Adenoiditis medical therapy

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Adenoiditis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Adenoiditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

The mainstay of therapy for adenoiditis is symptomatic therapy. Pharmacologic medical therapy is recommended among patients with recurrent and chronic adenoiditis. The best antibiotic therapy regimen include amoxicillin - clavulanic acid or a cephalosporin.

Medical Therapy

Antibiotic therapy

  • There are no proven evidence of medical therapy effectiveness in recurrent or chronic adenoiditis cases.[1]
  • Systemic oral antibiotics can be used if the suspected organism is a bacteria and should be prescribed for a long-term (i.e. 6 wk) for lymphoid tissue infection.
  • The most appropriate antibiotics are amoxicillin - clavulanic acid or a cephalosporin.
  • Cephalosporins and macrolides are considered good alternatives to penicillin in the acute setting.[2]
  • A macrolide such as erythromycin is indicated for patients allergic to penicillin.
  • Although antibiotic therapy can treat acute adenoiditis, it usually fails to eradicate the bacteria in chronic or recurrent adenoiditis.[3]
  • Nowadays with the current trend of resistant bacteria, the use of prophylactic or long-term antibiotics has been decreased.[4]

Symptomatic Treatment and Pain Management

  • Topical therapy:
    • Topical nasal steroids in children can be used to treat adenoid hypertrophy.
    • Topical nasal steroids can lead to adenoid shrinkage slightly (ie, up to 10%), which may help relieve some nasal obstruction symptoms. However, it is not a permanent therapy and all symptoms may raise again after discontinuation of topical nasal steroid.
    • A combination trial of topical nasal steroid spray and saline spray may be considered for effective control of symptoms in children.
  • In cases of viral adenoiditis, treatment with analgesics or antipyretics is often sufficient.[5]

References

  1. Havas T, Lowinger D (2002). "Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy". Arch. Otolaryngol. Head Neck Surg. 128 (7): 789–91. PMID 12117336.
  2. Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics 2004;113:866-882.
  3. Huang SW, Giannoni C (2001). "The risk of adenoid hypertrophy in children with allergic rhinitis". Ann. Allergy Asthma Immunol. 87 (4): 350–5. doi:10.1016/S1081-1206(10)62251-X. PMID 11686429.
  4. Karlıdağ T, Bulut Y, Keleş E, Alpay HC, Seyrek A, Orhan İ, Karlıdağ GE, Kaygusuz İ (2012). "Presence of herpesviruses in adenoid tissues of children with adenoid hypertrophy and chronic adenoiditis". Kulak Burun Bogaz Ihtis Derg. 22 (1): 32–7. PMID 22339566.
  5. Rajeshwary A, Rai S, Somayaji G, Pai V (2013). "Bacteriology of symptomatic adenoids in children". N Am J Med Sci. 5 (2): 113–8. doi:10.4103/1947-2714.107529. PMC 3624711. PMID 23641372.

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