Treatment Of Tonsillopharyngitis Research Articles

Knowledge, attitudes and practices of general practitioners and paediatricians towards Group A beta-haemolytic streptococcal tonsillopharyngitis: A cross-sectional study from Türkiye.

General practitioners (GPs) and paediatricians are very important in the management of sore throat in terms of providing correct diagnosis and treatment. The aim of this study was to evaluate the knowledge, attitudes and practices of GPs and paediatricians towards Group A beta-haemolytic streptococcal (GABHS) tonsillopharyngitis. Three vignettes/case studies, in which the causative agents were GABHS, Epstein-Barr virus (EBV) and non-EBV viral infection, were presented as part of a questionnaire sent to paediatricians and GPs to elicit information regarding their diagnosis and treatment of tonsillopharyngitis. In all, 236 physicians responded to the questionnaire (126 paediatricians, 106 GPs). GPs registered more accurate diagnoses of GABHS tonsillopharyngitis and tended to administer more symptomatic treatment in the case of non-EBV tonsillopharyngitis than paediatricians. Paediatricians requested more tests in the diagnosis of GABHS tonsillopharyngitis than GPs. Most GPs and paediatricians possess adequate knowledge regarding GABHS diagnosis and the differential diagnosis of patients. Differences between the hospital and general practice settings may have affected the approach to symptomatic treatment and requesting tests.

Role of multidimensional factors in the diagnosis and treatment of tonsillopharyngitis in primary care: a qualitative study

BackgroundTonsillopharyngitis is one of the most frequently observed upper respiratory tract infections, for which antibiotics are prescribed in ambulatory care. In most cases, tonsillopharyngitis is benign and self-limiting, mostly a viral condition. The aim of this study was to explore the diagnostic and treatment process of tonsillopharyngitis by general practitioners and to understand decisions regarding antibiotic prescribing and the factors that shape these practices.Methods/designThis was a qualitative interview study in primary care practices in Latvia. Semi-structured face-to-face interviews were conducted with general practitioners from November 2016 to January 2017. Thematic analysis was applied to identify factors that influence the prescribing practice in a primary care setting in conjunction with a specific context in which the prescriber practices.ResultsDecisions and practice of general practitioner are not static over time or context; they occur within an environmental setting influenced by individual factors of general practitioners, the health care system, and practice-specific factors that shape the diagnosis and antibiotic prescribing in the tonsillopharyngitis. Interviewed general practitioners rely primarily on their personal experience, perception, and skills acquired in their practice, which are encouraged by the environment, where the necessary tools and resources are not in place to encourage rational prescribing of antibiotics.ConclusionsGeneral practitioners’ decision regarding antibiotic prescribing is an unstable concept that differs between prescribers. The health care system could augment the experience of general practitioners through structural changes such as guidelines, availability of antibiotics, and available antibiotics package size.

Сучасні підходи до діагностики та лікування тонзилофарингіту (огляд міжнародних керівництв)

У статті подано огляд рекомендацій із лікування тонзилофарингіту в дітей. Приділяється увага застосуванню нестероїдних протизапальних препаратів (НПЗП) при даній патології. Підкреслюється, що місцеве застосування НПЗП дає можливість вирішити проблему купірування болю в горлі та поліпшення якості життя пацієнта при інфекційно-запальних процесах в ротоглотці, зокрема при тонзилофарингіті як вірусного, так і бактеріального походження.

Comparative evaluation of the efficacy of intravenous paracetamol and ibuprofen on the treatment of tonsillopharyngitis with fever: A prospective, randomized controlled, double-blind clinical trial.

OBJECTIVE:Tonsillopharyngitis is one of the constituents of upper respiratory tract infection (URTI). Fever is a URTI symptom requiring treatment due to the occurrence of discomfort and high fever-based complications. This study primarily sets out to observe and compare the efficacy of intravenous administration of paracetamol and ibuprofen drugs on fever in adult patients with tonsillopharyngitis.METHODS:This study was performed in a prospective, randomized controlled, double-blind design. The study population was divided as Group 1 (treated with paracetamol) and as Group 2 (treated with ibuprofen). While the first group was treated with paracetamol as 1000 mg in 150 ml normal saline, the second group was treated with ibuprofen as 400 mg in 150 ml normal saline. The primary outcome was the decrease in fever at 15, 30, and 60 min, while the secondary outcome was the need for additional treatment after 60 min.RESULTS:One hundred and eighty-five patients were included in the final analysis. The mean age of the paracetamol group (57.4% male) was 28.36 ± 9.6, whereas that of the ibuprofen group (54.9% male) was 27.45 ± 7.98. Fever was reduced significantly between 0 and 60 min in both groups (P ≤ 0.001 and P ≤ 0.001, respectively). Although the antipyretic effect of ibuprofen was more pronounced in the early period than that of paracetamol, no significant difference was noted between the two groups in terms of fever drop between 0 and 60 min (P = 0.350).CONCLUSION:Although both drugs prove effective in controlling fever at the 60 min, stronger efficacy of ibuprofen in the first 15 min may enable rapid discharge from the emergency department.

