Treatment Of Sore Throat Research Articles

Anti-inflammatory Activities of Mogrosides from Momordica grosvenori in Murine Macrophages and a Murine Ear Edema Model

Momordica grosvenori (Luo Han Guo), grown primarily in Guangxi province in China, has been traditionally used for thousands of years by the Chinese to make hot drinks for the treatment of sore throat and the removal of phlegm. The natural noncaloric sweetening triterpenoid glycosides (mogrosides) contained in the M. grosvenori fruits are also antioxidative, anticarcinogenic, and helpful in preventing diabetic complications. The aim of this study was to assess the anti-inflammatory properties of mogrosides in both murine macrophage RAW 264.7 cells and a murine ear edema model. The results indicate that mogrosides can inhibit inflammation induced by lipopolysaccharides (LPS) in RAW 264.7 cells by down-regulating the expression of key inflammatory genes iNOS, COX-2, and IL-6 and up-regulating some inflammation protective genes such as PARP1, BCL2l1, TRP53, and MAPK9. Similarly, in the murine ear edema model, 12-O-tetradecanoylphorbol-13-acetate-induced inflammation was inhibited by mogrosides by down-regulating COX-2 and IL-6 and up-regulating PARP1, BCL2l1, TRP53, MAPK9, and PPARδ gene expression. This study shows that the anticancer and antidiabetic effects of M. grosvenori may result in part from its anti-inflammatory activity.

The Cochrane Library and the Treatment of Sore Throat in Children and Adolescents: An Overview of Reviews

AbstractBackgroundSore throat is a common respiratory tract symptom responsible for 6% of children's visits to pediatricians or family physicians. Even though sore throat is usually self‐limiting, antibiotics are often prescribed in hopes of decreasing symptom length and the risk of developing sequelae. However, antibiotic over‐prescription could lead to adverse events in individuals and bacterial resistance in the community, so the efficacy and safety of antibiotics must first be established, and alternative treatment options should also be investigated.ObjectivesThis overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the efficacy and safety of different antibiotic treatment strategies (standard antibiotics, delayed antibiotics, short‐duration antibiotics and different types of antibiotics) to improve symptoms of sore throat in children and adolescents. The efficacy and safety of two other treatments, steroids and Chinese herbal medicine, are also investigated.MethodsIssue 1, 2011 of the CDSR was searched for all reviews examining the treatment of sore throat and disorders which commonly have sore throat as part of their clinical presentation. We also searched for reviews examining the prevention of important sequelae of sore throat. All systematic reviews examining pharmacologic or non‐pharmacologic treatments in children were identified, and data were extracted, compiled into tables and synthesized using quantitative and qualitative methods.Main resultsData pertaining to sore throat in children and adolescents were extracted from seven Cochrane reviews. Antibiotics provided only modest benefit over placebo for symptoms of sore throat and fever. Immediate versus delayed prescription of antibiotics resulted in a 58% decrease in severity of pain due to sore throat on day three (RR: 0.42; 95% CI: 0.33, 0.54), and a significant, moderate decrease in fever on day three (SMD: − 0.53; 95% CI: − 0.74, − 0.31). Most studies of macrolides, cephalosporins and carbacephem showed no significant benefit over oral penicillin for resolution of symptoms, but in two trials a short course of a cephalosporin compared to oral penicillin led to modest decreases in both sore throat (half a day; MD: − 0.50; 95% CI: − 0.78, − 0.22) and fever (seven hours; MD: − 0.30; 95% CI: − 0.45, − 0.14). Steroids compared to placebo decreased symptoms of sore throat in children with infectious mononucleosis at 12 hours (RR: 0.54; 95% CI: 0.30, 0.99) but not at any other measured time points. A higher rate of vomiting was associated with delayed antibiotics (RR: 0.07; 95% CI: 0.03, 0.20); vomiting, diarrhea and abdominal pain were associated with short‐duration antibiotics (RR: 1.74; 95% CI: 1.31, 2.32); and overall adverse effects were associated with macrolides (RR: 2.19; 95% CI: 1.04, 4.61). Trials involving Chinese herbal medications for sore throat were of low quality and no good evidence for the use of these agents was available.Antibiotics compared to placebo were associated with lower rates of acute rheumatic fever, but the difference was not statistically significant when only pediatric data were included (RR: 0.20: 95% CI: 0.01, 4.18). One review examining the secondary prevention of rheumatic fever found that intramuscular versus oral penicillin reduced the recurrence of rheumatic fever by 92% (RR: 0.08; 95% CI: 0.04, 0.18) and significantly reduced the number of participants who developed streptococcal throat infections (RR: 0.22; 95% CI: 0.17, 0.27; I2: 81%).Authors' ConclusionsEvidence from the CDSR suggests that antibiotics provide only modest improvements in symptoms of sore throat in children and adolescents. If antibiotics are prescribed, macrolides are less ideal compared to other agents, and there is some evidence that a short course of a newer cephalosporin may be slightly better than a standard course of penicillin. Any potential benefit of antibiotic treatment must be weighed against the cost of treatment and the possibility of adverse effects. Children with a past history of rheumatic fever or those living in a region with a high prevalence of this condition are more likely to benefit from antibiotics than those without these risk factors. Oral corticosteroids can decrease sore throat symptoms within the first day and may be helpful for children with severe symptoms of infectious mononucleosis. There is no compelling evidence that any Chinese herbal medicine has beneficial effects for the relief of sore throat symptoms or prevention of sequelae. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Acute sore throat revisited: clinical and experimental evidence for the efficacy of over-the-counter AMC/DCBA throat lozenges

