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Gessner A, Klimek L, Kuchar E, Stelzmueller I, Fal AM, Kardos P. Potential Saving of Antibiotics for Respiratory Infections in Several European Countries: Insights from Market Research Data. Antibiotics (Basel) 2023; 12:1174. [PMID: 37508270 PMCID: PMC10376894 DOI: 10.3390/antibiotics12071174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
Antibiotics represent an essential pillar in the treatment of respiratory infections (RI). Overuse of antibiotics in avoidable cases and inappropriate application in bacterial infections facilitate treatment resistance, threatening their effectiveness and causing a significant healthcare challenge. We therefore assessed the savings potential for antibiotics in ambulant care of selected RI (bronchitis and cough, pharyngitis, rhinosinusitis) in several European countries based on market research data for the year 2019. Number of antibiotic packages sold in pharmacies varied, with highest values in Serbia and France, and lowest in Sweden and Switzerland. Selected RI contributed nearly half of overall ambulant antibiotic prescriptions, with around one fifth given for bronchitis and cough; the vast majority was estimated to be of viral origin with potentially avoidable antibiotic use. Antibiotic consumption for selected RI in eight European countries (Austria, Belgium, the Czech Republic, France, Germany, Poland, Slovakia, and Switzerland) amounted to nearly 100 million, with an overall savings potential between 66.2 and 83.7 million packages. The highest estimated volume of avoidable antibiotics was in France (44.7 million, 0.80 per capita), and lowest in Switzerland (1.4 million, 0.18 per capita). Due to substantial savings potential, prudent use of antibiotics and adequate application of alternatives should be promoted in daily practice.
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Affiliation(s)
- André Gessner
- Institute for Clinical Microbiology and Hygiene, University Clinic Regensburg, 93053 Regensburg, Germany
| | - Ludger Klimek
- Centre for Rhinology and Allergology, 65183 Wiesbaden, Germany
| | - Ernest Kuchar
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Ingrid Stelzmueller
- Private Practice for Pulmonology, Internal Medicine and Pneumology, 5020 Salzburg, Austria
| | - Andrzej M Fal
- Department of Allergy, Lung Diseases, and Internal Medicine, Central Clinical Hospital, Ministry of Interior, 02-507 Warsaw, Poland
| | - Peter Kardos
- Lung Centre Frankfurt Maingau-Hospital, 60316 Frankfurt am Main, Germany
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2
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Detection of Oxacillin/Cefoxitin Resistance in Staphylococcus aureus Present in Recurrent Tonsillitis. Microorganisms 2023; 11:microorganisms11030615. [PMID: 36985189 PMCID: PMC10055619 DOI: 10.3390/microorganisms11030615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
Background: Recurrent tonsillitis is one of the most common diseases in childhood, caused many times by ß-lactam-resistant S. aureus. The objective of this study was to investigate an alternative method to identify resistance to oxacillin/cefoxitin in S. aureus from hospitalized children with recurrent tonsillitis. Methods: The samples of S. aureus came from patients with recurrent tonsillitis and were used in 16S rRNA sequencing and an antibiogram test for identification and verifying resistance, after which HSI methodology were applied for separation of S. aureus resistances. Results: The S. aureus isolated showed sensitivity to oxacillin/cefoxitin and the diagnostic images show a visual description of the resistance different groups formed, that may be related to sensitivity and resistance to oxacillin/cefoxitin, characterizing the MRSA S. aureus. Conclusions: Samples that showed phenotypic resistance to oxacillin/cefoxitin were clearly separated from samples that did not show this resistance. A PLS-DA model predicted the presence of resistance to oxacillin/cefoxitin in S. aureus samples and it was possible to observe the pixels classified as MRSA. The HSI was able to successfully discriminate samples in replicas that were sensitive and resistant, based on the calibration model it received.
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Karabela ŞN, Şenoğlu S, Altuntaş Aydin Ö, Baydili KN, Aksu Ö, Kart Yaşar K. Foodborne streptococcal tonsillopharyngitis outbreak in a hospital. Cent Eur J Public Health 2022; 30:225-229. [PMID: 36718924 DOI: 10.21101/cejph.a6027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Group A beta-haemolytic streptococci (GAS), which are responsible for most cases of acute bacterial tonsillopharyngitis, are transmitted from person to person and may rarely cause foodborne outbreaks. This study aims to report the epidemic caused by GAS in our hospital and to draw attention to the explosive outbreaks of the bacteria. METHODS Acute tonsillopharyngitis was seen in 201 of 450 hospital employees who ate in the hospital cafeteria on 4-5 June 2015. RESULTS GAS was detected in 106 (68%) of 157 cases and in 40 (63.5%) of 62 throat culture samples. The attack rate was 44.7%. The most suspected source of the outbreak was a food handler who had been showing signs of streptococcal tonsillopharyngitis for six days, and perhaps the food prepared by these staff. CONCLUSION It should not be forgotten that GAS can cause explosive outbreaks by infecting food through hand lesions or mouth secretions of food service personnel.
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Affiliation(s)
- Şemsi Nur Karabela
- Department of Infection Diseases and Clinical Microbiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sevtap Şenoğlu
- Department of Infection Diseases and Clinical Microbiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özlem Altuntaş Aydin
- Department of Infection Diseases and Clinical Microbiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kürşad Nuri Baydili
- Department of Management and Organization, Vocational School of Health Services, University of Health Sciences, Istanbul, Turkey
| | - Özlem Aksu
- Department of Medical Microbiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kadriye Kart Yaşar
- Department of Infection Diseases and Clinical Microbiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Rahman MM, Alam Tumpa MA, Zehravi M, Sarker MT, Yamin M, Islam MR, Harun-Or-Rashid M, Ahmed M, Ramproshad S, Mondal B, Dey A, Damiri F, Berrada M, Rahman MH, Cavalu S. An Overview of Antimicrobial Stewardship Optimization: The Use of Antibiotics in Humans and Animals to Prevent Resistance. Antibiotics (Basel) 2022; 11:667. [PMID: 35625311 PMCID: PMC9137991 DOI: 10.3390/antibiotics11050667] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Antimicrobials are a type of agent widely used to prevent various microbial infections in humans and animals. Antimicrobial resistance is a major cause of clinical antimicrobial therapy failure, and it has become a major public health concern around the world. Increasing the development of multiple antimicrobials has become available for humans and animals with no appropriate guidance. As a result, inappropriate use of antimicrobials has significantly produced antimicrobial resistance. However, an increasing number of infections such as sepsis are untreatable due to this antimicrobial resistance. In either case, life-saving drugs are rendered ineffective in most cases. The actual causes of antimicrobial resistance are complex and versatile. A lack of adequate health services, unoptimized use of antimicrobials in humans and animals, poor water and sanitation systems, wide gaps in access and research and development in healthcare technologies, and environmental pollution have vital impacts on antimicrobial resistance. This current review will highlight the natural history and basics of the development of antimicrobials, the relationship between antimicrobial use in humans and antimicrobial use in animals, the simplistic pathways, and mechanisms of antimicrobial resistance, and how to control the spread of this resistance.
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Affiliation(s)
- Md. Mominur Rahman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Mst. Afroza Alam Tumpa
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Mehrukh Zehravi
- Department of Clinical Pharmacy Girls Section, Prince Sattam Bin Abdul Aziz University, Alkharj 11942, Saudi Arabia;
| | - Md. Taslim Sarker
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Md. Yamin
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Md. Rezaul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Md. Harun-Or-Rashid
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Muniruddin Ahmed
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Sarker Ramproshad
- Department of Pharmacy, Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh; (S.R.); (B.M.)
| | - Banani Mondal
- Department of Pharmacy, Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh; (S.R.); (B.M.)
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata 700073, India;
| | - Fouad Damiri
- Labortory of Biomolecules and Organic Synthesis (BioSynthO), Department of Chemistry, Faculty of Sciences Ben M’Sick, University Hassan II of Casablanca, Casablanca 20000, Morocco; (F.D.); (M.B.)
| | - Mohammed Berrada
- Labortory of Biomolecules and Organic Synthesis (BioSynthO), Department of Chemistry, Faculty of Sciences Ben M’Sick, University Hassan II of Casablanca, Casablanca 20000, Morocco; (F.D.); (M.B.)
| | - Md. Habibur Rahman
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
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Hsu CJ, Wong LC, Lee WT. Immunological Dysfunction in Tourette Syndrome and Related Disorders. Int J Mol Sci 2021; 22:ijms22020853. [PMID: 33467014 PMCID: PMC7839977 DOI: 10.3390/ijms22020853] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/28/2022] Open
Abstract
Chronic tic disorder and Tourette syndrome are common childhood-onset neurological diseases. However, the pathophysiology underlying these disorders is unclear, and most studies have focused on the disinhibition of the corticostriatal–thalamocortical circuit. An autoimmune dysfunction has been proposed in the pathogenetic mechanism of Tourette syndrome and related neuropsychiatric disorders such as obsessive–compulsive disorder, autism, and attention-deficit/hyperactivity disorder. This is based on evidence from animal model studies and clinical findings. Herein, we review and give an update on the clinical characteristics, clinical evidence, and genetic studies in vitro as well as animal studies regarding immune dysfunction in Tourette syndrome.
