Adenoiditis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
== Medical Therapy == | |||
===Antimicrobial therapy=== | |||
*If the adenoiditis is caused by group A streptococus, then [[antibiotics]] are useful with [[penicillin]] or [[amoxicillin]] being first line.<ref name="pmid1459378">{{cite journal |author=Touw-Otten FW, Johansen KS |title=Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries |journal=Fam Pract |volume=9 |issue=3 |pages=255–62 |year=1992 |pmid=1459378 |doi=10.1093/fampra/9.3.255}}</ref> | |||
*Cephalosporins and [[macrolides]] are considered good alternatives to penicillin in the acute setting.<ref>Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics 2004;113:866-882.</ref> | |||
**A [[macrolide]] such as [[erythromycin]] is indicated for patients allergic to [[penicillin]]. | |||
*Individuals who fail penicillin therapy may respond to treatment effective against beta-lactamase producing bacteria.<ref>{{cite journal |author=Brook I |title=The role of beta-lactamase-producing-bacteria in mixed infections |journal=BMC Infect Dis |volume=9 |pages=202 |year=2009 |url=http://www.biomedcentral.com/1471-2334/9/202 |pmid=20003454 |pmc=2804585 |doi=10.1186/1471-2334-9-202}}</ref> such as [[clindamycin]] or [[amoxicillin-clavulanate]]. Aerobic and anaerobic beta lactamase producing bacteria that reside in the adenoidal tissues can "shield" group A streptococcus from penicillins.<ref>{{cite journal |author=Brook I |title=Microbiology and principles of antimicrobial therapy for head and neck infections |journal=Infect Dis Clin North Am |volume=21 |pages=355–91 |year=2007 |pmid=17561074 |url=http://linkinghub.elsevier.com/retrieve/pii/S0891-5520(07)00026-8 |doi=10.1016/j.idc.2007.03.014 |issue=2 }}</ref> | |||
====Empiric Therapy==== | |||
*Preferred regimen: [[Penicillin V]] PO 10 days or if compliance unlikely, [[benzathine penicillin]] IM single dose<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
*Alternate regimen (1): [[Cephalosporins|2nd generation Cephalosporins]] PO for 4–6 days | |||
*Alternate regimen (2): [[Clindamycin]] or [[azithromycin]] for 5 days | |||
*Alternate regimen (3): [[Clarithromycin]] for 10 days | |||
*Alternate regimen (4): [[Erythromycin]] for 10 days | |||
*Alternative regimen (5): [[Amoxicillin]] for 10 days | |||
====Challenges of Treatment==== | |||
Despite in vitro efficacy, there is frequently reported inability of [[penicillin]] to fully resolve [[GABHS]] from patients with acute and relapsing adenoiditis.<ref name="pmid17292576">{{cite journal |vauthors=Casey JR, Pichichero ME |title=The evidence base for cephalosporin superiority over penicillin in streptococcal pharyngitis |journal=Diagn. Microbiol. Infect. Dis. |volume=57 |issue=3 Suppl |pages=39S–45S |year=2007 |pmid=17292576 |doi=10.1016/j.diagmicrobio.2006.12.020 |url=}}</ref> | |||
*Over the past 50 years, the rate of penicillin failure has consistently increased from about 7% in 1950 to almost 40% in 2000. | |||
*There are several explanations for the failure of penicillin to eradicate [[GABHS]] adenoiditis:<ref name="pmid16251332">{{cite journal |vauthors=Brook I, Foote PA |title=Efficacy of penicillin versus cefdinir in eradication of group A streptococci and tonsillar flora |journal=Antimicrob. Agents Chemother. |volume=49 |issue=11 |pages=4787–8 |year=2005 |pmid=16251332 |pmc=1280135 |doi=10.1128/AAC.49.11.4787-4788.2005 |url=}}</ref> | |||
