Treatment Of Sore Throat Research Articles

Sore Throat - Guideline-based Diagnostics and Therapy

Sore throat is a common reason for consultation of family physicians. Acute sore throat (< 14 days) is usually triggered by infections of the pharynx. Less than 35 % of cases are caused by bacterial infections; nevertheless, antibiotics are prescribed far more often. Evidence-based guideline recommendations are available to reduce non-indicated administration of antibiotics in the treatment of sore throat. Update of the clinical guideline "sore throat" of the German College of General Practitioners and Family Physicians (DEGAM) by means of a systematic search of the literature for international guidelines and systematic reviews. After excluding red flags such as immunosuppression and severe systemic infections, acute sore throat is usually self-limiting with a mean duration of 7 days. Patients should be encouraged in self-management; ibuprofen and naproxen are recommended for symptomatic treatment. If antibiotics are considered, clinical scores (Centor, McIsaac, FeverPAIN) should be used to assess the risk of bacterial pharyngitis. At low risk (< 3 points), antibiotics are not indicated; if at least moderate (3 points), delayed prescription is an option; if high (> 3 points), antibiotics can be taken immediately. Even if scores suggestive a bacterial cause, the evidence suggests that antibiotic treatment only shortens the duration of symptoms modestly. Penicillin is the first choice (clarithromycin as an alternative). The antibiotic should be taken for 5-7 days. In the absence of red flags, a regular use of symptomatic treatment will help to control discomfort. If administration of antibiotics is still considered a risk-adapted approach, using clinical scores is recommended.

Antibiotics for treatment of sore throat in children and adults.

Antibiotics for treatment of sore throat in children and adults.

GC-MS analysis and physiochemical properties of Enterolobium cyclocarpum (elephant ear) seed oil

Background: The present study aimed to extract, evaluate the physicochemical properties, and chemical characterization of the seed Enterolobium cyclocarpum. E. cyclocarpum is a legume of the Leguminosae family. It is used as foliage, for animal feeding and oil is extracted for several application in folk medicine for the treatment of sore throat, colds, diarrhea, headache, intestinal ailments, and stomachache. The leaf infusion is used as a laxative In the West Indies; seeds are chewed for a sore throat. Methods: Three hundred grams (300 g) of each of the pulverized samples were extracted with 100% hexane using Soxhlet extractor to produce a light-brown oil of low viscosity. The physicochemical properties of the oil were analyzed using AOAC standard methods, while the oil components were characterized on an HP-5MS column Gas Chromatography coupled with Mass Spectrometry (GC-MS). Results: The yield of the oil is very low (only 4.11 % by weight), Fatty acid composition showed that undecanoic acid methyl ester (36.68%) was the dominant fatty acid, followed by 3-linoleic acid (25.04%), and 2-linolelaidic acid methyl ester (12.98%). Physicochemical properties of themed oil were moisture content (0.85%); refractive index (25oC), 1.45; Specific gravity, 0.86±0.02; iodine value, 68.55±0.02/100 g of oil; peroxide value, 6.58±0.03 meq. O2/kg of oil; free fatty acids, 2.63±0.01 mg of KOH/g of oil; acid value, 5.26±0.02 mg of KOH/g of oil; saponification value, 189.00±0.03; Unsaponifiable value, 0.66±0.01%. Conclusion: This study has shown that the seed oil of E. cyclocarpum displayed properties and constituents as a substitute oil for industrial, pharmaceutical, and domestic applications.

A novel anti-inflammatory treatment for bradykinin-induced sore throat or pharyngitis.

