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1.
Vestn Otorinolaringol ; 86(2): 85-89, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33929158

RESUMO

A description of a clinical case of oligosymptomatic pharyngitis associated with Neisseria gonorrhoeae is presented. On the example of oligosymptomatic localized gonococcal pharyngitis in a sexually active young man, included in the risk group for extragenital forms of sexually transmitted infections, an advantage has been shown molecular biological diagnostic method. Study of the spectrum of microflora of the oropharynx and urethra with assessment sensitivity to antibacterial drugs of representatives of the genus Neisseria isolated during mixed infection oropharynx, demonstrated that non-pathogenic Neisseria species are resistant to cephalosporins III-IV generations. Unrecognized forms of oropharyngeal gonococcal infection, as a consequence of the complications of clinical and diagnostic identification when patients refer to an otolaryngologist or dermatovenerologist, can serve a reservoir of resistant N. gonorrhoeae and a source of intractable gonococcal infection.


Assuntos
Gonorreia , Faringite , Antibacterianos/uso terapêutico , Cefalosporinas , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos , Masculino , Neisseria gonorrhoeae , Faringite/diagnóstico , Faringite/tratamento farmacológico
2.
J Paediatr Child Health ; 57(6): 797-802, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33876472

RESUMO

Rheumatic heart disease (RHD) is a large, preventable, global public health burden. In New Zealand (NZ), acute rheumatic fever (ARF) and RHD rates are highest for Maori and Pacific children. This structured review explores the evidence for primary prevention interventions to diagnose and effectively treat group A Streptococcus (GAS) pharyngitis and skin infections to reduce rates of ARF and RHD. Medline, EMBASE and Scopus databases were searched as well as other electronic publications. Included were 50 publications from 1980 onwards. This review has identified that there is little available evidence for effective primary prevention strategies to reduce ARF rates in NZ. However, two primary intervention strategies that should be considered by communities at high-risk of ARF are: the use of school-based clinics to identify and treat GAS pharyngitis and GAS skin infections; and intramuscular benzathine penicillin G with lignocaine analgesia in children who present with a GAS positive throat.


Assuntos
Faringite , Febre Reumática , Cardiopatia Reumática , Infecções Estreptocócicas , Criança , Humanos , Nova Zelândia , Faringite/tratamento farmacológico , Febre Reumática/tratamento farmacológico , Febre Reumática/prevenção & controle , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/prevenção & controle , Streptococcus pyogenes
3.
Cochrane Database Syst Rev ; 3: CD004406, 2021 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-33728634

