Effects of different extracts of Dendrobium officinale on rats with chronic pharyngitis induced by pepper water combined with ammonia / 中国中药杂志

Dendrobium officinale can serve as Chinese medicinal material effective in nourishing yin, clearing heat, and producing fluid, and is used to treat throat diseases, but its active substances and mechanism are not clear. To clarify the active fraction and underlying mechanism of D. officinale against chronic pharyngitis(CP), the present study induced a CP model in rats by pepper water combined with low-concentration ammonia, and crude polysaccharides of D. officinale(DOP), non-polysaccharides of D. officinale(DON), and total extract of D. officinale(DOT)(0.33 g·kg~(-1), calculated according to the crude drug) were administered by gavage for six weeks. The changes in oral secretions and pharyngeal conditions of rats with CP were observed and rated. The hematological indicators were determined by an automatic hematology analyzer. The serum levels of pro-inflammatory factors, such as tumor necrosis factor-alpha(TNF-α), interleukin 1β(IL-1β), and interleukin 6(IL-6), and T-lymphocyte cytokines, including interferon γ(IFN-γ), interleukin 4(IL-4), interleukin 17(IL-17), and transforming growth factor β1(TGF-β1) were detected by the enzyme-linked immunosorbent assay(ELISA). The proportions of CD3~+, CD4~+, and CD8~+cells in peripheral blood T lymphocyte subsets were determined by the flow cytometry. The histomorphological changes of the pharynx were observed by hematoxylin-eosin(HE) staining. The protein expression of nuclear factor-κB P65(NF-κB P65), cyclooxygenase-2(COX-2), F4/80, and monocyte chemoattractant protein-1(MCP-1) in the pharynx were detected by immunohistochemistry and Western blot. The results showed that DOP and DON could significantly relieve pharyngeal lesions, reduce white blood cells(WBC) and lymphocytes(LYMP), decrease the levels of pro-inflammatory factors TNF-α, IL-6, and IL-1β, and inhibit the protein expression of NF-κB P65, COX-2, F4/80, and MCP-1 in the pharynx. DOP was superior in reducing oral secretions and serum IL-17 level and inferior in increasing CD4~+/CD8~+ratio to DON. It is suggested that both polysaccharides and non-polysaccharides of D. officinale have anti-PC effects and the anti-inflammatory mechanism may be related to the regulation of T lymphocyte distribution and inhibition of the inflammatory signaling pathways mediated by NF-κB P65. The anti-inflammatory effect of DOP may be related to the regulation of Th17/Treg balance, while that of DON may be related to the regulation of the Th/Tc ratio.

Influence of acupoint application on clinical use of antibiotics: a real world study of 1.23 million primary clinic patients / 中国针灸

OBJECTIVE@#To observe the influence of acupoint application on the use of antibiotics in primary clinic practice, and explore the effect of acupoint application and its influence on the use of antibiotics based on common diseases in primary clinic (fever, cough, diarrhea, sore throat).@*METHODS@#With the help of the internet electronic diagnosis and treatment platform (the main TCM suitable technology promoted by this platform is acupoint application therapy), the diagnosis and treatment data of 1.23 million patients in 2 000 primary clinics from August 24, 2020 to March 31, 2021 were collected. The patients were divided into an application group (acupoint application treatment) and a non-application group (non-acupoint application treatment), and the proportion of antibiotic use in the two groups was compared. The propensity score was used to match age, gender, concomitant symptoms, diagnosed diseases and other confounding factors of treatment, and the disappearance rate of symptoms (fever, cough, diarrhea, sore throat) and the time to first disappearance of symptoms were compared between the two groups.@*RESULTS@#A total of 1 230 923 patients were analyzed, including 1 048 382 cases in the application group, accounting for 85.2%; 182 541 cases in the non-application group, accounting for 14.8%. The most patients who used acupoint application treatment were 0-2 years old, followed by 3-6 years old, and the patients over 15 years old who did not use acupoint application treatment were the most. The proportion of antibiotic use in the application group was 2.4%, lower than that in the non-application group (44.2%, P<0.001). The proportion of antibiotic use in all ages of patients in the application group was lower than that in the non-application group (P<0.001). Among the common diseases in primary clinic (fever, cough, diarrhea and sore throat), the proportion of antibiotic use in the application group was lower than that in the non-application group (P<0.01); the disappearance rate of symptoms in the application group was higher than that in the non-application group, and the time to first disappearance of symptoms was shorter than that in the non-application group (P<0.001).@*CONCLUSION@#Acupoint application has a certain influence on the use of antibiotics in primary clinic patients. In the treatment of common diseases, patients treated with acupoint application have better curative effect and lower proportion of antibiotic use.