BackgroundOften thought of as a minor health concern, sore throat or pharyngitis is an important public health issue. It is one of the most common symptoms of upper respiratory diseases including COVID‐19 and is a leading cause of physician visits and antibiotic prescriptions. However, few over‐the‐counter medications are proven to heal sore throat inflammation.MethodsAdenocarcinomic human alveolar basal epithelial cells (A549 cells) and three dimensional organotypic human respiratory tissues were used to study inflammation and various treatment effects on respiratory epithelia. The cells and tissues were studied both in the presence and absence of bradykinin, one of the first inflammatory mediators of pharyngitis. Inflammation was measured by analyzing the levels of prostaglandin E2 (PGE2), interleukin 8 (IL‐8), and leukotriene B4 (LTB4), transepithelial electrical resistance (TEER), and lactate dehydrogenase (LDH) release. Tissue morphology was analyzed by immunohistochemistry.ResultsIn studying pharyngitis using organotypic human respiratory tissue stimulated with bradykinin, we saw an increase in PGE2 and interleukin‐8 (IL‐8) in response to bradykinin. Acetyl salicylic acid (ASA), a nonspecific COX inhibitor, was able to mitigate a bradykinin‐induced increase in PGE2 in our studies. However, ASA was inflammatory above its therapeutic window, increasing the levels of PGE2 and IL‐8 above those seen with bradykinin stimulation alone. We describe a novel, scientifically validated treatment for sore throat, that contains a low dose of ASA and other anti‐inflammatory ingredients.ConclusionThis study elucidates the complex mechanisms involved in healing pharyngitis, an inflammatory condition of the upper respiratory epithelia. An ASA‐based formula (Biovanta) mitigated bradykinin‐induced inflammation more strongly than ASA alone in organotypic human respiratory tissues. Surprisingly, we found that many of the most common over the counter sore throat therapies exacerbate inflammation and IL‐8 in organotypic human respiratory tissues, suggesting these common treatments may increase the likelihood of further respiratory complications.

Use of and attitudes towards herbal medicine during the COVID-19 pandemic: A cross-sectional study in Vietnam

IntroductionHerbal medicine has a long and rich history of practice in Vietnam. The use and attitudes towards herbal medicine, during the COVID-19 pandemic was explored in this study. The aims were to examine (1) the prevalence and indications for herbal medicine use, (2) the factors associated with herbal medicine use, and (3) Vietnamese peoples' attitudes towards herbal medicine. MethodsA cross-sectional online survey was conducted in Vietnamese adults aged 18 years and older, distributed equally across the Northern, Central, and Southern regions of Vietnam, between September and October 2020. Descriptive statistics, chi-square tests, and univariate and multivariate logistic regression analyses were performed to achieve the study objectives. ResultsNearly half of the respondents reported using herbal medicine for common illnesses during the COVID-19 pandemic. The prevalence was strongly associated with marital status, urbanicity, monthly income, and health status perception. Ginger (Zingiber officinale Rosc.), honey (Mel), garlic (Allium sativum L.), and perilla (Perilla frutescens (L.) Britt.) were the most commonly used herbal medicines, mainly for the treatment of sore throat, cough, nasal congestion, and fever. Nearly 70% of the participants believed herbal medicines to be safe, to have less side effects than conventional medicines, and to be effective for minor health conditions. ConclusionThe use of herbal medicine during the COVID-19 pandemic was a common practice among Vietnamese people. These findings may have implications for future medical research in Vietnam, and for policy-makers and those in the pharmaceutical industry with regard to future regulations and product development.

Multiple in vitro biological effects of phenolic compounds from Terminalia chebula var. tomentella

Ethnopharmacological relevanceTerminalia chebula (TC), a well-known Indian Ayurvedic medicine introduced into China in the Sui and Tang Dynasties, has been recorded and used medicinally as Fructus Chebulae, together with its variety tomentella (TCT) in the Chinese Pharmacopoeia. They have been also used commonly for the treatment of diabetes mellitus by Tibetan medicine. Aim of the studyTo investigate the main bioactive and therapeutic principles in the fruits of TCT, based on the extensive evaluation of their anti-inflammatory and hypoglycemic activities. Materials and methodsThe TCT fresh fruits were analyzed by HPLC and separated further by column chromatography and preparative HPLC. The isolated compounds were identified by extensive spectroscopic analyses, including 1D/2D NMR, MS, UV, IR and ECD. Anti-inflammatory activity was evaluated by inhibition of NO production in RAW264.7 cells. The specific iNOS (PDB ID: 3E7G) structure was prepared by Discovery Studio 4.0, and the molecular docking simulation was performed on GOLD (version 5.2.2). Hypoglycemic activity was measured using the substrate solution of 4-nitrophenyl-α-d-glucopyranoside enzyme and buffer solution. ResultsThe HPLC analysis method of polyphenols in the fruits of TCT was established, and 13 main chromatographic peaks were identified, including six hydrolyzable tannins (2, 4–7, 10–11), three simple phenols (12–14), and one oleanane pentacyclic triterpene, arjungenin. Extensive chromatographic separation of TCT fresh fruits yielded 14 compounds, including one new natural hydrolyzable tannin, 2,3-(S)-HHDP-6-O-galloyl-d-glucose (1). The known compounds were identified as 10 hydrolyzable tannins (2–11) and three simple phenols (12–14). Compounds 10 (IC50 = 36.43 ± 0.21 μM), 11 (IC50 = 42.28 ± 0.09 μM) displayed stronger NO inhibitory activity than the positive control L-NMMA (IC50 = 42.34 ± 0.66 μM), while 2, 4, and 9 showed moderate inhibitory activity against NO production. Further molecular docking simulation of specific iNOS on 10 and 11, as well as five previously isolated lignans 15–19 showed that there were no obvious rules between docking results and the in vitro NO inhibitory activity for hydrolyzable tannins (10 and 11), while the mechanism of anti-inflammatory activity for lignans was related to the substitution of conjugated aldehyde groups. Moreover, most of the hydrolyzable tannins (1–2, 4–5, 9–11) and simple phenol (12) displayed stronger inhibitory effects on α-glucosidase than the positive control, quercetin (IC50 = 6.118 ± 0.071 μM), with IC50 values ranging from 0.079 to 16.494 μM. Among these bioactive isolates, the hydrolyzable tannins 2, 4–5, and 9–11, and simple phenol 12 are major chemical components in TCT fruit. ConclusionsThe results showed that lignans and hydrolyzed tannins are the main active ingredients of TCT fruits, responsible for the traditional treatment of sore throat and cough. Moreover, hydrolyzed tannins and simple phenolic compounds with potential hypoglycemic activity are closely related to the ethno-pharmacological uses of TCT fruits on diabetes in Tibetan medicine.