RESUMO

BACKGROUND: Antibiotics provide only modest benefit in treating sore throat, although their effectiveness increases in people with positive throat swabs for group A beta-haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated. This is an update of a review first published in 2010, and updated in 2013, 2016, and 2020. OBJECTIVES: To assess the comparative efficacy of different antibiotics in: (a) alleviating symptoms (pain, fever); (b) shortening the duration of the illness; (c) preventing clinical relapse (i.e. recurrence of symptoms after initial resolution); and (d) preventing complications (suppurative complications, acute rheumatic fever, post-streptococcal glomerulonephritis). To assess the evidence on the comparative incidence of adverse effects and the risk-benefit of antibiotic treatment for streptococcal pharyngitis. SEARCH METHODS: We searched the following databases up to 3 September 2020: CENTRAL (2020, Issue 8), MEDLINE Ovid (from 1946), Embase Elsevier (from 1974), and Web of Science Thomson Reuters (from 2010). We also searched clinical trial registers on 3 September 2020. SELECTION CRITERIA: Randomised, double-blind trials comparing different antibiotics, and reporting at least one of the following: clinical cure, clinical relapse, or complications and/or adverse events. DATA COLLECTION AND ANALYSIS: Two review authors independently screened trials for inclusion and extracted data using standard methodological procedures as recommended by Cochrane. We assessed the risk of bias of included studies according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions, and used the GRADE approach to assess the overall certainty of the evidence for the outcomes. We have reported the intention-to-treat analysis, and also performed an analysis of evaluable participants to explore the robustness of the intention-to-treat results. MAIN RESULTS: We included 19 trials reported in 18 publications (5839 randomised participants): six trials compared penicillin with cephalosporins; six compared penicillin with macrolides; three compared penicillin with carbacephem; one compared penicillin with sulphonamides; one compared clindamycin with ampicillin; and one compared azithromycin with amoxicillin in children. All participants had confirmed acute GABHS tonsillopharyngitis, and ages ranged from one month to 80 years. Nine trials included only, or predominantly, children. Most trials were conducted in an outpatient setting. Reporting of randomisation, allocation concealment, and blinding was poor in all trials. We downgraded the certainty of the evidence mainly due to lack of (or poor reporting of) randomisation or blinding, or both; heterogeneity; and wide confidence intervals. Cephalosporins versus penicillin We are uncertain if there is a difference in symptom resolution (at 2 to 15 days) for cephalosporins versus penicillin (odds ratio (OR) for absence of symptom resolution 0.79, 95% confidence interval (CI) 0.55 to 1.12; 5 trials; 2018 participants; low-certainty evidence). Results of the sensitivity analysis of evaluable participants differed (OR 0.51, 95% CI 0.27 to 0.97; 5 trials; 1660 participants; very low-certainty evidence). We are uncertain if clinical relapse may be lower for cephalosporins compared with penicillin (OR 0.55, 95% CI 0.30 to 0.99; number needed to treat for an additional beneficial outcome (NNTB) 50; 4 trials; 1386 participants; low-certainty evidence). Very low-certainty evidence showed no difference in reported adverse events. Macrolides versus penicillin We are uncertain if there is a difference between macrolides and penicillin for resolution of symptoms (OR 1.11, 95% CI 0.92 to 1.35; 6 trials; 1728 participants; low-certainty evidence). Sensitivity analysis of evaluable participants resulted in an OR of 0.79, 95% CI 0.57 to 1.09; 6 trials; 1159 participants). We are uncertain if clinical relapse may be different (OR 1.21, 95% CI 0.48 to 3.03; 6 trials; 802 participants; low-certainty evidence).  Azithromycin versus amoxicillin Based on one unpublished trial in children, we are uncertain if resolution of symptoms is better with azithromycin in a single dose versus amoxicillin for 10 days (OR 0.76, 95% CI 0.55 to 1.05; 1 trial; 673 participants; very low-certainty evidence). Sensitivity analysis for per-protocol analysis resulted in an OR of 0.29, 95% CI 0.11 to 0.73; 1 trial; 482 participants; very low-certainty evidence). We are also uncertain if there was a difference in relapse between groups (OR 0.88, 95% CI 0.43 to 1.82; 1 trial; 422 participants; very low-certainty evidence). Adverse events were more common with azithromycin compared to amoxicillin (OR 2.67, 95% CI 1.78 to 3.99; 1 trial; 673 participants; very low-certainty evidence). Carbacephem versus penicillin There is low-certainty evidence that compared with penicillin, carbacephem may provide better symptom resolution post-treatment in adults and children (OR 0.70, 95% CI 0.49 to 0.99; NNTB 14.3; 3 trials; 795 participants). Studies did not report on long-term complications, so it was unclear if any class of antibiotics was better in preventing serious but rare complications.  AUTHORS' CONCLUSIONS: We are uncertain if there are clinically relevant differences in symptom resolution when comparing cephalosporins and macrolides with penicillin in the treatment of GABHS tonsillopharyngitis. Low-certainty evidence in children suggests that carbacephem may be more effective than penicillin for symptom resolution. There is insufficient evidence to draw conclusions regarding the other comparisons in this review. Data on complications were too scarce to draw conclusions. These results do not demonstrate that other antibiotics are more effective than penicillin in the treatment of GABHS pharyngitis. All studies were conducted in high-income countries with a low risk of streptococcal complications, so there is a need for trials in low-income countries and Aboriginal communities, where the risk of complications remains high.


Assuntos
Antibacterianos/uso terapêutico , Faringite/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/efeitos adversos , Amoxicilina/uso terapêutico , Ampicilina/efeitos adversos , Ampicilina/uso terapêutico , Antibacterianos/efeitos adversos , Azitromicina/efeitos adversos , Azitromicina/uso terapêutico , Cefalosporinas/efeitos adversos , Cefalosporinas/uso terapêutico , Criança , Pré-Escolar , Clindamicina/efeitos adversos , Clindamicina/uso terapêutico , Humanos , Lactente , Macrolídeos/efeitos adversos , Macrolídeos/uso terapêutico , Pessoa de Meia-Idade , Penicilinas/efeitos adversos , Penicilinas/uso terapêutico , Faringite/microbiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Estreptocócicas/microbiologia , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Adulto Jovem
4.
Acute Med ; 20(1): 78-82, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33749697

RESUMO

We present the case of a previously healthy, immunocompetent male with Lemierre's Syndrome. He presented with headache, sore throat and pyrexia. Initial blood tests revealed raised inflammatory markers and electrolyte abnormalities. Blood cultured Fusobacterium necrophorum. He developed respiratory distress and imaging confirmed lung abscess and empyema due to septic emboli. He required surgical drainage and a prolonged course of antibiotics. This case highlights the rare, but life-threatening condition of Lemierre's Syndrome. We discuss the importance of prompt recognition and early antibiotic therapy.