**Poor penetration of [[penicillin]] into the adenoid tissues, as well as the epithelial cells.<ref name="cid.oxfordjournals.org">[http://cid.oxfordjournals.org/content/43/11/1398.full.pdf+html Kaplan EL, Chatwal GS, Rohde M. Reduced ability of penicillin to eradicate ingested Group A streptococci from epithelial cells: clinical and pathogenetic implications. ''Clin Infect Dis''. 2006;43:1398-406.]</ref> | |||
**Bacterial interactions between [[GABHS]] and the other members of the adenoidal bacterial flora.<ref name="pmid6390637">{{cite journal |vauthors=Brook I |title=The role of beta-lactamase-producing bacteria in the persistence of streptococcal tonsillar infection |journal=Rev. Infect. Dis. |volume=6 |issue=5 |pages=601–7 |year=1984 |pmid=6390637 |doi= |url=}}</ref> | |||
***It is hypothesized that the enzyme [[beta-lactamase]], secreted by beta-lactamase-producing aerobic and anaerobic bacteria that colonize the [[pharynx]], [[tonsil]]s and adenoids, may “shield” [[GABHS]] from [[penicillin]]. | |||
****These organisms include ''S. aureus'', ''[[Haemophillus influenzae]]'', and ''[[Prevotella]]'', Porphyromonas and ''[[Fusobacterium]]'' spp.<ref name="pmid6968177">{{cite journal |vauthors=Brook I, Calhoun L, Yocum P |title=Beta-lactamase-producing isolates of Bacteroides species from children |journal=Antimicrob. Agents Chemother. |volume=18 |issue=1 |pages=164–6 |year=1980 |pmid=6968177 |pmc=283957 |doi= |url=}}</ref> A recent increase was noted in the recovery of MRSA which was isolated from 16% of adenoids, making it more difficult to eradicate this and other beta-lactamase producing organisms.<ref>Brook I, Foote PA. Isolation of methicillin resistant ''Staphylococcus aureus'' from the surface and core of tonsils in children. ''Int J Pediatr Otorhinolaryngol''. 2006 ;70:2099-102.</ref> | |||
**Coaggregation between ''[[Moraxella catarrhalis]]'' and [[GABHS]], which can facilitate [[GABHS]] colonization.<ref name="pmid16849717">{{cite journal |vauthors=Brook I, Gober AE |title=Increased recovery of Moraxella catarrhalis and Haemophilus influenzae in association with group A beta-haemolytic streptococci in healthy children and those with pharyngo-tonsillitis |journal=J. Med. Microbiol. |volume=55 |issue=Pt 8 |pages=989–92 |year=2006 |pmid=16849717 |doi=10.1099/jmm.0.46325-0 |url=}}</ref> | |||
**Absence of normal bacterial flora and resultant lack of interference on the growth of [[GABHS]], makeing it easier for [[GABHS]] to colonize and invade the adenoid area.<ref name="pmid6362282">{{cite journal |vauthors=Grahn E, Holm SE |title=Bacterial interference in the throat flora during a streptococcal tonsillitis outbreak in an apartment house area |journal=Zentralbl Bakteriol Mikrobiol Hyg A |volume=256 |issue=1 |pages=72–9 |year=1983 |pmid=6362282 |doi= |url=}}</ref><ref name="pmid7488371">{{cite journal |vauthors=Brook I, Gober AE |title=Role of bacterial interference and beta-lactamase-producing bacteria in the failure of penicillin to eradicate group A streptococcal pharyngotonsillitis |journal=Arch. Otolaryngol. Head Neck Surg. |volume=121 |issue=12 |pages=1405–9 |year=1995 |pmid=7488371 |doi= |url=}}</ref><ref name="pmid10326813">{{cite journal |vauthors=Brook I, Gober AE |title=Interference by aerobic and anaerobic bacteria in children with recurrent group A beta-hemolytic streptococcal tonsillitis |journal=Arch. Otolaryngol. Head Neck Surg. |volume=125 |issue=5 |pages=552–4 |year=1999 |pmid=10326813 |doi= |url=}}</ref> | |||
**Poor penetration of penicillin into the adenoidal cells and adenoidal surface fluid (allowing intracellular survival of [[GABHS]])<ref name="cid.oxfordjournals.org" /> | |||
**Resistance (i.e., [[erythromycin]]) or tolerance (i.e., [[penicillin]]) to the administered antibiotic | |||
**Inappropriate dose, duration of therapy, or choice of [[antibiotic]] | |||
===Symptomatic Treatment and Pain Management=== | |||
*Treatments of adenoiditis consist of [[analgesics]] and [[lozenges]].<ref name="BoureauPelen1999">{{cite journal|last1=Boureau|first1=F|last2=Pelen|first2=F|last3=Verriere|first3=F|last4=Paliwoda|first4=A|last5=Manfredi|first5=R|last6=Farhan|first6=M|last7=Wall|first7=R|title=Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model|journal=Clinical Drug Investigation|volume=17|issue=1|year=1999|pages=1–8|issn=1173-2563|doi=10.2165/00044011-199917010-00001}}</ref> | |||
