Search

Objectives: The coronavirus outbreak has triggered the implementation of nationwide social distancing measures. We aimed to investigate the impact on patients with recurrent tonsillitis and parental perceptions towards tonsillectomy during the COVID-19 pandemic., Methods: A telephone questionnaire was conducted for all children awaiting tonsillectomy for recurrent tonsillitis after social distancing for 2 months at our centre. The COVID-19 lockdown period was compared with the 2 months prior to lockdown., Results: Forty-four children had been social distancing at home during lockdown. There was a significant reduction in tonsillitis episodes during the 2-month lockdown period in comparison with 2 months prior to lockdown (p = 0.0001). In 70% (n = 31) of cases parents wanted their child's tonsillectomy during the coronavirus outbreak., Conclusion: These findings demonstrate that viral exposure is a key factor in the pathophysiology of recurrent tonsillitis and that social distancing measures can reduce the frequency of recurrent tonsillitis. Despite the overall reduction in tonsillitis frequency during the lockdown period, the majority of parents wanted their child's tonsillectomy during the coronavirus outbreak. This demonstrates the impact tonsillitis has on the patient and their family's quality of life., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: Recurrent tonsillitis in children is a common disease affecting children quality of life and extends to their families. The aim of this study was to assess the effect of combined use of oral Azithromycin (AZT) plus Echinacea compared to exclusive use of AZT in children with recurrent tonsillitis., Material and Methods: A prospective comparative study including three groups of children with recurrent tonsillitis. Group 1: (100 patients) had no prophylactic treatment. Group 2 (100 patients) received [60 mg/kg] prophylactic dose of AZT divided as (10 mg/kg/day) over 6 consecutive days every month for 6 consecutive months. Group 3 (100 patients) received AZT as in group 2 plus commercially available Echinacea in a dose of 5 ml oral suspension; 3 times daily for 10 consecutive days every month for 6 consecutive months. Number of tonsillitis attacks and severity of tonsillitis symptoms were assessed and compared in different groups., Results: Group 2 and group 3 had significant less number of tonsillitis attacks and severity of assessed symptoms during 6 months of prophylactic treatment with significant better results in group 3 (i.e. AZT plus Echinacea) compared to group 2 (I.e. AZT alone). However; there was no significant difference in patients with any prophylaxis., Conclusion: The combined use of Echinacea with Azithromycin produced favorable outcome than Azithromycin alone in pediatric patients with recurrent tonsillitis., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Oral supplements (OS) support the immune system in fighting upper airways infection. This study aimed to analyze the effect of Difensil Immuno (DI) on the recurrence of tonsillitis and fever in children. A multicentric randomized clinical trial was conducted. One-hundred and twenty children with chronic tonsillitis were randomly assigned to group A, B or control. Patients in group A were treated with 10 mL of DI for 90 consecutive days, patients in group B underwent treatment with 15 mL of DI for 45 consecutive days. The following data were collected at baseline (T0), T1 and T2: tonsillitis and fever episodes, tonsillar volume, blood test results. One-way ANOVA was used to analyze within and between variances. Patients in group A and B statistically improved their clinical parameters (episode of tonsillitis and fever, tonsillar volume) when compared to control group both at T1 and T2. However, T1 variances were more consistent in group A than in group B. All patients in the study groups improved their clinical outcomes. No statistically significant variances were observed in blood parameters both at T1 and T2. Our results suggest that children treated with DI had fewer episodes of tonsillitis and fever and a reduction in their tonsillar volume.

Objective: To assess the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis or tonsillitis in children and adults with chronic/recurrent tonsillitis., Design: Retrospective cohort study., Setting: Data were retrieved from the VEGA register, a comprehensive regional cohort in Sweden., Participants: 1044 children (<15 years) and 2244 adults., Intervention: Tonsillectomy/adenotonsillectomy compared with no surgical treatment., Main Outcome Measures: Changes in yearly mean rates of medical care visits due to pharyngitis/tonsillitis., Results: In children, there was a significant decrease in the yearly mean medical care visits rate from 1.93 (1.82 to 2.04) before surgery to 0.129 (0.099 to 0.165) after surgery, with a mean change of -1.80 (-1.90 to -1.69), p<0.0001. In patients who did not undergo surgery, the corresponding mean change was -1.51 (-1.61 to -1.41), resulting in a mean difference in the change in visit rates between the intervention and control groups of -0.283 (-0.436 to -0.135), p=0.0002. In adults, a significant decrease in the yearly mean medical care visit rate was observed from 1.45 (1.39 to 1.51) before surgery to 0.152 (0.132 to 0.173) after surgery, with a mean change of -1.30 (-1.36 to -1.24), p<0.0001, compared with -1.18 (-1.24 to -1.13) in the control group. The difference in the change in yearly mean visit rate between the surgical and non-surgical groups was -0.111 (-0.195 to -0.028), p=0.0097. The subgroup analysis showed a greater effect of surgery in children, in patients with a higher number of medical care visits before surgery and in the first year of follow-up., Conclusion: In this cohort of patients moderately or less affected with chronic/recurrent tonsillitis, the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis and tonsillitis compared with no surgical treatment was low and of questionable clinical value., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Group A Streptococcus (GAS) infections account for an estimated 500,000 deaths every year. This bacterial pathogen is responsible for a variety of mild and life-threatening infections and the triggering of chronic autoimmune sequelae. Pharyngitis caused by group A Streptococcus (GAS), but not asymptomatic GAS carriage, is a prerequisite for acute rheumatic fever (ARF). Repeated bouts of ARF may trigger rheumatic heart disease (RHD), a major cause of heart failure and stroke accounting for 275,000 deaths annually. A vaccine that prevents pharyngitis would markedly reduce morbidity and mortality from ARF and RHD. Nonhuman primates (NHPs) have been utilized to model GAS diseases, and experimentally infected rhesus macaques develop pharyngitis. Here we use an NHP model of GAS pharyngitis to evaluate the efficacy of an experimental vaccine, Combo5 (arginine deiminase [ADI], C5a peptidase [SCPA], streptolysin O [SLO], interleukin-8 [IL-8] protease [SpyCEP], and trigger factor [TF]), specifically designed to exclude GAS components potentially linked to autoimmune complications. Antibody responses against all Combo5 antigens were detected in NHP serum, and immunized NHPs showed a reduction in pharyngitis and tonsillitis compared to controls. Our work establishes the NHP model as a gold standard for the assessment of GAS vaccines. IMPORTANCE GAS-related diseases disproportionally affect disadvantaged populations (e.g., indigenous populations), and development of a vaccine has been neglected. A recent strong advocacy campaign driven by the World Health Organization and the International Vaccine Institute has highlighted the urgent need for a GAS vaccine. One significant obstacle in GAS vaccine development is the lack of a widely used animal model to assess vaccine efficacy. Researchers in the field use a wide range of murine models of infection and in vitro assays, sometimes yielding conflicting results. Here we present the nonhuman primate pharyngeal infection model as a tool to assess vaccine-induced protection against colonization and clinical symptoms of pharyngitis and tonsillitis. We have tested the efficacy of an experimental vaccine candidate with promising results. We believe that the utilization of this valuable tool by the GAS vaccine research community could significantly accelerate the realization of a safe and effective GAS vaccine for humans., (Copyright © 2019 Rivera-Hernandez et al.)

