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Query: UMLS:C0040425 (tonsillitis)
 1,594 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A week after onset of a pharyngo-tonsillitis a previously healthy 23-year-old man developed high fever (41.4 degrees C), leukocytosis (12,200/microliters) with marked shift to the left, thrombocytopenia (86,000/microliters) and increased transaminases (GOT 83 U/l, GPT 113 U/l). Chest x-ray film suggested intrapulmonary abscesses with left-sided pleural effusion. The suspected diagnosis of "post-tonsillitis" septicaemia (Lemierre's syndrome) was confirmed by demonstrating anaerobic, fusiform, gram-negative bacteria (Fusobacterium nucleatum and necrophorum) in several blood cultures. Despite antibacterial treatment (amoxicillin/clavulanic acid, imipenem/cilastatin, clindamycin) he had recurrent pain referred to the kidney region and persisting fever. Repeated ultrasound and radiological examinations revealed new foci in the spleen, which were enlarging. Laparotomy with splenectomy performed on day 17 after the begin of treatment confirmed multiple splenic abscesses, but abscess pus and splenic tissue were sterile. After altogether 6 weeks of antibiotic treatment, finally with chloramphenicol, the patient was discharged in a good general state.
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PMID:[Lemierre's syndrome with splenic abscesses]. 139 37

Over a period of 9 years in general practice temporary enlargement of the spleen was found in 29 episodes of pharyngitis or tonsillitis, in 2 episodes of acute upper respiratory tract infection other than pharyngitis and in 6 episodes of acute cervical lymphadenitis. In five patients more than one episode of illness associated with splenomegaly was recorded. In 26 of the 37 episodes a possible aetiology was identified. Evidence only of infection with group A streptococci was found in 14 episodes, adenoviruses or coxsackie B viruses were isolated alone in 4 episodes and in 4 episodes the only finding was the presence in the blood of more than occasional atypical mononuclear cells; in 4 episodes there was evidence of both streptococcal and viral infection. Episodes with evidence of streptococcal infection only tended to be of shorter duration and to be more evenly distributed over the year than were episodes without such evidence. Temporary splenomegaly was noted also in two children with varicella (one of whom also had streptococcal infection) and in an adult with probable rubella.
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PMID:Splenomegaly in acute infections due to group A streptococci and viruses. 139 11

Post-streptococcal complications are known to be common among Ethiopian children. Little is known, however, about the epidemiology of beta-haemolytic streptococci in Ethiopia. A total of 816 children were studied during a one-year period: 24 cases of acute rheumatic fever (ARF), 44 chronic rheumatic heart disease (CRHD), 44 acute post streptococcal glomerulonephritis (APSGN), 143 tonsillitis, 55 impetigo, and 506 were apparently healthy children. Both ARF and APSGN occurred throughout the year with two peaks during the rainy and cold seasons. The female:male ratio among ARF patients was 1.4:1 and 1:1.9 among APSGN. The monthly carrier rate of beta-haemolytic streptococci group A varied from 7.5-39%, average being 17%. T type 2 was the most frequent serotype. Marked seasonal fluctuations were noted in the distribution of serogroups among apparently healthy children. Beta-haemolytic streptococci group A dominated during the hot and humid months of February-May. Strains were susceptible to commonly used antibiotics, except for tetracycline.
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PMID:A one-year study of streptococcal infections and their complications among Ethiopian children. 139 12

The result of a rapid co-agglutination test was compared with the clinical diagnosis of group A streptococcal tonsillitis, a laboratory culture from the throat serving as the correct result. The study was carried out in a family practice, with two GPs partaking: it included 105 consecutive patients. The outcome of the rapid test was significantly correlated to the degree of growth determined by throat culture, and it was superior to the clinical judgement. The statistical analysis of the results of the rapid test revealed (95% confidence limits in brackets) a specificity of 97% (91-100), sensitivity of 68% (48-84), a positive predictive value of 90% (70-99), and a negative predictive value of 89% (81-95). Although the co-agglutination test was superior to the clinical diagnosis, the sensitivity of this test is rather low when compared with other recently evaluated rapid tests for use in family practice.
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PMID:An evaluation of a commercial co-agglutination test for the diagnosis of group A streptococcal tonsillitis in a family practice. 141 Sep 54

Ten-day, double-blind, randomized, parallel treatment regimens of loracarbef (200 mg capsule twice daily or 15 mg/kg/day oral suspension in two divided doses up to a maximum of 375 mg/day; n = 169) and penicillin V (250 mg capsule four times daily or 20 mg/kg/day suspension in four divided doses up to a maximum of 500 mg/day; n = 175) were compared in the treatment of group A beta-haemolytic streptococcal (GABHS) pharyngitis and tonsillitis. Post-therapy clinical responses were similar for evaluable patients in both treatment groups: 97.4% of the loracarbef group (101/115 patients cured and 11/115 improved) and 96.0% of the penicillin group (101/124 patients cured and 18/124 improved). A statistically significant difference in the pathogen elimination rate was noted between treatment groups: post-therapy throat cultures were negative for GABHS in 94.8% (109/115) of loracarbef-treated patients compared with 87.1% (108/124) of penicillin-treated patients (p = 0.040). Loracarbef and penicillin V were comparable in terms of safety. Headache and nausea/vomiting were the most common events reported during therapy (nausea/vomiting were slightly less common in the loracarbef group). Three patients in each group were discontinued from the study due to drug-related adverse events; one due to rash in the loracarbef group and one due to rash and one due to vomiting in the penicillin group. These data support the conclusion that loracarbef twice daily is more effective in eradicating GABHS than penicillin V four times daily, and the two drugs are comparable in safety and clinical efficacy in the treatment of GABHS pharyngitis and tonsillitis.
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PMID:Loracarbef versus penicillin V in the treatment of streptococcal pharyngitis and tonsillitis. 142 89