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Affiliation(s)
- Chia-Jui Hsu
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan;
| | - Lee-Chin Wong
- Department of Pediatrics, Cathay General Hospital, Taipei 106, Taiwan;
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Wang-Tso Lee
- Department of Pediatric Neurology, National Taiwan University Children’s Hospital, Taipei 100, Taiwan
- Department of Pediatrics, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456 (ext. 71545); Fax: +886-2-2314-7450
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Katkowska M, Garbacz K, Kopala W, Schubert J, Bania J. Genetic diversity and antimicrobial resistance of Staphylococcus aureus from recurrent tonsillitis in children. APMIS 2019; 128:211-219. [PMID: 31692060 DOI: 10.1111/apm.13007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022]
Abstract
The aim of this study was to analyze the prevalence of Staphylococcus aureus in the tonsils of children subjected tonsillectomy due to recurrent tonsilitis and to determine the spa types of the pathogens, carriage of virulence genes and antimicrobial resistance profiles. The study included 73 tonsillectomized children. Bacteria, including S. aureus were isolated from tonsillar surface prior to tonsillectomy, recovered from tonsillar core at the time of the surgery, and from posterior pharynx 2-4 weeks after the procedure. Staphylococcus aureus isolates were compared by spa typing, tested for antimicrobial susceptibility and for the presence of superantigenic toxin genes (sea-seu, eta, etb, tst, lukS/lukF-PV) by multiplex polymerase chain reaction. Seventy-three patients (mean 7.1 ± 4.1 years, 61.6% male) were assessed. The most commonly isolated bacteria were S. aureus. The largest proportion of staphylococcal isolates originated from tonsillar core (63%), followed by tonsillar surface (45.1%) and posterior pharynx in tonsillectomized children (18.2%, p = 0.007). Five (6.3%) isolates were identified as MRSA (mecA-positive). Up to 67.5% of the isolates synthesized penicillinases (blaZ-positive isolates), and 8.8% displayed MLSB resistance. The superantigenic toxin genes were detected in more than half of examined isolates (56.3%). spa types t091, t084, and t002, and clonal complexes (CCs) CC7, CC45, and CC30 turned out to be most common. Staphylococcus aureus associated with RT in children showed pathogenicity potential and considerable genetic diversity, and no clones were found to be specific for this condition although further studies are needed.
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Affiliation(s)
- Marta Katkowska
- Department of Oral Microbiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Garbacz
- Department of Oral Microbiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Wacław Kopala
- Voivodeship Specialist Children's Hospital, Olsztyn, Poland
| | - Justyna Schubert
- Department of Food Hygiene and Consumer Health Protection, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Jacek Bania
- Department of Food Hygiene and Consumer Health Protection, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
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7
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Voitl P, Meyer R, Woditschka A, Sebelefsky C, Böck A, Schneeberger V. Occurrence of patients compared in a pediatric practice and pediatric hospital outpatient clinic. J Child Health Care 2019; 23:512-521. [PMID: 31129994 DOI: 10.1177/1367493519853431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The frequency of consultations and the waiting times in pediatric hospital outpatient clinics are steadily increasing. The aim of this study was to compare the occurrence of patients in a large pediatric group practice and a hospital-based general pediatric outpatient clinic. Primary parameters were the most common reasons for consultation, the waiting times and the reasons for selecting a certain institution. Most frequent diagnoses in the pediatric practice were upper respiratory tract infections (22.7% (n = 141/621)), otitis media (5.2% (n = 32/621)), and viral pharyngitis (3.9% (n = 24/621)). Most common reasons for consultation in the hospital outpatient clinic were upper respiratory tract infections (18.4% (n = 121/658)) and bacterial pharyngitis (17.9% (n = 118/658)). In the pediatric practice, bacterial pharyngitis was only diagnosed in 3.1% (n = 19/621) of the cases. Only slight differences exist between the two institutions regarding the observed entities, which mainly comprise mild to moderate acute illnesses. It can be concluded from this that the majority of patients might as well be treated in the nonhospital setting. Facilitating the communication and coordination between practices and hospitals might allow a better utilization of capacities. Thereby, waiting times, unnecessary reexaminations, and costs in the health-care system could be reduced.
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Affiliation(s)
- Peter Voitl
- First Vienna Pediatric Medical Center, Vienna, Austria
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8
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Wollein Waldetoft K, Brown SP. Alternative therapeutics for self-limiting infections-An indirect approach to the antibiotic resistance challenge. PLoS Biol 2017; 15:e2003533. [PMID: 29283999 PMCID: PMC5746204 DOI: 10.1371/journal.pbio.2003533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Alternative therapeutics for infectious diseases is a top priority, but what infections should be the primary targets? At present there is a focus on therapies for severe infections, for which effective treatment is most needed, but these infections are hard to manage, and progress has been limited. Here, we explore a different approach. Applying an evolutionary perspective to a review of antibiotic prescription studies, we identify infections that likely make a large contribution to resistance evolution across multiple taxa but are clinically mild and thus present easier targets for therapeutics development. Alternative therapeutics for these infections, we argue, would save lives indirectly by preserving the high efficacy of existing antibiotics for the patients who need them the most.
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Affiliation(s)
- Kristofer Wollein Waldetoft
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- * E-mail:
| | - Sam P. Brown
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States of America
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9
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Sum R, Swaminathan M, Rastogi SK, Piloto O, Cheong I. Beta-Hemolytic Bacteria Selectively Trigger Liposome Lysis, Enabling Rapid and Accurate Pathogen Detection. ACS Sens 2017; 2:1441-1451. [PMID: 28929742 DOI: 10.1021/acssensors.7b00333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For more than a century, blood agar plates have been the only test for beta-hemolysis. Although blood agar cultures are highly predictive for bacterial pathogens, they are too slow to yield actionable information. Here, we show that beta-hemolytic pathogens are able to lyse and release fluorophores encapsulated in sterically stabilized liposomes whereas alpha and gamma-hemolytic bacteria have no effect. By analyzing fluorescence kinetics, beta-hemolytic colonies cultured on agar could be distinguished in real time with 100% accuracy within 6 h. Additionally, end point analysis based on fluorescence intensity and machine-extracted textural features could discriminate between beta-hemolytic and cocultured control colonies with 99% accuracy. In broth cultures, beta-hemolytic bacteria were detectable in under an hour while control bacteria remained negative even the next day. This strategy, called beta-hemolysis triggered-release assay (BETA) has the potential to enable the same-day detection of beta-hemolysis with single-cell sensitivity and high accuracy.
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Affiliation(s)
- Rongji Sum
- Department
of Molecular Pathogenesis, Temasek Life Sciences Laboratory, Singapore 117604, Singapore
| | - Muthukaruppan Swaminathan
- Department
of Molecular Pathogenesis, Temasek Life Sciences Laboratory, Singapore 117604, Singapore
- Department
of Biological Sciences, National University of Singapore, Singapore 117558, Singapore
| | - Sahil Kumar Rastogi
- Department
of Molecular Pathogenesis, Temasek Life Sciences Laboratory, Singapore 117604, Singapore
| | | | - Ian Cheong
- Department
of Molecular Pathogenesis, Temasek Life Sciences Laboratory, Singapore 117604, Singapore
- Department
of Biological Sciences, National University of Singapore, Singapore 117558, Singapore
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10
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Chang LY, Lai CC, Chen CJ, Cho CY, Luo YC, Jeng MJ, Wu KG. Recent trends in prescribing antibiotics for acute tonsillitis in pediatric ambulatory care in Taiwan, 2000–2009: A nationwide population-based study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:500-506. [DOI: 10.1016/j.jmii.2015.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/05/2015] [Accepted: 08/27/2015] [Indexed: 11/17/2022]
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Zacharioudaki ME, Galanakis E. Management of children with persistent group A streptococcal carriage. Expert Rev Anti Infect Ther 2017; 15:787-795. [PMID: 28730858 DOI: 10.1080/14787210.2017.1358612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Chronic GAS carrier state is best defined as the prolonged presence of group A β-haemolytic Streptococcus (GAS) in the pharynx without evidence of infection or inflammation. Chronic GAS carriers have a low risk of immune mediated complications. Persistent pharyngeal carriage often raises management issues. In this study, we review the evidence on the management of persistent GAS carriage in children and propose a management algorithm. Areas covered: Chronic GAS pharyngeal carriage is quite common affecting 10-20% of school-aged children. Pathogenesis of carriage has been related to the pharynx microflora and to special properties of GAS, but several aspects are yet to be elucidated. Management greatly depends on whether the individual child belongs to a 'high-risk' group and might benefit from eradication regimens or not, when observation-only and reassurance are enough. Penicillin plus rifampin and clindamycin monotherapy have been recommended for eradication; limited evidence of effectiveness of azithromycin has been reported. Surgical intervention is not indicated. Expert commentary: GAS infection is a common reason for antibiotic use and abuse in children and asymptomatic carriers constitute the major reservoir of GAS in the community. Several aspects are yet to be elucidated and well-designed studies are needed for firm conclusions to be drawn.