Chronic tonsillitis is one of the most common diseases to modern people, which treatment requires a preventative care course approach. The general purpose of the present research could be framed as follows: to estimate clinical efficiency of bacteriophage medications, in the case of 'Ostophag' mixture for preventative care. Study population consisted eighty people. Participants were divided into two groups (forty patients in each) both diagnosed compensated and decompensated forms of chronic tonsillitis with pathogenic microflora in the lacunae of the palatine tonsils. In the first group we built monotherapy on bacteriophage medications use, whereas in the second one monotherapy was founded on antiseptic implication. The results of the present investigation showed high efficiency of bacteriophage medications a means of chronic tonsillitis salvage care.

The purpose was to determine the current evidence for preferable antibiotic treatment in three common clinical situations with insufficient consensus: Q1: Can antibiotic treatment prevent future attacks of acute pharyngo-tonsillitis (APT) in patients with recurrent APT (RAPT)? Q2: Which antibiotic regimen is preferable in the treatment of APT in patients with RAPT? Q3: Which antibiotic regimen is preferable in the treatment of relapsing APT? Five databases were searched systematically for randomized clinical trials on patients with RAPT with or without current APT or with relapse of APT. Of the unique publications, 643 were found. Five studies addressing Q1 (n = 3) and Q2 (n = 2) met the eligibility criteria. No studies reporting on Q3 were included. Q1: Two studies found that clindamycin and cefpodoxime, respectively, were effective in preventing future APT episodes and in eradicating group A streptococci from the tonsils of RAPT patients. One study found that long-term azithromycin had no effect on the number of APT episodes. Q2: Two studies reported superior clinical and microbiological effects of clindamycin and amoxicillin with clavulanate, respectively, compared to penicillin. The four studies showing superior effects of clindamycin and amoxicillin with clavulanate were assessed to have high risk of bias. Hence, the level of evidence was moderate. There is considerable evidence to suggest that clindamycin and amoxicillin with clavulanate are superior to penicillin with preferable effects on the microbiological flora and the number of future attacks of APT in patients with RAPT. Antibiotic treatment is an option in patients with RAPT, who has contraindications for tonsillectomy.

Background: Previous trials, performed in subjects affected by recurrent streptococcal pharyngo-tonsillar infection, have shown that the use for 90 days of Streptococcus salivarius K12 (K12), an oral colonizing probiotic producing lantibiotic bacteriocins, reduces the occurrence of streptococcal and viral pharyngitis and acute otitis media (AOM). The aim was to evaluate the role of K12 in reducing the incidence of streptococcal and viral pharyngo-tonsillitis and AOM when administered in two separate trimesters, from October to December and then from April to June, in pediatric subjects with non-recurrent streptococcal infection., Methods: We retrospectively analyzed the incidence of pharyngo-tonsillitis and AOM in 133 children by comparing the number of episodes occurring between September 1st, 2014 and August 31st, 2015, when no treatment with K12 was given, with the period between September 1st, 2015 and August 31st, 2016, when K12 was administered., Results: Analysis of the findings for the 133 children demonstrated that K12 use decreased the incidence of pharyngo-tonsillitis by about 90% (P<0.001) and the occurrence of AOM by about 70% (P<0.001) and confirms the high safety profile of the strain., Conclusions: As already demonstrated in subjects with recurrent streptococcal pharyngo-tonsillar infection, K12, if administered for two trimesters out of 12 months, is associated with a reduced incidence of pharyngitis and AOM in pediatric subjects with non-recurrent streptococcal infection.

Though evaluation and analysis on the relevant literatures at home and abroad in recent years, the total number of retrieved literature was 2 664. According to the inclusion criteria and exclusion criteria,the literatures were screened out, and the results were as follows：374 literatures. To analyse the advantages and evidence of Chinese medicine in the prevention and treatment of adult acute tonsillitis. It is found to be effective, convenient and practical for the treatment of acute tonsillitis by traditional Chinese medicine (TCM) like treatment according to syndrome differentiation, Chinese patent drug, self Chinese medicine prescription and external treatment. TCM has obvious advantages in the prevention and treatment of acute tonsillitis, has the function of supplementing or substituting antibiotics, and has the function of regulating the defense function of organism., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Chinese Pharmaceutical Association.)

