Evaluation on immediate analgesic efficacy and safety of Kai-Hou-Jian spray (children's type) in treating sore throat caused by acute pharyngitis and tonsillitis in children: study protocol for a randomized controlled trial.

BACKGROUND: Acute pharyngitis and tonsillitis are common respiratory diseases for which children seek medical care. Their main clinical manifestation is sore throat which interferes with patients' quality of life. However, there is no proven effective or safe method to treat it. It is necessary to find an excellent strategy to reduce sore throat and reduce the burden of acute illness. We designed the randomized controlled trial with the characteristics of traditional Chinese medicine (TCM) to determine the clinical positioning of Kai-Hou-Jian spray (children's type) (KHJS) through evidence-based research. This trial aims to evaluate the immediate analgesic efficacy of KHJS on sore throat caused by acute pharyngitis and tonsillitis (wind-heat syndrome/heat exuberance in lung and stomach syndrome) in children and to observe its safety. METHODS/DESIGN: This is a prospective, multicenter, randomized, double-blind, parallel-group, placebo-controlled trial. It will include 240 children with acute pharyngitis/tonsillitis from 7 study sites across China. All participants are randomly assigned to two parallel treatment groups, one with KHJS and the other with placebo sprays, for 5 consecutive days. The primary outcome is the time of analgesic onset. Secondary outcomes include duration of analgesic effect, area under time curve of 0-3 h Wong-Baker FACES Pain Rating Scale (WBS) score (AUC0-3 h), rate of analgesic onset, rate of disappearance of sore throat, changes of WBS score (in days), effective rate of pharyngeal signs, and effective rate of TCM syndrome. The incidence of adverse events during the trial is the primary safety outcome. In addition, vital signs and laboratory tests before and after medication are monitored. DISCUSSION: To our knowledge, this will be the first clinical trial to explore the immediate analgesic efficacy of a Chinese patent medicine spray for acute pharyngitis/tonsillitis induced sore throat in children in a multicenter, randomized, double-blinded, parallel-group, placebo-controlled manner. Not only might it prove the efficacy and safety of KHJS in the treatment of sore throat caused by acute pharyngitis/tonsillitis in children, but it might also provide evidence for the treatment of acute sore throat with Chinese herbal medicine. TRIAL REGISTRATION: A multicenter, randomized, double-blind, very low-dose, parallel controlled trial for the immediate analgesic effect and safety of Kai-Hou- Jian spray (children's type) in the treatment of sore throat caused by acute pharyngitis and tonsillitis in children. Chinese Clinical Trial Registry ChiCTR2000031599 . Registered on 5 April 2020.

[The value of herbal medicine in the treatment of acute tonsillopharyngitis of non-streptococcal genesis]. / Znachenie fitoterapii v lechenii ostorogo tonzillofaringita nestreptokokkovogo geneza.

The purpose of the study. To establish the effectiveness of symptom reduction and preventive action of the herbal drug Tonsilgon N (HD) as monotherapy for exacerbations of chronic tonsillitis/pharyngitis in adult patients. MATERIAL AND METHODS: The study included 60 adult male and female patients aged 18 to 60 years with an established diagnosis of acute tonsillopharyngitis. In total, each patient underwent 5 visits. Visit 1 - enrollment in the study and beginning of HD monotherapy, Visit 2 - on Day 7, Visit 3 - on Day 14 and completion of HD monotherapy, Visit 4 - on Day 60 and Visit 5 - on Day 180. The diagnosis of the disease and the examination of the patient was carried out on the basis of anamnesis, general clinical and ENT examination, palpation of regional lymph nodes. The severity of the clinical signs was evaluated on the basis of the symptom score. The general condition of the patient was also evaluated using a visual analogue scale (VAS) and the number of exacerbations of tonsillopharyngitis during the observation period. RESULTS: The number of exacerbations of chronic tonsillitis and episodes of ATP for 6 months after the end of treatment decreased 4.8 times compared to the previous period. During the course of treatment (14 days), complaints of patients with ATP (general health and/or fatigue, pain when swallowing, headache, cough, burning sensation, a lump in the throat, hoarseness, pain and dryness in the throat, difficulty swallowing) had a pronounced tendency to regression. Improvement was also noted on examination and clinical evaluation. According to the results of the analysis of the evaluation of general condition according to the VAS (according to the standard technique in cm), there was a significant improvement both during the treatment period by 2.2 times, and during the observation period (180 days) from the period of Visit 2 to Visit 4 by 31.3 times. CONCLUSION: The use of HD as monotherapy for non-streptococcal ATP has shown its high efficiency. The possibility of using Tonsilgon N was shown as a prophylactic agent that reduces the number of exacerbations of inflammatory diseases in the pharynx during the period after the treatment course.

Impact of Traditional Versus Flavored Tongue Depressors on Pediatric Oropharynx Exam.

