scholarly journals Respiratory tract infection and risk of bleeding in oral anticoagulant users: self-controlled case series

BMJ ◽  
2021 ◽  
pp. e068037
Author(s):  
Haroon Ahmed ◽  
Heather Whitaker ◽  
Daniel Farewell ◽  
Julia Hippisley-Cox ◽  
Simon Noble
Keyword(s):  
General Practice ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Major Bleeding ◽  
Oral Anticoagulant ◽  
Case Series ◽  
Risk Of Bleeding ◽  
Relative Incidence ◽  
Time Periods

Abstract Objective To estimate the association between untreated, community acquired, respiratory tract infections and bleeding in oral anticoagulant users. Design Self-controlled case series. Setting General practices in England contributing data to the Clinical Practice Research Datalink GOLD. Participants 1208 adult users of warfarin or direct oral anticoagulants with a general practice or hospital admission record of a bleeding event between January 2010 and December 2019, and a general practice record of a consultation for a community acquired respiratory tract infection for which immediate antibiotics were not prescribed (that is, untreated). Main outcome measures Relative incidence of major bleeding and clinically relevant non-major bleeding in the 0-14 days after an untreated respiratory tract infection, compared to unexposed time periods. Results Of 1208 study participants, 58% (n=701) were male, median age at time of first bleed was 79 years (interquartile range 72-85), with a median observation period of 2.4 years (interquartile range 1.3-3.8). 292 major bleeds occurred during unexposed time periods and 41 in the 0-14 days after consultation for a respiratory tract infection. 1003 clinically relevant non-major bleeds occurred during unexposed time periods and 81 in the 0-14 days after consultation for a respiratory tract infection. After adjustment for age, season, and calendar year, the relative incidence of major bleeding (incidence rate ratio 2.68, 95% confidence interval 1.83 to 3.93) and clinically relevant non-major bleeding (2.32, 1.82 to 2.94) increased in the 0-14 days after an untreated respiratory tract infection. Findings were robust to several sensitivity analyses and did not differ by sex or type of oral anticoagulant. Conclusions This study observed a greater than twofold increase in the risk of bleeding during the 0-14 days after an untreated respiratory tract infection. These findings have potential implications for how patients and clinicians manage oral anticoagulant use during an acute intercurrent illness and warrant further investigation into the potential risks and how they might be mitigated.

Acupuncture Therapy for Fever Induced by Viral Upper Respiratory Tract Infection (Urti) in Military Medical Service: A Case Series

2014 ◽  
Vol 32 (6) ◽  
pp. 509-511 ◽  
Author(s):  
SeungWon Kwon ◽  
KyoungHo Shin ◽  
WooSang Jung ◽  
SangKwan Moon ◽  
KiHo Cho
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Medical Service ◽  
Case Series ◽  
Treatment Session ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Accompanying Symptoms

We report the cases of eight military patients with fever (≥38°C) induced by viral upper respiratory tract infection (URTI) who requested treatment with acupuncture in the military medical service room. All patients were treated immediately after diagnosis with classical acupuncture (GV14, GB20, TE8 points) and a new type of acupuncture, equilibrium acupuncture ( Feibing and Ganmao points). After one treatment session (20 min), reduction of body temperature was confirmed in all patients. Accompanying symptoms such as headache, myalgia and nasal obstruction also showed a tendency to decrease. Within 3 days of treatment, six of the eight patients had recovered from the URTI. No adverse effects of acupuncture treatment were reported.

scholarly journals Limited value of chest radiography in predicting aetiology of lower respiratory tract infection in general practice

2008 ◽  
Vol 58 (547) ◽  
pp. 93-97 ◽  
Author(s):  
A Willy Graffelman ◽  
Francois EJA Willemssen ◽  
Harmine M Zonderland ◽  
Arie Knuistingh Neven ◽  
Aloys CM Kroes ◽  
...  
Keyword(s):  
General Practice ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Lower Respiratory Tract Infection ◽  
Chest Radiography ◽  
Lower Respiratory Tract

scholarly journals Antibiotherapy management in respiratory infections in ambulatory in Tunisia

10.3823/0805 ◽  
2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Mohamed Chakroun ◽  
Amine Chakroun ◽  
Mohamed Hsairi
Keyword(s):  
General Practice ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Maxillary Sinusitis ◽  
Acute Bronchitis ◽  
Concomitant Treatment ◽  
Main Diagnosis ◽  
Infectious Episode ◽  
Tract Infections

