Acute Pharyngotonsillitis Research Articles

A scoring system for management of acute pharyngo-tonsillitis in adults

Objectives The aim of this study was to develop and evaluate a scoring system for the management of acute pharyngo-tonsillitis. Methods We conducted a prospective study between May 2004 and June 2005. Patients with acute pharyngo-tonsillitis were evaluated for causative pathogens and were assessed clinical symptoms and pharyngo-tonsillar finding by a clinical scoring system. Results A total 214 adult patients were enrolled in this study. Streptococcus pyogenes were identified at 13.6%. Thirty-one viruses were also identified by PCR. They were adenovirus (4.8%), influenza virus (1.0%), RS virus (6.3%), and human metapneumovirus (2.9%). Numbers of total white blood cells and levels of C-reactive protein showed a significant positive correlation with clinical scores ( p < 0.001) and were also higher in cases with S. pyogenes. The clinical scores rapidly improved after the antimicrobial treatments in moderate cases and severe cases. Conclusion The current study strongly suggested that the clinical scoring system reflected disease severity well and would be very useful for evaluating clinical course and decision making for the antimicrobial treatment of acute pharyngo-tonisllitis.

Antibiotic resistance pattern of group-a beta-hemolytic streptococci isolated from north Indian children

The current resistance pattern of GABHS (group-A beta-hemolytic streptococci) in India has not been discussed. To fill the above-mentioned void, we planned this study to determine the prevalence and degree of antibacterial resistance in GABHS isolates. Children with acute pharyngo-tonsillitis who had not received antibiotic in the preceding week, attending the pediatric OPD, were prospectively enrolled over a period of 1 year. Throat swabs were collected from each child and transported to microbiology laboratory, as early as possible. A throat swab culture for GABHS was done. All GABHS were subjected to antibiotic susceptibility and minimum inhibitory concentration (MIC) test according to Clinical Laboratory Standard Institute (CLSI) guidelines. In the present study, 12.6% (55/435) of the children with acute pharyngo-tonsillitis had throat swab culture positive for GABHS. The prevalence of macrolide resistance was 10.2%. The MIC50 for macrolide-resistant strain was 0.5 microg/mL (range, 0.125-8 microg/mL), and MIC90 was 8 microg/mL (range, 0.125-8 microg/mL). Tetracycline and co-trimoxazole resistances were 24.5% and 12.2% respectively. The values of MIC50 for tetracycline- and co-trimoxazole-resistant strains were 4 microg/mL (range, 0.125-32 microg/mL) and 2 microg/mL (range, 0.25-8 microg/mL) respectively. All isolates were sensitive to penicillin G and chloramphenicol on disc diffusion test. However, their MIC50 was 0.032 microg/mL (range, 0.012-0.125 microg/mL) and 2 microg/mL (range, 0.25-4 microg/mL) respectively. High prevalence of antimicrobial resistance found among GABHS needs a longitudinal surveillance of isolates from different centers in India.

Clinical utility of a new rapid test for the detection of group A Streptococcus and discriminate use of antibiotics for bacterial pharyngitis in an outpatient setting

To evaluate the clinical usefulness of the Diaquick Strep. A Test (SAT) as a rapid streptococcal antigen test, and its effect on antibiotic use in children. This was a prospective study of children with acute catarrh, fever, and acutely inflamed throat/tonsils. Paired throat swabs for SAT and culture were collected. None of the children received antibiotics prior to testing. Five hundred and five children were included in the study: 278 were boys (55%) and 409 (81%) were aged under 5 years. The SAT was negative in 434 cases (86%) and positive in 71 (14%); culture was negative in 425 cases (84%) and positive in 80 (16%), including nine cultures that grew bacteria other than group A beta-hemolytic streptococci (GAS). Both the SAT and culture were negative in 422 cases (84%) and positive in 68 (13%), but were inconsistent in 15 cases (3%). For GAS infection, the SAT positive predictive value was 95.8% (68/71). The negative predictive value for the whole group as well as for children under five years of age was over 99% (422/425 and 355/358, respectively). SAT sensitivity was almost 96%. Finally, only 74 children (15%) were given antibiotics, while a staggering 431 (85%) were not. The Diaquick Strep. A Test (SAT) is a quick, reliable, and clinically useful test, which could help to dramatically reduce the usage of antibiotics in children with fever, catarrh, and acute pharyngotonsillitis.

