Adenoiditis medical therapy: Difference between revisions

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*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>
*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>
**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>
**Bacterial interactions between [[GABHS]] and the other members of the adenoidal bacterial flora.
***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]].
***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>
****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.
**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>
**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.
**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

Revision as of 21:09, 1 June 2017

Adenoiditis Microchapters

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Patient Information

Overview

Historical Perspective

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Causes

Differentiating Adenoiditis from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

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History and Symptoms

Physical Examination

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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.
      • 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.[5] 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.[6]
    • Coaggregation between Moraxella catarrhalis and GABHS, which can facilitate GABHS colonization.
    • 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.
    • 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

  1. ↑ Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics 2004;113:866-882.
  2. ↑ 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.
  3. ↑ 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. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
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