Assuntos
Síndrome de Lemierre , Faringite , Sepse , Antibacterianos/uso terapêutico , Fusobacterium necrophorum , Humanos , Síndrome de Lemierre/complicações , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/tratamento farmacológico , Masculino , Faringite/tratamento farmacológico , Faringite/etiologia , Sepse/tratamento farmacológico
5.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(2): 143-147, 2021 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-33627208

RESUMO

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 MEFV gene in 6 children (46%). Recurrent fever in all children gradually returned to normal without antibiotics. Ten children were treated with a single dose of glucocorticoids, and fever was relieved after treatment. Of all the children, 4 were treated with cimetidine, among whom 2 had response; 4 children were treated with colchicine, among whom 2 had response and 2 were withdrawn from the drug due to adverse reactions. Tonsillectomy was performed for 2 children, among whom 1 was followed up for 3 years without recurrence and 1 still had recurrence. 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.


Assuntos
Linfadenite , Faringite , Estomatite Aftosa , Criança , Pré-Escolar , Febre/etiologia , Humanos , Lactente , Linfadenite/diagnóstico , Faringite/diagnóstico , Faringite/tratamento farmacológico , Pirina , Estudos Retrospectivos , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/tratamento farmacológico , Estomatite Aftosa/genética
6.
BMC Pediatr ; 21(1): 52, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33494718

RESUMO

BACKGROUND: Diagnosis of Group A Streptococcus (GAS) pharyngitis in children is hindered by variable sensitivity of clinical criteria and rapid Strep A tests (SAT), resulting in reliance on throat cultures as the gold standard for diagnosis. Delays while awaiting culture reports result in unnecessary antibiotic prescriptions among children, contributing to the spread of antimicrobial resistance (AMR). METHODS: Diagnostic accuracy study of an automated SAT (A-SAT) in children up to 16 years of age presenting to an emergency room with signs and symptoms of pharyngitis between March and June 2019. Paired throat swabs for A-SAT and culture were collected. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for A-SAT were calculated. RESULTS: Two hundred and ninety-one children were included in this study. 168 (57.7%) were boys and the mean age was 4.2 years. A-SAT was positive in 94 (32.3%) and throat culture was positive in 90 (30.9%) children. A-SAT and throat culture results showed a high level of consistency in our cohort. Only 6 (2%) children had inconsistent results, demonstrating that the A-SAT has a high sensitivity (98.9%), specificity (97.5%), PPV (94.7%) and NPV (99.5%) for the diagnosis of GAS pharyngitis in children. Only 92 (32%) children were prescribed antibiotics while the vast majority (68%) were not. CONCLUSIONS: A-SAT is a quick and reliable test with diagnostic accuracy comparable to throat culture. Its widespread clinical use can help limit antibiotic prescriptions to children presenting with pharyngitis, thus limiting the spread of AMR.


Assuntos
Faringite , Infecções Estreptocócicas , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Faringite/diagnóstico , Faringite/tratamento farmacológico , Prescrições , Sensibilidade e Especificidade , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes , Emirados Árabes Unidos
7.
BMJ ; 372: m4903, 2021 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-33414239