Acute respiratory tract infections are the commonest acute conditions managed in general practice and the main causes of antibiotic use. In Tunisia, the rates of antibiotic prescriptions remain high in general practice. In order to assess antibiotics prescribing practices of 23 general practitioners when facing an ENT or a respiratory tract infection, we conducted an observational study from February 1st, 2014 to November 25th, 2014. The study involved 374 patients, 45.6 mean age of years, among them 193 men (51.6%) and 174 (51.9%) with comorbidities. Tonsillitis, acute maxillary sinusitis and acute bronchitis are the main diagnosis, accounting for over 90% of ENT and respiratory tract infection. The diagnosis of these infections was based on clinical criteria, additional tests were prescribed for only 75 patients (20%). An antibiotic was prescribed for 360 patients (96.2%). β-lactams were the main prescribed class of antibiotics (58.3%). The antibiotic treatment was considered as inappropriate in 42.5% of prescriptions. The main causes were the prescription of amoxicillin-clavulanic acid during tonsillitis, non-antipneumococcal fluoroquinolones, when streptococci or streptococcus pneumoniae are presumed to be responsible for infection (tonsillitis, acute maxillary sinusitis, pneumonia), and unnecessary combination of antibiotics. A concomitant treatment was prescribed for 365 patients (97.6%). The most prescribed drugs were antipyretics (71.4%), corticosteroids (44.7%) and mucolytic (30.2%). The outcome was favorable in 333 cases (89%) and unfavorable in 26 cases (7.1%). The total average cost of an infectious episode was 79.776 ± 36.988 TND (45 ± 20 USD)., with a minimum and maximum values respectively 19.5 and 315.5 TND (35 to 558 USD). This study highlights the frequency of antibiotics prescription (96.2%) during supposed viral infections such as acute bronchitis, tonsillitis or when antibiotic prescription has to be debatable such as in acute otitis media, sinusitis maxillary or exacerbations of COPD. The over-use of antibiotics is an important concern in many countries of the region leading to emergence of bacterial resistance. National guidelines should be developed in order to promote rational use of antibiotics.

scholarly journals Improving assessment of children with suspected respiratory tract infection in general practice

2019 ◽  
Vol 8 (2) ◽  
pp. e000450 ◽  
Author(s):  
Cheng Chen ◽  
Ruth Crowley
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Improvement Project ◽  
Antibiotic Overuse ◽  
Safety Netting ◽  
The Way

Upper respiratory tract infection (URTI) in children is one of the most common reasons for general practice (GP) attendance over the winter months. It is crucial to be able to risk stratify and determine the severity of illness in these patients. It is important both to recognise those who are clinically unwell and require treatment escalation, and also to not overprescribe antibiotics due to the ongoing problem of antibiotic overuse and resistance.This quality improvement project was undertaken to improve the way in which these consultations were held and also the way they were documented. It was recognised that key features in assessing a potentially unwell child were to measure their heart rate (HR) and respiratory rate (RR). As children can often deteriorate rapidly and their clinical course may not necessarily be easy to predict, we wanted to make sure that parents were being provided with safety netting information in the event that the child should become more unwell after the consultation.Through the course of our project, we managed to improve the proportion of consultations for URTI or ‘viral illness’ in children in which HR and RR were documented from 57% to 100%. The proportion of consultations in which safety netting information for parents was discussed and documented improved from 48% to 96%.By using quality improvement strategies, we have succeeded in improving both the safety and efficiency in the way children who present with URTI are assessed in GP.

scholarly journals Common upper respiratory tract infection leading to uncommon retropharyngeal abscess - A case series on paediatrics

2020 ◽  
Vol 11 (1) ◽  
pp. 836-839
Author(s):  
Lalduhawmi T C ◽  
Diya C ◽  
Keerthana Arjunan ◽  
Jerlin Anusha R ◽  
Keerthana Chandrasekar
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Oral Hygiene ◽  
Case Series ◽  
Upper Respiratory Tract Infection ◽  
Retropharyngeal Abscess ◽  
Retropharyngeal Space ◽  
Upper Respiratory Tract ◽  
Upper Respiratory

Retropharyngeal abscess is the formation of pus in retropharyngeal space, which occurs as a frequent complication of Upper Respiratory Tract Infection (URI). It is commonly seen in children less than 5 years old. The clinical manifestations includes neck mass, fever, cervical lymphadenopathy, neck stiffness, agitation, cough, drooling, torticollis, respiratory distress, stridor, and with signs of tonsillitis, pharyngitis, and otitis media. The first-line treatment includes drugs such as ampicillin-sulbactam and clindamycin. This case series highlights the complications of untreated upper respiratory tract infection leading to retropharyngeal abscess. Oral hygiene should be maintained to prevent future complications. Two patients were admitted in the paediatric inpatient unit and were diagnosed as a case of retropharyngeal abscess, following for which their management was done. After assessing, the clinical presentations and management scenario of the patients, age, and poor hygienic conditions are associated with the patients' risk factors for acquiring Retropharyngeal Abscess. In paediatrics, maintaining hygiene, especially oral hygiene and early diagnosis can prevent future complications of retropharyngeal abscess.

Etiology of Respiratory Tract Infection in Adults in a General Practice Setting

1998 ◽  
Vol 17 (10) ◽  
pp. 685-689 ◽  
Author(s):  
D. Lieberman ◽  
P. Shvartzman ◽  
M. Ben-Yaakov ◽  
Z. Lazarovich ◽  
S. Hoffman ◽  
...  
Keyword(s):  
General Practice ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Practice Setting ◽  
General Practice Setting

scholarly journals A Case-Control Study of Acute Respiratory Tract Infection in General Practice Patients in The Netherlands

2005 ◽  
Vol 41 (4) ◽  
pp. 490-497 ◽  
Author(s):  
A. B. van Gageldonk-Lafeber ◽  
M.-L. A. Heijnen ◽  
A. I. M. Bartelds ◽  
M. F. Peters ◽  
S. M. van der Plas ◽  
...  
Keyword(s):  
General Practice ◽  
Tract Infection ◽  
The Netherlands ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Case Control Study ◽  
Case Control ◽  
Acute Respiratory Tract Infection ◽  
Control Study
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