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

Among adults, acute sinusitis, tonsillitis/pharyngitis, community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) are the most commonly encountered respiratory tract infections (RTIs) in the community. Empiric antibacterial therapy is the most widely used approach for the treatment of such infections. The appropriate antibacterial requires consideration of a number of patient-, pathogen- and drug-related factors. One additional factor is the global spread of resistance among common respiratory pathogens such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, which limits the utility of existing antibacterials. Telithromycin (HMR 3647), the first of a new family of antibacterials, the ketolides, was designed specifically to provide optimal therapy for community-acquired RTIs. This agent, which has a broad spectrum of antibacterial activity against common respiratory pathogens (including resistant strains and atypical/intracellular organisms), has been clinically and bacteriologically evaluated against gold-standard comparators in a series of phase III clinical trials. The results of these studies demonstrate that telithromycin, at a dosage of 800 mg once daily, is an effective, well-tolerated agent for the treatment of the most commonly encountered community-acquired RTIs. Moreover, telithromycin meets the challenge of increasing antibacterial resistance. High rates of clinical cure and bacteriologic eradication were achieved, even in patients infected with problematic resistant pathogens such as penicillinG- and macrolide-resistant S. pneumoniae. In summary, telithromycin represents a promising new antibacterial for the treatment of community-acquired RTIs. With high efficacy and bacterial eradication rates, good tolerability and convenient once-daily administration, telithromycin therapy should result in increased patient compliance and improved outcomes, thereby minimizing the risk of developing antibacterial resistance.
Infection 2001 Dec
PMID:Clinical management of respiratory tract infections in the community: experience with telithromycin. 1178 52

The treatment of respiratory tract infections (RTIs) continues to challenge the knowledgeable and conscientious physician. Upper RTIs such as sinusitis and tonsillitis/pharyngitis - while not generally life-threatening - are associated with personal cost and suffering, while infections of the lower respiratory tract, including community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB), represent a more serious clinical challenge and account for almost half of all community-acquired infections. Moreover, such infections may be fatal. Laboratory tests for etiologic agents of RTIs are often insensitive and slow and identify the causative pathogen in only a minority of cases. Therapy for RTIs is, therefore, generally presumptive and instituted before there is a clear understanding of etiology. Such an approach requires antibacterials that possess a spectrum of activity which covers both the common and atypical/intracellular pathogens associated with RTIs to enable physicians to confidently prescribe treatment. A major barrier to the confident prescribing of empiric therapies for RTIs is the increasing prevalence of resistance to existing antibacterial agents among respiratory tract pathogens. Increasing levels of antibacterial resistance now threaten the utility of existing agents, primarily the beta-lactams and macrolides, and continue to drive the search for newer agents which retain activity against drug-resistant respiratory tract pathogens. This need is emphasized by recent evidence that bacterial resistance may be associated with poorer clinical outcomes, particularly for patients with severe infections. There is enormous concern and uncertainty about the factors that contribute to increasing bacterial resistance and treatment strategies that should be adopted to minimize this problem. The arguments have raged particularly around recent Infectious Diseases Society of America (IDSA) guidelines on the treatment of CAP, which have advocated a greater role for fluoroquinolones. One school of thought - driven in part by concerns over cost of therapy - advocates the use of older agents such as amoxicillin, in the hope that any resistance that is incurred will be to these agents, leaving the newer agents for select cases with acquired resistance. Advocates of the newer agents argue that this approach represents a false economy and that there is a greater likelihood of first-line success with newer agents, so that patients are less likely to require a second physician visit and a second course of antibacterial therapy.
Infection 2001 Dec
PMID:Barriers to the effective management of respiratory tract infections in the community. 1178 53