Objective: Streptococcus salivarius K12 (BLIS K12) is a probiotic strain strongly antagonistic to the growth of Streptococcus pyogenes, the most important bacterial cause of pharyngeal infections in humans. Shown to colonize the oral cavity and to be safe for human use, BLIS K12 has previously been reported to reduce pharyngo-tonsillitis episodes in children or adults known to have experienced recurrent streptococcal infection. The present study was focussed upon evaluating the role of BLIS K12 in the control of streptococcal disease and acute otitis media in children attending the first year of kindergarten., Patients and Methods: By randomization, 222 enrolled children attending the first year of kindergarten were divided into a treated group (N = 111) receiving for 6 months a daily treatment with BLIS K12 (Bactoblis®) and a control group (N = 111) who were monitored as untreated controls. During the 6 months of treatment and 3 months of follow-up, the children were evaluated for treatment tolerance, and for episodes of streptococcal pharyngo-tonsillitis, scarlet fever and acute otitis media., Results: During the 6-month trial (N = 111 per group) the incidence of streptococcal pharyngo-tonsillitis, scarlet fever and acute otitis media was approximately 16%, 9% and 44% respectively in the treated group and 48%, 4% and 80% in the control group. During the 3-months follow-up (N = 29 per group) the corresponding rates of infection were 15%, 0% and 12% in the treated group and 26%, 6% and 36% in the controls. No apparent side effects were detected in the treated group either during treatment or follow-up. All of the enrolled children completed the study., Conclusions: The daily administration of BLIS K12 to children attending their first year of kindergarten was associated with a significant reduction in episodes of streptococcal pharyngitis and acute otitis media. No protection against scarlet fever was detected.

Experience of the use of complex liquid pyo bacteriophage as a mean of prophylaxis of the acute tonsilitis in a military collective. In 2015-2016 was evaluated the effectiveness of an integrated liquid pyo bacteriophage in the outbreak of acute tonsillitis among conscripts as a mean of emergency prevention, reduction of disease incidence and communication prevention. The authors have studied an epidemiological efficacy and safety of the drug , and determined an accuracy of the cause-and-effect link on the epidemic process. Based on the results of the study, it has been concluded that the use of the complex liquid pyo bacteriophage in acute tonsillitis focuses for emergency prevention of diseases is effective, has been proved a significant reduction of military morbidity. The use of bacteriophages, including pyo bakteriopahge, is a promising direction of prevention of infectious diseases of bacterial aetiology in military units.

A 23-year-old woman with preexisting Graves' disease who received thiamazole treatment presented with fever, dysphagia, hyperthyroidism and leukopenia. With suspicion of thyreotoxicosis accompanied by drug-induced agranulocytosis she was successfully managed by plasmapheresis, G‑CSF administration and inhibition of periphereal conversion of thyroid hormones. In due course she underwent thyroidectomy. Thiamazole is frequently associated with drug-induced agranulocytosis. Long-term therapy with thiamazole requires critical evaluation and alternatives should be considered early. Plasmapheresis is an adequate treatment option to achieve normal thyroid hormonal status.

Currently Staphylococcus aureus is the predominant pathogen isolated from the respiratory tract of patients with recurrent tonsillitis. Because of an increase in multi-drug resistant strains of S. aureus, there is a pressing need for effective treatments and preventive approaches to reduce the risk of invasive and life-threatening infections. A preventive vaccine against S. aureus would have a tremendous clinical impact. However, multiple clinical trials have failed to identify an agent that can induce protective responses. Most trials have been based on subunit vaccines using one or a few purified antigens, which may not be enough to confer protection. Here, the impact of a whole-cell vaccine comprised of heat-inactivated S. aureus was investigated in patients with RT. The vaccine was well tolerated and had no significant local or systemic reactions. Immunization with heat-inactivated S. aureus elicited a significant antibody response characterized by production of IgG1 and IgG2 antibodies and, to a lesser extent, of IgA antibodies. Notably, this response was associated with an important decrease in the incidence of tonsillitis and bacterial colonization of the oropharyngeal mucosa. Our results show that whole-cell inactivated S. aureus is safe and capable of evoking specific antibody responses in patients with recurrent tonsillitis., (© 2015 The Societies and Wiley Publishing Asia Pty Ltd.)

This study was undertaken with the purpose of improving the effectiveness of the preventive treatment of chronic adenoiditis in the children. The open randomized comparative study included 219 children aged from 6 to 7 years presenting with clinical and anamnestic signs of chronic adenoiditis. The study group was comprised of 113 patients given the Streptococcus salivarius K12-based probiotic complex during 30 days in combination with the nasal-douche. The control group consisted of 106 patients treated with the nasal douche alone. The analysis of the results of the study has demonstrated that episodes of exacerbation of adenoiditis on day 30 after the onset of the treatment occurred in 56 (49.6%) children of the study group compared with 95 (88.7%) patients of the control group. Three months later, acute sinusitis was diagnosed in 4 (3.5%) children of the study group compared with 14 (13.2%) ones in the control group. Acute otitis media was documented in 2 (1.8%) and 5 (4.7%) children of the study and control groups respectively. It is concluded that the treatment with the use of the Streptococcus salivarius K12-based probiotic complex permits to decrease the frequency of exacerbations of chronic adenoiditis and its complications in the children and reduces the requirement for medication therapy.

Background: Measles is the leading killer among vaccine-preventable diseases; it is responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children annually., Objectives: To assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality., Search Methods: We searched CENTRAL 2013, Issue 4, MEDLINE (1966 to May week 4, 2013) and EMBASE (1980 to May 2013)., Selection Criteria: Randomised controlled trials (RCTs) and quasi-RCTs comparing antibiotics with placebo or no treatment, to prevent complications in children with measles., Data Collection and Analysis: Two review authors independently extracted data and assessed trial quality., Main Results: Seven trials with 1263 children were included. The methodological quality of most studies was poor. Only two studies were randomized, double-blind trials. There was variation in antibiotics used, their doses, schedule and evaluation of outcome. Pooled study data showed that the incidence of pneumonia was lower in the treatment group compared to the control group. However, the difference was not statistically significant. Of the 654 children who received antibiotics, 27 (4.1%) developed pneumonia; while out of 609 children in the control group, 59 (9.6%) developed pneumonia (odds ratio (OR) 0.35; 95% confidence interval (0.12 to 1.01). The one trial that showed an increase in the rate of pneumonia with antibiotics was conducted in 1942 and compared oral sulfathiazole with symptomatic treatment. If the results of this trial are removed from the meta-analysis, there is a statistically significant reduction in the incidence of pneumonia in children receiving antibiotics (OR 0.26; 95% CI 0.12 to 0.60). The incidence of other complications was significantly lower in children receiving antibiotics: purulent otitis media (OR 0.34; 95% CI 0.16 to 0.73) and tonsillitis (OR 0.08; 95% CI 0.01 to 0.72). There was no difference in the incidence of conjunctivitis (OR 0.39; 95% CI 0.15 to 1.0), diarrhea (OR 0.53; 95% CI 0.23 to 1.22) or croup (OR 0.16; 95% CI 0.01 to 4.06). No major adverse effects attributable to antibiotics were reported., Authors' Conclusions: The studies reviewed were of poor quality and used older antibiotics. This review suggests a beneficial effect of antibiotics in preventing complications such as pneumonia, purulent otitis media and tonsillitis in children with measles. On the basis of this review, it is not possible to recommend definitive guidelines on the type of antibiotic, duration or the day of initiation. There is a need for more evidence from high-quality RCTs to answer these questions.

