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Rampedi PN, Ogunrombi MO, Adeleke OA. Leading Paediatric Infectious Diseases-Current Trends, Gaps, and Future Prospects in Oral Pharmacotherapeutic Interventions. Pharmaceutics 2024; 16:712. [PMID: 38931836 PMCID: PMC11206886 DOI: 10.3390/pharmaceutics16060712] [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: 03/16/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
Paediatric infectious diseases contribute significantly to global health challenges. Conventional therapeutic interventions are not always suitable for children, as they are regularly accompanied with long-standing disadvantages that negatively impact efficacy, thus necessitating the need for effective and child-friendly pharmacotherapeutic interventions. Recent advancements in drug delivery technologies, particularly oral formulations, have shown tremendous progress in enhancing the effectiveness of paediatric medicines. Generally, these delivery methods target, and address challenges associated with palatability, dosing accuracy, stability, bioavailability, patient compliance, and caregiver convenience, which are important factors that can influence successful treatment outcomes in children. Some of the emerging trends include moving away from creating liquid delivery systems to developing oral solid formulations, with the most explored being orodispersible tablets, multiparticulate dosage forms using film-coating technologies, and chewable drug products. Other ongoing innovations include gastro-retentive, 3D-printed, nipple-shield, milk-based, and nanoparticulate (e.g., lipid-, polymeric-based templates) drug delivery systems, possessing the potential to improve therapeutic effectiveness, age appropriateness, pharmacokinetics, and safety profiles as they relate to the paediatric population. This manuscript therefore highlights the evolving landscape of oral pharmacotherapeutic interventions for leading paediatric infectious diseases, crediting the role of innovative drug delivery technologies. By focusing on the current trends, pointing out gaps, and identifying future possibilities, this review aims to contribute towards ongoing efforts directed at improving paediatric health outcomes associated with the management of these infectious ailments through accessible and efficacious drug treatments.
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Affiliation(s)
- Penelope N. Rampedi
- Department of Clinical Pharmacology and Therapeutics, School of Medicine, Sefako Makgatho Health Science University, Pretoria 0208, South Africa; (P.N.R.); (M.O.O.)
| | - Modupe O. Ogunrombi
- Department of Clinical Pharmacology and Therapeutics, School of Medicine, Sefako Makgatho Health Science University, Pretoria 0208, South Africa; (P.N.R.); (M.O.O.)
| | - Oluwatoyin A. Adeleke
- Preclinical Laboratory for Drug Delivery Innovations, College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
- School of Biomedical Engineering, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 3J5, Canada
- School of Pharmacy, Sefako Makgatho Health Science University, Pretoria 0208, South Africa
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Lau JSY, Korman TM, Woolley I. Life-long antimicrobial therapy: where is the evidence? J Antimicrob Chemother 2019; 73:2601-2612. [PMID: 29873746 DOI: 10.1093/jac/dky174] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The decision to prescribe long-term or 'life-long' antibiotics in patients requires careful consideration by the treating clinician. While several guidelines exist to help assist in this decision, the long-term consequences are yet to be well studied. In this review, we aim to provide a summary of the available evidence for patient populations where long-term antibiotic therapy is currently recommended in clinical practice. We will also discuss the pitfalls of this approach, including medication adverse effects, economic cost and any possible contribution to the emerging epidemic of microbial resistance.
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Affiliation(s)
- Jillian S Y Lau
- Monash University, Clayton, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Tony M Korman
- Monash University, Clayton, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Ian Woolley
- Monash University, Clayton, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
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Types of Aerobic Bacteria Isolated from Iraqi Patients with Acute Tonsillitis and their Susceptibility to Different Antibiotics. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2018. [DOI: 10.22207/jpam.12.4.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nasirian H, TarvijEslami S, Matini E, Bayesh S, Omaraee Y. A clinical decision rule for streptococcal pharyngitis management: An update. J Lab Physicians 2017; 9:116-120. [PMID: 28367027 PMCID: PMC5320874 DOI: 10.4103/0974-2727.199635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Group A streptococcal (GAS) pharyngitis is a common disease worldwide. We aimed to establish a pragmatic program as a clinical decision rule for GAS pharyngitis diagnosis. MATERIALS AND METHODS This article derived from a research project on children aged 6-15 years. Five hundred and seventy-one children met the enrollment criteria on whom throat culture and validities of clinical findings were assessed in positive and negative throat culture groups. RESULTS Positive GAS throat culture group included 99 (17.3%) patients with a positive culture. Negative GAS throat culture group included 472 (82.6%) patients. Exudate or enlarged tender nodes each one had 63% and 68% sensitivity and 31.5% and 37.5% specificity with a high percentage of negative predictive value (NPV) 80.54% and 85.09%, respectively. Sequence test revealed validities of exudate plus enlarged nodes at 43.62% sensitivity and 57.19% specificity with 83% NPV. CONCLUSIONS High NPV of 83% indicated that similar prevalence in the absence of either exudate or enlarged tender lymph nodes. Probability of GAS negative throat cultures among children suspected of GAS pharyngitis was 83% and would correctly not receive inopportune antibiotics.