Characterization of the chemical constituents of Jie-Geng-Tang and the metabolites in the serums and lungs of mice after oral administration by LC-Q-TOF-MS.

Jie-Geng-Tang (JGT), a traditional formula, is employed in the treatment of sore throat and cough and comprises Platycodonis Radix and Glycyrrhizae Radix et Rhizoma in the ratio 1 : 2. Our previous study demonstrated that JGT protected mice from S. aureus-induced acute lung injury (ALI). Five constituents of JGT showed antibacterial activities against S. aureus in vitro. However, the potential effective constituents of JGT in vivo were still unclear. In this study, the chemical constituents of JGT were identified by liquid chromatography with quadrupole time-of-flight spectrometry (LC-Q-TOF-MS). A total of 96 constituents were identified or assumed, including seven organic acids, 45 flavonoids, 36 triterpene saponins, and eight compounds of other types. The structures of 31 of the constituents were confirmed by comparing them with corresponding authentic standards. Moreover, 15 prototypes and 49 metabolites were deduced in the serums of mice, 24 prototypes and 47 metabolites were deduced in the lungs of mice after the oral administration of JGT. Three types of constituents, namely organic acids, flavonoids, and triterpene saponins, could be absorbed into the blood. Moreover, flavonoids and triterpene saponins were more likely distributed in the lung than in the blood. To the best of our knowledge, this is the first report on the systematic metabolites profile of JGT in vivo. The results reported were beneficial to the elucidation of the effective material basis of JGT.

A Therapeutic Equivalence of Two Formulations of the Fixed Combination of Benzydamine Hydrochloride and Cetylpyridinium Chloride in the Treatment of Sore Throat Associated with Upper Respiratory Tract Infection

A Therapeutic Equivalence of Two Formulations of the Fixed Combination of Benzydamine Hydrochloride and Cetylpyridinium Chloride in the Treatment of Sore Throat Associated with Upper Respiratory Tract Infection

Evaluation on immediate analgesic efficacy and safety of Kai-Hou-Jian spray (children\u2019s type) in treating sore throat caused by acute pharyngitis and tonsillitis in children: study protocol for a randomized controlled trial