Objective: To evaluate the efficacy of an immunostimulant (bacterial lysate) Broncho-Vaxom in the management of children with recurrent acute tonsillitis., Methods: A 5-year retrospective cohort study of 177 children presenting with a diagnosis of recurrent acute tonsillitis. Patients' demographics and laboratory studies at presentation were retrieved. For patients given Broncho-Vaxom, we defined response as a decrease in the frequency of acute tonsillitis episodes after 3 months of therapy (partial: by ≤50% and total: by >50%). Patients showing response to Broncho-Vaxom were further followed until study-end or need for tonsillectomy., Results: The median age of patients was 4.5 years (range: 1-15 years) with 63.8% being males. 131 (74%) patients received Broncho-Vaxom as initial therapy, and 99 (75.6%) showed response (51.2% total and 24.4% partial response). A normal ESR level was the only predictor of total compared with no response (OR: 3.53, 95% CI: 1.03-12.07); while both normal ESR (OR: 7.15-times, 95% CI: 1.18-43.39) and normal CRP (OR: 12.66, 95% CI: 1.43-111.86) levels were independent predictors of total over partial response. None of the patients showing total response required tonsillectomy on long-term follow up while in those with partial response 34.4% required subsequent tonsillectomy (median follow-up: 9 months)., Conclusions: A considerable proportion of children receiving Broncho-Vaxom for recurrent acute tonsillitis show a decrease in the frequency of episodes in the short term, and very few patients eventually require tonsillectomy on long-term follow up., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Streptococcus salivarius K12 has been shown to inhibit the growth of Streptococcus pyogenes due to bacteriocins release. Because of its ability to colonize the oral cavity, we have tested the strain K12 for its efficacy in preventing streptococcal pharyngitis and/or tonsillitis in adults., Methods: Forty adults with a diagnosis of recurrent oral streptococcal pharyngitis were enrolled in the study. Twenty of these subjects took for 90 days a tablet containing Streptococcus salivarius K12 (Bactoblis®). The other 20 subjects served as untreated controls. A 6-month follow-up was included to evaluate any persistent protective role., Results: The 20 adults who completed the 90-day course of Bactoblis® showed a reduction in their episodes of streptococcal pharyngeal infection (about 80%). The 90 days treatment was also associated with an approximately 60% reduction in the incidence of reported pharyngitis in the 6-month period following use of the product. The product was well tolerated by the subjects with no treatment-related side effects or drop-outs reported., Conclusion: Prophylactic administration of Streptococcus salivarius K12 to adults having a history of recurrent oral streptococcal pathology reduced the number of episodes of streptococcal pharyngeal infections and/or tonsillitis.

Objective: A food-borne tonsillopharyngitis outbreak was reported between 9th and 13th of February, 2008, in Söke State Hospital, Aydın, Turkey., Methods: This descriptive cohort study was carried out immediately after the outbreak. In order to determine the probable origin, a questionnaire involving demographical features, clinical features, and possible risk factors was distributed to 403 persons. The participants of the questionnaire (n = 403) were divided into two groups: the study group (n = 252); those with any two of the following three complaints; sore throat, fever, and dizziness, and the control group (n = 151); those without these complaints., Results: This investigation revealed that 252 people were affected by this outbreak. Group A β-hemolytic streptococci were isolated from the throat cultures of 63 affected individuals (25%) and an employee working in the patisserie that made desserts served for lunch. Since the number of people who ate the milky dessert was statistically higher compared to the non-eaters, the milky dessert was thought to be the origin of the outbreak., Conclusions: We suggest that throat infections among employees working in food production may cause outbreaks of upper respiratory tract infections.

The morbidity of tonsillitis in military drafting personnel of internal troops of Ministry of the Interior of Russia was high and had the up trend during 2000-2007. In 2008-2009 took place new increase of these diseases. The most unfortunate was the Second training center. Overcrowded accommodation of cadets in kasernes and complete rotation 2 times per year promoted this increase. The conditions of accommodation of cadets ware improved in 2010, preventive prophylaxis of tonsillitis was provided with the help of Bitsillin-5. As a result, the amount of ill in the Second training center during the summer 2010 was 5, 6 times lower than in the same period of 2009. It shows that the best antiepidemic effect can be achieved with combination of measures against the carry-over of causative agent and medicated prophylaxis.

The present clinical study had the objective to evaluate the role of a hypertonic solution of sterile water from the Adriatic Sea in the prevention and treatment of chronic adenoiditis in children. It included 30 children aged from 2.5 to 15 years. The control group was comprised of 30 children treated by intransal drop infusion of physiological saline followed by irrigation of the nasal cavity with framicetin as recommended by the manufacturer. The study failed to reveal a significant difference (P > 0.05) between dynamics of the symptoms of chronic adenoiditis in the patients of either group assessed based on the 10-point analog visual scale. However, the frequency of relapses of adenoiditis during the observation period (3 months) was significantly lower in the patients treated with the hypertonic solution of sterile seawater. Microbiological investigations of the material from the pharyngonasal cavity showed no difference between the occurrence of tansient bacterial microflora in the patients of the study and control groups.