Acute respiratory infections accounts for 20-40% of outpatient and 12-35% of inpatient attendance in a general hospital. Upper respiratory tract infections including nasopharyngitis, pharyngitis, tonsillitis and otitis media constitute 87.5% of the total episodes of respiratory infections. The vast majority of acute upper respiratory tract infections are caused by viruses. Common cold is caused by viruses in most circumstances and does not require antimicrobial agent unless it is complicated by acute otitis media with effusion, tonsillitis, sinusitis, and lower respiratory tract infection. Sinusitis is commonly associated with common cold. Most instances of rhinosinusitis are viral and therefore, resolve spontaneously without antimicrobial therapy. The most common bacterial agents causing sinusitis are S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus and S. pyogenes. Amoxycillin is antibacterial of choice. The alternative drugs are cefaclor or cephalexin. The latter becomes first line if sinusitis is recurrent or chronic. Acute pharyngitis is commonly caused by viruses and does not need antibiotics. About 15% of the episodes may be due to Group A beta hemolytic streptococcus (GABS). Early initiation of antibiotics in pharyngitis due to GABS can prevent complications such as acute rheumatic fever. The drug of choice is penicillin for 10-14 days. The alternative medications include oral cephalosporins (cefaclor, cephalexin), amoxicillin or macrolides.
Indian J Pediatr 2001 Dec
PMID:Upper respiratory tract infections. 1183 68

Little evidence exists from randomized controlled trials to support the role of tonsillectomy in children with recurrent tonsillitis. Despite this, parents report a great change for the better in their children following the operation. Previous trials vary in their inclusion criteria, both in terms of the definition of tonsillitis and in the frequency of sore throats required before entry into the study is permitted. The aims of this study are to define tonsillitis from the perspective of parents whose children are awaiting tonsillectomy for recurrent sore throats, and to determine whether such parents have a better understanding of the difference between tonsillitis and other sore throats than parents of children from a normal population control group. These aims demonstrate whether parents who request tonsillectomy for their children do so on the basis of a recognized clinical problem. We report that parents can clearly identify a sore throat illness that they call tonsillitis and which is differentiated from other sore throats by different symptom complexes. The parental history is important in the assessment of a child prior to tonsillectomy. The views of parents whose children have recurrent tonsillitis must be further investigated if the difference between randomised controlled trial results and parents' opinions regarding the benefit of tonsillectomy is to be understood.
Clin Otolaryngol Allied Sci 2001 Dec
PMID:How well do parents recognize the difference between tonsillitis and other sore throats? 1184 23

Previous reports have suggested that the incidence of tonsillectomy, and/or tonsillitis in children, is influenced by factors such as parental smoking, maternal health and previous parental tonsillectomy. The reports have considered single factors and have not considered the possible confounding effect of the factors upon one another. Previous studies have not investigated the influence of social class. This paper uses the background of a large case-control trial of children awaiting tonsillectomy for recurrent tonsillitis, and a normal control group to study the influence of parental smoking, parental surgical history, parental tonsillectomy, family atopy and social class upon the reported incidence of sore throats and tonsillitis. A multivariate analysis is used. The paper shows that parental smoking, previous parental surgery and social class have no effect upon the number of sore throat episodes. A history of parental tonsillectomy and a family history of atopy are both significant predictive factors for the number of reported sore throats and episodes of tonsillitis in children.
Clin Otolaryngol Allied Sci 2001 Dec
PMID:Is the incidence of tonsillectomy influenced by the family medical or social history? 1184 28

Tonsillar tissue is a component of mucosa-associated lymphoid tissue (MALT), which has evolved to protect vulnerable mucosal surfaces. Helicobacter pylori, implicated as an aetiological factor in duodenal ulcers and gastritis, induces the appearance of lymphoid aggregates (MALT) in the stomach. This organism is cytotoxic via a nitric oxide synthase cascade. The possibility that tonsillar tissue processes Helicobacter pylori or that Helicobacter pylori can colonize the palatine tonsils is explored. The study design was that of a prospective study. We determined if Helicobacter pylori (i) forms part of the normal microenvironment of the tonsil, (ii) plays a role in the pathogenesis of tonsillitis and (iii) is associated with increased expression of inducible nitric oxide synthase (iNOS) in macrophages of the tonsil. Serology for Helicobacter pylori was performed on 50 patients undergoing tonsillectomy. Tonsillar specimens were monitored for urease activity by CLO test (a sealed plastic slide holding an agar gel, which contains urea and detects the urease enzyme of Helicobacter pylori), and immunocytochemically probed for Helicobacter pylori and iNOS expression. The mean age of this patient group was 17.2 years (3-36 years). Fourteen (28%) were sero-positive for Helicobacter pylori but no evidence of this pathogen was found in any tonsillar specimen. The number of macrophages staining for iNOS, per field, under a magnification of x40, was increased in sero-positive patients (13.3 +/- 1.3 versus 9.9 +/- 0.7; P = 0.01). Helicobacter pylori does not appear to colonize the tonsil. We believe that Helicobacter pylori primes the tonsils by inducing macrophage iNOS expression. The higher expression in sero-positive patients is a reflection of a pro-inflammatory reaction to Helicobacter pylori that is both local and systemic.
Clin Otolaryngol Allied Sci 2001 Dec
PMID:Helicobacter pylori and tonsillectomy. 1184 33