**[[Analgesics]] can help reduce [[edema]] and [[inflammation]] to allow the patient to resume swallowing liquids.<ref name="BoureauPelen1999" /> | |||
*Topical anesthetics for temporary relief, such as viscous [[lidocaine]] solutions are often prescribed.<ref name="BoureauPelen1999" /> | |||
*Gargling with warm [[saline]] water.<ref name="urlTonsillitis - Treatment - NHS Choices">{{cite web |url=http://www.nhs.uk/Conditions/Tonsillitis/Pages/Treatment.aspx |title=Tonsillitis - Treatment - NHS Choices |format= |work= |accessdate=}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 21:00, 1 June 2017
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Adenoiditis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
Medical Therapy
Antimicrobial therapy
- If the adenoiditis is caused by group A streptococus, then antibiotics are useful with penicillin or amoxicillin being first line.[1]
- 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.
- Individuals who fail penicillin therapy may respond to treatment effective against beta-lactamase producing bacteria.[3] such as clindamycin or amoxicillin-clavulanate. Aerobic and anaerobic beta lactamase producing bacteria that reside in the adenoidal tissues can "shield" group A streptococcus from penicillins.[4]
Empiric Therapy
- Preferred regimen: Penicillin V PO 10 days or if compliance unlikely, benzathine penicillin IM single dose[5]
- Alternate regimen (1): 2nd generation Cephalosporins PO for 4–6 days
- Alternate regimen (2): Clindamycin or azithromycin for 5 days
- Alternate regimen (3): Clarithromycin for 10 days
- Alternate regimen (4): Erythromycin for 10 days
- Alternative regimen (5): Amoxicillin for 10 days
Challenges of Treatment
Despite in vitro efficacy, there is frequently reported inability of penicillin to fully resolve GABHS from patients with acute and relapsing adenoiditis.[6]
- Over the past 50 years, the rate of penicillin failure has consistently increased from about 7% in 1950 to almost 40% in 2000.
- There are several explanations for the failure of penicillin to eradicate GABHS adenoiditis:[7]
- Poor penetration of penicillin into the adenoid tissues, as well as the epithelial cells.[8]
- Bacterial interactions between GABHS and the other members of the adenoidal bacterial flora.[9]
- It is hypothesized that the enzyme beta-lactamase, secreted by beta-lactamase-producing aerobic and anaerobic bacteria that colonize the pharynx, tonsils and adenoids, may “shield” GABHS from penicillin.
- These organisms include S. aureus, Haemophillus influenzae, and Prevotella, Porphyromonas and Fusobacterium spp.[10] A recent increase was noted in the recovery of MRSA which was isolated from 16% of adenoids, making it more difficult to eradicate this and other beta-lactamase producing organisms.[11]
- It is hypothesized that the enzyme beta-lactamase, secreted by beta-lactamase-producing aerobic and anaerobic bacteria that colonize the pharynx, tonsils and adenoids, may “shield” GABHS from penicillin.
- Coaggregation between Moraxella catarrhalis and GABHS, which can facilitate GABHS colonization.[12]
- Absence of normal bacterial flora and resultant lack of interference on the growth of GABHS, makeing it easier for GABHS to colonize and invade the adenoid area.[13][14][15]
- Poor penetration of penicillin into the adenoidal cells and adenoidal surface fluid (allowing intracellular survival of GABHS)[8]
- Resistance (i.e., erythromycin) or tolerance (i.e., penicillin) to the administered antibiotic
- Inappropriate dose, duration of therapy, or choice of antibiotic
Symptomatic Treatment and Pain Management
- Treatments of adenoiditis consist of analgesics and lozenges.[16]
- Analgesics can help reduce edema and inflammation to allow the patient to resume swallowing liquids.[16]
- Topical anesthetics for temporary relief, such as viscous lidocaine solutions are often prescribed.[16]
- Gargling with warm saline water.[17]
References
- ↑ Touw-Otten FW, Johansen KS (1992). "Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries". Fam Pract. 9 (3): 255–62. doi:10.1093/fampra/9.3.255. PMID 1459378.