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Affiliation(s)
- Maria E Zacharioudaki
- a Department of Paediatrics, School of Medicine , University of Crete , Heraklion , Greece
| | - Emmanouil Galanakis
- a Department of Paediatrics, School of Medicine , University of Crete , Heraklion , Greece
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12
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Bacteriology and antibiotic sensitivity of tonsillar diseases in Chinese children. Eur Arch Otorhinolaryngol 2017; 274:3153-3159. [DOI: 10.1007/s00405-017-4603-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022]
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Point-Counterpoint: A Nucleic Acid Amplification Test for Streptococcus pyogenes Should Replace Antigen Detection and Culture for Detection of Bacterial Pharyngitis. J Clin Microbiol 2016; 54:2413-9. [PMID: 27440817 DOI: 10.1128/jcm.01472-16] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Nucleic acid amplification tests (NAATs) have frequently been the standard diagnostic approach when specific infectious agents are sought in a clinic specimen. They can be applied for specific agents such as S. pyogenes, or commercial multiplex NAATs for detection of a variety of pathogens in gastrointestinal, bloodstream, and respiratory infections may be used. NAATs are both rapid and sensitive. For many years, S. pyogenes testing algorithms used a rapid and specific group A streptococcal antigen test to screen throat specimens, followed, in some clinical settings, by a throat culture for S. pyogenes to increase the sensitivity of its detection. Now S. pyogenes NAATs are being used with increasing frequency. Given their accuracy, rapidity, and ease of use, should they replace antigen detection and culture for the detection of bacterial pharyngitis? Bobbi Pritt and Robin Patel of the Mayo Clinic, where S. pyogenes NAATs have been used for well over a decade with great success, will explain the advantages of this approach, while Richard (Tom) Thomson and Tom Kirn of the NorthShore University HealthSystem will discuss their concerns about this approach to diagnosing bacterial pharyngitis.
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14
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Systematic review of factors contributing to penicillin treatment failure in Streptococcus pyogenes pharyngitis. Otolaryngol Head Neck Surg 2016; 137:851-857. [DOI: 10.1016/j.otohns.2007.07.033] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 07/06/2007] [Accepted: 07/25/2007] [Indexed: 11/21/2022]
Abstract
Objective Review the evidence for various explanations for microbiologic treatment failure following use of penicillin in group A streptococcal (GAS) tonsillopharyngitis. DATA SOURCE Systematic review of the literature based on Medline and EMBASE searches, and review of reference lists of included studies. RESULTS The explanations for penicillin treatment failure in GAS tonsillopharyngitis include 1) carrier state, 2) lack of compliance, 3) recurrent exposure, 4) in vivo copathogenicity of β-lactamase–producing normal pharyngeal flora, 5) in vivo bacterial coaggregation, 6) poor antibiotic penetration to tonsillopharyngeal tissue, 7) in vivo eradication of normal protective flora, 8) early initiation of antibiotic therapy resulting in suppression of an adequate host immune response, 9) intracellular localization of GAS, 10) GAS tolerance to penicillin, 11) contaminated toothbrushes or orthodontic appliances, and 12) transmission from the family pet. There is very little type I or II evidence to support any of the above-cited explanations for treatment failure in GAS tonsillopharyngitis; available studies are mostly observational (in patients) or laboratory-based without clinical confirmation. CONCLUSION Multiple explanations have been offered by investigators to explain penicillin treatment failures in GAS tonsillopharyngitis, but the evidence base to support the proposed explanations is generally weak by current standards. Further research is needed to better understand the mechanism(s) of penicillin treatment failure in GAS tonsillopharyngitis.
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Saleh N, Awada S, Awwad R, Jibai S, Arfoul C, Zaiter L, Dib W, Salameh P. Evaluation of antibiotic prescription in the Lebanese community: a pilot study. Infect Ecol Epidemiol 2015; 5:27094. [PMID: 26112266 PMCID: PMC4481048 DOI: 10.3402/iee.v5.27094] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 11/16/2022] Open
Abstract
Background Antibiotics are considered among the most commonly prescribed drug classes in developing countries. Inappropriate prescription of antibiotics is a major public health concern and is related to the development of antimicrobial resistance. Objective This study aimed at assessing the appropriateness of antibiotic prescription by non-infectious disease physicians in a community setting in Lebanon. Methods A pilot cross-sectional study was undertaken on community pharmacy patients presenting with antibiotic prescription. It was performed over a period of 4 months in different regions of Lebanon. Participants answered a questionnaire inquiring about socio-demographic characteristics, medical conditions, symptoms that required medical attention, the doctor's diagnosis, the prescribed antibiotic, and whether laboratory tests were ordered to identify the causative organism or not. Data were analyzed using SPSS 17. Results We studied 270 patients (49.3% males and 50.7% females). This study showed that the most-prescribed antibiotics were the cephalosporins (82%) and that almost half of the illnesses for which antibiotics were prescribed were respiratory tract infections (41%). The study also showed that the choice of the prescribed antibiotic was appropriate in 61.5% of the studied cases, while the prescribed dose and the duration of the treatment were inaccurate in 52 and 64% of the cases, respectively. In addition, fever seemed to be a factor that influenced the physician's prescriptions, since the choice of drug conformity to guidelines increased from 53.7% (1 day of fever) to 88.9% (1 week of fever), and the dose prescription compliance to guidelines was higher (55.9%) for patients suffering from fever compared to those with no fever (38.1%). Conclusion This study showed a high prevalence of inappropriate antibiotic prescriptions in Lebanon. Therefore, actions should be taken to optimize antibiotic prescription.
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Affiliation(s)
- Nadine Saleh
- Epidemiology & Biostatistics Department, Faculty of Public Health II, Lebanese University, Beirut, Lebanon
| | - Sanaa Awada
- Clinical & Epidemiological Research Laboratory, Master & Research Department, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Rana Awwad
- Clinical & Epidemiological Research Laboratory, Master & Research Department, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Sahar Jibai
- Clinical & Epidemiological Research Laboratory, Master & Research Department, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Chadi Arfoul
- Clinical & Epidemiological Research Laboratory, Master & Research Department, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Liliana Zaiter
- Clinical & Epidemiological Research Laboratory, Master & Research Department, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Wissam Dib
- Clinical & Epidemiological Research Laboratory, Master & Research Department, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Pascale Salameh
- Epidemiology & Biostatistics Department, Faculty of Public Health II, Lebanese University, Beirut, Lebanon.,Clinical & Epidemiological Research Laboratory, Master & Research Department, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon;
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Rosenberg P, McIsaac W, Macintosh D, Kroll M. Diagnosing streptococcal pharyngitis in the emergency department: Is a sore throat score approach better than rapid streptococcal antigen testing? CAN J EMERG MED 2015; 4:178-84. [PMID: 17609003 DOI: 10.1017/s1481803500006357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTBackground:Reducing the number of unnecessary antibiotic prescriptions given for common respiratory infections has been recommended as a way to limit bacterial resistance. This study assessed the validity of a clinical sore throat score in 2 community emergency departments (EDs) and its impact on antibiotic prescribing. We also attempted to improve on this approach by using a rapid streptococcal antigen test.Methods:A total of 126 patients with new upper respiratory tract infections accompanied by sore throat were assessed by a physician. Pharyngeal swabs were obtained for a rapid test and throat culture, and information was gathered to determine the sore throat score. The sensitivity and specificity of the score approach were compared with usual physician care based on the rapid test results.Results:Of the 126 cases of new upper respiratory infections with sore throat, physicians who followed their usual care routine, guided by the rapid test results, prescribed antibiotics for 46 patients. Of the 46 prescriptions, 18 were given to patients with culture-negative results for group A streptococcal (GAS) pharyngitis. Use of the sore throat score would not have reduced the number of prescriptions but would have missed only 1 patient with a positive culture result (p< 0.05). The rapid test was not as sensitive as throat culture.Conclusions:An explicit clinical score approach to the management of GAS pharyngitis is valid in a community ED setting and could improve the pattern of antibiotic prescribing. While the addition of a rapid streptococcal antigen test significantly decreased the sensitivity of detecting GAS infections, a combined approach consisting of the clinical score and throat culture for patients with negative results on the rapid test would decrease antibiotic prescribing and telephone follow-up without decreasing the sensitivity of detecting GAS infection.
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Affiliation(s)
- Paul Rosenberg
- Department of Emergency Medicine, Etobicoke Campus of William Osler Health Centre, Toronto, Ontario, Canada
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Abstract
The objective of the present work was to summarize the available literature data concerning the importance of and prospects for for the application of bacteriophages for the treatment of the most common diseases of the upper respiratory tract and the ear.