The ketolide telithromycin (HMR-3647; Ketek), a derivative of clarithromycin, has been launched by Aventis Pharma (formerly Hoechst Marion Roussel) for the treatment of respiratory tract infections with gram-positive or gram-negative cocci, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, intracellular pathogens, atypical microorganisms, toxoplasma or anaerobic bacteria. By May 2001, filings in the US and EU had been completed and a filing in Japan was expected to take place in the fourth quarter of 2001. In July 2001, telithromycin was granted marketing authorization by the EC for the treatment of community-acquired respiratory tract infections, including those caused by bacteria resistant to commonly used antibiotics. In October 2001, the product was launched in Germany. In March 2000, telithromycin was submitted to the US FDA and the EMEA, under the EU centralized approval procedure, for approval for the treatment of community-acquired pneumonia (CAP), acute sinusitis, acute exacerbations of chronic bronchitis and tonsillitis/pharyngitis. The company had expected to launch the product in early 2001. The CPMP issued a positive opinion for all four indications on April 23 2001. In September 2001, the company indicated that it expected the product to be launched in Japan in 2002. The FDA's Anti-infectives Advisory Committee was due to review telithromycin for all the submitted indications on January 29 2001; however, this was postponed. This postponement was thought to be at Aventis' request in order to discuss the potential for a resistant pneumococcal infection labeling which would boost product sales. The revised date for the meeting was April 26 2001, at which the Anti-Infective Drugs Advisory Committee of the FDA recommended approval of telithromycin for the treatment of CAP in patients 18 years of age or older. The committee failed to recommend approval for the use of the drug for the remaining three indications for which it was filed, citing concerns over potential cardiovascular risk and liver toxicity; at this time, the company was in active discussions with the FDA regarding approval of the remaining three indications. An approvable letter for CAP, acute bacterial exacerbations of chronic bronchitis and acute bacterial sinusitis was received by the company in June 2001; Aventis also received a non-approvable letter for the treatment of tonsillitis/pharyngitis at this time. In April 1999, ABN Amro predicted annual sales of DM 50 million in 2001, rising to DM 100 million in 2002. In February 1999, Lehman Brothers estimated a 70% probability that this ketolide would come to market. The analysts also estimated a launch date of 2001, with peak sales of US $700 million in 2009. Analysts Merrill Lynch predicted in September 200, that the product would be launched by 2001, with sales of euro 50 million in that year, rising to euro 284 million in 2004. Deutsche Bank predicted in August 2001, that sales of the product would reach euro 5 million in 2001, rising to euro 300 million in 2005. Analysts at Merrill Lynch predicted in November 2001, that the product would be resubmitted in the US in mid-2002, and would make sales of US $5 million in 2001, rising to US $250 million in 2004.
Curr Opin Investig Drugs 2001 Dec
PMID:Telithromycin. Aventis Pharma. 1189 30

(1) Apart from acute laryngitis in children, the use of steroids in acute ENT infections is not supported by clinical data. (2) A single dose of steroids (oral or intramuscular dexamethasone, 0.6 mg/kg) has only moderate efficacy in children with acute laryngitis, but it can hasten symptom relief. Available clinical data fail to show whether steroid therapy reduces the frequency of severe respiratory complications in this setting, or if it is helpful in minor cases. (3) There are no published data justifying the use of steroids as adjuvant treatment in other acute ENT infections, such as non allergic rhinitis, sinusitis, pharyngitis, tonsillitis and otitis. Two randomised trials have shown an analgesic effect of steroids in pharyngitis, but there are no published comparisons with standard analgesics such as paracetamol. (4) Severe complications appear to be rare with single-dose and short-term steroid therapy (for less than a week). However, there is a potential risk of rare but severe complications of chickenpox, and avascular necrosis of the femoral head. (5) Routine use of steroids for recurrent ENT infections has the same risks as long-term steroid therapy.
Prescrire Int 2001 Dec
PMID:Steroid therapy of acute ENT infections: rarely indicated. 1193 78