Clinical features of children with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome: an analysis of 13 cases / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of children with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, a polygenic and multifactorial autoinflammatory disease with unknown pathogenesis.@*METHODS@#A retrospective analysis was performed on the medical data of 13 children with PFAPA syndrome.@*RESULTS@#All 13 children had disease onset within the age of 3 years, with a mean age of onset of (14±10) months. They all had periodic fever, with 8-18 attacks each year. The mean interictal period of fever was (30±5) days. Pharyngitis, cervical adenitis, and aphthous stomatitis were the three cardinal symptoms, with incidence rates of 100% (13/13), 85% (11/13), and 38% (5/13) respectively. There were increases in white blood cells, C-reactive protein, and erythrocyte sedimentation rate during fever. Of all the 13 children, 6 underwent whole exome sequencing and 7 underwent panel gene detection for autoinflammatory disease, and the results showed single heterozygous mutations in the @*CONCLUSIONS@#For children with unexplained periodic fever with early onset accompanied by pharyngitis, cervical adenitis, aphthous stomatitis, elevated inflammatory indices, and good response to glucocorticoids, PFAPA syndrome should be considered. This disorder has good prognosis, and early diagnosis can avoid the long-term repeated use of antibiotics.

Peritonsillar and deep neck infections: a review of 330 cases / Infecções peritonsilares e cervicais profundas: revisão de 330 casos

Abstract Introduction: Deep neck infections are defined as suppurative infectious processes of deep visceral spaces of the neck. Objective: The aim of this study is to review different factors that may influence peritonsillar and deep neck infections and may play a role as bad prognosis predictors. Methods: We present a retrospective study of 330 patients with deep neck infections and peritonsillar infections who were admitted between January 2005 and December 2015 in a tertiary referral hospital. Statistical analysis of comorbidities, diagnostic and therapeutic aspects was performed with Excel and SPSS. Results: There has been an increase in incidence of peritonsilar and deep neck infections. Systemic comorbidities such as diabetes or hepatopathy are bad prognosis factors. The most common pathogen was S. viridans (32.1% of positive cultures). 100% of the patients received antibiotics and corticosteroids, 74.24% needed surgical treatment. The most common complications were mediastinitis (1.2%) and airway obstruction (0.9%). Conclusion: Systemic comorbidities are bad prognosis predictors. Nowadays mortality has decreased thanks to multidisciplinary attention and improvements in diagnosis and treatment.

Resumo Introdução: Infecções cervicais profundas são definidas como processos infecciosos supurativos dos espaços viscerais profundos do pescoço. Objetivo: Analisar diferentes fatores que podem influenciar as infecções peritonsilares e cervicais profundas que podem desempenhar um papel como preditores de mau prognóstico. Método: Apresentamos um estudo retrospectivo de 330 pacientes portadores de infecções cervicais profundas e de infecções peritonsilares admitidos entre janeiro de 2005 e dezembro de 2015 em um hospital terciário de referência. A análise estatística de comorbidades, aspectos diagnósticos e terapêuticos foi realizada utilizando-se os programas Excel e o SPSS. Resultados: Houve um aumento na incidência de infecções peritonsilares e infecções cervicais profundas. Comorbidades sistêmicas como diabetes ou doença hepática são fatores de mau prognóstico. O patógeno mais comum foi S. viridans (32,1% das culturas positivas). 100% dos pacientes receberam antibióticos e corticosteroides, e 74,24% necessitaram de tratamento cirúrgico. As complicações mais comuns foram mediastinite (1,2%) e obstrução das vias aéreas (0,9%). Conclusão: Comorbidades sistêmicas são preditores de mau prognóstico. Atualmente, a mortalidade diminuiu graças ao cuidado multidisciplinar e melhorias no diagnóstico e tratamento.