The aim of this study was to verify the frequency of atypical bacterial infections in children undergoing tonsillectomy because of severely recurrent acute tonsillopharyngitis (AT) and the possible benefit of surgery in cases in which Mycoplasma pneumoniae and Chlamydophila pneumoniae seem to play a role in causing the recurrences. A total of 118 patients (76 males; mean age +/- standard deviation, 6.67 +/- 3.31 years) were enrolled: 59 underwent tonsillectomy because of severely recurrent AT and 59 underwent adenotonsillectomy because of obstructive sleep apnea syndrome (OSAS). The results show, for the first time, that the great majority of children with a history of severely recurrent AT (and, therefore, considered to be eligible for elective tonsillectomy) are infected by atypical bacteria, mainly M. pneumoniae, and that tonsillectomy seems to be effective in reducing the recurrence of both AT and acute respiratory disease during 12 months follow-up postsurgery.

Background: Measles is the leading killer among vaccine-preventable diseases, responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children annually., Objectives: To assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality., Search Strategy: In this 2008 update we searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1) MEDLINE (1966 to January week 1, 2008), EMBASE (1980 to December 2007) and the National Research Register (Issue 3, 2007)., Selection Criteria: Randomized controlled trials (RCTs) and quasi-RCTs comparing antibiotics with placebo or no treatment to prevent complications in children with measles., Data Collection and Analysis: Two review authors independently extracted data and assessed trial quality., Main Results: Seven trials with 1385 children were included. Pooled study data showed that the incidence of pneumonia was lower in the treatment group compared to the control group. However, the difference was not statistically significant. In children who received antibiotics, 1.9% developed pneumonia, while in the control group 6% developed pneumonia (OR 0.28; 95% CI 0.06 to 1.25). The one trial that showed an increase in the rate of pneumonia with antibiotics was conducted in 1942 and compared oral sulfathiazole with symptomatic treatment. If the results of this trial are removed from the meta-analysis, and the remaining six studies are combined, there is a statistically significant reduction in the incidence of pneumonia in children receiving antibiotics (OR 0.17; 95% CI 0.05 to 0.65). The number needed to treat to prevent one episode of pneumonia is 24 patients. The incidence of other complications was significantly lower in children receiving antibiotics: purulent otitis media (OR 0.34; 95% CI 0.16 to 0.73) and tonsillitis (OR 0.08; 95% CI 0.01 to 0.72). There was no difference in the incidence of conjunctivitis (OR 0.39; 95% CI 0.15 to 1.0), diarrhea (OR 0.53; 95% CI 0.23 to 1.22) or croup (OR 0.16; 95% CI 0.01 to 4.06)., Authors' Conclusions: This review suggests a beneficial effect of antibiotics in preventing complications such as pneumonia, purulent otitis media and tonsillitis in children with measles. On the basis of this review, it is not possible to give definitive guidelines on the type of antibiotic, duration, or the day of initiation. Use of penicillin or co-trimoxazole may be considered. There is a need to generate more evidence by well planned RCTs to answer these questions.

As early as in 1878, medical teams managing children born with a velopalatine cleft had noted the prevalence of middle-ear pathologies largely related to anatomic and inflammatory Eustachian tube dysfunction. The aim of this study was to describe otologic sequels related to a velopalatine cleft and to suggest an adapted management. These sequels are evolving presentations of chronic serous otitis; they worsen the functional prognosis (hypoacousia) and more rarely the vital prognosis (cerebral or infectious complications of cholesteatoma). We must stress the importance of prevention: during the initial management, by Eustachian tube rehabilitation, and by ENT (Ear, Noseand Throat) follow-up allowing to prevent these sequels and to bring hearing to normal as soon as possible, so as to support cognitive development, language skills, and sociofamilial integration of the children.

Respiratory tract infections are frequent and they are one of the commonest causes of antibiotic prescription. However, there are few clinical guidelines that consider this group of infections. This document has been written by the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society. The primary objective has been to define the recommendations for the diagnosis and antibiotic treatment of respiratory tract infections apart from pneumonia. The clinical syndromes evaluated have been: a) pharyngitis; b) sinusitis; c) acute otitis media and otitis externa; d) acute bronchitis, laryngitis, epiglottitis; e) acute exacerbation of chronic bronchitis; and f) respiratory infectious in patients with bronchiectasis. This document has focused on immunocompetent patients.

Objective: Although much has been written on how to manage recurrent pharyngotonsillitis, it remains a controversial topic. The composition of normal commensal oropharynx bacteria may be disrupted by frequently using antimicrobials, by inhibiting sensitive organisms and by allowing resistant organisms to overgrowth. This may cause the recurrence of acute episodes. The aim of this study was to evaluate the efficacy of ribosomal immunotherapy in the prophylaxis of recurrent pharyngotonsillitis., Methods: A total of 160 children aged between 5 and 14 years with recurrent pharyngotonsillitis were ramdomized to receive either ribosomal immunotherapy (group A one tablet a day, 8 days a month for 3 months) or a placebo (group B same dosage for the same period)., Results: At the end of the study, each patient treated with Immucytal presented a subjective decrease of symptoms. Compared with group B, group A experienced a significant improvement of some clinical parameters., Conclusions: The results show that ribosomal immunotherapy causes a significant improvement of both specific and non-specific immunity and may be effective in the prophylaxis of recurrent pharyngotonsillitis and in preventing recurrences without entailing side effects or bacterial resistance.

