Biomedical subjects

D B Middleton

Publications and source records attributed to D B Middleton.

4 recordsLinked to original sources

PubMed1991

An approach to pediatric upper respiratory infections.

Upper respiratory tract infections are the most common diseases encountered in office pediatrics. The majority of these illnesses, including the common cold and pharyngitis, are viral in etiology, present with rhinitis and fever, and are self-limited and benign. Management consists of fluids, rest, saltwater nose drops and analgesics. Antihistamines appear to relieve only those symptoms potentiated by allergy. With the exception of streptococcal pharyngitis, upper respiratory tract infections do not require antibiotic therapy. However, otitis media and sinusitis, which sometimes are difficult to diagnose, are markedly improved by antibiotics that cover Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. In 10 percent of children, otitis media and sinusitis are recalcitrant to antibiotic therapy. For these patients, referral to an otolaryngologist, myringotomy, placement of tympanostomy tubes or a short trial of prednisone may be efficacious.

Analgesics↗

PubMed1990

Immunizations.

The primary care physician has few tools as effective as immunization. Patients deserve to be advised about prophylaxis and appropriately treated when the need arises. Monitoring of the CDC's Morbidity and Mortality Weekly Report (MMWR) is the most efficient manner of keeping current. The Journal of the American Medical Association usually quotes the important advances from the MMWR. The local health department is generally helpful in covering local crises or giving travel advice.

Humans↗

PubMed1988

Standardized symptomatic treatment versus penicillin as initial therapy for streptococcal pharyngitis.

A multicenter, double-blind, randomized, placebo-controlled trial was conducted to determine whether the addition of penicillin was superior to patient education and anti-inflammatory drug therapy for relief of the acute discomforts of pharyngitis caused by group A beta-hemolytic streptococcus (GABHS). One hundred seventy-eight patients, aged 4 to 29 years, received appropriate symptomatic therapy, including specific doses of aspirin or acetaminophen, plus penicillin (91 patients) or placebo (87) for the initial 48 hours of illness. All had 24-hour office and 48-hour telephone reevaluations. In 123 patients (57 with clinically severe pharyngitis), throat cultures yielded GABHS. Penicillin provided a margin of 20% improvement over anti-inflammatory therapy for the complaint of sore throat only after 48 hours of treatment (for the 123 patients with GABHS, p = 0.01; for the 57 with both severe pharyngitis and GABHS, p = 0.05). No significant improvement was noted for fever, malaise, odynophagia, exudate, adenitis, or pharyngitis. The failure of penicillin to provide much additional benefit makes its routine early prescription specifically for symptomatic relief questionable.

Acetaminophen↗

PubMed1978

Rocky Mountain spotted fever: gastrointestinal and laboratory manifestations.

Sixty-six cases of serologically documented Rocky Mountain spotted fever (RMSF) from North Carolina are reviewed. Gastrointestinal manifestations were present in 80% of these patients. Because other common expressions of RMSF occasionally do not accompany severe gastrointestinal dysfunction, improper diagnosis and therapy can result. Sixty percent of the patients had hyponatremia and thrombocytopenia. Over 70% of those who had liver or muscle enzyme evaluations had at least one abnormality. RMSF should be strongly considered in the differential diagnosis of patients with a combination of these findings.

Adolescent↗