Recovery of interfering and β-lactamase-producing bacteria from group A β-haemolytic streptococci carriers and non-carriers

The purpose of this study was to compare the frequency of recovery of aerobic and anaerobic organisms with interfering capability against group A beta-haemolytic streptococci (GABHS) and beta-lactamase-producing bacteria (BLPB) from the tonsils of GABHS carriers and non-carriers. The presence of aerobic and anaerobic bacteria capable of such interference in vitro was evaluated in cultures obtained from the tonsils of 20 healthy children who were non-GABHS carriers and 20 who were GABHS carriers, and also from 20 children who were asymptomatic after completing a course of penicillin for acute GABHS pharyngo-tonsillitis (PT) and were non-GABHS carriers and 20 who were GABHS carriers. In healthy children, 32 interfering isolates were recovered from 16 non-GABHS carriers (1.6 per child) and 13 were isolated from 7 GABHS carriers (0.65 per child) (P<0.001). In children who had suffered acute GABHS PT, 26 interfering organisms were recovered from 15 non-GABHS carriers (1.3 per child) and 8 were isolated from 5 GABHS carriers (0.4 per child) (P<0.005). In healthy children, 13 BLPB were recovered from 5 non-GABHS carriers and 13 were isolated from 6 GABHS carriers. In children who had suffered acute GABHS PT, 14 BLPB were recovered from 5 (25 %) non-GABHS carriers and 32 were isolated from 17 (85 %) GABHS carriers (P<0.05). It was demonstrated in this study that there was a higher rate of recovery of aerobic and anaerobic organisms capable of interfering with GABHS in non-GABHS carriers than in GABHS carriers. This was observed in all GABHS non-carriers and included healthy children as well as those recently treated for symptomatic GABHS PT with penicillin that failed to eradicate GABHS. A higher rate of recovery of BLPB was observed only in GABHS carriers who were treated with penicillin for GABHS PT.

Prevalência de Streptococcus pyogenes em orofaringe de crianças que freqüentam creches: estudo comparativo entre diferentes regiões do país

Trinta por cento das faringotonsilites agudas são de etiologia estreptocócica com potencial de complicações como a glomerulonefrite difusa aguda e febre reumática. Crianças de creches apresentam maior incidência destas infecções. OBJETIVO: Identificar e comparar a prevalência do Streptococcus pyogenes na orofaringe entre crianças que freqüentam creches e crianças não-institucionalizadas, em duas regiões do Brasil. CASUÍSTICA E MÉTODO: Estudo prospectivo com 200 crianças, provenientes da cidade de Porto Velho/RO e São Paulo/SP, em quatro grupos, freqüentadoras ou não de creches. Realizou-se swab de orofaringe e cultura para identificação do Streptococcus pyogenes. RESULTADOS: Prevalência de 8% e 2% entre as crianças de São Paulo que atendem a creches e do grupo controle, respectivamente, apresentando valor estatístico (p=0,02). Prevalência de 24% e 16% nos grupos de Porto Velho/RO que freqüentam creche e controle respectivamente, não caracterizando diferença estatisticamente significante (p=0,18). Observou-se diferença estatisticamente significante entre os grupos creche e controle de São Paulo/SP aos seus correspondentes de Porto Velho/RO (p &lt; 0,01). CONCLUSÃO: Os resultados deste estudo nos permitem sugerir que freqüência em creches representa um fator de risco para a colonização de orofaringe pelo Streptococcus pyogenes, fato observado em populações distintas, porém com significância estatística em apenas uma das duas amostras.

Prevalence of Streptococcus pyogenes as an oropharynx colonizer in children attending daycare: a comparative study of different regions in Brazil

SummaryThirty percent of acute pharyngotonsillitis is caused by Streptococcus pyogenes, which increased the risk of glomerulonephritis and rheumatic fever. Children attending daycare centers have a higher incidence of these infections.Aimto identify and compare the prevalence of Streptococcus pyogenes in the oropharynx of children who are enrolled and who are not enrolled in daycare centers in different regions of Brazil.Materials and MethodsA prospective study of two hundred children from Sao Paulo/SP and Porto Velho/RO. Children from each city were divided into two groups: those attending, and those not attending daycare centers. Swabs of the oropharynx were taken for bacteriological culture and identification.ResultsThe prevalence of Streptococcus pyogenes in the São Paulo groups were 8% and 2% for daycare and control groups, which was statistically significant (p=0.02). The prevalence in children from Porto Velho/RO was 24% and 16% for daycare and control groups, which was statistically significant (p=0.015). Statistical analysis also showed a significant difference between the corresponding groups in the two locations (p<0.01).ConclusionThese results show that daycare attendance is a risk factor for oropharyngeal streptococcal colonization; this was seen in different populations, but was statistically significance in only one of the two samples.