Background: The rate of recovery methicillin resistant Staphylococcus aureus (MRSA) in tonsils that were removed because of recurrent Group A-beta-hemolytic streptococci (GABHS) tonsillitis was not previously reported. MRSA may serve as a potential source for the spread of these organisms to other body sites as well to other individuals. This study investigated the rate of recovery of MRSA as well as other aerobic organisms from tonsils that were removed because of recurrent GABHS infection., Patients and Methods: Core and surface tonsillar cultures for aerobic bacteria were obtained from 44 children who had tonsillectomy because of recurrent GABHS tonsillitis., Results: A total of 167 aerobic isolates were recovered from the core of the tonsils (3.8/specimen) and 151 (3.4/specimen) were isolated from the surface. The predominant isolates were alpha-hemolytic streptococci, GABHS, S. aureus, gamma-hemolytic streptococci, Haemophilus influenzae and Moraxella catarrhalis. Concordance in the recovery of all organisms was noted in 117 instances. Certain organisms (i.e. GABHS, S. aureus) were recovered more often from the tonsillar cores, where other (i.e. alpha-hemolytic streptococci, gamma-hemolytic streptococci) were recovered more often from the tonsillar surface. Forty-four beta-lactamase-producing bacteria (BLPB) were recovered from 32 (75%) of the tonsillar cores, and 28 were isolated from 23 (52%) of the tonsillar surfaces. The predominant BLPB were S. aureus, H. influenzae and M. catarrhalis. Seven isolates of MRSA were recovered from the cores and two were isolated from the surface. Five of the core isolates and the two surface isolates were also BLPB. All of the MRSA isolates were resistant to oxacillin, penicillin and erythromycin and were susceptible to clindamycin, trimethoprim-sulfamethoxazole and vancomycin., Conclusions: These data demonstrated that in recurrently GABHS infected tonsils, BLPB was recovered from over 75% of the tonsillar cores, core tonsillar cultures yielded more GABHS and S. aureus, and MRSA was isolated from 16% of the tonsils.

We analyzed the hypomethylation of DNA and the sensitivity to apoptosis of tonsillar cells and peripheral blood lymphocytes (PBL) in twenty children with either recurrent tonsillitis (RT) or tonsillar hypertrophy (TH). We found no significant differences in DNA methylation of PBL obtained from RT and TH groups. Hypomethylation of DNA extracted from tonsillar tissue was higher in TH than in RT and was associated with lower spontaneous and thapsigargin-induced apoptosis. By contrast, RT showed a low level of DNA hypomethylation and was associated with high sensitivity to spontaneous and thapsigargin-induced apoptosis.

To evaluate prevalence, main causes and social factors of chronic tonsillitis (CT), we examined 321 families 335 children (age 1-15 years) from which had diagnosis of CT. The examination detected CT in the other 114 children from these families. Families of 120 healthy children matched for age served control. Family tonsillitis was detected in 171 (53.3%) families of the study group and 15 (17.5%) families of the control group (p < 0.05). Of 307 mothers of reproductive age, 84 (26.3%) were diagnosed to have CT, 36 (11.2%) of them had a history of tonsillectomy. Our data suggest the existence of family CT. To prevent it, early preventive measures should be taken.

Background: Recurrent acute pharyngotonsillitis remains a common illness in children and young adults and can lead to serious complications if not treated. cefpodoxime proxetil is a second-generation oral cephalosporin, which shows potent antibacterial activity against both Gram-positive and Gram-negative bacteria and high stability in the presence of beta-lactamases., Objective: We aimed to evaluate the efficacy of second-generation cephalosporins in the prophylaxis of recurrent pharyngotonsillitis in children., Methods: A total of 180 children aged between 4 and 14 years with recurrent pharyngotonsillitis were randomized to receive either cefpodoxime proxetil (100 mg twice a day, 6 days a month for 6 months) or placebo (at the same dosage)., Results and Conclusions: Our results show that treatment with cefpodoxime proxetil may be effective in reducing symptoms of recurrent pharyngotonsillitis and preventing recurrences without causing side effects or developing bacterial resistance.

Background: The development of allergies is a complex in which both composition and influence of the intestinal flora play an important role. We observed in earlier studies that the presence of an orally administered probiotic Escherichia coli strain in the intestine stimulated both a serum and local antibody response, decreased the presence of pathogens, the number of infections and the need for antibiotics., Methods: The preventive effect of oral colonization after birth with a probiotic E. COLI strain was assessed by evaluating the results of a questionnaire both 20 years (150 full-term infants) and 10 years (77 preterm infants) after colonization., Results: Differences in occurrence of allergies in colonized and control subjects were statistically significant both after 10 and 20 years (p < 0.01). Specific serum IgE antibodies confirmed the presence of allergies in 100% of 10-year-old and 91% of 20-year-old patients with clinical symptoms of allergy. Ten years after colonization, the occurrence of repeated infections was significantly lower in colonized subjects than it was in controls (p < 0.01); 20 years later, no differences were found in these groups., Conclusions: Intentional colonization of the intestine with E. coli after birth (offering the advantage of the first colonizer) was found to decrease the incidence of allergies and repeated infections in later life., (Copyright 2003 S. Karger AG, Basel)

Intracellularly persistent group A streptococci (GAS, Streptococcus pyogenes) have been associated with recurrent tonsillopharyngitis and antibiotic treatment failure. As a supplementation of the published in vitro data, conventional bacteriology and molecular epidemiology was performed on material from 29 adult patients of a German army hospital with anamnestic signs of recurrent tonsillopharyngitis. Pre-surgery tonsil swabs and the surgically removed tonsils were examined with respect to growth of aerobic bacteria in absence and presence of antibiotics with exclusively extracellular activity. Under such antibiotic selection, Staphylococcus aureus and GAS were cultured from specimens of 13 and 3 patients, respectively. In every material GAS-positive by culture methods, the intracellular location of the penicillin-susceptible GAS isolates was confirmed by immunohistologic examination of tonsillar sections using a GAS-specific IgG antibody. The three intracellular GAS isolates were typed by emm gene sequencing and could be associated to types M6 and M49 (two isolates). The bacteria were serially passaged on sheep blood agar, and semiquantitative mRNA analysis from virulence genes was performed using bacteria of the 4th and 25th passage after isolation. An M-type-specific pattern of virulence gene expression and different gene expression levels in relation to the passage number were observed.

