Signs Of Tonsillitis Research Articles

Assessing the appropriateness of paediatric antibiotic overuse in Australian children: a population-based sample survey

BackgroundInfections caused by antibiotic resistant pathogens are increasing, with antibiotic overuse a key contributing factor.ObjectiveThe CareTrack Kids (CTK) team assessed the care of children in Australia aged 0–15 years in 2012 and 2013 to determine the proportion of care in line with clinical practice guidelines (CPGs) for 17 common conditions. This study analyses indicators relating to paediatric antibiotic overuse to identify those which should be prioritised by antimicrobial stewardship and clinical improvement programs.MethodA systematic search was undertaken for national and international CPGs relevant to 17 target conditions for Australian paediatric care in 2012–2013. Recommendations were screened and ratified by reviewers. The sampling frame comprised three states containing 60% of the Australian paediatric population (South Australia, New South Wales and Queensland). Multi-stage cluster sampling was used to select general practices, specialist paediatric practices, emergency departments and hospital inpatient services, and medical records within these. Medical records were reviewed by experienced paediatric nurses, trained to assess eligibility for indicator assessment and compliance with indicators. Adherence rates were estimated.ResultsTen antibiotic overuse indicators were identified; three for tonsillitis and one each for seven other conditions. A total of 2621 children were assessed. Estimated adherence for indicators ranged from 13.8 to 99.5% while the overall estimate of compliance was 61.9% (95% CI: 47.8–74.7). Conditions with high levels of appropriate avoidance of antibiotics were gastroenteritis and atopic eczema without signs of infection, bronchiolitis and croup. Indicators with less than 50% adherence were asthma exacerbation in children aged > 2 years (47.1%; 95% CI: 33.4–61.1), sore throat with no other signs of tonsillitis (40.9%; 95% CI: 16.9, 68.6), acute otitis media in children aged > 12 months who were mildly unwell (13.8%; 95% CI: 5.1, 28.0), and sore throat and associated cough in children aged < 4 years (14.3%; 95% CI: 9.9, 19.7).ConclusionThe results of this study identify four candidate indicators (two for tonsillitis, one for otitis media and one for asthma) for monitoring by antibiotic stewardship and clinical improvement programs in ambulatory and hospital paediatric care, and intervention if needed.

Common upper respiratory tract infection leading to uncommon retropharyngeal abscess - A case series on paediatrics

Retropharyngeal abscess is the formation of pus in retropharyngeal space, which occurs as a frequent complication of Upper Respiratory Tract Infection (URI). It is commonly seen in children less than 5 years old. The clinical manifestations includes neck mass, fever, cervical lymphadenopathy, neck stiffness, agitation, cough, drooling, torticollis, respiratory distress, stridor, and with signs of tonsillitis, pharyngitis, and otitis media. The first-line treatment includes drugs such as ampicillin-sulbactam and clindamycin. This case series highlights the complications of untreated upper respiratory tract infection leading to retropharyngeal abscess. Oral hygiene should be maintained to prevent future complications. Two patients were admitted in the paediatric inpatient unit and were diagnosed as a case of retropharyngeal abscess, following for which their management was done. After assessing, the clinical presentations and management scenario of the patients, age, and poor hygienic conditions are associated with the patients' risk factors for acquiring Retropharyngeal Abscess. In paediatrics, maintaining hygiene, especially oral hygiene and early diagnosis can prevent future complications of retropharyngeal abscess.

A life-threatening sore throat

A 21-year-old man presented in August, 2003, with a 1-week history of a sore throat, nausea and vomiting, and abdominal pain. On admission he was febrile and dehydrated with signs of a chest infection and severe sepsis. He also had a tender, swollen neck but no signs of tonsillitis or abscesses. Blood tests showed thrombocytopaenia; platelets 30×109/L, white cell count; 6·6×109/L, C-reactive protein; 326 mg/L, urea; 19·8 mmol/L and creatinine; 199 mmol/L. We gave the patient oxygen, intravenous fluids, ceftriaxone and clarithromycin. The next day the patient's condition deteriorated and the microbiologist advised us to change the antiobiotics to gentamicin and levofloxacin. Later that day, anaerobic blood cultures grew gram negative bacteria, and the microbiologist advised us to add piperacillin/tazobactam and metronidazole to cover Pseudomonas and Bacterioides. We stopped ceftriaxone and gentamicin. After 48 h, the patient needed ventilation for worsening respiratory failure. CT of his neck showed oropharangeal oedema, and parapharangeal oedema on the right. On day 4 the bacteria in culture were identified as Fusobacterium necrophorum and Peptostreptococcus magnus. We diagnosed Lemierre's syndrome and as the fusobacterium isolate was sensitive to penicillin, we replaced levofloxacin with benzylpenicillin. We reviewed the original CT and noticed thrombus in the right internal jugular vein. CT of the chest showed septic emboli and multiple cavitating lesions (figure). The patient was ventilated for 18 days, required a tracheostomy, developed bilateral pleural effusions and a left-sided pneumothorax. He eventually made a full recovery and was discharged after 5 weeks in hospital. When last seen in February, 2004, he had returned to work as an auto mechanic, but was still taking warfarin and receiving physiotherapy.