Management Of Pharyngitis Research Articles

Assessing the knowledge, attitude, and practice of frontline physicians in Egyptian university hospitals regarding pharyngitis and acute rheumatic fever: a cross-sectional study that calls for action

BackgroundAcute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major public health issues. Although the primary and secondary prevention of RHD through appropriate management of bacterial pharyngitis and ARF are well-described in the literature, few studies address the knowledge, attitude, and practice (KAP) of developing countries. We aimed to evaluate the KAP of the frontline physicians in Egyptian university hospitals regarding pharyngitis and ARF.MethodsWe employed a cross-sectional design between September 1st, 2022, and January 31st, 2023 using a self-administered questionnaire in 21 Egyptian universities. The questionnaire was developed based on previous studies and recent guidelines and included four domains: sociodemographic data, knowledge, attitude, and practice regarding pharyngitis and ARF. We utilized both online (Google Forms) and paper surveys. Frontline physicians, including interns, residents, and assistant lecturers, were conveniently invited to participate. Furthermore, with the help of participating phycisians in recruiting their colleagues, we utilized the snowball method. Data were analyzed using IBM SPSS version 27 software.ResultsThe final analysis included 629 participants, of whom 372 (59.1%) were males and 257 (40.9%) had direct contact with ARF patients. Most participants (61.5%) had a fair knowledge level while 69.5% had a fair level of practice regarding ARF and pharyngitis. Higher satisfactory knowledge levels were noted regarding pharyngitis (17.1% vs. 11.3%; p-value: 0.036) and ARF (26.8% vs. 18%; p-value: 0.008) among physicians dealing directly with ARF cases compared to physicians in departments not dealing directly with ARF cases. Physicians in Cairo region universities had significantly higher levels of satisfactory knowledge about ARF compared to Delta and Upper Egypt region universities (p = 0.014). Delta region universities showed significantly lower levels of practice compared to Cairo and Upper Egypt region universities (p = 0.027). The most frequently recognized barriers against health promotion were low socioeconomic status (90.3%) and lack of adequate public education (85.8%).ConclusionsDespite the fair knowledge and practice levels towards bacterial pharyngitis and ARF among participants, many gaps were still identified that might contribute to RHD prevalence. Educational interventions should be implemented by updating the local guidelines in Egypt for diagnosis and management based on the most recent guidelines.

Diagnosis and Treatment of Group A Streptococcal Pharyngitis in Children

The purpose of this review is to summarize the current evidence regarding the management of streptococcal pharyngitis in children. This article aims to provide a valid support to discriminate streptococcal pharyngitis from viral cases and treat it appropriately to avoid the development of complications. Differential diagnosis based only on clinical features is not always easy. For this reason, different clinical scores were created to provide an accurate diagnosis. Microbiological tests are valuable tools as well, but their use is not recommended unanimously. Concerning treatment, all guidelines agree on the drug to be used. However, doubts remain about the optimal duration of antibiotic therapy, especially in this specific historical moment as we are experiencing a peak in streptococcal infections. [ Pediatr Ann . 2024;53(6):e234–e238.]

Preadmission course and management of severe pediatric group A streptococcal infections during the 2022-2023 outbreak: a single-center experience.

The massive increase of infections with Group A Streptococcus (GAS) in 2022-2023 coincided in Switzerland with a change of the recommendations for the management of GAS pharyngitis. Therefore, the objective of the present study was to investigate whether the clinical manifestations and management before hospitalization for GAS infection differed in 2022-2023 compared with 2013-2022. Retrospective study of GAS infections requiring hospitalization in patients below 16years. Preadmission illness (modified McIsaac score), oral antibiotic use, and outcome in 2022-2023 were compared with 2013-2022. Time series were compared with surveillance data for respiratory viruses. In 2022-2023, the median modified McIsaac score was lower (2 [IQR 2-3] vs. 3 [IQR 2-4], p = < 0.0001) and the duration of preadmission illness was longer (4days [3-7] vs. 3 [2-6], p = 0.004) than in 2013-2022. In both periods, withholding of preadmission oral antibiotics despite a modified McIsaac score ≥ 3 (12% vs. 18%, n.s.) or ≥ 4 (2.4% vs. 10.0%, p = 0.027) was rare. Respiratory disease, skeletal/muscle infection, and invasive GAS disease were significantly more frequent in 2022-2023, but there were no differences in clinical outcome. The time course of GAS cases in 2022-2023 coincided with the activity of influenza A/B. We found no evidence supporting the hypothesis that the 2022-2023 GAS outbreak was associated with a change in preadmission management possibly induced by the new recommendation for GAS pharyngitis. However, clinical manifestations before admission and comparative examination of time-series strongly suggest that viral co-circulation played an important role in this outbreak.