Acute sore throat is a minor, self-limiting ailment, but patients commonly seek advice and treatment for immediate symptomatic relief. However, most sore throats due to upper respiratory tract infections are viral in nature, and antibiotics often prescribed are not suitable for the treatment of sore throat, as reflected in many European guidelines. Many topical treatments are available over the counter, including throat sprays, gargles and lozenges. We discuss some of the 'ideal' features of over-the-counter options in the treatment of simple sore throat cases. The main features include the direct targeting of the viral and inflammatory causes, the provision of local pain relief, rapid onset of action and prolonged duration of action, effectiveness over a range of different types of sore throat, an ability to address the emotional aspects associated with having a sore throat and a good safety profile. Some recent clinical and experimental evidence on the efficacy and postulated mechanism of action for amylmetacresol and 2,4-dichlorobenzyl alcohol-containing lozenges, that have been marketed for many years are also discussed as an illustration of such targeted approach.

Die Halsschmerz-Leitlinie der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin

The aim of this guideline is to propose a diagnostic and therapeutic approach to manage sore throat in ambulatory care. Relevant literature on the treatment of sore throat in primary care was retrieved and evaluated. During its development, the guidelines underwent a panel test, a practice test and a consensus conference. Sore throat is mostly a short, self-limiting infection. Accurate etiologic diagnosis is generally not possible. Routine antibiotic treatment of sore throat for the prevention of complications is currently not indicated. The effect of antibiotics on symptoms and duration of disease is, at best, moderate. It is more pronounced in patients with typical clinical symptoms and signs of pharyngitis caused by group A streptococci (GAS) and slightly more pronounced again in cases of additional positive throat swab for GAS. An algorithm for decision-making is proposed. Rapid testing for streptococcal antigen or a culture for GAS is only recommended if the result is likely to influence therapeutic decision-making. Patients with more severe illness and signs of GAS pharyngitis can be given antibiotic therapy for symptomatic relief.

Non-antibiotic treatment of sore throat

Sore throats are common presentations in emergency and primary care settings and, although only between 5 and 10 per cent of adults with this condition are found to have bacterial infections, the use of antibiotics is still widespread. This article refers to a case study to describe the causes and complications of acute sore throats, and reviews the literature on the use of antibiotics. It also recommends the McIsaac scoring system as a reliable method of diagnosis and treatment decision making.

Letter by Carapetis Regarding Article, “Is Primary Prevention of Rheumatic Fever the Missing Link in the Control of Rheumatic Heart Disease in Africa?”