How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel / Como evitar o uso inadequado de antibióticos nas infecções de vias aéreas superiores? Posição de um painel de especialistas

Abstract Introduction: Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. Objectives: To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. Methods: A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Results: Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Conclusions: Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use.

Resumo Introdução: A resistência bacteriana a antibióticos nos processos infecciosos é um fato crescente nos últimos anos, especialmente devido ao seu uso inapropriado. Ao longo dos anos vem se tornando um grave problema de saúde pública devido ao prolongamento do tempo de internação, elevação dos custos de tratamento e aumento da mortalidade relacionada às doenças infecciosas. Quase a metade das prescrições de antibióticos em unidades de pronto atendimento é destinada ao tratamento de alguma infecção de vias aéreas superiores, especialmente rinossinusites, otite média aguda supurada e faringotonsilites agudas, sendo que uma significativa parcela dessas prescrições é inapropriada. Nesse contexto, os otorrinolaringologistas têm um papel fundamental na orientação de pacientes e colegas não especialistas, para o uso adequado e racional de antibióticos frente a essas situações clínicas. Objetivos: Realizar uma revisão das atuais recomendações de utilização de antibióticos nas otites médias, rinossinusites e faringotonsilites agudas adaptadas à realidade nacional. Método: Revisão na base PubMed das principais recomendações internacionais de tratamentos das infecções de vias aéreas superiores, seguido de discussão com um painel de especialistas. Resultados: Os antibióticos devem ser utilizados de maneira criteriosa nas infecções agudas de vias aéreas superiores não complicadas, a depender da gravidade da apresentação clínica e dos potenciais riscos associados de complicações supurativas e não supurativas. Conclusões: Constantes revisões a respeito do tratamento das principais infecções agudas são necessárias para que sejam tomadas medidas coletivas no uso racional e apropriado de antibióticos. Somente com orientação e transformações no comportamento de médicos e pacientes é que haverá mudanças do paradigma de que toda infecção de vias aéreas superiores deva ser tratada com antibióticos, minimizando por consequência os efeitos de seu uso inadequado.

Streptococcal acute pharyngitis

Acute pharyngitis/tonsillitis, which is characterized by inflammation of the posterior pharynx and tonsils, is a common disease. Several viruses and bacteria can cause acute pharyngitis; however, Streptococcus pyogenes (also known as Lancefield group A β-hemolytic streptococci) is the only agent that requires an etiologic diagnosis and specific treatment. S. pyogenes is of major clinical importance because it can trigger post-infection systemic complications, acute rheumatic fever, and post-streptococcal glomerulonephritis. Symptom onset in streptococcal infection is usually abrupt and includes intense sore throat, fever, chills, malaise, headache, tender enlarged anterior cervical lymph nodes, and pharyngeal or tonsillar exudate. Cough, coryza, conjunctivitis, and diarrhea are uncommon, and their presence suggests a viral cause. A diagnosis of pharyngitis is supported by the patient's history and by the physical examination. Throat culture is the gold standard for diagnosing streptococcus pharyngitis. However, it has been underused in public health services because of its low availability and because of the 1- to 2-day delay in obtaining results. Rapid antigen detection tests have been used to detect S. pyogenes directly from throat swabs within minutes. Clinical scoring systems have been developed to predict the risk of S. pyogenes infection. The most commonly used scoring system is the modified Centor score. Acute S. pyogenes pharyngitis is often a self-limiting disease. Penicillins are the first-choice treatment. For patients with penicillin allergy, cephalosporins can be an acceptable alternative, although primary hypersensitivity to cephalosporins can occur. Another drug option is the macrolides. Future perspectives to prevent streptococcal pharyngitis and post-infection systemic complications include the development of an anti-Streptococcus pyogenes vaccine.