Efficacy of homoeopathic similimum in comparision with biochemic medicines in the management of recurrent pharyngitis: A randomized control trial

Efficacy of homoeopathic similimum in comparision with biochemic medicines in the management of recurrent pharyngitis: A randomized control trial

Оцінка обізнаності щодо діагностики та менеджменту фарингіту в дітей серед лікарів загальної практики

Sore throat and pharyngitis account for up to 5.0% of all medical visits to a general practitioner. The etiology of pharyngitis in both adults and children is dominated by viruses, but in 20.0-30.0% of children the cause may be bacteria, most often the Group A β-hemolytic streptococcus. Purpose - to assess the knowledge of general practitioners regarding the diagnosis and management of pharyngitis in children, to determine further ways to increase their level of awareness. Materials and methods. A survey of 60 general practitioners in the Ternopil region of Ukraine was conducted to determine their awareness of the diagnosis and management of pharyngitis in children. The questionnaire and statistical methods were used. Results. In total, 45.0% of general practitioners in individual cases prescribed bacteriological cultures from the oropharynx to patients with acute pharyngitis. However, they rarely (6.7%) used the Center or McIsaac criteria to choose a treatment strategy for acute pharyngitis. Antibiotic therapy for the treatment of pharyngitis was used in individual cases by 86.7% of respondents. Amoxicillin was chosen as a first-line antibiotic by 38.3% of respondents, while protected aminopenicillins were chosen by 36.6%. Only 10.0% of general practitioners indicated a 10-day course of antibiotic therapy. A little more than half of the correct answers were to questions related to the appointment of antibacterial therapy to healthy children in whom the Group A β-hemolytic streptococcus was detected during bacteriological examination or an increased level of antistreptolysin-O in the blood. Conclusions. The results of our study showed a different level of knowledge of general practitioners regarding some aspects of diagnosis and management of pharyngitis in children. Insufficient knowledge was demonstrated regarding the possibilities of diagnosing the streptococcal etiology of pharyngitis, in particular the use of both clinical and laboratory research methods. Despite good knowledge about prescribing antibacterial therapy, poor awareness about the duration of antibacterial therapy and incomplete knowledge about the choice of antibacterial agent are shown. Relatively satisfactory knowledge was demonstrated regarding the strategy of management of streptococcal carriage in healthy children. The presented data indicate the need to improve the awareness of general practitioners regarding the diagnosis and treatment of pharyngitis, taking into account the modern complications of streptococcal infection. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Nationwide survey on the management of pediatric pharyngitis in Italian emergency units

BackgroundAcute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units.MethodsA multicentric national study was conducted in Italian emergency departments between April and June 2022.ResultsA total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis.ConclusionsThe study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis.

Management of Pharyngitis with Homoeopathic Approach

Pharyngitis is an inflammation in mucous membrane of oropharynx. Usually either it is caused by bacteria or virus. Bacteria of Group A beta hemolytic streptococci, Group B&amp;C streptococci may involve in causing this infection and Virus such like Epstein-Barr virus, Human immunodeficiency virus, rhinovirus, influenza, adenovirus, coronavirus, and parainfluenza. Homoeopathy is prescribed based on symptom similarity and is treated on the grounds of root cause, so recurrence is avoided. Keywords: Pharyngitis, Homoeopathy, Inflammation, Sore throat, Pain, Bacteria, Virus

Assessment of adherence to guidelines for testing and treatment of pharyngitis among children in Palestine: A retrospective review study.