Increased recovery of Moraxella catarrhalis and Haemophilus influenzae in association with group A β-haemolytic streptococci in healthy children and those with pharyngo-tonsillitis

The inflamed tonsils harbour numerous types of bacteria, alone or in combination with group A beta-haemolytic streptococci (GABHS). The cohabitation of the tonsils by GABHS and certain other bacterial species may contribute to the inflammatory process and the failure of penicillin therapy. This study evaluated the recovery of Moraxella catarrhalis, Haemophilus influenzae, Staphylococcus aureus and Streptococcus pneumoniae in association with GABHS in healthy children and those with acute pharyngo-tonsillitis (APT). Pharyngo-tonsillar cultures were obtained from 548 children with APT and 866 healthy children. GABHS was recovered from 112 (20.4%) children with APT. Of the 114 H. influenzae isolates, 32 were recovered in association with GABHS (29% of all patients who had GABHS) and 82 were isolated without GABHS (19%) (P=0.0267). Of the 69 M. catarrhalis isolates, 25 were recovered in association with GABHS (22% of all patients who had GABHS) and 44 were isolated without GABHS (10%) (P=0.0012). In contrast, there was no association between the isolation of GABHS and the recovery of Staph. aureus or Strep. pneumoniae. GABHS was recovered from 104 (12%) healthy children. Of the 69 M. catarrhalis isolates, 24 were recovered in association with GABHS (23% of all patients who had GABHS) and 80 were isolated without GABHS (10%) (P=0.006). There was no association between the isolation of GABHS and the recovery of H. influenzae, Staph. aureus or Strep. pneumoniae. This study demonstrates an association between the recovery of GABHS and H. influenzae and M. catarrhalis from pharyngo-tonsillar cultures of patients with APT and M. catarrhalis from pharyngo-tonsillar cultures of healthy children.

Papel do teste de detecção rápida do antígeno do estreptococcus beta-hemolítico do grupo a em pacientes com faringoamigdalites

O Streptococcus beta-hemolítico do grupo A (SGA) é o agente etiológico mais comum das faringoamigdalites (FA). O diagnóstico etiológico correto e tratamento adequado evitam complicações supurativas e não-supurativas da faringoamigdalite estreptocócica, entretanto, métodos clínicos de diagnóstico não são confiáveis. Os métodos rápidos de detecção do antígeno do SGA podem ser utilizados no diagnóstico deste agente e evitar uso indevido de antibióticos. OBJETIVOS: Os autores objetivaram avaliar a sensibilidade e especificidade dos testes rápidos para detecção do antígeno do SGA em nosso meio. FORMA DE ESTUDO: Clínico prospectivo. METODOLOGIA: Oitenta e um pacientes com faringoamigdalite aguda, atendidos no PS-ORL do Hospital das Clínicas da FMUSP, no período de maio de 2001 a abril de 2002, foram submetidos a duas coletas simultâneas de material de orofaringe com swabs. O teste rápido de detecção do SGA foi confrontado com a cultura em placa agar-sangue ("gold standard" para o diagnóstico etiológico). RESULTADOS: De 81 pacientes, 56% tiveram teste rápido positivo e 44% negativo; 40.7% apresentaram crescimento de SGA na cultura; a sensibilidade e especificidade do teste rápido foram, respectivamente, 93,9% e 68,7%. O valor preditivo negativo e positivo foram, respectivamente, 94,2% e 67,4%. CONCLUSÕES: A alta sensibilidade do exame permite utilizá-lo com intuito de identificar pacientes com SGA. Os testes de detecção rápida do antígeno estreptocócico se mostraram uma importante arma coadjuvante no diagnóstico etiológico das faringoamigdalites.

