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PubMedDate not supplied

Therapy for pharyngitis and tonsillitis caused by group A beta-hemolytic streptococci: a meta-analysis comparing the efficacy and safety of cefadroxil monohydrate versus oral penicillin V.

A meta-analysis was conducted to compare the efficacy and safety of oral cefadroxil monohydrate (30 mg/kg QD or 15 mg/kg BID) with that of oral penicillin V (8, 10, or 15 mg/kg BID, TID, or QID) in the treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis and tonsillitis treated for 10 days. A simple random effects model was used for combining the efficacy and safety results of nine comparative trials performed in the United States. A total of 1646 patients aged < or = 19 years were considered evaluable; 1406 patients were evaluable using revised bacteriologic criteria, and 1499 patients were considered fully evaluable for safety. The results demonstrate significantly better response rates (P < 0.05) with cefadroxil monohydrate than with penicillin V for overall cure (91.8% versus 81.3%), bacteriologic cure (92.6% versus 81.4%), and bacteriologic recurrence (4.2% versus 10.5%); clinical cure rates were statistically similar (90.5% versus 90.2%). Revised bacteriologic criteria analysis revealed bacteriologic cure rates of 95.8% versus 88.7% (P < 0.05) and bacteriologic recurrence rates of 4.9% versus 7.1% (P = NS) for cefadroxil monohydrate and penicillin V, respectively. Adverse events related to drug administration occurred infrequently and did not differ significantly between treatment groups (P > 0.05). Compliance with cefadroxil monohydrate was at least as good as with penicillin V. Penicillin is currently the drug of choice in the treatment of GABHS pharyngitis and tonsillitis. Based on the information described in this large meta-analysis, cefadroxil monohydrate is an excellent alternative to oral penicillin V in the treatment of GABHS pharyngitis and tonsillitis.

Administration, Oral↗

PubMedDate not supplied

[Prolonged hospital stay in patient with head and neck cancer: impact of nutritional status and pharyngeal problems].

UNLABELLED: Patients who underwent surgery for head and neck malignant neoplasms loose two important human functions: phonation and swallowing. The purpose of this study is to determine the impact of nutritional status and pharyngeal problems in hospital stay in these patients. PATIENTS AND METHODS: Fifty-four patients with oral and pharyngolaryngeal carcinomas underwent surgery were prospective studied to determinate predictors of 2 weeks or longer hospital stay. We studied the impact of malnutrition, tumour location, pharyngeal postoperative problems and infections on hospital stay. RESULTS: 53% of the patients unwent surgery had more than two weeks of hospital stay. Postoperative pharyngeal problems was the strongest correlate of prolonged hospital stay (69% of patients) while only 23% of patients had longer stay because of severe infection (sepsis, neunoniae). Malnutrition or tumor location were not risk factors of prolonged hospitalization stay in our study. CONCLUSIONS: These findings suggest that swallowing problems are the strongest predictors of long hospital stay in head and neck cancer patients.

Head and Neck Neoplasms↗

PubMedDate not supplied

[Fast diagnostic tests in the management of group A beta-heamolytic streptococcal pharyngitis].

OBJECTIVE: Routine clinical diagnosis of Streptococcus pyogenes in pharyngitis is not always easy. The use in common practice of rapid diagnosis test (RDT), might offer a best control of the antibiotic treatments. The aim of this study is to present seven rapid diagnosis tests, to assess their feasibility and finally to determine the bacteriological correlation. METHOD: We propose to compare the results obtained with seven RDT, and to assess their interest in medical diagnosis for group A streptococcus pharyngitis. A prospective study was conducted for three months, a RDT was performed for children (n=75) between eight and fourteen years old presenting acute pharyngitis. Several throat sampling were performed to order cultures. RESULTS: The group A streptococcus was isolated in 33% (n=25) of throat sampling. Comparing cultures results, and for all studied tests, we obtained comparable performances with manufacturer data, specificity upper than 94% and sensitivity upper than 88%. CONCLUSION: All assessed RDT may offer to physicians a decision-making tool for rapid diagnosis. However, because of its complexity, the agglutination test can be used only in pathology laboratories.

Adolescent↗

PubMed2004

[Effects of surface anesthesia of the pharyngeal mucous membrane on negative pressure airway reflex].