One of the most common reasons for pediatric outpatient visits is acute pharyngitis, an upper respiratory tract infection. Bacterial pharyngitis is caused by Group A beta-hemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes. This research aimed to assess physicians' adherence to clinical guidelines for diagnosis, management, and selecting appropriate treatment for children suspected of bacterial pharyngitis. A retrospective, observational study was conducted by reviewing patient charts for childred aged 3 to 13 years old diagnosed with pharyngitis from June 2019 until December 2019 at the Emergency Department of Palestine Medical Complex (PMC). The Modified Centor score, throat swab collections, and assessment of antimicrobial selection were used to assess the extent of physicians' adherence to clinical guidelines for appropriate diagnosis and management of pharyngitis. SPSS was used for data analysis. Out of 290 cases diagnosed with acute pharyngitis, 217 patients (74.8%) had a Modified Centor score of ≥2; 126 received antibiotics, and eight had their throat swabbed to confirm the diagnosis; furthermore, 73 patients (25.2%) had a Modified Centor score of <2; 34 of them received antibiotics. Azithromycin was the most commonly prescribed antibiotic (41.3%), followed by amoxicillin-clavulanic acid (38.1%). The frequency of empirical antibiotics prescribing was significantly higher among children with a Centor score >2, older children, and those presenting with fever. Most cases were not appropriately tested to confirm the diagnosis of bacterial pharyngitis and were mostly treated with inappropriate antimicrobial agents such as azithromycin. Nonadherence to clinical guidelines is very evident in this study.

543. Perceived Ease of Use and Operator Performance of a rapid Multiplex PCR Diagnostic System in a Near Patient Setting

Abstract Background Access to multiplex molecular diagnostic tests for the rapid and accurate diagnosis of pharyngitis and other respiratory infections is limited in the near patient setting, but has potential to improve patient outcomes and antibiotic stewardship. The BioFire® Respiratory/Sore Throat (R/ST) Panel (bioMérieux, Salt Lake City, UT), designed for use with the BioFire® SpotFire System, is an Investigational Use Only (IUO) PCR-based sample-to-answer diagnostic test that identifies four bacteria and 10 viruses from nasopharyngeal swabs or throat swabs in ∼16 minutes. This study evaluated the ease of use and operator performance of the IUO R/ST Panel in the near patient setting. Methods A total of 35 test operators representative of the intended users in the near patient setting (i.e. non-laboratory professionals) participated across five study sites in the US and UK. Only Instrument and Panel Quick Guide training materials were provided during the eight months of R/ST Panel testing. Upon study completion, anonymous questionnaires were administered to assess operators’ perceived ease of use of the BioFire SpotFire System, R/ST Panel testing, and training materials; the accuracy of results interpretations were also evaluated. Further, results obtained by operators in the near patient setting and trained laboratory personnel were evaluated for reproducibility. Results Overall, 96.9% of operators reported that the system and panel were easy to use and that the provided training materials were sufficient to allow the user to perform the testing. The success rate of obtaining valid results on the initial test was 96.9%, similar to the rates observed for trained laboratory personnel. Reproducibility between site operators and trained laboratory personnel demonstrated an overall positive percent agreement of 99.0%. Conclusion The BioFire SpotFire System is an easy to use system that can be installed and operated in a near patient setting with minimal training. The R/ST Panel is also easy to use with minimal risk for user error. Implementation of this new system may aid in timely diagnosis and appropriate management of pharyngitis and other respiratory infections. Data presented are from assays that have not been cleared or approved for diagnostic use. Disclosures Ashley Ky, MLS(ASCP), bioMérieux: Employee|bioMérieux: Stocks/Bonds Jeffrey Bastar, PhD, bioMerieux: Employee|bioMerieux: Stocks/Bonds Kristen Holmberg, n/a, bioMerieux: Employee Hana Bay, BS, Biomerieux: Employee|Biomerieux: Stocks/Bonds Tiffani Jones, PhD, bioMerieux: Employee|bioMerieux: Stocks/Bonds Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, F(AAM), BioFire: Grant/Research Support|Luminex: Grant/Research Support Virve Enne, BSc PhD, Biomerieux: Advisor/Consultant Cynthia Andjelic, PhD, bioMerieux: Employee.