Oral clindamycin 300 mg BID compared with oral amoxicillin/clavulanic acid 1 g BID in the outpatient treatment of acute recurrent pharyngotonsillitis caused by group a β-hemolytic streptococci: An international, multicenter, randomized, investigator-blinded, prospective trial in patients between the ages of 12 and 60 years

Background: The increasing rate of treatment failure with penicillin and other β-lactam antibiotics in pharyngotonsillitis caused by group A β-hemolytic streptococci (GABHS) has prompted the search for alternative antimicrobials. Both clindamycin and amoxicillin/clavulanic acid have excellent clinical activity in pharyngotonsillitis. Objective: This study compared the clinical andbacteriologic efficacy and tolerability of oral clindamycin with those of oral amoxicillin/clavulanic acid in the outpatient treatment of acute recurrent GABHS pharyngotonsillitis. Methods: This was an international, multicenter, randomized, investigator-blinded, prospective study in patients with acute recurrent pharyngotonsillitis. Recurrence was defined as ⩾-2 episodes of documented pharyngeal and/or tonsillar infection within the 12 months before the study. A rapid diagnostic test for GABHS was performed before initiating therapy, and positive results were confirmed by pharyngotonsillar culture. Patients were randomly assigned to receive oral clindamycin 300 mg BID or oral amoxicillin/clavulanic acid 1 g BID for 10 days. Culture was repeated on day 12. The primary study end points were clinical and bacteriologic efficacy assessed on day 12, and clinical and bacteriologic recurrence rates assessed at a visit taking place up to 3 months after the completion of treatment. Tolerability was the secondary end point. Results: Seven hundred seventy-four patients withacute, recurrent GABHS pharyngotonsillitis were enrolled in the study (mean age, 28 years; age range, 12–60 years). Five hundred forty-two patients (272 clindamycin, 270 amoxicillin/clavulanic acid) were clinically evaluable at day 12. Four hundred ninety-four patients were bacteriologically evaluable, and the safety population included 772 patients. There were no significant differences between groups at baseline. In terms of clinical efficacy at day 12, 252/272 (92.6%) patients in the clindamycin group and 230/270 (85.2%) patients in the amoxicillin/clavulanic acid group were considered cured ( P < 0.003). At day 12, bacteriologic eradication was achieved in 237/242 (97.9%) and 238/252 (94.4%) patients in the respective treatment groups ( P = NS). No clinical response was observed in the absence of bacteriologic eradication. At 3-month follow-up, clinical cure was achieved in 267/280 (95.4%) patients in the clindamycin group and 267/280 (95.7%) patients in the amoxicillin/clavulanic acid group ( P = NS); bacteriologic eradication was observed in 235 (99.2%) and 237 (99.6%) of the respective treatment groups ( P = NS). Both treatments were well tolerated. Adverse events were reported in 53/384 (13.8%) patients in the clindamycin group and 41/390 (10.5%) patients in the amoxicillin/clavulanic acid group. The most commonly reported adverse events involved the digestive system (mainly diarrhea), occurring in 33 (8.6%) and 22 (5.6%) patients in the respective treatment groups. Conclusions: In this study in patients with acute recurrentGABHS pharyngotonsillitis, oral clindamycin 300 mg BID and oral amoxicillin/clavulanic acid 1 g BID achieved comparable rates of bacteriologic eradication at 12 days and 3 months and comparable clinical cure rates at 3 months. Patients who received clindamycin had significantly greater clinical cure rates at 12 days. Both regimens were well tolerated.

Role of rapid antigen detection test for the diagnosis of group-A ß-hemolytic streptococcus in patients with pharyngotonsillitis

SummaryGroup A ß-hemolytic streptococcus (GAS) is an important pharyngotonsillitis etiologic agent. Correct etiologic diagnosis and early treatment prevent suppurative and non-suppurative complications of streptococcal pharyngotonsillitis, however, clinical diagnostic methods are not reliable. Within this context, rapid detection methods of GAS antigen are useful to diagnose this agent.AimThe objective of the present study was to determine the sensitivity and specificity of rapid GAS antigen detection tests used in Brazil.Study DesignClinical prospective.MethodsEighty-one patients with clinical diagnosis of acute pharyngotonsillitis seen at the otorhinolaryngology emergency department of University Hospital, FMUSP, between May 2001 and April 2002, were submitted to two simultaneous collections of oropharyngeal material using swabs. Rapid GAS antigen detection test was compared to culture on blood agar, the gold standard for the diagnosis of this etiologic agent.ResultsAmong the 81 studied patients, the rapid test was positive in 56% and negative in 44%. GAS growth in culture was observed for 40.7% of the patients. The sensitivity and specificity of the rapid test were, respectively, 93.9% and 68.7%, and the negative and positive predictive values were 94.2 and 67.4%, respectively.ConclusionsWe concluded that the high sensitivity of the test permits its use for the identification of patients with GAS. Rapid streptococcal antigen detection tests have been shown to be an important supporting tool in the etiologic diagnosis of pharyngotonsillitis.