BACKGROUND: Upper airway reflexes include a reflex protecting the airway as well as another one dilating the airway. The latter reflex, the pharyngeal dilator reflex to negative airway pressure (NPAR), plays an important role in maintaining airway patency, although the peripheral receptors involved in NPAR have not been specified. METHODS: The effects of surface anesthesia of the pharyngeal mucous membrane on NPAR were evaluated by observing activity of the musculus genioglossus (GG) in rabbits. Following anesthesia with thiopental, two incisions were made on the trachea of each rabbit. Through these incisions, a tube connected to the anesthetic circuit was inserted into the lung and another tube connected to an aspirator into the pharynx. Effects of negative pressure on the myelogram of the GG were recorded with and without surface anesthesia with 1% lidocaine. RESULTS: Electric discharge from the GG was increased in the sessions with exposure to negative pressure without surface anesthesia, but was significantly decreased in those with surface anesthesia. CONCLUSIONS: These findings suggest that the peripheral receptors of NPAR are located in the pharyngeal mucous membrane.

Airway Resistance↗

PubMed1992

[Diagnosis of acute pharyngitis].

The diagnosis of acute pharyngitis relies on a good analysis of its signs and symptoms, one of the objectives of this thorough clinical study being to differentiate between pharyngitis as a symptom and as a disease. Establishing correlations between the clinical diagnosis of acute pharyngitis and a tentative microbiological diagnosis facilitates the first-line treatment.

Acute Disease↗

PubMed2004

Candidosis of the pharyngeal mucosa in patients with infectious mononucleosis.

The aim of our study was to assess the frequency rate of Candida yeast-like fungi in isolations from nasal and pharyngeal mucosa in patients diagnosed with IM who had undergone an antibiotic therapy. The study was performed in 51 patients aged 17-33. The diagnosis of IM was made on the basis of clinical symptoms, haematological, biochemical and serologic examination results. The material constituted of nasal and pharyngeal swabs. The identification of Candida species was done according to the routine microbiological diagnostics. Our results show that among the Candida genus, C. albicans was the only pathogenic species isolated from patients with IM. It was observed only in pharyngeal swabs in 27.4% of the patients.

Adolescent↗

PubMed2005

[Acute pharyngitis].

The signs and symptoms of acute pharyngitis was described, and principles of diagnostic and therapeutic approach was discussed, concentrating on differentiation between the various forms of virus and bacterial pharyngitis. The economical and clinical importance of rational diagnosis of acute pharyngitis was pointed out, in aspect of antibiotic prescribing limited to acute streptococcal tonsillitis.

Acute Disease↗

PubMed2006

Efficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis - a randomised, double-blind, placebo-controlled study with adaptive design and interim analysis.

OBJECTIVE: This randomised, double-blind, parallel group phase II/III study with adaptive two-stage design and interim analysis compared the efficacy and tolerability of spray (containing a Salvia officinalis fluid extract) against placebo in the treatment of patients with acute viral pharyngitis. - STUDY PARTICIPANTS: in two study parts, a total of 286 patients with subjective and objective evidence of pharyngitis were randomized. In the first study part 122 patients were enrolled. In the second study part 164 patients were included. The treatment duration per patient was 3 days, including one baseline visit and one final visit. - MAIN OUTCOME MEASURES: Area under Curve for change of throat pain intensity (spontaneous pain), documented every 15 minutes within the first 2 hours after the first application as compared to baseline using a visual analog scale (VAS 100 mm). - RESULTS: Following the interim analyses of the first study part the 15 % spray containing 140 microl sage extract per dose was the most promising preparation for the second study part (main study) whereas for the 30% and the 5% preparation results made superiority over placebo unlikely in the final analysis. Overall, the 15 % spray was significantly superior to placebo for the primary efficacy variable with regard to a reduction of the throat pain intensity score. Only minor side effects such as dry pharynx or burning of mild intensity were seen. - CONCLUSIONS: The efficacy and tolerability profile of a 15 % sage spray indicated that this preparation provides a convenient and safe treatment for patients with acute pharyngitis. A symptomatic relief occurred within the first two hours after first administration and was statistically significantly superior to placebo.

Acute Disease↗

PubMed1991

[Oropharyngeal dysphagia due to a primary change in the pharyngeal musculature. A manometric and isotopic study].

Twenty-five patients with oropharyngeal dysphagia due to a variety of disorders (4 with muscular dystrophy, 4 with myasthenia gravis and 13 with inflammatory myopathies) were studied clinically by esophageal manometry and isotopic clearance. Clinically patients had moderate dysphagia and 45% other symptoms such as nasal regurgitation, bronchial aspiration, etc. The most important manometric abnormality was the feeble contractions of the pharyngeal musculature, more pronounced in patients with severe dysphagia (grade II). Isotopic clearance of the oropharynx showed slowing of the pharyngeal emptying curve and an increased residual activity in this area. Isotopic oropharyngeal clearance is a useful, comfortable and noninvasive test for determining the clinical improvement which accompanies the manometric recovery of the pharyngeal muscular contraction.

