Common upper respiratory tract problems in the elderly – A guide to clinical diagnosis and prudent prescription

Abstract

Upper respiratory tract infections (URTIs) in the elderly (those aged 65 years and older) are not more common than in younger people, but complications are more common. Influenza and respiratory syncitial virus are the two most common pathogens affecting morbidity and mortality. Hospitalisation, bronchitis, pneumonia and death are all significantly increased in the elderly. Influenza vaccine is recommended for all persons aged 65 and older. Antibiotics have no benefit in the treatment or prevention of complications from influenza. Otitis media and tonsillitis are uncommon. Sinusitis should be treated with antibiotics. Amoxycillin remains the drug of choice for patients who are not allergic to penicillin. Pneumococcal vaccine is recommended as prophylaxis against pneumococcal pneumonia, which is often seen as a complication of influenza. Chronic idiopathic cough, anosmia, gastroesophageal reflux disease, asthma and chronic post-nasal drip may all present as upper respiratory tract-like illness. There is no benefit from using common cough mixtures or many other OTC preparations for the management of URTIs, as their side effects are significantly greater in older persons. SA Fam Pract 2006;48(5): 20-23)