RESUMO

OBJECTIVE: To assess the use of proton pump inhibitors (PPIs) to treat persistent throat symptoms. DESIGN: Pragmatic, double blind, placebo controlled, randomised trial. SETTING: Eight ear, nose, and throat outpatient clinics, United Kingdom. PARTICIPANTS: 346 patients aged 18 years or older with persistent throat symptoms who were randomised according to recruiting centre and baseline severity of symptoms (mild or severe): 172 to lansoprazole and 174 to placebo. INTERVENTION: Random blinded allocation (1:1) to either 30 mg lansoprazole twice daily or matched placebo twice daily for 16 weeks. MAIN OUTCOME MEASURES: Primary outcome was symptomatic response at 16 weeks measured using the total reflux symptom index (RSI) score. Secondary outcomes included symptom response at 12 months, quality of life, and throat appearances. RESULTS: Of 1427 patients initially screened for eligibility, 346 were recruited. The mean age of the study sample was 52.2 (SD 13.7) years, 196 (57%) were women, and 162 (47%) had severe symptoms at presentation; these characteristics were balanced across treatment arms. The primary analysis was performed on 220 patients who completed the primary outcome measure within a window of 14-20 weeks. Mean RSI scores were similar between treatment arms at baseline: lansoprazole 22.0 (95% confidence interval 20.4 to 23.6) and placebo 21.7 (20.5 to 23.0). Improvements (reduction in RSI score) were observed in both groups-score at 16 weeks: lansoprazole 17.4 (15.5 to19.4) and placebo 15.6 (13.8 to 17.3). No statistically significant difference was found between the treatment arms: estimated difference 1.9 points (95% confidence interval -0.3 to 4.2 points; P=0.096) adjusted for site and baseline symptom severity. Lansoprazole showed no benefits over placebo for any secondary outcome measure, including RSI scores at 12 months: lansoprazole 16.0 (13.6 to 18.4) and placebo 13.6 (11.7 to 15.5): estimated difference 2.4 points (-0.6 to 5.4 points). CONCLUSIONS: No evidence was found of benefit from PPI treatment in patients with persistent throat symptoms. RSI scores were similar between the lansoprazole and placebo groups after 16 weeks of treatment and at the 12 month follow-up. TRIAL REGISTRATION: ISRCTN Registry ISRCTN38578686 and EudraCT 2013-004249-17.


Assuntos
Lansoprazol/administração & dosagem , Faringite/tratamento farmacológico , Inibidores da Bomba de Prótons/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Esofagite Péptica/complicações , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Faringite/etiologia , Qualidade de Vida , Reino Unido
8.
Sex Transm Infect ; 97(2): 118, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33328193

RESUMO

We report a five-time recurrent pharyngotonsillitis caused by group A streptococcus (GAS) after sexual contacts and had no recurrence after concurrent therapy to both partners. Although Streptococcus pyogenes (GAS) is a Gram-positive streptococcus capable of causing a recurrent pharyngotonsillitis, the recurrent GAS pharyngotonsillitis as STI has not been published.A 30-year-old man had a high fever and sore throat. He had a repeated pharyngotonsillitis caused by GAS in spite of the sufficient antimicrobial therapy after having sex with his partner, including oral penile and oral vaginal sex. In contrast, a hug and kiss alone did not precede his episodes of pharyngotonsillitis. His partner had GAS carriage on her pharynx. He had no recurrence after concurrent therapy to both partners. The recurrent GAS pharyngotonsillitis as STI has not been published. In a patient with recurrent pharyngotonsillitis caused by GAS, the sexual history and pharyngeal carrier status of the partner should be checked.


Assuntos
Faringite/microbiologia , Doenças Sexualmente Transmissíveis/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/patogenicidade , Adulto , Antibacterianos/uso terapêutico , Portador Sadio/tratamento farmacológico , Portador Sadio/microbiologia , Feminino , Humanos , Masculino , Faringite/diagnóstico , Faringite/tratamento farmacológico , Faringe/microbiologia , Recidiva , Comportamento Sexual , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/transmissão , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/transmissão , Streptococcus pyogenes/isolamento & purificação , Resultado do Tratamento
9.
Phytomedicine ; 80: 153368, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33091857

RESUMO

BACKGROUND: The most common symptoms of mild upper respiratory tract infections (URTIs) are sore throat, muffled dysphonia, and swelling and redness of the throat, which result from the inflammation process following acute bacterial or viral infection. HYPOTHESIS/PURPOSE: As propolis is a natural resinous substance traditionally used to maintain oral cavity and upper respiratory tract health due to its antimicrobial and anti-inflammatory properties, the aim of this study is to evaluate the efficacy of an oral spray based on poplar-type propolis extract with a known and standardized polyphenol content, on the remission of the symptoms associated with mild uncomplicated URTIs. STUDY DESIGN: A monocentric, randomized, double-blind, placebo-controlled clinical trial was performed. METHODS: This study was conducted in 122 healthy adults who had perceived mild upper respiratory tract infections. Participants, randomly assigned to receive either propolis oral spray (N = 58) or placebo (N = 64), underwent four visits (baseline = t0, after 3 days = t1 and after 5 days = t2 and after a follow-up of 15 days = t3) in an outpatient setting. Propolis oral spray total polyphenol content was 15 mg/ml. The dosage was 2-4 sprays three times/day (corresponding to 12-24 mg of polyphenols/day), for five days. The duration of the study was 8 weeks. RESULTS: After 3 days of treatment, 83% of subjects treated with propolis oral spray had remission of symptoms, while 72% of subjects in the placebo group had at least one remaining symptom. After five days, all subjects had recovered from all symptoms. This means that resolution from mild uncomplicated URTIs took place two days earlier, instead of taking place in five days as recorded in the control group. There was no relationship between the ingestion of propolis oral spray or placebo and adverse reactions. CONCLUSION: Propolis oral spray can be used to improve both bacterial and viral uncomplicated URTI symptoms in a smaller number of days without the use of pharmacological treatment, leading to a prompt symptom resolution.