To the Editor: Karthikeyan and Mayosi make a compelling case for increasing the focus on sore throat treatment in Africa with the aim of preventing rheumatic fever.1 However, in citing one of my articles in relation to their statement “Several arguments have been made against adopting primary antibiotic prophylaxis for the prevention of RF and RHD as a public health intervention in the community,” I believe they have misrepresented my position. I have never argued against the importance of treating streptococcal sore throat in primary care. On the contrary, I have repeatedly reinforced the importance of this strategy in …

Rheumatic heart disease in indigenous populations.

Rates of acute rheumatic fever and chronic rheumatic heart disease in Aboriginal people, Torres Strait Islanders and Māori continue to be unacceptably high. The impact of rheumatic heart disease is inequitable on these populations as compared with other Australians and New Zealanders. The associated cardiac morbidity, including the development of rheumatic valve disease, and cardiomyopathy, with possible sequelae of heart failure, development of atrial fibrillation, systemic embolism, transient ischaemic attacks, strokes, endocarditis, the need for interventions including cardiac surgery, and impaired quality of life, and shortened life expectancy, has major implications for the individual. The adverse health and social effects may significantly limit education and employment opportunities and increase dependency on welfare. Additionally there may be major adverse impacts on family and community life. The costs in financial terms and missed opportunities, including wasted young lives, are substantial. Prevention of acute rheumatic fever is dependent on the timely diagnosis and treatment of sore throats and skin infections in high-risk groups. Both Australia and New Zealand have registries for acute rheumatic fever but paradoxically neither includes all cases of chronic rheumatic heart disease many of whom would benefit from close surveillance and follow-up. In New Zealand and some Australian States there are programs to give secondary prophylaxis with penicillin, but these are not universal. Surgical outcomes for patients with rheumatic valvular disease are better for valve repair than for valve replacement. Special attention to the selection of the appropriate valve surgery and valve choice is required in pregnant women. It may be necessary to have designated surgical units managing Indigenous patients to ensure high rates of surgical repair rather than valve replacement. Surgical guidelines may be helpful. Long-term follow-up of the outcomes of surgery in Indigenous patients with rheumatic heart disease is required. Underpinning these strategies is the need to improve poverty, housing, education and employment. Cultural empathy with mutual trust and respect is essential. Involvement of Indigenous people in decision making, design, and implementation of primary and secondary prevention programs, is mandatory to reduce the unacceptably high rates of rheumatic heart disease.

Chemical composition and antimicrobial activity of Hypericum hircinum L. Subsp. majus essential oil

throats, colds, and as an antitussive [3]. In this study we report the chemical composition of the essential oils hydrodistilled from different parts during the phenological cycle and analyzed by GC and GC-MS, and the antimicrobial activity of the oils against a panel of human opportunistic pathogenic bacteria and fungi by using the agar diffusion and dilution method [4, 5]. Ninety-two volatile components were identified in the oils of H. hircinum subsp. majus (61 in leaves, 53 in flowers, and 64 in fruits), representing 81.41–94.36% of the total essential oils (Table 1). The oils from leaves and flowers were dominated by sesquiterpene hydrocarbons, while the fruits oils were rich in monoterpenes. The major compounds were cis--guaiene (23.25–41.23%) and -selinene (8.48–25.20%) in leaves, -selinene (18.29%) and limonene (15.23%) in flowers, and limonene (14.01–38.72%) and -pinene (9.88–16.31%) in fruits. The development stages of the plant during the annual phenological cycle influence the composition of the fruits oils much more than the leaves oils. The results of antimicrobial activity (Tables 2 and 3) indicated that the essential oils were active against the gram-positive bacteria S. aureus, S. mutans, and B. subtilis, the gram-negative E. coli, and the yeast C. albicans; the latter was the most sensitive microorganism tested, with the lowest MIC value (155 g/mL). The ANOVA test (P 0.05) showed significantly different activities for different harvesting times. In particular, the most active oils were those obtained during the fruiting stage, confirming the harvesting time of the plant in the traditional uses [3]. The maximum inhibition zones and MIC values of the bacteria and yeast species sensitive to the essential oils were in the range of 9.6–20.5 mm and 155–625 g/mL. In particular, S. mutans, an oral pathogen responsible for caries, showed good sensitivity to the oils (MIC values in the range of 625–1250). Recently, it has been shown that oral bacteria are associated with many systemic diseases, such as pneumonia and cardiovascular diseases [6]. The results support the traditional use of this plant in Southern Italy, and suggest its use in the treatment of sore throats and colds.

