Adenoiditis medical therapy
Adenoiditis Microchapters |
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Treatment |
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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
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".