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Affiliation(s)
- E V Nosulya
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 125367
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Branch J, Kakutani T, Kuroda S, Shiba Y, Kitagawa I. Pasteurella multocida Infective Endocarditis: A Possible Link with Primary Upper Respiratory Tract Infection. Intern Med 2015; 54:3225-31. [PMID: 26666618 DOI: 10.2169/internalmedicine.54.4973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 50-year-old Japanese man presented with fever and upper respiratory tract symptoms that required urgent inpatient admission. A physical examination revealed conjunctival hemorrhages and peripheral embolic phenomena. Blood cultures grew Pasteurella multocida, and an echocardiography revealed a mitral valve vegetation suggestive of infective endocarditis (IE), which was confirmed using the Modified Duke Criteria. After several antibiotic regimens proved ineffective, valve replacement was performed, with a good eventual outcome. P. multocida IE is rare and may sometimes have no preceding risk factors. P. multocida infections of the upper respiratory tract are unusual but may be an inciting event for IE. It is essential to check blood cultures and to repeat the performance of physical examinations to appreciate the developing features of IE.
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Affiliation(s)
- Joel Branch
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan
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Yildizoglu U, Polat B, Gumral R, Kilic A, Tosun F, Gerek M. Effect of antibiotic use on bacterial flora of tonsil core in patients with recurrent tonsillitis. Eur Arch Otorhinolaryngol 2014; 272:1525-8. [PMID: 25510984 DOI: 10.1007/s00405-014-3434-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/04/2014] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the effects of commonly used antibiotics on bacterial flora of the tonsil core. Patients who underwent tonsillectomy for recurrent chronic tonsillitis were included in the study. Three groups were formed: group 1 was treated for 10 days preoperatively with amoxicillin/clavulanic acid; group 2 was treated for 10 days preoperatively with clarithromycin; and group 3 included patients who underwent tonsillectomy without preoperative antibiotic use. The removed palatine tonsils were sent to our microbiology department in sterile tubes for bacteriological analysis. Seventy-three patients (group 1 = 19, group 2 = 20, group 3 = 34 patients) aged 3-18 years (mean 7 years) were included in the study. At least one bacterium was isolated from all tonsils, except for two cases in group 1; the difference in single bacterial growth among groups was not significant (p = 0.06). On the other hand, the numbers of patients with pathogenic bacterial growth was significantly lower in group 2 (n = 2) compared with group 1 (n = 10) and group 3 (n = 27) (p < 0.001). The bacterium isolated most frequently from the tonsils was Streptococcus viridans. Pseudomonas aeruginosa was the only pathogenic bacterium that grew in all three groups. Clarithromycin was more effective than amoxicillin/clavulanic acid in eradicating pathogenic bacteria in the tonsil core. Pseudomonas aeruginosa might be responsible for resistant or recurrent tonsil infections. To prevent endocarditis, antibiotic prophylaxis toward S. viridians, which is the most prevalent bacterium in the tonsil core, should be kept in mind for patients with heart valve damage.
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Affiliation(s)
- Uzeyir Yildizoglu
- Department of Otorhinolaryngology Head and Neck Surgery, Beytepe Military Hospital, Cankaya, 06800, Ankara, Turkey,
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Barbosa Júnior AR, Oliveira CDL, Fontes MJF, Lasmar LMDLBF, Camargos PAM. [Diagnosis of streptococcal pharyngotonsillitis in children and adolescents: clinical picture limitations]. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2014; 32:285-91. [PMID: 25510990 PMCID: PMC4311780 DOI: 10.1016/j.rpped.2014.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/18/2014] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To assess the utility of clinical features for diagnosis of streptococcal pharyngotonsillitis in pediatrics. METHODS A total of 335 children aged 1-18 years old and presenting clinical manifestations of acute pharyngotonsillitis (APT) were subjected to clinical interviews, physical examinations, and throat swab specimen collection to perform cultures and latex particle agglutination tests (LPATs) for group A streptococcus (GAS) detection. Signs and symptoms of patients were compared to their throat cultures and LPATs results. A clinical score was designed based on the multivariate logistic regression analysis and also was compared to throat cultures and LPATs results. Positive throat cultures and/ or LPATs results were used as a reference standard to establish definitive streptococcal APT diagnosis. RESULTS 78 children (23.4%) showed positivity for GAS in at least one of the two diagnostic tests. Coryza absence (odds ratio [OR]=1.80; p=0.040), conjunctivitis absence (OR=2.47; p=0.029), pharyngeal erythema (OR=3.99; p=0.006), pharyngeal exudate (OR=2.02; p=0.011), and tonsillar swelling (OR=2.60; p=0.007) were significantly associated with streptococcal pharyngotonsilitis. The highest clinical score, characterized by coryza absense, pharyngeal exudate, and pharyngeal erythema had a 45.6% sensitivity, a 74.5% especificity, and a likelihood ratio of 1.79 for streptococcal pharyngotonsilitis. CONCLUSIONS Clinical presentation should not be used to confirm streptococcal pharyngotonsilitis, because its performance as a diagnostic test is low. Thus, it is necessary to enhance laboratory test availability, especially of LPATs that allow an acurate and fast diagnosis of streptococcal pharyngotonsilitis.
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Barbosa Júnior AR, Oliveira CDL, Fontes MJF, Lasmar LMDLBF, Camargos PAM. Diagnosis of streptococcal pharyngotonsillitis in children and adolescents: clinical picture limitations. REVISTA PAULISTA DE PEDIATRIA 2014. [DOI: 10.1590/s0103-05822014000400002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To assess the utility of clinical features for diagnosis of streptococcal pharyngotonsillitis in pediatrics.METHODS: A total of 335 children aged 1-18 years old and presenting clinical manifestations of acute pharyngotonsillitis (APT) were subjected to clinical interviews, physical examinations, and throat swab specimen collection to perform cultures and latex particle agglutination tests (LPATs) for group A streptococcus (GAS) detection. Signs and symptoms of patients were compared to their throat cultures and LPATs results. A clinical score was designed based on the multivariate logistic regression analysis and also was compared to throat cultures and LPATs results. Positive throat cultures and/or LPATs results were used as a reference standard to establish definitive streptococcal APT diagnosis.RESULTS: 78 children (23.4%) showed positivity for GAS in at least one of the two diagnostic tests. Coryza absence (odds ratio [OR]=1.80; p=0.040), conjunctivitis absence (OR=2.47; p=0.029), pharyngeal erythema (OR=3.99; p=0.006), pharyngeal exudate (OR=2.02; p=0.011), and tonsillar swelling (OR=2.60; p=0.007) were significantly associated with streptococcal pharyngotonsilitis. The highest clinical score, characterized by coryza absense, pharyngeal exudate, and pharyngeal erythema had a 45.6% sensitivity, a 74.5% especificity, and a likelihood ratio of 1.79 for streptococcal pharyngotonsilitis.CONCLUSIONS: Clinical presentation should not be used to confirm streptococcal pharyngotonsilitis, because its performance as a diagnostic test is low. Thus, it is necessary to enhance laboratory test availability, especially of LPATs that allow an acurate and fast diagnosis of streptococcal pharyngotonsilitis.
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Sarrell EM, Giveon SM. Streptococcal pharyngitis: a prospective study of compliance and complications. ISRN PEDIATRICS 2012; 2012:796389. [PMID: 22778988 PMCID: PMC3388424 DOI: 10.5402/2012/796389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 04/28/2012] [Indexed: 11/23/2022]
Abstract
Background. Uncertainty exists concerning the necessity of 10-day antibiotic treatment of group A beta hemolytic streptococcus (GABHS) pharyngitis. Objective. To assess the incidence of GABHS recurrence and suppurative and nonsuppurative complications in relation to compliance. Methods. (Design). Prospective cohort observational study. (Subjects). 2,000 children aged 6 months to 18 years with sore throat and positive GABHS culture. (Main Outcome Measures). Recurrence of symptomatic culture positive GABHS pharyngitis, incidence of suppurative, and long-term, regional, nonsuppurative complications of GABHS pharyngitis, over a ten year period. Results. 213 (11%) of the children received no treatment. Most children received antibiotics for only 4-6 days (in correlation with the duration of fever, which in most cases lasted up to 3 days). Three hundred and six (15.3%) children had clinically diagnosed recurrent tonsillopharyngitis; 236 (12.3%) had positive GABHS findings within 10 to 14 days and thirty-four (1.7%) within 21-30 days after the index positive GABHS culture. The remaining 1.3% had no positive culture despite the clinical findings. Almost all recurrences [236 (11.6%)] occurred within 14 days and 156 (7.6%) in the fully treated group. The presence of fever during the first 3 days of the disease was the most significant predictor for recurrence. Other predictors were the age younger than 6 years and the presence of cervical lymphadenitis. No increase in the incidence of nonsuppurative or suppurative complications was noted during the 10-year follow-up period, compared to the past incidence of those complications in Israel. Conclusions. Our data suggests that the majority of children discontinue antibiotics for GABHS tonsillopharyngitis a day or two after the fever subsides. The incidence of complications in our study was not affected by this poor compliance.