Prevention of Rheumatic Fever

To the Editors: Lennon et al present a meta-analysis of school or community-based studies involving treatment of streptococcal sore throat (some including treatment of throat carriage as well) and claim that the summary estimate of efficacy (59%) is likely to represent a “true treatment effect.”1 We question this result and indeed the validity of the meta-analytic methodology used. Because of the paucity of randomized controlled trials (RCT), the inclusion criteria were broadened to include before/after and observational studies. As a result, only one RCT was included—the authors' own study (the NZ randomized controlled trial (ref. 17 in the Lennon et al paper) is listed as published in the Pediatric Infectious Diseases Journal, but does not appear to have been published at the time of submission of this letter), a trial of very high quality involving almost 87,000 person-years of observation, which found no significant reduction in acute rheumatic fever (ARF) incidence in the treatment group. That trial, the scope of which is unlikely to be repeated, surely qualifies as the most important ARF research in at least the past 2 decades. However, in this meta-analysis, the results of this RCT are pooled with 2 observational studies (comparing ARF incidence in schools with interventions to schools without the intervention) and 3 before/after studies (comparing ARF incidence in a region before the intervention and after the intervention), none of which involved any blinding or randomization. Interestingly, in the Forest plots of the study results, the study demonstrating the largest treatment effect, and with the greatest impact on the pooled efficacy result, was the least able of all the studies to determine the specific effectiveness of a sore throat treatment intervention.2 This report documents changes in the incidence of ARF in a region of Cuba over 10 years, during which a comprehensive ARF/RHD public health intervention was instituted, which included not only primary prophylaxis but also “secondary prevention of ARF/RHD, training of health personnel, healthcare education via dissemination of information, community involvement, and epidemiological surveillance.” Comprehensive programs such as this have been associated with ARF incidence reductions over a long period previously in the Caribbean,3 which may speak to their overall effectiveness, but does not permit one to estimate the effectiveness of any single component of the intervention, particularly in the absence of any attempt to control for multiple other confounding factors that may be present in a single region over a 10-year period. Lennon et al also do not address the issues of practicality of such school or community based programs, particularly in resource-poor countries, where the burden of ARF/RHD is the greatest. One of the studies included in the analysis pointed out that it cost US $12 per child enrolled in school per year (in 1970s currency),4 and we would be interested to know the cost of the New Zealand RCT, which we suspect to have been expensive. In low and middle income countries, there are additional barriers including access to microbiological diagnosis, training of primary care staff, transport to and from remote areas, availability of antibiotics, and ability to follow-up patients that would require considerable additional resources to overcome.5 As a result, such programs would be even less affordable in these settings. Meta-analysis can be a powerful tool, but only if appropriate studies are selected for inclusion in the pooled analysis. Although the 5 observational or before/after studies included in the analysis provide some encouraging nonrandomized data in favor of community-based primary prophylaxis, they are not of sufficient quality to include in a meta-analysis. For an intervention where the only true efficacy study does not demonstrate a significant treatment effect, and which has significant cost implications for countries with the highest disease burden, we believe it is unreasonable to conclude, as Lennon et al do, that “in communities with high rates of RF (we suggest greater than 50 per 100,000 children per year), the school- and/or community-based programs be actively considered.” Jonathan Carapetis, MB BS, PhD Menzies School of Health Research and Charles Darwin University Darwin, Australia Andrew Steer, MB BS, FRACP Department of Pediatrics University of British Columbia Vancouver, Canada

