Managing Minor Illness

Managing Minor Illness

Issues

Antibiotic useNegativesCost, resistance, side-effects, probably viral (SMAC)

PositivesCatching serious illness early

Patient behaviourWe want to positively influence health-seeking behaviour

-trigger for attendance (nursery said so…)

-encourage self-Rx, seeing Pharmacist

Beware – prescription is a “contract to cure”

Info ResourcesGuidelinesNationalNICE, HPA & Ofsted

LocalPCT prescribing policies

Practiceprescribing policies

Being Effective

Disease-Illness model

What to do if the patient and you have differing preferred outcomes

How can you bring the patient round to your way of thinking?

Confidence & trust - listening & understanding

Giving good explanations

Being positive and giving a clear prognosis

Looking at the long-term and not hoping for too much in a single consultation

Tools at the end – good safety-nets, delayed prescriptions, printing script and then discussion

Illnesses to Discuss

Sore throat

Otitis media

Otitis externa

Cough

Sinusitis

Conjunctivitis

Diarrhoea & vomiting

Cystitis

Thrush

Insect bites

Cellulitis

Impetigo

Richard de Ferrars 14.8.06

Guidance on Managing Minor Illness

Sore throat

Viral vs bacterial

High fever, systemic upset, duration (4-5d), painful LN, exudate on tonsils

Try hard to avoid day 1-2 antibiotic unless clearly unwell. Delayed script days 3-4

Use Pen V/ erythromycin (not Amoxicillin)

Otitis media

NNT is 15-20 so the norm is w&s or delayed script (80% recover at 3 days)

Prescribe antibiotics if:

Under 2y with bilateral OM

Systemically unwell

Discharge/ perforation

Recurrent infections

Use Amoxicillin/ erythromycin

Otitis media with perforation

By convention, treat with antibiotics

Oral is uncontroversial

Topical is possibly more effective but concerns re ototoxicity

Don’t usually swab

Use Amoxicillin/ erythromycin/ Sofradex

Otitis externa

Drops alone (eg Sofradex) or add in oral if very bad

Lecture about cotton buds

Swab if Rx failure or frequent recurrences

Soggy ear canal full of debris not responded to 5-7d of drops – speak to ENT (microsuction)

Conjunctivitis

Sticky eye with URTI vs conjunctivitis

Look at inside of lower eyelid for redness (none – not conjunctivitis!)

80% resolved at 5d without antibiotic – use delayed script

Itch suggests allergic conjunctivitis

Use Chloramphenicol

Acute Cough

Acute cough in a well child/ adult is a viral illness. (Dry cough, fever, myalgia, clear chest)

Record basic obs – pulse, RR, oxygen sats in COPD

More likely to treat if:

Old & young

Chronic chest disease (esp COPD)

Chest signs

Systemically unwell (high fever, feeling lousy, tachycardia, tachypnoea)

Use Amoxicillin/ erythromycin (single antibiotic is the norm)

D & V

Vast majority are self-limiting. May be food-related or droplet spread (eg Noravirus)

Simple D&V – fluids & eating advice

Consider stool sample if:

Lasting more than several days

Sounds like Campylobacter (high fevers, lots of cramps, may have blood in stool)

Ask about occupation – food-handler, care worker = no work until 48h past last D/V episode

Bad D&V – remember to look at long-term meds (stop diuretic, ACE, AT2)

Urinary Tract Infection

Simple lower uti in women 15-65:

Dip-test (pos leuc OR nitrite)

Treat with 3d of Trimethoprim

Don’t send msu but safety-net review with sample if no better after 3d

Back pain, fever, nausea/ vomiting, feeling unwell = upper uti

2 weeks of Ciprofloxacin or Co-Amoxiclav

Send msu

Pregnant women, women over 65, men

Always send msu

Usually 7d course of antibiotics

Children under 3 – talk to supervisor

Impetigo

90% staph, 10% strep

Use oral flucloxacillin unless very localised

Thrush

30-40% self-diagnoses are wrong!

Swab if recurrent & not previously swabbed (OK for patient to take the swab)

Use oral Fluconazole unless pregnant

In-growing toenail

Gunky – use Flucloxacillin and foot soaks

Very unusual to need nail surgery –

Tell them to stop cutting into the corners and make a single cut across the top

Possible Fungal Nail Infection

All GP’s treat differently

I would suggest send clippings and only consider treatment if fungus on microscopy

Hay-fever

All treatments are available OTC

Start with simple antihistamine (Cetirizine.Clemastine useful 2nd line)

Add in nasal steroid/ eye-drops if needed

Differences between tabs are minimal – try and avoid switching

Depot steroids are frowned on. 1 week of oral Pred 20mg is preferable (eg exams, wedding)

Insect Bites/ Stings

Rule of thumb – swelling & redness in first 48h are reaction not infection

Mark redness and consider antibiotic if still extending after 48h

10.8.10