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The New England Journal of Medicine May 2017
Topics: Exanthema; Humans; Male; Pharyngitis; Pharynx; Scarlet Fever; Streptococcus pyogenes; Young Adult
PubMed: 28514617
DOI: 10.1056/NEJMicm1612308 -
MMW Fortschritte Der Medizin Jan 2023
Topics: Humans; COVID-19; Cough; Pharyngitis; Rhinorrhea
PubMed: 36648683
DOI: 10.1007/s15006-023-2272-x -
The Cochrane Database of Systematic... Jul 2015Antibiotics are sometimes used to prevent recurrent sore throat, despite concern about resistance. However, there is conflicting primary evidence regarding their... (Review)
Review
BACKGROUND
Antibiotics are sometimes used to prevent recurrent sore throat, despite concern about resistance. However, there is conflicting primary evidence regarding their effectiveness.
OBJECTIVES
To assess the effects of antibiotics in patients with recurrent sore throat.
SEARCH METHODS
The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 5); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 25 June 2015.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of antibiotics in adults and children suffering from pre-existing recurrent sore throat, defined as three or more sore throats in a year, examining the incidence of sore throat recurrence, with follow-up of at least 12 months post-antibiotic therapy.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality and extracted data. Multiple attempts to contact the authors of one study yielded no response.
MAIN RESULTS
We identified no trials that met the inclusion criteria for the review. We discarded the majority of the references retrieved from our search following screening of the title and abstract. We formally excluded four studies following review of the full-text report.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine the effectiveness of antibiotics for preventing recurrent sore throat. This finding must be balanced against the known adverse effects and cost of antibiotic therapy, when considering antibiotics for this purpose. There is a need for high quality RCTs that compare the effects of antibiotics versus placebo in adults and children with pre-existing recurrent sore throat on the following outcomes: incidence of sore throat recurrence, adverse effects, days off work and absence from school, and the incidence of complications. Future studies should be conducted and reported according to the CONSORT statement.
Topics: Adult; Anti-Bacterial Agents; Child; Humans; Pharyngitis; Recurrence; Secondary Prevention
PubMed: 26171901
DOI: 10.1002/14651858.CD008911.pub2 -
Journal of Clinical Microbiology May 2020Each year, there are an estimated 11 million visits to ambulatory care centers for pharyngitis in children between the ages of 3 and 18 years. While there are many... (Review)
Review
Each year, there are an estimated 11 million visits to ambulatory care centers for pharyngitis in children between the ages of 3 and 18 years. While there are many causes of pediatric pharyngitis, group A streptococcal pharyngitis represents 15 to 30% of infections and is the only cause for which treatment is recommended. Unfortunately, clinical suspicion is insufficient for the accurate diagnosis of group A streptococcal pharyngitis, and laboratory testing for confirmation of infection is required to prevent complications of infection. Traditionally, throat swabs are inoculated onto agar plates for isolation of the large-zone beta-hemolytic streptococcus. However, traditional culture methods present a potential delay in treatment due to turnaround times of 18 to 48 h. In order to improve turnaround times and enhance antimicrobial stewardship, multiple point-of-care assays have been developed. This review describes current point-of-care testing for group A streptococcal pharyngitis, including rapid antigen detection tests and more recent molecular methods. Additional attention is given to the diagnostic considerations when choosing a method for group A streptococcal point-of-care testing, implementation of molecular group A streptococcal testing, and the institutional cost of immunoassays compared to those of newer molecular methods.
Topics: Adolescent; Antigens, Bacterial; Child; Child, Preschool; Humans; Molecular Diagnostic Techniques; Pediatrics; Pharyngitis; Point-of-Care Systems; Point-of-Care Testing; Streptococcal Infections; Streptococcus pyogenes
PubMed: 32161094
DOI: 10.1128/JCM.01494-19 -
The Journal of Allergy and Clinical... Jun 2023Children and adults with autoinflammatory disorders, who often experience recurrent fevers, rashes, cold-induced symptoms, conjunctivitis, lymphadenopathy, recurrent...
Children and adults with autoinflammatory disorders, who often experience recurrent fevers, rashes, cold-induced symptoms, conjunctivitis, lymphadenopathy, recurrent infections, aphthous stomatitis, and abnormal blood cell counts, may present to the allergist/immunologist because the symptoms mimic allergies and disorders of immunity. In recent years, there has been increased recognition of non-monogenic autoinflammatory disorders, including periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome and syndrome of undifferentiated recurrent fevers. For many clinical practitioners, the natural history, diagnostic criteria, differential diagnoses, and preferred therapies remain challenging because of the presumed rarity of patients and the evolving field of autoinflammation. Here, we aim to provide a practical framework for the clinical allergist/immunologist to evaluate and treat this patient population.