Letter to the Editor

4 January 2009 Dear Editor, RE: EPIDEMIOLOGY OF ACUTE RHEUMATIC FEVER IN NEW ZEALAND 1996–2005 BY JAINE R ET AL. 2008;44:564 Jaine et al. using hospital discharge data, outline the large ethnic disparities for acute rheumatic fever (ARF) in New Zealand over a recent decade suggesting that ARF epidemiology has not been reviewed recently. Importantly, this subject was reviewed by the New Zealand Child and Youth Epidemiology Service and published online in 2007 reviewing hospital discharge data by age, ethnicity and geographic area of origin but adding interpretation to disparities found by using the New Zealand Deprivation Index (NZ Dep Index) score. Maori and Pacific children are over-represented in the bottom quintile of the NZ Dep Index with a risk ratio for having ARF of 28.65 (95% CI 17.43–47.08) compared with the top quintile as the index.1 The NZ Dep Index is a small area index of deprivation used as a proxy for socio-economic status and made up of variables likely to influence health outcome, for example, income, employment, telephone access, transport access, living space and education. While genetic/ethnic status cannot be ruled out as a precursor to rheumatic fever, public health measures seem likely to overcome this propensity as witnessed by the very low recurrence rates in a well-delivered secondary prophylaxis programme in New Zealand.2 Household crowding is an important facilitating factor for the spread of infectious disease.3 This was especially well shown in a New Zealand case control study for meningococcal disease, another disease spread via the naso-pharyngeal route,4 where the odds ratio for a case having a crowded house was 10.7 (95% CI 3.9–29.5). Improved housing would be an obvious intervention. However, for cases living in crowded houses, medical interventions can override environmental risk factors at least as shown in inner city Baltimore, USA, in the 1960s, where access to community primary health care clinics was enhanced and rheumatic fever declined by 60% over 10 years.5 Thus, in the absence of direction from the medical literature, we conducted a school-based sore throat clinic programme in a randomised controlled trial designed to improve access to health care known to be a problem in disadvantaged New Zealand Maori and Pacific populations. In spite of the size of this study and more than 86 000 person years, we were able to show only a clinically important effect on ARF and not able to support this statistically.6 This then led to a meta-analysis7 of community and school-based studies of streptococcal throat treatment programmes to prevent rheumatic fever. Of 653 studies screened, only six met the criteria of a randomised controlled trial or trials of before/after design examining treatment of sore throats in a community setting with ARF as an outcome. The data were pooled and a meta-analysis of these trials for ARF control produced a relative risk of 0.41 (95% CI 0.23, 0.70 P= 0.001), which favoured this approach with a suggestion of ∼60% reduction in rheumatic fever. This directs us towards this approach to rheumatic fever control, and we believe new public health initiatives are warranted for ‘at risk’ communities. This supports the approach already being undertaken, with success, in smaller New Zealand communities.8 An economic analysis is being performed to support such an initiative in larger populations.

The Effect of Alternative Graphical Displays Used to Present the Benefits of Antibiotics for Sore Throat on Decisions about Whether to Seek Treatment: A Randomized Trial

We conducted an Internet-based randomized trial comparing four graphical displays of the benefits of antibiotics for people with sore throat who must decide whether to go to the doctor to seek treatment. Our objective was to determine which display resulted in choices most consistent with participants' values. This was the first of a series of televised trials undertaken in cooperation with the Norwegian Broadcasting Company. We recruited adult volunteers in Norway through a nationally televised weekly health program. Participants went to our Web site and rated the relative importance of the consequences of treatment using visual analogue scales (VAS). They viewed the graphical display (or no information) to which they were randomized and were asked to decide whether to go to the doctor for an antibiotic prescription. We compared four presentations: face icons (happy/sad) or a bar graph showing the proportion of people with symptoms on day three with and without treatment, a bar graph of the average duration of symptoms, and a bar graph of proportion with symptoms on both days three and seven. Before completing the study, all participants were shown all the displays and detailed patient information about the treatment of sore throat and were asked to decide again. We calculated a relative importance score (RIS) by subtracting the VAS scores for the undesirable consequences of antibiotics from the VAS score for the benefit of symptom relief. We used logistic regression to determine the association between participants' RIS and their choice. 1,760 participants completed the study. There were statistically significant differences in the likelihood of choosing to go to the doctor in relation to different values (RIS). Of the four presentations, the bar graph of duration of symptoms resulted in decisions that were most consistent with the more fully informed second decision. Most participants also preferred this presentation (38%) and found it easiest to understand (37%). Participants shown the other three presentations were more likely to decide to go to the doctor based on their first decision than everyone based on the second decision. Participants preferred the graph using faces the least (14.4%). For decisions about going to the doctor to get antibiotics for sore throat, treatment effects presented by a bar graph showing the duration of symptoms helped people make decisions more consistent with their values than treatment effects presented as graphical displays of proportions of people with sore throat following treatment. ISRCTN58507086.