We compared patient-reported discomfort associated with oropharynx examination using traditional (unflavored) versus flavored tongue depressors among pediatric patients presenting to the emergency department in a single-blinded, placebo-controlled randomized trial using a convenience sample ages 3 to 12 years. Our primary outcome was patient discomfort. Secondary outcomes included provider perceptions of patient discomfort, provider-reported examination ease, and caregiver perceptions of patient discomfort. Of 96 recruited patients, 92 (95.8%) completed the study. Forty-six (50%) were randomized to a traditional tongue depressor. Mean patient-reported oropharynx examination discomfort scores were 2.3 cm (95% confidence interval = 1.4-3.2 cm) with traditional tongue depressors versus 1.9 cm (95% confidence interval = 1.0-2.8 cm) with flavored tongue depressors ( P = .72). There were similarly no significant differences between the 2 arms with regard to any of the secondary outcomes. We conclude that the use of flavored tongue depressors does not appear to significantly alleviate discomfort associated with examination of the oropharynx in pediatric patients.

[Effectiveness of a herbal preparation tonsilgon N for the treatment of children presenting with chronic adenoiditis].

The objective of the present study was to estimate the effectiveness of the herbal preparation tonsilgon N exhibiting the anti-inflammatory and immunostimulating properties for the treatment of the children presenting with pathology of a pharyngeal tonsil. A total of 62 children at the age varying from 3 to 11 years with chronic adenoiditis (CA) were available for the examination. The study group was comprised of 32 children, the control one included 30 patients. The study has demonstrated the improvement of daytime nasal breathing in the study group compared with the control patients by 15% on day 5, by 30% on day 7, and by 73% on day 9 after the onset of the treatment. The intensity of rhinorrhea in the children treated with the herbal preparation decreased sooner than in the control group. Nasal breathing at night improved as soon as day 5 after the onset of therapy. However, the difference between the treated and control children was statistically significant only on day 7 whereas night-time nasal breathing on day 9 improved in the study group by 1.4 times compared with the control one. It is concluded that the inclusion of therapy with tonsilgon N in the combined treatment of the children presenting with chronic adenoiditis increases its effectiveness and accelerates the process of reconvalescence. Tonsilgon N is a safe medication suitable for the prolonged application.

Factors associated with the use of rapid antigen diagnostic tests in children presenting with acute pharyngitis among French general practitioners.

In this investigation, we wanted: (i) to describe the attitudes and declared practices of a representative sample of French general practitioners (GPs) regarding rapid antigen diagnostic tests (RADTs) for acute pharyngitis and (ii) to identify the GPs' characteristics associated with the use of an RADT in the last paediatric patient with pharyngitis. We performed a cross-sectional survey conducted in 2012 among a representative sample of 1,126 self-employed GPs in France. 60.1 % of GPs declared that they used an RADT in their last patient aged between 3 and 16 years presenting with acute pharyngitis; 29.6 % of these tests were positive. Among the GPs who did not use an RADT, 50.2 % prescribed an antibiotic, compared to 30.5 % of prescriptions among GPs who performed an RADT, whatever its result. In a multivariate analysis, GPs' age between 45 and 54 years and having attended Continuing Medical Education (CME) sessions on infectious diseases in the past year were significantly associated with an increased use of an RADT in the last patient with pharyngitis, whereas a low volume of activity, occasionally practising alternative medicine, receiving pharmaceutical representatives at the practice and declaring a consultation duration <15 min were factors associated with a decreased use of RADTs. The use of RADTs by GPs must be promoted; our findings could help define interventions to improve practice.

Impact on antibiotic prescription of rapid antigen detection testing in acute pharyngitis in adults: a randomised clinical trial.

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.

[Local therapy for laryngopharyngeal inflammatory diseases in children].

The article devoted to the treatment of inflammatory diseases of throat and larynx in children. Features of clinical course of inflammation process, predominant ethiological factors as well group of drugs used in childhood are described. Special attention was paid to drugs for topical treatment and peculiarities of their usage in children. The role of eliminative agents in treatment of inflammatory diseases of throat is elucidated. Outcome of research of efficacy and safety of Aqualor throat cleansing as an initial monotherapy of mild and moderate pharyngolaryngites in children elder 6 y.o. are presented. Data obtained let us to recommend Aqualor throat cleansing as a safe and effective remedy for treatment of non-complicated pharyngolaryngitis in children.

[Review of acupuncture treatment for chronic pharyngitis].

A search in the database of CNKI and VIP access was performed to gather relevant literature about acupuncture treatment for chronic pharyngitis to evaluate and analyze the present situation of clinical research. The results indicate that the combination therapy is the major treatment for chronic pharyngitis, especially in the combination of acupuncture and Chinese herbs. There is great progress in clinic research in which proper scientific methodology was adopted. However, it demands further improvement in research quality, cases quality, diagnostic criteria, evaluation standard of efficacy, quality control and effectiveness of treatment. The research design of investigating mechanism is in accordance with traditional theory of TCM. The results suggest that new ideas and innovative approaches and valuable observation indices should be applied to improve research level.