Assuntos
Faringite/tratamento farmacológico , Polifenóis/uso terapêutico , Própole/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Polifenóis/análise , Polifenóis/normas , Própole/administração & dosagem , Própole/química , Infecções Respiratórias/etiologia , Resultado do Tratamento , Adulto Jovem
10.
Adv Ther ; 38(2): 1078-1093, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33315168

RESUMO

INTRODUCTION: Analogies or differences of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome in children and adults are barely known. The aim of our study was to compare the overall characteristics of a large cohort of patients, both children and adults, diagnosed with PFAPA syndrome. METHODS: In the last decade, we identified 120 children and 63 adults with periodically recurring fevers, who fulfilled the criteria for PFAPA diagnosis. The two subcohorts were analyzed according to demographic features, clinical manifestations, laboratory data, and responses to therapies. RESULTS: The mean age of onset was 2.4 ± 1.5 and 19.7 ± 10.3 years, respectively, in children and adults, while attacks occurred every 3.8 ± 0.8 and every 4.3 ± 2.3 weeks, respectively, in children and adults. A higher prevalence of exudative pharyngitis was observed in children (58.8%), and the majority of children had only two cardinal signs during flares. In adults, there was a higher interpersonal variability of the intercritical periods. Inflammatory markers measured during non-febrile periods were normal in children but altered in the totality of adults during febrile periods. A strong efficacy of corticosteroids in controlling the pediatric syndrome was observed, but response rates to steroids were less brilliant in adults. Colchicine and interleukin-1 inhibitors were used in the management of the steroid-resistant adult syndrome. Conversely, tonsillectomy was performed in a very low number of children, but was effective in 60.7% of adults when treated after 16 years. The mean age of disappearance of PFAPA symptoms has been 6.4 ± 2.4 years in children, while only 27% of adults have shown a complete drug-free symptom regression. CONCLUSIONS: A linear conformity of the PFAPA syndrome has been observed between pediatric and adult patients. PFAPA symptoms tended to disappear with no sequelae in 94.1% of children, while the disease was still active in almost 3/4 of adults at the time of our assessment.


Assuntos
Linfadenite , Faringite , Estomatite Aftosa , Tonsilectomia , Adulto , Criança , Pré-Escolar , Febre/diagnóstico , Febre/tratamento farmacológico , Febre/epidemiologia , Humanos , Lactente , Linfadenite/diagnóstico , Linfadenite/tratamento farmacológico , Linfadenite/epidemiologia , Faringite/diagnóstico , Faringite/tratamento farmacológico , Faringite/epidemiologia , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/tratamento farmacológico , Estomatite Aftosa/epidemiologia
12.
Vestn Otorinolaringol ; 85(5): 57-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33140935

RESUMO

Acute respiratory infections (ORI) consistently occupy one of the leading places among infectious and inflammatory diseases in children. Most often, antibacterial drugs are used to stop the inflammatory process in the pharynx. Cationic peptides have an extremely broad antimicrobial spectrum, rendering the effect not only in bacterial infections and mycoses, and protozoans. THE PURPOSE OF THE STUDY: To demonstrate that the test drug is effective and safe for the treatment of acute viral pharyngitis in childhood. MATERIALS AND METHODS: In the period from September 2019 to January 2020, 120 patients aged 6 to 18 years were treated with the drug «Doritricin¼ for viral pharyngitis. RESULTS: According to the research results it can be concluded that «Diretrizes¼ provides fast and high effect in pediatric practice.


Assuntos
Faringite , Infecções Respiratórias , Infecções Estreptocócicas , Adolescente , Antibacterianos/uso terapêutico , Criança , Humanos , Peptídeos , Faringite/tratamento farmacológico , Faringe , Infecções Respiratórias/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes
13.
Vestn Otorinolaringol ; 85(5): 65-70, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33140937

RESUMO

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.