Inappropriate use of antibiotics in the treatment of pharyngo-tonsilitis in children in Khartoum, Sudan

Pharyngo-tonsillitis represents a major public health problem all over the world. Recent studies in Sudan have revealed alarming results reporting antibiotics over prescription in the management of acute tonsillitis. The aim of this study was to estimate the prevalence of Group A Beta hemolytic streptococci and document the appropriateness of using antibiotics in the treatment of acute tonsillo-pharyngitis in Jaafar Ibn Auf Pediatrics Hospital. A cross sectional hospital based study was conducted in the period January to August 2012 in Jaafar Ibn Auf Hospital, the largest tertiary pediatrics hospital in Sudan. The sample size was 100 including children aged 2-17 years and got antibiotics treatment for their current sore throat. A pharyngeal swab was collected at presentation from tonsils and posterior pharynx. Gram staining was done first, and then Group A Beta hemolytic streptococci were isolated and identified in the laboratory by their growth characteristics. All children included in the study were assessed clinically and subjected to a structural questionnaire. Data were analyzed by SPSS version 19. The estimated prevalence of Group A Beta hemolytic streptococci tonsillitis and/or pharyngitis was 22%, nevertheless the proportion of antibiotic prescription was 100%. Most children were treated inappropriately regarding the need for using antibiotics, the type of antibiotics used and the duration of management. As many studies suggested that increased using of antibiotics may be due to uncertainty of diagnosis, requesting scoring system or rapid diagnostic test can contribute to the reduction of the rate of antibiotics prescription

Impacto do uso da prova rápida para estreptococo beta-hemolítico do grupo A no diagnóstico e tratamento da faringotonsilite aguda em pronto-socorro de Pediatria / Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a Pediatric emergency room / Impacto del uso de la prueba rápida para estreptococos beta-hemolíticos del grupo A en el diagnóstico y tratamiento de la faringotonsilitis en emergencia de Pediatría

OBJETIVO: Avaliar o impacto da realização rotineira da prova rápida para pesquisa de estreptococo do grupo A no diagnóstico e tratamento da faringotonsilite aguda em crianças. MÉTODOS: Estudo prospectivo e observacional que contou com a utilização de protocolo de pesquisa estabelecido na Unidade de Emergência do Hospital Universitário da Universidade de São Paulo para o atendimento de crianças e adolescentes com faringotonsilite aguda. RESULTADOS: Com base na avaliação clínica, dos 650 pacientes estudados, antimicrobianos seriam prescritos para 389 indivíduos (59,8%) e, com o uso da pesquisa de estreptococo do grupo A, foram prescritos em 286 pacientes (44,0%). Das 261 crianças que não receberiam antibiótico pelo quadro clínico, 111 (42,5%) tiveram pesquisa de estreptococo do grupo A positiva. O diagnóstico baseado no quadro clínico apresentou sensibilidade de 61,1%, especificidade de 47,7%, valor preditivo positivo de 44,9% e valor preditivo negativo de 57,5%. CONCLUSÕES: O diagnóstico clínico da faringotonsilite estreptocócica mostrou baixa sensibilidade e especificidade. O uso rotineiro da prova rápida para pesquisa de estreptococo permitiu a redução do uso de antibióticos e a identificação de um grupo de risco para as complicações da infecção estreptocócica, pois 42,5% dos pacientes com prova rápida positiva não receberiam antibióticos, se levado em consideração apenas o diagnóstico clínico.

OBJECTIVE: To evaluate the impact of the routine use of rapid antigen detection test in the diagnosis and treatment of acute pharyngotonsillitis in children. METHODS: This is a prospective and observational study, with a protocol compliance design established at the Emergency Unit of the University Hospital of Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. RESULTS: 650 children and adolescents were enrolled. Based on clinical findings, antibiotics would be prescribed for 389 patients (59.8%); using the rapid antigen detection test, they were prescribed for 286 patients (44.0%). Among the 261 children who would not have received antibiotics based on the clinical evaluation, 111 (42.5%) had positive rapid antigen detection test. The diagnosis based only on clinical evaluation showed 61.1% sensitivity, 47.7% specificity, 44.9% positive predictive value, and 57.5% negative predictive value. CONCLUSIONS: The clinical diagnosis of streptococcal pharyngotonsillitis had low sensitivity and specificity. The routine use of rapid antigen detection test led to the reduction of antibiotic use and the identification of a risk group for complications of streptococcal infection, since 42.5% positive rapid antigen detection test patients would not have received antibiotics based only on clinical diagnosis.

