DOI: https://doi.org/10.22263/2312-4156.2017.4.81
Bereznyakov I.G., Levadnaya Y.V.
Antibacterial therapy of tonsillopharyngitis
Kharkov Medical Academy of Post-Graduate Education, Kharkov, Ukraine
Vestnik VGMU. 2017;16(4):81-88.
Abstract.
Acute tonsillopharyngitis is caused mainly by viruses. Among the bacterial pathogens, the greatest importance is attached to β-hemolytic streptococci of group A (BHSA), which account for 5-15% of cases in adults and 20-30% in children. BHSA are the only common pathogens of tonsillopharyngitis, with the isolation of which antibacterial therapy is always administered.
To confirm the streptococcal etiology of tonsillopharyngitis, culture tests of the material obtained from the patient’s throat or rapid testing are used.
Differential diagnosis between viral and bacterial tonsillopharyngitis is difficult. The most famous are Sentor criteria modified by McIsaac. If there are 4 or more points according to McIsaac’s criteria, the probability of streptococcal etiology of BHSA exceeds 50%, and empirical antibacterial therapy is indicated to the patients. In patients with mild to moderate spontaneous resolution of tonsillopharyngitis, alternatives to urgent antibacterial therapy (i.e. administered immediately after making the diagnosis) can be the delayed use of antibiotics.
The antibiotic treatment of patients suffering from tonsillopharyngitis enables about 7 times reduction in the number of peritonsillar abscess cases, the cases of acute otitis media decrease 3,5 times,those of acute rheumatic fever – also 3,5 times.
BHSA retain 100% sensitivity to penicillins. High sensitivity to glycopeptides, oxazolidinones, respiratory fluoroquinolones, co-trimoxazole, macrolides (primarily, 16-membered) is also observed.
In patients without anamnestic indications of an allergy to penicillin, the drugs of choice are amoxicillin in a dose of up to 1,0 g per day for a period of 10 days or a 1-fold intramuscular injection of benzathine benzylpenicillin. In patients with penicillin allergy, oral administration of cephalosporins of the 1st generation, macrolides, clindamycin is recommended.
The routine use of antibiotics after tonsillectomy is not justified.
Key words: tonsillopharygitis, еtiology, antibacterial therapy, pathogens, clinical criteria.
References
1. Bisno AL. Acute pharyngitis. N Engl J Med. 2001 Jan;344(3):205-11.
2. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov;55(10):1279-82. doi: http://dx.doi.org/10.1093/cid/cis847
3. Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical examination. Does this patient have strep throat? JAMA. 2000 Dec;284(22):2912-8.
4. Kuppalli K, Livorsi D, Talati NJ, Osborn M. Lemierre's syndrome due to Fusobacterium necrophorum. Lancet Infect Dis. 2012 Oct;12(10):808-15. doi: http://dx.doi.org/10.1016/S1473-3099(12)70089-0
5. Linder JA. Sore throat: avoid overcomplicating the uncomplicated. Ann Intern Med. 2015 Feb;162(4):311-2. doi: 10.7326/M14-2899
6. Centor RM. Expand the pharyngitis paradigm for adolescents and young adults. Ann Intern Med. 2009 Dec;151(11):812-5. doi: http://dx.doi.org/10.7326/0003-4819-151-11-200912010-00011
7. Centor RM, Atkinson TP, Ratliff AE, Xiao L, Crabb DM, Estrada CA, et al. The clinical presentation of Fusobacterium-positive pharyngitis and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study. Ann Intern Med. 2015 Feb;162(4):241-7. doi: http://dx.doi.org/10.7326/M14-1305
8. Otvagin IV, Sokolov NS. Modern aspects of diagnostics of the infections caused by group A streptococci. Klin Mikrobiologiia Antimikrob Khimioterapiia. 2011;13(3):223-30. (In Russ.)
9. Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1(3):239-46.
10. McIsaac WJ1, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ. 1998 Jan;158(1):75-83.
11. McIsaac WJ1, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA. 2004 Apr;291(13):1587-95. doi: http://dx.doi.org/10.1001/jama.291.13.1587
12. ESCMID Sore Throat Guideline Group; Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012 Apr;18 Suppl 1:1-28. doi: http://dx.doi.org/10.1111/j.1469-0691.2012.03766.x
13. Barnett ML, Linder J1. Antibiotic prescribing to adults with sore throat in the United States, 1997-2010. JAMA Intern Med. 2014 Jan;174(1):138-40. doi: http://dx.doi.org/10.1001/jamainternmed.2013.11673
14. Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2006 Oct;(4):CD000023. doi: http://dx.doi.org/10.1002/14651858.CD000023.pub3
15. Spurling GK, Del Mar CB, Dooley L, Foxlee R, Farley R. Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev. 2013 Apr;(4):CD004417. doi: http://dx.doi.org/10.1002/14651858.CD004417.pub4
16. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2013 Nov;(11):CD000023. doi: http://dx.doi.org/10.1002/14651858.CD000023.pub4
17. Azovskova OV, Ivanchik NV, Dekhnich AV, Krechikova OI, Kozlov RS, Agapova ED, i dr. Dynamics of an antibiotikorezistentnost of respiratory strains Streptococcus pyogenes in Russia during 1999-2009. Klin Mikrobiologiia Antimikrob Khimioterapiia. 2012;14(4):309-21. (In Russ.)
18. Dhiwakar M, Clement WA, Supriya M, McKerrow W. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev. 2010 Jul;(7):CD005607. doi: http://dx.doi.org/10.1002/14651858.CD005607.pub3
Information about authors:
Bereznyakov I.G. – Doctor of Medical Sciences, professor, head of the Chair of Therapy, Kharkov Medical Academy of Post-Graduate Education;
Levadnaya Y.V. – Candidate of Medical Sciences, associate professor of the Chair of Therapy, Kharkov Medical Academy of Post-Graduate Education.
Correspondence address: Ukraine, 61075, Kharkov, 122 Aleksandrovsky ave., Kharkov City General Clinical Hospital No. 25, Chair of Therapy. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Yuliya V. Levadnaya.