534. Evaluation of a Rapid Multiplex PCR Diagnostic Device for the Detection of Microorganisms from Nasopharyngeal and Throat Swab Specimens in the Near Patient Setting

Abstract Background Limited availability of multiplex molecular tests in the near-patient setting can impact the rapid diagnosis and treatment of patients experiencing symptoms of respiratory tract infections, including pharyngitis. The BioFire® Respiratory/Sore Throat (R/ST) Panel (bioMérieux, Salt Lake City, UT), designed for use with the BioFire® SpotFire System, is a PCR-based sample-to-answer diagnostic test that identifies four bacteria and 10 viruses (including SARS-CoV-2) from nasopharyngeal swab (NPS) or throat swab (TS) specimens in about 16 minutes. This study evaluated the performance of an Investigational Use Only (IUO) version of the BioFire R/ST Panel in the near patient setting. Methods NPS and TS specimens were prospectively enrolled from symptomatic consented/assented volunteers of all ages, or obtained as residual leftover specimens. Enrollment was conducted between December 2020 and September 2021 at five study sites in the US and UK (adult and pediatric emergency departments or urgent care clinics) with testing performed by personnel representative of the intended users (non-laboratory professionals). Several analytes that were not circulating during the COVID-19 pandemic were supplemented with archived specimens of known analyte composition. Performance was determined for both sample types by comparison to FDA cleared multiplex PCR tests or culture and PCR followed by sequencing of isolates (Streptococcus from throat swabs). Results A total of 1131 NPS and 452 TS prospectively collected specimens and 542 NPS and 128 TS archived specimens were tested with the BioFire R/ST Panel. For NPS specimens (prospective and archived) overall positive percent agreement (PPA) was 98.7% and negative percent agreement (NPA) was 99.1%, and for TS specimens (prospective and archived) overall PPA was 95.9% and NPA was 99.2%. Conclusion The BioFire R/ST Panel is a sensitive, specific, and robust test for rapid detection of a wide range of organisms in NPS and TS specimens in the near-patient setting. This test is expected to aid in the timely diagnosis and appropriate management of pharyngitis and other respiratory infections. Data presented are from assays that have not been cleared or approved for diagnostic use. Disclosures Jeffrey Bastar, PhD, MSCI, bioMerieux: Employee|bioMerieux: Stocks/Bonds Ashley Ky, MLS(ASCP), bioMérieux: Employee|bioMérieux: Stocks/Bonds Kristen Holmberg, n/a, bioMerieux: Employee Hana Bay, BS, Biomerieux: Employee|Biomerieux: Stocks/Bonds Daria Drobysheva, PhD, bioMerieux: Employee Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, F(AAM), BioFire: Grant/Research Support|Luminex: Grant/Research Support Virve Enne, BSc PhD, Biomerieux: Advisor/Consultant Cynthia Andjelic, PhD, bioMerieux: Employee.

Knowledge, Attitude, and Practice of House Officers to the Diagnosis and Management of Bacterial Pharyngitis: A Multicenter Cross-Sectional Study.

Pharyngitis is one of the most common clinical presentations in pediatric clinics. Streptococcal pharyngitis reaches a nadir in the early school years, and it is vital to diagnose it earlyto avoid the serious complications that can arise from improper treatment, such as acute rheumatic fever and rheumatic heart disease. This is a cross-sectional multicenter study of medical house officers conducted from January to February 2018. This study surveyed 135 house officers at Khartoum's primary health centers and hospitals. Most of the respondents were males (76/135;56%). Most of the house officers reported seeing patients with throat complaints 1-2 times per week (58/135; 43%). The most common complication was acute rheumatic fever (65/135; 48%). Out of all the criteria of a Group A beta-hemolytic streptococcus (GAS) pharyngitis diagnosis, absence of cough and tender lymph nodes were the least recognized by house officers, i.e. 11.9%(16/135) and 45.2% (61/135), respectively. Only (4/135) 3% knew the full criteria for diagnosing bacterial pharyngitis. Throat culture was the most commonly used lab test to diagnose bacterial pharyngitis (115/135; 85.2%). The majority of participants did not recognize an IM injection of benzathine penicillin G as the first-line management of bacterial pharyngitis (101/135; 74.8%). The participants had moderate knowledge (93/135; 68.9%). Those with poor knowledge also happened to have poor practice (p = 0.009). Those who see more cases per week were also more likely to have good knowledge (p = 0.000). House officers with a moderate attitude constituted about 48.9%(66/135) of the whole sample. The most often prescribed medication was amoxicillin-clavulanic acid for one week (53/135; 39.3%). The practice score was associated with a lower knowledge (p = 0.009). Only 20.7%(28/135) of the participants in our study were adherent to the use of benzathine penicillin G as the first-line management of bacterial pharyngitis. House officers had poor-to-moderate knowledge regarding the diagnosis and management of bacterial pharyngitis, especially in regardto what antibiotic to use. However, their fear of antibiotic resistance was a good behavior.

