Sore throat − most common reason for prescribing antibiotics by primary care physicians. However, pharyngotonsillitis is one of the diseases among acute infections of the upper respiratory tract in the practice of primary care physicians, when the restriction of antibiotic therapy is conditional.
This article on estet-portal.com provides the latest recommendations regarding indications for prescribing and duration of antibiotic therapy for pharyngotonsillitis.
- Need for antibiotic therapy for tonsillitis
- Indications for antibiotic therapy in pharyngotonsillitis
- Study results on the efficacy of a short course of antibioticotheraPII
Need for antibiotic therapy for tonsillitis
During clinical studies on the advisability of prescribing antibiotic therapy for pharyngotonsillitis, the following was revealed: among approximately 29 consultations conducted per 1000 inhabitants for sore throat, in 2/3 of patients it was caused by tonsillitis, which 80% of patients needed antibiotic treatment.
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The main causative agent was streptococcus group A. However, the frequency of its isolation as a cause of inflammation does not exceed 33%.
This is why the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) guidelines, as well as the British (NICE) and Swedish guidelines for the treatment of angina, target patients who are more likely to benefit from antimicrobial therapy and to prevent the development of possible complications that group A streptococcus can cause:
Indications for prescribing antibiotic therapy for pharyngotonsillitis
The main factors in selecting patients for antibiotic therapy should be three of the four available criteria:
- fever;
- swollen and painful lymph nodes in the neck;
- purulent plaque on the tonsils in the absence of cough;
- positive test for group A streptococcus antigen.
The recommended antimicrobial strategy is a ten-day course of phenoxymethylpenicillin as the most appropriate antibiotic.
However, the risk of long-term antibiotic use in the gastrointestinal tract, allergic manifestations and
for a period of 5 days versus 10 days. 17 primary care centers in Sweden
ii. Results of a study on the effectiveness of a short course of antibiotic therapy Patients aged 6 years and older with pharyngotonsillitis caused by group A streptococci with clinical signs were examined: fever ≥38.5 ° C, enlarged painful lymph nodes in the neck, purulent plaque on the tonsils in the absence of cough and antigen positive test for streptococcus A.
The total number of patients was 433 (215 of them were treated for 5 days, 218 × 10 days). The drug was prescribed
at a dose of800 mg 4 times a day for 5 days of therapy
or 1000 mg 3 times a day − 10 day course. Approaches to the treatment of infectious diseases of the lower respiratory tract
Streptococcal eradication rate was determined by the rapid test for Streptococcus A antigen. It was also obligatory to conduct a
bacteriological examination. It has been proven that the use of phenoxymethylpenicillin at a dose of 800 mg 4 times a day for 5 days was not inferior in effectiveness to its administration at a dose of 1000 mg 3 times a day for 10 days. Although the rate of eradication was lower in the 5-day treatment group, it took less time to resolve symptoms.
was registered.
Furthermore, the 5-day group showed low incidence and duration of side effects from antibiotic therapy. There was a slightly longer use of analgesics to reduce the severity of sore throat at 10 days of treatment compared to 5 days.
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