BackgroundAcute pharyngitis and tonsillitis are common respiratory diseases for which children seek medical care. Their main clinical manifestation is sore throat which interferes with patients’ quality of life. However, there is no proven effective or safe method to treat it. It is necessary to find an excellent strategy to reduce sore throat and reduce the burden of acute illness. We designed the randomized controlled trial with the characteristics of traditional Chinese medicine (TCM) to determine the clinical positioning of Kai-Hou-Jian spray (children’s type) (KHJS) through evidence-based research. This trial aims to evaluate the immediate analgesic efficacy of KHJS on sore throat caused by acute pharyngitis and tonsillitis (wind-heat syndrome/heat exuberance in lung and stomach syndrome) in children and to observe its safety.Methods/designThis is a prospective, multicenter, randomized, double-blind, parallel-group, placebo-controlled trial. It will include 240 children with acute pharyngitis/tonsillitis from 7 study sites across China. All participants are randomly assigned to two parallel treatment groups, one with KHJS and the other with placebo sprays, for 5 consecutive days. The primary outcome is the time of analgesic onset. Secondary outcomes include duration of analgesic effect, area under time curve of 0–3 h Wong-Baker FACES Pain Rating Scale (WBS) score (AUC0-3 h), rate of analgesic onset, rate of disappearance of sore throat, changes of WBS score (in days), effective rate of pharyngeal signs, and effective rate of TCM syndrome. The incidence of adverse events during the trial is the primary safety outcome. In addition, vital signs and laboratory tests before and after medication are monitored.DiscussionTo our knowledge, this will be the first clinical trial to explore the immediate analgesic efficacy of a Chinese patent medicine spray for acute pharyngitis/tonsillitis induced sore throat in children in a multicenter, randomized, double-blinded, parallel-group, placebo-controlled manner. Not only might it prove the efficacy and safety of KHJS in the treatment of sore throat caused by acute pharyngitis/tonsillitis in children, but it might also provide evidence for the treatment of acute sore throat with Chinese herbal medicine.Trial registrationA multicenter, randomized, double-blind, very low-dose, parallel controlled trial for the immediate analgesic effect and safety of Kai-Hou- Jian spray (children's type) in the treatment of sore throat caused by acute pharyngitis and tonsillitis in children. Chinese Clinical Trial Registry ChiCTR2000031599. Registered on 5 April 2020

Electroacupuncture in the prevention and treatment of sore throat and nausea and vomiting after gastrointestinal surgery: a randomized controlled trial

To observe the effect of electroacupuncture (EA) intervention on postoperative sore throat (POST) and postoperative nausea and vomiting (PONV) after endotracheal intubation and general anesthesia. According to the random number table, 60 patients of gastrointestinal surgery under general anesthesia with tracheal intubation were randomly divided into EA group (30 cases) and control group (30 cases). Patients in the EA group were given acupuncture at Shaoshang (LU11) 30 minutes before general anesthesia, and EA at Chize (LU5) and Hegu (LI4) continued until the operation was completed. The incidence and severity of POST and visual analogue scale (VAS) score at 12, 24, and 48 h after surgery, and the incidence and severity of PONV at 12, 24 h after surgery were analyzed, respectively. The incidence and severity of POST and PONV, and VAS score in the EA group were significantly lower than those in the control group 12 h and 24 h after surgery (P<0.05). Both groups had significant reductions in VAS score at 24 h and 48 h after surgery compared with that at 12 h (P<0.05). EA can significantly improve the prognosis of patients on sore throat and reduce the incidence of PONV.

Антисептики как альтернатива системной антибактериальной терапии

Sore throat is one of the most frequent reasons for going to the doctor and prescribing irrational antibacterial therapy. The reasons for this are many – from the difficulties of etiological diagnosis and the development of relapses and possible severe complications to the personal attitude of doctors and patients to the choice of treatment. At the same time, the issue of antibiotic resistance, side effects associated with the appointment of antibacterial therapy, is one of the most important problems of modern health care around the world. Difficulties in the process of clinical observation of patients, the peculiarities of the course of infectious and inflammatory diseases of the pharynx are factors requiring constant improvement of methods of providing medical care. Antiseptics play a significant role in the treatment of sore throat, exceeding the frequency of use of antibiotics. So, one of the antiseptics used topically, the effectiveness of which has been proven in clinical studies, is Strepsils, which includes 2,4-dichlorobenzyl alcohol and amylmetacresol. The results of clinical studies of the drug indicate its positive effect in patients with sore throat. All this things allow us to recommend that this complex antiseptic be more often included in the treatment of infectious and inflammatory diseases of the oral cavity and pharynx.

Anti-inflammatory, wound healing and antioxidant potential of compounds from Dioscorea bulbifera L. bulbils.

