Are empiric antibiotics for acute exudative tonsillitis needed in children?

Chang

Journal of Medical Virology

et al. 2015

Acute respiratory infection (ARI) is a leading cause of morbidity and hospitalization in children. To profile the viruses causing ARI in children admitted to a community-based hospital in central Taiwan, a cross-sectional study was conducted on children under 14 years of age that were hospitalized with febrile ARI. Viral etiology was determined using conventional cell culture and a commercial respiratory virus panel fast assay (xTAG RVP), capable of detecting 19 different respiratory viruses and subtype targets. Demographic, clinical, and laboratory data were recorded and analyzed. The RVP fast assay identified at least one respiratory virus in 130 of the 216 specimens examined (60.2%) and rose to 137 (63.4%) by combining the results of cell culture and RVP fast assay. In order of frequency, the etiological agents identified were, rhinovirus/enterovirus (24.6%), respiratory syncytial virus (13.8%), adenovirus (11.5%), parainfluenza virus (9.2%), influenza B (8.4%), influenza A (5.4%), human metapneumovirus (4.6%), human coronavirus (2%), and human bocavirus (2%). Co-infection did not result in an increase in clinical severity. The RVP assay detected more positive specimens, but failed to detect 6 viruses identified by culture. The viral detection rate for the RVP assay was affected by how many days after admission the samples were taken (P = 0.03). In conclusion, Rhinovirus/enterovirus, respiratory syncytial virus, and adenovirus were prevalent in this study by adopting RVP assay. The viral detection rate is influenced by sampling time, especially if the tests are performed during the first three days of hospitalization.

Section: Discussionsupporting

confidence: 90%

Molecular viral epidemiology and clinical characterization of acute febrile respiratory infections in hospitalized children in Taiwan

Chang

Journal of Medical Virology

et al. 2015

“…We reviewed 30 full-text articles, of which 11 were included (Supplemental Fig 7). [46][47][48][49][50][51][52][53][54][55][56] Previous antimicrobial exposure was not mentioned in 4 studies but was assumed to be absent owing to the studies' prospective nature 51,53 and subjects' acute presentation. 55,56 Mean age was available in 6 (55%) studies and averaged 75.6 months (Supplemental Appendix 2).…”

Section: Pharyngitismentioning

confidence: 99%

Bacterial Prevalence and Antimicrobial Prescribing Trends for Acute Respiratory Tract Infections

Kronman¹,

2014

WHAT'S KNOWN ON THIS SUBJECT: Many pediatric acute respiratory tract infections (ARTI) are viral and do not require antimicrobial treatment. Recent estimates of antimicrobial overprescribing for these infections, defined based on the published bacterial disease prevalence among all ARTI, are not available. WHAT THIS STUDY ADDS:Based on the published bacterial prevalence rates for pediatric ARTI, antimicrobial agents are prescribed almost twice as often as expected to outpatients nationally, amounting to an estimated 11.4 million potentially preventable antimicrobial prescriptions annually. abstract BACKGROUND AND OBJECTIVES: Antimicrobials are frequently prescribed for acute respiratory tract infections (ARTI), although many are viral. We aimed to determine bacterial prevalence rates for 5 common childhood ARTI -acute otitis media (AOM), sinusitis, bronchitis, upper respiratory tract infection, and pharyngitis-and to compare these rates to nationally representative antimicrobial prescription rates for these ARTI. METHODS:We performed (1) a meta-analysis of English language pediatric studies published between 2000 and 2011 in Medline, Embase, and the Cochrane library to determine ARTI bacterial prevalence rates; and (2) a retrospective cohort analysis of children age ,18 years evaluated in ambulatory clinics sampled by the 2000-2010 National Ambulatory Medical Care Survey (NAMCS) to determine estimated US ARTI antimicrobial prescribing rates. RESULTS:From the meta-analysis, the AOM bacterial prevalence was 64.7% (95% confidence interval [CI], 50.5%-77.7%); Streptococcus pyogenes prevalence during pharyngitis was 20.2% (95% CI, 15.9%-25.2%). No URI or bronchitis studies met inclusion criteria, and 1 sinusitis study met inclusion criteria, identifying bacteria in 78% of subjects. Based on these condition-specific bacterial prevalence rates, the expected antimicrobial rescribing rate for ARTI overall was 27.4% (95% CI, 26.5%-28.3%). However, antimicrobial agents were prescribed in NAMCS during 56.9% (95% CI, 50.8%-63.1%) of ARTI encounters, representing an estimated 11.4 million potentially preventable antimicrobial prescriptions annually.

“…Необходимость АБ-терапии при БГСА-тонзиллите/фарин-гите обусловлена высоким риском развития осложнений острого периода (перитонзиллярный и ретрофарингеаль-ный абсцесс, гнойный шейный лимфаденит), а также таких стрептококк-ассоциированных заболеваний, как ревма-тизм и гломерулонефрит [9][10][11][12][13][14].…”

Section: острый стрептококковый тонзиллит (J030  рубрикация по мкбunclassified

“…Избегать необоснованного профилактического назна-чения антибактериальных, антифунгальных и проти-вовирусных средств. Доказано, что в 50-70% случаев острый тонзиллит/ фарингит имеет вирусную этиологию [8][9][10][11][12]. При этом наиболее частыми возбудителями являются аденовирусы, вирусы Эпштейна -Барр и энтеровирусы.…”

unclassified

Algorithms for the selection of etiotropic therapy for bacterial infection of the upper respiratory tract in children

2016

The article tells about the etiology of acute tonsillitis, pharyngitis, sinusitis and acute otitis media in children; there is data on the sensitivity of the bacterial pathogens of the infectious and inflammatory diseases of the respiratory tract to the most commonly prescribed antibiotics. The focus is on the global spread of antibiotic resistance of pathogens and questions of restraining its further acceleration. Approaches to the rational use of antibiotics for bacterial infections of the upper respiratory tract are discussed. Benefits of antibiotics in dispersible tablets are demonstrated. Algorithms for the primary selection of antibiotics for acute bacterial tonsillitis, pharyngitis, sinusitis and acute otitis media in children are suggested.