OBJETIVO: Evaluar el impacto de la realización de rutina de la prueba rápida para investigación de estreptococos del grupo A en el diagnóstico y tratamiento de la faringotonsilitis aguda en niños. MÉTODOS: Estudio prospectivo y observacional que contó con el uso de protocolo de investigación establecido en la Unidad de Emergencia del Hospital Universitario de la USP para la atención a niños y adolescentes con faringotonsilitis aguda. RESULTADOS: Con base en la evaluación crítica, de los 650 pacientes estudiados, antimicrobianos serían prescritos a 389 individuos (59,8%) y, con el uso de la investigación de estreptococos del grupo A se los prescribieron a 286 pacientes (44,0%). De los 261 niños que no recibirían antibióticos por el cuadro clínico, 111 (42,5%) tuvieron investigación de estreptococos del grupo A positiva. El diagnóstico basado en el cuadro clínico presentó sensibilidad del 61,1%, especificidad del 47,7%, valor predictivo positivo del 44,9% y valor predictivo negativo del 57,5%, CONCLUSIONES: En este estudio, el diagnóstico clínico de la faringotonsilitis estreptocócica mostró baja sensibilidad y especificidad. El uso de rutina de la prueba rápida para investigación de estreptococos permitió la reducción del uso de antibióticos y la identificación de un grupo de riesgo para las complicaciones de la infección estreptocócica, pues el 42,5% de los pacientes con prueba rápida positiva no recibirían antibióticos si se llevara en consideración solamente el diagnóstico clínico.

role of dexamethasone in reducing the severity of postoperative sore throat

Effect of intravenously administered dexamethasone in reducing the incidence and severity of post operative sore throat in patients receiving general anesthesia with endotracheal intubation. To investigate the effect of dexamethasone administered intravenously preoperative in reducing post operative sore throat. 80 patients receiving general anesthesia with endotracheal intubation in randomized double blinded placebo controlled were randomly assigned to two groups: group1[control] patients receiving normal saline 2 mLiv and group 2 [D] patients received dexamethasone 8 mg iv. After surgery, visual analogue scale [VAS] scores at rest and with effort [swallowing movement] for post operative sore throat were recorded. This study revealed that post operative sore throat during the first 24 hr following surgery was lower in dexamethasone group [D] compared to the control group [C]. Nine [22.4%] patients in the dexamethasone group had postoperative sore throat, compared to 23[57.5%] patients in the control group [p<0.01]. Postoperatively at one hour, three hours, six hours, 12 hours and 24 hours, the VAS scores for postoperative sore throat at rest and during effort were lower in dexamethasone group [D] compared to the control group [p<0.01] at corresponding time intervals. Preoperative administration of dexamethasone 8mg iv reduces the incidence and severity of postoperative sore throat in patients receiving general anesthesia with endotracheal intubation.

Consenso sobre diagnóstico y tratamiento de infecciones de vías respiratorias altas / Consensus guidelines for the management of upper respiratory tract infections

Las infecciones respiratorias altas son la primera causa de prescripción de antibióticos. La faringitis aguda es de origen viral en la mayoría de los casos; los episodios virales pueden diferenciarse de los de origen bacteriano producidos por Streptococcus pyogenes por criterios clínico-epidemiológicos (criterios de Centor), por pruebas diagnósticas rápidas o por el cultivo de fauces. Cuando la etiología es estreptocócica, la droga de elección es penicilina V (cada 12 horas). La otitis media aguda (OMA) es una de las causas más frecuentes de prescripción de antibióticos en niños. Los patógenos principales son Streptococcus pneumoniae, Haemophilus influenzae no tipable y Moraxella catarrhalis. Los antecedentes, la evaluación clínica junto con la otoscopía permiten establecer el diagnóstico. En niños menores de 2 años se recomienda tratamiento antibiótico precoz al igual que en niños mayores de 2 años con otitis bilateral, otorrea, presencia de comorbilidad o cuadro clínico grave. En la Argentina, debido a los bajos niveles de resistencia de S. pneumoniae a penicilina la droga de elección es amoxicilina; ante falta de respuesta al tratamiento puede utilizarse amoxicilina/clavulánico para cubrir cepas de H. influenzae y de M. catarrhalis productoras de betalactamasas. Las rinosinusitis son virales en la mayoría de los casos y menos del 5% se complican con sinusitis bacteriana. El diagnóstico es clínico y en general no se requieren estudios complementarios. Los patógenos bacterianos implicados son los mismos que causan OMA, por esta razón también se recomienda la amoxicilina como droga de elección.