Deglutition Disorders↗

PubMed2006

[An analysis of the causes of refractory pharyngeal paraesthesia in 600 cases].

OBJECTIVE: To investigate the causes of refractory pharyngeal paraesthesia. METHOD: Besides routine examination of otolaryngology, 600 patients were tested by fiberoptic laryngoscopy, fiberoptic gastroesophagoscopy, nasal sinuses CT, styloid process X-ray as well as neck and thyroid gland B ultrasonography. Then, they were treated according to respective causes. RESULT: Among 600 cases of refractory pharyngeal paraesthesia, 229 (38.2%) cases were diagnosed as gastroesophagitis, 113 (18.8%) nasal sinusitis, 57 (9.5%) climacteric syndromes, 40 (6.7%) chronic tonsillitis, 22 (3.7%) carcinophobia, 13 (2.2%) subacute thyroiditis or thyrophymas, 9 (1.5%) elongation of styloid process and 117 (19.5%) other causes. All patients were treated according to respective causes and total cure rate was 84.2% after 6 months. CONCLUSION: There are many causes of pharyngeal paraesthesia. We should pay attention to its relationship with gastroesophagitis and nasal sinusitis etc, especially, gastroesophageal reflux disease.

Adult↗

PubMedDate not supplied

[Free forearm skin flap with vascular microanastomosis in the reconstruction of the posterior pharyngeal wall].

The posterior wall of the oropharynx and hypopharynx is a single anatomo-functional structure which is artificially divided into oro and hypo by an imaginary line at the valleculae floor level. From the oncological point of view this division serves merely for classification purposes. In fact, the tumors of the posterior wall of both the oro and hypopharynx have the same risk factors, the same lymphatic drain, the same clinical behaviour, the same means of treatment and, almost certainly, the same prognosis. One of the most important problems after posterior pharyngeal wall resection and larynx preservation, is reconstruction without interfering with laryngeal functions. Between April 1990 and April 1991 four patients with squamous cell carcinoma of the posterior pharyngeal wall underwent, surgery after a complete staging including CT and panendoscopy. All underwent bilateral neck dissection, resection of the tumor preserving the larynx and free forearm flap reconstruction. The anastomosis between the radial and superior thyroid arteries and between the venae comitantes and the branches of the internal or external jugular veins were performed under operating microscope with the microvascular technique. The overall average surgical time was 8 hours. No flap necrosis, fistulae or donor site morbidity were observed. Postoperative radiotherapy was initiated without delay. This approach was chosen because, in the authors' experience, in cases of advanced posterior pharyngeal wall cancer, the results of radiotherapy alone are quite disappointing. The feasibility of surgical resection with good, radical macroscopic margins, easily allows margins which are microscopically free of disease and this is an important prognostic factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗

PubMed1991

Treatment of beta-hemolytic streptococcal pharyngitis with cefaclor or penicillin. Efficacy and interaction with beta-lactamase-producing organisms in the pharynx.

The recommended treatment for group A beta-hemolytic streptococcal pharyngitis has continued to be penicillin given in parenteral or oral form. Treatment failures, as determined by the continued presence of the streptococcal organism in the pharynx, however, do occur in 6% to 25% of patients treated with penicillin. Furthermore, beta-lactamase produced by other bacteria in the pharynx could potentially inactivate the penicillin, resulting in increased treatment failures or infection relapses. A study was undertaken to compare the efficacy of cefaclor, which is relatively resistant to inactivation by beta-lactamase, with penicillin for eradicating the group A beta-hemolytic streptococcal organism from the throats of 93 patients with pharyngitis. Additionally, extensive cultures for potential beta-lactamase-producing organisms were conducted on 37 patients; 27% of these had one or more pharyngeal organisms that were producing beta-lactamase. No statistically significant difference was found between the clinical responses or the bacteriological cure rates of those treated with cefaclor and those treated with penicillin when stratified by the presence or absence of beta-lactamase-producing organisms. The prevalence of beta-lactamase-producing organisms in the pharynx, however, was increased after treatment with penicillin, whereas no change was noted following treatment with cefaclor.

Adolescent↗

PubMedDate not supplied

Antibiotic use in the treatment of non-streptococcal pharyngitis.