BackgroundDioscorea bulbifera L. (Dioscoreaceae) has been traditionally used in Thai folk medicine as a diuretic and anthelmintic, for longevity preparations, and for wound and inflammation treatment. This plant is also commonly used in traditional Indian and Chinese medicines in the treatment of sore throat, gastric cancer, rectal carcinoma and goiters. However, the wound healing effects of the active compounds in this plant have not been investigated.ObjectiveThis study aimed to identify compounds responsible for the wound healing activity of D. bulbifera and determine their potential anti-inflammatory and antioxidant activities.MethodsCrude extracts of D. bulbifera bulbils, their derived fractions and eleven purified compounds were tested for anti-inflammatory activity against LPS-induced NO production in RAW264.7 macrophages. The wound healing effects were evaluated via cell proliferation and migration assays using human dermal fibroblasts (HDFs), and the antioxidant effects were determined using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and hydroxyl radical (•OH) scavenging activity assays.Results15,16-Epoxy-6α-O-acetyl-8β-hydroxy-19-nor-clero-13(16),14-diene-17,12;18,2-diolide (2), (+)-catechin (5), quercetin (6) and myricetin (11) exhibited significantly potent wound healing effects and promoted marked cell proliferation, resulting in % viabilities of 107.4–137.6, 121.1–151.9, 98.0–131.9, 90.9–115.9, respectively. Among them, (+)-catechin produced the highest % cell migration, resulting in 100.0% wound closure sooner (at day 2) than the other compounds. In addition, 1 μg/ml (+)-catechin significantly increased fibroblast migration by 2.4-fold compared to that in the control after 24 h. Regarding anti-inflammatory properties, kaempferol (7) and quercetin (6) decreased (p < 0.005) NO production, with IC50 values of 46.6 and 56.2 μM, respectively. In addition, the crude extracts, solvent fractions and flavonoid compounds were also found to possess marked antioxidant activity in both DPPH and •OH radical scavenging assays.ConclusionsThese findings provide more evidence to support the traditional use of D. bulbifera for the treatment of wounds and inflammation.

Abstract 16550: Community Perception and Treatment of Sore Throat Among Children in a Rheumatic Heart Disease Endemic Setting

Introduction: Although Group A Streptococcal (GAS) pharyngitis (sore throat) can be treated, its complications -- acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant public health problems in low- and middle -income countries. Examining community perceptions and health seeking behavior for sore throat in these settings could translate into effective ARF/RHD prevention strategies. Objective: To develop a local explanatory model of sore throat health seeking behavior that can be used in designing ARF/RHD preventive interventions Methods: This focus group discussions-based qualitative study was conducted in 3 districts of Uganda (Lira in the north, Wakiso in central and Mbarara in the west). Overall, 50 participants were included in these discussions about sore throat in children. Thematic analysis was done on transcribed and translated audio recordings. Results: Perception of sore throat, treatment practices and challenges/barriers to seeking proper care for sore throat were major topics discussed during the focus group discussions. Across the 3 districts, sore throat was perceived to be a common and serious problem within the community. Although the majority of participants could not tell the exact cause of sore throat, they believed that poor hygiene could be a related factor. Variable methods of treatment were used across all districts. However, traditional medicine use and practices were more common in Lira and Wakiso districts while there was more trust in modern medicine in Mbarara district. Improvement in a child’s symptoms was the most common reason for stopping treatment. Individual, societal and health system factors such as distance to health facility, long waiting time and lack of medicines influenced care givers’ decisions to seek proper care for sore throat. Conclusions: Our findings show interplay between care givers’ knowledge, beliefs and preferences and the health care system as major determinants of caregivers’ behavior to seek proper care for pharyngitis. Community ARF/RHD educational programs in Uganda should emphasize the consequences of untreated or poorly treated pharyngitis and the importance of seeking proper care and treatment.

Sore Throat Treatment Guidelines are Fanning the Flames of Antimicrobial Resistance

Sore throat represents a significant yet under-recognised battle in the war against antimicrobial resistance (AMR). It is one of the most common reasons people visit a doctor and approximately 60% walk away with a prescription for antibiotics.1 However, studies have indicated that 70–95% of all cases are viral2 and most patients would be better served with symptom relief. A systematic review of global sore throat management guidelines by members of the Global Respiratory Infection Partnership (GRIP) suggested the problem could be rooted in a focus on serious, yet increasingly rare, conditions, such as quinsy and acute rheumatic fever (ARF). While ARF can be a dangerous complication of Group A streptococci (GAS), which are identified in 15–30% of sore throat cases, the incidence of ARF is exceedingly rare in most parts of the world.3 All but one of the 36 identified guideline documents discussed antibiotic therapy and less than two-thirds advocated the use of laboratory tests to confirm GAS. Just 50% gave advice on symptom relief, which evidence suggests is the most appropriate approach in most cases.4 Dr Martin Duerden, lecturer in therapeutics and prescribing at Cardiff University, Cardiff, UK, member of the GRIP, recently retired general practitioner, and co-author of the review, believes countries should re-evaluate their guidelines. In this interview, Dr Duerden talks about the role of fit-for-purpose sore throat guidelines in antimicrobial stewardship, the importance of appropriate symptom relief, and how coronavirus disease (COVID-19) could represent an opportunity for change.