Treatment of tonsillopharyngitis in children

Tonsillopharyngitis is a common disease among pediatric patients. Visits associated with sore throat account for 6 to 8% of all visits to pediatricians and general practitioners. Tonsillopharyngitis can have both infectious and non-infectious etiologies. In pediatric practice, most cases of upper respiratory tract infections are of viral origin, especially in children of early and preschool age. In most cases, uncomplicated course and non-infectious etiology of the disease do not require the administration of antibacterial drugs. The bacterial nature of the disease can be distinguished from the viral one using the data of culture analysis and rapid test for group A β-hemolytic streptococcus (GABHS) or Streptococcus pyogenes . The etiotropic therapy of streptococcal tonsillopharyngitis is antibiotic therapy. In GABHS, antibiotic therapy shortens the duration and reduces the severity of symptoms, reduces the Likelihood of purulent complications, post-streptococcal diseases and prevents the generalization of streptococcal infection. The use of modern antiseptic herbal medicines may be an additional and alternative line of therapy. The authors presented a literature review of the clinical trials results of a modern herbal medicine and provided the results of their own case of the combined treatment of a 10-year-old child with a diagnosis: acute moderate tonsillopharyngitis, bilateral cervical lymphadenitis; acute rhinitis; chronic adenoiditis, exacerbation; degree 2 adenoids. Antibacterial therapy included amoxicillin: oral: 100 mg/kg/day in 2 divided doses for 10 days, combined with an anti-inflammatory and antiseptic herbal medicine due to the complicated course of the disease in the form of concomitant regional lymphadenitis. The course of therapy resulted in clear positive changes: overall well-being improved as early as on the second day of treatment, sore throat and submandibular region ceased to cause pain by 5th day of treatment, the temperature became normal by 5th day of the disease. This clinical observation shows the possibility to introduce an anti-inflammatory herbal medicine to the complex treatment of acute tonsillopharyngitis in children, including cases of complicated course of the disease.

Місце топічних препаратів у лікуванні тонзилофарингітів

Місце топічних препаратів у лікуванні тонзилофарингітів

PIH33 - Analysis of Antibiotics’ Use in the Treatment of Tonsillopharyngitis in Children Population of Nis District

PIH33 - Analysis of Antibiotics’ Use in the Treatment of Tonsillopharyngitis in Children Population of Nis District

Современные представления о тонзиллофарингите

Современные представления о тонзиллофарингите

Современные подходы к диагностике и лечению тонзиллофарингитов (обзор международных руководств)

В статье представлен обзор рекомендаций по лечению тонзиллофарингитов у детей. Уделяется внимание применению нестероидных противовоспалительных препаратов (НПВП) при данной патологии. Подчеркивается, что местное применение НПВП дает возможность решить проблему купирования боли в горле и улучшения качества жизни пациента при инфекционно-воспалительных процессах в ротоглотке, в частности при тонзиллофарингите как вирусного, так и бактериального происхождения.

До питання етіологічної діагностики тонзилофарингітів у дітей

У статті проведений літературний аналіз сучасного стану проблеми ранньої діагностики тонзилофарингітів у дитячому віці, а саме своєчасної етіологічної діагностики захворювання. Висвітлені питання етіології, епідеміології, клініки, диференціальної діагностики, параклінічної діагностики, напрямки лікування тонзилофарингітів у дітей. Основна увага була приділена літературному огляду проблем і сучасним можливостям швидкої етіологічної діагностики тонзиліту в дітей, а також принципам раціональної антибактеріальної терапії та методам профілактики захворювання з позицій доказової медицини. У роботі наголошується на тому, що особливе значення має рання діагностика стрептококової етіології тонзилофарингіту, яка дозволяє на самому початку захворювання призначити обґрунтовану антибактеріальну терапію. Це призведе до скорочення тривалості хвороби, істотного зниження ризику ранніх ускладнень і значного скорочення періоду заразності пацієнта, що, у свою чергу, знижує ймовірність поширення стрептококової інфекції. Золотим стандартом виявлення β-гемолітичного стрептокока з метою призначення антибактеріальної терапії є стрептотест. Використання експрес-тестових систем у клініці дитячих інфекційних хвороб повинно покращити ранню етіологічну діагностику тонзилофарингітів у дітей і тим самим сприяти своєчасному адекватному призначенню лікування, що в кінцевому результаті має значно знизити ризик розвитку ускладнень та сприяти позитивному економічному ефекту.