Upper respiratory tract infections are the most common source of antibiotic prescriptions. Acute pharyngitis is caused mainly by viruses, viral cases can be distinguished from acute streptococcal pharyngitis using Centor clinical epidemiological criteria, by rapid antigen tests or throat culture. Treatment of choice for streptococcal infection is penicillin V given in two daily doses. In children, acute otitis media (AOM) is the infection for which antibiotics are most often prescribed. Predominant causative pathogens include Streptococcus pneumoniae, Haemophilus influenzae non-type b and Moraxella catarrhalis. Diagnosis is based on history, physical examination and otoscopic exam. Antibiotic treatment should be initiated promptly in all children < 2 years of age, and in older children presenting bilateral AOM, otorrhoea, co-morbidities or severe illness. In Argentina, amoxicillin is the drug of choice given the low penicillin resistance rates for S. pneumoniae. In children who fail amoxicillin therapy, amoxicillin/clavulanate provides better coverage against beta-lactamase producing H. influenzae and M. catarrhalis. Rhinosinusitis is caused mainly by viruses, secondary bacterial complication occurs in less than 5% of cases. Diagnosis is based on physical examination and additional studies are not usually required. Acute bacterial sinusitis is caused by the same pathogens that cause AOM and amoxicillin is the drug of choice.

Variabilidad e idoneidad en el tratamiento antimicrobiano de las faringoamigdalitis agudas pediátricas en Asturias, España / Variability of antibiotic treatment in paediatric acute pharyngotonsillitis in Asturias, Spain

Introducción. Las faringoamigdalitis agudas suponen un importante porcentaje de las consultas pediátricas y una de las principales causas de prescripción antibiótica. Nuestro objetivo fue analizar los hábitos de prescripción antimicrobiana en niños diagnosticados con faringoamigdalitis aguda en servicios de urgencias hospitalarios y consultas pediátricas de atención primaria en Asturias (España). Métodos. Estudio descriptivo multicéntrico que evalúa pacientes pediátricos diagnosticados con faringoamigdalitis aguda en los servicios de urgencias de 5 hospitales y en 80 consultas pediátricas de atención primaria. La idoneidad de las prescripciones se estableció por comparación con estándares de referencia. Resultados. Se incluyeron 563 niños con faringoamigdalitis agudas, 49,7% en atención primaria (IC 95% 45,6-53,8%), a los largo de 30 días no consecutivos (6,8% de las consultas pediátricas). Se prescribieron antibióticos en el 75,5% de las faringoamigdalitis (IC 95% 71,9-79,0%) [(78,3% en los menores de 3 años (IC 95% 71,8-84,8%)]. El antibiótico más indicado fue la amoxicilina [39,1% de los casos que recibieron antibioterapia (IC 95% 34,4-43,7%)]. Se encontraron diferencias signifcativas en el porcentaje de prescripción antibiótica entre atención primaria y urgencias hospitalarias (70,0% contra 80,9%, p= 0,003). El tratamiento prescrito se consideró de primera elección en el 43,3% de los tratados (IC 95% 38,6-48,0%) e inadecuado en el 56,0% (IC 95% 51,3-60,7%). Conclusiones. Pese a que la mayoría de las faringomigdalitis agudas pediátricas son de probable etiología vírica, tres cuartas partes de ellas reciben tratamiento antibiótico en nuestro medio, siendo la elección inapropiada en más de la mitad de los casos.

