Paediatrics: how to manage pharyngitis in an era of increasing antimicrobial resistance

The most prevalent diseases in infants and children, are respiratory infections including the common cold, acute rhinosinusitis, acute otitis media, flu-like illness, acute bronchitis, and pneumonia. Despite being mostly innocuous, they have a large negative impact on society and are a leading source of morbidity and mortality globally. They are further divided into two classes upper respiratory tract and lower respiratory tract infections. The purpose of this research is to review the available information about types of upper and lower respiratory tract infection in paediatrics. The common upper respiratory tract infections include acute pharyngitis which is usually self- limiting and benign and is mostly caused by viruses while inflammation of the mucosa of the paranasal sinuses and nasal cavity is a sign of acute rhinosinusitis. Common colds frequently come with uncomplicated rhinosinusitis, which does not have any clinically visible spread of the inflammation outside the paranasal sinuses and nasal cavity. A viral or bacterial infection of the middle ear causes acute otitis media. Bronchitis, bronchiolitis and pneumonia are lower respiratory infections common among children. More than one-third of children develop bronchiolitis in the first two years of life, which is the most common reason for hospitalization in the first year of life. The hospitalization rate for children has increased from 1% to 3% over the past 30 years while pneumonia is a significant contributor of morbidity and mortality among under 5 years children. Early diagnosis and prompt management can lead to better health outcomes among children.

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“…Evidence for clearing carriage for prevention of rheumatic fever, however, is inadequate and indirect. 16…”

Section: Pharyngitismentioning

confidence: 99%

Types of upper and lower respiratory tract infection in pediatrics

Hothan

Alawami²,

Baothman³

et al. 2022

Int J Community Med Public Health

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“…Regarding the therapeutic approach, nearly 25% of Italian emergency units administer amoxicillin-clavulanate as the initial course of treatment for Group A β-hemolytic streptococcus pharyngitis. Both amoxicillin and penicillin have proven efficacy in treating this bacterial infection [ 13 , 14 ]. Therefore, the utilization of antibiotics with a wider spectrum of activity does not confer any benefits and is linked to a heightened risk of adverse effects [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Nationwide survey on the management of pediatric pharyngitis in Italian emergency units

et al. 2023

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Background Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units. Methods A multicentric national study was conducted in Italian emergency departments between April and June 2022. Results A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis. Conclusions The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis.

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“…The use of antibiotics also offers a largely dependable defense against rheumatic fever and glomerulonephritis, conditions that frequently result in arthritis, myocarditis, and even death. (Robinson JL.,2021).…”

Section: Bacterial or Viral Infection Can Cause Tonsillitismentioning

confidence: 99%

Limiting the role of antibiotics in children with adenotosilitis

Eldin

Abdelal

Rabou

et al. 2022

ijhs

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Background In the past, group A beta-haemolytic streptococcus infection consequences were the main goal of empirical antibiotic therapy of sore throat. Antimicrobial stewardship is crucial due to the threats posed by multi-resistant pathogens. The aim of this study : was to investigate the possibility of limiting the role of antibiotic in children with adenotosilitis Methods: This hospitalbased, randomised, prospective research involved 120 child who visited OPD of both Pediatrics and Otorhinolaryngology departments, pesented with adenotonsillitis were enrolled . All cases met the eligibility requirements were randomly assigned to two groups: 60 cases in Group A got systemic antibiotics. Group B 60 cases received symptomatic treatment with immune modulator, vit D 2000-5000 IU orally once daily. The cases were selected through 2 months from 4118 February 2022 to April 2022. Age :2 years to 9 years. In younger children less than 3 years, dysphagia was expressed by the mothers as difficult swallowing and crying during feeding with drolling of saliva. Results: Regarding baseline symptoms and indicators and after three days, there was no discernible difference between groups A and B. However, after six days of therapy, group B considerably outperformed group A in terms of absent sore throat, dysphagia, and tonsillar hypertrophy. Comparing group B to group A, there was a noticeable improvement in clinical symptoms and indicators. Parents' clinical cure assessments of patients dramatically increased in group B, and group B also had a much shorter time to clinical cure.Conclusion: Vitamin D supplementation can reduce inflammation and modulate innate and adaptive immunity in children with adenotonsillitis, which can be utilised in place of antibiotics in these situations to restrict the usage of antibiotics.

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Paediatrics: how to manage pharyngitis in an era of increasing antimicrobial resistance

Cited by 10 publications

References 81 publications

Types of upper and lower respiratory tract infection in pediatrics

Types of upper and lower respiratory tract infection in pediatrics

Nationwide survey on the management of pediatric pharyngitis in Italian emergency units

Limiting the role of antibiotics in children with adenotosilitis

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