ORAL III GENERATION CEPHALOSPORIN CEFTIBUTEN IN TREATMENT OF ACUTE TONSILLOPHARYNGITIS AND OTITIS

Tonsillopharyngitis is a common multietiological infectious disease, more often caused by streptococci infection. The development and adoption of oral III generation cephalosporins into clinical practice significantly widened the possibilities of treatment of inflammatoryinfectious diseases, including tonsillopharyngitis. One of the III generation cephalosporins is Ceftibuten (Cedax) — a drug with b-lactam properties, which inhibits bacterial peptidoglycan synthesis. It has relatively long post-antibiotic effect, characterized by high activity in point of majority of enterobacteria, and is very stable to destructive action of -lactamases. It also can be accumulated in tissues, providing high concentration of active substance in inflammation nidus. The therapeutic dose of the drug for adults is 400 mg/day. Ceftibuten is recommended and effectively used in pediatric practice in treatment of tonsillopharyngitis and otitis.

Comparison of short-course (5 day) cefuroxime axetil with a standard 10 day oral penicillin V regimen in the treatment of tonsillopharyngitis

Oral penicillin V given three times daily in doses of 50,000-100,000 IU daily has been the standard treatment for tonsillopharyngitis for the last few decades. These regimens, initially recommended by the American Heart Association, were extrapolated from i.v. dosing with long-acting forms of penicillin which had been shown to prevent post-streptococcal sequelae. More recently, several antibiotics, including cefuroxime axetil, have been shown to be at least as effective as penicillin G in eradicating group A beta-haemolytic streptococci (GABHS) but their influence on post-streptococcal sequelae has never been assessed in a large-scale trial. The German Society for Pediatric Infectious Diseases (DGPI) undertook a large study of culture-proven tonsillopharyngitis involving several agents and included a 1 year follow-up to establish the effect on sequelae. In one arm of this study, cefuroxime 250 mg bid was compared with 50,000 IU penicillin V given in three divided doses. Cefuroxime axetil was more effective than oral penicillin V in eradicating GABHS at the assessment 2-4 days post-treatment (441/490 (90%) patients versus 1196/1422 (84%) patients; P = 0.001). Clinically, the two agents were equivalent in efficacy, and carriage rates were similar (11.1% and 13.8%, respectively) in patients receiving cefuroxime axetil and penicillin V, 7-8 weeks post-treatment. One case of glomerular nephritis occurred in a patient given penicillin V. There were no post-streptococcal sequelae confirmed for patients treated with cefuroxime axetil. The findings confirm the previously reported efficacy of short-course (4-5 day) treatments with cefuroxime axetil and indicate that short-course treatment is comparable to the standard oral penicillin V regimen in preventing post-streptococcal sequelae.

Group A Beta-hemolytic Streptococcal Infections

Group A Beta-hemolytic Streptococcal Infections

Optimum treatment of streptococcal pharyngitis.

Streptococcal pharyngitis is a common infection in children and adolescents. The great majority of these infections are caused by group A beta-haemolytic streptococci. Although the use of penicillins for group A beta-haemolytic streptococcal pharyngitis has reduced the incidence of rheumatic fever, in the past decade several studies of pharyngitis treatment have reported penicillin failure. It has also been suggested that in comparison with the penicillins the cephalosporins are associated with a lower rate of clinical failure. Cephalosporins have drawbacks in cost, administration frequency or adverse effect profile. Moreover, there is the theoretical risk of cross-antigenicity to cephalosporins in penicillin-allergic patients. Erythromycin is a traditional alternative to penicillins, especially in penicillin-allergic patients, for the treatment of tonsillopharyngitis. However, increased resistance as well as failure rates as high as 24.7% have been reported for erythromycin in the treatment of pharyngitis. Therefore oral penicillins, and alternatively oral cephalosporins, should be considered first-line agents for the treatment of culture-confirmed group A beta-haemolytic streptococcal tonsillopharyngitis. Cephalosporins are useful especially for the treatment of recurrent streptococcal tonsillopharyngitis.

A Multicenter Comparative Study of Brodimoprim and Amoxicillin Therapy in the Treatment of Tonsillopharyngitis in Adults

To compare the efficacy and safety of brodimoprim (BDP) with those of amoxicillin (AMX) in patients with acute bacterial pharyngitis/tonsillitis. Randomized controlled study. Hospital and general practices in Austria, Germany and Switzerland. 519 adult patients of both sexes aged 12 to 75 years. Patients were allocated to an 8- to 12-day treatment with BDP (400 mg loading dose followed by 200mg once a day) or AMX (750mg t.i.d). Resolution of clinical signs/symptoms and negative bacterial examination at completion of therapy. Clinical cure/improvement rate of 97.8% and 94.8% in respectively the BDP and the AMX group. Bacterial eradication in 87.7% of the cases treated with BDP and 88.3% of those receiving AMX. Very good/good tolerability in 85.2% BDP- and 82.8% AMX treated patients.