176 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
INFECTION AND TRAINING
FEVER
•Fever impairs concentric muscle strength, mental cog-
nition, and pulmonary perfusion; and increases over-
all caloric and oxygen demand and insensible fluid
loss resulting in decreased exercise capacity and
increased risk of injury (Brenner et al, 1984).
- Options to treat fever include acetaminophen
(650–1000 mg q 4–6 h) and nonsteroidal anti-inflam-
matory drugs(NSAIDs) like ibuprofen (800 mg TID)
(Kauffman, 1999). - When an athlete is dehydrated, using NSAIDs during
exercise may reduce renal blood flow and precipitate
acute renal failure (McDonald, 1997).
RHINORRHEA AND NASAL CONGESTION
- The most common complaints related to infections in
athletes are rhinorrhea and nasal congestion, most
commonly seen with URIs and acute sinusitis.
•Typical URI symptoms include rhinorrhea, congestion,
sneezing, sore throat, cough, hoarseness, malaise, and
headache. Typical findings include nasal mucosa edema
and erythema, rhinorrhea, oropharyngeal erythema, and
cervical lymphadenopathy. Temperature greater than
100 °F (37.7°C) is unusual (Levy and Kelly, 1999). - URI treatment is aimed at symptom relief with rest
and good hydration being paramount.
1.Oral or nasal decongestants can help relieve conges-
tion, but side effects can include nervousness, insom-
nia, tachycardia, and increased blood pressure.
2.Sedating antihistamines are good choices for
sneezing and rhinorrhea as their anticholinergic
action dries the nasal mucosa and increases mucous
viscosity. Side effects can include sedation, dry
mouth, urinary retention, blurry vision, and consti-
pation (Levy and Kelly, 1999). Athletes in warm
climates should use them with caution since they
impair sweating and increase the risk of heat
exhaustion or heat stroke (Lillegard, Butcher, and
Rucker 1999).
3. Nasal ipratropium can provide the anticholinergic
effect of the nonsedating antihistamines without
the systemic side effects. (Hayden et al, 1996). - Diagnosis of acute sinusitis relies on combining a
constellation of signs and symptoms. Common indi-
cators are unilateral sinus pain and tenderness, puru-
lent rhinorrhea, lack of response to standard URI
therapy, sinus pain with leaning forward, maxillary
toothache, and “double sickening.” “Double sickening”
is when a patient has a URI that starts to improve, but
then gets acutely worse. Fever and other constitutional
symptoms may be present. Transillumination and
radiographs of the sinuses are generally not useful
(Fagnan, 1998).
•Treatment of acute sinusitis is as follows:- Analgesics and decongestants in doses discussed
above. - Nasal saline rinses,^1 / 4 tsp of table salt in 8 oz of
warm water, can give short-term relief and help
remove mucous. Placing a warm washcloth over
the affected sinus and its corresponding nostril may
also help. - Sedating antihistamines are not recommended
because they increase mucous viscosity and may
impede sinus drainage. - Antibiotics should cover the most common
causative pathogens, Streptococcus pneumoniae,
Haemophilus influenza, and Moraxella catarr-
halis. Appropriate first-line choices include
10–14 day regimens of amoxicillin (500 mg TID),
and trimethoprim-sulfamethoxazole DS (one pill
bid). Second-line choices include cefuroxime
(250–500 mg bid), amoxicillin-clavulanate (875 mg
bid), doxycycline (100 mg bid), and clarithromycin
(500 mg bid) (Fagnan, 1998).
COUGH- Most commonly seen with URIs, sinusitis, bronchitis,
and pneumonia (Williamson, 1999).
•Focusing treatment on the underlying infection, ces-
sation of smoking, and adequate hydration may pro-
vide significant relief (Simon, 1995). - If the cough is especially irritating, however, cough
medicines may be tried.
1.The most effective cough suppressant is a narcotic
such as codeine (10–30 mg q 3–4 h). It will suppress
cough as well as provide sedation to help the
patient sleep.
2.Nonnarcotic options include dextromethorphan
(10–20 mg q4h), benzonatate (100 mg TID), and
guaifenesin (600–1200 mg bid) (Simon, 1995). - Symptoms of acute bronchitis may include URI
symptoms, but cough, productive or nonproductive, is
typically the most predominant feature (Levy and
Kelly, 1999). - Most cases of acute bronchitis, in the absence of under-
lying lung disease, are viral. Atypical bacteria such as
Mycoplasma pneumoniaand Chlamydia trachomatis
may also cause bronchitis in a small percentage of
cases (Williamson, 1999). Bordetella pertussisshould
also be suspected, even in adults immunized as chil-
dren (Birkebaek et al, 1999).