Assuntos
Faringite , Infecções Estreptocócicas , Tonsilite , Adolescente , Adulto , Feminino , Medicina Herbária , Humanos , Masculino , Pessoa de Meia-Idade , Faringite/diagnóstico , Faringite/tratamento farmacológico , Streptococcus pyogenes , Tonsilite/diagnóstico , Tonsilite/tratamento farmacológico , Adulto Jovem
14.
Aten. prim. (Barc., Ed. impr.) ; 52(9): 637-644, nov. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-198440

RESUMO

OBJECTIVE: This study was aimed at evaluating the appropriateness of use and interpretation of rapid antigen detection testing (RADT) and antibiotic prescribing for acute pharyngitis six years after a multifaceted intervention. DESIGN: Before-and-after audit-based study. LOCATION: Primary care centres in eight autonomous Communities. PARTICIPANTS: General practitioners (GP) who had participated in the HAPPY AUDIT intervention study in 2008 and 2009 were invited to participate in a third audit-based study six years later (2015). METHOD: RADTs were provided to the participating practices and the GPs were requested to consecutively register all adults with acute pharyngitis. A registration form specifically designed for this study was used. RESULTS: A total of 121 GPs out of the 210 who participated in the first two audits agreed to participate in the third audit (57.6%). They registered 3394 episodes of pharyngitis in the three registrations. RADTs were used in 51.7% of all the cases immediately after the intervention, and in 49.4% six years later. Antibiotics were prescribed in 21.3% and 36.1%, respectively (P < .001), mainly when tonsillar exudates were present, and in 5.3% and 19.2% of those with negative RADT results (P < .001). On adjustment for covariables, compared to the antibiotic prescription observed just after the intervention, significantly more antibiotics were prescribed six years later (odds ratio: 2.24, 95% confidence interval: 1.73-2.89). CONCLUSIONS: This study shows that that the long-term impact of a multifaceted intervention, focusing on the use and interpretation of RADT in patients with acute pharyngitis, is reducing


OBJETIVO: Evaluar la adecuación del uso e interpretación de las técnicas antigénicas rápidas (TAR) y la prescripción antibiótica en la faringitis aguda 6 años después de haber realizado una intervención multifacética. DISEÑO: Estudio antes-después basado en una auditoria. EMPLAZAMIENTO: Centros de salud en 8 comunidades autónomas. PARTICIPANTES: Se invitaron a médicos de familia (MF) que ya habían participado en el estudio de intervención HAPPY AUDIT en 2008 y 2009 a un nuevo AUDIT 6 años después (2015). MÉTODO: Se proporcionaron TAR a los centros participantes, y se pidió a los MF que registraran consecutivamente a todos los adultos con faringitis aguda. Usamos un registro diseñado específicamente para este estudio. RESULTADOS: Ciento veintiuno MF de los 210 que participaron en los primeros registros (57,6%) aceptaron a participar en el tercer registro. Se registraron 3.394 episodios de faringitis agudas en las 3 auditorías. Se usaron TAR en el 51,7% de los casos inmediatamente después de la intervención y en el 49,4%, 6 años después. Se prescribieron antibióticos en el 21,3%y 36,1%, respectivamente (p < 0,001), principalmente cuando había exudado amigdalar y en el 5,3 y 19,2% de los resultados de TAR negativos (p < 0,001). Después de ajustar por las distintas covariables, comparado con la prescripción antibiótica observada justo después de la intervención, prescribieron significativamente más antibióticos 6 años más tarde (odds ratio: 2,24 [IC 95%: 1,73-2,89]). CONCLUSIONES: Este estudio muestra que se reduce el impacto de una intervención multifacética a largo plazo enfocada al uso e interpretación de TAR en pacientes con faringitis aguda


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Faringite/diagnóstico , Faringite/tratamento farmacológico , Testes Imediatos , Antibacterianos/uso terapêutico , Testes Imunológicos/métodos , Doença Aguda , Faringite/microbiologia , Antígenos de Bactérias/análise , Resultado do Tratamento , Fatores de Tempo
16.
Artigo em Chinês | MEDLINE | ID: mdl-32791616

RESUMO

Objective:To evaluate the anti-reflux treatment efficacy for the chronic pharyngitis patients with the reflux finding score(RFS) from 8-10. Method:One hundred and twelve patients with clinical diagnosis of chronic pharyngitis and RFS score of 8-10 were randomly divided into control and treatment groups. The treantment group was given the proton pump inhibitors, gastrointestinal motility drugs and the traditional Chinese patent drugs(treatment group). The control group was given only the traditional Chinese patent drugs(control group). Result:The visual analogue scale(VAS) of the patients in treatment group declined significantly after treatment. The efficacy of treatment group was significantly higher than that of control group(77.36% vs 30.61%, P<0.01). Conclusion:For the patients with chronic pharyngitis with RFS 8-10, anti-reflux treatment should be used together with traditional Chinese patent drugs.


