Azithromycin in the treatment of pharyngitis and tonsillitis. From the point of view of bacteriologist and clinician

1 Pracownia Bakteriologii i Wirusologii, CSK MSW w Warszawie. Kierownik: dr n. biol. Krzysztof Filczak
2 Zakład Profilaktyki Zagrożeń Środowiskowych i Alergologii, WUM. Kierownik: prof. dr hab. n. med. Bolesław Samoliński
3 Oddział Chorób Dziecięcych i Noworodkowych, CSK MSW w Warszawie. Ordynator: dr n. med. Adam J. Sybilski Adres do korespondencji: Dr n. med. Adam J. Sybilski, Oddział Chorób Dziecięcych i Noworodkowych, CSK MSW w Warszawie, ul. Wołoska 137, 02-507 Warszawa, tel.: 22 508 12 38, e-mail: adam.sybilski@cskmswia.pl Praca finansowana ze środków własnych

Pediatr Med rodz Vol 9 Numer 1, p. 50–56
ABSTRACT

Bacteriologist’s and clinician’s point of view to infection is variable. What about bacterial infection throat and tonsil? Characteristic: Bacteriologist: Acute pharyngitis and tonsillitis (APT) mainly caused by viruses (rhinovirus, adenovirus, influenza and parainfluenza viruses, RSV). Bacterial etiology is only in 10–30%. The most common bacterial etiologic factor is Streptococcus pyogenes. The gold diagnostic standard is the throat swab culture with antibiogram. Clinician: The infection usually occurs through droplets. The incubation period continues from 12 hours to 4 days. The diagnosis is based on symptoms: sore throat, fever, headache, malaise, slight enlargement of the cervical lymph nodes. On clinical examination: swollen and congested mucous membrane of the throat. Treatment: Bacteriologist: Correct swabbing the throat has a major impact on the entire diagnostic process. We take the swab from the surface or tonsil crypts. Swab is seeded and incubated at 35–37°C. The first assessment is in 18–24 hours. In the GP practice the rapid diagnostic tests (RADT streptococcal antigen detection clinic may be helpful. Clinician: the first step is limiting the spread of infec tion (elimination of contact), second – symptomatic treatment, if there is S. pyogenes etiology, the first-line treatment is fenoksymetylpenicylina (p.o. or .iv.) In case of hypersensitivity, macrolides should be used. Azithromycin: Bacteriologist: Azithromycin is macrolide, and including the spectrum of the most common pathogens causing pharyngitis and tonsillitis. Clinician: Azithromycin is an effective drug in APT, commonly used at a dose: in children (10 mg/kg once daily for three days), and adults (1×500 mg – three days). Recent studies suggest a better antibiotic activity double dose (cumulative dose – 60 mg/kg/treatment). These two approaches (bacteriologist and clinician) complement each other.

Keywords: pharyngitis, tonsillitis, symptoms, treatment, azithromycin