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Affiliation(s)
- E. Michael Sarrell
- Pediatric and Adolescent Ambulatory Community Clinics-Clalit Health Care Services, 128 Alozorov Street, Tel-Aviv, Israel
- IPROS Network of the Israel Ambulatory Pediatrics Association, Israel Ambulatory Pediatric Association, Tel-Aviv, Israel
| | - Shmuel M. Giveon
- Department of Family Practice, Clalit Health Services HMO, Sharon-Shomron District and Department of Family Practice, Tel-Aviv University, Tel-Aviv, Israel
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Pham V, Gungor A. Bilateral peritonsillar abscess: case report and literature review. Am J Otolaryngol 2012; 33:163-7. [PMID: 21371779 DOI: 10.1016/j.amjoto.2010.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 12/20/2010] [Indexed: 11/29/2022]
Abstract
Although uncommon, bilateral peritonsillar abscess (PTA) may still present with symptoms found in unilateral cases but lack hallmark findings such as an asymmetric tonsillar bulge and uvular deviation. We present the case of an 18-year-old woman deemed to have a bilateral PTA based on physical examination and radiographic imaging. She underwent successful surgical drainage with needle aspiration, followed by incision and drainage. A computed tomography with intravenous contrast should be obtained when a patient displays signs suggestive of a bilateral PTA but the diagnosis is not certain. To our knowledge, this is the first report of 2 different bacterial species cultured from contralateral abscesses during the same encounter.
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Affiliation(s)
- Viet Pham
- The University of Texas Medical Branch, Department of Otolaryngology, Galveston, TX 77555-0521, USA.
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Gamboa Mutuberría J, Sistiaga Suárez JA, Wills Villarraga D, Rivera Rodríguez T. Enfermedades inflamatorias laríngeas y faríngeas del adulto. Medicine (Baltimore) 2011; 10:6190-6198. [PMID: 32287894 PMCID: PMC7143595 DOI: 10.1016/s0304-5412(11)70240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- J Gamboa Mutuberría
- Servicio de Otorrinolaringología. Hospital Universitario Príncipe de Asturias. Universidad de Alcalá. Alcalá de Henares. Madrid. España
| | - J A Sistiaga Suárez
- Servicio de Otorrinolaringología. Hospital Universitario Príncipe de Asturias. Universidad de Alcalá. Alcalá de Henares. Madrid. España
- CIBERER
| | - D Wills Villarraga
- Servicio de Otorrinolaringología. Hospital Universitario Príncipe de Asturias. Universidad de Alcalá. Alcalá de Henares. Madrid. España
| | - T Rivera Rodríguez
- Servicio de Otorrinolaringología. Hospital Universitario Príncipe de Asturias. Universidad de Alcalá. Alcalá de Henares. Madrid. España
- CIBERER
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Llor C, Madurell J, Balagué-Corbella M, Gómez M, Cots JM. Impact on antibiotic prescription of rapid antigen detection testing in acute pharyngitis in adults: a randomised clinical trial. Br J Gen Pract 2011; 61:e244-51. [PMID: 21619748 PMCID: PMC3080229 DOI: 10.3399/bjgp11x572436] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 09/03/2010] [Accepted: 10/22/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Acute pharyngitis is one of the most frequent reasons for a GP consultation, and in most cases an antibiotic is prescribed. AIM To determine the impact of rapid antigen detection testing (RADT) to identify group A beta haemolytic streptococcus in acute pharyngitis on the utilisation of antibiotics and appropriateness of their use. DESIGN AND SETTING Cluster randomised controlled trial in primary care centres in Catalonia, Spain. METHOD Patients with acute pharyngitis aged 14 years or older with at least one Centor criterion (fever, tonsillar exudate, tender enlarged anterior cervical lymph nodes, or absence of cough) were recruited. Participant physicians were randomly assigned to one of two study arms: an intervention group (assigned to RADT) and a control group (following usual care, without RADT). RESULTS Of the 557 adults enrolled, 543 could be evaluated for analysis (281 [51.7%] in the intervention group and 262 [48.3%] in the control group). GPs without access to RADT were more likely to prescribe antibiotics compared with those who performed rapid tests (64.1% versus 43.8%, P<0.001). The more Centor criteria the patients presented, the greater the number of antibiotics prescribed, regardless of whether RADT was available (P<0.001). Antibiotics were prescribed in 30.7% of the cases with negative RADT results. Inappropriate antibiotic prescription was observed in 226 cases (43%), and was significantly greater in the control than in the intervention group (60% versus 26.9%; P<0.001). CONCLUSION Even though more than 30% of negative RADT results resulted in antibiotic prescribing, the study findings support the use of RADT in the consultation. This strategy has an important impact on reducing antibiotic prescription among adults with acute pharyngitis.
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Affiliation(s)
- Carl Llor
- Primary Healthcare Centre Jaume I, Tarragona, University Rovira I Virgili, Spain.
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Adherence of families to a group a streptococcal pharyngitis protocol used in a pediatric emergency department. Pediatr Emerg Care 2011; 27:374-8. [PMID: 21494166 DOI: 10.1097/pec.0b013e318216b216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In an effort to limit inappropriate antibiotic use for children with pharyngitis, our pediatric emergency department (PED) has implemented a strep throat protocol using preprinted prescriptions given to families pending pharyngeal swab results. We sought to determine the rate of adherence of families managed with this protocol and to identify whether clinical features are associated with adherence. METHODS We conducted a prospective cohort study of children aged 2 to 17 years presented to the PED with suspected group A streptococcal (GAS) pharyngitis. Prescription-filling activity was tracked using a novel carbon-copy prescription and compared with throat swab result. Health records were reviewed for demographic and clinical information. Adherence was defined as prescriptions being filled after notification of a positive swab result and prescriptions not being filled when throat swab result was negative. RESULTS Three hundred nine children were screened for GAS pharyngitis. One hundred swabs (32.4%) were positive for GAS pharyngitis, of which 15 prescriptions were filled before swab results. No record of prescription filling was found for 37 of the children with positive swab results. Only 9 families (4.3%) filled the prescription when the swab result was negative. Overall, 247 families (80.2%) were adherent to the protocol. Families of children aged 2 to 5 years were more likely to be adherent than those aged 13 to 17 years (odds ratio, 3.5; 95% confidence interval, 1.15-10.66). CONCLUSIONS Most families are adherent to our GAS pharyngitis protocol. Very few families filled prescriptions when the swab result was negative. Age was the only factor influencing adherence. Our current GAS pharyngitis protocol is an effective management strategy for children presenting with pharyngitis to the PED.
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Omurzakova NA, Yamano Y, Saatova GM, Alybaeva MS, Nishioka K, Nakajima T. Prevalence of Group A b-Hemolytic Streptococcus Among Children with Tonsillopharyngitis in Kyrgyzstan: The Difficulty of Diagnostics and Therapy. Open Rheumatol J 2010; 4:39-46. [PMID: 21253454 PMCID: PMC3023070 DOI: 10.2174/1874312901004010039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/05/2010] [Accepted: 07/16/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Rheumatic fever (RF) is well known disease as a result of frequent complication of the group A b-hemolytic streptococcal (GABHS) tonsillopharyngitis, have noticeably grown for the last 15 years among young generation in the Kyrgyz Republic. It is important to hold a study about the prevalence of RF and GABHS and their susceptibility to antibiotics in the Kyrgyz Republic. MATERIALS AND METHODS We have studied 200 children with chronic tonsillopharyngitis at the National Center of Pediatrics and Child Surgery in Bishkek (the Kyrgyz Republic) from August till September 2008. 188 (48 out of them are with RF) out of total 200 children are Kyrgyz and 12 are Russian (2 out of them are with RF). 111 out of total are female (34 out of them are with RF) and 89 are male (17 out of them are with RF). The average age of the subjects is 10.9±6.0 (from 3 to 17 years old). The presence of GABHS was assessed using two ways: by the rapid antigen detection test (RADT) for outcrop of streptococcus antigen in smear from mucosal surface of tonsils, and by bacterial culture analysis (BA). RADT was used to determine its specificity and sensitivity in order to recommend practitioners its further wide use. Furthermore, the discovered culture of GABHS have been investigated on susceptibility to antibiotics by disc-diffusion method. RESEARCH RESULTS: GABHS antigen was positive in 72 (36.0 %) subjects from RADT and in 80 (40.0%) subjects from BA out of 200 total subjects. In the patients with RF (n=51), GABHS was positive in 18 (35.2%) subjects by RADT and in 24 (47.0%) subjects by BA. In the subjects without RF (n=149), GABHS was positive in 54 (36.2%) subjects by RADT and in 56 (37.5%) by BA. Among 80 GABHS positive results sensitive to antibiotics were: to penicillin only 10 (12.5%), to ampicillin-29 (36.2%), to amoxicillin-36 (45.0%), to ceftriaxon - 31 (38.7%), to roxithromycin - 21 (26.2%), to erythromycin- 19 (23.7%). It is noted that 21 (26.2%) GABHS positive results were absolutely resistant for all these tested antibiotics. RADT showed that its specificity is 85% as well as its sensitivity is equal to 67.5%. CONCLUSION In this study the sensitivity of RADT was low; therefore, the negative results of RADT don't exclude presence of GABHS. High prevalence of GABHS antigen demonstrates not only in patients with RF, but also among healthy children (without RF) of the Kyrgyz Republic. The high prevalence of GABHS at children with RF (47.0%), probably, presents a low sensitivity to antibiotics and irregular secondary prophylaxis. Significant presence of GABHS among healthy children (37.5%) requires improvement of primary prevention to prevent further spread of RF and Rheumatic Heart Disease (RHD) in the country.