Topics: Humans; Child; Adult; Stomatitis, Aphthous; Lymphadenitis; Pharyngitis; Fever; Lymphadenopathy; Nasopharyngitis; Syndrome
PubMed: 36958521
DOI: 10.1016/j.jaip.2023.03.014 -
Journal of General Internal Medicine Oct 2014
Topics: Anti-Bacterial Agents; Humans; Lemierre Syndrome; Male; Pharyngitis; Young Adult
PubMed: 24841558
DOI: 10.1007/s11606-014-2879-9 -
The Cochrane Database of Systematic... Jul 2015Sore throat is a common side-effect of general anaesthesia and is reported by between 30% and 70% of patients after tracheal intubation. The likelihood of a sore throat... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sore throat is a common side-effect of general anaesthesia and is reported by between 30% and 70% of patients after tracheal intubation. The likelihood of a sore throat varies with the type, diameter, and cuff pressure of the endotracheal tube used. If intubation is essential, it may be helpful to give drugs prophylactically to alleviate postoperative sore throat. Local anaesthetics and steroids have been used for this purpose. This review was originally published in 2009 and was updated in 2015.
OBJECTIVES
The objective of this review was to evaluate the efficacy and any harm caused by topical and systemic lidocaine used prophylactically to prevent postoperative sore throat in adults undergoing general anaesthesia with endotracheal intubation.
SEARCH METHODS
We searched CENTRAL (The Cochrane Library 2013, Issue 9), MEDLINE (January 1966 to October 2013), and EMBASE (1980 to October 2013). We also contacted manufacturers and researchers in the field. The original search was undertaken in June 2007. We reran the search in February 2015 and found four studies of interest. We will deal with those studies when we next update the review.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) of topical and systemic prophylactic lidocaine therapy versus control (using air or saline) that reported on the risk and severity of postoperative sore throat as an outcome.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information, such as the risk of any adverse effects.
MAIN RESULTS
We included 19 studies involving 1940 participants in this updated review. Of those 1940 participants, 952 received topical or systemic lidocaine therapy and 795 were allocated to the control groups. Topical and systemic lidocaine therapy appeared to reduce the risk of postoperative sore throat (16 studies, 1774 participants, risk ratio (RR) was 0.64 (95% confidence interval (CI) 0.48 to 0.85), the quality of the evidence was low), although when only high-quality trials were included (eight studies, 814 participants) the effect was no longer significant (RR 0.71, 95% CI 0.47 to 1.09). Lidocaine given systemically in two studies (320 participants) did not reveal evidence of an effect (RR 0.44, 95% CI 0.19 to 1.05 ). The severity of sore throat as measured on a visual-analogue scale (VAS) was reduced by lidocaine therapy (six trials, 611 participants, (mean difference (MD) -10.80, 95% CI -14.63 to -6.98). The adverse effects of lidocaine were not reported in these studies, though toxicity is generally rare.
AUTHORS' CONCLUSIONS
In our revised systematic review, although the results of included studies show generally positive results, they should be interpreted carefully. The effect size of lidocaine appeared to be affected by study quality; drug concentration; route of administration; management of cuff pressure during anaesthesia; the included population; and the type of outcome measured.
Topics: Anesthesia, General; Anesthetics, Local; Humans; Intubation, Intratracheal; Lidocaine; Pharyngitis; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 26171894
DOI: 10.1002/14651858.CD004081.pub3 -
International Journal of... 2018Hyaluronic acid plays a role in controlling inflammatory airway processes and mucociliary clearance, and it is also involved in tissue healing and remodelling. Some... (Review)
Review
Hyaluronic acid plays a role in controlling inflammatory airway processes and mucociliary clearance, and it is also involved in tissue healing and remodelling. Some studies have tested the effectiveness of topically administered hyaluronic acid in patients with upper airway diseases with positive preliminary results. This article describes the use of topically administered hyaluronic acid in patients with otolaryngological disorders. Pertinent studies published between January 2000 and October 2016 were selected by means of a MEDLINE search using the following terms: 'hyaluronic acid' and 'otolaryngology', 'otitis', 'pharyngitis', 'tonsillitis', 'rhinitis', 'rhinosinusitis' and 'nose'. Twelve of the 19 initially identified papers were selected, corresponding to 902 patients as a whole. There is some evidence that topically administered hyaluronic acid is effective or moderately effective in different otolaryngological conditions, as it improves the global subjective and clinical status of patients with inflammation of the nasopharyngeal and oto-tubaric complex, those with rhinitis or rhinosinusitis and those who have undergone nasal and sinonasal surgery. However, these findings should be viewed cautiously as they are based on a limited number of studies, some of which were probably under-powered because of their small patient samples.