Meta-Analysis of Trials of Streptococcal Throat Treatment Programs to Prevent Rheumatic Fever

Rheumatic fever (RF) is the commonest cause of pediatric heart disease globally. Penicillin for streptococcal pharyngitis prevents RF. Inequitable access to health care persists. To investigate RF prevention by treating streptococcal pharyngitis in school- and/or community-based programs. Medline, Old Medline, the Cochrane Library, DARE, Central, NHS, EED, NICE, NRMC, Clinical Evidence, CDC website, PubMed, and reference lists of retrieved articles. Known researchers in the field were contacted where possible. Randomized, controlled trials or trials of before/after design examining treatment of sore throats in schools or communities with RF as an outcome where data were able to be pooled for analysis. Two authors examined titles, abstracts, selected articles, and extracted data. Disagreements were resolved by consensus. QUANTITATIVE ANALYSIS TOOL: Review Manager version 4.2 to assess pooled relative risks and 95% confidence intervals. Six studies (of 677 screened) which met the criteria and could be pooled were included. Meta-analysis of these trials for RF control produced a relative risk of 0.41 (95% CI: 0.23-0.70). There was statistical heterogeneity (I = 70.5%). Hence a random effects analysis was conducted. Many studies were poor quality. Title and available abstracts of non-English studies were checked. There may be publication bias. This is the best available evidence in an area with imperfect information. It is expected acute RF cases would diminish by about 60% using a school or community clinic to treat streptococcal pharyngitis. This should be considered in high-risk populations.

Topical antiseptics for the treatment of sore throat block voltage-gated neuronal sodium channels in a local anaesthetic-like manner

Lozenges for the treatment of sore throat provide relief of discomfort in cases of oral inflammation. This effect has not been fully explained so far. Here, we have examined the proposition that key components of pharmaceutical preparations for the treatment of sore throat which are routinely regarded antiseptics might have sodium channel-blocking, i.e. local anaesthetic-like effects. We investigated the effects of hexylresorcinol, amylmetacresol and dichloro-benzylalcohol on voltage-operated neuronal (Na(V)1.2) sodium channels heterologously expressed in HEK 293 cells in vitro. Hexylresorcinol, amylmetacresol and dichloro-benzylalcohol reversibly blocked depolarisation-induced whole-cell sodium inward currents. The half-maximum blocking concentrations (EC(50)) at -150 mV were 23.1, 53.6 and 661.6 microM, respectively. Block induced by hexylresorcinol and amylmetacresol was increased at depolarised potentials and use-dependent during trains of depolarisations applied at high frequency (100 Hz) indicating that both drugs bind more tightly to inactivated conformations of the channel. Estimates for the inactivated state affinity were 1.88 and 35 microM for hexylresorcinol and amylmetacresol, respectively. Hexylresorcinol and amylmetacresol are 10-20 fold more potent than the local anaesthetic lidocaine in blocking sodium inward current. Both drugs show an increased effect at depolarised membrane potentials or in conditions of high-frequency discharges.

The Geographic Distribution, Ownership, Prices, and Scope of Practice at Retail Clinics

Retail clinics are clinics within a retail store that provide simple acute and preventive care services for a fixed price without an appointment. To describe characteristics of retail clinics, including their location, scope of practice, prices, acceptance of insurance, and ownership, and to estimate the proportion of the U.S. population that lives within a short driving distance of such a clinic. Cross-sectional descriptive study. United States. All 982 retail clinics operating as of August 2008. Population living within a 5- and 10-minute driving distance of a retail clinic. In August 2008, 42 operators ran 982 clinics in 33 states; 88.4% were located in urban areas. Nearly half (44%) of all clinics were located in 5 states (Florida, California, Texas, Minnesota, and Illinois). All offered sore throat treatment (average price, $78) and more than 95% offered treatment of skin conditions, immunizations, pregnancy testing, and lipid or diabetes screening. Almost all (97%) accepted private insurance and Medicare fee-for-service (93%). Among 42 clinic operators, 25 are existing health care companies that operate 11% of the clinics, and 3 are for-profit retail chains that operate 73% of the clinics. An estimated 10.6% of the total U.S. and 13.4% of the urban U.S. population lives within a 5-minute driving distance of a retail clinic, whereas 28.7% (total) and 35.8% (urban) live within a 10-minute driving distance. Our inventory of clinics stopped in August 2008 and estimates of proximity are based on 2000 census data. Retail clinics are positioned to provide immunizations and care for simple acute conditions for a substantial segment of the urban U.S. population. California Healthcare Foundation.