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Affiliation(s)
- Hosain Nasirian
- Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
| | - Saeedeh TarvijEslami
- Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
| | - Esfandiar Matini
- Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
| | - Seyedehsara Bayesh
- Students' Research Committee, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Yasaman Omaraee
- Department of Ophthalmology, Roskilde Hospital, Roskilde, Denmark
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Yoon YK, Park CS, Kim JW, Hwang K, Lee SY, Kim TH, Park DY, Kim HJ, Kim DY, Lee HJ, Shin HY, You YK, Park DA, Kim SW. Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections. Infect Chemother 2017; 49:326-352. [PMID: 29299900 PMCID: PMC5754344 DOI: 10.3947/ic.2017.49.4.326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 12/20/2022] Open
Abstract
These guidelines were developed as part of the 2016 Policy Research Servicing Project by the Korea Centers for Disease Control and Prevention. A multidisciplinary approach was taken to formulate this guideline to provide practical information about the diagnosis and treatment of adults with acute upper respiratory tract infection, with the ultimate aim to promote the appropriate use of antibiotics. The formulation of this guideline was based on a systematic literature review and analysis of the latest research findings to facilitate evidence-based practice, and focused on key questions to help clinicians obtain solutions to clinical questions that may arise during the care of a patient. These guidelines mainly cover the subjects on the assessment of antibiotic indications and appropriate selection of antibiotics for adult patients with acute pharyngotonsillitis or acute sinusitis.
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Affiliation(s)
- Young Kyung Yoon
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chan Soon Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Wook Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Kyurin Hwang
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Sei Young Lee
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Do Yang Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Hyun Jun Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Dong Young Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Hyun Jong Lee
- Korean Association of Otorhinolaryngologists, Seoul, Korea
| | - Hyun Young Shin
- Korean Association of Family Medicine, Seoul, Korea.,Department of Family Medicine, Myongji Hospital, Seonam University, College of Medicine, Goyang, Korea
| | - Yong Kyu You
- Korean Medical Practitioners Association, Seoul, Korea.,Department of Internal Medicine, Nammoon Medical Clinic, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Shin Woo Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Korean Society for Chemotherapy, Seoul, Korea.,Department of Internal Medicine, Kungpook National University, School of Medicine, Daegu, Korea.
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Eslami ST, Nassirian A, Nassirian H, Hatami E, Sobhani E, Najibpour R. Comparing performance of amoxicillin and intramuscular benzathine penicillin in relieving manifestations of streptococcal pharyngitis in children. Ghana Med J 2015; 48:185-8. [PMID: 25709132 DOI: 10.4314/gmj.v48i4.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare clinical and bacteriologic responses to intramuscular benzathine penicillin G (BPG) and single dose of amoxicillin in Group A streptococcal (GAS) pharyngitis. DESIGN This study included 571 children from 6 to 15 years old age, with pharyngitis, who were admitted to 45 elementary and guidance schools from 7 regions of Education Organization in North-East of Iran, Mashhad. They were screened for enrollment and if he/she presented pharyngitis with clinical criteria of sore throat, erythema, exudate and tender or enlarged anterior cervical lymph nodes. Exclusion criteria included reports of antibiotic use, negative throat culture for GAS and history of allergy to the drugs. Clinical and bacteriologic responses to BPG and once daily orally amoxicillin were considered and compared. RESULTS In the amoxicillin group, treatment failure was more than the penicillin group (18.9% vs. 6.4%, respectively) but the difference was not statistically significant (p < 0.05). Both drugs were significantly effective in reducing pharyngitis manifestations but penicillin was significantly more effective in reducing exudate than amoxicillin. CONCLUSION Our study was in line with studies comparing the two drugs. The results show that once-daily therapy with amoxicillin is as effective as intramuscular benzathine penicillin G for the treatment of GAS pharyngitis, but penicillin was significantly more effective in reducing exudate and concurrent signs vs. amoxicillin.