Impact of rapid antigen detection testing on antibiotic prescription in acute pharyngitis in adults. FARINGOCAT STUDY: a multicentric randomized controlled trial.

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.

Impact of rapid streptococcal test on antibiotic use in a pediatric emergency department.

UNLABELLED: Acute pharyngitis is commonly seen in children. Group A beta-hemolytic Streptococcus is the most common bacterial cause of acute pharyngitis and accounts for approximately 15% to 30% of cases in children, but this condition is generally overdiagnosed and overtreated. The availability of rapid streptococcal tests (RSTs) have made this diagnosis simpler and reduced the use of antibiotics. Overuse of antibiotics leads to drug-resistant bacterial strains. Reducing the number of antibiotic prescriptions provided for upper respiratory tract infections has been strongly recommended to limit bacterial resistance. OBJECTIVE: To assess the impact of RSTs on antibiotic prescriptions in children with pharyngitis in the emergency department. METHODS: A retrospective study from September 2005 to September 2007 of all patients (3-18 years old) presenting to the pediatric emergency department with sore throat as the chief complaint or suspected clinically to have acute pharyngitis and who had an RST performed. Patients with a negative RST result had a culture performed. The information of the patients with the diagnosis of pharyngitis was also collected in a 2-year control period before the availability of the test. Patients with a negative RST result had a culture performed. In addition, the antibiotic prescriptions for these patients were also recorded. RESULTS: A total of 8280 patients were included in the study. Throat culture results of 1723 patients were reviewed in the pre-RST phase. During the post-RST phase, 6557 children underwent RST. The RST results were positive in 1474 children (22.5%) and negative in 5083 patients (77.5%). Rapid strep testing was associated with a lower antibiotic prescription rate for children with pharyngitis (41.38% for those treated in the pre-RST phase versus 22.45% for those treated in the post-RST phase; P < 0.001). CONCLUSIONS: The availability of a RST could substantially reduce the unnecessary prescription of antibiotics. This study supports the screening of all children with pharyngitis by performing an RST to guide decision making for antibiotic administration. This strategy has a significant impact on reducing the antibiotic prescription rate to almost 50%. In addition, only 2 children (0.04%) had negative rapid antigen test results with cultures positive for Streptococcus.

[ISKRA guidelines on sore throat: diagnostic and therapeutic approach--Croatian national guidelines]. / Smjernice iskra za grlobolju: dijagnosticki i terapijski pristup--Hrvatske nacionalne smjernice.

Sore throat is most commonly caused by viruses, but when caused by bacteria, the most important is group A streptococcus (GAS). The aim of these guidelines is to determine optimal treatment for streptococcal sore throat and reasonable indications for tonsillectomy, as well as recommend how to differentiate streptococcal infection for which antibiotics are justified, from numerous other sore throats where antibiotics wont have a significant effect on disease course, but might contribute to bacterial resistance to antibiotics. The development of the guidelines was initiated by the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the Croatian Ministry of Health and Social Welfare in accordance with the principles of AGREE (Appraisal of Guidelines for Research and Evaluation) methodology which means that the guidelines are the result of consensus between all interested professional societies and institutions. For streptococcal sore throat diagnostics, the Working Group recommends evaluation of clinical presentation according to Centor criteria and for patients with Centor score 0-1, antibiotic therapy is not recommended nor bacteriological testing, while for patients with Centor score 2-4 bacteriological testing is recommended (rapid test or culture) as well as antibiotic therapy in case of positive result. The drug of choice for the treatment of streptococcal tonsillopharyngitis is oral penicillin taken for ten days (penicillin V) or in case of poor patient compliance benzathine penicillin G can be administered parenterally in a single dose. Other antibiotics (macrolides, clindamycin, cephalosporins, co-amoxiclav) are administered only in case of hypersensitivity to penicillin or in recurrent infections. Tonsillectomy is a widely accepted surgical procedure that decreases the number of sore throats in children and should be performed only if indications for this procedure are established. Absolute indications include five or more streptococcal infections per year, tonsillitis complications, permanent respiratory tract obstruction, obstructive sleep apnea syndrome and suspected tonsillar malignancy. Relative indications include chronic tonsillitis and occlusion disturbances.

¿Es posible el diagnóstico clínico de la faringoamigdalitis estreptocócica? / Is streptococcal pharyngitis diagnosis possible?

