Adenoiditis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The mainstay of therapy for adenoiditis is symptomatic therapy. Pharmacologic medical therapy is recommended among patients with recurrent and chronic adenoiditis. | |||
== Medical Therapy == | == Medical Therapy == | ||
=== | === [[Antibiotic]] therapy: === | ||
* | **There are no proven evidence of medical therapy effectiveness in recurrent or chronic [[adenoiditis]] cases. | ||
*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> | **Systemic oral antibiotics can be used if the suspected organism is a bacteria and should be prescribed for a long-term (ie, 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.<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]]. | **A [[macrolide]] such as [[erythromycin]] is indicated for patients allergic to [[penicillin]]. | ||
* | **Although antibiotic therapy can treat acute adenoiditis, it usually fail to eradicate the bacteria in chronic or recurrent adenoiditis. | ||
**Nowadays with the current trend of resistant bacteria, the use of prophylactic or long-term antibiotics has been decreased. | |||
====Challenges of Treatment==== | ====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> | 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> | ||
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****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> | ****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> | **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. | **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="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" /> | **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 | **Resistance (i.e., [[erythromycin]]) or tolerance (i.e., [[penicillin]]) to the administered antibiotic | ||
**Inappropriate dose, duration of therapy, or choice of [[antibiotic]] | **Inappropriate dose, duration of therapy, or choice of [[antibiotic]] | ||
===Symptomatic Treatment and Pain Management=== | ===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 [[analgesic]]s or [[antipyretic]]s is often sufficient. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} |
Revision as of 21:09, 1 June 2017
Adenoiditis Microchapters |
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Treatment |
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.
Medical Therapy
Antibiotic therapy:
- There are no proven evidence of medical therapy effectiveness in recurrent or chronic adenoiditis cases.
- Systemic oral antibiotics can be used if the suspected organism is a bacteria and should be prescribed for a long-term (ie, 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.[1]
- A macrolide such as erythromycin is indicated for patients allergic to penicillin.
- Although antibiotic therapy can treat acute adenoiditis, it usually fail to eradicate the bacteria in chronic or recurrent adenoiditis.
- Nowadays with the current trend of resistant bacteria, the use of prophylactic or long-term antibiotics has been decreased.
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.[2]
- 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:[3]
- Poor penetration of penicillin into the adenoid tissues, as well as the epithelial cells.[4]
- Bacterial interactions between GABHS and the other members of the adenoidal bacterial flora.[5]
- 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.[6] 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.[7]
- 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.[8]
- 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.[9]
- Poor penetration of penicillin into the adenoidal cells and adenoidal surface fluid (allowing intracellular survival of GABHS)[4]
- 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
- 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.
References
- ↑ Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics 2004;113:866-882.
- ↑ 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.
- ↑ 4.0 4.1 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.
- ↑ 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.