Topics: Adjuvants, Immunologic; Humans; Hyaluronic Acid; Mucociliary Clearance; Otorhinolaryngologic Diseases; Pharyngitis; Randomized Controlled Trials as Topic; Rhinitis; Sinusitis
PubMed: 29569499
DOI: 10.1177/2058738418766739 -
MSphere Oct 2023Sore throat is one of the most common complaints encountered in the ambulatory clinical setting. Rapid, culture-independent diagnostic techniques that do not rely on...
Sore throat is one of the most common complaints encountered in the ambulatory clinical setting. Rapid, culture-independent diagnostic techniques that do not rely on pharyngeal swabs would be highly valuable as a point-of-care strategy to guide outpatient antibiotic treatment. Despite the promise of this approach, efforts to detect volatiles during oropharyngeal infection have yet been limited. In our research study, we sought to evaluate for specific bacterial volatile organic compounds (VOC) biomarkers in isolated cultures , in order to establish proof-of-concept prior to initial clinical studies of breath biomarkers. A particular challenge for the diagnosis of pharyngitis due to is the likelihood that many metabolites may be shared by and other related oropharyngeal colonizing bacterial species. Therefore, we evaluated whether sufficient metabolic differences are present, which distinguish the volatile metabolome of Group A streptococci from other streptococcal species that also colonize the respiratory mucosa, such as and . In this work, we identified 27 discriminatory VOCs (-values < 0.05), composed of aldehydes, alcohols, nitrogen-containing compounds, hydrocarbons, ketones, aromatic compounds, esters, ethers, and carboxylic acid. From this group of volatiles, we identify candidate biomarkers that distinguish from other species and establish highly produced VOCs that indicate the presence of , supporting future breath-based diagnostic testing for streptococcal pharyngitis. IMPORTANCE Acute pharyngitis accounts for approximately 15 million ambulatory care visits in the United States. The most common and important bacterial cause of pharyngitis is , accounting for 15%-30% of pediatric pharyngitis. Distinguishing between bacterial and viral pharyngitis is key to management in US practice. The culture of a specimen obtained by a throat swab is the standard laboratory procedure for the microbiologic confirmation of pharyngitis; however, this method is time-consuming, which delays appropriate treatment. If left untreated, pharyngitis may lead to local and distant complications. In this study, we characterized the volatile metabolomes of and other related oropharyngeal colonizing bacterial species. We identify candidate biomarkers that distinguish from other species and provide evidence to support future breath-based diagnostic testing for streptococcal pharyngitis.
Topics: Humans; Child; Streptococcus pyogenes; Streptococcal Infections; Pharyngitis; Anti-Bacterial Agents; Biomarkers
PubMed: 37791788
DOI: 10.1128/msphere.00194-23 -
The Lancet. Infectious Diseases Oct 2019Data from mathematical models suggest that kissing and saliva exchange during sexual activity might be major contributors to community gonorrhoea morbidity. Although... (Review)
Review
Data from mathematical models suggest that kissing and saliva exchange during sexual activity might be major contributors to community gonorrhoea morbidity. Although there is little evidence to support this, it provokes discussion of the potential role of the oropharynx in gonorrhoea control. Improved sensitivity and ease of diagnostic testing, as well as increased screening for extragenital infections among men who have sex with men, have increased awareness of the high frequency of oropharyngeal gonorrhoea. However, there are insufficient data to determine the mechanisms of transmission for these infections. Innovative studies that use quantitative microbiological techniques are needed to accurately assess how oral gonorrhoea or saliva exchange in infected people contribute to the morbidity of gonorrhoea in the community. More empirical data on pharyngeal gonorrhoea infections, and the role of transmission to and from the oropharynx, are needed to inform prevention planning.
Topics: Female; Gonorrhea; Homosexuality, Male; Humans; Male; Models, Biological; Neisseria gonorrhoeae; Oropharynx; Pharyngitis; Prevalence; Risk; Saliva; Sexual Partners; Sexual and Gender Minorities
PubMed: 31324518
DOI: 10.1016/S1473-3099(19)30306-8