Objetivo. Determinar la validez de la puntuación de Centor (adenopatías cervicales, exudado amigdalar, fiebre y ausencia de síntomas catarrales) para filiar la faringoamigdalitis de origen estreptocócico. Diseño. Estudio descriptivo. Emplazamiento. Centro de Salud San Fernando 2 (zona periurbana de Madrid). Participantes. Se incluyó a 140 pacientes mayores de 14 años que acudieron a la consulta entre el 14 de febrero y el 12 de mayo de 2005 con «dolor de garganta» como principal síntoma. Mediciones principales. Se determinaron la sensibilidad (S), la especificidad (E), los valores predictivos postivo y negativo (VPP y VPN) y los cocientes de probabilidad de la puntuación de Centor; se utilizó el frotis faríngeo como método de referencia. Resultados. En total, 34 pacientes presentaron frotis positivo (24,3%; intervalo de confianza [IC] del 95%, 17,6-32,4%). El hallazgo de los 4 criterios de Centor presentaba un VPP del 48,1% (IC del 95%, 30,7-66,0%) y un VPN del 81,4% (IC del 95%, 73,3-87,5%), aunque sólo la fiebre (odds ratio [OR] = 3,64; IC del 95%, 1,40-9,49) y el exudado amigdalar (OR = 6,18; IC del 95%, 2,08-18,35) muestran asociación con la etiología estreptocócica. Conclusiones. El sistema de puntuación clínica alcanza un alto VPN y una especificidad que permiten diagnosticar con bastante certeza las faringoamigdalitis no estreptocócicas. Sin embargo, su VPP es bajo: una puntuación alta (3 o 4 criterios) no asegura que sea una faringoamigdalitis estreptocócica. Queda por resolver qué actitud se debe adoptar ante estos pacientes con sospecha de faringitis estreptocócica: test microbiológico, antibioterapia inmediata o antibioterapia diferida

Objective. To determine the validity of the Centor score (cervical adenopathy, tonsillar exudate, fever, and absence of catarrh symptoms) in diagnosing streptococcal pharyngitis (gold standard: throat swab). Design. Descriptive study. Setting. San Fernando 2 Health Centre, Madrid (outer urban area), Spain. Participants. On hundred forty patients over 14 years old who had a "sore throat" as main symptom and attended clinic between 14 February and 12 May, 2005. Main measurements. Sensitivity, specificity, predictive values, and probability quotients of the score variables. Main measurements. Sensitivity, specificity, positive and negative predictive values, and the probability quotients of the Centor score were determined. Pharyngeal throat culture was used as the reference method. Results. Thirty four patients had positive throat culture (24.3%; 95% CI, 17.6%-32.4%). Finding the 4 criteria in the Centor score had a positive predictive value (PPV) of 48.1% (95% CI, 30.7%-66.0%) and a negative predictive value (NPV) of 81.4% (95% CI, 73.3%-87.5%); although only fever (OR, 3.64; 95% CI, 1.40-9.49) and tonsillar exudate (OR, 6.18; 95% CI, 2.08-18.35) were linked to streptococcal aetiology. Conclusions. The high NPV and specificity of the clinical score makes the diagnosis of non-streptococcal pharyngitis very accurate. However, the PPV is low: a high Centor score (3 or 4 criteria) does not mean streptococcal pharyngitis with certainty. What approach to take with patients suspected of streptococcal pharyngitis is not yet resolved (microbiological test, early antibiotic, or postponed antibiotic)

Síndrome PFAPA, un reto para el pediatra / PFAPA syndrome: a challenge in pediatrics

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An unusual sore throat.

A young homeless man recently presented to a health clinic located in a youth service. He complained that, over the past day, his throat had become increasingly painful with an obstructed sensation. On examination, his uvula was very swollen and red. He had no other significant symptoms and examination was otherwise normal.

[Therapeutic management of necrotizing neck infections]. / Therapeutisches Management nekrotisierender Weichteilinfektionen des Halses.

BACKGROUND: Necrotizing neck infections are uncommon soft-tissue infections, usually caused by virulent, toxin producing bacteria. Necrotizing fasciitis represents a special form of necrotizing soft tissue infection with a mortality rate of up to 76% even though aggressive therapy is recommended. PATIENTS AND METHODS: In the last 2 years we treated four patients with severe necrotizing neck infections and five suffering from necrotizing fasciitis. RESULTS: Microbiological analysis revealed mixed infections with Candida albicans, Streptococcus pyogenes, Fusobacterium, Proprioni bacteria and Staphylococcus. The surgical management was not only restricted to drainage, but also included functional neck dissection in order minimize the spread of the disease. Eight of our patients recovered completely, but one died due to toxic shock as consequence of a delayed in therapy. CONCLUSION: Complete recovery of patients suffering from necrotizing fasciitis depends on early and aggressive surgical therapy including neck dissection and drainage as well as an interdisciplinary strategy of conservative therapy. Hyperbaric oxygen should be considered as a treatment adjunct in patients with necrotizing fasciitis if surgery and antibiotic treatment fail.