An unusual case of recurrent tonsillitis due to pseudomonas aeruginosa. Pseudomonas (P.) aeruginosa in the head and neck region of an immunocompetent patient is mainly seen in ear infections, and sometimes in sinusitis. P. aeruginosa is an occasional finding in tonsil smears as part of normal microbial flora, but it rarely produces suppurative tonsil infection. We report a case of a previously healthy young female with recurrent episodes of tonsillitis due to P. aeruginosa infection. Although the patient received complete regimens of antibiotics (orally and intravenously) repeatedly, definitive eradication was only achieved after tonsillectomy.

A group of 54 children aged from three to 13 years was qualified to tonsillectomy for laryngological indications. In sera of all children following measurements were performed: the concentrations of C-reactive protein (CRP), alpha1-acid glycoprotein (AGP) and alpha1-antichymotrypsin (ACT) were measured using rocket immunoelectrophoresis according to Laurell, also concentrations of three main immunoglobulin classes (IgA, IgG, IgM) and antistreptolysin titer. The microheterogeneity of both AGP and ACT was investigated, using crossed affinity immunoelectrophoresis according to Bog-Hansen with Concanavalin A (Con A) as a ligand. Results were expressed as reactivity coefficients (RC), being the proportion of all Con A-reacting variants to the non-reacting variant. It is worth mentioning that there was no difference in all investigated parameters as well between groups obtained by categorizing children according to the presence or absence of elevated antistreptolysin titer. It may mean that at least in some cases the chronic inflammation was caused by streptococci non-producing streptolysin O. The results obtained suggest that the absence of the arthritic pain does not exclude the need of antibiotic therapy in children after tonsillectomy. Generally it is postulated that estimation of acute phase proteins concentrations and glycosylation profiles, which were previously shown to be useful in clinical assessment of various diseases may serve as additional marker in laryngology in cases where indications to tonsillectomy are still controversial.

A total of 342 patients with clinical signs of tonsillitis and suspected group A beta-haemolytic streptococci (GAS) aetiology, verified with rapid test and GAS culture, were enrolled in a randomized, placebo-controlled, double-blind, multicentre study. They received antibiotic treatment for 10 days, followed by 10 days of alpha-streptococcal or placebo spray treatment in the ratio of 2 : 1. Pharyngeal status, throat culture and adverse events were investigated up to 75 days after treatment. The frequency of bacteriologically verified clinical recurrence was 13% in the alpha-streptococcal group and 15% in the placebo group at the follow-up on day 22. The corresponding figures at the last valid visit after 45-75 days were 19% and 30%, respectively, a statistically significant difference (p = 0.037). Furthermore, at the last valid visit 5% of subjects in the alpha-streptococcal and 12% in the placebo group were healthy carriers, bacteriological treatment failures, of GAS (p = 0.029). Treatment with alpha-streptococci and placebo spray were equally well tolerated. Thus, re-colonization with alpha-streptococci seem to hinder late recurrences of GAS pharyngotonsillitis.

The failure to eradicate group A beta-hemolytic streptococci from the pharynx is partly due to a low compliance, but above all, an alteration of the oropharyngeal microbiological flora: reduction of alpha-haemolytic streptococci which inhibit group A beta-hemolytic streptococci and increase of microorganisms such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. These latter act indirectly destroying the beta-lactamic ring of penicillins. However, this obstacle is overcome by the use of antibiotics which do not contain beta-lactamic rings such as macrolides or associating amoxicillin with clavulanic acid or with new cephalosporins which are more resistant to beta lactamases. To restrict the diffusion of resistance to antibiotics, it is essential to limit their use diagnosing streptococcal tonsillopharyngitis more precisely, thanks to an improved use of micro-biological diagnostic tests and by a more extended use of tonsillectomy in recurrent tonsillitis (more than 6-7 in 1-2 years). Adenoiditis is closely related to the post nasal drip syndrome, to recurrent otitis media and to otitis media with effusion. All these situations could, therefore, represent an indication, although not well defined, for adenoidectomy. Nasopharyngeal obstruction due to adeno-tonsillar hypertrophy becomes critical during sleep when the hypotony of the upper airway muscles becomes additional to the anatomical obstruction. At this point the inspiratory effort required and the consequent decrease of intra airway pressure increase the pharyngeal obstruction suctioning the pharyngeal walls toward the median line. The resulting clinical picture is defined as sleep-disordered breathing (SDB) due to adenotonsillar hypertrophy (idiopathic), to be distinguished from SDB due to cranio-facial abnormalities or neuromuscular diseases. SDB includes both the more serious sleep apnea syndrome and the less severe upper airway respiratory resistance syndrome. A combination of symptoms and clinical data detectable both while awake or asleep, make the diagnosis simple. During sleep, both apnea and paradoxical inspiratory movements are highly specific while snoring is highly sensitive. To evaluate nasopharyngeal obstruction radiography and optic fibre endoscopy are both equally reliable. The gold standard test for non idiopathic SDB is the polysomnography, whereas for SDB, due to adenotonsillar hypertrophy, one is limited today to the recording during sleep of O2 saturation or of end tidal CO2. These investigations are, however, generally used up to 2 years of age, when the decision to carry out an adenoidectomy and especially a tonsillectomy is more difficult because of the greater risks which surgery involves at this age. The pharmacological therapy has a purely palliative function and is based on antibiotics, local vasoconstrictors, steroids and theophylline which acts more as an antiflogistic than as a breath stimulant. O2 therapy and nasal continuous positive airway pressure (CPAP) give better results, but are more difficult to carry out, in particular on a long term basis. Adenoidectomy especially if associated with tonsillectomy, leads to the resolution of the symptoms, but not always to a normalization of functional alterations (hypoxia and hypercapnia). For this reason, it is necessary to act on other factors which cause oedema of the nasopharyngeal mucosa contributing to the obstruction. In this area, the prevention of viral infections can be achieved by vaccination against influenza and by preventing the child from attending crowded day care centers. With regard to allergic inflammation, skin prick tests could be a first step in view of allergens avoidance measures. With regard to indoor air pollution, passive smoke must be stopped and the child kept out of the kitchen.