Ambroxol: A CNS Drug?

For almost three decades ambroxol has been used in the therapy of airway diseases. In 2002, ambroxol lozenges were marketed for the treatment of sore throat making use of its local anesthetic effect. Detailed investigations of ambroxol with modern pharmacological methods yielded additional interesting results: ambroxol has been found to have profound effects on neuronal voltage-gated Na(+), as well as Ca(2+) channels, and to effectively reduce chronic inflammatory and neuropathic pain in rodents. The question was raised whether ambroxol affects the central nervous system (CNS) directly, or whether its effects can be explained solely by a peripheral action. This issue was addressed by re-examining pharmacokinetics, as well as toxicology of ambroxol. It has been concluded that even at the highest clinically used doses ambroxol does not have significant direct effects on the CNS. At clinically relevant plasma concentrations ambroxol either does not penetrate blood-brain barrier, or its brain levels are too low to cause relevant effects. The analgesic effects of ambroxol by either systemic administration to animals, or by topical application in humans can be explained by ambroxol-induced blockade of ion channels in peripheral neurons.

Isolation of Two Bioactive ent-Kauranoids from the Leaves of Isodon xerophilus

Isodon xerophilus has been used as a herbal cold tea for the prevention and treatment of sore throat and inflammation in southernwestern China. A phytochemical study on the ethyl acetate (EtOAc) soluble fraction of I. xerophilus leaves led to the isolation of two new ent-kauranoids, xerophinoids A (1) and B (2), together with 14 known diterpenoids. The structures of xerophinoids A (1) and B (2) were illustrated using spectroscopic methods including 1D and 2D NMR analyses. To study their biological activities, the effects of xerophinoids A (1) and B (2) on nitrite production, tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta were examined. In addition, xerophinoids A (1) and B (2) also exhibited potent cytotoxicity against several human tumor cell lines (IC50 < 11 microM), but they had no toxicity on human T-lymphocyte (C8166).

Death Of Child With Leukaemia Subjected To Traditional Uvulectomy

A case is reported of a 5 year old girl who had uvulectomy done by traditional practitioners as treatment for sore throat. She was admitted 24 hours after the procedure due to epistaxis. At the time of admission the epistaxis had stopped but the pharynx was badly inflamed and she was found to be severely anemic. Unfortunately before anything could be done the patient expired. Autopsy however revealed that the child had Acute Leukemia The case is worthy of note since the practice of traditional uvulectomy is still common in many countries and also because sore throat, one of the commonest reasons for which it is performed can be due to serous life threatening conditions like Leukemia as well as to remind us that traditional Uvulectomy causes a lot of unnecessary morbidity and mortality and something must be done about it