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Neri G, Citraro L, Martinotti S, Tomato E, Castriotta A, De Rosa M, Pignatelli GF, Croce A. The Role of Atypical Microorganisms in Chronic Oropharyngeal Phlogosis. EUR J INFLAMM 2010. [DOI: 10.1177/1721727x1000800310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The recurrent or chronic “non specific pharyngitis” is one of the most common complaints of adults treated in an outpatient setting and it is a disease without a certain aetiology, but with many probable causes which can be of bacterial or viral nature, but incidence of atypical microorganism infection, such as Chlamydia trachomatis (Ct), Mycoplasma hominis (Mh) and Ureaplasma urealyticum (Uu) is believed to be on the rise. The increase is correlated above all to sexual behavior and to diffusion of new microbiological diagnostic methods, such as PCR. From 840 patients affected by recurrent episodes of chronic pharyngeal phlogosis and examined from 2006 to 2008, we selected 67 patients, 37 women and 30 men. On the basis of molecular and cultural analysis, 85.07% of patients were positive to Ct, and 89.55% were positive to Mollicutes (Mh+Uu), showing a vast overlapping of co-infections of Uu and Mh. Our data indicated a higher rate of infection by atypical microorganism in selected patients affected by chronic pharyngitis. It is important to suspect this aetiology during recurrent chronic pharingitis because patients with these oropharingeal infections, must be considered as carriers and the correct treatment, only possible after exact diagnosis, is above all necessary to prevent fearful complications in other body areas.
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Affiliation(s)
| | - L. Citraro
- Postgraduate School of Otolaryngology, G. d'Annunzio University Chieti-Pescara, Chieti
| | - S. Martinotti
- Oncology and Experimental Medicine Department, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - E. Tomato
- Oncology and Experimental Medicine Department, G. d'Annunzio University Chieti-Pescara, Chieti, Italy
| | - A. Castriotta
- Postgraduate School of Otolaryngology, G. d'Annunzio University Chieti-Pescara, Chieti
| | - M. De Rosa
- Postgraduate School of Otolaryngology, G. d'Annunzio University Chieti-Pescara, Chieti
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Madurell J, Balagué M, Gómez M, Cots JM, Llor C. Impact of rapid antigen detection testing on antibiotic prescription in acute pharyngitis in adults. FARINGOCAT STUDY: a multicentric randomized controlled trial. BMC FAMILY PRACTICE 2010; 11:25. [PMID: 20331895 PMCID: PMC2859488 DOI: 10.1186/1471-2296-11-25] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 03/23/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Acute pharyngitis is one of the most frequent consultations to the general practitioner and in most of the cases an antibiotic is prescribed in primary care in Spain. Bacterial etiology, mainly by group A beta-hemolytic streptococcus (GABHS), accounts for 10-20% of all these infections in adults. The purpose of this study is to assess the impact of rapid antigen detection testing (RADT) to identify GABHS in acute pharyngitis on the utilization of antibiotics in primary care. METHODS/DESIGN Multicentric randomized controlled trial in which antibiotic prescription between two groups of patients with acute pharyngitis will be compared. The trial will include two arms, a control and an intervention group in which RADT will be performed. The primary outcome measure will be the proportion of inappropriate antibiotic prescription in each group. Two hundred seventy-six patients are required to detect a reduction in antibiotic prescription from 85% in the control group to 75% in the intervention group with a power of 90% and a level of significance of 5%. Secondary outcome measures will be specific antibiotic treatment, antibiotic resistance rates, secondary effects, days without working, medical visits during the first month and patient satisfaction. DISCUSSION The implementation of RADT would allow a more rational use of antibiotics and would prevent adverse effects of antibiotics, emergence of antibiotic resistance and the growth of inefficient health expenses.
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Affiliation(s)
- Jordi Madurell
- Primary Healthcare Center Hostalric, Institut d'Assistència Sanitària de Girona, Breda-Hostalric, Spain
| | - Montse Balagué
- Primary Healthcare Center, Centre Penitenciari d'Homes. Catalonian Institute of Health, Barcelona, Spain
| | - Mónica Gómez
- Primary Healthcare Center Doctor Josep Torner i Fors, Salut Maresme, Malgrat de Mar, Spain
| | - Josep M Cots
- Primary Healthcare Center La Marina. University of Barcelona, Barcelona, Spain
| | - Carl Llor
- Primary Healthcare Center Jaume I. University Rovira i Virgili, Tarragona, Spain
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Segal N, El-Saied S, Puterman M. Peritonsillar abscess in children in the southern district of Israel. Int J Pediatr Otorhinolaryngol 2009; 73:1148-50. [PMID: 19481820 DOI: 10.1016/j.ijporl.2009.04.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 04/28/2009] [Accepted: 04/30/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Peritonsillar abscess is the most common deep neck infection and still provides a challenge to care givers in terms of diagnosis and treatment in the pediatric population. This study reviews our experience over the years 2004-2007 at the Soroka University Medical Center in the southern district of Israel in treating children with peritonsillar abscess. We compared our results with data regarding peritonsillar abscess in adults. METHODS We performed a retrospective chart review of 126 children diagnosed and proved to have a peritonsillar abscess. Data regarding: age, sex, ethnicity, number of patients per year, seasonality, prior history of tonsillar infection, prior antibiotic treatment, length of hospitalization, surgical treatment, bacterial results and in hospital antibiotic treatment was collected from the medical charts of the patients. RESULTS The average age of children with peritonsillar abscess was 12.8 years. 92 patients (73%) were above 10 years of age. We did not find an increase in the number of children with peritonsillar abscess per year over the time period of the study. The number of patients with peritonsillar abscess was significantly higher in the autumn and spring, 79 (62.6%) patients did not have prior history of tonsillar infections and 64 (67.4%) children were treated with antibiotics prior to the diagnosis of an abscess. In 95 (75.4%) patients the drainage method was needle aspiration, in 30 (28.3%) patients incision and drainage was performed and only one patient underwent bilateral quinsy tonsillectomy (0.8%). The bacterial culture was negative in 37 (36.7%) patients. In 29 patients (45% of positive cultures) the causative organism was Streptococcus group A. Mixed culture was present in 10 (15.6%) patients, nine cultures (14%) were positive for anaerobes, alone or in combination with other pathogens. Eighty-one patients (64.2%) were treated with amoxicillin-clavulanate potassium, 24 (19%) received cefuroxime and 17 (13.5%) were treated with cefuroxime+ metronidazole. The average hospital stay was 3 days. CONCLUSION Peritonsillar abscess, a potentially life threatening infection, is similar in presentation and bacteriology in the pediatric and the adult population. Based on our review we conclude that peritonsillar abscess in children can be effectively treated by the same methods used in the adult population.
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Affiliation(s)
- Nili Segal
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, Ben Gurion University of the Negev, Israel.
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Are clinical scoring systems for the diagnosis of group A beta-hemolytic streptococci pharyngitis useful? South Med J 2007; 100:1187. [PMID: 18090957 DOI: 10.1097/smj.0b013e31815a94e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Diagnosis of Group A β-Hemolytic Streptococcus Using the Breese Clinical Scoring System. South Med J 2007; 100:1192-7. [DOI: 10.1097/smj.0b013e31815a94a8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Casey JR, Pichichero ME. Symptomatic relapse of group A beta-hemolytic streptococcal tonsillopharyngitis in children. Clin Pediatr (Phila) 2007; 46:307-10. [PMID: 17475987 DOI: 10.1177/0009922806293919] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The frequency of symptomatic relapses following various antibiotic treatments for group A beta-hemolytic streptococcal tonsillopharyngitis was evaluated in 1080 pediatric patients. Within 5 days of completing therapy, the rank-order frequency of treatment failures was (1) penicillin, (2) amoxicillin, (3) first-generation cephalosporins, (4) beta-lactamase stable cephalosporins and amoxicillin-clavulanate ( P = .005). Retreatment of symptomatic failures resulted in another symptomatic relapse more often with penicillin than with cephalosporins (P = .02). Clinicians should be aware that the rate of symptomatic failures after antibiotic therapy for group A beta-hemolytic streptococcal tonsillopharyngitis differs by drug and is not an uncommon event.
