dummy, Placebo- and Active- Controlled, Parallel-Group
Comparison of Diclofenac-K and Ibuprofen for the Treatment
of Adults with Influenza-like Symptoms
RATIONAL ?
• The alleviation of influenza-like symptoms, such as fever, headache, and muscle/joint aches and pains, is important so that sufferers can return to their normal daily activities.
• This study assessed the efficacy and tolerability of diclofenac-K 12.5 mg versus ibuprofen 200 mg and placebo against influenza-like symptoms (oral temperature >38.1°C, and at least moderate headache and muscle/joint aches and pains).
RATIONAL ?
• Infection with a variety of viruses can produce an acute illness associated with influenza-like symptoms--fever, myalgia, headache, and cough.
• The median duration of fever and associated headache in influenza is 3 days, but cough and malaise often persist for 1 to 2 weeks.
• The alleviation of influenza-like symptoms, such as fever, headache, and muscle/joint aches and pains, is important in maintaining a more or less normal degree of daily activity
• With their antipyretic and analgesic activity, nonsteroidal anti-inflammatory drugs (NSAIDs) are a choice for the management of such symptoms, although they have no effect on the duration of illness or spread of the virus.
RATIONAL ?
• Cataflam, the first member of the phenylacetic acid class of NSAIDs, has been shown to effectively lower body temperature when administered as a 25-mg tablet .
• A new immediate-release formulation containing of diclofenac-K has been developed to allow safe and effective use of diclofenac-K at a low dose that could be suitable for nonprescription use.
Effect From 1st. hour
87%
1st. Day Assessment
96%
87%
94%
95%
EOS Assessment
93%
97%
Rescue Medication
The numbers of patients who took rescue medication during the entire treatment period were 1 (0.8%), and 14 (12.2%) in
the diclofenac-K, and placebo groups, respectively.
Results
• Compared to placebo, the initial dose of diclofenac-K (2 x 12.5 mg) significantly lowered body temperature as early as 30 minutes after dosing.
•The onset (within 30 minutes), duration (-4 hours), and magnitude of the antipyretic effect (peak effect, ~0.8°C) were
• In this 3-day study, diclofenac-K was effective compared with placebo in relieving influenza-like symptoms, with comparable tolerability.
At the 1st. Day of pharyngiotonsilitis
At the 4th. Day of pharyngiotonsilitis
Questions ??
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