Effect of antibacterial therapy on the clinical course of streptococcal tonsillopharyngitis in children.

Authors

DOI:

https://doi.org/10.26641/2307-0404.2019.4.189264

Keywords:

group A β-hemolytic streptococcus, tonsillopharyngitis, children, antibacterial therapy

Abstract

The aim of this study was to determine the effect of antibiotic therapy (AT) on the clinical course of streptococcal tonsillopharyngitis (STP) in children, depending on the timing of its administration, since the data on the need to start AT in the first days of the disease to achieve the effect are controversial. A retrospective analysis of inpatient medical records at “The Communal Dnipro City Clinical Hospital N 21 named after Professor Ye.G. Popkova” DRC” in the period from January 2012 to December 2018 was conducted. The inclusion criteria for the study were: 1) the diagnosis - tonsillopharyngitis; 2) the age of the patient: 3 to 18 yrs; 3) the exclusion of an alternative diagnosis (diphtheria, infectious mononucleosis, scarlet fever); 4) no complications; 5) positive results of the culture study on β-hemolytic streptococcus group A (GAS) (Streptococcus pyogenes) of the oropharyngeal swab. The study included 109 medical cards of children with STP. Depending on the timing of the onset of rational AT, all patients were divided into 5 groups. The first one consisted of 27 children who received AT from the 1st day of the disease, 2nd - 48 children (AT from the 2nd day), 3rd - 17 children (AT from the 3rd day) and the fourth - 7 children (AT from the 4th day), 5th - 10 children (AT from the 5th day). Clinical symptoms were evaluated by exa­mining the patient with the main objective and subjective symptoms of STP. It was a retrospective open comparative study. All patients received the full recommended course of STP AT. The study showed no significant differences in the reduction of clinical symptoms of STP, regardless of the timing of antibiotic therapy (1-5 days from the onset of the disease) in almost half of patients with STP, which confirms the inadequacy of antibacterial therapy in children with tonsillopharyngitis. We believe that antibiotic therapy should only be used to prevent late complications in cases of children with tonsillopharyngitis only with a confirmed GAS etiology, and we propose the widespread use of the McIsaac Score, the Streptococcus Expression Test (RST) and the culture study of the oropharyngeal swab to confirm the etiology of GAS in children with tonsillopharyngitis to reduce the frequency of antibiotics overusing.

Author Biographies

T. Haiduk

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

A. Cherhinets

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

L. Shostakovych-Koretska

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

References

Nishiyama M, Morioka I, Taniguchi-Ikeda M, Mori T, Tomioka K, Nakanishi K, Fujimura J, Nishimu­ra N, Nozu K, Nagase H, Ishibashi K, Ishida A, Iijima K. Clinical features predicting group A streptococcal pharyngitis in a Japanese paediatric primary emergency medical centre. J Int Med Res. 2018 May;46(5):1791-800. Epub 2018 Mar 8. PubMed PMID: 29517940; PubMed Central PMCID: PMC5991234. doi: https://doi.org/10.1177/0300060517752954

Danchin MH, Rogers S, Kelpie L, et al. Burden of acute sore throat and group A streptococcal pharyngitis in school-aged children and their families in Australia. Pediatrics Nov. 2007;120(5):950-7. doi: https://doi.org/10.1542/peds.2006-3368

van Driel ML, De Sutter AI, Habraken H, Thor­ning S, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2016 Sep 11;9(9):CD004406. PubMed PMID: 27614728; PubMed Central PMCID: PMC6457741. doi: https://doi.org/10.1002/14651858.CD004406.pub4

Ellis CS, Camacho-Walsh ME. AGREE Apprai­sal of Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis. Ad­vanced Emergency Nursing Journal. 2015;37(1):34-41. doi: https://doi.org/10.1097/TME.0000000000000044

Gottlieb M, Koyfman A, Long B. Clinical Mi­mics: An Emergency Medicine-Focused Review of Strep­tococcal Pharyngitis Mimics. J Emerg Med. 2018 May;54(5):619-29. doi: https://doi.org/10.1016/j.jemermed.2018.01.031

Khan ZZ, Salvaggio MR. Group A Streptococcal (GAS) Infections. Medscape. [updated 2018 Sep. 07] Available from: https://emedicine.medscape.com/article/­228936-overview#showall

Lennon DR, Farrell E, Martin DR, Stewart JM. Once-daily amoxicillin versus twice-daily penicillin V in group A beta-haemolytic streptococcal pha­ryngitis. Arch Dis Child. 2008 Jun;93(6):474-8. doi: https://doi.org/10.1136/adc.2006.113506

McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ. 1998 Jan 13;158(1):75-83. PubMed PMID: 9475915; PubMed Central PMCID: PMC1228750.

Martin WJ, Steer AC, Smeesters PR, et al. Post-infectious group A streptococcal autoimmune syndromes and the heart. Autoimmun Rev. 2015 Aug;14(8):710-25. doi: https://doi.org/10.1016/j.autrev.2015.04.005

Gerber MA, Baltimore RS, Eaton CB, et al. Pre­vention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009 Mar 24;119(11):1541-51. doi: doi.org/10.1161/CIRCULATIONAHA.109.191959

Rammelkamp CH, Wannamaker LW, Denny FW. The Epidemiology and Prevention of Rheumatic Fever. Bull N Y Acad Med. 1952 May;28(5):321-34. PubMed PMID: 19312604; PubMed Central PMCID: PMC1877185.

Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 2010 Sep;126(3):e557-64. doi: https://doi.org/10.1542/peds.2009-2648

Spinks A, Glasziou PP, Del Mar CB. Anti­biotics for sore throat. Cochrane Database Syst Rev. 2013 Nov 5;(11):CD000023. doi: https://doi.org/10.1002/14651858.CD000023.pub4

Downloads

How to Cite

1.
Haiduk T, Cherhinets A, Shostakovych-Koretska L. Effect of antibacterial therapy on the clinical course of streptococcal tonsillopharyngitis in children. Med. perspekt. [Internet]. 2019Dec.26 [cited 2024Mar.29];24(4):69-74. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/189264

Issue

Section

CLINICAL MEDICINE