Prof. Dr. Hüseyin Güvenç; He answered questions about upper respiratory tract infection in children, unnecessary use of antibiotics, the effect of respiratory tract infections on pneumonia in children, causes and treatment of pneumonia, throat infection in children and high fever in children.
What diseases are included in the concept of respiratory tract infections? ?
It is a large area that starts from the nose and extends to the lungs. Ear infections and sinus infections are also in this group, but we mostly encounter them as upper respiratory tract infections. While upper respiratory tract infections can be mild, there are also people who have very severe ones.
How should antibiotics be used due to upper respiratory tract infection and cough?
“70-80 percent of upper and lower respiratory tract infections and cough are caused by Most of them consist of viruses. There is no point in giving antibiotics to this group of viruses. Antibiotics do not affect viruses. The remaining 20-30 percent is caused by bacteria. It is absolutely necessary to use antibiotics in this group. When we use antibiotics without needing them, resistance to these antibiotics develops over time. Later, when it is needed, that is, when used at the right time (bacterial infections), it does not show the expected effect.
Can a preliminary diagnosis be made based on the shape of the child's cough?
If the child is coughing or has not coughed in our presence, we check his cough by asking him to cough during the examination. This already gives us an idea. Cough may be less in upper respiratory tract infections. In upper respiratory tract infections; Runny nose, cold and watery eyes may occur. When we encounter such findings, it is more likely a viral infection.
There are patients with hoarse coughs. Without examining the child, we understand that this is a laryngitis, that is, an infection involving the vocal cords, the vast majority of which are of viral origin. It is pointless to use antibiotics in these diseases.
“RESPIRATORY TRACT CAUSED BY BACTERIA WE USE ANTIBIOTICS FOR INFECTIONS”
What is a throat infection, what symptoms does it cause in children?
When we say throat infection, we mean pharyngitis and tonsil infection. The more common type is the inflammation of the part of the larynx where the vocal cords are located, which we call laryngitis. In such infections, there is a milder clinical picture if it is a viral infection. Fever may be visible but not very high. Children may experience nasal congestion or runny nose. The cough is milder.
When it comes to bacterial infections, the most common type we encounter is Group A Beta Hemolytic Streptococcus, also known as Beta Microbe in society. These can cause serious tonsillitis, high fever, sore throat when swallowing, cough, and weakness in the body. We can roughly distinguish between these two when talking to the patient and examining him. If we think it is a virus, we do not recommend antibiotics. If we think it is caused by bacteria, then we start using antibiotics.
What are the conditions that require tonsils to be removed? Are tonsils tissues that do not serve any purpose?
We consider tonsils as sentinels of the throat. They have functions to retain the bacteria or microbes we inhale and prevent them from going down.
However, if a child has tonsillitis 5-6 times during a winter period, the tonsils become very large and prevent the child from breathing easily. The condition of the tonsils also negatively affects the child's ability to eat; If it negatively affects weight gain and growth, then we start to think 'we can remove this tonsil'. We weigh the benefits and harms, and if the benefits come to the fore, we say 'do not buy'. If it affects the child negatively for the reasons I have just mentioned, then we decide whether or not it should be removed by consulting an ear, nose and throat specialist.
There are two concepts; One is 'cold' and the other is 'flu'. What is the difference between them?
“These two concepts are quite different. They are both viral infections, and we do not use antibiotics if there are no complications in either of them, that is, unless bacteria are added as a second infection.
In the common cold, the fever does not rise very much, you do not feel very sick, you only have a mild feeling. There may be runny nose and cough. In flu infection, fever may be very high, sore throat, and muscle pain may occur. It can cause such serious fatigue that we fall into bed. In short, a cold has no fever or a slight fever, while high fever is the most important symptom of a flu infection. Even this helps us greatly in distinguishing between the two.”
. Do you recommend flu vaccination for all children? Or do you only recommend it to children in the risk group?
“We do not recommend a routine flu vaccine for children. “If a child goes to nursery, kindergarten or school, has respiratory infections or flu infections very frequently during the winter, and has a particularly allergic nature - this could be allergic rhinitis or bronchitis - then we recommend vaccination.”
“IF THE CHILD HAS A TENDENCY TO ALLERGY, COLD MAY TURN INTO PNEUUMARY”
. Can having the flu frequently cause pneumonia in the future?
“Flu is one of the complications of infection. If the person with flu has an allergic tendency, there is a possibility that the infection will progress faster. These may develop bronchiolitis and pneumonia. If there is no allergy and the patient is not going to school yet, that is, if he/she is not in a crowded environment, then the possibility of pneumonia decreases a little.”
. How do you understand pneumonia? What methods are used for diagnosis?
“Pneumonia can be viral or bacterial. It may occur as a secondary infection following viral infection. If a viral infection occurs, the child's general condition will deteriorate compared to a day or two ago; His appetite decreases, he feels exhausted, he wants to lie down all the time, maybe he vomits from time to time. His cough increases, but it is a soft cough; Children who cough up the tissue sometimes do not cough it out and throw it back into the digestive system. In such a case, we suspect pneumonia.
For diagnosis, we listen to the lungs with a stethoscope, have a blood count and take a chest x-ray. Then, with a definitive diagnosis, we begin the treatment approach. Slow and late response to treatment and he says. If the appropriate antibiotic is not selected, then such children may have nutritional problems. Vomiting can be added to these symptoms, and fluid deficiencies begin to appear with vomiting. In very severe cases; The lungs cannot provide enough oxygen to the body. Then oxygen and respiratory support may be required. For this reason, it should be examined as soon as possible and then treatment should be started.”
. After what degree is high fever harmful in children?
“For us, the fever limit is approximately 38 degrees. We do not even recommend antipyretics below 38 degrees. At 39 degrees and above, there may be a risk of febrile seizures in infancy and the 5-6 age group. The room temperature should not be kept too high; The environment will be cool so that the body can transfer heat to the outside. Second, we need to undress the child. He will not be able to wear any clothes; To ensure good heat transfer. Thirdly, in order to control the fever, the body needs to have plenty of fluids. If necessary, you should take a shower with warm water, which helps reduce body temperature. If you cannot take a shower, we recommend wet dressing with warm water. In the past, cologne and alcohol were recommended, now we do not recommend them anymore. "We adjust antipyretic medications according to the child's weight and age and try to reduce the child's temperature below 38."
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