Diagnosis and management of pharyngitis in children: a survey study in Ukraine.

The purpose of our study was to evaluate the knowledge of pediatricians in diagnosis and management of sore throat in children and to identify further ways to raise their awareness. We conducted a survey among pediatricians on evaluation of diagnosis and management of pharyngitis in children. The study involved pediatricians of Ternopil region, Ukraine. Overall, 112 pediatricians participated in the study. Among the participants 79 (70.5%) were primary care physicians and 33 (29.5%) worked in the secondary and tertiary care hospitals. Overall, 70.5% of pediatricians prescribed a throat swab for patients with pharyngitis in selected cases. However, they rarely (20 %) used Centor or McIsaak criteria to choose management strategy of sore throat. Amoxicillin as a first-line antibiotic for streptococcal pharyngitis was chosen by 66.1% of respondents and primary care pediatricians prescribed it more often than pediatricians in hospitals (p<0.001), but antibiotic therapy was prescribed for 10 days only by 52.7% of respondents. Less than half of the correct answers were to the questions related to prescription of antibacterial therapy in healthy children, in which GAS is detected in throat swab (39.3%) and in cases of positive antistreptolysin O (ASL-O - 25.9%). The study showed a wide range of knowledge of pediatricians about the diagnosis and management of GAS pharyngitis - from satisfactory responses concerning prescription of antibiotic therapy to low level of knowledge about the diagnosis and determination of strategies in healthy carriers. These data emphasize the need to improve knowledge about the strategies of GAS pharyngitis control.

Antibiotic prescribing and use of corticosteroids for the emergency department management of acute uncomplicated pharyngitis.

Acute pharyngitis is common in the ambulatory setting. The Modified Centor score uses five criteria to predict Group A Streptococcus (GAS) infection and can be used to guide management. The objective of this study was to describe the emergency department (ED) management (throat cultures, antibiotics and corticosteroids) of acute, uncomplicated pharyngitis by Centor score. This was a retrospective chart review of adult (>17 years) patients with an ED discharge diagnosis of acute pharyngitis from January 2016 to December 2018. Of 638 patients included, 286 (44.8%) had a Centor score of 0-1, 328 (51.4%) had a score of 2-3 and 24 (3.8%) had a score of ≥4. Of those with a Centor score of 0-1, 83 (29.0%) had a throat culture, 88 (30.8%) were prescribed antibiotics, 15 (5.2%) were positive for GAS and 74 (25.9%) received corticosteroids. Of those with a Centor score of 2-3, 156 (47.6%) had a throat culture, 220 (67.1%) were prescribed antibiotics, 44 (13.4%) were positive for GAS and 145 (44.2%) received corticosteroids. Of those with a Centor score ≥4, 14 (58.3%) had a throat culture, 18 (75.0%) were prescribed antibiotics, 7 (29.2%) were positive for GAS and 12 (50.0%) received corticosteroids. A higher Centor score was associated with a higher risk of GAS infection, increased antibiotic prescribing and use of corticosteroids. Many patients with low Centor scores were prescribed antibiotics and had throat cultures. Further work is required to understand clinical decision-making for the management of acute pharyngitis.

A Quality Improvement Initiative to Improve Antibiotic Stewardship at a Federally Qualified Health Center

The development of antibiotic resistance is a growing public health concern. Antibiotic stewardship programs (ASPs) employ strategies to improve antibiotic prescribing practices. The purpose of this quality improvement project was to pilot an ASP with a focus on the management of sinusitis and pharyngitis. Antibiotic prescribing practices were evaluated before and after the implementation of the pilot ASP. The primary aim of this project was to improve the concordance of antibiotic prescribing practices with clinical practice guidelines. Although not statistically significant, it was noted that there was an improvement in adherence to clinical practice guidelines after the pilot ASP was implemented.