Antibiotic Treatment of Children With Sore Throat

Of children with sore throat, 15% to 36% have pharyngitis caused by group A beta-hemolytic streptococci (GABHS). Performance of a GABHS test prior to antibiotic prescribing is recommended for children with sore throat. Penicillin, amoxicillin, erythromycin, and first-generation cephalosporins are the recommended antibiotics for treatment of sore throat due to GABHS. To measure rates of antibiotic prescribing and GABHS testing and to evaluate the association between testing and antibiotic treatment for children with sore throat. Analysis of visits by children aged 3 to 17 years with sore throat to office-based physicians, hospital outpatient departments, and emergency departments in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1995 to 2003 (N = 4158) and of a subset of visits with GABHS testing data (n = 2797). National rates of antibiotic prescribing, prescribing of antibiotics recommended and not recommended for GABHS, and GABHS testing. Physicians prescribed antibiotics in 53% (95% confidence interval [CI], 49%-56%) of an estimated 7.3 million annual visits for sore throat and nonrecommended antibiotics to 27% (95% CI, 24%-31%) of children who received an antibiotic. Antibiotic prescribing decreased from 66% of visits in 1995 to 54% of visits in 2003 (P = .01 for trend). This decrease was attributable to a decrease in the prescribing of recommended antibiotics (49% to 38%; P = .002). Physicians performed a GABHS test in 53% (95% CI, 48%-57%) of visits and in 51% (95% CI, 45%-57%) of visits at which an antibiotic was prescribed. GABHS testing was not associated with a lower antibiotic prescribing rate overall (48% tested vs 51% not tested; P = .40), but testing was associated with a lower antibiotic prescribing rate for children with diagnosis codes for pharyngitis, tonsillitis, and streptococcal sore throat (57% tested vs 73% not tested; P<.001). Physicians prescribed antibiotics to 53% of children with sore throat, in excess of the maximum expected prevalence of GABHS. Although there was a decrease in the proportion of children receiving antibiotics between 1995 and 2003, this was due to decreased prescribing of agents recommended for GABHS. Although GABHS testing was associated with a lower rate of antibiotic prescribing for children with diagnosis codes of pharyngitis, tonsillitis, and streptococcal sore throat, GABHS testing was underused.

Faringitis aguda, ¿estreptocóccica? Empleo del estudio etiológico y de antimicrobianos en dos centros pediátricos universitarios

The diagnosis and treatment of sore throat in pediatric patients attending one of two facilities at a university hospital: pediatric ambulatory facility (PAF) and emergency unit (EU) in a period of 14 months are described. There were 421 patients at the PAF and 289 at the EU, of whom 65% and 76% were studied for Streptococcus pyogenes respectively. Streptococcus were detected in both centers in 37% of cases, with a peak detection of 50% at ages 6 to 10 years. There were 217 patients without any bacteriological study, of whom 162 (75%) received antibiotics. The importance of bacteriological confirmation prior to antibiotic prescription in this disease is emphasized.

Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis.

BackgroundRheumatic fever continues to put a significant burden on the health of low socio-economic populations in low and middle-income countries despite the near disappearance of the disease in the developed world over the past century. Antibiotics have long been thought of as an effective method for preventing the onset of acute rheumatic fever following a Group-A streptococcal (GAS) throat infection; however, their use has not been widely adopted in developing countries for the treatment of sore throats. We have used the tools of systematic review and meta-analysis to quantify the effectiveness of antibiotic treatment for sore throat, with symptoms suggestive of group A streptococcal (GAS) infection, for the primary prevention of acute rheumatic fever.MethodsTrials were identified through a systematic search of titles and abstracts found in the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 4, 2003), MEDLINE (1966–2003), EMBASE (1966–2003), and the reference lists of identified studies. The selection criteria included randomised or quasi-randomised controlled trials comparing the effectiveness of antibiotics versus no antibiotics for the prevention of rheumatic fever in patients presenting with a sore throat, with or without confirmation of GAS infection, and no history of rheumatic fever.ResultsTen trials (n = 7665) were eligible for inclusion in this review. The methodological quality of the studies, in general, was poor. All of the included trials were conducted during the period of 1950 and 1961 and in 8 of the 10 trials the study population consisted of young adult males living on United States military bases. Fixed effects, meta-analysis revealed an overall protective effect for the use of antibiotics against acute rheumatic fever of 70% (RR = 0.32; 95% CI = 0.21–0.48). The absolute risk reduction was 1.67% with an NNT of 53. When meta-analysis was restricted to include only trials evaluating penicillin, a protective effect of 80% was found (Fixed effect RR = 0.20, 95% CI = 0.11–0.36) with an NNT of 60. The marginal cost of preventing one case of rheumatic fever by a single intramuscular injection of penicillin is approximately US$46 in South Africa.ConclusionAntibiotics appear to be effective in reducing the incidence of acute rheumatic fever following an episode of suspected GAS pharyngitis. This effect may be achieved at relatively low cost if a single intramuscular penicillin injection is administered.