Role of rapid antigen detection test for the diagnosis of group A beta-hemolytic streptococcus in patients with pharyngotonsillitis

SummaryGroup A β -hemolytic streptococcus (GAS) is an important pharyngotonsillitis etiologic agent. Correct etiologic diagnosis and early treatment prevent suppurative and non-suppurative complications of streptococcal pharyngotonsillitis; however, clinical diagnosis is not reliable. Within this context, rapid detection methods of GAS antigen are useful to diagnose this agent.AimThe objective of the present study was to determine sensitivity and specificity of rapid GAS antigen detection tests used in Brazil.Study designClinical prospective. Method: Eighty-one patients with clinical diagnosis of acute pharyngotonsillitis seen at the otorhinolaryngology emergency department of the University Hospital, FMUSP, between May 2001 and April 2002 were submitted to two simultaneous collections of oropharyngeal material using swabs. The rapid GAS antigen detection test was compared to culture on blood agar, the gold standard for the diagnosis of this etiologic agent.ResultsAmong the 81 patients studied, the rapid test was positive in 56% and negative in 44%. GAS growth in culture was observed in 40.7% of the patients. Sensitivity and specificity of the rapid test were, respectively, 93.9% and 68.7%, and the negative and positive predictive values were 94.2 and 67.4%, respectively. Conclusions: We concluded that high sensitivity of the test allows its use in the identification of patients with GAS. Rapid streptococcal antigen detection tests have been shown to be an important adjuvant tool in the etiologic diagnosis of pharyngotonsillitis.

Penicillin V, loracarbef and clindamycin in tonsillar surface fluid during acute group A streptococcal pharyngotonsillitis

Patients with acute group A- strepotococcal pharyngotonsillitis were randomly assigned to treatment for 10 d with either phenoxymethylpenicillin (PcV), loracarbef or clindamycin. The concentrations of the drugs, respectively, were determined in tonsillar surface fluid (TSF), serum and the saliva in each patient on altogether 5 occasions; before, during and 4 d after end of therapy. On the same occasions blood was drawn for analysis of C-reactive protein (CRP) and orosomucoid. On the last d of treatment PcV could be detected in TSF in 1 of 6 patients only. Loracarbef had a slower decrease in TSF during therapy and measurable levels did occur 2 d after end of therapy corresponding to MIC 100 for GAS. This may be related to the somewhat better clinical results of the cephalosporins than of PcV, and possibly indicates that an extended therapy with these drugs in primary GAS pharyngotonsillitis for more than the arbitrarily chosen 10 d could reduce the number of recurrent episodes. PcV and loracarbef were not detected in serum after the end of treatment. The concentration of clindamycin in both TSF and the saliva was fairly longstanding during therapy and reached levels exceeding MIC 100 for GAS, in both TSF and serum 2 d after the end of treatment. Several investigations have shown that GAS, especially in the stationary phase may invade respiratory epithelial cells and are present intracellularly in patients with acute pharyngotonsillitis as well as in asymptomatic carriers. The same T-type, identical DNA fingerprints and arbitrarily primed patterns are found in GAS before and after treatment failure indicating that the primary episode and the failures are caused by the same strain. The longstanding concentrations of clindamycin in TSF, roughly independent of the degree of the local inflammation combined with its intracellular accumulation and activity against resting GAS seem to explain the efficiency of the drug in recurrent GAS pharyngotonsillitis. CRP and orosomucoid were of limited value in differing between bacterial and viral pharyngtonsillitis and a correlation between antibiotic concentration and CRP/orosomucoid levels was not found.

Prevalence of the internalization-associated gene prtF1 in a bacterial population of Streptococcus pyogenes isolated from children with acute pharyngotonsillitis before and after antibiotic therapy.