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Affiliation(s)
- S T Eslami
- Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
| | - A Nassirian
- Department of Library, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - H Nassirian
- Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
| | - E Hatami
- Department of Pathology, Faculty of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - E Sobhani
- Department of Library, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - R Najibpour
- Students' Research Committee, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
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Mazur E, Bochyńska E, Juda M, Kozioł-Montewka M. Empirical validation of Polish guidelines for the management of acute streptococcal pharyngitis in children. Int J Pediatr Otorhinolaryngol 2014; 78:102-6. [PMID: 24290006 DOI: 10.1016/j.ijporl.2013.10.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/22/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Group A Streptococcus (GAS) pharyngitis is currently the only commonly occurring form of acute pharyngitis for which antibiotic therapy is definitely indicated. Polish guidelines advocate the use of modified Centor score (MCS) to assess the probability of GAS pharyngitis. They advise performing throat culture or rapid antigen detection test (RADT) in children with score 2-3 in MCS and treating with antibiotic only those in whom GAS was detected. Negative RADT results should be confirmed by culture. In children with score 4, the guidelines allow to introduce empiric antibiotic therapy. Phenoxymethyl penicillin is recommended as a drug of choice to treat GAS pharyngitis. The aim of our study was to evaluate the accuracy of strategy recommended by Polish guidelines in identifying those children with acute pharyngitis who require antibiotic treatment. Hence, diagnostic values of score 4 in MCS and RADT were assessed using throat culture as a reference standard. Phenoxymethyl penicillin efficacy in GAS eradication and prevention of post-streptococcal complications were estimated as well. METHODS Ninety children between 2 and 15 years of age with acute pharyngitis symptoms suggesting GAS etiology (MCS ≥ 2), participated in our study. At the initial visit MCS was evaluated and two throat swabs were collected to perform RADT and culture. In children with GAS pharyngitis treated with penicillin, microbiological cure was assessed by performing two control throat cultures. Next, children were under observation for 3 months. RESULTS Positive predictive value of score 4 in MCS turned out to be 48.05% (95% CI: 36.5-59.7%). RADT sensitivity, specificity and diagnostic accuracy proved to be 100%, 96%, and 98%, respectively. GAS eradication rate in children treated with penicillin turned out to be 92.5%. No post-streptococcal sequelae occurred in any child in 3-month observation. CONCLUSIONS Empiric antibiotic therapy in children with score 4 in MCS will result in significant overtreatment of those with nonstreptococcal pharyngitis. New generation RADT diagnostic value in GAS detection proved to be equivalent to that of culture, which obviates the need of backup culture in children with negative RADT results. Phenoxymethyl penicillin revealed high eradication efficacy and proved to prevent post-streptococcal sequelae in children with acute GAS pharyngitis.
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Affiliation(s)
- Elżbieta Mazur
- Medical Microbiology Department, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland.
| | - Ewa Bochyńska
- Specjalistyka Czechów Medical Center, ul. Kompozytorów Polskich 8, 20-848 Lublin, Poland
| | - Marek Juda
- Pharmaceutical Microbiology Department, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland
| | - Maria Kozioł-Montewka
- Medical Microbiology Department, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland
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Mazur E. Management of acute streptococcal pharyngitis: still the subject of controversy. CENTRAL EUROPEAN JOURNAL OF MEDICINE 2013; 8:713-719. [PMID: 32215121 PMCID: PMC7089329 DOI: 10.2478/s11536-013-0216-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 05/03/2013] [Indexed: 11/30/2022]
Abstract
Although most cases of acute pharyngitis are viral in origin, antibiotics are overused in its treatment. Streptococcus pyogenes (group A streptococcus, GAS), the principal bacterial pathogen of acute sore throat, is responsible for merely 5-30% of cases. Moreover, GAS pharyngitis is currently the only commonly occurring form of acute pharyngitis for which antibiotic therapy is definitely indicated. Therefore the differentiation between GAS pharyngitis and that of viral etiology is crucial. Accordingly, scientific societies as well as respected advisory bodies in Europe and North America, issued guidelines for the management of acute pharyngitis with the aim of minimizing unnecessary antibiotic prescriptions in its treatment. The aim of this review work is to confront the state of the art in acute GAS pharyngitis diagnosis and treatment with different approaches to its management represented by current European and North American guidelines. Although based on scientific evidence, international guidelines differ substantially in opinions whether GAS pharyngitis diagnosis should be based on microbiological testing, clinical algorithm or a combination of both. On the other hand, some European guidelines consider GAS pharyngitis to be a mild, self-limiting disease that does not require a specific diagnosis or antimicrobial treatment except in high-risk patients. There is an agreement among guidelines that if antibiotic therapy is indicated, phenoxymethyl penicillin should be the drug of choice to treat GAS pharyngitis.
