Azithromycin in the treatment of pharyngitis and tonsillitis. From the point of view of bacteriologist and clinician
Krzysztof Filczak1, Adam J. Sybilski2,3
Bacteriologist’s and clinician’s point of view to infection is variable. What about bacterial infection throat and tonsil? Characteristic: Bacteriologist: Acute pharyngitis and tonsillitis (APT) mainly caused by viruses (rhinovirus, adenovirus, influenza and parainfluenza viruses, RSV). Bacterial etiology is only in 10–30%. The most common bacterial etiologic factor is Streptococcus pyogenes. The gold diagnostic standard is the throat swab culture with antibiogram. Clinician: The infection usually occurs through droplets. The incubation period continues from 12 hours to 4 days. The diagnosis is based on symptoms: sore throat, fever, headache, malaise, slight enlargement of the cervical lymph nodes. On clinical examination: swollen and congested mucous membrane of the throat. Treatment: Bacteriologist: Correct swabbing the throat has a major impact on the entire diagnostic process. We take the swab from the surface or tonsil crypts. Swab is seeded and incubated at 35–37°C. The first assessment is in 18–24 hours. In the GP practice the rapid diagnostic tests (RADT streptococcal antigen detection clinic may be helpful. Clinician: the first step is limiting the spread of infec tion (elimination of contact), second – symptomatic treatment, if there is S. pyogenes etiology, the first-line treatment is fenoksymetylpenicylina (p.o. or .iv.) In case of hypersensitivity, macrolides should be used. Azithromycin: Bacteriologist: Azithromycin is macrolide, and including the spectrum of the most common pathogens causing pharyngitis and tonsillitis. Clinician: Azithromycin is an effective drug in APT, commonly used at a dose: in children (10 mg/kg once daily for three days), and adults (1×500 mg – three days). Recent studies suggest a better antibiotic activity double dose (cumulative dose – 60 mg/kg/treatment). These two approaches (bacteriologist and clinician) complement each other.