Adenoiditis medical therapy: Difference between revisions
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== Medical Therapy == | == Medical Therapy == | ||
=== | === Antibiotic therapy: === | ||
*There are no proven evidence of medical therapy effectiveness in recurrent or chronic [[adenoiditis]] cases.<ref name="pmid12117336">{{cite journal |vauthors=Havas T, Lowinger D |title=Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy |journal=Arch. Otolaryngol. Head Neck Surg. |volume=128 |issue=7 |pages=789–91 |year=2002 |pmid=12117336 |doi= |url=}}</ref> | *There are no proven evidence of medical therapy effectiveness in recurrent or chronic [[adenoiditis]] cases.<ref name="pmid12117336">{{cite journal |vauthors=Havas T, Lowinger D |title=Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy |journal=Arch. Otolaryngol. Head Neck Surg. |volume=128 |issue=7 |pages=789–91 |year=2002 |pmid=12117336 |doi= |url=}}</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. | *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. | ||
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*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> | *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. | *Although antibiotic therapy can treat acute adenoiditis, it usually fail to eradicate the bacteria in chronic or recurrent adenoiditis.<ref name="pmid11686429">{{cite journal |vauthors=Huang SW, Giannoni C |title=The risk of adenoid hypertrophy in children with allergic rhinitis |journal=Ann. Allergy Asthma Immunol. |volume=87 |issue=4 |pages=350–5 |year=2001 |pmid=11686429 |doi=10.1016/S1081-1206(10)62251-X |url=}}</ref> | ||
<ref name="pmid11686429">{{cite journal |vauthors=Huang SW, Giannoni C |title=The risk of adenoid hypertrophy in children with allergic rhinitis |journal=Ann. Allergy Asthma Immunol. |volume=87 |issue=4 |pages=350–5 |year=2001 |pmid=11686429 |doi=10.1016/S1081-1206(10)62251-X |url=}}</ref> | |||
*Nowadays with the current trend of resistant bacteria, the use of prophylactic or long-term antibiotics has been decreased.<ref name="pmid22339566">{{cite journal |vauthors=Karlıdağ T, Bulut Y, Keleş E, Alpay HC, Seyrek A, Orhan İ, Karlıdağ GE, Kaygusuz İ |title=Presence of herpesviruses in adenoid tissues of children with adenoid hypertrophy and chronic adenoiditis |journal=Kulak Burun Bogaz Ihtis Derg |volume=22 |issue=1 |pages=32–7 |year=2012 |pmid=22339566 |doi= |url=}}</ref> | *Nowadays with the current trend of resistant bacteria, the use of prophylactic or long-term antibiotics has been decreased.<ref name="pmid22339566">{{cite journal |vauthors=Karlıdağ T, Bulut Y, Keleş E, Alpay HC, Seyrek A, Orhan İ, Karlıdağ GE, Kaygusuz İ |title=Presence of herpesviruses in adenoid tissues of children with adenoid hypertrophy and chronic adenoiditis |journal=Kulak Burun Bogaz Ihtis Derg |volume=22 |issue=1 |pages=32–7 |year=2012 |pmid=22339566 |doi= |url=}}</ref> | ||
===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> | ||
*Over the past 50 years, the rate of penicillin failure has consistently increased from about 7% in 1950 to almost 40% in 2000. | *Over the past 50 years, the rate of penicillin failure has consistently increased from about 7% in 1950 to almost 40% in 2000. | ||
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**Bacterial interactions between [[GABHS]] and the other members of the adenoidal bacterial flora. | **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> | |||
**Coaggregation between ''[[Moraxella catarrhalis]]'' and [[GABHS]], which can facilitate [[GABHS]] colonization. | **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. | **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. | ||
**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 therapy: | ||
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**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. | **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. | **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. | *In cases of viral adenoiditis, treatment with [[analgesic]]s or [[antipyretic]]s is often sufficient.<ref name="pmid23641372">{{cite journal |vauthors=Rajeshwary A, Rai S, Somayaji G, Pai V |title=Bacteriology of symptomatic adenoids in children |journal=N Am J Med Sci |volume=5 |issue=2 |pages=113–8 |year=2013 |pmid=23641372 |pmc=3624711 |doi=10.4103/1947-2714.107529 |url=}}</ref> | ||
<ref name="pmid23641372">{{cite journal |vauthors=Rajeshwary A, Rai S, Somayaji G, Pai V |title=Bacteriology of symptomatic adenoids in children |journal=N Am J Med Sci |volume=5 |issue=2 |pages=113–8 |year=2013 |pmid=23641372 |pmc=3624711 |doi=10.4103/1947-2714.107529 |url=}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 21:13, 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
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.[1]
- 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.[2]
- 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.[3]
- Nowadays with the current trend of resistant bacteria, the use of prophylactic or long-term antibiotics has been decreased.[4]
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.[5]
- 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:
- Poor penetration of penicillin into the adenoid tissues, as well as the epithelial cells.[6]
- 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.[7] 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.[8]
- 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).[6]
- 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.[9]
References
- ↑ 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.
- ↑ Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics 2004;113:866-882.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 6.0 6.1 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, 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.
- ↑ 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.