Patients with Sore Throat: A Survey of Self-Management and Healthcare-Seeking Behavior in 13 Countries Worldwide.

BackgroundAcute sore throat is one of the most common problems for which patients consult their general practitioner and is a key area for inappropriate antibiotic prescribing. The objective of this study was to investigate patients’ attitudes related to healthcare-seeking behavior and self-management of sore throat.MethodsWe conducted an observational, questionnaire-based study across 13 countries (Australia, Brazil, China, France, Germany, Italy, the Philippines, Russia, Saudi Arabia, South Africa, Thailand, the UK and the USA) on respondents who reported having had a sore throat in the previous 12 months. Data were collected on their experiences, contact with healthcare professionals, treatment practices and opinions about antibiotics.ResultsA total of 5196 respondents (approximately 400 per country) completed the survey. Over 80% of respondents sought advice for a sore throat, with 30% consulting a general practitioner. The desire to limit the worsening of symptoms was the main reason for seeking treatment. Other reasons concerned resolving persistent symptoms and reducing the impact on daily life/sleep. Self-management for sore throat was mainly medicated sore throat remedies. “Wanting an antibiotic” was rated much lower (55%) than most other reasons for visiting a doctor, but this differed greatly between countries. The percentage of respondents using antibiotics varied widely, for example, 10% in the UK and 45% in Saudi Arabia. There was considerable variation in the proportion of respondents who thought that antibiotics would be effective against sore throat (from 24% in France to 94% in Saudi Arabia).ConclusionsOur findings suggest that knowledge of effective treatments for sore throat varied widely. The results of this study should enable healthcare professionals to better anticipate patients’ needs. This will support healthcare professionals in their role as antibiotic stewards, helping to reduce the misuse of antibiotics, and further guiding patients towards symptomatic self-management of sore throat.

FORMULATION AND EVALUATION OF MEDICATED LOZENGES FOR SORE THROAT

Objective: The objective of the present work was to formulate and evaluate lozenges for a sore throat using Loratadine. Loratadine is a long-acting peripheral H1-receptor antagonist which is mainly used as an antihistamine. Loratadine lozenges were prepared to prevent the itching and inflammation in sore throat.&#x0D; Methods: Solid dispersion of Loratadine was prepared using β-cyclodextrin in the ratios of 1:1, 1:2, and 1:3 to enhance the solubility of Loratadine. The prepared solid dispersion of Loratadine was analyzed for solubility enhancement. Loratadine lozenges were then formulated with mannitol, sucrose, acacia, xanthan gum, liquid glucose by heat, and congealing technique. The prepared lozenges were evaluated for drug-excipient incompatibility study, diameter, thickness, weight variation, hardness, friability, in vitro release study, and drug content.&#x0D; Results: The results of the Fourier transform infrared study showed that there was no interaction between the selected drug and excipients. In vitro drug release study of Loratadine lozenges were performed in pH 6.8 phosphate buffer, wherein &gt;90% of the drug was released within 30 min for all the formulations. The lozenges were optimized based on in vitro release data. Formulation F7 of Loratadine lozenges exhibited 99.1% release in 30 min. Stability studies revealed that the formulation was stable.&#x0D; Conclusion: From the present work, it was concluded that the Loratadine lozenges can be considered as a suitable delivery system for the treatment of sore throat.

Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat.