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Affiliation(s)
- Elżbieta Mazur
- Medical Microbiology Department, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland
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Abstract
Although the incidence of acute rheumatic fever and rheumatic heart disease has decreased significantly in regions of the world where antibiotics are easily accessible, there remains a high incidence in developing nations as well as in certain regions where there is a high incidence of genetic susceptibility. These diseases are a function of poverty, low socioeconomic status, and barriers to healthcare access, and it is in the developing world that a comprehensive prevention program is most critically needed. Development of group A streptococcal vaccines has been under investigation since the 1960s and 50 years later, we still have no vaccine. Factors that contribute to this lack of success include a potential risk for developing vaccine-induced rheumatic heart disease, as well as difficulties in covering the many serological subtypes of M protein, a virulence factor found on the surface of the bacterium. Yet, development of a successful vaccine program for prevention of group A streptococcal infection still offers the best chance for eradication of rheumatic fever in the twenty-first century. Other useful approaches include continuation of primary and secondary prevention with antibiotics and implementation of health care policies that provide patients with easy access to antibiotics. Improved living conditions and better hygiene are also critical to the prevention of the spread of group A streptococcus, especially in impoverished regions of the world. The purpose of this article is to discuss current and recent developments in the diagnosis, pathogenesis, and management of rheumatic fever and rheumatic heart disease.
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Affiliation(s)
- Christopher Chang
- Division of Allergy, Asthma and Immunology, Thomas Jefferson University, Nemours/A.I. Dupont Children's Hospital, 1600 Rockland Road, Wilmington, DE 19803, USA.
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Abstract
OBJECTIVE To present the long-term follow-up of children hospitalised for severe rheumatic carditis who were treated with corticosteroids. METHODS This is a retrospective analysis of the outcome of 242 patients with severe rheumatic carditis after discharge from two public hospitals in Niteroi, Brazil. We followed up 118 patients for 4 years or more, with an average of 7.7 years. They were treated with antibiotics to accomplish bacterial eradication and either intravenous methylprednisolone - 40 cases - or oral prednisone - 78 patients - to treat carditis. They were followed up in outpatient clinic. RESULTS Cardiac failure was categorised as classes III and IV according to the New York Heart Association classification. In the intravenous corticosteroid group, 21 cases (52.5%) had isolated mitral valve regurgitation, 12 (30%) had mitral plus aortic involvement, and seven (17.5%) had aortic lesion only. In the oral prednisone group, 45 (58%) had mitral valve regurgitation only, 27 (34%) had mitral plus aortic involvement, and six (8%) had aortic lesion only. A total of 28 children were in their first disease attack, of whom 19 (68%) had a rupture of chordae tendineae. A total of 58 patients (49%) sustained recurrence of carditis because of neglected secondary prophylaxis. In all, 19 cases (16%) underwent cardiac surgery - valve replacement or valvuloplasty. In 33% of the cases, the outcome was favourable - asymptomatic at follow-up. The overall mortality rate was 6.8%. CONCLUSION Many critically ill patients who complied with secondary prophylaxis were left with minor injuries, whereas those who neglected it or abandoned it had serious sequelae. The rate of abandonment and loss to follow-up was very high. Many cases (49%) were re-hospitalised because of carditis recurrence.