Assuntos
Refluxo Laringofaríngeo/tratamento farmacológico , Faringite/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Humanos , Inibidores da Bomba de Prótons/uso terapêutico , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(30): e19922, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791655

RESUMO

BACKGROUND: Chronic pharyngitis is a common disease with a dry throat, sore throat, pharyngeal itching, dry cough, and difficulty in swallowing, bringing inconvenience to patients' daily life. Banxia-Houpo-Tang (BHT) has proven to be effective in the treatment of chronic pharyngitis, yet its real extent is not well understood. To prove this point, we will perform a protocol for a systematic review and meta-analysis of BHT for chronic pharyngitis. METHODS/DESIGN: We will search for electronic databases both English and Chinese from inception to December 2019. Two experienced researchers select the qualified articles from: The Cochrane Library, EBM Reviews, OVID, Web of Science, PubMed, Chinese National Knowledge Infrastructure (CNKI), China Academic Journal Network Publishing Database (CAJD), China Biomedical Literature database (CBM), VIP Database for Chinese Technical Periodicals (VIP). Journal Integration Platform and WAN FANG Database. We select the appropriate searching language. The primary outcome was remission rate, and the secondary outcomes include clinical symptoms, clinical examination, adverse event. Data extraction and quality assessment will be conducted by 2 experienced researchers independently. Data analysis and the risk of bias assessment will be determined by RevMan 5.3 software. RESULTS: Based on the current proofs, we will get the exact evidence about the safety and effectiveness of BHT in the treatment of chronic pharyngitis. CONCLUSION: Our study is the first meta-analysis to evaluate the efficacy and safety of BHT in the treatment of chronic pharyngitis, and it will provide evidence for alternative treatment for the management of chronic pharyngitis. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/QNF6X.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Faringite/tratamento farmacológico , Doença Crônica , Gengibre , Humanos , Magnolia , Metanálise como Assunto , Perilla , Fitoterapia , Pinellia , Revisões Sistemáticas como Assunto , Wolfiporia
18.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32747473

RESUMO

BACKGROUND: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits. METHODS: In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability. RESULTS: Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70). CONCLUSIONS: This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial.


Assuntos
Antibacterianos/uso terapêutico , Educação à Distância/organização & administração , Prescrição Inadequada/prevenção & controle , Atenção Primária à Saúde , Infecções Respiratórias/tratamento farmacológico , Doença Aguda , Bronquite/tratamento farmacológico , Bronquite/virologia , Chicago , Criança , Pré-Escolar , Comunicação , Intervalos de Confiança , Educação à Distância/métodos , Feminino , Humanos , Lactente , Análise de Intenção de Tratamento , Modelos Logísticos , Masculino , Razão de Chances , Otite Média/tratamento farmacológico , Pacientes Ambulatoriais , Enfermagem Pediátrica/educação , Enfermagem Pediátrica/estatística & dados numéricos , Pediatras/educação , Pediatras/estatística & dados numéricos , Faringite/tratamento farmacológico , Faringite/microbiologia , Faringite/virologia , Desenvolvimento de Programas , Melhoria de Qualidade , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Sinusite/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico
19.
Medicine (Baltimore) ; 99(29): e21060, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702848

RESUMO

BACKGROUND: Postoperative sore throat (POST) is an important concern in surgical patients undergoing endotracheal intubation. Its prevalence after thyroidectomy is up to 80%. The current study aimed to assess the effect of dexmedetomidine and remifentanil on postoperative sore throat. METHODS: Seventy-four patients who underwent thyroidectomy were randomized to receive either dexmedetomidine (group D) or remifentanil (group R). At anesthesia induction, group D received dexmedetomidine 1 µg/kg over 10 minutes, followed by continuous dexmedetomidine infusion at 0.3 to 0.6 µg/kg/hour during surgery. Group R received remifentanil of 3 to 4 ng/ml during induction, followed by 1.5 to 2.5 ng/ml remifentanil infusion during surgery. POST at rest and swallowing was assessed during the first 24 hours in serial time periods (0-1, 1-6, and 6-24 hours). Hoarseness and postoperative pain score were also assessed. RESULTS: POST incidence at rest (0-1, 1-6, and 6-24 hours) and swallowing (1-6 and 6-24 hours) was lower in group D than in group R. POST severity was significantly lower in group D than in group R during each time period. The incidence of postoperative hoarseness was also lower in group D than in group R at 1 to 6 and 6 to 24 hours. The postoperative pain score was lower in group D than in group R during each time period. CONCLUSION: Intraoperative dexmedetomidine infusion reduced the incidence and severity of POST for 24 hours after thyroidectomy.