Introduction. Acute pharyngotonsillitis accounts for a large portion of antibiotic prescriptions in pediatric offces. Our aim was to analyze the antimicrobial prescription habits for acute pharyngotonsillitis in children from hospital emergency departments and primary care pediatric clinics in Asturias (Spain). Methods. Multicenter descriptive study evaluating pediatric patients with a diagnosis of acute pharyngotonsillitis in 5 hospital emergency departments and 80 pediatric primary care clinics. Appropriateness of prescription was established by comparing with reference standards. Results. Five hundred sixty-three children with acute pharyngotonsillitis [49.7% in primary care CI 95% 45.6-53.8%)] were included along 30 nonconsecutive days. Antibiotics were prescribed in 75.5% of cases (95% CI 71.9-79.0%) [78.3% in children under 3 years of age (95% CI 71.8-84.8%)]. Amoxicillin was the antibiotic most frequently prescribed [39.1% (95% CI 34.4-43.7%)]. Signifcant differences in the frequency or antibiotic prescription were found between primary care and hospital emergency departments (70% vs. 80.9%, p= 0.003). The treatment prescribed was considered frst choice in 43.3% (95% CI 38.6-48.0%) and inappropriate in 56.0% (95% CI 51.3-60.7%). Conclusions. Although in most cases pediatric acute pharyngotonsillitis is viral in origin, three out of four are treated with antibiotics. Treatment was inappropriate in more than half of the cases in our study.

Etiological aspects of penicillin-failure in the treatment of tonsillitis and pharyngitis caused by group A, beta-hemolytic streptococci [GABHS]

To observe and study the cause of penicillin-failure and to see the therapeutic effects of other drugs and find out more effective and better remedy. A Retrospective study. This study was conducted in Microbiology Department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, National institute of Child Health from April 2004 - June 2005. A total of 300 children attending OPD's and admitted [250 suspected and 50 Normal as control cases] of age group 5 - 15 years were included in this study. Drug sensitivity pattern of streptococcus pyogenes isolated in infected and control children was observed. Antibiotic discs used were Penicillin [10] units and Erythromycin [15 micrograms]. The organism isolated GABHS shows 100% sensitivity to penicillin, while in case of erythromycin, it was sensitive in 24[85.7%] infected cases and resistant to 4[14.3%] cases. Pharyngotonsillitis is a disease of poor community, the therapy with penicillin is economical compared with Cephalosporin group. Penicillin therapy is helpful in preventing the supporative and n supporative complications caused by GABHs

Physicians’ responsibility for antibiotic use in infants from periurban Lima, Peru / Responsabilidad del médico en el uso de antibióticos en niños menores de 1 año de zonas periurbanas de Lima, Perú

Objetivo. Describir el uso de antibióticos en niños de 2 a 12 meses de edad en entornos donde estos medicamentos se pueden obtener sin prescripción. Métodos. Se analizaron los datos de un estudio de cohorte efectuado entre septiembre del 2006 y diciembre del 2007 en 1 023 niños menores de 2 meses de la zonaperiurbana de Lima, Perú, cuyo seguimiento se realizó hasta el año de edad. Resultados. De los 1 023 niños, 770 (75,3%) tomaron 2 085 tandas de tratamiento antibiótico. Se registraron dos tandas por niño por año (rango 0–12). Las tasas más elevadas de uso de antibióticos se encontraron en los niños de 3 a 6 meses (37,2%). Los niños recibieron antibióticos para 8,2% de los resfriados comunes, 58,6% de las faringitis, 66,0% de las bronquitis, 40,7% de las diarreas, 22,8% de las dermatitis y 12,0% de las obstruccionesbronquiales. La prescripción de un médico fue la razón más frecuente para el uso de antibióticos (90,8%). Se comprobó el uso de medicamentos sin prescripción en 6,9% de los niños, y en 63,9% de ellos este fue precedido por una prescripción médica. Conclusiones. En el entorno estudiado, los niños menores de 1 año a menudo estánexpuestos a los antibióticos. El abuso de los antibióticos es frecuente ante enfermedades como faringitis, bronquitis, obstrucción bronquial y diarrea, pero por lo general es inadecuado (83,1% de las tandas de tratamiento antibiótico) según las etiologías más comunes en este grupo etario. Las intervenciones dirigidas a mejorar el uso de los antibióticos deben concentrarse en los médicos, ya que la prescripción médica fue la razón más común para el uso de antibióticos.