Sore throat is a common condition caused by viruses or bacteria, and is a leading cause of antibiotic prescription in primary care. The most common bacterial species is group A streptococcus ('strep throat'). Between 50% to 70% of pharyngitis cases are treated with antibiotics, despite the majority of cases being viral in origin. One strategy to reduce antibiotics is to use rapid tests for group A streptococcus to guide antibiotic prescriptions. Rapid tests can be used alone or in combination with a clinical scoring system. To assess the efficacy and safety of strategies based on rapid tests to guide antibiotic prescriptions for sore throat in primary care settings. We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and LILACS, as well as the trial registries ClinicalTrials.gov and the WHO ICTRP on 5 June 2019. We included randomised controlled trials (RCTs) comparing rapid tests with management based on clinical grounds to guide the prescription of antibiotics for people with a sore throat in ambulatory care settings. We included trials that randomised individuals, as well as cluster-RCTs in which individual practitioners (or practices) or emergency departments were randomised. Two review authors independently extracted data on the primary outcomes (number of participants provided with an antibiotic prescription; number of participants with an antibiotic dispensed) and secondary outcomes (duration of sore throat symptoms; duration of other symptoms; quality of life measures; number of participants with a complication attributed to the index infection; number of participants in need of re-consultation by the end of follow-up; number of participants in need of hospital admission by the end of follow-up; number of satisfied participants; number of participants with an adverse event attributed to the rapid test).We assessed the risk of bias of all included trials and used GRADE to assess the certainty of the evidence. We performed meta-analyses and sensitivity analyses when feasible. We included five trials (2891 children and adult participants in total; 2545 participants after adjusting for clustering). Management in the intervention group was as follows: in three trials rapid testswereused in combination with a clinical scoring system; in one trial, some physicians were asked to use rapid testsalone, while others were asked to use rapid testsin combination with a clinical scoring system; in one trial, rapid testswereused alone. Based on data from five trials (2545 participants), a large reduction in prescribed antibiotics was found in the rapid test group (481/1197) versus management based on clinical grounds (865/1348), for a summary risk difference (RD) of -25%, 95% confidence interval (CI) -31% to -18%; I2 = 62%; moderate-certainty evidence. Estimates of effect on antibiotic prescription rates were stable in various sensitivity analyses. Based on data from two trials (900 people) originating from the same overarching study, the evidence suggests that rapid testsmaynot reduce dispensed antibiotic treatments: rapid test group (156/445) versus management based on clinical grounds (197/455); summary RD -7%, 95% CI -17% to 2%; I2 = 53%; low-certainty evidence. Four trials (2075 participants) reported data on the number of participants with a complication attributed to the index infection; the summary odds ratio (OR) was 0.85, 95% CI 0.03 to26.65; P = 0.93;I2 = 62%; very low-certainty evidence,which means that people in the rapid testing group were less likely to develop complications of the index infection, but theevidence is very uncertain. Two trials (1161 participants) reported on the number of participants in need of re-consultation by the end of follow-up; the summary OR was 1.12, 95% CI 0.57 to 2.21; P = 0.74; I2 = 59%; low-certainty evidence, which means that participants in the rapid testing group were more likely to be in need of re-consultation by the end of the study follow-up,but the evidence is uncertain. Lack of data impeded assessment of other secondary outcomes (including safety outcomes) and of sources of heterogeneity. AUTHORS' CONCLUSIONS: Rapid testing to guide antibiotic treatment for sore throat in primary care probably reduces antibiotic prescription rates by 25% (absolute risk difference), but may have little or no impact on antibiotic dispensing. More studies are needed to assess the efficacy and safety of rapid test-guided antibiotic prescribing, notably to evaluate patient-centred outcomes and variability across subgroups (e.g. adults versus children).

School-based Streptococcal A Sore-throat Treatment Programs and Acute Rheumatic Fever Amongst Indigenous Māori: A Retrospective Cohort Study.