Assuntos
Dexmedetomidina/uso terapêutico , Faringite/tratamento farmacológico , Faringite/etiologia , Período Pós-Operatório , Remifentanil/uso terapêutico , Tireoidectomia/efeitos adversos , Adulto , Analgésicos não Narcóticos/normas , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/normas , Analgésicos Opioides/uso terapêutico , Dexmedetomidina/normas , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Remifentanil/normas , Tireoidectomia/métodos
20.
Cochrane Database Syst Rev ; 6: CD012431, 2020 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-32497279

RESUMO

BACKGROUND: Sore throat is a common condition caused by viruses or bacteria, and is a leading cause of antibiotic prescription in primary care. The most common bacterial species is group A streptococcus ('strep throat'). Between 50% to 70% of pharyngitis cases are treated with antibiotics, despite the majority of cases being viral in origin. One strategy to reduce antibiotics is to use rapid tests for group A streptococcus to guide antibiotic prescriptions. Rapid tests can be used alone or in combination with a clinical scoring system. OBJECTIVES: To assess the efficacy and safety of strategies based on rapid tests to guide antibiotic prescriptions for sore throat in primary care settings. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and LILACS, as well as the trial registries ClinicalTrials.gov and the WHO ICTRP on 5 June 2019. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing rapid tests with management based on clinical grounds to guide the prescription of antibiotics for people with a sore throat in ambulatory care settings. We included trials that randomised individuals, as well as cluster-RCTs in which individual practitioners (or practices) or emergency departments were randomised. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data on the primary outcomes (number of participants provided with an antibiotic prescription; number of participants with an antibiotic dispensed) and secondary outcomes (duration of sore throat symptoms; duration of other symptoms; quality of life measures; number of participants with a complication attributed to the index infection; number of participants in need of re-consultation by the end of follow-up; number of participants in need of hospital admission by the end of follow-up; number of satisfied participants; number of participants with an adverse event attributed to the rapid test). We assessed the risk of bias of all included trials and used GRADE to assess the certainty of the evidence. We performed meta-analyses and sensitivity analyses when feasible. MAIN RESULTS: We included five trials (2891 children and adult participants in total; 2545 participants after adjusting for clustering). Management in the intervention group was as follows: in three trials rapid tests were used in combination with a clinical scoring system; in one trial, some physicians were asked to use rapid tests alone, while others were asked to use rapid tests in combination with a clinical scoring system; in one trial, rapid tests were used alone. Based on data from five trials (2545 participants), a large reduction in prescribed antibiotics was found in the rapid test group (481/1197) versus management based on clinical grounds (865/1348), for a summary risk difference (RD) of -25%, 95% confidence interval (CI) -31% to -18%; I2 = 62%; moderate-certainty evidence. Estimates of effect on antibiotic prescription rates were stable in various sensitivity analyses. Based on data from two trials (900 people) originating from the same overarching study, the evidence suggests that rapid tests may not reduce dispensed antibiotic treatments: rapid test group (156/445) versus management based on clinical grounds (197/455); summary RD -7%, 95% CI -17% to 2%; I2 = 53%; low-certainty evidence. Four trials (2075 participants) reported data on the number of participants with a complication attributed to the index infection; the summary odds ratio (OR) was 0.85, 95% CI 0.03 to 26.65; P = 0.93; I2 = 62%; very low-certainty evidence, which means that people in the rapid testing group were less likely to develop complications of the index infection, but the evidence is very uncertain. Two trials (1161 participants) reported on the number of participants in need of re-consultation by the end of follow-up; the summary OR was 1.12, 95% CI 0.57 to 2.21; P = 0.74; I2 = 59%; low-certainty evidence, which means that participants in the rapid testing group were more likely to be in need of re-consultation by the end of the study follow-up, but the evidence is uncertain. Lack of data impeded assessment of other secondary outcomes (including safety outcomes) and of sources of heterogeneity.  AUTHORS' CONCLUSIONS: Rapid testing to guide antibiotic treatment for sore throat in primary care probably reduces antibiotic prescription rates by 25% (absolute risk difference), but may have little or no impact on antibiotic dispensing. More studies are needed to assess the efficacy and safety of rapid test-guided antibiotic prescribing, notably to evaluate patient-centred outcomes and variability across subgroups (e.g. adults versus children).


Assuntos
Antibacterianos/uso terapêutico , Faringite/tratamento farmacológico , Faringite/microbiologia , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação , Adulto , Técnicas Bacteriológicas , Criança , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Faringite/virologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Estreptocócicas/microbiologia
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