Treatment of non-streptococcal pharyngitis (NSP) varies among physicians. Recent data regarding difficult-to-culture bacterial pathogens have increased interest in antibiotic treatment of NSP. This study examined physician behavior regarding antibiotic treatment of NSP in preparation for a prospective clinical trial. The records of 358 patients with pharyngitis-related diagnoses from a large private family physician practice and an urban hospital's housestaff clinic were reviewed. No significant relationship between the presence of streptococcus and the prescribing of antibiotics was found. Physicians gave antibiotics to 50% of patients with clinical signs and symptoms of pharyngitis. Many of these tested negative for streptococcus. Physicians used antibiotics effective against Mycoplasma and Chlamydia less than one half of the time. Projected costs of drug treatment for patients with NSP was $1,200. Family medicine educators are encouraged to monitor their own and their residents' antibiotic prescribing behaviors when treating common upper respiratory infections.

Adult↗

PubMed1989

[A food-borne outbreak of group A streptococcal pharyngitis].

In August 1988, following a luncheon, an explosive epidemic of pharyngitis due to group A streptococci (M type 11, T type 3/13/B3264 and opacity factor positive) occurred among the staff of an institution in Ankara. Epidemiological investigation indicated that the outbreak was food-borne. A salad prepared by bean with boiled egg was incriminated as the vehicle of transmission. Group A streptococci were isolated from the throats of 37 (63.8 percent) of 58 persons with pharyngitis. High levels of antistreptolysin O titers were observed in serum samples from 39 (81.2 percent) of 48 persons with pharyngitis. Secondary transmission had accounted for only 3.8% of cases.

Antistreptolysin↗

PubMedDate not supplied

The treatment of nonstreptococcal pharyngitis with erythromycin: a preliminary study.

This preliminary study evaluated the effectiveness of enteric-coated erythromycin in the treatment of adults with nonstreptococcal pharyngitis. Twenty-six patients, aged 12 or older, with nonstreptococcal pharyngitis were randomly assigned in a double-blind fashion to receive either enteric-coated erythromycin or placebo for 10 days. Each day the patients rated the soreness of their throats and how sick they felt. The use of erythromycin appeared to decrease the median number of days for the feeling of sickness to improve (two days versus four days, P less than .01) as well as to decrease the median number of days for the feeling of sickness to resolve (three-and-a-half days versus five days, P less than .05). This apparent improvement in sickness occurred even though there was no significant decrease in the soreness of the throat in patients treated with erythromycin compared to those patients treated with placebo. Treatment with enteric-coated erythromycin appeared to shorten the time until improvement in this group of adults with nonstreptococcal pharyngitis.

Adolescent↗

PubMed1989

[Cobalt teletherapy of patients with pharyngeal cancer].

127 patients with pharyngeal cancer were irradiated in the years 1970-1979 with telecobalt-60 in total doses of 60-65 Gy. In the group with not advanced pharyngeal cancer 34% of patients survived during 5 years without any symptoms of neoplasm. In the group with advanced pharyngeal cancer and lymph nodes metastases the 5 years survival was within 15%. The 5-years survival depended mainly upon the extensiveness of the neoplasm. The therapeutic results were influenced also by the age of the patient; 35% were above 60 years of age and 17.3% died before the 5 years period without any symptoms of cancer.

Adult↗

PubMedDate not supplied

Pharyngitis 1987: a survey of physicians' attitudes and practices in southern Alberta.

A questionnaire survey concerning Streptococcal pharyngitis was completed by 85 southern Alberta family physicians. The data revealed a significant trend to overtreat pharyngitis with antibiotics because of the unreliability of clinical diagnosis and the lack of diagnostic manoeuvres with suitable ability to influence management. These data and a further questionnaire survey directed to the appreciation of other bacterial pharyngitides, demonstrate the importance of laboratory reports in biasing treatment, and further suggest that significant overtreatment of non-Streptococcal pharyngitis also occurs.

Alberta↗

PubMed1979

A comprehensive study of pharyngeal flap surgery: tailor made flaps.

Three methods of pharyngeal flap surgery were analyzed with multiview videofluoroscopy and nasopharyngoscopy at least six months post-operatively. It was found that, by varying the type of insertion of the flap into the palate, post-operative flap width could be "tailored" to the size of the gap in the velopharyngeal sphincter. The value of varying flap width according to gap size was assessed by analyzing speech results in 60 patients specifically assigned for narrow, moderate, or wide flaps. Results show a marked improvement in the effectiveness of pharyngeal flap surgery when operations are prescribed according to the degree of lateral pharyngeal wall motion seen pre-operatively.

Cineradiography↗