Objective. To describe the use of antibiotics in Peruvian children under 1 year in a setting where they are available without a prescription. Methods. Data were analyzed from a cohort study between September 2006 and December 2007 of 1 023 children < 2 months old in periurban Lima, Peru, followed until they were 1 year old. Results. Seven hundred seventy of 1 023 (75.3%) children took 2 085 courses of antibiotics. There were two courses per child per year (range 0–12). Higher rates of antibiotic usewere found in children 3–6 months old (37.2%). Antibiotics were given to children for 8.2% of common colds, 58.6% of all pharyngitis, 66.0% of bronchitis, 40.7% of diarrheas, 22.8%of dermatitis, and 12.0% of bronchial obstructions. A physician’s prescription was the most common reason for antibiotic use (90.8%). Medication use without a prescription was found in 6.9% of children, and in 63.9% of them it was preceded by a physician’s prescription. Conclusions. Infants are often exposed to antibiotics in this setting. Overuse of antibiotics is common for diagnoses such as pharyngitis, bronchitis, bronchial obstruction, and diarrhea but is typically inappropriate (83.1% of courses) based on the most common etiologies for this age group. Interventions to improve the use of antibiotics should focus on physicians, since a physician’s prescription was the most common reason for antibiotic use.

Análisis de los fenotipos y genotipos de resistencia a eritromicina y clindamicina en cepas de Streptococcus pyogenes aisladas en Chile en un período de 10 años / Resistance phenotypes and genotypes of Streptococcus pyogenes clinical isolates in Chile over a 10-year period

Background: Macrolide and lincosamide resistance in Streptococcus pyogenes is due to the acquisition of mef, ermB and ermA genes, which confer different resistance phenotypes, namely M, MLSBconstitutive and MLSBinducible respectively. The last report of resistance in Chile was done in the period 1990-1998, in which resistance to macrolides was 5.4 percent, with M phenotype as the predominant one. Aim: To characterize the evolution of erythromycin and clindamycin resistance and their associated genes in S. pyogenes strains isolated from patients with invasive and non-invasive infections in the period 1996 to 2005. Material and Methods: Resistance to erythromycin and clindamycin was determined in 1,282 clinical isolates using the disk diffusion test. Resistant isolates were analyzed by polymerase chain reaction (PCR) for the presence of the above mentioned resistance genes. Results: Global resistance to erythromycin and clindamycin was 3.5 and 0.7 percent respectively. Eighty percent of the resistant strains possessed the M. phenotype. Conclusions: Resistance levels of S. pyogenes have decreased in Chile in the last years. Most resistant strains have M phenotype in contrast to many countries in which the MLSB constitutive phenotype is the predominant one.

Penicillin V-induced drug rash with eosinophilia and systemic symptoms / Erupción cutánea inducida por la penicilina V con eosinofilia y síntomas sistémicos

DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), previously named "drug hypersensitivity syndrome", is a severe adverse drug reaction characterized by skin rash, fever, lymph node enlargement and internal organ involvement. We report on a 7-year old girl who developed DRESS syndrome caused by penicillin V treatment.

El síndrome DRESS (así llamado por las indíciales del inglés "drug reaction with eosinophilia y systemic symptoms ") es una reacción a medicamentos, acompañada por eosinofilia y síntomas sistémicos. Conocida anteriormente como "síndrome de hipersensibilidad a los medicamentos, se trata de una reacción adversa severa a los medicamentos, caracterizada por erupción cutánea, fiebre, agrandamiento de los ganglios y compromiso de órganos internos. El presente trabajo reporta el caso de una niña de 7 años de edad, que desarrolló el síndrome DRESS a partir de un tratamiento con penicilina V.