We describe a retrospective case series of postanginal sepsis and Lemierre's syndrome (LS) identified from laboratory records of Fusobacterium necrophorum isolates and from clinical case note review. Some patients presented with sore throat, tonsillitis, quinsy or a septicaemic illness, whereas others presented with symptoms related to metastatic septic lesions with later recognition of the significance of the preceding sore throat. Patients with otitis media and mastoiditis are included in the study. The incidence of postanginal sepsis and LS appears to have increased over the study period (1994-99). The population of patients who had received antibiotics pre-admission has decreased in recent years. Attention is drawn to features which may assist in differentiating this condition from simple viral sore throats not requiring antibiotic therapy. A prospective study of the incidence of this rare but life-threatening condition mainly affecting young people is required in view of the more restricted use of antibiotic treatment for sore throat now recommended.
Commun Dis Public Health 2001 Dec
PMID:Investigation of postanginal sepsis and Lemierre's syndrome in the South West Peninsula. 1210 95

The global epidemic of HIV infection remains appalling. By 2001, there were an estimated 1.4 million HIV-infected children, with 4.5 million deaths. In the UK, paediatric cases are clustered around population centres where there are high concentrations of infected immigrant adults, and to a lesser extent, areas where IV drug abuse is common. The highest incidence remains in London and the southeast. With the national redistribution of immigrant and refugee families, any doctor in any specialty may expect to be involved with children who are HIV positive, or have clinical AIDS. The majority of children are infected vertically, i.e. infection of the infant from an infected mother in the pre-, peri-, or post-natal periods. Rates of transmission vary from 15-20% in the developed countries. Children with HIV infection may have their primary presentation to ENT doctors, who should have appropriate thresholds for suspecting the diagnosis. The most common presenting features include persistent generalised lymphadenopathy, hepatosplenomegaly, chronic/recurrent diarrhoea, poor growth, and fever. Fifteen to twenty percent of untreated children will present with an AIDS-defining illness by 12 months, typically with Pneumocystis pneumonia at approximately 3-4 months of age. Seventy percent of perinatally infected children will exhibit some signs or symptoms by 12 months Without treatment, the median age to progression to AIDS is approximately 6 years, and 25-30% will have died by this age. The median age of death is approximately 9 years. Children may also present with repeated/unusual ear infections, sinus disease (inc. mastoiditis), tonsillitis, orbital/peri-orbital cellulitis, oral candidiasis, and dental infections. Infections with streptococcus pneumoniae and group A streptococcus are common, and often progress to severe systemic infection with an appreciable mortality. Infections may be due to unusual pathogens such as Pseudomonas, 'typical' and atypical Mycobacteria, Candida, Aspergillus, etc. Fungal infections of the sinuses (inc. Aspergillus and Rhizopus spp.) may be particularly devastating, with rapid spread to involve bone and the central nervous system. Another classical presentation, which may present to ENT doctors, is that of bilateral parotid enlargement, especially in children who are 'slow progressors', many of whom also have Lymphoid Interstitial Pneumonitis (LIP). A major attitudinal change has occurred due to advances in 3 main areas: (i) the multidisciplinary management of the infected mother (inc. counselling, antenatal screening, elective caesarean section, advising against breast feeding, etc.), (ii) the prevention of vertical transmission, using anti-retroviral therapy to the infected mother during pregnancy, and to the potentially infected infant in the first weeks of life, and (iii) major advances due to the advent of highly active anti-retroviral treatment. With effective use of these measures, transmission rates may be reduced to <2%. None of the measures though, affect a cure, and it will still be many years before the development of effective vaccines. ENT doctors may be referred children already known to be HIV-positive. Knowing how to talk to infected children (and their parents) is full of potential pitfalls, and requires careful forethought. Many infection-control policies have required considerable rethinking due to the AIDS epidemic. This has especially been the case with respect to needle-stick injuries, post-exposure prophylaxis, sterilization and re-use of equipment, and safe approaches to surgery.
Int J Pediatr Otorhinolaryngol 2003 Dec
PMID:HIV infection in children--impact upon ENT doctors. 1466 74


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