The prevalence of the internalization-associated prtF1 gene was studied in 837 isolates of Streptococcus pyogenes obtained from 713 pediatric patients presenting with acute pharyngotonsillitis before and after antibiotic therapy. Its association with macrolide resistance and with bacteriological treatment failure was determined. The bacterial population isolated from baseline pharyngeal swabs showed an overall prtF1 positivity rate of 33%. A higher prtF1 positivity was found among erythromycin-resistant strains (45%) showing, however, marked differences between the inducible (iMLS), constitutive (cMLS), and efflux pump (M) resistance phenotypes. The prevalence was statistically higher (p < 0.001) in strains belonging to iMLS (84%) and cMLS (67%) phenotypes as compared to the M phenotype (15%). Interestingly, the prevalence of the prtF1 gene was significantly lower (p = 0.04) in strains belonging to M resistance phenotype as compared to erythromycin-susceptible strains (28%). Failed bacterial eradication was demonstrated in 124 patients. The prtF1 positivity rate remained unchanged in strains isolated before and after therapy in patients treated with macrolides (9/54). On the other hand, the positivity rate for the prtF1 gene was significantly higher (p = 0.015) in strains isolated after therapy with beta-lactams (21/70) as compared to baseline isolates (6/70), indicating a differential selection imposed on the organism by these agents. Finally, a high overall eradication rate (88%) of prtF1-positive isolates, belonging to both the erythromycin-susceptible and -resistant phenotypes, was demonstrated following macrolide treatment.

Prevalence of the Internalization-Associated Gene prtF1 in a Bacterial Population of&lt;I&gt; Streptococcus pyogenes&lt;/I&gt; Isolated from Children with Acute Pharyngotonsillitis before and after Antibiotic Therapy

Prevalence of the Internalization-Associated Gene prtF1 in a Bacterial Population of&lt;I&gt; Streptococcus pyogenes&lt;/I&gt; Isolated from Children with Acute Pharyngotonsillitis before and after Antibiotic Therapy

Efficacy of cefpodoxime in the prophylaxis of recurrent pharyngotonsillitis

Background: Recurrent acute pharyngotonsillitis remains a common illness in children and young adults and can lead to serious complications if not treated. cefpodoxime proxetil is a second-generation oral cephalosporin, which shows potent antibacterial activity against both Gram-positive and Gram-negative bacteria and high stability in the presence of beta-lactamases. Objective: We aimed to evaluate the efficacy of second-generation cephalosporins in the prophylaxis of recurrent pharyngotonsillitis in children. Methods: A total of 180 children aged between 4 and 14 years with recurrent pharyngotonsillitis were randomized to receive either cefpodoxime proxetil (100 mg twice a day, 6 days a month for 6 months) or placebo (at the same dosage). Results and conclusions: Our results show that treatment with cefpodoxime proxetil may be effective in reducing symptoms of recurrent pharyngotonsillitis and preventing recurrences without causing side effects or developing bacterial resistance.

Efficacy of cefpodoxime in the prophylaxis of recurrent pharyngotonsillitis

Background: Recurrent acute pharyngotonsillitis remains a common illness in children and young adults and can lead to serious complications if not treated. Cefpodoxime proxetil is a second-generation oral cephalosporin, which shows potent antibacterial activity against both Gram- and Gram-negative bacteria and high stability in the presence of beta-lactamases. Objective: We aimed to evaluate the efficacy of second-generation cephalosporins in the prophylaxis of recurrent pharyngotonsillitis in children. Methods: A total of 180 children aged between 4 and 14 years with recurrent pharyngotonsillitis were randomized to receive either cefpodoxime proxetil (100 mg twice a day, 6 days a month for 6 months) or placebo (at the same dosage). Results and conclusions: Our results show that treatment with Cefpodoxime proxetil may be effective in reducing symptoms of recurrent pharyngotonsillitis and preventing recurrences without causing side effects or developing bacterial resistance.

Detection of Group A beta-hemolytic Streptococcus employing three different detection methods: culture, rapid antigen detecting test, and molecular assay.

In order to study the prevalence of Group A beta-hemolytic Streptococcus (GABHS) pharyngotonsillitis in our pediatric population and to compare different sampling methods of GABHS detection, oropharyngeal swabs from 50 children with acute pharyngotonsillitis, between 1 and 12 years old, were used simultaneously for culture, molecular assay and rapid GABHS antigen detection tests. All children were clinically examined at the Division of Pediatric Otorhinolaryngology of the Federal University of São Paulo. Diagnostic criteria were based on signs and symptoms, including sore throat, fever and oropharyngeal purulent secretion. Children that had been treated with antibiotics were excluded. Overall, combining the three methods, the prevalence of GABHS was 34%. GABHS was diagnosed in 30% of the bacterial cultures, in 25% of the samples tested with the molecular nucleic acid hybridization method and in 26% of the cases tested with the rapid antigen detection test. There was no significant difference between these three methods.