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Baltimore RS. Commentary on 'Different antibiotic treatments for group A streptococcal pharyngitis (Review)'. ACTA ACUST UNITED AC 2012; 7:84-85. [PMID: 32313520 PMCID: PMC7163477 DOI: 10.1002/ebch.1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This is a commentary of Cochrane review, published in this issue of EBCH, first published as: van Driel ML, De Sutter AIM, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis (Review). Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.:CD004406. DOI: 10.1002/14651858.CD004406.pub2. Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration
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Affiliation(s)
- Robert S Baltimore
- Department of Pediatrics and Epidemiology, Yale University School of Medicine, New Haven, CT, USA
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Contreras Chova F, Narbona López E, Jerez Calero A. Bacteriología, virosis y micosis. Utilización de antibióticos. MANUAL DE OTORRINOLARINGOLOGÍA INFANTIL 2012. [PMCID: PMC7152313 DOI: 10.1016/b978-84-8086-905-8.50050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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13
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Piñeiro Pérez R, Hijano Bandera F, Alvez González F, Fernández Landaluce A, Silva Rico JC, Pérez Cánovas C, Calvo Rey C, Cilleruelo Ortega MJ. [Consensus document on the diagnosis and treatment of acute tonsillopharyngitis]. An Pediatr (Barc) 2011; 75:342.e1-13. [PMID: 21920830 PMCID: PMC7105079 DOI: 10.1016/j.anpedi.2011.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 07/23/2011] [Accepted: 07/25/2011] [Indexed: 10/25/2022] Open
Abstract
Acute tonsillopharyngitis is one of the most common childhood diseases. Viruses are the most frequent origin. Group A Streptococcus (Streptococcus pyogenes) is the main bacterial cause. A culture or a rapid antigen-detection test of a throat-swab specimen should only be done on the basis of clinical scores, in order to avoid over-diagnosis of bacterial origin and unnecessary antibiotic prescription. The objectives of treatment are: the reduction of symptoms, reduce the contagious period, and prevent local suppurative and systemic complications. Ideally, only confirmed cases should receive antibiotics. If there is no possibility to perform a rapid antigen-detection test, or in some cases if the result is negative, it is recommended to perform a culture and, if there is high suspicious index, to prescribe antibiotics. Penicillin is the treatment of choice, although amoxicillin is also accepted as the first option. Amoxicillin/clavulanate is not indicated in any case as empirical treatment. Macrolides are not a first choice antibiotic, and should be reserved for those patients with immediate penicillin allergy reaction or for the treatment of streptococcal carriers. It is of primordial importance to adapt the prescribing of antibiotics to the scientific evidence.
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Rimoin AW, Hoff NA, Fischer Walker CL, Hamza HS, Vince A, Rahman NA, Andrasevic S, Emam S, Vukelic D, Elminawi N, Ghafar HA, da Cunha ALA, Qazi S, Gardovska D, Steinhoff MC. Treatment of streptococcal pharyngitis with once-daily amoxicillin versus intramuscular benzathine penicillin G in low-resource settings: a randomized controlled trial. Clin Pediatr (Phila) 2011; 50:535-42. [PMID: 21317198 PMCID: PMC6089546 DOI: 10.1177/0009922810394838] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Primary prevention of acute rheumatic fever is achieved by proper antibiotic treatment of group A β -hemolytic streptococcal (GAS) pharyngitis. METHODS To assess noninferiority of oral amoxicillin to intramuscular benzathine penicillin G (IM BPG). Children (2 to 12 years) meeting enrollment criteria were randomized 1:1 to receive antibiotic treatment in 2 urban outpatient clinics in Egypt and Croatia. RESULTS A total of 558 children (Croatia = 166, Egypt = 392) were randomized, with 368 evaluable in an intention-to-treat (ITT) analysis, and 272 evaluable in the per protocol (PP) analysis. In Croatia, ITT and PP treatment success rates were comparable for IM BPG and amoxicillin (2.5% difference vs 1.1% difference, respectively). In Egypt, amoxicillin was not comparable with IM BPG in ITT analysis (15.1% difference), but was comparable in PP analysis (-9.3% difference). CONCLUSION If compliance is a major issue, a single dose of IM BPG may be preferable for treatment of GAS pharyngitis.
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Affiliation(s)
| | | | | | | | - Adriana Vince
- University Hospital for Infectious Diseases, Zagreb, Croatia
| | | | - Sasa Andrasevic
- University Hospital for Infectious Diseases, Zagreb, Croatia
| | | | | | | | | | | | - Shamim Qazi
- World Health Organization, Geneva, Switzerland
| | - Dace Gardovska
- Riga Stradins University and Children’s University Hospital, Riga, Latvia
| | - Mark C. Steinhoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Cincinnati Children’s Hospital, Cincinnati, OH
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