Objective: To test the hypothesis that treatment failures of streptococcal pharyngotonsillitis may be caused by reinfection by the patients' own streptococci remaining on a toothbrush or in the bedclothes., Design: To elucidate the role of streptococcal contamination of the environment, hygienic measures regarding change of toothbrush and bed linen and washing of toys were given to half of the patients/families. Throat specimens were taken from all the patients before treatment with phenoxymethylpenicillin for 5 days, and the patients were followed-up for 1 month. At a home visit after 6-10 days, throat specimens were taken from the patients and all permanent residents of the home. Environmental samples were taken from pillowcases, floors, toothbrushes, dummies, and toys., Setting: Six health care centres., Subjects: 114 patients of all ages suffering from group A streptococcal pharyngotonsillitis, and 289 family members., Measurements and Main Results: 54 patients/families received hygiene instructions. The total number of recurrences was 40 (35%). There was no difference in treatment failure rate between patients/families that had taken or not taken hygienic measures., Conclusions: Hygienic measures have no decisive influence on the risk of recurrence of streptococcal pharyngotonsillitis.

Antibiotic susceptibility of the circulating beta-hemolytic streptococci of serogroups A, B, C and G isolated from healthy and sick children and adults within 1987-1996 (more than 900 cultures) was studied. It was shown that the MICs of betalactam antibiotics did not change (within the susceptibility levels) with respect to the serogroup A, C and G streptococci. The number of the strains resistant to erythromycin and lincomycin increased the same as the frequency of the strains simultaneously resistant to chloramphenicol, tetracycline and gentamicin. Tomicid and solkarmon, drugs alternative to antibiotics, were found to be active against the above streptococci groups and efficient in the treatment and prophylaxis of streptococcoses. A suggestion that betalactams are not safe in the treatment of the toxic shock syndrome due to the group A streptococci is discussed.

This paper reports on the experience of using vaccination in the treatment of recurrent tonsillitis. All of the 82 patients, who were aged between 5 and 67 years and who suffered from recurrent tonsillitis, were given an injection of a bacterial vaccine (Broncasma Berna, Swiss Serum Institute, Berne) that has been used in many countries for three decades. A dose of 0.05 ml was given once every 4 to 14 days (average once a week) on 3 to 20 occasions (average 8). The treatment prevented 75 of the 82 patients (91%) from having attacks of recurrent tonsillitis for extended periods. These 75 patients included three who relapsed into recurrent tonsillitis in spite of having tonsillectomies. As the dose used was relatively small, none of the patients complained of spontaneous pain or fever although three complained of slight tenderness at the injection point on the following day. The effect on recurrent tonsillitis of the Paspat intracutaneous injection (Luitpold Werk, Munich) has also been investigated recently. It was effective in two patients who did not respond to Broncasma Berna. In this retrospective study, low doses of bacterial vaccine reduced the incidence of recurrent tonsillitis and were well tolerated.

Eighty four children with allergic rhinitis out of 316 consecutive cases were investigated, treated and followed-up for 2 years. Diagnostic skin testing were done with identified common allergens found in Saudi environment (2). Cat fur, Bermuda grass and mesquite were the most common allergens found. Symptoms of recurrent rhinosinusitis, otitis media with effusion, tonsils and adenoids infection were commonly noticed among them. The rapid change of environment in Saudi Arabia in the form of agricultural and other factors seem to play part in the increasing incidence of allergic manifestation in paediatric population. With antiallergic treatment and control of infection, most of these children responded well and only four children required surgery. The treatment of allergic disease saves a lot of children from unnecessary surgical procedures usually carried out on them.

In a randomized, placebo-controlled, double-blind, multicentre study, 130 patients with recurrence of group A beta-hemolytic streptococci (GAS) and clinical signs of pharyngotonsillitis were enrolled. The patients received antibiotic treatment for 10 days, followed by 10 days of alpha-streptococci-inhibitory to GAS-or placebo spray treatment. Patients taking antibiotic treatment for at least 9 days and using the spray for at least 5 days were included in the efficacy analysis. In addition, recurrence within the first 5 days of spray treatment was classified as 'early treatment failure'. The clinical recurrences (bacteriologically verified) in the alpha- (n = 51) and placebo-treated (n = 61) patient groups were 2% (n = 1) and 23% (n = 14) respectively, in patients given spray for at least 5 days (p = 0.004). The inclusion of 'early treatment failures' reduces this difference (p = 0.064). Both treatments were equally well tolerated. Thus, alpha-streptococci given as a spray and used for at least 5 days significantly prevented recurrence of GAS pharyngotonsillitis.

Recurrent ENT infections are extremely frequent in children. Actually, early childhood is a period of adaptation to the environment, with low immunologic defences. The hypertrophy of the lymphoid tissue in the Waldeyer ring, which is normal in early childhood, gives a particular picture to these problems. The repercussions of such recurrent ENT infections on the status of the lower respiratory tract, on the stature and weight as on the general well-being of the child, and their potential complications, are sufficient reasons for eradicating them. The various therapeutical means to reach this goal, are described.

Recurrent streptococcal tonsillitis/pharyngitis is a great problem, especially in certain epidemiological situations. Patients treated with antibiotics often have a disturbed normal throat flora and may lack, e.g., alpha-streptococci known in vitro to have an interfering activity against group A streptococci. Thirty-one patients with recurrent streptococcal tonsillitis were given antibiotics for 10 days. At the end of this treatment they were sprayed in their mouths with four selected alpha-streptococcal strains known to have strong growth inhibiting activity in vitro against most beta-streptococci group A. The follow-up period after this colonization was 3 months. After alpha-streptococcal treatment, none of the patients attracted a new tonsillitis during the follow-up period while 8% of the controls had a second tonsillitis. Treatment of streptococcal tonsillitis/pharyngitis with antibiotics followed by recolonization with alpha-streptococci seems to hinder further recurrences.

The authors report a study designed to explore the usefulness of long-acting penicillin in the management of recurrent tonsillitis. The trial, conducted in Sri Lanka, involved 179 patients aged 2 to 20 who had suffered multiple attacks of tonsillitis annually. The results showed a significant reduction in the number of attacks of tonsillitis experienced by the treated group, especially those aged 5 to 11, resulting in a drop in the number requiring tonsillectomy.