- ↑ Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics 2004;113:866-882.
- ↑ Brook I (2009). "The role of beta-lactamase-producing-bacteria in mixed infections". BMC Infect Dis. 9: 202. doi:10.1186/1471-2334-9-202. PMC 2804585. PMID 20003454.
- ↑ Brook I (2007). "Microbiology and principles of antimicrobial therapy for head and neck infections". Infect Dis Clin North Am. 21 (2): 355–91. doi:10.1016/j.idc.2007.03.014. PMID 17561074.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Casey JR, Pichichero ME (2007). "The evidence base for cephalosporin superiority over penicillin in streptococcal pharyngitis". Diagn. Microbiol. Infect. Dis. 57 (3 Suppl): 39S–45S. doi:10.1016/j.diagmicrobio.2006.12.020. PMID 17292576.
- ↑ Brook I, Foote PA (2005). "Efficacy of penicillin versus cefdinir in eradication of group A streptococci and tonsillar flora". Antimicrob. Agents Chemother. 49 (11): 4787–8. doi:10.1128/AAC.49.11.4787-4788.2005. PMC 1280135. PMID 16251332.
- ↑ 8.0 8.1 Kaplan EL, Chatwal GS, Rohde M. Reduced ability of penicillin to eradicate ingested Group A streptococci from epithelial cells: clinical and pathogenetic implications. Clin Infect Dis. 2006;43:1398-406.
- ↑ Brook I (1984). "The role of beta-lactamase-producing bacteria in the persistence of streptococcal tonsillar infection". Rev. Infect. Dis. 6 (5): 601–7. PMID 6390637.
- ↑ Brook I, Calhoun L, Yocum P (1980). "Beta-lactamase-producing isolates of Bacteroides species from children". Antimicrob. Agents Chemother. 18 (1): 164–6. PMC 283957. PMID 6968177.
- ↑ Brook I, Foote PA. Isolation of methicillin resistant Staphylococcus aureus from the surface and core of tonsils in children. Int J Pediatr Otorhinolaryngol. 2006 ;70:2099-102.
- ↑ Brook I, Gober AE (2006). "Increased recovery of Moraxella catarrhalis and Haemophilus influenzae in association with group A beta-haemolytic streptococci in healthy children and those with pharyngo-tonsillitis". J. Med. Microbiol. 55 (Pt 8): 989–92. doi:10.1099/jmm.0.46325-0. PMID 16849717.
- ↑ Grahn E, Holm SE (1983). "Bacterial interference in the throat flora during a streptococcal tonsillitis outbreak in an apartment house area". Zentralbl Bakteriol Mikrobiol Hyg A. 256 (1): 72–9. PMID 6362282.
- ↑ Brook I, Gober AE (1995). "Role of bacterial interference and beta-lactamase-producing bacteria in the failure of penicillin to eradicate group A streptococcal pharyngotonsillitis". Arch. Otolaryngol. Head Neck Surg. 121 (12): 1405–9. PMID 7488371.
- ↑ Brook I, Gober AE (1999). "Interference by aerobic and anaerobic bacteria in children with recurrent group A beta-hemolytic streptococcal tonsillitis". Arch. Otolaryngol. Head Neck Surg. 125 (5): 552–4. PMID 10326813.
- ↑ 16.0 16.1 16.2 Boureau, F; Pelen, F; Verriere, F; Paliwoda, A; Manfredi, R; Farhan, M; Wall, R (1999). "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model". Clinical Drug Investigation. 17 (1): 1–8. doi:10.2165/00044011-199917010-00001. ISSN 1173-2563.
- ↑ "Tonsillitis - Treatment - NHS Choices".