Adecuación del tratamiento de la faringoamigdalitis aguda a la evidencia científica

ObjetivosAnalizar la idoneidad de los hábitos de prescripción de antibióticos en los pacientes pediátricos diagnosticados de faringoamigdalitis agudamétodosEstudio descriptivo de una serie de pacientes pediátricos diagnosticados de faringoamigdalitis aguda en los servicios de urgencias de 11 hospitales españoles. Estudio de idoneidad mediante la elaboración de estándares de referencia de uso apropiado y comparación de los datos del estudio descriptivo con tales estándaresResultadosSe revisan 1.716 casos diagnosticados de faringoamigdalitis aguda. En el 80,9% de ellas se prescribieron antibióticos, en su mayoría siguiendo criterios empíricos. Los antibióticos más empleados fueron: amoxicilina (36,0 %), amoxicilina-ácido clavulánico (22,5 %), cefixima (6,6 %), azitromicina (5,8 %) y cefuroxima (5,2 %). El 39,5 % correspondían a menores de 3 años, de los que el 75,9% recibieron tratamiento empírico. El 22,8 % de las prescripciones se clasificaron como de primera elección, el 22,4% de uso alternativo y el 54,8 % inapropiadasConclusionesEn la mayoría de las faringoamigalitis se prescribió tratamiento antibiótico y en casi todos los casos se hizo de forma empírica. Además de la prescripción de antibióticos, en una proporción muy superior a la prevista de amigdalitis bacterianas, en un número no despreciable de casos se indicaron otros antibióticos diferentes a los considerados idóneos para esta enfermedad

The Use of Probiotics in Head and Neck Infections.

Recurrent episodes of infections in the upper respiratory tract are very common. The pathogenesis behind these recurrences is still not well understood, but much attention has been paid to the adherence of the microorganisms to epithelial structures and to the protective function of the normal bacterial flora (bacterial interference). Thus, in vitro as well as in vivo studies have shown that both aerobic and anaerobic bacteria of the normal flora in the upper respiratory tract can hinder the growth of pathogens and the establishment of a renewed infection. Studies have shown that lack of interfering bacteria facilitates recurrence of these diseases. Recolonization with interfering alpha-streptococci has been performed successfully in acute streptococcal pharyngotonsillitis, as well as in acute otitis media. The number of recurrences has significantly been lowered in these diseases after recolonization with alpha-streptococci, which is the dominating normal bacteria in the upper respiratory tract. Several mechanisms have been proposed to be responsible for this interaction, such as competition of the adhering sites at the epithelial cells, production of hydrogen peroxide, competition for nutritients, and production of specific growth inhibiting factors such as bacteriocins. Other human components like lactoferrin are also important in the defense against microorganisms, and are important parts of the unspecific and specific immune system.

Azithromycin in children: A critical review of the evidence

Background: Azithromycin is a macrolide antibiotic that can be dosed once daily. In the last decade, the body of literature concerning the clinical applications of azithromycin has grown rapidly, leading to improved understanding as well as new questions about the role of this drug in the treatment of adult and pediatric infections. Objective: This review explores the use of azithromycin in the treatment of pediatric infections. Methods: We conducted a MEDLINE literature search to identify pertinent English-language studies of azithromycin published between 1987 and 2001. Results: The use of azithromycin in the treatment of acute Streptococcus pyogenes pharyngotonsillitis, acute otitis media, community-acquired pneumonia, pertussis, skin and soft tissue infections, Mycobacterium avium complex (MAC), trachoma, typhoid fever, cat-scratch disease, cryptosporidiosis, and legionnaires' disease has been studied in clinical trials. Conclusions: Azithromycin is indicated as a first-line treatment for respiratory tract infections caused by Legionella species, Mycoplasma pneumoniae, and Chlamydia pneumoniae, and as empiric therapy for community-acquired pneumonia in older children and adolescents who are deemed appropriate for outpatient oral therapy. Azithromycin in a single dose is an excellent treatment for chlamydia cervicitis/urethritis and for trachoma and has demonstrated efficacy in prophylaxis and treatment of disseminated MAC infections in children who have AIDS. Azithromycin may be considered as an alternative in the treatment of skin and soft tissue infections, although local patterns of resistance of pathogens must be considered in its selection.