Аналіз обізнаності лікарів практичної медицини щодо діагностики та лікування фарингіту в дітей

Painful throat is the main symptom of pharyngitis and one of the most common reasons to refer to a primary care physician. In 60.0–70.0% of cases acute pharyngitis is caused by viruses, including rhinoviruses, adenoviruses, enteroviruses, coronaviruses and others. More then about 5.0–15.0% of pharyngitis cases in adults and around 20.0–30.0% of cases in children are caused by bacterial infections, among which group A β hemolytic Streptococcus. Among other causative agents of bacterial pharyngitis, group C and group G Streptococcus, Mycoplasma pneumoniae, Chlamydia pneumoniae and Arcanobacterium haemolyticus are also reported, although much less frequently. Severe group A β-hemolytic Streptococcus-related diseases, such as acute rheumatic fever, rheumatic heart disease, post-streptococcal glomerulonephritis, and invasive infections are accountable for more than 517 000 deaths each year. Therefore, the issue of timely diagnosis and proper management of streptococcal pharyngitis is very important. Purpose — to study, evaluate and analyze the knowledge of pediatricians in diagnosis and management of sore throat in children and to identify further ways to raise their awareness. Matherials and methods. The poll among pediatricians on evaluation of diagnosis and management of pharyngitis in children were conducted. The study involved pediatricians of Ternopil region, Ukraine. In general 112 pediatricians were questioned. Among the participants 79 (70.5%) were the primary care pediatricians and 33 (29.5%) worked as the secondary and tertiary care pediatricians. Questionnaire and statistical research methods were used. Results. Overall, 70.5% of pediatricians prescribed a throat swab for patients with pharyngitis in selected cases. However, they rarely (20.0%) used Centor or McIsaak criteria to choose management strategy of sore throat. Amoxicillin as a first-line antibiotic for streptococcal pharyngitis was chosen by 66.1% of respondents and primary care pediatricians prescribed it more often than the secondary and tertiary care pediatricians (p=0.0006), but antibiotic therapy was prescribed for 10 days only by 52.7% of respondents. Less than half of the correct answers were to questions related to the prescribing of antibacterial therapy in healthy children, in which group A β-hemolytic Streptococcus is detected in throat swab (39.3%) and in cases of positive antistreptolysin-O (25.9%). Conclusions. The research showed a wide range of knowledge of pediatricians about the diagnosis and management of group A β-hemolytic Streptococcus pharyngitis — from satisfactory responses to the prescription of antibiotic therapy to low knowledge about the diagnosis and determination of strategies in healthy carriers. These data emphasize the need to improve knowledge about the strategies of group group A β-hemolytic Streptococcus pharingytis control. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: group A β-hemolytic Streptococcus, pharyngitis, diagnosis, treatment.

Clinical Evaluation, Diagnosis and Surgical Management of Traumatic Pharyngitis in a Non-descript Cattle

Present study reports, a successful diagnosis and surgical management of a traumatic pharynigitis in a 3-year-old, nondescript cattle, caused by a submandibular foreign body (sewing-needle). Suture and wound dehiscence were observed as postoperative complication but the animal recovered completely after 15 days of surgery.

Trends in the use of antibiotics for pharyngitis in Saudi Arabia.

Pharyngitis is one of the most common diagnoses for antibiotic prescriptions worldwide. Antibiotics should be prescribed for bacterial pharyngitis to reduce its complications. The aims of this study were to assess antibiotic prescriptions for pharyngitis cases, and their relationship with physicians' knowledge regarding its diagnosis and management. A cross-sectional study was conducted. First, prescriptions for pharyngitis cases using the modified Centor criteria was evaluated at primary care centers in Saudi Arabia. Second, physicians' knowledge of the modified Centor score and the diagnosis and management of pharyngitis was assessed using a self-administered questionnaire. Out of 104 pharyngitis cases, 79% (n = 82) were prescribed antibiotics, of which 28% were evidence-based prescriptions. First-line antibiotics were prescribed in 34% of patients, and second-line (broad-spectrum) antibiotics such as amoxicillin/clavulanate were prescribed in half of the patients. The main significant predictors of antibiotic prescriptions were age < 3 years (odds ratio, 0.13; 95% CI, 0.02 to 0.97), tonsillar exudate (odds ratio, 21.14; 95% CI, 2.88 to 155.09), and throat erythema (odds ratio, 9.30; 95% CI, 1.18 to 73.41). Overall, physicians (n = 29) had adequate knowledge about the modified Centor score and the management of pharyngitis. Most prescribed antibiotics for pharyngitis were unnecessarily prescribed; the majority being broad-spectrum antibiotics. Despite physicians' adequate knowledge of the modified Centor score and the management of pharyngitis, their practice failed to demonstrate that. Induction of the Saudi Antimicrobial Stewardship Program in the primary care centers, accessibility to diagnostic tools, and educational programs may help in reducing unnecessary antibiotic prescriptions.