Acute rheumatic fever (ARF) predominantly affects indigenous Māori schoolchildren in Bay of Plenty region, and more so male Māori students, especially when socioeconomically deprived. We evaluated the effectiveness of strategies for reducing ARF with group A streptococcal pharyngitis treatment in 2011-18. We retrospectively assessed outcomes of 3 open cohorts of Māori schoolchildren receiving different interventions: Eastern Bay rural Cohort 1, mean deprivation decile 9.80, received school-based sore-throat programs with nurse and general practice (GP) support; Eastern Whakatane township/surrounds Cohort 2, mean deprivation 7.25, GP management; Western Bay Cohort 3, mean deprivation 5.98, received predominantly GP care, but 3 highest-risk schools received school-based programs. Cases were identified from ICD10 ARF-coded hospital discharges, notifications to Ministry of Health, and a secondary-prevention penicillin database. Primary outcomes were first-presentation ARF cohorts' incidence preintervention (2000-10) and postintervention (2011-18) with cases over annual school rolls' Māori students-year denominators. Overall, ARF in Maori schoolchildren declined in the cohorts with school-based programs. Cohort 1 saw a postintervention (2011-18) decline of 60%, 148 to 59/100,000/year, rate ratio (RR) = 0.40(CI 0.22-0.73) P = 0.002. Males' incidence declined 190 to 78 × 100,000/year RR = 0.41(CI 0.19-0.85) P = 0.013 and females too, narrowing gender disparities. Cohort 3 ARF incidence decreased 48%, 50 to 26/100,000/year RR = 0.52(CI 0.27-0.99) P = 0.044. In contrast, ARF doubled in Cohort 2 students with GP-only care without school-based programs increasing 30 to 69/100,000/year RR = 2.28(CI 0.99-5.27) P = 0.047, especially for males 39/100,000/year to 107/100,000/year RR = 2.71(CI 1.00-7.33) P = 0.0405. School-based programs with indigenous Māori health workers' sore-throat swabbing and GP/Nurse support reduced first-presentation ARF incidence in Māori students in highest-risk settings.

Self-medication practices with antibiotics among nursing students: A cross-sectional descriptive survey at tertiary care teaching hospital in Uttarakhand

BackgroundMisuse and overuse of antimicrobials is one of the world's most pressing public health problems. Nurses are important members of healthcare team and thus it is essential to know behaviour of antibiotics use among budding nurses. Aim & objectiveTo assess prevalence and practices of self-medication with antibiotic among undergraduate nursing students. Methods and materialThis cross-sectional descriptive study was conducted on 216 randomly selected undergraduate nursing students studying at a tertiary care teaching hospital in Uttarakhand. Data was collected using a valid and reliable questionnaire for self-medication practices with antibiotics and were analysed by using descriptive statistics. ResultsPrevalence of self-medication with antibiotics was 78.7% and among them 53.5% practiced it for 2–3 times in past one year. Azithromycin (37.5%) and Amoxicillin (30.1%) were commonly used antibiotics, primarily for the treatment of sore throat (30.6%) and fever (27.1%). The main reasons for self-medication were adequate knowledge of antibiotics use (39.4%), and to save time (30.6%) &cost (13.5%). The main source of obtaining antibiotics was hospital pharmacy (66%) with verbal advice from nurses/paramedical staff (32.3%) and senior undergraduate nursing students (23.7%). Surprisingly, 68.3% participants suddenly stopped the antibiotic use and 52.7% of them changed over the drugs during treatment. ConclusionsHigh prevalence of self-medication practices with antibiotics among budding nurses is a serious issue; which necessitate educating them with risks and harms of inappropriate use of antimicrobials. Furthermore, sensitizing the pharmacists for not advising and selling antibiotics without medical prescription.

Modern approaches to the treatment of sore throat

The larynx is the first part of the respiratory and digestive tract and it performs vital functions. The air stream, passing through the throat and coming into contact with its mucous membrane, is moistened, warmed up and purified. Due to the anatomical structure of the mouth cavity and pharynx, it creates conditions for entry, presence and inactivation of microorganisms, viruses and fungi. Under normal conditions, due to effective protective mechanisms (mucociliary and immune), pathogens are trapped in the upper respiratory tract while the lower sections remain «clean». Acute pharyngitis is a widespread, polyetiological disease of the upper respiratory tract. There are quite a few preconditions for its development. A favorable background for local inflammation is the reduction of specific and non-specific protection factors, which may be observed in the existing chronic inflammation and worsened in diabetes mellitus and metabolic syndrome, with prolonged use of cytostatics and/or glucocorticosteroids and many other immunocompromised conditions. Due to the prevalence of pharyngitis, the development of effective screening and treatment methods is particularly relevant. Given the localized nature of inflammatory process in the pharynx and the possibility of side effects, general anti-inflammatory drugs are used less and less frequently, and local non-steroidal anti-inflammatory drugs are increasingly drawing the attention of physicians. The article discusses the possibilities and effectiveness of the medication based on benzidamine hydrochloride in treating pharyngitis of diverse etiology. The article presents the studies of foreign scientists, as well as dosages and peculiarities of the medication application. Treatment of acute tonsillipharyngitis with local non-steroidal anti-inflammatory drugs is commonly accepted and widely used in the practice of pediatricians, therapists and otorhinolaryngologists and allows to achieve rapid relief of the patient’s condition.