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Affiliation(s)
- Janet R Casey
- University of Rochester School of Medicine, Elmwood Pediatric Group, Rochester, New York, USA.
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34
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Fox JW, Cohen DM, Marcon MJ, Cotton WH, Bonsu BK. Performance of rapid streptococcal antigen testing varies by personnel. J Clin Microbiol 2006; 44:3918-22. [PMID: 16971645 PMCID: PMC1698329 DOI: 10.1128/jcm.01399-06] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rapid carbohydrate antigen tests are frequently used to diagnose group A streptococcal (GAS) pharyngitis. Despite evidence of modest sensitivity in medical settings, rapid antigen tests are available to the public for self-testing. We sought to determine if the personnel performing a rapid streptococcal antigen test influence the test's performance characteristics. Throat swabs of pediatric patients performed for GAS pharyngitis in a tertiary-care children's hospital network were included during two study periods in 2004 and 2005. The performance characteristics of a rapid carbohydrate antigen test were evaluated in three clinical settings against a nucleic acid probe test method according to the personnel performing the test (laboratory technologist versus nonlaboratory personnel). Between the study periods, nonlaboratory personnel from one site underwent retraining. Subsequently, the performance characteristics of the rapid antigen test were reassessed. The sensitivity of the rapid antigen test varied widely among the different testing sites (56 to 90%). Notably, test sensitivity was consistently greater when the test was performed by laboratory technologists than when it was performed by nonlaboratory personnel (P < 0.0001). Although the rapid antigen test sensitivity significantly improved after nonlaboratory personnel at one testing site were retrained (sensitivity before versus after retraining; P < 0.0001), the sensitivity remained greater in the laboratory technologist cohort (P < 0.0001). These data confirm the important relationship of the operator performing a rapid streptococcal antigen test with the test's accuracy, even in a clinical setting, where operator training is mandated. Therefore, its use outside the medical setting by lay persons cannot be recommended without culture backup.
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Affiliation(s)
- James W Fox
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Akron, Akron, Ohio 44308, USA.
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35
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Abstract
Pneumococcal conjugate vaccine use has caused a decrease in the incidence of recurrent and refractory acute otitis media in the United States and a shift in the predominant pathogens. Now Haemophilus influenzae is the most commonly isolated organism (about 60% of the total), and more than half the strains make beta-lactamase, rendering them resistant to amoxicillin. Penicillin nonsusceptible pneumococci, the main target of antibiotic therapy in the 1990s, has become a much less common isolate (10%- 25% of the total). These changes impact antibiotic selection for acute otitis media. Penicillin treatment of group A streptococcal tonsillopharyngitis does not meet the minimum United States Food and Drug Administration standards for first-line treatment, which is 85% or greater eradication at the end of therapy. Recent results with amoxicillin suggest its efficacy is also waning. Cephalosporins have the highest bacteriologic and clinical efficacy. This has implications for optimal antibiotic therapy.
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Affiliation(s)
- Michael E Pichichero
- Department of Microbiology and Immunology, Pediatrics and Medicine, University of Rochester Medical Center, Elmwood Pediatric Group, Rochester, New York 14642, USA
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36
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Blumer JL, Reed MD, Kaplan EL, Drusano GL. Explaining the poor bacteriologic eradication rate of single-dose ceftriaxone in group a streptococcal tonsillopharyngitis: a reverse engineering solution using pharmacodynamic modeling. Pediatrics 2005; 116:927-32. [PMID: 16199703 DOI: 10.1542/peds.2004-2294] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore pharmacokinetic factors underlying the poor bacteriologic eradication rate with a single 500-mg dose of ceftriaxone for streptococcal tonsillopharyngitis and to identify the minimum ceftriaxone dose required for effective treatment. METHODS Population modeling techniques were applied to pharmacokinetic data derived from paired plasma and tonsil samples from 153 children to assess the contribution of pharmacokinetic variability to patients' responses to ceftriaxone. In addition, a Monte Carlo simulation was performed to determine (1) the amount of time that free ceftriaxone concentrations must exceed the minimum inhibitory concentration (MIC) of group A Streptococcus to achieve bacteriologic eradication and (2) the ceftriaxone dose required to maintain free drug concentrations above the target MIC for the requisite amount of time. Ceftriaxone MICs for group A Streptococcus were obtained from a previous trial, in which all MICs (n = 115) were < or = 0.064 mg/L; 33.9% were susceptible at < or = 0.016 mg/L, 66.4% were susceptible at 0.032 mg/L, and 1.7% were susceptible at 0.064 mg/L. RESULTS Mean population pharmacokinetic parameters and their variances reflected substantial variability of clearance and half-life in the target population. Tonsillar ceftriaxone protein binding was 89.1%. The proportions of 1000 simulated patients with free ceftriaxone concentrations that exceeded MICs of 0.016 mg/L, 0.032 mg/L, and 0.064 mg/L at 24 hours were 71.7%, 65.4%, and 57.2%, respectively, and at 48 hours were 41.8%, 35.8%, and 28.6%, respectively. The amount of time that free ceftriaxone concentrations need to exceed MIC to achieve bacteriologic success was estimated to be 36 hours. Using this time criterion, two 500-mg doses of ceftriaxone separated by 18 hours should achieve a bacteriologic cure rate of approximately 95%. CONCLUSIONS Pharmacokinetic variability and high ceftriaxone tonsillar protein binding explain the high microbiologic failure rate for a single 500-mg dose of ceftriaxone in group A streptococcal tonsillopharyngitis. Monte Carlo simulation suggests that a second dose administered 18 hours after the first will be required to achieve an acceptable bacteriologic cure rate.
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Affiliation(s)
- Jeffrey L Blumer
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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37
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Bourbeau PP. Role of the microbiology laboratory in diagnosis and management of pharyngitis. J Clin Microbiol 2003; 41:3467-72. [PMID: 12904340 PMCID: PMC179871 DOI: 10.1128/jcm.41.8.3467-3472.2003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paul P Bourbeau
- Division of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania 17822-0131, USA.
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38
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Rush C, Simon MW. The effect of amoxicillin-clavulanate, cefixime and azithromycin on normal throat flora in children with group A streptococcal pharyngitis. Clin Pediatr (Phila) 2003; 42:447-9. [PMID: 12862350 DOI: 10.1177/000992280304200511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carol Rush
- Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA
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39
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Del Carmen Trojavchich M, Crisci CD, Shafa M, Rybicki BA. Relationship between group A beta-hemolytic streptococcal tonsillopharyngitis and asthma. Pediatr Allergy Immunol 2003; 14:50-4. [PMID: 12603711 DOI: 10.1034/j.1399-3038.2003.02070.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Increasing morbidity due to asthma in children and antimicrobial resistance among human pathogens are both major public-health concerns. Frequent use of antibiotics during childhood might be a factor underlying the rising severity and prevalence of asthma and other allergic disorders. The objective of the study was to determine if pediatric patients with asthma or allergic rhinitis have an altered rate of group A beta hemolytic streptococcal (GABHS) tonsillopharyngeal infection which might support any change in guidelines for antibiotic prescription. A prospective analysis of all patients presenting a clinical feature of GABHS pharyngitis with a sore throat in two pediatric clinics located in Detroit, MI, USA and San Antonio de Areco, Buenos Aires, Argentina. Eligible patients aged between 2 and 18 years were screened for the presence of asthma and/or allergic rhinitis and administered a test (rapid strep test) and throat culture to determine GABHS infection. At the Redford Medical Center, Detroit, 500 patients met the eligibility criteria, with 168 (33.6%) having a positive strep test. At the San Antonio de Areco's Hospital, in a rural area 100 km away from Buenos Aires, 188 patients met the eligibility criteria, with 41 (21.8%) having a positive strep test or GABHS throat cultures. In both the Detroit [odds ratio (OR) = 1.36; 95% confidence interval (CI) 0.72-2.57] and Buenos Aires clinics (OR = 0.50; 95% CI 0.23-1.07), patients with asthma or allergic rhinitis were not at an increased risk for true GABHS tonsillopharyngeal infections when compared with the general pediatric population. These results suggest that children with asthma do not differ from the normal population in their risk of developing GABHS tonsillopharyngeal infection and should not be liberally prescribed antibiotics.