A Case Report: Management of Granular Pharyngitis with Ayurveda

Background: Granular pharyngitis is an acute or subacute form of throat disease which is extremely common in autumn and spring. It is characterized by marked swelling of the follicular tissue of the pharynx, which has a granular glazed appearance. Symptomatically it can be correlated with Kaphaja Rohini or Kanthashalooka. Methods: A 20-year-old patient presented with complaint of recurrent dry cough, rhinorrhea, dysphagia, dry and sore throat, tiredness of voice since last 4 months. Management done with OPD based treatment. here in this case report treatment chosen was i.e. Yashtimadhu Ghanavati, Shitopaladi Churna, Naradiya Laxmi Vilasa Rasa Orally, Dashamoola Kwatha (Kavala), Yashtimadhu Churna (Pratisarana). Result: There was marked improvement in symptoms like recurrent dry cough, rhinorrhea, dysphagia, dry and sore throat tiredness of voice with the treatment of 1 month. Conclusion: Significant result was observed with this treatment protocol in the management of granular pharyngitis.

Nasopharyngeal Isolates from a Cohort of Medical Students with or without Pharyngitis.

ObjectivesFew studies have investigated pharyngeal colonisation in the United Arab Emirates (UAE). This study aims to identify the pharyngeal organisms present in a cohort of medical students with and without symptomatic pharyngitis.MethodsThis study was conducted between September 2016 and June 2018 at the College of Medicine and Health Sciences, UAE University, Al-Ain. Nasopharyngeal swabs were collected from preclinical and clinical medical students attending the college during the study period. The specimens were tested for 16 viral and nine bacterial pathogens using a real-time polymerase chain reaction assay.ResultsA total of 352 nasopharyngeal swabs were collected from 287 students; of these, 22 (7.7%) had pharyngitis symptoms. Overall, the most common isolates were human rhinovirus, Streptococcus pneumoniae and Haemophilus influenzae, with no significant differences in terms of gender, year of study or stage of study. The prevalence of S. pyogenes in asymptomatic and symptomatic students was 1.1% and 0%, respectively. A Centor score of ≥2 was not associated with S. pyogenes-positive samples. Six pathogens were isolated from symptomatic students including H. influenzae. Fusobacterium necrophorum was not detected in any of the samples.ConclusionThe diagnosis and management of pharyngitis should be tailored to common pathogens in the region. This study found that S. pyogenes and F. necrophorum were not detected among students with symptoms of pharyngitis; moreover, Centor scores of ≥2 were not associated with the presence of S. pyogenes. This cut-off score therefore should not be employed as an empirical measure to initiate penicillin therapy in this population.

Ayurveda Treatment Protocol in the Management of Galagraha (Pharyngitis)- A Case Study

Pharyngitis is inflammation of the pharynx, which affects in back of the throat. It is most often referred to simply as sore throat; it is one of the most common reasons for doctor visit. The condition is the usual phenomenon in paediatric population due to intake of cold drinks, junk food etc. This disease is more recurrent now a days than earlier As per ayurvedic classics the condition has close similarity with the disease Galagraha. Aim: In this article management of pharyngitis with ayurvedic modalities were discussed. Material &amp; Method: A 32 years male patient visited ENT OPD of Shalakya Tantra, I.P.G.T&amp;R.A Hospital on 16/12/2019 with complaints of pain and foreign body sensation of throat, Recurrent moderate cough, mild fever and head ache, difficulty in swallowing along with congestion in posterior pharyngeal wall aggravate since 10 days. He consulted a local hospital near his house but didn’t get a satisfactory relief. History reveals the reccurents of disease since 3 years. We started Triphala + Darvi kwatha kawala thrice/Day, Haritaki Kwatha pana Twice BD with honey (20 ml Before food), Khadiradi vati (2 Tab -4 times/ day) for Chushanartha, Sitopaladi churna -3gm +Yastimadhu 1 gm, Naradiya Lakshmi vilasa rasa-125 mg-2 times a day for 14 days Followed by Virechana and Nasya. Marked relief was found in signs and symptoms within 7 days and cured completly within 21 days of treatment. Conclusion: Study concluded that the above Ayurvedic treatment can prove to be an effective alternate management in Chronic Catarrhal Pharyngitis with proper diet and regimen.