A total of 49 children (20 females, 29 males; age range, 6 months-12 years) with upper respiratory tract infections (otitis media, sinusitis, pharyngitis and/or tonsillitis) were treated orally with 25 mg/kg.day sultamicillin suspension in two equal doses for an average of 9.2 days. There was bacteriological evidence of sultamicillin-sensitive pathogens in 44 patients prior to treatment. On completion of treatment, 42 (85.7%) patients were rated as clinically cured and there was improvement in the remaining seven (14.2%) patients. Pathogens were totally eradicated in 32/44 (73.7%) cases but were still present in two (4.5%) and in 10 cases follow-up bacteriological evaluation was not possible. Tolerability of sultamicillin was good and only three possible or probable treatment-related adverse events were recorded.
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PMID:An open non-comparative pilot study of the safety and efficacy of oral sultamicillin in the treatment of mild to moderate upper respiratory tract infections in children. 145 26

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.
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PMID: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. 146 91

A group of thirty General Practitioners in the Sligo/Leitrim area were studied to examine their prescribing patterns of commonly-occurring clinical situations. Using a structured questionnaire, the doctors were presented with seven case histories of conditions which were both common and require a prescription. The doctors were asked to to record the drug that they would prescribe in a normal situation. The results were analysed according to the range of drugs used, the degree of generic versus proprietary prescribing and the variation in costs for each case and for each doctor. The study was carried out in October 1990-March 1991. Of all the prescriptions written, 21% were for generic preparations (ie 46 out of 210) and these were most commonly chosen in the areas of Tonsillitis and Osteoarthritis. Prescribers of generics showed no differences as regards age, size of practice or distance from hospital. The choice of drug was most consistent in the area of Urinary Tract Infection, which was also the cheapest prescribing area. Prescribing for Non-Ulcer-Dyspepsia showed the greatest variation in drug choice and was also the most expensive area of the cases in this study. Doctors who used generic preparations in at least three of the seven cases in this study demonstrated a saving of 21% in their prescribing costs. Overall, the degree of generic prescribing was greatest in the areas where the potential savings were only moderate and the least generic prescribing was present in the group of drugs where the greatest potential savings might be made.
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PMID:Patterns of prescribing in Irish general practitioners. 147 54

These guidelines deal with the evaluation of anti-infective drugs for the treatment of respiratory tract infections. Five clinical entities are described: streptococcal pharyngitis and tonsillitis, otitis media, sinusitis, bronchitis, and pneumonia. A wide variety of microorganisms are potentially pathogenetic in these diseases; these guidelines focus on the bacterial infections. Inclusion of a patient in a trial of a new drug is based on the clinical entity, with the requirement that a reasonable attempt will be made to establish a specific microbial etiology. Microbiologic evaluation of efficacy requires isolation of the pathogen and testing for in vitro susceptibility. Alternatively, surrogate markers may be used to identify the etiologic agent. The efficacy of new drugs is evaluated with reference to anticipated response rates. Establishment of the microbial etiology of respiratory tract infections is hampered by the presence of "normal flora" of the nose, mouth, and pharynx, which may include asymptomatic carriage of potential pathogens. This issue is addressed for each category of infection described. For example, it is suggested that for initial phase 2 trials of acute otitis media and acute sinusitis tympanocentesis or direct sinus puncture be used to collect exudate for culture. Acute exacerbations of chronic bronchitis also present difficulties in the establishment of microbial etiology. These guidelines suggest that clinical trials employ an active control drug but leave open the possibility of a placebo-controlled trial. For pneumonia, the guidelines suggest the identification and enrollment of patients by the clinical type of pneumonia, e.g., atypical pneumonia or acute bacterial pneumonia, rather than by etiologic organism or according to whether it was community or hospital acquired. For each respiratory infection, the clinical response is judged as cure, failure, or indeterminate. Clinical improvement is not acceptable unless quantitative response measures can be applied.
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PMID:Evaluation of new anti-infective drugs for the treatment of respiratory tract infections. Infectious Diseases Society of America and the Food and Drug Administration. 147 53

The present work deals with trials of the method of rapid diagnosis of streptococcal infection, carried out in children's infectious hospital, with the use of a new diagnostic kit. The proposed diagnosticum has proved to be highly sensitive and specific in scarlet fever and tonsillitis. The sensitivity and specificity of the diagnosticum depend on the duration of the disease, prehospital treatment and the quality of the bacteriological analysis.
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PMID:[The rapid diagnosis of acute streptococcal infection in children]. 148


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