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40
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Evans P, Miser WF. Sinusitis and Pharyngitis. Fam Med 2003. [DOI: 10.1007/978-0-387-21744-4_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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41
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Esposito S, Marchisio P, Bosis S, Droghetti R, Mattina R, Principi N. Comparative efficacy and safety of 5-day cefaclor and 10-day amoxycillin treatment of group A streptococcal pharyngitis in children. Int J Antimicrob Agents 2002; 20:28-33. [PMID: 12127708 DOI: 10.1016/s0924-8579(02)00118-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A total of 384 children with group A beta-haemolytic streptococcal (GABHS) pharyngitis were randomized to receive either 40 mg/kg/day of cefaclor in two doses for 5 days (192 patients), or 40 mg/kg/day of amoxycillin in three doses for 10 days (192 patients). The signs and symptoms of pharyngitis were recorded and throat cultures were obtained at presentation and on days 6-7, 11-15, 16-20 and 28-35. Patient compliance was significantly higher in the children treated with cefaclor (100 vs. 95.1%; P = 0.003). At the end of follow-up, the percentage of clinical success was 91.4% for cefaclor and 91.9% for amoxycillin (P = 0.974); bacteriological success was obtained in 85.7 and 89.6% children (P = 0.348), respectively. Both treatments were well-tolerated with adverse event rates of 8.3% in the cefaclor group and 9.4% in the amoxcillin group (P = 0.857). Our study shows that five days' treatment with cefaclor is as effective and safe as the conventional 10-day course of amoxycillin in the treatment of GABHS pharyngitis, but compliance seems to be significantly greater.
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Affiliation(s)
- Susanna Esposito
- Pediatric Department I, University of Milan, Via Commenda 9, 20122 Milan, Italy
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42
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Characterization of Arcanobacterium haemolyticum isolates originating from pneumonic piglets, the first isolates from piglet lungs in Yugoslavia. ACTA VET-BEOGRAD 2002. [DOI: 10.2298/avb0204223s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Affiliation(s)
- H M Corneli
- Primary Children's Medical Center and Department of Pediatrics, University of Utah College of Medicine, Salt Lake City, Utah, USA.
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Bycroft TC, O'Connor T, Hoff C, Bohannon A. When choosing injectable penicillin for the treatment of group A beta-hemolytic streptococcal pharyngitis, there is a less painful choice. Pediatr Emerg Care 2000; 16:398-400. [PMID: 11138880 DOI: 10.1097/00006565-200012000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether injection of patients with Bicillin CR is less painful than injection with Bicillin LA. To discover if Bicillin CR with the addition of procaine, which doubles the volume, causes the injection to be less painful. DESIGN An experimental, double-blinded crossover design was used for this study. SETTING University children's and women's tertiary care emergency Department (ED) with an annual pediatric census of 22,000. PARTICIPANTS A convenience sample was enrolled from the student body of a large university and house staff, and employees of a 152 bed children's and women's hospital in southern Alabama. The sample size was limited to 50 participants, all of whom completed the study. METHODS Each participant received two penicillin injections, one Bicillin CR and one Bicillin LA, and rated the pain of the injection immediately after the injection, 1 hour after the injection and 12 hours after the injection. A visual analogue scale was the tool used for measuring the pain. The penicillin injections were randomized using a random number generator. RESULTS For each of the three periods, comparisons of pain were made between the Bicillin CR versus Bicillin LA injections. Bicillin LA pain score values were consistently higher for all but the 12-hour comparison. These differences were statistically significant (P < 0.008-0.002). CONCLUSIONS Injection of Bicillin CR with the addition of procaine to the benzathine penicillin G is statistically significantly less painful than the injection of Bicillin LA without the addition of procaine to the benzathine penicillin G, even though the Bicillin LA is one-half the volume of the Bicillin CR due to the addition of procaine to the Bicillin CR.
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Affiliation(s)
- T C Bycroft
- Children and Women's Hospital, Mobile, Alabama, USA.
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45
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Pichichero ME. Judicious use of antibiotics in pediatric respiratory infections 2000. Pediatr Infect Dis J 2000; 19:909-10. [PMID: 11001125 DOI: 10.1097/00006454-200009000-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M E Pichichero
- Elmwood Pediatric Group, University of Rochester, NY 14642, USA.
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46
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Pichichero ME, Casey JR, Mayes T, Francis AB, Marsocci SM, Murphy AM, Hoeger W. Penicillin failure in streptococcal tonsillopharyngitis: causes and remedies. Pediatr Infect Dis J 2000; 19:917-23. [PMID: 11001127 DOI: 10.1097/00006454-200009000-00035] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Penicillin administered for 10 days has been the treatment of choice for group A beta-hemolytic streptococcal tonsillopharyngitis since the 1950s. The bacteriologic failure rate of 10 days of penicillin therapy ranged from approximately 2 to 10% until the early 1970s. Beginning in the late 1970s bacteriologic and clinical failure rates with penicillin therapy began to increase steadily over time and are now reported to be approximately 30%. The primary cause of penicillin treatment failure in streptococcal tonsillopharyngitis may be lack of compliance with the 10-day therapeutic regimen. Other causes of penicillin treatment failure include reexposure to Streptococcus-infected family members or peers; copathogenicity, in which bacteria susceptible to a class of drugs are protected by other, colocalized bacterial strains that lack the same susceptibility; antibiotic-associated eradication of normal protective pharyngeal flora; and penicillin tolerance, whereby streptococcal bacteria repeatedly or continuously exposed to sublethal concentrations of antibiotic become increasingly resistant to eradication. Although 10 days of penicillin therapy is effective in the management of tonsillopharyngitis for many patients, multiple factors may, singly or together, cause treatment failure. A number of antibiotics, particularly the cephalosporins, have been demonstrated to be superior to penicillin at eradicating group A beta-hemolytic Streptococcus, and several are effective when administered for 4 to 5 days. CONCLUSIONS Ten days of penicillin therapy may not be the best therapeutic choice for all pediatric patients. Other antibiotics, shortened courses of the cephalosporins in particular, may be preferable in some cases.
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Affiliation(s)
- M E Pichichero
- Elmwood Pediatric Group, University of Rochester, NY 14642, USA.
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47
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Brooker C, Kamien M, Ward AM. Differences in teaching about the acute sore throat within one medical faculty. MEDICAL EDUCATION 2000; 34:269-274. [PMID: 10733723 DOI: 10.1046/j.1365-2923.2000.00507.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To examine the consistency of teaching about the acute sore throat in four departments in one medical faculty, and to determine whether there is agreement between what is taught and the evidence-based literature. DESIGN Cross-sectional study. SUBJECTS 71 undergraduates and 15 postgraduate general practice registrars and four lecturers. RESULTS Differences were identified in teaching about the diagnostic value of a throat swab, a full blood count and clinical scoring, as well as on the use of penicillin in suspected streptococcal pharyngitis. Only one department based their teaching on the evidence-based literature. No department discussed issues of cost-effectiveness. Half of the students identified discrepancies in the teaching about the sore throat and were initially confused by them. CONCLUSION One method of resolving disagreement between teachers from different disciplines is to rely on the evidence-based literature. This type of study can be useful in curricular development and in correcting teaching inconsistencies within a faculty.
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Affiliation(s)
- C Brooker
- Department of General Practice, University of Western Australia, Western Australia, Australia
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48
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Badgett JT, Hesterberg LK. Management of group A streptococcus pharyngitis with a second-generation rapid strep screen: Strep A OIA. Microb Drug Resist 2000; 2:371-6. [PMID: 9158797 DOI: 10.1089/mdr.1996.2.371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Empirical therapy of presumed group A streptococcus (GAS) pharyngitis leads to unnecessary and inappropriate use of antibiotics and pressure for emergence of resistant strains of common bacteria. Immunoassay technology has produced several rapid tests for GAS. The wide variations in diagnosis and treatment of acute pharyngitis are reviewed including the impact of rapid strep tests. Published studies comparing Strep A OIA to routine agar culture and other rapid strep screens are presented to assess the reliability and applicability of this novel assay. These data suggest that Strep A OIA may be superior to the "gold standard" throat culture and other rapid streptococcal antigen detection assays. Judicious use of Strep A OIA can result in rapid, precise diagnoses and eliminate unnecessary and inappropriate use of antibiotics. Careful antibiotic selection can reduce the pressure for emergence of resistant bacteria. This innovative, effective assay can contribute to a lessening of this serious clinical challenge.
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Affiliation(s)
- J T Badgett
- Department of Pediatrics, University of Louisville School of Medicine, Kentucky 40492, USA
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49
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Hayden SR, Brown MD. Likelihood ratio: A powerful tool for incorporating the results of a diagnostic test into clinical decisionmaking. Ann Emerg Med 1999; 33:575-80. [PMID: 10216335 DOI: 10.1016/s0196-0644(99)70346-x] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S R Hayden
- Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, CA 92103, USA
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50
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Carbon C, Bax RP. Regulating the use of antibiotics in the community. BMJ (CLINICAL RESEARCH ED.) 1998; 317:663-5. [PMID: 9728001 PMCID: PMC1113840 DOI: 10.1136/bmj.317.7159.663] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- C Carbon
- Hospital Bichat, Claude Bernard, 75877 Paris Cedex 18, France.
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